Exam 3 Musculoskeletal

The nurse is preparing to perform an intermittent urinary catheterization on a client with a spinal cord injury. The client reports a sudden onset of headache along with nausea and sweating, and the nurse assesses a blood pressure of 185/110 mm Hg. What is the best action by the nurse? A Elevate the head of the bed to an upright position. B Notify the Rapid Response Team. C Perform the procedure to relieve the bladder distention. D Reduce the temperature of the room to reduce the sweating.

A

The nursing instructor is teaching a group of nursing students about emergency care for extremity fractures. What statement made by a participant indicates a need for further teaching? A "I should not apply direct pressure on the affected area." B "I should not remove the client's shoes." C "I should cut the clothing over the affected area." D "I should apply a splint above and below the fracture."

A

What assessment finding helps the nurse to identify rheumatoid arthritis in a client with joint pain? A Presence of bilateral joint swelling B Pain in weight bearing joints C Crepitus may be felt or heard D Joint stiffness after inactivity

A

Which antidepressant drug is often used to treat nerve pain in clients with fibromyalgia syndrome? A Pregabalin (Lyrica) B Trazodone (Desyrel) C Nortriptyline (Pamelor) D Amitriptyline (Elavil)

A

Which assessment finding suggests to the nurse that a client is experiencing sciatic nerve compression? A Severe pain when the client's leg is held straight and lifted upward B Urinary incontinence C Frequent diarrhea-like bowel movements D Inability to bear weight on the affected leg

A

Which drug may be administered to a client undergoing knee arthroplasty to reduce postoperative pain? A Capsaicin (Adlea) B Cefazolin (Ancef) C Dalteparin (Fragmin) D Enoxaparin (Lovenox)

A

Which intervention does the nurse suggest to a client with a leg amputation to help cope with loss of the limb? A Talking with an amputee close to the client's age who has had the same type of amputation B Drawing a picture of how the client sees him- or herself C Talking with a psychiatrist about the amputation D Engaging in diversional activities to avoid focusing on the amputation

A

Which statement about chronic complications from fractures is accurate? A Avascular necrosis is a chronic complication of fracture. B Fat embolism syndrome is a chronic complication of fracture. C Surgical repair of fractures prevents chronic complications. D Prednisone therapy decreases the risk of chronic complications.

A

Which statement about spinal cord injuries is correct? A They occur mostly in young males. B They occur mostly in African-Americans. C They are usually caused by falls. D The thoracic level is the location of most injuries.

A

Which type of traction is used to correct bone deformities of the lower extremities? A Russell's traction B Pelvic belt C Pelvic sling D 90-90 traction

A

he nurse is caring for a client with systemic sclerosis. What teaching does the nurse provide to the client's spouse about nutrition prior to discharge home? A Provide small frequent meals throughout the day. B Keep the client's head at 90 degrees during meals. C Avoid solid foods and instead provide liquid foods. D Choose foods that increase gastric secretion.

A

What statements about performing a closed reduction for a dislocated elbow are correct? Select all that apply. A A commercial immobilizer is used to keep the bone in place. B The ends of the bones are manually pulled and realigned. C A fiberglass synthetic cast is used to immobilize the arm. D It is most commonly used for simple fractures. E It does not require sedation or analgesics.

A,B,D

A rock climber has sustained an open fracture of the right tibia after a 20-foot fall. The nurse plans to assess the client for which potential complications after the first 24 hours? Select all that apply. A Acute compartment syndrome (ACS) B Fat embolism syndrome (FES) C Congestive heart failure D Urinary tract infection (UTI) E Osteomyelitis

A,B,E

Which assessment findings alert the nurse that a client with a spinal cord injury is developing neurogenic shock? Select all that apply. A Hypotension B Tachycardia C Warm, dry skin D Pupillary dilation E Projectile vomiting F Facial flushing

A,C

The nurse is assessing a client with a fracture of the upper arm. How does the nurse conduct the assessment? Select all that apply. A Ask about the cause of the fracture. B Place the client in a supine position. C Compare the upper extremities. D Support the affected arm and flex the elbow. E Elevate the extremity

A,C,D

The nurse is educating a group of people at a community center about emergency care for physical trauma. What does the nurse teach this group? Select all that apply. A Call 911 then assess for airway, breathing, and circulation. B Remove the person's shoes. C Cut the clothing over the affected area. D Remove jewelry on the affected extremity. E Immobilize the extremity.

A,C,D,E

A client accidentally severed a finger while working in the kitchen. What emergency care is appropriate for this client? Select all that apply. A Apply direct pressure with dry gauze at the amputation site. B Place the severed finger directly in a watertight sealed plastic bag. C Elevate the extremity above the heart level. D Place the sealed plastic bag containing the severed finger in ice. E Ensure the severed finger does not come in contact with water.

A,C,E

A client who had a total hip arthroplasty will be discharged from the hospital shortly. What teaching does the nurse provide for this client? Select all that apply. A Use a walker as an ambulatory aid. B Cleanse the hip incision with antiseptic solution. C Sit up in a firm, supporting chair during the daytime. D Perform postoperative exercises such as crossing over of the legs. E Avoid bending the hips more than 90 degrees.

A,C,E

In addition to trauma, which assessment findings are risk factors for back pain? Select all that apply. A Smoking B Hypertension C Obesity D Anemia E Hyperkalemia F Advanced age

A,C,F

Which complications occur most commonly after conventional diskectomy, laminectomy, or spinal fusion? Select all that apply. A Nerve injury B Wound infection C Paralysis D Dural tears E Bowel perforation F Encephalitis

A,D

The nurse is attending to a client with acute compartment syndrome (ACS). What physiologic changes are observed in with this condition? Select all that apply. A Increase in compartment pressure B Decrease of capillary pressure C Decrease in lactic acid production D Release of histamine E Pressure on nerve endings

A,D,E

Which statements about complex regional pain syndrome (CRPS) are accurate? Select all that apply. A It is also known as reflex sympathetic dystrophy. B It can be managed by intramuscular phentolamine. C It makes the skin hot and dry. D It is characterized by paresis and muscle spasms. E It can be managed by biphosphonates and antidepressants.

A,D,E

The nurse is caring for a client postoperatively after an anterior cervical diskectomy and fusion. Which assessment finding is of greatest concern to the nurse? A Neck pain is at a level 7 on a 0-to-10 scale. B The client is reporting difficulty swallowing secretions. C The client has numbness and tingling bilaterally down the arms. D Serosanguineous fluid oozes onto the neck dressing.

B

The nurse is caring for a client with a spinal cord injury resulting from a diving accident, who has a halo fixator and an indwelling urinary catheter in place. The nurse notes that the blood pressure is elevated and that the client is reporting a severe headache. The nurse anticipates that the health care provider will request which medication? A Dopamine hydrochloride (Inotropin) B Nifedipine (Procardia) C Methylprednisolone (Solu-Medrol) D Ziconotide (Prialt)

B

A client has a first-degree sprained ankle. What nonsurgical method of treatment does the nurse suggest to the client? A Alternate hot and cold compresses. B Perform range of motion exercises. C Avoid weight-bearing exercise until recovery is complete. D Apply an ankle brace or splint.

A

A client has received preoperative teaching from the nurse for a microdiskectomy. Which statement by the client indicates a correct understanding of the nurse's instruction? A "I can go home the day of the procedure." B "I can go home 48 hours after the procedure." C "I'll have a drain in place after the procedure." D "I'll need to wear special stockings after the procedure."

A

A client has sustained a fracture of the left tibia. The extremity is immobilized using an external fixation device. Which postoperative instruction does the nurse include in this client's teaching plan? A "Use pain medication as prescribed to control pain." B "Clean the pin site when any drainage is noticed." C "Wear the same clothing that is normally worn." D "Apply bacitracin (Neosporin) if signs or symptoms of infection develop around pin sites."

A

A client has undergone an elective below-knee amputation of the right leg as a result of severe peripheral vascular disease. In postoperative care teaching, the nurse instructs the client to notify the health care provider if which change occurs? A Observation of a large amount of serosanguineous or bloody drainage B Mild to moderate pain controlled with prescribed analgesics C Absence of erythema and tenderness at the surgical site D Ability to flex and extend the right knee

A

A client is prescribed lidocaine 5% patches (Lidoderm) for knee pain. What does the nurse teach this client about this therapy? A Apply the patch on clean, intact skin. B Keep the patch in place for 6 hours. C Avoid using more than one patch at a time. D Obtain a complete blood count before beginning therapy.

A

A client with a compound fracture of the left femur is admitted to the emergency department after a motorcycle crash. Which action is most essential for the nurse to take first? A Check the dorsalis pedis pulses. B Immobilize the left leg with a splint. C Administer the prescribed analgesic. D Place a dressing on the affected area.

A

A client with a spinal cord tumor and a poor prognosis has lost bladder control. The client asks the nurse whether the suggested surgery will be "worth it." What is the nurse's best response? A "It should help return bladder control." B "Let me call the surgeon so you can ask the rest of your questions." C "What do you think?" D "What does your family think?"

A

A client with amyotrophic lateral sclerosis (ALS) is degenerating rapidly and will soon need respiratory support. What does the nurse plan to review with this client? A Advance directives B How to use the ventilator C Funeral plans D Nutritional support

A

A client with severe muscle spasticity has been prescribed tizanidine (Zanaflex, Sirdalud). The nurse instructs the client about which adverse effect of tizanidine? A Drowsiness B Hirsutism C Hypertension D Tachycardia

A

A client's left arm is placed in a plaster cast. Which assessment does the nurse perform before the client is discharged? A Assess that the cast is dry. B Ensure that the client has 4 × 4 gauze to take home for placement between the cast and the skin. C Check the fit of the cast by inserting a tongue blade between the cast and the skin. D Ensure that the capillary refill of the left fingernail beds is longer than 3 seconds.

A

An older adult client has had a right open reduction and internal fixation (ORIF) of a fractured hip. Which intervention does the nurse implement for this client? A Keep the client's heels off the bed at all times. B Reposition the client every 3-4 hours. C Administer preventive pain medication before deep-breathing exercises. D Prohibit the use of antiembolic stockings.

A

Before administering low-molecular-weight heparin (LMWH) to an older adult client after total knee arthroplasty, the nurse notes that the client's platelet count is 50,000/mm3. What action is most important for the nurse to take? A Notify the health care provider of the platelet count. B Administer the prescribed LMWH on schedule. C Assess the activated partial thromboplastin time (aPTT). D Assess the International Normalized Ratio (INR)

A

During physical assessment, the nurse has the client hold the leg straight while the nurse gently lifts the leg upward. If the client responds with severe pain, which finding does the nurse suspect? A A vertebra is pressing on the sciatic nerve. B There is a compression fracture present. C The client has scoliosis. D The client has spinal stenosis.

A

Herniation of a disc occurs most commonly in which area of the spine? A A Between L4 and L5 B Between C3 and C4 C Between T6 and T7 D At the sacrum

A

In addition to frequent repositioning, the nurse anticipates a consultation request for which special pressure relief device to help prevent pressure ulcers in the client with a spinal cord injury? A Chair pad B Thromboembolism-deterrant (TED) hose C Trapeze D Water bottle

A

In the emergency department (ED), which is the nursing priority in assessing the client with a spinal cord injury? A Patent airway B Indication of allergies C Level of consciousness D Loss of sensation

A

The nurse assesses a client diagnosed with Sjögren's syndrome. The nurse anticipates that the client will also have which common condition? A Dry eyes B Abdominal bloating after eating C Excessive production of saliva in the mouth D Intermittent episodes of diarrhea

A

The nurse is preparing a discharge plan for a client who has been ordered prednisone (Deltasone). What instruction does the nurse give this client? A Avoid crowds and people with infection. B Observe for dehydration. C Monitor for decreased blood pressure. D Increase fluid intake

A

The nurse is caring for a client in the emergency department whose spinal cord was injured at the level of C7 1 hour ago. Which assessment finding requires the most rapid action? A Electrocardiographic monitoring shows a sinus bradycardia at a rate of 50. B The client demonstrates flaccid paralysis below the level of injury. C The client's chest moves very little with each respiration. D After two fluid boluses, the client's systolic blood pressure remains 80

C

The nurse is caring for a client with a total knee arthroplasty. What action does the nurse take when the client is using a continuous passive motion (CPM) machine? A Allows the client to take control of the machine B Encourages the use of CPM whenever awake C Checks the cycle and range of motion settings at least once every 8 hours D Stores the machine on the floor when not in use

C

The nurse is caring for a client with lupus erythematosus. What does the nurse teach the client about skin protection? A Cleanse the skin with an antiseptic soap. B Rub skin completely dry after bathing. C Wear a large-brimmed hat when in the sun. D Use rubbing alcohol to clean the hands.

C

The nurse is instructing a local community group about ways to reduce the risk for musculoskeletal injury. What information does the nurse include in the teaching plan? A "Avoid contact sports." B "Avoid rigorous exercise." C "Wear helmets when riding a motorcycle." D "Avoid driving in inclement weather."

C

The nurse is teaching a client and her husband about sexuality issues after a spinal cord injury. Which comment by the client indicates a correct understanding of the nurse's instruction? A "I can no longer become pregnant." B "If I become pregnant, I cannot give birth." C "I may still be able to get pregnant." D "My children will be paralyzed."

C

The nurse performing an assessment on a client 6 hours postoperative for diskectomy notices the presence of clear drainage from the incision site. The nurse suspects the drainage may be cerebrospinal fluid (CSF) and evaluates the client for which accompanying sign/symptom? A Change in level of consciousness B Nausea and vomiting C Sudden headache D Decerebrate posturing

C

What assessment finding typically indicates there is a fracture of the hip? A Skin color B Blood in the urine C Groin pain D Inability to void

C

What does the nurse teach a client with osteomalacia to include in the daily diet? A Phosphorus B Calcitonin C Vitamin D D Vitamin A

C

What manifestation is usually seen in fat embolism but not in blood clot embolism? A Altered mental status B Increased pulse C Petechiae D Dyspnea

C

Which initial assessment is the first priority for a client with a spinal cord injury? A Level of consciousness B Ability to recall the events of the injury C Airway, breathing, and circulation D Degree of numerologic injury

C

Which metabolic disorder may be responsible for the development of joint degradation in the client with osteoarthritis (OA)? A Aging B Hemophilia C Diabetes mellitus D Sickle cell disease

C

Which nursing intervention is best for preventing complications of immobility when caring for a client with spinal cord problems? A Frequent ambulation B Encouraging nutrition C Regular turning and repositioning D Special pressure-relief devices

C

The nurse is preparing a client who underwent vertebroplasty for discharge. What measures does the client take after discharge? Select all that apply. A Removing the dressing after 12 hours B Avoiding driving for 12 hours after discharge C Monitoring of the puncture site for infection D Walking the next day after discharge E Avoiding operating heavy machinery for 16 hours after discharge

C,D

Which dietary supplements may be recommended specifically to a client with osteoarthritis (OA)? Select all that apply. A Iron B Garlic C Chondroitin D Glucosamine E Niacin

C,D

The nurse is caring for an older adult client with chronic low back pain who has been prescribed an opioid. For which adverse effects of the drug does the nurse monitor the client? Select all that apply. A Incontinence B Low serum sodium C Constipation D Drowsiness E Acute confusion

C,D,E

The nurse is developing a teaching plan for a client with a history of low back pain. Which instructions does the nurse plan to include in teaching the client about preventing low back pain and injury? Select all that apply. A "Standing for long periods of time will help to prevent low back pain." B "Keep weight within 50% of ideal body weight." C "Begin a regular exercise program." D "When lifting something, the back should be straight and the knees bent." E "Do not wear high-heeled shoes."

C,D,E

A client with a left ankle fracture is using a cane for support. What statements about the use of a cane are correct? Select all that apply. A The cane is placed on the left side. B The elbow of the arm holding the cane is flexed at 45 degrees. C The top of the cane is parallel to the stylus of the wrist. D The client's unaffected leg and arms are assessed for strength. E A hemi-cane will provide more support for the client.

C,E

The nurse prepares to perform a neurovascular assessment on a client with closed multiple fractures of the right humerus. Which technique does the nurse use? A Inspect the abdomen for tenderness and bowel sounds. B Auscultate lung sounds. C Assess the level of consciousness and ability to follow commands. D Assess sensation of the right upper extremity.

D

The nurse uses different noninvasive techniques to assess the viability of a client's limb. What statement about these techniques is accurate? A The ratio of brachial systolic pressure by ankle systolic pressure is the ankle-brachial index (ABI). B ABI is used in Doppler ultrasonography. C A normal ABI should be less than 1. D Transcutaneous oxygen pressure is reliable for predicting healing.

D

The nurse's next door neighbor has accidentally severed his thumb while working with power tools. What does the nurse do to help preserve the severed thumb until the neighbor is transported to the hospital? A Places the thumb directly in a watertight, sealed, plastic bag. B Places the severed thumb in a container of ice. C Rinses the semidetached part of the thumb in tap water thoroughly. D Ensures the severed thumb does not come in contact with water.

D

To prevent the leading cause of death for clients with spinal cord injury, collaboration with which component of the health care team is a nursing priority? A Nutritional therapy B Occupational therapy C Physical therapy D Respiratory therapy

D

Weight control can help reduce chronic back pain. The nurse recommends weight loss as an intervention when the client's weight exceeds ideal weight by what percentage? A 3% B 5% C 7% D 10%

D

What is an early manifestation of fat embolism syndrome? A Petechiae B Lethargy C Headache D Low arterial oxygen

D

What statement related to musculoskeletal assessment is accurate? A A 30-year-old injury cannot be responsible for current musculoskeletal problems. B A motor vehicle crash can lead to osteomalacia. C Weight-bearing activities increase the risk for osteoporosis. D Knowledge of a client's occupation is helpful for musculoskeletal assessment.

D

Which position accurately describes the Williams' position? A Lying prone with the head of the bed flat B Lying supine with the head flat and the feet elevated 30 degrees C Sitting in a reclining wheelchair with the knee-gatch raised D Semi-Fowler's with a pillow under the knees to keep them flexed

D

Which statement about multiple sclerosis (MS) is correct? A MS affects more men than women. B It usually occurs in people older than 50 years. C MS is seen more often in the warmer climates. D It occurs more frequently among whites than other races.

D

Which statement about spinal cord tumors is correct? A Clients with spinal cord tumors have flaccid paralysis more often than spastic paralysis. B A positive Babinski's sign is a lumbosacral manifestation. C Clients with these tumors often lose bowel control before losing bladder control. D These clients are managed primarily by surgery.

D

Which statement about strains and sprains is accurate? A A sprain is also referred to as a muscle pull. B Sprains are usually caused by lifting heavy items. C A strain is the excessive stretching of a ligament. D Strains are classified based on their severity.

D

The nurse is caring for an older adult client diagnosed with osteoarthritis. Which client statement indicates to the nurse that the client is using effective coping strategies? A "I do not know how long my wife will be able to take care of me at home." B "The bus is coming to pick me up from the senior center three times a week so I can play cards." C "I am helping with the dishes and laundry, but I hurt so badly when I am doing it." D "I do not know how much longer my neighbor can continue to help clean my house."

B

The nurse is caring for an older client post hip-repair surgery. What postoperative care must the nurse perform for this client? A Instruct the client to maintain bed rest for a week. B Monitor the client frequently to prevent falls. C Reposition the client every 4 hours. D Inspect the client's heels once a day.

B

The nurse is performing a postoperative assessment on a client after open back diskectomy. The nurse becomes concerned that the wound drainage contains cerebrospinal fluid when it appears as what color? A Blood-colored B Clear C Yellow D Green

B

The nurse is teaching a client with a long-leg cast about care of the extremity after cast removal. What statement made by the client indicates a need for further teaching? A "I will have to wear elastic bandages." B "I will remove dead skin by gentle scrub." C "I must exercise slowly as instructed by my physical therapist." D "I will have to support my lower extremity with pillows."

B

The nurse is teaching a group of nursing students about venous thromboembolism (VTE). What statement made by a participant indicates a need for further instruction? A "Chemotherapy may cause VTE." B "Surgery lasting at least 1 hour can cause VTE." C "Oral contraceptives may cause VTE." D "Smoking and immobility can cause VTE."

B

The nurse refers a client with an amputation and the client's family to which community resource? A American Amputee Society (AAS) B Amputee Coalition of America (ACA) C Community Workers for Amputees (CWA) D National Amputee of America Society (NAAS)

B

Which description accurately defines a closed reduction? A Commercial immobilizer that is used to keep the bone in place B Process where the ends of the bones are manually pulled and realigned C Fiberglass synthetic cast used to immobilize an upper extremity D Procedure that does not require general anesthesia

B

Which drug does the nurse expect to administer as part of the treatment plan for a client with relapsing multiple sclerosis (MS)? A Penicillin-based antibiotic B Immunomodulator C Calcium channel blocker D Antispasmodic

B

Which element is a risk factor for osteoarthritis (OA)? A Thin build B Obesity C Non-smoker D Male

B

Which genitourinary manifestation may occur in fibromyalgia syndrome? A Dyspnea B Pelvic pain C Constipation D Abdominal pain

B

Which statement about amyotrophic lateral sclerosis (ALS) is accurate? A It affects the autonomic nervous system of the client. B ALS affects men more than women. C It can be cured by administering riluzole (Rilutek). D ALS results in death mainly due to cardiac failure.

B

Which statement about autonomic dysreflexia is accurate? A It occurs when a spinal cord injury is present below T6. B It can be caused due to a distended bladder. C It causes orthostatic hypotension in the client. D It increases the client's heart rate.

B

Which statement indicates to the nursing instructor that the nursing student understands the normal healing process of bone after a fracture? A "A callus is quickly deposited and transformed into bone." B "A hematoma forms at the site of the fracture." C "Calcium and vascular proliferation surround the fracture site." D "Granulation tissue reabsorbs the hematoma and deposits new bone."

B

Which statement is true regarding the use of opioid analgesics in the treatment of acute low back pain? A They are the primary treatment option. B They are no more effective than nonsteroidal analgesics and should be avoided. C They should be used initially, then the client should begin nonsteroidal drugs. D They should be used and combined with oral steroids.

B

Which voluntary muscle is controlled by the central and peripheral nervous system? A Smooth B Skeletal C Nonstriated D Cardiac

B

A client has been provided with a body cast that is still wet. Which safety measures are appropriate for this client? Select all that apply. A The leg should be elevated on pillows covered with plastic. B The client should be turned every hour. C The client should be assisted to the bathroom if required. D The perineal area of the cast should be covered with plastic. E Neurovascular assessment should be performed distal to the cast.

B,D,E

What postoperative care is expected after hip replacement surgery for an older client? Select all that apply. A Instructing the client to maintain bedrest for a week B Monitoring the client frequently to prevent falls C Repositioning the client every 4 hours D Inspecting the client's heels every 8 to 12 hours E Encouraging the client for early ambulation

B,D,E

Osteomyelitis etiology

Bacteremia (usually Staph. Aureus, Pseudomonas), underlying disease, penetrating trauma (animal bites, puncture wounds, surgery), long-term IV catheters, IV drug abusers, long-term hemodialysis, Salmonella infection, sickle cell anemia, poor dental hygiene, radiation therapy, slow healing ulcer (DM, PVD)

Fracture Interventions: Traction

Bedrest care; Application of a pulling force for reduction, alignment, and rest; relieve muscle spasms, prevent or correct deformity continuous or intermittent "running" or balanced

A client has sustained a rotator cuff tear while playing baseball. The nurse anticipates that the client will receive which immediate conservative treatment? A Surgical repair of the rotator cuff B Prescribed exercises of the affected arm C Immobilizer for the affected arm D Patient-controlled analgesia with morphine

C

A client has undergone a kyphoplasty. What discharge teaching does the nurse provide to the client and family? A Remove the dressing after 12 hours. B Avoid driving for 48 hours after surgery. C Monitor the puncture site for infection. D Start activities a day after the dressing is removed.

C

A client is diagnosed with osteoarthritis (OA). Which medication is considered the primary drug of choice for treatment? A Methotrexate (MTX) B Adalimumab (Humira) C Acetaminophen (Tylenol) D Leflunomide (Arava)

C

A client is in skeletal traction. Which nursing intervention ensures proper care of this client? A Ensure that weights are attached to the bed frame or placed on the floor. B Ensure that pins are not loose, and tighten as needed. C Inspect the skin at least every 8 hours. D Remove the traction weights only for bathing.

C

A client who has undergone an anterior cervical diskectomy with fusion is experiencing difficulty swallowing a soft diet. The client is breathing normally and is wearing a large neck brace. What is the nurse's best action? A Contact the provider to report possible loosening of the graft and screws. B Notify the Rapid Response Team since the client may need intubation. C Reassure the client that this is usually a temporary postoperative effect. D Remove the neck brace while the client is eating to facilitate swallowing.

C

A client who recently underwent total hip arthroplasty and is on anticoagulants is preparing for discharge from the hospital. Which information is most important for the nurse to provide to the client and caregiver? A Use an abduction pillow between the legs. B Keep heels off the bed. C Avoid using a straight razor. D Reorient frequently.

C

A client with bone cancer is most susceptible to what type of fracture? A Simple fracture B Compound fracture C Spontaneous fracture D Stress fracture

C

A construction worker who reports pain in the vertebral column and hips is diagnosed with secondary osteoarthritis (OA). What does the nurse tell the client may have been the cause? A Aging B Genetic changes C Trauma or abuse D Obesity

C

An older adult client is undergoing treatment for a fracture. Which pain medication must be avoided in this client? A Oxycodone B Oxycodone with acetaminophen (Percocet) C Meperidine (Demerol) D Morphine

C

Assessment findings reveal that an older adult client with severe osteoarthritis of the left hip can no longer perform activities of daily living (ADLs) and has had several falls in the home over the past month. To which community resource does the nurse refer the client? A Local senior citizen center B Citizens for Better Care C Home health care agency D Meals on Wheels

C

In assessing a client with back pain, the nurse uses a paper clip bilaterally on each limb. What is the nurse assessing? A Gait B Mobility C Sensation D Strength

C

In which stage of bone healing is callus formed? A Stage one B Stage two C Stage three D Stage four

C

Sensation that is felt in an amputated part immediately after surgery is known as which of the following? A Neuroma B Chronic limb pain C Phantom limb pain D Flexion contracture

C

The client with a spinal cord injury at T2 is experiencing autonomic dysreflexia. Which intervention has the highest priority? A Administering hydralazine (Apresoline) B Loosening any tight clothing C Placing the client in a sitting position D Checking the urinary catheter tubing

C

The nurse instructor is educating nursing students about compartment syndrome. What statement made by a nursing student indicates a need for further instruction? A "It is a complication of fractures." B "Plasma proteins leak into the interstitial space, causing edema." C "It causes an absence of pulses." D "The color of tissue pales."

C

The nurse is assessing the laboratory report of a client with a fractured hip. Which finding indicates the presence of fat embolism syndrome (FES)? A Decreased erythrocyte sedimentation rate (ESR) B Increased serum calcium levels C Decreased red blood cell (RBC) count D Increased serum potassium levels

C

complex regional pain syndrome (CRPS)

is also known as reflex sympathetic dystrophy. Paresis and muscle spasms are some of the symptoms of it. Biphosphonates and antidepressants can be used to manage the condition. It may be managed by a chemical sympathetic nerve block using an intravascular infusion of phentolamine.

Ziconotide (Prialt)

is an N-type calcium channel blocker that is used to treat severe chronic back pain and failed back surgery syndrome (FBSS) and is also used for clients with cancer, AIDS, and unremitting pain from other nervous system disorders. If symptoms such as hallucinations and delusions occur the client must stop the drug immediately and contact the health care provider. Should not be given to clients with severe mental health/behavioral health problems because it can cause psychosis.

lupus erythematosus

is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue. It can affect the skin, joints, kidneys, brain, and other organs.

systemic sclerosis

is an autoimmune or connective tissue disease. It is characterized by thickening of the skin caused by accumulation of collagen, and by injuries to the smallest arteries.

Dopamine hydrochloride (Inotropin)

is an inotropic agent used to treat severe hypotension.

Nifedipine (Procardia)

is given to treat the elevated blood pressure

Balanced skin traction

is indicated for fracture of the femur or pelvis.

Sudden and intense headache occurs when there is ?

leakage of CSF

Buck's traction

may be applied before surgery to help decrease pain associated with muscle spasm

riluzole (Rilutek)

may cause liver toxicity, and liver enzymes will need to be checked frequently. Should be taken twice a day without food and when the stomach is empty, may cause tachycardia

Paget's Interventions Nonsurgical:

meds for pain relief or to go in remission : 1. NSAIDs 2. bisphonates (didronal, fosamax, Actonel, skelid, aredia, zometa) 3. calcitonin sc heat, massage, exercise program, PT, orthotic device, Paget's Disease/ Arthritis Foundation

Leg cast

mobility with assistive aid and cast shoe (or walking cast), ice and elevation for 24 hours

The most common major complications of diskectomy, laminectomy, or spinal fusion are?

nerve injury and dural tears

Spondylolisthesis?

occurs when one vertebrae slips forward on the one below it.

Paget's Interventions Surgical:

partial or total joint replacement for secondary arthritis

A decreased RBC count indicates WHAT?

presence of fat embolism syndrome (FES)

How are Spinal cord tumors are managed?

primarily by surgery to remove as much of the tumor as possible

If injury is at C5-6, the client has problems in?

pulling up the arms against resistance.

Paget's Assessment Xrays:

radiolucent or "punched out" areas, malalignment, fractures, secondary arthritic changes, enlarged bone mass, thick cortex CT, MRI bone scan bone biopsy

Autonomic dysreflexia?

refers to an excessive, uncontrolled sympathetic output that is caused due to a noxious stimulus. This stimulus often arises from a distended bladder. It is seen in upper spinal cord injuries (SCI) above the level of T6. Because it involves excessive sympathetic output, and therefore, causes severe hypertension. It also causes bradycardia, which is a decrease in heart rate.

Osteomyelitis Interventions Surgical: to minimize disfigurement; usually for chronic cases

sequestrectomy: debride the infected bone to allow revascularization of tissue bone grafts: to fill up the cavities left after excision of necrotic bone; donor from posterior ileum; sterile technique critical Muscle flap for wound coverage, enhances blood flow Amputation may be necessary

Labs for Musculoskeletal

serum calcium phosphorous alkaline phosphatase muscle enzymes (CK M&B, CPK, AST, SGOT, ALD, LDH) Radiographic: Xrays Tomogram Xeroradiography Myelogram Arthrogram Arthroscopy Diskogram CT bone biopsy muscle biopsy electromyography bone scan gallium/thallium scans MRI Ultrasound DEXA thermography

Osteoporosis assessment Labs

serum calcium vitamin D phosphorus alkaline phosphatase urinary calcium; serum protein thyroid function T-score

If the injury is at C4-5, the client has problems in ?

shrugging the shoulders upward against resistance.

Plaster traction

skeletal traction with a plaster cast

Buck's traction

skeletal: pins, wires, screws, or tongs surgically inserted into the bone by physician with sterile technique; longer traction time, heavier weights (up to 30 pounds)

Arm cast

sling to elevate arm above the heart, hand higher than elbow, ice for 24-48 hours, weight of arm in sling should not hang just from the neck

If the injury is at C7, the client has problems in?

straightening his or her flexed arms against resistance.

Prednisone does what?

suppresses the immune system and increases the risk for infection or decreased healing, so the client is asked to avoid crowds.

Lupus erythematosus

systemic (chronic, progressive inflammatory connective tissue disorder that can cause whole body systems to fail directly or indirectly with vasculitis) SLE with spontaneous exacerbations and remissions; potentially fatal Autoimmune, ? Genetic, hormones, ? Environment (sun exposure) Women 8-10 times more than men; 20-40 years old more in African-Americans, Hispanics, Native American, Polynesian most (~50%) clients have some degree of kidney or cardiac involvement, may be life-threatening

Gout "gouty arthritis"

systemic disease in which urate crystals deposit in joints and other body tissues, causing inflammation Primary: common (90%); inborn error of purine metabolism; males more Secondary: hyperuricemia caused from another disease; ex.: renal disease, carcinomas, diuretic overuse; EtOH

After cervical diskectomy with fusion what commonly happens?

temporary dysphagia

CT shows?

the bones, nerves, disks, and ligaments

Osteoporosis begins in ?

the spine progressing to pelvis, ribs, & extremities

Cervical SCIs are more common than?

thoracic and lumbosacral cord injuries.

most SCIs are caused by?

trauma from motor vehicle crashes

The Williams' position is?

typically used for clients with low back pain from a bulging or herniated disk, is described as lying in semi-Fowler's position with a pillow under the knees to keep them flexed.

Skin traction

use of Velcro boot, belt, or halter secured around a body part; decreases spasms; limits weight (up to 10 pounds); contraindicated with ulcers, burns, DM, PVD

granulation

with fibroblasts, osteoblasts

Almost 80% of spinal cord injuries (SCIs) occur in ?

young males and the majority of them are Euro-Americans.

MS

• occur more frequently among whites • Women are affected twice as often as men. •it usually affects people between 20 and 40 years of age. •There is a higher incidence in the colder climates of the Northeastern states, the Great Lakes, and Pacific Northwestern states, as well as Canada.

Genu varum

Bow-legged deformities are known as

A client reports pain when moving the neck. What diagnostic test is used to provide images of the muscles in the neck? A Plain x-rays B Computed tomography (CT) C Magnetic resonance imaging (MRI) D Myelogram or postmyelogram CT

C

A side effect antiepileptic drugs is?

Low serum sodium

Hip Resurfacing

May hold the need for THR forever or at least a long time for selected patients Usually 55 years old or younger, solid bone composition Quicker recovery, Less pain, Less risk of dislocation, improved ROM, enhanced ability for higher impact activities than traditional THR

Shoulder Replacement

Neer prosthesis, with or without cement subluxation or dislocation a major complication frequent CSM checks CPM machine

RA assessment

Pain fatigue weakness anorexia weight loss low grade fever bilateral, symmetric joint involvement ischemic skin lesions Morning stiffness Fingers: spindle-like, "swan neck" deformity, may drift to ulnar side of hand muscle atrophy joint deformity with decreased function osteoporosis Baker's cysts, tendon rupture nodules Inflamed organs/arteries

DJD Interventions (Nonsurgical)

Pain : drug therapy/non drug: to reduce pain, relieve muscle spasm, & reduce inflammation (rare) Bedrest care/Exercise therapy: rest, positioning, PT Heat/Cold Application Health Education: diet therapy, wt loss Self-care Assistance: Arthritis Foundation, OT

Genu valgum

Poor alignment of the knees, or knock-knee

Gout interventions

Usually diagnosed and treated early so few chronic alterations in quality of life/body image Drug therapy: colchicine, NSAIDs, Allopurinol, Probenecid, ACTH, Uloric (febuxostat) Diet therapy (controversial) Stress management Increase fluid intake to help prevent stone formation Client education to manage or minimize gouty condition and to avoid hospitalization

RA Other diagnostics:

Xray, CT scan arthrocentesis: aspiration of synovial fluid for assessment and relief of pressure bone scan MRI

osteomalacia

causes softening of the bone due to the decrease in vitamin D in the body.

x-rays show?

changes in the bone, such as changes in the joints and in the positioning and alignment of bones.

Risk factors of primary Degenerative Joint Disease

combination of many factors (elderly, genetics)

DJD: Assessment : Psychosocial

decreased socialization, isolation dependence on others role changes grieving process altered body image, self-esteem Anxiety, depression

temporary dysphagia

difficulty swallowing

Myelogram or postmyelogram CT is used for?

evaluating lesions of the nerve root and any other mass lesion or infection that is within or invading the thecal sac.

RA Interventions Drug therapy

for analgesic,antipyretic, and antiinflammatory effect as well as to slow the progress of the disease salicylates/ NSAIDs DMARDs steroids Biologic Response Modifiers other

Growth hormone

increases bone length and determines the amount of bone matrix formed before puberty.

autonomic dysreflexia

is an excessive, uncontrolled sympathetic output characterized by severe hypertension, bradycardia, severe headache, nasal stuffiness, and flushing; it must be promptly treated to prevent a hypertensive stroke. Placing the client in a sitting position creates the effect of orthostatic hypotension to relieve hypertensive pressure on the brain, and is the very first priority.

Effusion

is the accumulation of fluid in the knee joint.

Risk factors of secondary Degenerative Joint Disease

joint injury, specific diseases, obesity

Androgens

promote body-tissue building and increase bone mass.

Glucocorticoids

regulate the intestinal absorption of calcium and phosphorous

RA Psychosocial

role changes decreased socialization from fatigue, disability poor self-esteem disturbed body image depression helplessness loss of control

MRI provides images of?

spinal tissue, bones, spinal cord, nerves, ligaments, disks, and musculature

Estrogens

stimulate osteoblastic or bone-building activity.

Osteoporosis Interventions Drugs

1. supplements: calcium supplements, vit D 2. bisphosphonates: alendronate (fosamax); risedronate (actonel); ibandronate (Boniva); zoledronic (zometa, reclast) 3. estrogen/estrogen agonists: within 3-5 years of menopause (oral or patch); "hormone replacement therapy"; reloxifene (Evista) 4. other: parathyroid hormone; calcitonin; teriparatide (Forteo);

Back Pain Interventions Nonsurgical Surgical:

2 common Discectomy with or without fusion: remove offending portion of disc laminectomy: removal of 1 or more laminae of disc with osteophytes & herniated pulpososes Artificial disc , X-stop Spinal fusion

Cast brace

2 cylindrical casts attached with hinge, signs of healing present already

Dislocation: complete separation of joint

(Subluxation: partial or incomplete separation of a joint) s/s: deformity, local pain, swelling, loss of joint function Dx.: Xray, joint aspiration Rx.: emergency to decrease risk of avascular necrosis; realign joint usually with closed reduction; immobilization; pain relief, PT, education (prevent reoccurrances)

Lupus assessment Labs

(same as RA) elevated ANA (antinuclear antibodies) Skin biopsy (lupus cell & inflammatory changes) CBC: pancytopenia: decrease of all blood cell types Tests to assess body system functioning

Gout phases

1. Asymptomatic hyperuricemia 2. Acute gouty attack with severe pain, esp. great toe 3. Intercritical asymptomatic phase (lasts months or years) 4. Chronic tophaceous gout with deposits of urate crystals under the skin (causes lumps) and in bodily organs after repeated acute attacks

Paget's Disease

"osteitis deformans" metabolic disorder of bone remodeling in which bone resorption or loss results in bone deposits that are weak, enlarged, and disorganized Etiology: ?, latent viral infection as much as 20-40 years ago (respiratory virus and measles identified in bone biopsy), genetics, mainly in elderly, European ethnic groups

Connective Tissue Disease Degenerative Joint Disease

"osteoarthritis", "wear and tear disease" progressive deterioration of and loss of articular cartilage; mainly in weight-bearing joints cartilage erodes over time from wear and tear, joint space narrows, bone spurs (osteophytes) develop; inflammatory enzymes alter cartilage metabolism

callus formed

& transformed from fibrous tissue to bone

Back Pain Interventions Nonsurgical

1-2 days bedrest, proper positioning, exercise, massage, chiropractics, antiinflammatory agents, muscle relaxants, heat or ice, pain meds, learn body mechanics, pelvic traction, weight control, back supports, PT/OT, acupuncture, TENS

The nurse anticipates providing collaborative care for a client with a traumatic amputation of the right hand with which health care team members? Select all that apply. A Occupational therapist B Physical therapist C Psychologist D Respiratory therapist E Speech therapist

A,B,C

Crepitus

A grating sound in the knee

Which assessment findings alert the nurse that a client with a spinal cord injury is experiencing autonomic dysreflexia? Select all that apply. A Bradycardia B Headache C Hypertension D Nasal stuffiness E Cold, clammy skin

A,B,C,D

What is Neurogenic Shock?

A potentially life-threatening complication of spinal cord injury in clients with injuries above T6 and is characterized by bradycardia; hypotension; and warm, dry skin. The nurse should notify the provider immediately so that fluids can be restored to the circulating blood volume. Bradycardia is related to shock and not hypoxia, so increasing oxygen or suctioning are not indicated.

Osteomyelitis: Sample NOC

Activity Tolerance Pain Control Joint Movement Knowledge: Illness Care, Meds. Infection Control

Sample NOC for Fractures

Activity Tolerance: Walking Pain Control Knowledge: illness Tissue Perfusion Safety Behavior: Fall Prevention Social Involvement

Sample Nursing Diagnoses for Fractures

Acute Pain Risk for Peripheral Neurovascular Dysfunction Risk for Infection Impaired Mobility Altered Nutrition: Less than Body Requirements Risk for Injury Activity Intolerance Ineffective Coping Self-Care Deficit Body Image Disturbance Fear Constipation Diversional Activity Deficit

Complications of fractures

Acute compartment syndrome (internal or external pressure); emergency treatment to avoid irreversible damage shock (bleeding from fracture, sever arteries from fractured piece(s)) fat embolism syndrome: serious problem with fat being released from marrow into blood (petechiae in ~50%, mental status change) DVT especially in fractures of pelvis and legs infection of wound or bone (osteomyelitis) avascular necrosis with disrupted blood flow; hip fractures usual delayed union/nonunion/ malunion

Osteomyelitis: Sample NANDA

Acute pain Risk for impaired Skin Integrity Risk for Spread of Infection Impaired Physical Mobility

Nursing Diagnoses for Traction

Anxiety Risk for Impaired Skin Integrity Risk for Impaired Gas Exchange Constipation Self-care Deficit Pain Impaired Mobility

SCIs in older adults

Are caused by falls

Amputation Interventions

Assess tissue perfusion at amputated site (flap pink, warm, pulse strength) Accept complaints and descriptions of phantom pain, "real" drug therapy for pain relief TENS, relaxation, psychotherapy, u/s, massage prophylactic antibiotics monitor for s/s infection ROM exercise, prevent flexion contractures, PT Client education prosthesis fitting and teaching for self-care, use of shrinker dressing or stocking, figure 8 bandages rewrapped tid meet with other amputees, especially a peer psychologist, counselor, sex therapist realistic goal-setting home care, OT, rehab., support group

A client has a grade III compound fracture of the right tibia. To prevent infection, which intervention does the nurse implement? A Apply bacitracin (Neosporin) ointment to the site daily with a sterile cotton swab. B Use strict aseptic technique when cleaning the site. C Leave the site open to the air to keep it dry. D Assist the client to shower daily and pat the wound site dry.

B

A client has been provided with a long-leg cast that is still wet. What instructions does the nurse provide to unlicensed assistive personnel (UAP) in caring for this client? A Elevate the client's leg on pillows covered with plastic. B Turn the client every hour. C Assist the client to the bathroom if required. D Wash any spillages off the client's cast.

B

A client has had surgery for carpal tunnel syndrome (CTS). What does the nurse teach the client before discharge? A Restrict hand movements for 2 weeks after surgery. B Check neurovascular status of the fingers every hour. C Take prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) on an empty stomach. D Elevate the affected arm to heart level.

B

A client is taking ziconotide (Prialt) for severe chronic back pain. The nurse instructs the client to stop taking the drug and call the provider immediately if which side effect occurs? A Numbness and tingling of extremities B Hallucinations and delusions C Nausea with vomiting D Blurred vision

B

A client reports severe pain and a grating sound in the knee. How does the nurse document this condition? A Effusion B Crepitus C Genu valgum D Genu varum

B

A client returns to the neuromedicine floor after undergoing an anterior cervical diskectomy and fusion (ACDF). What is the nurse's first action? A Administer pain medication. B Assess airway and breathing. C Assist with ambulation. D Check the client's ability to void.

B

A client who has had back surgery is preparing for discharge. What does the nurse teach this client to help prevent back injury after this surgery? A "Driving is allowed several days after discharge." B "Push rather than pull objects when moving them." C "Sleep on a firm mattress and avoid prolonged standing." D "When sitting, place both feet flat on the ground."

B

A client with multiple sclerosis will begin therapy with fingolimod (Gilenya). Which instruction does the nurse give the client about this drug? A Monitor daily fingerstick blood sugar. B Monitor pulse daily. C Report symptoms of vertigo. D Report symptoms of flushing.

B

A football player is admitted to the emergency department with a sprained ankle. What emergency care is needed for the client with this type of injury? A Do not apply a splint below the injury. B Use elastic wrap for the first 24 to 48 hours. C Do not apply a splint above the injury. D Apply warm compresses for the first 24 hours.

B

A halo fixator with a jacket is used to immobilize the spine of a client following a vertebral fracture. What nursing assessment monitors for neurogenic shock? A Assess the client's breath sounds every 2 to 4 hours. B Monitor for severe bradycardia every 2 to 4 hours. C Monitor the client every hour for severe hypotension. D Check if a finger can be inserted between the jacket and the client's skin.

B

For what type of fracture is physical assessment done with the client in a sitting or standing position? A Pelvic B Upper arm C Lower arm D Leg

B

In caring for a client in the early postoperative period after anterior cervical diskectomy and fusion (ACDF), which nursing intervention is the priority? A Maintaining cervical alignment B Maintaining an open airway C Intravenous pain management D Strict intake and output

B

In teaching a client with acute secondary gout, which instruction about preventing recurrence is most important for the nurse to include? A "Limit your intake of fruits and vegetables." B "Weight Watchers has healthy meal plans." C "Limit fluid intake to 1500 mL/day." D "Discuss with your health care provider about having your estrogen and progesterone levels checked to see where you are in menopause."

B

Rheumatoid arthritis (RA) affects most of the synovial joints. Which joint may be involved in the most severe cases? A Sacroiliac B Temporomandibular C Metacarpophalangeal D Proximal interphalangeal

B

The nurse assesses a client with a spinal cord injury. To assess motor function in the L2-L4 vertebrae, the nurse applies resistance and asks the client to perform which motion? A Dorsiflexion of the feet B Elevation of the legs C Flexion of the feet D Flexion of the knees

B

The nurse is assessing the skeletal system of an African-American client. What must the nurse know to assess the client correctly? A African Americans have lesser bone density than Asians. B African Americans have a decreased incidence of osteoporosis. C African Americans have a shorter stature than Egyptian Americans. D African Americans have less bone density than Irish Americans.

B

The nurse is assisting a client who had a right total hip arthroplasty with getting up from bed. What action does the nurse take? A Stands on the left side of the bed when assisting client. B Reminds the client to stand on the left leg after getting out of bed. C Lifts the client and assists the client to stand. D Asks the client to pivot on the right side to sit in the chair.

B

Paget's Assessment: 80% asymptomatic

Bone and joint pain long bone bowing loss of normal spinal curvature enlarged, thick skull pathologic fractures osteogenic sarcoma flushed, warm skin Apathy, lethargy hyperparathyroidism gout urinary or renal stones heart failure from fluid overload Pain from misshapened bones pressing on adjacent structures

A client admitted to the intensive care unit earlier that day after sustaining a cervical spinal cord injury in a motor vehicle crash is intubated and is receiving mechanical ventilation. The nurse notes a heart rate of 56 beats/min; blood pressure of 88/60 mm Hg; and warm, dry skin. Which action does the nurse perform next? A Continue to assess the client every 2-4 hours. B Increase the oxygen flow to the client. C Notify the provider of these findings immediately. D Suction the client to clear the airway of secretions.

C

A client diagnosed with rheumatoid arthritis (RA) is started on methotrexate (Rheumatrex). Which statement made by the client indicates to the nurse that further teaching is needed regarding drug therapy? A "Drinking alcoholic beverages should be avoided." B "The health care provider should be notified 3 months before a planned pregnancy." C "Any side effects of this drug will be mild." D "I will avoid any live vaccines."

C

A client experiencing kyphosis appears withdrawn and does not initiate any conversation with the nurse when medications are given each day. Which statement by the nurse is most supportive of this client? A "It is normal to feel depressed at times about your condition. You have my support." B "You could exercise more often to build up your strength and endurance." C "How do you feel about the pain in your spine? I am here if you want to talk." D "What does your family say to you? Try talking to them."

C

The nurse is caring for a client who had an arthrocentesis for removal of excessive synovial fluid. What intervention does the nurse perform for this client? A Use a warm compress for pain. B Rest the affected joint for 12 hours. C Avoid the use of acetaminophen. D Monitor the site for bleeding or leakage of synovial fluid.

D

Osteoporosis Risk factors

female, postmenopausal, thinner women, nonexercisers, immobilization, diet low in Ca++ and vit. D, malabsorption, little or no sunlight, EtOH and cigarette smoking, meds, family history, aging, Northern European, Asian-American, Caucasians

Clients with fractures or trauma more likely to develop VTE because of ?

Chemotherapy, oral contraceptives, smoking, and immobility

DJD Nursing Diagnoses

Chronic pain Impaired physical mobility Activity intolerance Self-care deficit Body image disturbance Knowledge deficit: beware of "cures" Ineffective Health Maintenance

Amputation Assessment

Circulation in body psychological preparation body image disturbance social isolation role changes Loss of independence social support religious and spiritual beliefs coping strengths X-rays segmental limb BPs Doppler ultrasound transcutaneous oxygen pressure

The nurse is caring for a client with Buck's traction. What care does the nurse provide for this client? A Inspect the skin every 12 hours for irritation or inflammation. B Remove the belt or boot used for traction to inspect the skin once a day. C Monitor circulation every 4 hours after traction is applied. D Ensure the weights are freely hanging at all times.

D

A trapeze does what?

helps the client reposition him- or herself

Cast Care

Client education re: purpose of cast, cast application, care of cast. Handle wet cast with palm of hand only. Turn every 1-2 hours to allow air circulation for drying of the cast. Elevate casted extremity, monitor arterial circulation. No plastic pillows with wet cast. Protect long leg or spica cast from feces & urine; plastic covering at perineal opening. It may be easier to use fracture bedpans. CSM hourly for 24 hours, then every 4. Bivalve cast if too tight; fit 1finger under cast. Assess cast for integrity, sharp edges "petal edges", drainage (circle), swelling of affected body part. Do not turn a spica cast by abductor bar. Synthetic casts can be come wet during bathing and swimming, (sometimes instructed to dry with hair dryer). Never put foreign objects under cast (ex.: coat hanger); benadryl prn itch Cast removal with cast saw which is loud and vibrates but will not cut the skin. Skin is usually dry and scaly initially.

Common types of fractures

Closed (nondisplaced) open (compound) comminuted (fragmented) displaced Oblique spiral impacted greenstick

The nurse is preparing a client with osteoarthritis for self-management. What does the nurse tell the client about exercising? A Use passive exercise more often than active exercise. B Maintain the number of repetitions of each exercise. C Avoid medication for mild pain. D Avoid resistive exercises when the joints are inflamed.

D

The nurse is providing instructions to a client with a spinal cord injury about caring for the halo device. The nurse plans to include which instructions? A "Begin driving 1 week after discharge." B "Avoid using a pillow under the head while sleeping." C "Swimming is recommended to keep active." D "Keep straws available for drinking fluids."

D

Anterior Cruciate Ligament Injury

Common knee ligament injury usually in sports s/s: "popping" with impact or twisting, instability, acute pain, swelling Dx.: Xrays, MRI Rx.: intact: rest, ice, NSAIDS, elevation, PWB tear: PT, knee immobilizer, aspiration of any effusion, surgery to reconstruct ACL with autologous/allograft tissue

Carpal Tunnel Syndrome

Common; median nerve becomes compressed in wrist, causing pain, weakness, and numbness wrist flexion causes nerve impingement against the flexor retinaculum (fibrous tissue sheet in the carpal tunnel) wrist extension causes increased pressure in the distal portion of the carpal tunnel Adults 30-60 years old (peak) women more than men affects usually dominant hand now seen in kids due to computer use Repetitive strain injury Need close attention to ergonomics

TKR: Postoperative

Continuous Passive Motion Machine: mobility to reduce stiffness, maintain circulation, exercise, prevents scar formation; settings in flexion, cycle speed, extension knee immobilizer at night for extension PT exercises, ambulation wound care, VS, anticoagulants as for THR Pain relief

The nurse is providing medication instructions to a client diagnosed with amyotrophic lateral sclerosis (ALS) who has been prescribed riluzole (Rilutek). Which statement indicates to the nurse that the client understands the instructions? A "Riluzole should be taken with food." B "I plan to take riluzole once daily." C "I will call the health care provider if my pulse goes below 50." D "I will need frequent checks of my liver enzymes."

D

A client has a short-leg cast following a fracture of the ankle. What does the nurse teach the client about managing the fracture? A Avoid walking to prevent damage to the cast. B Apply ice for the first 12 hours. C Report if the cast is not tight enough. D Elevate the affected leg on several pillows.

D

A client is admitted with a spinal cord injury at the fifth thoracic vertebra secondary to a gunshot wound. Which nursing intervention is the priority for this client's care? A Auscultating bowel sounds every 2 hours B Beginning a bladder retraining program C Monitoring nutritional status D Positioning the client to maximize ventilation potential

D

A client is being discharged with paraplegia secondary to a motor vehicle crash and expresses concern over the ability to cope in the home setting after the injury. Which is the best resource for the nurse to provide for the client? A Hospital library B Internet C Provider's office D National Spinal Cord Injury Association

D

A client is brought to the emergency department (ED) via ambulance after a motor vehicle crash. What condition does the nurse assess for first? A Bleeding B Head injury C Pain D Respiratory distress

D

A client who has just undergone spinal surgery must be moved. How does the nurse plan to move this client? A Getting the client up in a chair B Keeping the client in the Trendelenburg position C Lifting the client in unison with other health care personnel D Log-rolling the client

D

A client with a fracture asks the nurse about the difference between a compound fracture and a simple fracture. Which statement by the nurse is correct? A "Simple fracture involves a break in the bone, with skin contusions." B "Compound fracture does not extend through the skin." C "Simple fracture is accompanied by damage to the blood vessels." D "Compound fracture involves a break in the bone, with damage to the skin."

D

A client's short-leg cast has been removed. What does the nurse teach the client about caring for the extremity after cast removal? A Scrub the affected extremity well to remove dead, scaly skin. B Perform weight-bearing exercises. C Avoid placing the extremity on pillows. D Apply elastic bandages around the extremity.

D

A family member of a client with a recent spinal cord injury asks the nurse, "Can you please tell me what the real prognosis for recovery is? I don't feel like I'm getting a straight answer." What is the nurse's best response? A "Every injury is different, and it is too soon to have any real answers right now." B "Only time will tell." C "The Health Insurance Portability and Accountability Act requires that I obtain the client's permission first." D "Please request a meeting with the health care provider."

D

An older adult client has multiple tibia and fibula fractures of the left lower extremity after a motor vehicle crash. Which pain medication does the nurse anticipate will be requested for this client? A Cyclobenzaprine (Flexeril) B Ibuprofen (Advil) C Meperidine (Demerol) D Patient-controlled analgesia (PCA) with morphine

D

The incidence of what type of fracture is highest in older adults? A Wrist B Rib C Femoral shaft D HIP

D

The nurse is assessing an older client for changes in the musculoskeletal system. What does the nurse teach the client for proper self-care at home? A Avoid weight-bearing exercises. B Apply cool compresses to the joints. C Avoid isometric exercises. D Prevent pressure on bone prominences.

D

The nurse observes that the client is unable to grasp a pen and form a fist when assessing motor function. Based on this assessment, what is the most likely level of spinal cord injury in the client? A C4-5 B C5-6 C C7 D C8

D

he ambulatory surgery postanesthesia care unit (PACU) nurse has just received report about clients who had arthroscopic surgery. Which client will the nurse plan to assess first? A Young adult client who has been in the PACU for 30 minutes after left knee arthroscopy under local anesthesia B Adult client who had a synovial biopsy of the right knee under local anesthesia and has been in the PACU for 20 minutes C Adult client who has multiple right knee incisions for repair of torn cartilage and arrived in the PACU an hour ago D Middle-aged adult client who returned to the PACU 25 minutes ago after left knee arthroscopic surgery under epidural anesthesia

D

A client is in traction after a major leg injury. What nursing care is necessary for the client? Select all that apply. A Inspect the skin every 14 hours. B Remove the belt used for traction once in a day. C Monitor circulation every 4 hours after traction is applied. D Ensure the weights are freely hanging at all times. E Inspect the traction equipment every 8 to 12 hours.

D,E

The nurse is caring for a postoperative client with total joint arthroplasty. What actions does the nurse take to prevent venous thromboembolism (VTE) postoperatively? Select all that apply. A Massage the legs. B Keep the legs slightly abducted. C Use the knee gatch on the bed. D Apply elastic stockings. E Administer anticoagulants.

D,E

The nurse is monitoring a client for major complications following lumbar spinal surgery. What assessments does the nurse make to monitor for fat embolism syndrome (FES)? Select all that apply. A Observe for clear fluid on or around the dressing. B Monitor vital signs carefully for hypotension and tachycardia. C Assess for abdominal distention, nausea, or vomiting. D Observe for chest pain, dyspnea, anxiety, and mental status changes. E Observe for pain or swelling around the wound site or the legs. F Note petechiae around the neck, upper chest, and conjunctiva.

D,E

Musculoskeletal aging changes

Decreased bone density degeneration of joint cartilage muscle tissue atrophy causes changed posture, poor coordination, gait changes, increased risk of falls with injury pain tolerance, description of pain posture standing & walking gait stance & swing mobility aids, safety physical & psychosocial assessment

Musculoskeletal assessment

Demographics History of trauma, surgery, illness, medications, family history, diet, lifestyle, occupation pain tolerance, description of pain posture standing & walking gait stance & swing mobility aids, safety physical & psychosocial assessment

Gout assessment

Demographics family history joint inflammation (inspection only; too painful for palpation) tophi at ears, arms, fingers near joints renal calculi or other renal dysfunction serum uric acid elevated (serial tests to avoid false positives with food intake) synovial fluid aspiration (needle like crystals)

Adverse effect of tizanidine?

Drowsiness

Carpal Tunnel Syndrome Interventions

Drug therapy: NSAIDs, corticosteroid injections Immobilization with splint (neutral or slight extension position) for all or part of the day/night Educate about good body mechanics

Lupus assessment

Dry, scaly raised, red "butterfly" rash on face or upper body; originally looked like wolf bites (lupus means wolf in Latin) joint difficulties similar to RA muscle atrophy myalgia Fever weakness fatigue weight loss anorexia nephritis pleural effusions dyspnea pericarditis Tachycardia chest pain Raynaud's phenomenon seizures psychosis migraines peripheral neuropathies cranial nerve palsies abdominal pain mesenteric arteritis pancreatitis lymph, spleen and/or liver enlargement Alopecia Photosensitivity reaction

Other Arthroplasties

Elbow Finger Wrist Ankle Toe

Other nonsurgical therapies for fractures

Electrical bone stimulation used when surgery ineffective (noninvasive to fully implantable with electric coils or electrodes); treatment takes months if successful at all Ultrasound fracture treatment as adjunct or alternative to surgery; ~ 20 minutes a day; very good results thus far

DJD: Assessment

Elevated or normal ESR , CRP (C reactive protein) possible Xrays: structural joint changes Ct scan/MRI Bone scan: early DJD before detectable on Xray

Fracture Interventions

Emergency care: assess for resp. distress, bleeding, head injury, chest pain 1st visualize extremity or body part; pressure for bleeding; splint for comfort & neurovascular stability CMS check closed reduction: manipulation of bony ends to realign fracture, anesthesia or analgesia used; X-ray to verify bone set bandages or splints for immobilization of UE due to NWB status Pain management: opiods, muscle relaxants, antiinflammatories ice and/or heat elevation massage, warm therapy therapeutic touch, distraction, imagery, music therapy or other relaxation Incision site care: Aseptic technique with any wound care Frequent VS, monitor for infection Diet Therapy: High protein, high calorie diet for healing, vitamin supplements, high calcium, high in iron Exercise Therapy: PT exercises, ambulation with assistive devices as necessary Self-care assistance client education discharge planning to meet anticipated needs safely Cast care: immobilizes affected part while allowing movement of the rest; allows early mobility, reduces pain Cast materials: plaster of Paris (open weave cotton covered with anhydrous calcium sulfate) with stockinette; feels warm initially from chemical reaction; dries in 24-72 hours; becomes hard, shiny, odorless Cast materials: fiberglass cast: lighter than plaster, minimal drying time ~10-15 minutes; bear weight in 30 minutes; good for upper extremities because WB not needed; different colors- good for children & adolescents polyester-cotton knit: 7 minutes to dry; WB in 20 minutes; good for UE- NWB

DJD Sample NOC

Endurance Energy Conservation Pain Control Joint Movement Knowledge: illness care, medications, health promoting behaviors Self-care ADLs

Musculoskeletal NOC labels

Endurance, Energy Conservation, Joint Movement, Ambulation: Walking, Safety Behavior: Fall Prevention, Pain Control

Musculoskeletal NIC

Energy Management Home Maintenance Exercise Therapy: Ambulation Pain Management Fall Prevention

Lyme Disease

Etiology: bite of infected deer tick s/s: erythema migrans (bulls eye rash), viral s/s, fatigue, joint and muscle pain Dx.: s/s, ELISA (enzyme-linked immunoassay) and/or Western Blot blood test Rx.: antibiotics (po for acute; IV for chronic prn)

Fibromyalgia

Etiology: unknown; more in women; neuroendocrine dysregulation? s/s: chronic fatigue, muscle aches especially at "pressure points", stiffness, anxiety, irritable bowel syndrome, nonrestorative sleep, paresthesias Dx.: may have low ANA titer, r/o other disorders, s/s especially pressure points of pain

Carpal Tunnel Syndrome etiology

Excessive hand exercise edema hemorrhage thrombosis of the carpal artery Colles' fracture of the wrist hand burns Synovitis repetitive hand movements from occupation, hobby genetics lengthy computer use

Fractures: bone remodeling/stages of healing; about 6 weeks

hematoma granulation callus formed osteoclasts & phagocytes remove the debris, necrotic bone resorbed * delayed in elderly (~3-6 months)

Osteomyelitis Assessment

Fever, usually above 101 tenderness with palpation Erythema, warmth bone deformity/pain: constant, localized, pulsating, worse with movement ulceration with sinus tract, drainage elevated ESR as infection worsens, elevated WBC with diff Blood culture bone scan MRI bone or soft tissue biopsy to determine microorganism

Bone cancer assessment

General health medical history, radiation Pain, swelling palpable mass, deformity disability, loss function low grade fever (Ewings) pallor, fatigue anxiety, fear ability for ADLs support systems loss of control grieving high alk. phosphatase elevated serum Ca++ from primary cancer elevated ESR X-ray CT to evaluate soft tissue damage bone biopsy to diagnose type of tumor bone scan to evaluate extent of cancer MRI grading to TNM (tumor size, nodal involvement, metastasis)

hematoma

in 24-72 h

Potential complications - amputations

Hemorrhage from cut blood vessels; hold pressure to area infection from surgery risk, soiling, contamination phantom limb pain ~80%; "stump pain" Immobility complications: atelectasis, pneumonia, DVT, skin breakdown neuroma: sensitive tumor of nerve cells at severed nerve endings; usually in UE flexion contractures

Metastatic bone disease

In adults: Originates from a primary site usually spread through bloodstream, beginning in the bone marrow; 20-70% of metastatic disease causes bone cancer; perhaps underreported! usually over 40 years old pathological fractures at acetabulum and proximal femur mostly Osteosarcoma **** Ewing's sarcoma: usually children & teens Chondrosarcoma: usually ages 50-70, in cartilage Chordoma: rare; ages 50-70 usually at base of skull and spine

Postoperative bone cancer care

Incision Site Care: Pressure dressing & surgical drain Safety Behavior: PT exercises, ROM, CPM, NWB until healing completed for bone grafts, CSM especially related to braces, casts, etc. Body Image Enhancement: psych. support, assess body image; cosmetic dressing to hide the bony defects Coping Enhancement: client education for d/c home, F/U care; alert to s/s complications; stress management

Osteomyelitis

Infection of the bone Acute (less than 4 weeks) vs chronic pathogen invasion> bone and surrounding tissue become inflamed> increased vascularity, edema> vessel thromboses> ischemia to bone> necrosis, abcess

Cast complications

Infection, odor circulation impairment peripheral nerve damage skin breakdown, "painful hot spot under cast" complications of immobilty: pneumonia, DVT, constipation contracted joint degenerative arthritis muscle atrophy

When should Meperidine (Demerol) not be used?

in older adult clients because it has toxic metabolites that can cause seizures and other complications.

Paget's Assessment Labs:

increased alkaline phosphatase high urinary hydroxyproline calcium in blood and urine (may be low, nl, or high) uric acid elevation

THR: intraoperative

Intraop.: laminar flow air room early in day general or epidural (neuroaxial) anesthesia 8" incision usually anterolateral thigh closed with staples (newer with 2 4" incisions; very experienced surgeon- less risks/complications) cemented vs noncemented (*) prosthesis wound drain(s)

Herniated discs occur most often between?

L4 and L5.

TKR: Intraoperative

Laminar flow OR, usually early in day General or epidural anesthesia osteotomies of femoral and tibial condyles and posterior patella to prepare surfaces for prosthesis 8" incision surgical drain(s) pressure dressing

Types of casts

Leg cast Arm cast Body cast/spica Cast brace

Osteoporosis is essentially ?

irreversible; attempt to retard the bone loss and protect from injury and disability

Osteoporosis

Loss of density of bone and enlargement of the bone spaces due to disturbance of mineral metabolism, inadequate absorption of calcium into bone, and failure of the osteoblasts to lay down sufficient matrix Only 20% are male

Osteoporosis assessment

Low back pain "dowager's hump", kyphosis weight loss compressed vertebrae, height loss (up to 3") spontaneous fractures or from trauma constipation Respiratory compromise disturbed body image decreased social/physical activity altered sexuality anxiety fear

Principles of Traction

Maintain correct balance of weight per MD's order. Maintain continuous traction unless ordered otherwise. Weights should be hanging freely always. Assess skin under or near traction appliances hourly initially and then every 4 hours for CSM and skin integrity esp. with elderly Monitor pin sites in skeletal traction for signs of infection. Pin care as ordered. Inspect all ropes, pulleys, and knots for patency at least every shift. Prevent friction. Maintain correct body alignment. Maintain and assess 4 P's: pounds, pull, pulleys, pressure.

Lupus interventions Drug therapy:

NSAIDs or tylenol topical cortisone to reduce inflammation of rash plaquenil to reduce inflammatory response systemically steroid therapy immunosuppressan IV Rituxan (rituximab) counters autoimmune diseases Experimental: bone marrow stem cell infusions

Fibromyalgia Drugs

NSAIDs, gabapantin, tricyclic antidepressants (amitriptyline), pregabalin (Lyrica), skeletal muscle relaxants, benzodiazepines exercise/rest psychological support massage therapy alternating heat/cold therapy diet: decrease EtOH, caffeine, sugar intake

Herniated nucleus pulposus (HNP)?

is a bulging disc

Degenerative Joint Disease facts

More than 27 million in the U.S. have s/s DJD; maybe many more with changes on Xray Women more than men; elderly; Native American groups Assessment: demographics, occupation, trauma, sports, obesity, family history, previous/ present med. status, ADL ability Joint pain, changes, effusions, muscle atrophy, compression, crepitus

Rheumatoid Arthritis

Most destructive to joints chronic, progressive, systemic, inflammatory process synovitis> articular cartilage erodes after inflammatory response causes vascular granulation tissue> bone destruction, fibrous adhesions, bony ankylosis, calcifications, osteoporosis can occur

Avascular necrosis?

is a chronic complication of fracture which occurs due to death of the bone tissue from a lack of blood supply.

Scoliosis?

is a curvature of the spine.

Osteoporosis NIC

Nutritional therapy: increase calcium, vitamin D; avoid alcohol and excessive caffeine Environmental Safety management: safety education, hazard-free environment Exercise therapy: PT strengthening, ROM, weight-bearing exercise program (walking, bicycling) Pain management: analgesics, muscle relaxants, NSAIDs; dorsolumbar orthotic support Self-care Assistance Health Education Electromagnetic therapy Surgery: kyphoplasty, vertebroplasty

When your patient has (FES) what are the symptoms?

Observe for and report chest pain, dyspnea, anxiety, and mental status changes (particularly common in older adults). Note petechiae around the neck, upper chest, buccal membrane, and conjunctiva. Monitor arterial blood gas values for decreased Pao2.

Surgical management of fractures

Open reduction with internal fixation (ORIF) *(+): early mobilization, direct visualization of site, good fixation with hardware *(-) potential postop complications External fixation with closed reduction (external metal apparatus with pins inserted in bone) *(+): minimal blood loss, early ambulation, easy access to wound if an open fracture *(-): pin infection, body image Ilizarov procedure: circular external device that can be adjusted for rotation, lengthening, widening; used for malunions, bone defects, etc.; long-time use Bone grafts: treat nonunion or bony defects; donor bone from client (iliac crest), cadavers, or banked bone from femoral heads removed for THR on other patients; careful screening for communicable disease

Nursing Diagnoses

Pain Anticipatory Grieving Altered Body Image Fear Anxiety Impaired Physical Mobility Altered Nutrition: less than body requirements Altered Role Performance Risk for Injury Spiritual Distress PC: Fractures

Osteomyelitis NIC Interventions Nonsurgical:

Pain Management/ Infection Control: pain meds; IV antibiotics for weeks in hospital or home setting, potent oral antibiotics; Contact precautions Wound Care, Skin Surveillance: wound irrigation/packing with antibiotics; Hyperbaric oxygen therapy increases tissue perfusion Exercise Therapy Education (s/s further infections like C. diff, candida albicans) emotional support

Interventions for bone cancer

Pain Management: analgesics, chemo (chondrosarcomas resistant to chemo) & radiation to reduce tumor size, bracing and immobilization of body part Surgery with or without chemo/radiation: ex.: excision, total joint replacements

Carpal Tunnel Syndrome Assessment: affected hand/fingers

Pain description numbness paresthesias Phalen's wrist test/maneuver Tinel's sign Okutsu sign weak pinch clumsiness Fine movement difficulty muscle weakness and wasting over time swelling skin discoloration nail changes increased/decreased palmar sweating

Spinal stenosis ?

is a narrowing of the spinal canal or nerve root.

Describe Russell's traction ?

is a type of lower extremity traction in which the affected leg is extended and a sling under the knee suspends the leg.

Fracture Assessment

Preceding events medication history substance abuse medical history occupation/recreation nutritional history knowledge about health promotion Physical assessment to identify any life-threatening complications generalized then specific assessment Pain, swelling, CSM, impaired skin integrity, deformity, crepitus, lost motion Body image fear low H&H perhaps high ESR elevated calcium, phosphorous as released from bone X-rays tomograms CT scan bone scan MRI

Newer RA Interventions

Pulse therapy with rapid infusions of steroids or chemotherapeutic agents Plasmapheresis to remove antibodies that are causing RA; "plasma exchange"

Sample RA meds: relieve pain, slow RA disease

Remicade (infliximab) ~$762/mo. Arava (leflunomide) $630/mo. Enbrel (etonercept) $463/mo. HUMIRA (adalimumab) $1077/mo. Rituxan (rituximab) $659/mo. * increased risk of fungal infections (histoplasmosis especially) due to immunosuppression

RA Interventions

Rest/PT exercises for strength Positioning/OT for devices for ADLs ice to reduce inflammation heat to relieve morning stiffness and pain TENS acupuncture imagery, music therapy to relieve stress OT: cope with ADLs fatigue management (facilitate sleep and rest, pacing activities, obtain assist prn, set priorities) education for compliance, support group, counselor or spiritual leader Enhance body image (acceptance, trusting relationship, use of personal items while in hospital, assist in care, coping strategies, empathy) PT conditioning program

Evaluation Musculoskeletal

Review NOC goals, socioeconomic concerns, medication education/compliance

RA Laboratory

Rheumatoid factor Antinuclear Antibody Titer Erythrocyte Sedimentation Rate Serum Complement Serum Protein Electrophoresis Immunoglobulins CBC, CRP Synovial fluid analysis

Types of traction

Skin Buck's Thomas splint with Pearson attachment Plaster Brace Circumferentia

Spastic paralysis is more common in ? Although flaccid paralysis may occur at times in?

Spinal cord tumor

RA

Spontaneous exacerbations & remissions systemic response; inflammatory response affects other organs or body system; vasculitis> malfunction of organ Etiology: ?; autoimmune, Epstein-Barr virus, genetic (2-3 times more often in families), environmental factors, stress women more than men; usually 35-50 y.o.

Sports injuries

Strain: excessive stretching of a muscle or tendon "muscle pull", inflammation, impaired muscle function cold/heat therapy, exercise, restricted activity, muscle relaxants surgery of ruptured muscle or tendon Sprain: excessive stretching/tearing of a ligament twisting motions, usually pain & swelling RICE initially: Rest, ice, compression bandage for swelling and support of a joint, elevation above heart; casting or surgery if severe Later: heat 2 days after to relieve spasms and help vasodilation Rotator Cuff Injury: degenerative changes with age, overuse, injury shoulder pain, inability to abduct arm or maintain abduction (drop arm test) at the shoulder NSAIDs, PT, sling, ice/heat, exercises with careful control progressing to active exercises; surgery for complete recovery Repeat injuries common (~50%)

Overhead, or 90-90, traction is ?

a type of upper extremity traction where the elbow is flexed and the arm is at a right angle to the body over the upper chest.

Carpal Tunnel Syndrome Interventions

Surgery: relieve pressure on the median nerve by nerve decompression synovectomy or removal of a space-occupying lesion via endoscopic incision (less than 1/2"), scalpels or laser Postop.: VS, pressure dressing care, elevation above heart, CSM hourly, splint used for 2 wks after sutures d/c, restrict certain hand movements for 4-6 wks. Might not be a cure.

fingolimod (Gilenya) PATIENTS NEEDS TO DO WHAT?

The client should be taught to monitor the pulse daily, and it can cause bradycardia, especially within the first 6 hours of taking i

Lupus assessment Psychosocial:

body image affected with disfiguring rash, side effects from steroids decreased socialization or ADLs due to fatigue and weakness role changes fear, anxiety depression

Potential complications of Connective Tissue Disease

bone cysts synovitis subluxation joint deformity, immobility pain muscle spasm

Hip Arthroplasty for DJD

Total Hip Replacement (THR): most common arthroplasty for DJD usually older than 60; newer cases now with 40% younger than 55; contraindicated for infection anywhere in body, severe osteoporosis, or severe inflammation Preop.: client education!, meet with PT, SDA

DJD Interventions (surgical)

Total Joint Replacement: prosthetic system of 2 parts one for each joint surface; "arthroplasty": surgical creation of a joint

Knee Arthroplasty for DJD

Total Knee Replacement (TKR): 2nd most common; 3 part system : femoral component, tibial plate, & patellar button for severe DJD, disability, and for those over 60 mostly Preop.: client education.esp. related to postoperative period

Etiology of fractures

Trauma malnutrition osteoporosis pathologic from disease states (ex.: cancer) Caucasian women the most

Etiology of amputations

Trauma thermal injuries tumors infections Metabolic disorders (Paget's) congenital anomalies severe peripheral vascular disease heavy smoker poor hygiene leading to necrosis, gangrene

Amputation

Traumatic vs surgical physical impairment and psychosocial trauma related to amputation self-esteem and body image affected Traumatic: unanticipated severing of a body part; ex.: chain saw, MVA; wrap severed part in cool, dry cloth, moistened with NS if possible, sealed plastic bag placed in ice water Surgical: open (guillotine) vs closed (flap) method the higher the level of the amputation, the more energy is required for ambulation

SYMPTOMS OF autonomic dysreflexia?

bradycardia, headache, hypertension, and nasal stuffiness, flushing warm skin

Carpal Tunnel Syndrome Assessment

X-rays EMG (detects nerve dysfunction before muscle atrophy)

Osteoporosis assessment Radiology

Xrays (after 25-40% bone loss) CT DEXA: (or DXA) (assess in nondominant arm, but hip more accurate) detects as little as 1-3% loss) Peripheral quantitative u/s

Acute compartment syndrome is?

a complication of fractures in which increased pressure within one or more compartments reduces circulation to the area. Plasma proteins leak into the interstitial fluid space and edema occurs. Edema increases pressure on nerve endings and causes pain. Sensory perception deficits or paresthesia generally appears before changes in vascular or motor signs. The color of the tissue pales, and pulses begin to weaken but rarely disappear.

Sjögren's syndrome

a disorder of your immune system identified by its two most common symptoms — dry eyes and a dry mouth.

The earliest manifestations of FES are ?

a low arterial oxygen level (hypoxemia), dyspnea, and tachypnea (increased respirations).

Transcutaneous oxygen pressure is?

a method that measures oxygen pressure to indicate blood flow in the limb, and has proven reliable for predicting healing.

Brace traction

a pull for correction of an alignment deformity

Osteoporosis Characterized by:

abn. porousness, fragility, and reduction in quantity of bone

Long-term corticosteroid therapy such as prednisone therapy can?

also increases the risk for chronic complications such as aseptic necrosis.

Closed reduction involves?

applying a manual pull or traction to move the ends of a fractured bone to realign them. This is the most common nonsurgical method for managing a simple fracture. A commercial immobilizer or an elastic bandage is used to keep the scapula or clavicle bone in place during healing.

Immunomodulators such as interferon-beta, synthetic proteins like glatiramer acetate, and monoclonal antibodies such as natalizumab

are among the current drug therapies recommended for early and continuous treatment of relapsing types of MS.

Lupus interventions Skin care:

avoid prolonged UV light (sun and fluorescents) cover head and skin with hat and clothing SPF 15+ mild cleansers, lotion consult cosmetologist for rash cover-up and hair care, wig

Circumferential traction

belt around the body with weights; "pelvic traction" usually for low back pai

Back Pain

cervical or lumbar most common; herniated disc, strain, spasm, degeneration, trauma, poor posture, poor body mechanics herniated disc mostly L4-5, L5S1 with pressure on sciatic nerve: "sciatica" : pain down buttocks & leg Spinal stenosis: pressure in the nerves from narrowing of spinal space Xray, MRI, myelogram, s/s, CT, EMG

Surgical repair of fractures can cause?

chronic complications such as aseptic necrosis because the hardware used in the procedure can interfere with circulation.

Regular turning and repositioning are the best way to prevent?

complications of immobility in clients with spinal cord problems

Osteoporosis Etiology

decreased osteoblastic activity or increased osteoclastic activity, less BMD

How do you save a severed body part?

direct pressure should be applied at the amputation site with dry gauze. The extremity is elevated above the heart level to prevent bleeding. The severed part must not come in contact with water to prevent tissue damage. The severed part must be completely wrapped in dry sterile gauze or a clean cloth. Then the wrapped finger is placed in a watertight sealed plastic bag. This bag is again immersed in a bag containing 1 part ice with 3 parts water.

Body cast/spica

encircles trunk of the body, and 1 or 2 extremities

What is Fat embolism syndrome (FES)?

fat globules are released from the yellow bone marrow into the bloodstream within 12 to 48 hours after an injury or other illness (mechanical theory). These globules clog small blood vessels that supply vital organs, most commonly the lungs, and impair organ perfusion.