MedSurg2 Musculoskeletal: chapters 60-63

a normal response, and indicates the presence of phantom limb sensation

Client admitted to unit for after a BKA. The client tells the nurse, "I think I'm going crazy. I can feel my left foot itching." The nurse interprets the client's statement to be: a. a normal response, and indicates the presence of phantom limb pain b. a normal response, and indicates the present of phantom limb sensation c. an abnormal response, and indicates that the client is in denial about the limb loss d. an abnormal response, and indicates the client needs more psychological support

the left leg is internally rotated

A client had a total left hip arthroplasty. What clinical manifestation would indicated to the nurse that the prosthesis is dislocated? a. the left leg is internally rotated b. there are diminished peripheral pulses on the affected extremity c. the leg length in the same as the right leg d. the client has discomfort when moving in bed

R-rest I- ice C- compression E- elevation

The major treatment for sprains and strains is the acronym ?

edema, swelling, loss of pain

The sprain is elevated to reduce?

fever (99 F) redness edema

What are signs of infection you would usually see?

eat diet rich in calcium/vitamin D exercise fall prevention

What are some lifestyle modifications for osteoporosis?

older age, heredity, race, sex, early menopause

What are some non modifiable for osteoporosis?

pain management

What is the major issue you deal with in gout as a nurse?

rest when needed, hot/cold packs

What is the tx for rheumatoid arthritis?

removing all external sources of pressure, such as clothing and jewelry

Which nursing intervention is essential in caring for a client with compartment syndrome? a. wrapping the affected extremity with a compression dressing to help decrease to help decrease the swelling b. keeping the affected extremity below the level of the heart c. starting an I.V. line in the affected extremity an anticipation of venogram studies d. removing all external sources of pressure, such as clothing and jewelry

sprain

Which term refers to an injury to ligaments and other soft tissues surrounding a joint? a.Strain b.Dislocation c.Sprain d.Subluxation

abnormal sensation

While reading a client's chart, the nurse notices that the client is documented to have paresthesia. The nurse plans care for a client with a. involuntary twitch of muscle tone b. absence of muscle tone c. abnormal sensations d. absence of muscle movement suggesting nerve damage

signs of infection

Why do you assess the incision for a total knee replacement?

elevate the residual limb on a pillow

client S/P AKA today. For the first 24 hours postoperatively, the nurse makes it a priority to do which of the following to properly manage the surgical site? a. elevate the residual limb of a pillow b. change dressings as often as needed c. loosen the stump dressing every 4 hours d. maintain the residual limb in a dependent position

principles of effective traction

continuous traction counter traction body has to be in a straight alignment the ropes need to move freely through all pulley's exact amount of wt ordered

patient teaching of osteomalacia

diet make sure patient gets plenty of calcium, get plenty of exposure to sunlight (20 mins a day w/ sunscreen)

age, race, sex, heredity, ⬇️ wt/bone structure, estrogen deficiency or menopause

risk factors for osteoporosis

pain (worse w/ wt bearing) swelling deformity

s/sx of benign bone tumor

painful joint movement distinct lump may be palpated if ruptures (warm, tender, edematous)

s/sx of bursitis

pain swelling limp or abnormal gait difficulty moving involved extremity

s/sx of malignant bone tumors

⬇️ tolerance to meds, prevent over sedation ⬇️ IV rate, avoid CHF ⬆️ risk of: CHF

special considerations for elderly clients with hip fractions

insect repellent, wear light colored clothes, tuck pants inside socks

How do you prevent lyme disease?

20 mintues

How long can you leave ice on a patient with a sprain?

malignant bone tumors

abnormal osteoblasts or myeloblasts (marrow cells) that exhibit rapid and uncontrollable growth

skin traction

achieved by applying devices to the skin that indirectly affect the muscles or bones

skeletal traction

applied directly to a bone by using a wire (Kirschner), pin (Steinmann), or cranial tongs (Crutchfield)

dislocation

articular surfaces no longer in contact supporting ligaments, torn, stretched, or relaxed

lupus

chronic inflammatory autoimmune disease affects females more

stretched or pulled beyond its capacity

A client has been diagnosed with a muscle strain. What does the physician mean with the term "strain"? a.injury resulting from a blow or blunt trauma b.injuries to ligaments surrounding a joint c.subluxation of a joint d. stretched or pulled beyond its capacity

dislocation

A client who has fallen and injured a hip cannot place weight on the leg and is in significant pain. After radiographs and indicate intact but malpositioned bones, what would the physician diagnose? a. sprain b. dislocation c. strain d. fracture

maintain consistent traction tension while repositioning

A client with a fractured femur is in balanced suspension traction. The client needs to be repositioned toward the head of the bed. During repositioning, what should the nurse do? a. release the weights and replace them immediately after positioning b. place slight additional tension on the traction cord c. maintain consistent traction tension while repositioning d. reposition the bed instead of repositioning the client

monitor body temperature

A patient with systemic lupus erythematousus (SLE) is getting ready for discharge. The nurse knows the patient has understood the teaching when stating that she needs to: a. be active as possible between flare ups b. stop her corticosteroids when symptoms are relieved c. get as much exposure to sunlight as possible to help control skin rashes d. monitor body temperature

prevent further loss of circulation to extremity promote comfort promote optimum level of mobility

Care of clients with amputations what are the nursing implications?

CPM prevents increases range of motion of the joint

Following a total knee replacement, the surgeon orders a continuous passive motion (CPM) device. The client asks about the purpose of this treatment. What is the best response by the nurse? a. "CPM strengthens the muscles of the leg." b. "CPM increases range of motion of the joint." c. "CPM prevents injury by limiting flexion of the knee." d. "CPM delivers analgesic agents directly into the joint."

6-8 weeks

How long do you take antibiotics for osteomyelitis?

6 months

How long do you take oral antibiotics for osteomyelitis?

1 hour

How long does the ice have to be off the sprain?

8 to 12 hrs

How long should a CPM for a total knee replacement be worn?

ambulation STD ROM isometric exercise

How would you as the nurse prevent a patient from getting a DVT?

staphylococcus aureus

Most cases of osteomyelitis are caused by which microorganism? a. escherichia coli b. proteus species c. staphylococcus aureus d. pseudomonas species

TMJ care

Temporomandibular joint (TMJ) care: referral to a dentist who has experience managing clients w/ TMD. Analgesics are prescribed/ recommended, such as NSAIDs. The client is fitted with a custom mouth guard during sleep. TENS, injection of local anesthetic to relieve muscle spasm, muscle relaxants, and oral irrigations with ice water also are used to reduce and relieve discomfort. Tricyclic antidepressants (amitriptyline) are sometimes prescribed to relieve pain

joint stillness, decreased endurance, decreased range of motion

The nurse is admitting an older adult to a skilled nursing facility. What assessment parameters will the nurse expect to find with the musculoskeletal assessment? select all that apply a. joint stiffness b. decreased endurance c. increase in height d. increased muscle strength e. decreased rate of motion

compare parts of the body symmetrically

The nurse is performing an assessment of a client's musculoskeletal system and is appraising the client's bone integrity. What action should the nurse perform during this phase of assessment? a. assess extremities when in motion rather than at rest b. percuss as many joints as are accessible c. administer analgesia 30 to 60 minutes before assessment d. compare parts of the body symmetrically

compartment syndrome

Two days after application of a cast to treat a fractured femur, the client reports severe, deep, and constant pain in the leg. What willl the nurse suspect? a Compartment syndrome. b.Infection. c.Phlebitis. d.Chronic venous insufficiency.

buck's, russell's

What are the 2 common types of skin traction?

pain, impaired mobility, self care deficit

What are the first priority nursing problems with rheumatoid arthritis?

hip, knee, and shoulder

What are the most common areas of body dislocation?

dislocation deep vein thrombosis

What are the most common complications with hip fractures?

age, heredity, non modifiable, obesity, ⬇️ bone density

What are the risk factors for osteoarthritis?

apply antiembolism stockings

Which nursing action would help prevent deep vein thrombosis in a client who has had an orthopedic surgery? a. Apply cold packs b. Apply antiembolism stockings c. Instruct about exercise, as prescribed d. Instruct about using client-controlled analgesia, if prescribed

osteomalacia

a metabolic bone disease, is a softening of bones generally caused by vitamin D deficiency

osteoarthristis

chronic, is the most common form of arthritis It also is known as the "wear and tear" disease and typically affects the weight-bearing joints morning stiffness

gout

metabolic disorder, inflammation of the toes or joints urinate crystals is the major problem, sensitivity to touch

traction

method of pulling structures of the musculoskeletal system

open reduction internal fixation

stabilize the reduced fracture, the surgeon secures the bone with metal screws, plates, rods, nails, or pins

fibromyalgia symptoms

stiffness, unrefreshing sleep, tension HA, irritable bowel, q/ recurring diarrhea difficulty w/ concentration/related cognitive functions depression/mood disorders restless leg syndrome vaginal pain/dryness painful menstrual periods irritable bladder/urinary complaints

fever, wt loss, pain in joints, muscle pain, fatigue, butterfly rash, sensitivity to sunlight (called the great imitator because it resembles the flu)

symptoms of lupus

rheumatoid arthritis

systemic inflammatory auto immune disorder of the connective tissue, chronic

What is the client teaching for rheumatoid arthritis?

teach to use adaptive equipment functional positioning (putting it in the normal position you would place it in- open) immunizations must be current signs of infection must be reported stat

amputation

the removal of a limb may occur as a result of trauma (traumatic amputation) or in an effort to control disease or disability (therapeutic amputation)

pneumonia, skin breakdown, wound infection

A client has had surgical repair of a hip injury after joint manipulation was unsuccessful. After surgery, the nurse implements measure to prevent complications. Which complications is the nurse seeking to prevent?Selcet all that apply. a. diarrhea b. penumonia c. skin breakdown d. wound infection

hip, knee

A client with a lengthy history of degenerative joint disease is being seen by an orthopedic surgeon. What joints are most commonly replaced? Select all that apply. a. hip b. finger c. shoulder d. knee

systemic lupus erythematosus (SLE)

A nurse is providing care for a client who has a rheumatic disorder. The nurse's comprehensive assessment includes the client's mood, behavior, LOC, and neurologic status. What is this client's most likely diagnosis? a. osteoarthritis (OA) b. rheumatoid arthritis (RA) c. systemic lupus erhthematousus (SLE) d. gout

preserve of increase range of motion while minimizing exertion

A nurse's plan of care for a client with rheumatoid arthritis includes several exercise based interventions. What goal should the nurse prioritize? a. increase joint size and strength b. limit energy output in order to preserve strength for healing c. maximize range of motion while minimizing exertion d. preserve of increase range of motion while minimizing exertion

small frame and female sex

A nursing educator is reviewing the risk factors for osteoporosis with a group of recent graduates. What risk factor of the following should the educator describe? a. high alcohol intake and low body mass index b. male sex, diabetes, and hight protein intake c. small frame and female sex d. recurrent infections and prolonged use of NSAIDs

move the client up in bed or move the CPM machine down toward the foot of the bed

Client is placed on continuous passive motion (CPM) post operatively after a total knee replacement. The nurse observes that the client's knee is externally rotating during flexion. What should the nurse do next? 1. move the client up in bed or move the CPM machine down toward the foot of the bed 2. sport the client's knee with sandbags to prevent external rotation 3. assist the client to sit up in bed in a 45 degree position 4. Do nothing; the client's knee is properly aligned

use elevated seating/raise toilet seat do not cross your legs use ABD pillow between the leges while in bed

How would you as the nurse care for a client who has had a total hip replacement if you are preventing flexion at > 90 degrees. What are somethings you would do?

protect the affected leg from internal rotation

The nurse is caring for a client who underwent a total hip replacement yesterday. What should the nurse do to prevent dislocation of the new prosthesis? a. keep the hip flexed by placing pillows under the client's knee b. protect the affected leg from the internal rotation c. have the client reposition himself independently d. keep the affected leg in a position of adduction

Within 30 minutes, then every 1 to 2 hours

The nurse is helping to set up Buck's traction on an orthopedic client. How often should the nurse assess circulation to the affected leg? a. within 30 minutes, then every 4 hours b. within 30 minutes, then every shift c. within 30 minutes, then every 1 to 2 hours d. within 30 minutes, then every 8 hours

⬆️ Age ⬆️ female ⬆️ hx osteoporosis presence of chronic condition

What are the risk factors of hip fractures?

A- alcohol use C- corticosteroid use C- calcium low E- estrogen low S- smoking S- sedentary lifestyle

What are the risk factors that lead to osteoporosis?

external rotation leg shortening pain radiates from hip all the way down to the knee

What are the s/sx of a hip fracture?

high fever-chills rapid pulse tenderness, redness, swelling pain over affected extremity

What are the s/sx of osteomyelitis?

popping sound or joint suddenly gives out pain or muscle spasm numbness, tingling not symmetrical, limited ROM edema, cool to touch, pale or dusky color of distal tissue

What are the signs and symptoms of dislocation?

place a pillow between the client's legs when turning

What nursing intervention should the nurse prioritize to facilitate healing in a client who has suffered a hip fracture? a. administer analgesics as required b. place a pillow between the client's legs when turning c. maintain prone positioning at all times d. encourage internal and external rotation of the affected leg

shoulders, wrist, elbows, and hands

Where does rheumatoid arthritis happen?

wash hands prior to dressing changes wear sterile gloves to apply a new dressing

Which actions can the nurse take to help prevent osteomyelitis for a client with an open fracture? a. wash hands prior to dressing changes b. wear a protective gown c. wear a mask d. wear goggles e. wear sterile gloves to apply a new dressing

bone densitometry

A clinic nurse is caring for a client with a history of osteoporosis. What diagnostic test will bestallow the care team to assess the client's risk of fracture? a. Arthroscopy b. Arthrography c. Bone densitometry d. Bone scan

you will receive IV antibiotics for 3 to 6 weeks

A nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? a. use your continuous passive motion machine for 2 hours each day b. you need to perform weight bearing exercises twice a week c. you will receive IV antibiotics for 3 to 6 weeks d. you need to limit the amount of protein and calcium in your diet

capillary refill of more than 3 seconds

Which is an indicator of neurovascular compromise? a. warm skin temperature b. diminished pain c. capillary refill of more than 3 seconds d. pain upon active stretch

being male

Which is not a risk factor for osteoporosis? a. being post menopausal b. small framed, thin white or asian american c. family history d. being male

Pain, pulse, pallor, paresthesia, paralysis

What is the 5 P's ?

skeletal traction is interrupted to turn and reposition the client

Which is an inaccurate principle of traction? a. the client must be in a good alignment in the center of the bed b. the weight are not removed unless intermittent treatment treatment is prescribed c. skeletal traction is interrupted to turn and reposition the client d. the weights must hang freely

keep the client's hips in abduction at all times

A nurse is caring for a patient who is postoperative day 1 right hip replacement. How should the nurse position the patient? a. seat the client in a low chair as soon as possible b. keep the client's hips in abduction at all times c. keep hips flexed at no less than 90 degrees d. elevate the head of the bed to high fowler's

inflammation, edema, tenderness, muscle spasm

What are the s/sx of sprains and strains?

pin care for external fixation

Assess pin sites for redness, swelling, increased tenderness, and drainage. Examine pins for signs of breakage, bending, or shifting pin care is done daily during the first 48 to 72 hours, and then daily or weekly until pin sites are dry without crusting The client/family member should receive pin care instructions if the client is discharged home Using aseptic technique, the nurse or caretaker uses cotton-tipped applicators and sterile water, saline, or other prescribed solution such as chlorhexidine solution to cleanse pin sites Iodine-based products interfere with tissue healing and are not recommended for cleaning pin sites. Use at least one applicator per pin—do not use applicator more than once. Clean pin site from pin outward. Gently remove crusts around pin sites Cleanse the length of the pins from pin site to end of pin. Some clinical sites may recommend wrapping the pin with gauze for the first week to 10 days. Do not apply ointment to pin sites unless specifically ordered. Obtain culture if purulent drainage is present.

massage, yoga

What can you suggest as the nurse to help a patient with fibromyalgia?

contact the primary provider immediately

A client has had a cast placed for the treatment of a humeral fracture. The nurse's most recent assessment shows signs and symptoms of compartment syndrome. What is appropriate action? a. contact the primary provider immediately b. assess the client's joint function symmetrically c. perform active range of motion exercises d. arrange for a STAT assessment of the client's serum calcium levels

pain medication, corticosteroid therapy, probenecid

A client is admitted with an acute attack of gout. What interventions are essential for the client? Select all that apply. a. pain medication b. serum uric acid concentration c. dietary consult d. corticosteroid therapy e. probenecid

Apply ice packs for the first 24 to 48 hours, then apply heat packs

A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction? a."Apply heat packs for the first 24 to 48 hours." b. "Apply ice packs for the first 12 to 18 hours." c. "Apply heat packs for the first 24 hours, then apply ice packs for the next 48 hours." d. "Apply ice packs for the first 24 to 48 hours, then apply heat packs."

bursitis

A client tells the health care provider about shoulder pain that is present even without any strenuous movement. The health care provider identifies a sac filled synovial fluid. What condition will the nurse educate the client about? a. a fracture of the clavicle b. ankylsing spondylitis c. osteoarthritis of the shoulder d. bursitis

I should use my heating pad this evening to reduce some of the pain in my knee

A client undergoes an arthroscopy at the outpatient clinic. After the procedure, the nurse provides discharge teaching. Which responses by the client indicates the need for further teaching? a. elevating my leg will reduce swelling after the procedure b. my physician may prescribe pain pills after the procedure c. I may notice some bruising or swelling in my knee d. I should use my heating pad this evening to reduce some of the pain in my knee

increased uric acid levels

A clinic nurse is caring for a client with suspected gout. While explaining the pathophysiology of gout to the client, what should the nurse explain? a. autoimmune processes in the joints b. unstable serum calcium levels c. increased uric acid levels d. chronic metabolic acidosis

assess pain level monitor vital signs check pulses in surgical extremity set up continuous passive motion (CPM) machine

A nurse is caring for a client who is postoperative total knee arthroplasty. Which of the following are appropriate nursing actions? (Select all that apply) a. assess pain level b. monitor vital signs c. remove surgical drains d. apply heat to postoperative knee e. check pulses in surgical extremity f. set up continuous passive motion (CPM) machine

dull aching pain in affected joints

A nurse is caring for a client with osteoarthritis. The nurse collects data, knowing that which of the following is a clinical manifestation associated with the disorder? a. morning stiffness b. positive rheumatoid factor c. an elevated segmentation rate d. dull aching pain in affected joints

tricyclic antidepressants

The nurse is caring for a client who is being treated for fibromyalgia. What intervention will best assist the client to restore normal sleep patterns? a. range of motion exercises before sleeping b. administering opioids at bed time c. increasing activity during the day d. tricyclic antidepressants

x-ray, othroscopy, arthograph

What diagnostic tests are done for a patient with a dislocation?

slow and steady progression of destructive changes in weight-bearing joints and those that are repeatedly used for work

What is characterized by osteoarthritis?

pallor temperature pain movement sensation pulses capillary refill

What is involved in a neuromuscular assessment?

compartment syndrome

What is one of the most particular complication with a dislocation?

fracture

a break in the continuity of a bone. Fractures may affect tissues or organs near the bones as well

fibromyalgia

a chronic inflammatory illness consisting of musculoskeletal pain, fatigue, mood disorders, and sleep disturbances. The pain is widespread, affecting muscles, ligaments, and tendons.

osteomyelitis

infection of the bone caused by staph aureus, strep phyogenes

bursitis

inflammation of a bursa

sprain

injury to ligament surrounding the joint

strain

injury to the muscle

lyme disease

is caused by the host deer tick, spiracketal bacteria have red bites at bite site called bulls eye

open reduction fixation

is performed in the operating room, the bone is surgically exposed and realigned

benign bone tumor

over grown cluster of normal bone cells

increase fluid intake and perform prescribed foot exercises

A nurse is caring for a client who has suffered a hip fracture and who will require an extended hospital stay. The nurse should ensure that the client does what action to prevent common complications associated with a hip fracture? a. remain on bed rest for 14 days or until instructed by the orthopedic surgeon b. use supplementary oxygen when transferring or mobilizing c. increase fluid intake and perform prescribed foot exercises d. avoid requesting analgesia unless pain becomes unbearable

osteomyelitis

A nurse is caring for a client who is recovering in the hospital following orthopedic surgery. The nurse is performing frequent assessments for signs and symptoms of infection in the knowledge that the client faces a high risk of what infectious complication? a. septic arthritis b. osteomyelitis c. sepsis d. cellulitis

joint stiffness, especially in the morning

A nurse is performing the health history and physical assessment of a client who has a diagnosis of rheumatoid arthritis (RA). What assessment finding is most consistent with the clinical presentation of RA? a. visible atrophy of the knee and shoulder joints b. signs of systemic infection c. joint stiffness, especially in the morning d. cool joints with decreased range of motion

apply ice for 15 to 20 min alternating with 1 hr rest for the first 24 hr perform isometric exercises on the affected extremity monitor the incisions for infection

A nurse is preparing a client for an arthroscopy during which time a repair of the meniscus is planned. Which of the following should the nurse reinforce from the preoperative teaching?(select all that apply) a. apply ice for 15 to 20 min alternating with 1 hr rest for the first 24 hr b. keep the joint in a dependent position c. perform isometric exercises on the affected extremity d. expect the affected extremity to be placed in a case after the procedure e. monitor the incisions for infection

keep the cast and extremity elevated the cast needs to be kept clean and dry allow the wet cast 24 to 72 hours to dry

A nurse is preparing a list of cast instructions for a client who has just had a plaster cast applied to the right forearm. Select all instructions that the nurse includes on the list. 1. keep the cast and extremity elevated 2. the cast needs to be kept clean and dry 3. allow the wet cast 24 to 72 hours to dry 4. expect tingling and numbness in the extremity 5. use a hair dryer set on warm to hot setting to dry the cast 6. use a soft padded object that will first under the cast to scratch the skin under the cast

seafood

A nurse is teaching a client with gout about food items to eliminate from the diet. The nurse tells the client that which of the following purine rich food items should be limited? a. seafood b. plain yogurt c. cheddar cheese d. whole grain bread

T- temperature R- ropes hang freely A- alignment C- circulation check (5 P's) T- type and location of fracture I- increase fluid intake O- overheard trapeze N- no weights on bed or floor

What is the care of a client in traction?

electromyograph (EMG )

Which diagnostic test would the nurse expect to be ordered for a client with lower extremity muscle weakness? a. biopsy b. althocentesis c. bone scan d. electrograph (EMG)

it promotes healing by increasing circulation and movement of the knee joint

Which is a benefit of a continuous passive motion (CPM) device when applied after knee surgery? a. it promotes healing by immobilizing the knee joint b. it provides active range of motion c. it promotes healing by increasing circulation and movement of the knee joint d. it prevents infection and controls edema and bleeding

joint pain, swelling, warmth, anathema, mobility limitations, fever, malaise

s/sx of rheumatoid arthritis?

bending down to put on socks

A nurse is reviewing a patient's activities of daily living prior to discharge from total hip replacement. The nurse should identify what activity as posing a potential risk for hip dislocation? a. bending down to put on socks b. straining during a bowel movement c. transferring from a sitting to standing position d. lifting items above shoulder level

adduction

Which body movement involves moving toward the midline? a. abduction b. adduction c. eversion d. pronation