Musculoskeletal #2

Compartment Syndrome s/sx

-PAIN -Late: no pedal pulses, paralysis, pallor

A 2 year old is admitted for a repair of a fractured femur and is in Bryant's traction. Which finding indicated that the traction is working properly? A. The buttocks are 15 degrees off the bed B. The infant no longer complains of pain C. The legs are suspended in the traction D. The pins are secured within the pulley

A

A nurse is caring for a pt admitted with fractures to the pelvis, femur, and ulna. Which finding should be reported to the physician immediately? A. Hematuria B. Muscle spasms C. Dizziness D. Nausea

A

A nurse is caring for a child who has Legg-Calve-Perthes disease and is in Buck extension traction. Which of the following actions should the nurse take? A. Reposition the child every 2 hr. B. Remove the traction boot during baths. C. Apply antibiotic ointment to pin sites daily. D. Reduce fluid intake.

A The nurse should reposition the child should be repositioned every 2 hr to prevent skin breakdown.

Spiral Fracture

A ragged break occurs when excessive twisting forces are applied to a bone

A nurse in an urgent care center is caring for a client who experienced an ankle injury. Prior to examination by the provider, which of the following nursing actions should the nurse perform? (Select all that apply.) A. Apply ice to the affected area B. Encourage range of motion of the foot. C. Provide the client with a light snack. D. Apply a compression bandage. E. Elevate the foot.

A, D, E

Fat Embolism s/sx

ARDS, dyspnea, tachypnea, tachycardia, cyanosis, changes in LOC, petechiae on neck and chest wall, feeling of impending doom

Scoliosis

Abnormal lateral curvature of the spine often diagnoses in preadolescence/adolescence TSLO brace 25-40 degree curvature Spinal fusion 40-50 degree curvature >45 degrees = lung and heart affected

Myotonic Muscular Dystrophy

Affects skeletal & smooth muscles -GI & cardiac issues

Simple Fracture

An uncomplicated fracture in which the broken bones to not pierce the skin

Greenstick Fracture

Bending and incomplete break of a bone; most often seen in children

Compound Fracture

Bone breaks through the skin

A nurse is discussing the differences between skeletal and skin traction with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates understanding? A. "Skeletal traction has less risk for infection than skin traction." B. "Clients with skin traction have more mobility than those with skeletal traction." C. "Skeletal traction is more appropriate than skin traction for reducing a fracture." D. "Clients with skin traction have more discomfort than those with skeletal traction."

C

A nurse is prioritizing pt care. Which pt should be at greatest risk for fat emboli following a fracture? A. A 50 year old with a fractured fibula B. A 20 year old female with a wrist fracture C. A 21 year old male with a fractured femur D. A 8 year old with a fractured arm

C

A nurse working in a community health center is preparing a flow sheet detailing essential screenings according to age group. At which developmental stage on the chart should the nurse add scoliosis screening? A. Infant B. Toddler/Preschooler C. Pre-adolescent/adolescent D. Older adult

C

A pt arrives in the ER with a possible fractured femur. The nurse should anticipate an order for what intervention? A. Trendelenburg's position B. Ice to the entire extremity C. Buck's traction D. Abduction pillow

C

An RN is assessing a pt with a fractured left tibia and fibula. Which data should the nurse report to the physician immediately? A. Localized edema and decolorization B. Generalized weakness and increasing sensitivity to touch C. Cap refill of 9 seconds and increasing pain D. Pain relived after taking 4mg of hydromorphone

C

Elevated levels of calcium ion in the blood stimulates the secretion of which hormone? A. Growth Hormone B. Parathyroid Hormone C. Calcitonin D. Thyroxine

C

A nurse is assessing a client who has a puncture wound on his foot. Which of the following findings is a manifestation of acute osteomyelitis? A. Numbness of toes on the affected foot B. Hypothermia C. Localized erythema D. Bradycardia

C Swelling and localized erythema are manifestations of acute osteomyelitis.

A nurse is caring for a client who has a fractured tibia as a result of a fall. The client x-ray shows that the bone is splintered into several pieces around the shaft. The nurse should identify that the client has which of the following types of fractures? A. Impacted B. Transverse C. Comminuted D. Oblique

C With a comminuted fracture, the impact fragments the bone into several pieces.

Talipes Equinovarus

Clubfoot -Casting (changed every week) -External fixation -Surgery to lengthen tendons, ligaments

Volkman's Contracture

Complication of compartment syndrome -Lack of blood flow, nerve & muscle injury

Osteomyelitis requires _____________ for 4-6 weeks followed by ________________ for an additional 4-8 weeks

IV antibiotics, oral antibiotics

Sprain

Injury to a ligament

Open Reduction Internal Fixation of fracture

ORIF, surgical alignment of fractured bones using screws, pins, wires, or nails to maintain bone alignment.

Oblique Fracture

Occurs at an angle across the bone

Transverse Fracture

Occurs straight across the bone

Osteosarcoma s/sx

Pain, swelling, redness, limited ROM, & pathologic fractures

Developmental Hip Dysplasia Treatment

Pavlik Harness - removed only for bathing, skin checks

Osteosarcoma

Primary malignant tumor of long bone

Strains/Sprains Treatment

REST ICE - 24-48hrs, 20-30mins, warm after COMPRESSION - wrap in 30min increments ELEVATION - above heart

Dislocations and Subluxations Treatment

Reduction under anesthesia

External fixation of fracture

Used for unstable fractures. Monitor closely for compartment syndrome Pin care Assess site frequently for infection

Osteomyelitis Clinical Manifestations

-Acute *Signs and symptoms of infection, localized pain, edema, erythema, and drainage -Chronic *Fever may be low grade and occur in the afternoon or evening *Recurrent pain, inflammation, swelling

Hypovolemic Shock s/sx

-Decreased BP, increased HR -Pallor -Anxiety, restlessness may be first sign -Oliguria -Polydipsia

Teaching for cast care

-Do not get cast wet -Blow cool air for itching -Immediately report hot spots or drainage from cast (infection) -Keep elevated at heart level for the first 48-72hrs -Report strange odor, numbness, tingling, burning, stinging, or swelling below cast

A nurse is providing discharge teaching to a client who has a Plaster of Paris walking cast on his left lower leg. Which of the following instructions should the nurse include? A. Apply ice to your foot after walking. B. A musty odor is normal as the cast ages. C. There is no need to cover the cast when showering. D. Report any numbness or pain in your toes.

D The client should be taught to check circulation, mobility, and sensation (perform CMS checks) daily and to inform the provider of any coolness, pallor, immobility, or diminished sensation.

Strain

Excessive stretching beyond normal capacity of muscles or tendon 1st degree: mild, rest & ice 2nd: torn muscle, rest & ice 3rd: severely torn, surgery

Comminuted Fracture

Fracture in which the bone is splintered or crushed

Compartment Syndrome

Involves the compression of nerves and blood vessels due to swelling within the enclosed space created by the fascia that separates groups of muscles

Osteomyelitis

Severe infection of bone, marrow, & soft tissueOsteosarcoma

Duchene Muscular Dystrophy

Sex-linked (X-linked) recessive disorder characterized by progressive muscle wasting and weakness -Cardiac & respiratory compromise

Hypovolemic Shock

Shock caused by fluid or blood loss.

Is the following statement true or false? Treatment & nursing interventions for a pt with scoliosis is determined by the degree of curve of the spine.

True

Spica cast

Abduction of hips

A nurse is assessing an older adult client who has experienced some loss of bone density. The nurse observes a "hunchback" curvature of the client's spine. The nurse should expect the provider to document which of the following disorders? A. Ankylosis B. Lordosis C. Kyphosis D. Scoliosis

C Kyphosis, a forward, "hunchback" curvature of the spine, is an abnormal angulation of the posterior curve of the thoracic spine resulting from multiple compression fractures, usually a result of osteoporosis. It is most common in older adults and tends to increase with aging.

Dislocations and Subluxations Clinical Manifestations

Local pain, worse with movement, edema, deformity of joint, loss of function

Strains/Sprains Nursing Interventions

-Ergonomic principles -Appropriate physical conditioning -Routine stretching -Frequent position changes

Developmental Hip Dysplasia Clinical Manifestations

-Limited abduction of hip -Click or instability of joint -Asymmetric gluteal folds -Affected leg is shorter

Strains/Sprains s/sx

-Local pain, edema, bruising -Decrease in function & movement -Prolonged cap refill, cool temp, muscle spasm

Compartment Syndrome Nursing Interventions

-Notify physician IMMEDIATELY -Release constrictive wraps -Bivalve cast - with permission - Reduce traction weight - with permission -NO elevation or ice -Monitor urine output (dark, red, brown) -Fasciotomy may be needed

Dislocations and Subluxations Nursing Interventions

-Pain relief -Assess neurovascular status -Educate on activity limitations -Referral to rehab/PT per MD's orders

Skin Traction (Bryant's traction)

-Used for femur fractures in children <2 yrs & developmental dysplasia of hips -Check neurovascular status often -Assess skin often -Buttocks off bed

Skin traction (Buck's traction)

-Used for hip fractures. Helps guide the bone into place. -Less invasive, decreased risk for infection -Keep foot elevated, do not remove unless doing skin checks

The nurse is preparing discharge teaching for a 12 year old with a fractured humerus. Which of the following information should the nurse include regarding cast care? A. "Keep the arm at heart level" B. "Handle the cast with the tips of the fingers only" C. "Apply an ice pack to any area that itches" D. "Foul smells are expected occurrences"

A

A nurse is caring for a client who requires cold applications with an ice bag to reduce the swelling and pain of an ankle injury. Which of the following actions should the nurse take? A. Apply the bag for 30 min at a time. B. Reapply the bag 30 min after removing it. C. Allow room for some air inside the bag. D. Place the bag directly on the skin.

A The nurse should leave the bag in place for 30 min, but should check the client's skin after 15 min to make sure there are no adverse effects

A nurse is assisting with a routine physical examination of an adolescent. The provider observes a lateral curvature of the spine. The nurse should expect the provider to document which of the following disorders? A. Kyphosis B. Scoliosis C. Lordosis D. Torticollis

B Scoliosis is an abnormal lateral curvature of the spine that typically observed in children over the age of 10 years. Mild scoliosis usually has few consequences, but more severe curvature can restrict lung function.

A 73 year old pt fell in her home and suffered a right hip fracture. She tells the nurse that she was walking in the kitchen, she felt something "snap" and this made her fall. What type of fracture is the pt most likely to have? A. Communited B. Greenstick C. Open D. Pathologic

D

A nurse is assessing a newborn who has developmental dysplasia of the hip (DDH). Which of the following findings should the nurse expect? A. Absent plantar reflexes B. Lengthened thigh on the affected side C. Inwardly turned foot on the affected side D. Asymmetric thigh folds

D

A nurse is taking care of a pt with possible osteomyelitis. Th RN knows that the definitive diagnosis for the osteomyelitis is achieved through which of the following testing procedure? A. X-ray evaluation B. Bone scan C. Blood cultures D. Bone biopsy & culture

D

During the assessment of a client who has a cast on his right leg, a nurse locates an area on the cast that feels warm to the touch. Which of the following complications should the nurse suspect? A. Poor circulation B. Pressure from the cast C. Uneven cast drying D. Infection

D

A nurse is caring for a toddler who has a fractured right femur and is in Bryant traction. When determining that the traction is appropriately assembled, the nurse should observe which of the following? A. Skin straps maintain the leg in an extended position. B. Weights are attached to a pin that is inserted into the femur. C. A padded sling is under the knee of the affected leg. D. The buttocks is elevated slightly off of the bed.

D Having the buttocks elevated slightly off of the bed is appropriate for Bryant traction. The child's hips are flexed at a 90° angle with the legs suspended by pulleys and weights. The weights must hang freely from the bed to maintain alignment.

Dislocations and Subluxations

Injury to ligaments allows disruption to joint

Fat Embolism

-Usually occurs in the first 48hrs after long bone or pelvis fracture. (20-30 yrs of age) -Freely floating fat globule in the blood stream, which can obstruct blood circulation to vital organs (e.g., heart, brain). Usually caused by a bone fracture that allows fat release.

A nurse is caring for an adolescent client who has a newly applied fiberglass cast for a fractured tibia. Which of the following is the priority action for the nurse to take? A. Perform a neurovascular assessment B. Explain the discharge instructions to the client and parents C. Provide reassurance to the client and parents D. Apply an ice pack to the casted leg

A

A nurse assessing a client who has multiple fractures in his left leg notes increasing edema. The nurse should recognize this finding as an early manifestation of which of the following complications? A. Fat embolism syndrome B. Pulmonary embolism C. Osteomyelitis D. Acute compartment syndrome

D