musculoskeletal/ neuro

A mother of a 5-year-old child brings the child to the emergency department and tells the nurse that the child fell. A fracture is suspected and an x-ray is taken. The results indicate that the child has a comminuted fracture of the right humerus. The mother asks the nurse to describe this type of fracture, and the nurse draws a picture for the mother. Which picture identifies this type of a fracture? Refer to figure.

*2. 2*

The nurse is assisting a health care provider (HCP) examining a 3 week old infant with developmental dysphagia of the hip. What test or sign should the nurse expect the HCP to assess?

1) Babinski's sign 2) the Moro reflex 3) ortolani"s maneuver 4) the palmar-plantar grasp

A child with developmental dysplasia of the hip is placed in a Pavlik harness. The nurse should demonstrate to the parents how to place the child in this harness by placing the child's legs in which position? 1. Prone 2. Abduction 3. Adduction 4. Extension

2 The Pavlik harness consists of chest and shoulder straps and foot stirrups. The device, which is used to correct hip dislocations in infants with developmental dysplasia of the hip, consists of a set of straps that hold the hips in flexion and abduction. Therefore, the remaining options are incorrect positions.

An alert child, who is crying loudly, is brought to the hospital emergency department for a simple fracture to the lower right arm that occurred after a fall off a bicycle. What is the nurse's priority assessment? 1. Mobility 2. Skin integrity 3. Neurovascular 4. Level of consciousness

3 neurovascular A simple fracture is a fracture of the bone across its entire shaft with some possible displacement but without breaking the skin. The priority assessment is the neurovascular status in the affected arm. The affected arm should be immobilized. Skin integrity is a higher priority in a compound fracture since there is an open wound. The level of consciousness is already established, as the child is alert and crying.

A child is placed in skeletal traction for treatment of a fractured femur. The nurse develops a plan of care and includes which intervention? 1. Ensure that all ropes are outside the pulleys. 2. Ensure that the weights are resting lightly on the floor. 3. Restrict diversional and play activities until the child is out of traction. 4. Check the health care provider's (HCP's) prescriptions for the amount of weight to be applied.

4. Check the health care provider's (HCP's) prescriptions for the amount of weight to be applied

A child has a right femur fracture caused by a motor vehicle crash and is placed in skin traction temporarily until surgery can be performed. During assessment, the nurse notes that the dorsalis pedis pulse is absent on the right foot. Which action should the nurse take? 1. Administer an analgesic. 2. Release the skin traction. 3. Apply ice to the extremity. 4. Notify the health care provider (HCP).

4. Notify the health care provider (HCP). Rationale: An absent pulse to an extremity of the affected limb after a bone fracture could mean that the child is developing or experiencing compartment syndrome. This is an emergency situation, and the HCP should be notified immediately. Administering analgesics would not improve circulation. The skin traction should not be released without an HCP's prescription. Applying ice to an extremity with absent perfusion is incorrect. Ice may be prescribed when perfusion is adequate to decrease swelling.

A child who has undergone spinal fusion for scoliosis complains of abdominal discomfort and begins to have episodes of vomiting. On further assessment, the nurse notes abdominal distention. On the basis of these findings, the nurse should take which action? 1. Administer an antiemetic. 2. Increase the intravenous fluids. 3. Place the child in a Sims's position. 4. Notify the health care provider (HCP).

4. Notify the health care provider (HCP). Rationale: Scoliosis is a three-dimensional spinal deformity that usually involves lateral curvature, spinal rotation resulting in rib asymmetry, and hypokyphosis of the thorax. A complication after surgical treatment of scoliosis is superior mesenteric artery syndrome. This disorder is caused by mechanical changes in the position of the child's abdominal contents, resulting from lengthening of the child's body. The disorder results in a syndrome of emesis and abdominal distention similar to that which occurs with intestinal obstruction or paralytic ileus. Postoperative vomiting in children with body casts or children who have undergone spinal fusion warrants attention because of the possibility of superior mesenteric artery syndrome. Options 1, 2, and 3 are incorrect.

calcium normal value

8.2-10.2 mg/dl

CK3 (MM) isoenzyme normal value

96-100%

An infant is brought to the child care clinic for a follow up visit. The nurse notes that the infant is wearing this apparatus . The nurse documents that the infant is wearing which device?

A Pavlik harness

The nurse is assisting HCP during exam of a infant with developmental hip dysplasia. The HCP perform the ortolani maneuver. The nurse determined that the infant exhibits a positive response to this maneuver if what is noticed?

A palpable click during abduction of the affected hip

An adolescent is seen in the emergency department for a suspected sprain of the ankle . X-rays have been obtained and a fracture had been ruled out. Which instructions should the nurse provide to the adolescent regarding home care for treatment of the sprain?

Apply ice to the injured area for a period of 30 min every 4-6 hours for the first 24 to 48 hours

A child has returned from surgery and had a hip spica cast. What is the nurses priority action for this client?

Assess the circulatory status

The nurse is reviewing the health care record of an infant suspected of having unilateral hip dysplasia . Which assessment finding should the nurse expect to note documented in the infants record regarding this condition?

Asymmetry of the gluteal skin folds when the infant is placed prone and the legs are extended against the exam table

A child who sustained a fractured ankle has a short leg cast applied, and the nurse provides home care instructions to the mother. The mother returns to the emergency department 16 hours later because the child is complaining of severe pain. The nurse notes that the child's toes are cool, pale, and puffy and that the child is agitated and crying loudly. The mother states, "I gave her the pain medication you sent with us just like you told us, and I have kept her foot up on two pillows since we left, except when she gets up to go to the bathroom. I don't understand why she hurts so much. Do something!" What is the most likely clinical situation that occurred? 1. Compartment syndrome 2. Inadequate pain medication 3. Skin breakdown around the cast edges 4. Noncompliance with home care instructions

Compartment syndrome

The pediatric nurse educator provides a teaching session to the nursing staff regarding juvenile idiopathic arthritis (JiA) which action by a nursing staff member in the care of a child with JIA indicates a need for further education ?

Emphasize the importance of rising quickly in the mornings

The parents of a child with juvenile idiopathic arthritis call the clinic nurse because the child is experiencing a painful exacerbation of the disease . The parents ask the nurse if the child can perform ROM exercises at this time. The nurse should make which response?

Have the child perform simple isometric exercises during this time

The nurse provides instructions to the parents of an infant with hip dysplasia regarding care of the Pavlik harness. Which statement by one of the parents indicates an understanding of the use of the harness?

I can remove the harness to bathe my infant

A 4 year old child sustains a fall at home. After an X-ray exam, the child is determined to have a fractured arm and a plaster cast is applied. The nurse provides instructions to the parents regarding care for the child's cast. Which statement by the parents indicates a need for further instruction?

I can use lotion or powder a round the cast edges to relieve itching

The nurse is proving instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by a parent indicated a need for further teaching?

I need to apply lotion on skin under brace

Parents bring their 2 week old infant to a clinic for treatment after a diagnosis of clubfoot made at birth. Which statement by the parents indicated a need for further teaching regarding this disorder?

I need to bring my infant back to the clinic in 1 month for a new cast

The nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by the parents indicate a need for further instruction?

I should apply lotion under the brace to prevent skin breakdown

The nurse is reinforcing instructions to the mother of a child who had a plaster cast applied to left arm. Which statement by the mother indicated need for more teaching?

I will have to use a heat lamp to help the cast dry

The nurse is implementing a teaching plan for a 4 month old child who had been diagnosed with developmental dysplasia of the hip. The child will be placed in the Pavlik harness. Which statement by the family indicates that they understand the care of the child while placed in this harness?

I will watch for redness or skin irritation where the straps are applied and call the HCP for red areas

A child sustains a fall at home and is brought to the hospital emergency department by the child's mother. After a radiographic examination, the child is determined to have a fractured arm, and a plaster cast is applied. The nurse provides instructions to the mother regarding neurocirculatory assessment and function. Which statement by the mother indicates a need for further instruction? 1. "I'll need to check her skin twice a day at the cast edges." 2. "If her hand gets real cool and pale, I can apply the heating pad to it." 3. "For the first couple of days, I should try to keep her hand higher than her heart most of the time, using pillows." 4. "If she seems way too fussy and her arm is painful even after I've given her the pain medication, it might be a problem, and I should call you for help to decide on what is happening."

If her hand gets real cool and pale I can apply the heating pad to it

A neighborhood nurse is attending a soccer game at a local middle school. One of the students falls off the bleachers and sustains an injury to the left arm. The nurse quickly attends to the child and suspects that the child's arm may be broken. Which nursing action would be the priority before transferring the child to the hospital emergency department? 1. Immobilize the arm. 2. Ask for the name of the child's pediatrician or family health care provider so that he or she can be contacted. 3. Have someone call the radiology department of the local hospital to let staff know that the child will be arriving. 4. Tell the child that the arm probably is fractured but not to worry because permanent damage to the arm will not occur.

Immobilize the arm

The nurse prepared a list of home care instructions for the parents of a child who has a plaster cast applied to the left forearm . which instructions should be included on the list?

Keep small toys and sharp objects away from the cast Elevate the extremity on pillows for the first 24-48 hours after casting to prevent swelling Contact the HCP if the child complains if numbness or tingling in the extremity

A 1 month old infant is seen in a clinic and is diagnosed with developmental dysplasia of the hip. On assessment the nurse understands that which finding should be noted in this condition?

Limited range of motion in the affected hip

this diagnosis musculoskeletal problems, especially those involving soft tissue more accurate than a CT scan for diagnosing many problems of the vertebral column if the patient has had previous spinal surgery a contrast medium is used

MRI magnetic resonance imaging

The clinic nurse is assessing a child with suspected juvenile rheumatoid arthritis (jra) which assessment finding should the nurse expect to note in a child who has been diagnosed with JRA?

Morning stiffness Painful stuff and swollen joints Limited ROM history of late afternoon temperature

A child with cerebral palsy is in a management program to achieve maximum potential for locomotion, self care and socialization in school. The nurse works with the child to meet these goals by performing which action?

Placing the child on a wheeled scooter board

Russell's traction is prescribed for a child with lower leg fracture. The mother of the child asks the nurse about the purpose of traction. The nurse explains to the mother that which is the primary action of this type of traction?

Reduces or realigns fracture site

The nurse is caring for a child who fractured there ulna bone and has a cast applied 24 hours ago. The child tells the nurse that the arm feels like it is falling asleep. Which nursing action is appropriate ?

Report the findings to the HCP

very serious and potentially fatal condition associated with muscle destruction due to an injury such as crush syndrome, high fever, convulsions, or prolonged muscle compression. Creatine kinase (CK) levels can rise up to five times greater than normal

Rhabdomyolysis

A child is brought to the emergency department and X-ray shows fracture. The mother states that the child was rollerblading and broke his fall. A plaster of Paris cast is applied to the arm. Which instructions should the nurse provide to patient?

The cast will mold to body part Keep cast elevated on pillows for the first day Make sure that the child can frequently wiggle fingers The cast needs to be kept dry

The nurse has reinforced teaching for a school age child who was given a brace to wear for treatment of scoliosis. The nurse determined that the child needs further teaching with what statement t?

This brace will correct my curve

The pediatric unit is preparing for the admission of a child with a dislocated hip. The child will be placed in Bucks extension traction preoperative for short term immobilization. The nurse prepared to place the child in which type of traction setup?

Type of skin traction in which legs in an extended position

A 9-year-old child fractures the left tibia along an epiphyseal line while using a skateboard. What is the nurses priority concern during future growth?

Uneven leg growth

procedure in which synovial fluid is aspirated from the joint for analysis or to relieve pressure (improves pain and mobility) this fluid buildup can be secondary to an inflammation process like bursitis. analysis of this synovial fluid can help diagnose crystals, hemarthrosis, noninflammatory conditions, and septic arthritis.

arthrocentesis

procedure that allows the surgeon to directly visualize a joint the knee and the shoulder are the joints most often evaluated invasive procedure performed under local or light anesthesia the patient is treated as a surgical candidate in a same day surgery setting

arthroscopy

hemarthrosis

blood in a joint

this can be extracted for microscopic examination to confirm cancer, damage (muscle biopsy) infection (bone biopsy) or inflammation a sterile pressure dressing is applied because bone is highly vascular the nurse inspects the biopsy site for bleeding, swelling, and hematoma formation increased pain that is unresponsive to analgesic medication may indicate bleeding into the soft tissue vital signs and neurovascular assessments are monitored

bone and muscle biopsy

high calcium level can mean

bone cancer extended immobilization hypophosphatemia Paget disease

this test measures bone strength several types of these scans (DEXA) this test measures the spine, hip, and total body bone density other tests measure other body areas such as the heel, fingers, or wrist. DEXA is used to diagnose osteoporosis

bone density scan

A child must wear a brace for correction of scoliosis. The nurse creates a plan of care knowing the child is at risk for which problem?

breaks in skin integrity

bone disorders commonly cause changes in these lab values. they have a inverse relationship meaning when _________ increases , ____________ decreases and vice versa

calcium phosphorous

high creatine kinase value could mean

cellular destruction of cells that store CK intramuscular injections

scan that is helpful in diagnosing problems of the joints or vertebral column

computed tomography

CK3 (MM) isoenzyme levels being high could mean

conditions that cause cellular damage is present

The nurse is caring for a child with a fracture who is placed in skeletal traction. The nurse should monitor for which sign of a serious complication associated with this type of traction?

elevated temperature

the aging musculoskeletal system: muscle strength declines can potentially lead to

falls

the aging musculoskeletal system: bone calcium loss can lead to potential

fractures

high uric acid level means

gout

gout

hereditary metabolic disease that is a form of acute arthritis, characterized by excessive uric acid in the blood and around the joints

in this procedure the surgeon makes several small incisions and distends the joint with injected saline the scope is inserted and the joint is visualized from different angles the joint is moved through ROM so tears, defects, or other soft tissue damage can be assessed and or repaired through the scope using special instruments depending on the extent of the procedure a bulky or small dressing wrapped with an elastic bandage may be applied

how a arthroscopy works

using aseptic technique the HCP administers a local anesthesia a needle is used to aspirate the content of the joint space for analysis the fluid is sent to a lab if required the HCP can instill medications like corticosteroids , anti inflammatories, or antibiotics. this site is covered with a sterile dressing to prevent infection

how does a arthrocentesis procedure looks like

low calcium level can mean

hyperphosphatemia nutritional deficit osteomalacia

if a repair was done during a arthroscopy the patient is seen by the surgeon

in 1 week to check for complications and progress physical and occupational therapy may be ordered

thrombophlebitis

inflammation of a vein with clot formation

the aging musculoskeletal system: articular cartilage wears down leading to

joint stiffness joint pain

myoglobin normal value

male 28-72 ng/ml female 25-58 ng/ml

uric acid normal value

male 4-8 female 2.5-7 mean over 60 4.2-8.2 women over 60 3.5-7.3

Creatine Kinase (CK) normal value

male 50-204 units/L women 36-160 units/L

Alkaline Phosphatase (ALP) normal value

men- 35-142 units/L women- 25-125 units/L

myalgia

muscle pain

protein found in striated (skeletal and cardiac) muscle it is what causes the red color of muscle when skeletal muscle is damaged this lab value level rises in the blood

myoglobin

high alkaline phosphatase level can mean

pages disease metastatic bone cancer new bone formation

arthrocentesis relieves pressure that can improve

pain mobility

if the patient has muscle destruction look for elevated CK, myoglobin, and serum potassium levels observe for dark urine, muscle weakness, and myalgia to monitor for

rhabdomyolysis

when muscle tissue is damaged many muscle serum enzymes are released into the bloodstream including (4)

skeletal muscle creatine kinase (CK-MM [CK3]) aldolase (ALD) aspartate aminotransferase (AST) lactate dehydrogenase (LDH)

high myoglobin value could mean

skeletal muscle destruction

what does the nurse monitor for after a arthrocentesis

the injection site for : bruising bleeding redness warmth

after a arthroscopy what are signs to teach the patients that are not common to report to the surgeon

thrombophlebitis infection increased joint pain

this lab value is normally found in the blood when this level rises in the serum , a condition called gout occurs

uric acid

a mild analgesic usually relieves pain the pt resumes activities usually within 24-48 hours if a surgical repair was performed the patient may have activity restriction and need a stronger analgesic

what happens after a arthroscopy

phosphorus normal value

2.5-4.5

low phosphorus value can mean

hypercalcemia gout vit D deficiency

high phosphorus value can mean

hypocalcemia bone cancer

lab test where this enzyme increases when bone is damaged in metabolic bone diseases and bone cancer, this increases to reflect osteoblast (bone forming cell) activity

Alkaline phosphatase (ALP)

the goal of treatment for rhabdomyolysis is to

restore normal fluid and electrolyte balance