NU144- Chapter 42: Management of Patients With Musculoskeletal Trauma

A client comes to the emergency department complaining of localized pain and swelling of his lower leg. Ecchymotic areas are noted. History reveals that the client got hit in the leg with a baseball bat. Which of the following would the nurse suspect as most likely?

Contusion

Which term refers to a blunt force injury to soft tissue?

Contusion

A client is brought to the emergency department after being struck with a baseball bat on the upper arm while diving for a pitched ball. Diagnostic tests reveal that the humerus is not broken but that the client has suffered another type of injury. What type of injury would the physician likely diagnose?

contusion

Which is not one of the general nursing measures employed when caring for the client with a fracture?

cranial nerve assessment

nonunion

failure of fractured bones to heal together

phantom limb pain

pain perceived in an amputated section

subluxation

partial separation of joint surfaces

delayed union

prolongation of expected healing time for a fracture

A client has had surgical repair of a hip injury after joint manipulation was unsuccessful. After surgery, the nurse implements measures to prevent complications. Which complications is the nurse seeking to prevent? Select all that apply.

skin breakdown wound infection pneumonia

debridement

surgical removal of contaminated and devitalized tissues and foreign material

arthroscope

surgical scope injected into the joint to examine or repair

avascular necrosis (AVN)

death of tissue secondary to a decrease or lack of perfusion; also called osteonecrosis

amputation

removal of a body part, usually a limb or part of a limb

fracture reduction

restoration of fracture fragments into anatomic alignment

A client asks the nurse why his residual limb cannot be elevated on a pillow. What is the best response by the nurse?

"Elevating the leg might lead to a flexion contracture."

A client with a fractured femur is admitted to the nursing unit. Which assessment finding requires follow up by the nurse? Select all that apply.

"I cannot seem to catch my breath." "I have a pins-and-needles sensation in my toes." Dorsoplantar weak and unequal bilaterally T 101.2 degrees F; HR 110; RR 28; pulse oximetry 90%

A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in client cast care?

"Keep your right leg elevated above heart level."

Two days after surgery to amputate the left lower leg, a client reports pain in the missing extremity. Which action by the nurse is most appropriate?

Administer medication, as ordered, for the reported discomfort.

A client is hospitalized for open reduction of a fractured femur. During the postoperative assessment, the nurse notes that the client is restless and observes petechiae on the client's chest. Which nursing action is indicated first?

Administer oxygen.

A client had an above-the-knee amputation of the left leg related to complications from peripheral vascular disease. The nurse enters the client's room and observes the dressing and bed covers saturated with blood. What is the first action by the nurse?

Apply a tourniquet.

Emergency medical technicians transport a client to the emergency department and inform the nurse that the client fell from a two-story building. The comatose client has a large contusion on the left side of the chest, a hematoma in the left parietal area, and a compound fracture of the left femur. The client was intubated and is maintaining an arterial oxygen saturation of 92% by pulse oximeter with a manual-resuscitation bag. Which intervention by the nurse has the highest priority?

Assessing the left leg

A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. What will the nurse suspect?

Avascular necrosis

A client who has extremity right wrist fracture complains of severe burning pain, frequent changes in the skin from hot and dry to cold, and feeling clammy skin that is shiny and growing more hair in the injured extremity. The nurse should anticipate providing care for what complication?

Complex regional pain syndrome

An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this?

Comminuted

A nurse is caring for a client who has had an amputation. What interventions can the nurse provide to foster a positive self-image? (Select all that apply.)

Encouraging the client to care for the residual limb Allowing the client to express grief Introducing the client to local amputee support groups

Which term refers to a fracture in which one side of a bone is broken and the other side is bent?

Greenstick

The nurse is monitoring a patient who sustained a fracture of the left hip. The nurse should be aware that which kind of shock can be a complication of this type of injury?

Hypovolemic

The nurse is monitoring a patient who sustained an open fracture of the left hip. What type of shock should the nurse be aware can occur with this type of injury?

Hypovolemic

A patient has suffered a femoral shaft fracture in an industrial accident. What is an immediate nursing concern for this patient?

Hypovolemic shock

Radiographic evaluation of a client's fracture reveals that a bone fragment has been driven into another bone fragment. The nurse identifies this as which type of fracture?

Impacted

Which nursing diagnosis takes highest priority for a client with a compound fracture?

Infection related to effects of trauma

Which factor inhibits fracture healing?

Local malignancy

A client with a traumatic amputation of the right lower leg is refusing to look at the leg. Which action by the nurse is most appropriate?

Provide feedback on the client's strengths and available resources.

Which nursing intervention is essential in caring for a client with compartment syndrome?

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

A client sustains an injury to the ligaments surrounding a joint. What will the nurse identify this injury as?

Sprain

An adult is swinging a small child by the arms, and the child screams and grabs his left arm. It is determined in the emergency department that the radial head is partially dislocated. What is this partially dislocated radial head documented as?

Subluxation

fracture

a break in the continuity of a bone

crepitus

a grating sound or sensation made by rubbing bony fragments together

strain

a musculotendinous stress injury

PRICE

acronym for protection, rest, ice, compression, elevation

disarticulation

amputation through a joint

sprain

an injury to ligaments and muscles and other soft tissues at a joint

cryotherapy

application of cold compresses or packets

contusion

blunt force injury to soft tissue; bruise

dislocation

complete separation of joint surfaces

When the client who has experienced trauma to an extremity reports severe burning pain, vasomotor changes, and muscles spasms in the injured extremity, the nurse recognizes that the client is likely demonstrating signs of

complex regional pain syndrome.

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?

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

A client with a recent left above-the-knee amputation states, "I can feel pain in my left toes." Which is the best response by the nurse?

"Describe the pain and rate it on the pain scale."

malunion

healing of a fractured bone in a malaligned position

A client who has injured a hip in a fall cannot place weight on the leg and is in significant pain. After radiographs indicate intact yet malpositioned bones, what repair would the physician perform?

joint manipulation and immobilization

Which term refers to the failure of fragments of a fractured bone to heal together?

Nonunion

A client is being discharged from the Emergency Department after being diagnosed with a sprained ankle. Which client statement indicates the client understands the discharge teaching?

"I'll make sure to keep my ankle elevated as much as possible."

autograft

tissue harvested from one area of the body and used for transplantation to another area of the same body

While riding a bicycle on a narrow road, the patient was hit from behind and thrown into a ditch, sustaining a pelvic fracture. What complications does the nurse know to monitor for that are common to pelvic fractures?

Hemorrhage and shock

Which of the following describes failure of the ends of a fractured bone to unite in normal alignment?

Nonunion

Which may occur if a client experiences compartment syndrome in an upper extremity?

Volkmann's contracture

Colles fracture occurs in which area?

Distal radius

An older adult client slipped on an area rug at home and fractured the left hip. The client is unable to have surgery immediately and is having severe pain. What interventions should the nurse provide for the patient to minimize energy loss in response to pain?

Administer prescribed analgesics around-the-clock.

allograft

tissue harvested from a donor for use in another person

A client who was in a motor vehicle crash is diagnosed with a stable T7 spinal fracture with no neurologic deficits. Which nursing intervention should the nurse implement?

Maintain bed rest with the head of the bed at 20 degrees.

A client is brought to the emergency department after injuring the right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. What does this mean?

One side of the bone is broken and the other side is bent.