ortho quiz/Musculoskeletal

A nurse is caring for a client who has been scheduled for a bone scan. Which statement should the nurse include when educating the client about this diagnostic test?

"You will be encouraged to drink water after the administration of the radioisotope injection." -helps eliminate isotope

4 Post-op complications after joint replacements/repairs

-DVT (can lead to PE) -infection -dislocation of extremity or prothesis placed in joint -impaired skin integrity/skin breakdown (can develop pressure ulcers from lack of mvmt)

A client has just had an arthroscopy performed to assess a knee injury. What nursing intervention should the nurse perform following this procedure?

-Wrap the joint in a compression dressing -extend/elevate joint -apply ice/cold packs

Nursing considerations for bone densitometry

-allergies -assess limitations of patient such as inability to lay flat (pain/orthopnea) -assess for anxiety -assess pt's ROM (may need assistance positioning) -increased fluids prior to help disperse radioisotope med in body -void prior to imaging (clearer image of pelvic bones)

PE prevention

-anticoagulants -compression devices -ambulation -good pulmonary hygiene -smoking cessation -avoid crossing legs for extended amount of time -regular exercise -plenty of fluids

Priority nursing interventions for Buck's traction

-check for skin impairments -keep skin dry/clean -check for good circulation before application and while in utilization -eliminate any wrinkles or loose areas on device -edu pt on calling for assistance with positioning -check for nerve damage (have pt dorsiflex/plantar flex foot) -check pulses, cap refill, temperature of toes, and skin color to assess circulatory flow -assess for signs of DVT r/t decreased mobilization f/baseline

Client Hx obtained pre-op

-consent -allergy -code status -medical hx -surgical hx -toleration of anesthesia (as well as any possible fam hx of complication) -smoking or alcohol use -medications taking and when last taken (including vitamins and OTC) -when they last ate/drank

Indicators of peripheral neurovascular dysfunction

-cool, pale, cyanotic, or mottled skin -cap refill >3 sec -weakness or paralysis with motion -paresthesia -unrelenting pain, pain on passive stretch, or absence of feeling.

Musculoskeletal changes w/aging

-decreased strength -loss of height -loss of flexibility/decreased ROM -muscle atrophy -stiffness/changes in posture

Post-care instructions after cast application

-do not get cast wet (wrap in plastic) -do not self remove cast -do not cut/tear cast -do not stick items into cast to itch skin -cover rough edges with padding -exercise extremity as instructed -elevate extremity above heart to prevent edema -contact HCP if swelling, burning, stinging, severe pain, odor/discharge, or discoloration in skin occurs

Bone pain characteristics

-dull -deep -aching

PE manifestations

-dyspnea -chest pain -anxiety -tachycardia -cough -hemoptysis -syncope -diaphoresis -tachypnea

Vitamin D rich foods

-eggs -milk -cheese -salmon

Nursing care for external fixation device

-elevate extremity above heart -check circulation Q2-4Hr -monitor dressing/surgical site for bleeding Q2-4Hr -Check pin sites for infection Q8-12hr (essentially Qshift); warmth/drainage expected for first 72hrs post op -edu pt on site care and exercises

S/Sx of an infection

-fever -wound that isnt healing >2wks -burning urination -sore throat -rash -wheezing or persistent cough -vomit

fat embolism manifestations

-hypoxemia -neurological compromise -rash hypoxia -tachypnea -dyspnea -tachycardia -substernal chest pain -low-grade fever -crackles -restlessness -agitation -seizures

prevention of fat embolism

-immobilization of fractures -support fractured bones when repositioning -maintain fluid/lytes balances

Discharge teaching for Total knee replacement

-keep pressure off heel -use assistive devices to prevent injury (side rails, shower chair, cane/walker, non-slip mats) -put pants on standing up -take clothing off surgical side last -no sitting in same position for more than an hr -use firm chair to sit not too low to ground -use nonsurgical leg first on stairs -avoid straining or putting too much wt on surgical leg

Post-op hip precautions after repair to prevent dislocation or delay healing

-no adduction/internal rotation of hips -knees always below hips when sitting -HOB <60 degrees -No bending down/over to pick something up -do not cross legs or ankles -use raised toilet seat (prevents hips from bending >90deg)

What can cause compromised nerve function from cast application?

-not elevating for first 24-48hr above heart -cast being too tight and occluding circulation -edema -cast should be removed immediately to prevent tissue breakdown/necrosis/compartment syndrome

Surgical Pre-op nurse edu to pt

-npo -assistive devices poss used afterwards -how long procedure will take -poss wounds they will have and how to care for them -precautions taken to prevent blood clots after (blood thinners, SCDs, compression stockings, exercises/early ambulation) -side effects of blood thinners -completion of antibiotics if prescribed after -non-pharm interventions allowed (ice, pillows) -explain any drains that pt could have temporarily

Aside from poor body mechanics or injury, what are other causes of back pain?

-osteoarthritis -rheumatoid arthritis -bony spurs -primary tumors -obesity -stress -unequal leg length -kidney disease -pelvic problems -abdominal aneurysms

Nursing Interventions for Back Pain

-pain mgmt -improve mobility -improve good body mechanics -improve self esteem -weight reduction (if needed) -health promotions (walking, avoid heels, stretching, good posture)

Nonsurgical Management of Back Pain

-proper positioning/posture -change positions frequently -avoid twisting, bending, lifting, reaching -limit sitting to 20-50min (based on comfort) -apply ice/heat -weight control

Possible post-op meds after bone repair

-protonix -stool softeners -anticoagulant -fosamax -iron supplement -vit c -antibiotic -pain medication -antiemetics

Health promotions to help prevent falls in elderly

-remove loose rugs -proper fitting shoes -vit d and calcium increased -utilize assistive devices (walker, cane, shower grab bars, elevated toilet seats)

Medical Treatment for Back Pain

-rest -stress reduction -OTC analgesics -muscle relaxers -heat/ice -massage -spinal manipulation -acupuncture -yoga -PT/Exercise conditioning

Manifestations of Back Pain

-sciatica -abnormal gait -spinal immobility -loss of motor leg strength -loss of sensory perception

What are some conditions a pt can develop as a complications of an external fixation device?

-septic arthritis -osteomyelitis -allergic reaction (angioedema, anaphylactic shock)

Nursing responsibilities after cast application

-support extremity -wash skin/apply lotion -give pt exercises to do at home and explain to move extremity as tolerated -inspect skin for any impairments -check pulses -assess for any numbness/tingling sensation

Physical assessment of back

-symmetry -ROM -presence of deformity -equal limb length -gait pattern -motor and sensory flexion of LEs

Calcium rich foods

-yogurt -milk -oranges -cheese -beans -broccoli -kale -mozzarella

8 characteristics of pain

1. Location 2. Quality (what kind is it?) 3. Severity (on 10 point scale) 4. Aggravating factors 5. Relieving factors 6. History (when did it start and how did it progress?) 7. Context (under what circumstances does it occur?) 8. Accompanying symptoms

pulmonary embolism

A blood clot that breaks off from a large vein and travels to the blood vessels of the lung, causing obstruction of blood flow.

What type of splint is used to keep proper alignment and decrease the risk of dislocation in a hip repair?

Abductor splint -keeps pt from crossing legs/ankles

A client has symptoms of osteoporosis and is being assessed during an annual physical examination. The assessment shows that the client will require further testing related to a possible exacerbation of osteoporosis. The nurse should anticipate which diagnostic test?

Bone densitometry

ganglion

Collection of gelatinous material near tendon sheaths/joints -appear round, firm, cystic swelling, usually on inner wrist

A nurse is providing care for a client whose pattern of laboratory testing reveals long-standing hypocalcemia. Which other laboratory result is most consistent with this finding?

Elevated parathyroid hormone

carpal tunnel syndrome (CTS)

Entrapment neuropathy that occurs when median nerve at wrist is compressed.

Fat embolism

Freely floating fat globule in the blood stream, which can obstruct blood circulation to vital organs (e.g., heart, brain). -caused by injury to subcutaneous tissue or a bone fracture that allows fat release.

Tendonitis

Inflammation of muscle tendon sheath -common in shoulder and elbow

Bivalving a cast

Involves splitting the cast along both sides to allow space for swelling, facilitate taking x-rays or make a half cast for use as an intermittent splint.

A client has come to the clinic for a regular check-up. The nurse's initial inspection reveals an increased thoracic curvature of the client's spine. The nurse should document the presence of which condition?

Kyphosis

Calcitonin

Lowers blood calcium levels

Peroneal nerve

Nerve that runs down the back of the leg and branches out to the muscles of the foot. -assessment of this nerve is evaluated by pricking the skin centered between the great toe and second toe

Impingement Syndrome

Overuse (repetitive, overhead mvmt) or trauma to shoulder -inflamed/irritated rotator cuff -surgical repair indicated for stage 2-3 impingement

Open Reduction Internal Fixation (ORIF)

Surgical procedure involving the use of steel rods, plates, or screws to realign a severe bone fracture to normal position -internal fixation stay in place until there in solid bone development

What 2 vitamins help increase strength of bones?

Vit D and Calcium

What activity helps strengthen bones and help absorb calcium back into the bone?

Weight bearing exercises -walking -climbing stairs -jogging

Continuous passive motion device

a device that promotes range of motion, circulation, and healing by moving the joint of the pt w/o any effort from pt. -it also helps prevent scar tissue build up/formation -rate/extension/flexion prescribed by doctor -duration is usually 10-14days

Lordosis

abnormal increase in the forward curvature of the lumbar spine

Scoliosis

abnormal lateral curvature of the spine

The leading cause of musculoskeletal-related disability is

arthritis

Bone necrosis can occur if there is a decreased ______ supply.

blood

Parathyroid hormones help ______ absorption by maintaining the level of ______ in blood.

calcium calcium

Cervical and lumbar curves are

concave

thoracic and sacral curves are

convex

hemoptysis

coughing up blood

Epiphyses

ends of long bones that consist of compact bone externally and spongy bone internally

A client has sustained traumatic injuries that involve several bone fractures. A fracture of what type of bone may interfere with the protection of the client's vital organs?

flat bones -sternum is an example of

cortical bone

hard, dense, strong bone that forms the outer layer of bone; also called compact bone

Vit D function in bone

helps increase absorption of calcium

Fosamax

helps treat osteoporosis -reduces risk for fractures

Vit D deficiency can lead to

increased risk for fractures

Prior to surgery, a pt cannot exhibit any signs of an ______ 2-4wks prior to the procedure

infection

Bursitis

inflammation of a bursa - fluid fill sacs that prevent friction between joint structures

Buck's Traction

knee immobility -helps reduce muscle spasms and pain associated with a fracture -also used while plan of action is formed for repair of fracture

A nurse is caring for an older adult who has been diagnosed with geriatric failure to thrive. The nurse should perform interventions to prevent what complication?

muscle atrophy

Arthroplasty

partial or total replacement of a joint with a prosthesis -PT usually begins within 24hr of surgery

Why are antibiotics given prior to a surgery?

prophylactic precaution for infection -can also be given during procedure and continued afterwards dependent upon pt's ability to fight off infections

Dupuytren Disease

results in a slowly progressive contracture of the palmar fascia

Diaphysis of femur

shaft of femur -constructed of cortical bone

Fracture pain

sharp and piercing -relieved by immoblization

cancellous bone

spongy, porous, bone tissue in the inner part of a bone

Kyphosis

thoracic curvature of spine

Why are foley catheters and drains removed asap after a surgery?

to help reduce risk for infection

external fixation devices

used to manage open fractures with soft tissue damage provide support for complicated or comminuted fractures