PrepU CH 37: Management of Patients with Musculoskeletal Trauma

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? "CPM delivers analgesic agents directly into the joint." "CPM increases range of motion of the joint." "CPM prevents injury by limiting flexion of the knee." "CPM strengthens the muscles of the leg."

"CPM increases range of motion of the joint." Explanation: CPM increases circulation and range of motion of the knee joint. Chapter 37: Management of Patients with Musculoskeletal Trauma.

The nurse is admitting a client who is to undergo an open reduction with internal fixation for a fractured femur. About which comment by the client should the nurse be most concerned? "I was worried I would have an incision and scar." "The surgeon is planning to use a metal plate and screws to fix my hip." "The surgeon can see the bones when putting them in correct position." "A joint replacement or bone graft is not necessary."

"I was worried I would have an incision and scar." Explanation: An open reduction involves a surgical dissection for the visualization of the bone ends and fragments. A metal plate and screws are used to correct and stabilize the fracture through internal fixation. Chapter 37: Management of Patients with Musculoskeletal Trauma, Fractures, p. 1160.

An older adult patient had a hip replacement. When should the patient begin with assisted ambulation with a walker? 24 hours 2 to 3 weeks 1 week 72 hours

24 hours Explanation: Following hip arthroplasty (total hip replacement), patients begin ambulation with the assistance of a walker or crutches within a day after surgery. Chapter 37: Management of Patients with Musculoskeletal Trauma, Amputation, p. 1199.

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? Give pain medication to the client after providing care. Avoid administering too much medication because the client is older. Administer prescribed analgesics around-the-clock. Administer prescribed pain medication only when the client requests it.

Administer prescribed analgesics around-the-clock. Explanation: Pain associated with hip fracture is severe and must be carefully managed with around-the-clock dosing of pain medication to minimize energy loss in response to pain. The client may not request the medication even if they are in pain, and it should be offered at the prescribed time. Give pain medication prior to providing any type of care involved in moving the client. Chapter 37: Management of Patients with Musculoskeletal Trauma, Fractures of Specific Sites, p. 1187.

Which nursing intervention is appropriate for monitoring the client for the development of Volkmann's contracture? Assess the radial pulse. Assess for paresthesia in the toes. Assess capillary refill in the toes. Assess mobility of the shoulder.

Assess the radial pulse. Explanation: Volkmann's contracture is a type of acute compartment syndrome that occurs with a supracondylar fracture of the humerus. The nurse assesses neurovascular function of the hand and forearm. Chapter 37: Management of Patients with Musculoskeletal Trauma, Fractures of Specific Sites, p. 1180.

An important nursing assessment, post fracture, is to evaluate neurovascular status. Therefore, the nurse should check for: Capillary refill. Swelling and discoloration. Crepitus. Shortening and deformity.

Capillary refill. Explanation: Assessment for neurovascular impairment includes checking for weak pulses or delayed capillary refill (normal is <2 seconds). Chapter 37: Management of Patients with Musculoskeletal Trauma, Fracture Healing and Complications, p. 1163.

A client who has undergone a lower limb amputation is preparing to be discharged home. What outcome is necessary prior to discharge? Client can demonstrate safe use of assistive devices. Client has a healed, nontender, nonadherent scar. Client can perform activities of daily living independently. Client is free of pain.

Client can demonstrate safe use of assistive devices. Explanation: A client should be able to use assistive devices appropriately and safely prior to discharge. Scar formation will not be complete at the time of hospital discharge. It is anticipated that the client will require some assistance with ADLs postdischarge. Pain should be well managed, but may or may not be wholly absent. Chapter 37: Management of Patients with Musculoskeletal Trauma, Amputation, p. 1199.

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

Compartment syndrome. Explanation: Compartment syndrome refers to the compression of nerves, blood vessels, and muscle within a closed space. This leads to tissue death from lack of oxygenation. Chapter 37: Management of Patients with Musculoskeletal Trauma, Fracture Healing and Complications, p. 1162.

Which of the following is a term used to describe a soft tissue injury produced by a blunt force? Hematoma Contusion Strain Sprain

Contusion Explanation: A contusion is a soft tissue injury produced by blunt force, such as a blow, kick, or fall, that results in bleeding into soft tissues (ecchymosis, or bruising). A hematoma develops when the bleeding is sufficient to form an appreciable solid swelling. A strain, or a "pulled muscle," is an injury to a musculotendinous unit caused by overuse, overstretching, or excessive stress. A sprain is an injury to the ligaments and supporting muscle fibers that surround a joint often caused by a trauma, wrenching or twisting motion. Chapter 37: Management of Patients with Musculoskeletal Trauma, Contusions, Strains, and Sprains, p. 1153.

The nurse in an orthopedic clinic is caring for a new client. What sign or symptom would lead a nurse to suspect that a client has a rotator cuff tear? Pain worse in the morning Minimal pain with movement Ability to stretch arm over the head Difficulty lying on affected side

Difficulty lying on affected side Explanation: Clients with a rotator cuff tear experience pain with movement and limited mobility of the shoulder and arm. They especially have difficulty with activities that involve stretching their arm above their head. Many clients find that the pain is worse at night and that they are unable to sleep on the affected side. Chapter 37: Management of Patients with Musculoskeletal Trauma, Injuries to the Tendons, Ligaments, and Menisci, p. 1154.

Colles fracture occurs in which area? Humeral shaft Clavicle Distal radius Elbow

Distal radius Explanation: A Colles fracture is a fracture of the distal radius (wrist). It is usually the result of a fall on an open, dorsiflexed hand. Chapter 37: Management of Patients with Musculoskeletal Trauma, Radial and Ulnar Shafts, p. 1181.

Which nursing intervention is appropriate for a client with a closed-reduction extremity fracture? Administer prescribed enema to prevent constipation Encourage participation in ADLs Use frequent dependent positioning to prevent edema Promote intake of omega-3 fatty acids

Encourage participation in ADLs Explanation: General nursing measures for a client with a fracture reduction include administering analgesics, providing comfort measures, encouraging participation with ADLs, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing the client for self-care. Omega-3 fatty acids have no implications on the diet of a client with a fracture reduction. Dependent positioning may increase edema because the extremity is below the level of the heart. While some pain medications may contribute to constipation, this intervention would be reserved for a client experiencing constipation and not as a preventative measure. Chapter 37: Management of Patients with Musculoskeletal Trauma, Fractures, p. 1160.

After a car accident, a client is admitted to an acute care facility with multiple traumatic injuries, including a fractured pelvis. For 24 to 48 hours after the accident, the nurse must monitor the client closely for which potential complication of a fractured pelvis? Volkmann's ischemic contracture Compartment syndrome Infection Fat embolism

Fat embolism Explanation: Fat embolism is a relatively rare but life-threatening complication of pelvis and long-bone fractures, arising 24 to 48 hours after the injury. It occurs when fat droplets released at the fracture site enter the circulation, become lodged in pulmonary capillaries, and break down into fatty acids. Because these acids are toxic to the lung parenchyma, capillary endothelium, and surfactant, the client may develop pulmonary hypertension. Signs and symptoms of fat embolism include an altered mental status, fever, tachypnea, tachycardia, hypoxemia, and petechiae. Compartment syndrome and infection may complicate any fracture and aren't specific to a pelvis fracture. Volkmann's ischemic contracture is a potential complication of a hand or forearm fracture. Chapter 37: Management of Patients with Musculoskeletal Trauma, Fractures, p. 1162.

Which term refers to a break in the continuity of a bone? Dislocation Subluxation Fracture Malunion

Fracture Explanation: A fracture is a break in the continuity of the bone. A malunion occurs when a fractured bone heals in a misaligned position. Dislocation is a separation of joint surfaces. A subluxation is a partial separation or dislocation of joint surfaces. Chapter 37: Management of Patients with Musculoskeletal Trauma, Fractures, p. 1157.

A client has just undergone a leg amputation. What will the nurse closely monitor the client for during the immediate postoperative period? Unexplainable burning pain (causalgia) Neuroma Hematoma Chronic osteomyelitis

Hematoma Explanation: Hematoma, hemorrhage, and infection are potential complications in the immediate postoperative period. Sleeplessness, nausea, and vomiting may occur but are adverse reactions, not complications. Chronic osteomyelitis and causalgia are potential complications that are likely to arise in the late postoperative period. A neuroma occurs when the cut ends of the nerves become entangled in the healing scar. This would occur later in the postoperative course. Chapter 37: Management of Patients with Musculoskeletal Trauma, Amputation, p. 1197.

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 Cardiogenic Septic Neurogenic

Hypovolemic Explanation: In a client with a pelvic fracture, the nurse should be aware of the potential for hypovolemic shock resulting from hemorrhage. Cardiogenic shock, in which the heart cannot pump enough blood to meet the body's needs, often arises from severe myocardial infarction. Neurogenic shock is often a consequence of spinal cord injury and resulting loss of sympathetic nervous system function. Septic shock results from body-wide infection. Chapter 37: Management of Patients with Musculoskeletal Trauma, Fracture Healing and Complications, p. 1162.

A patient has suffered a femoral shaft fracture in an industrial accident. What is an immediate nursing concern for this patient? Knee and hip dislocation Infection Pain resulting from muscle spasm Hypovolemic shock

Hypovolemic shock Explanation: Frequently, the patient develops shock, because the loss of 1,000 mL of blood into the tissues is common with fractures of the femoral shaft. Chapter 37: Management of Patients with Musculoskeletal Trauma, Fractures, p. 1162.

The nurse is caring for a client with a spica cast. What is the nurse's priority intervention? Promote elimination with a regular bedpan. Keep the cast clean and dry. Position the client on the affected side. Keep the legs in abduction.

Keep the cast clean and dry. Explanation: Keeping the cast clean and dry around the perineal opening is a priority. A spica cast has a built-in abduction bar. The client should be positioned on the unaffected side every 2 hours and prone twice a day. A fracture bedpan is easier to use for the client with a spica cast. Chapter 37: Management of Patients with Musculoskeletal Trauma, The Patient with a Cast, Splint, or Brace, p. 1171.

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 NPO (nothing by mouth) status for surgical repair. Sit the client upright in a padded chair for meals. Maintain bed rest with the head of the bed at 20 degrees. Withhold opioid pain medication to prevent ileus.

Maintain bed rest with the head of the bed at 20 degrees. Explanation: The client should maintain limited bed rest with the head of the bed lower than 30 degrees. If the client's pain is not controlled with a lower form of pain medication, then an opioid may be used to treat the pain. The nurse should monitor for an ileus. Stable spinal fractures are treated conservatively and not with surgical repair. The client should avoid sitting until the pain eases. Chapter 37: Management of Patients with Musculoskeletal Trauma, Clinical Manifestations, p. 1162.

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? Sepsis Septic arthritis Cellulitis Osteomyelitis

Osteomyelitis Explanation: Infection is a risk after any surgery, but it is of particular concern for the postoperative orthopedic client because of the risk of osteomyelitis. Orthopedic clients do not have an exaggerated risk of cellulitis, sepsis, or septic arthritis when compared to other surgical clients. Chapter 37: Management of Patients with Musculoskeletal Trauma, Fractures, p. 1160.

An elderly client's hip joint is immobilized prior to surgery to correct a femoral head fracture. What is the nurse's priority assessment? The presence of internal or external rotation Signs of neurovascular compromise The client's complaints of pain The presence of leg shortening

Signs of neurovascular compromise Explanation: Because impaired circulation can cause permanent damage, neurovascular assessment of the affected leg is always a priority assessment. Leg shortening and internal or external rotation are common findings with a fractured hip. Pain, especially on movement, is also common after a hip fracture. Chapter 37: Management of Patients with Musculoskeletal Trauma, Fractures of Specific Sites, p. 1186.

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

Sprain Explanation: A sprain is an injury to the ligaments surrounding a joint. A strain is an injury to a muscle when it is stretched or pulled beyond its capacity. A contusion is a soft tissue injury resulting from a blow or blunt trauma. A fracture is a break in the continuity of a bone. Chapter 37: Management of Patients with Musculoskeletal Trauma, Contusions, Strains, and Sprains, p. 1153.

Six weeks after an above-the-knee amputation (AKA), a client returns to the outpatient office for a routine postoperative checkup. During the nurse's assessment, the client reports symptoms of phantom pain. What should the nurse tell the client to do to reduce the discomfort of the phantom pain? Elevate the level of the amputation site. Apply intermittent hot compresses to the area of the amputation. Avoid activity until the pain subsides. Take opioid analgesics as prescribed.

Take opioid analgesics as prescribed. Explanation: Opioid analgesics may be effective in relieving phantom pain. Heat, immobility, and elevation are not noted to relieve this form of pain. Chapter 37: Management of Patients with Musculoskeletal Trauma, Amputation, p. 1197.

A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's care plan? Remove the traction at least every 8 hours. Teach the client how to prevent problems caused by immobility. Apply the traction straps snugly. Assess the client's level of consciousness.

Teach the client how to prevent problems caused by immobility. Explanation: By teaching the client about prevention measures, the nurse can help prevent problems caused by immobility, such as hypostatic pneumonia, muscle contracture, and atrophy. The nurse applies traction straps for skin traction — not skeletal traction. For a client in skeletal traction, the nurse should assess the affected limb, rather than assess the level of consciousness. Removing skeletal traction is the physician's responsibility — not the nurse's. Chapter 37: Management of Patients with Musculoskeletal Trauma, The Patient in Traction, p. 1176.

A nurse is caring for a client in skin traction. In order to prevent bony fragments from moving against one another, the nurse should caution the client against performing what action? Coughing without splinting Turning from side to side Shifting one's weight in bed Bearing down while having a bowel movement

Turning from side to side Explanation: To prevent bony fragments from moving against one another, the client should not turn from side to side; however, the client may shift position slightly with assistance. Bearing down and coughing do not pose a threat to bone union. Chapter 37: Management of Patients with Musculoskeletal Trauma, The Patient in Traction, p. 1175.

Which may occur if a client experiences compartment syndrome in an upper extremity? Callus Volkmann's contracture Subluxation Whiplash injury

Volkmann's contracture Explanation: If compartment syndrome occurs in an upper extremity, it may lead to Volkmann's contracture, a claw-like deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. A whiplash injury is a cervical spine sprain. Callus refers to the healing mass that occurs with true bone formation after a fracture. Subluxation refers to a partial dislocation. Chapter 37: Management of Patients with Musculoskeletal Trauma, Nursing Management of the Patient with an Immobilized Upper Extremity, p. 1171.

The nurse is checking the traction apparatus for a client in skin traction. Which finding would require the nurse to intervene? Body aligned opposite to line of traction pull Ropes freely moving over pulleys Weights hanging and touching the floor Pulleys without evidence of the obstruction

Weights hanging and touching the floor Explanation: When checking traction equipment, the weights should be freely hanging. Weights that touch the floor require the nurse to intervene. The body should be aligned in an opposite line to the pull of the traction. The ropes should be freely moving over unobstructed pulleys. Chapter 37: Management of Patients with Musculoskeletal Trauma, The Patient in Traction, p. 1175.

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? Within 30 minutes, then every 4 hours Within 30 minutes, then every shift Within 30 minutes, then every 1 to 2 hours Within 30 minutes, then every 8 hours

Within 30 minutes, then every 1 to 2 hours Explanation: After skin traction is applied, the nurse assesses circulation of the foot or hand within 15 to 30 minutes and then every 1 to 2 hours. Chapter 37: Management of Patients with Musculoskeletal Trauma, The Patient in Traction, p. 1175.

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? subluxation contusion sprain strain

contusion Explanation: A contusion is a soft tissue injury resulting from a blow or blunt trauma. Sprains are injuries to the ligaments surrounding a joint. A strain is an injury to a muscle when it is stretched or pulled beyond its capacity. A subluxation is a partial dislocation. Chapter 37: Management of Patients with Musculoskeletal Trauma, Contusions, Strains, and Sprains, p. 1153.

Which is not one of the general nursing measures employed when caring for the client with a fracture? assisting with ADLs providing comfort measures cranial nerve assessment administering analgesics

cranial nerve assessment Explanation: Cranial nerve assessment would only be carried out for head-related injuries or diseases. General nursing measures include administering analgesics, providing comfort measures, assisting with ADLs, preventing constipation, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing client for self-care. Chapter 37: Management of Patients with Musculoskeletal Trauma.

Which of the following disorders results in widespread hemorrhage andmicrothrombosis with ischemia? Disseminated intravascular coagulation (DIC) Avascular necrosis (AVN) Complex regional pain syndrome (CRPS) Fat embolism syndrome (FES)

Disseminated intravascular coagulation (DIC) Explanation: DIC is a systemic disorder that results in widespread hemorrhage and microthrombosis with ischemia. AVN of the bone occurs when the bone loses its blood supply and dies. CRPS is a painful sympathetic nervous system problem. FES occurs when the fat globules released when the bone is fractured occludes the small blood vessels that supply the lungs, brain, kidneys, and other organs. Chapter 37: Management of Patients with Musculoskeletal Trauma, Fracture Healing and Complications, p. 1164.

A client who is undergoing skeletal traction reports pressure on bony areas. Which action would be most appropriate to provide comfort for the client? Administering prescribed analgesics. Assisting with range-of-motion and isometric exercises. Applying warm compresses. Changing the client's position within prescribed limits.

Changing the client's position within prescribed limits. Explanation: Changing the position of a client within prescribed limits helps relieve pressure on bony areas and promotes comfort. Analgesics help to relive pain but may not help relieve pressure on bony areas. Warm compresses aid blood circulation. The client should not exercise while on traction unless prescribed to regain strength in the affected limb. Chapter 37: Management of Patients with Musculoskeletal Trauma, The Patient in Traction, p. 1176.

The nurse is caring for a client who sustained rib fractures in an automobile accident. What symptoms does the nurse recognize as a complication of rib fractures and should immediately be reported to the physician? Blood pressure of 140/90 mm Hg Heart rate of 94 beats/minute Crackles in the lung bases Client complains of pain in the affected rib area when taking a deep breath

Crackles in the lung bases Explanation: Crackles in the lung bases can be an indicator that the client has developed pneumonia from shallow respirations. The blood pressure is high but may be due to pain. It is expected that the client will have pain in the rib area when taking deep breaths. A heart rate of 94 beats/minute is within normal range. Chapter 37: Management of Patients with Musculoskeletal Trauma, Fracture Healing and Complications, p. 1162.

Which of the following would lead a nurse to suspect that a client has a rotator cuff tear? Increased ability to stretch arm over the head Pain worse in the morning Minimal pain with movement Difficulty lying on affected side

Difficulty lying on affected side Explanation: Clients with a rotator cuff tear experience pain with movement and limited mobility of the shoulder and arm. They especially have difficulty with activities that involve stretching their arm above their head. Many clients find that the pain is worse at night and that they are unable to sleep on the affected side. Chapter 37: Management of Patients with Musculoskeletal Trauma, Injuries to the Tendons, Ligaments, and Menisci, p. 1154.

The client with a fractured left humerus reports dyspnea and chest pain. Pulse oximetry is 88%. Temperature is 100.2 degrees Fahrenheit (38.5 degrees Centigrade); heart rate is 110 beats per minute; respiratory rate is 32 breaths per minute. The nurse suspects the client is experiencing: Fat embolism syndrome Complex regional pain syndrome Compartment syndrome Delayed union

Fat embolism syndrome Explanation: The clinical manifestations described in the scenario are characteristic of fat embolism syndrome. Chapter 37: Management of Patients with Musculoskeletal Trauma, Fracture Healing and Complications, p. 1162.

A patient sustains an open fracture with extensive soft tissue damage. The nurse determines that this fracture would be classified as what grade? II I III IV

III Explanation: Open fractures are graded according to the following criteria (Schaller, 2012): Grade I is a clean wound less than 1 cm long. Grade II is a larger wound without extensive soft tissue damage or avulsions. Grade III is highly contaminated and has extensive soft tissue damage. It may be accompanied by traumatic amputation and is the most severe. Chapter 37: Management of Patients with Musculoskeletal Trauma, Fractures, p. 1159.

The nurse assesses a client after total right hip arthroplasty and observes a shortening of the extremity. The client reports severe pain in the right side of the groin. What is the priority action of the nurse? Externally rotate the extremity. Apply Buck's traction. Bend the knee and rotate the knee internally. Notify the health care provider.

Notify the health care provider. Explanation: If any clinical manifestations of dislocation of the prosthesis occur, including acute groin pain in the affected hip or shortening of the affected extremity, the nurse (or the client, if at home) must immediately notify the surgeon, because the hip must be reduced and stabilized promptly so that the leg does not sustain circulatory and nerve damage. After closed reduction, the hip may be stabilized with Buck's traction or a brace to prevent recurrent dislocation. As the muscles and joint capsule heal, the chance of dislocation diminishes. Stresses to the new hip joint should be avoided for the first 8 to 12 weeks, when the risk of dislocation is greatest. Chapter 37: Management of Patients with Musculoskeletal Trauma, Fractures of Specific Sites, p. 1185.

A client arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the client to describe the pain? Sore and aching A dull, deep, boring ache Sharp and piercing Similar to "muscle cramps"

Sharp and piercing Explanation: The nurse must carefully evaluate pain associated with the musculoskeletal condition, asking the client to indicate the exact site and to describe the character and intensity of the pain using a pain rating scale. Most pain can be relieved by elevating the involved part, applying ice or cold packs, and administering analgesic agents as prescribed. Pain associated with the underlying condition (e.g., fracture, which is sharp and piercing) is frequently controlled by immobilization. Pain due to edema that is associated with trauma, surgery, or bleeding into the tissues can frequently be controlled by elevation and, if prescribed, intermittent application of ice or cold packs. Ice bags (one third to one half full) or cold application devices are placed on each side of the cast, if prescribed, making sure not to indent or wet the cast. Unrelieved or disproportionate pain may indicate complications. Pain associated with compartment syndrome is relentless and is not controlled by modalities such as elevation, application of ice or cold, and usual dosages of analgesic agents. Severe burning pain over bony prominences, especially the heels, anterior ankles, and elbows, warns of an impending pressure ulcer. This may also occur from too-tight elastic wraps used to hold splints in place. Chapter 37: Management of Patients with Musculoskeletal Trauma, Fractures, p. 1159.

A client in the emergency department is being treated for a wrist fracture. The client asks why a splint is being applied instead of a cast. What is the best response by the nurse? "You would have to stay here much longer because it takes a cast longer to dry." "Not all fractures require a cast." "It is best if an orthopedic doctor applies the cast." "A splint is applied when more swelling is expected at the site of injury."

"A splint is applied when more swelling is expected at the site of injury." Explanation: Splints are noncircumferential and will not compromise circulation when swelling is expected. A splint is applied to support and immobilize the injured joint. A fracture will swell as part of the inflammation process. The client would not have to stay longer if a fiberglass cast is applied. Fiberglass cast dry in approximately 30 minutes. An orthopedic doctor is not needed to apply the cast. Many nurses and technicians are trained in proper application of a cast. Some fractures may not be treated with a cast but it would not be appropriate to answer with this response because it does not reflect the actual reason for a splint being applied. Chapter 37: Management of Patients with Musculoskeletal Trauma, Delayed Complications, p. 1166.

The client displays manifestations of compartment syndrome. What treatment will the nurse expect the client to be scheduled for? A total knee replacement A total hip replacement An open reduction A fasciotomy

A fasciotomy Explanation: A treatment option for compartment syndrome is fasciotomy. Chapter 37: Management of Patients with Musculoskeletal Trauma, Fracture Healing and Complications, p. 1163.

The nurse is caring for a 24-year-old female client with a right tibial fracture treated with a cast 2 hours ago. The client now reports unrelenting pain, rated as 7/10, despite taking oxycodone, and decreased sensation in the right foot. A nursing assessment reveals the right foot is cooler and paler than the left foot, with delayed capillary refill and a weak pulse. >Complete the following sentence by choosing from the lists of options. "Based on the nursing assessment, the priority action the nurse should take is to": Select... notify the orthopedic health care provider immediately administer pain medication and assess pain level in 30 minutes elevate the right leg "and prepare the client for" Select... discharge home fasciotomy bivalving of the cast

Based on the nursing assessment, the priority action the nurse should take is to: notify the orthopedic health care provider immediately and prepare the client for: bivalving of the cast Explanation: A client in a cast is at risk for compartment syndrome, a sudden and severe buildup of pressure in an enclosed space, that can lead to tissue ischemia and loss of limb, if not promptly treated. Clinical manifestations of compartment syndrome include loss of sensation, pale and cool skin, delayed capillary refill, weak pulses, and paresthesia in the affected limb as well as pain that is unrelieved by position change, ice, or increasing doses of analgesia. Because of the risk for permanent neurovascular impairment, the nurse needs to notify the health care provider immediately so that measures can be taken to relieve pressure within the cast. To relieve pressure within the confined right lower leg, the nurse should anticipate that the cast will need to be bivalved (cut in half longitudinally). If compartment syndrome is suspected, the nurse should not delay measures to relieve pressure within the confined space of the cast by administering an analgesic and waiting 30 minutes to determine the outcome. The nurse may elevate the right leg to reduce swelling, but it is not the priority action. The nurse should not prepare the client for discharge until after pressure has been relieved from the right lower leg. If pressure is not relieved through bivalving the cast, a fasciotomy may be needed to relieve pressure within the muscle compartment. Chapter 37: Management of Patients with Musculoskeletal Trauma, Acute Compartment Syndrome, p. 1169.

A client sustains a fractured right humerus in an automobile accident. The arm is edematous, the client states not being able to move or feel the fingers, and the nurse does not feel a pulse. What condition should the nurse be concerned about that requires emergency measures? Compartment syndrome Subluxation Dislocation Muscle spasms

Compartment syndrome Explanation: Separation of adjacent bones from their articulating joint interferes with normal use and produces a distorted appearance. The injury may disrupt local blood supply to structures such as the joint cartilage, causing degeneration, chronic pain, and restricted movement. Compartment syndrome is a condition in which a structure such as a tendon or nerve is constricted in a confined space. The fractured humerus may also be dislocated but is not the result of the impaired circulatory status. Muscle spasms may occur around the fracture site but are not the cause of circulatory impairment. Subluxation is a partial dislocation. Chapter 37: Management of Patients with Musculoskeletal Trauma, Fracture Healing and Complications, p. 1162.

In a client with a dislocation, the nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable. Which complication does the assessments help the nurse to monitor in the client? Compartment syndrome Fat embolism syndrome Disseminated intravascular coagulation Carpal tunnel syndrome

Compartment syndrome Explanation: The nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable in a client with a dislocation to assess for compartment syndrome. It is a complication associated with dislocation. A client with a dislocation does not experience an increased risk of complications such as disseminated intravascular coagulation, carpal tunnel syndrome, or fat embolism syndrome. Chapter 37: Management of Patients with Musculoskeletal Trauma, Contusions, Strains, and Sprains, p. 1154.

A client with a fractured distal left radius reports discomfort at the cast site, with pain specifically in the upper forearm. What would the nurse expect the physician to do? Apply a fiberglass cast. Remove the cast. Cut a cast window. Initiate physical therapy.

Cut a cast window. Explanation: After the cast dries, a cast window, or opening, may be cut. This usually is done when the client reports discomfort under the cast or has a wound that requires a dressing change. The window permits direct inspection of the skin, a means to check the pulse in a casted arm or leg, or a way to change a dressing. Chapter 37: Management of Patients with Musculoskeletal Trauma, The Patient with a Cast, Splint, or Brace, pp. 1166-1168.

The client who had a total hip replacement was discharged home and developed acute groin pain in the affected leg, shortening of the leg, and limited movement of the fractured leg. The nurse interprets these findings as indicating which complication? Dislocation of the hip Contracture of the hip Avascular necrosis of the hip Re-fracture of the hip

Dislocation of the hip Explanation: Manifestations of a dislocated hip prosthesis are increased pain at the surgical site, acute groin pain in the affected leg, shortening of the leg, abnormal external or internal rotation, and limited movement of the fractured leg. The client may report a "popping" sensation in the hip. Chapter 37: Management of Patients with Musculoskeletal Trauma, Fractures of Specific Sites, p. 1191.

A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan? Maintaining the client on complete bed rest Applying heat to the stump as the client desires Elevating the stump for the first 24 hours Removing the pressure dressing after the first 8 hours

Elevating the stump for the first 24 hours Explanation: Stump elevation for the first 24 hours after surgery helps reduce edema and pain by increasing venous return and decreasing venous pooling at the distal portion of the extremity. Bed rest isn't indicated and could predispose the client to complications of immobility. Heat application would be inappropriate because it promotes vasodilation, which may cause hemorrhage and increase pain. The initial pressure dressing usually remains in place for 48 to 72 hours after surgery. Chapter 37: Management of Patients with Musculoskeletal Trauma, Amputation, p. 1199.

The client is scheduled for a meniscectomy of the right knee. The nurse would plan postoperative care based on what surgical procedure? Excision of damaged joint fibrocartilage Replacement of one of the articular surfaces of a joint Incision and diversion of the muscle fascia Replacement of knee with artificial joint

Excision of damaged joint fibrocartilage Explanation: The most common site for meniscectomy is the knee; the procedure refers to the excision of damaged joint fibrocartilage. Fasciotomy refers to the incision and diversion of the muscle fascia to relieve muscle constriction. Hemiarthroplasty refers to the replacement of one of the articular surfaces of a joint. Total joint arthroscopy is the replacement of a joint with synthetic material. Chapter 37: Management of Patients with Musculoskeletal Trauma, Meniscal Injuries, p. 1157.

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? Increase fluid intake and perform prescribed foot exercises. Use supplementary oxygen when transferring or mobilizing. Avoid requesting analgesia unless pain becomes unbearable. Remain on bed rest for 14 days or until instructed by the orthopedic surgeon.

Increase fluid intake and perform prescribed foot exercises. Explanation: Deep vein thrombosis (DVT) is among the most common complications related to a hip fracture. To prevent DVT, the nurse encourages intake of fluids and ankle and foot exercises. The client should not be told to endure pain; a proactive approach to pain control should be adopted. While respiratory complications commonly include atelectasis and pneumonia, the use of deep-breathing exercises, changes in position at least every 2 hours, and the use of incentive spirometry help prevent the respiratory complications more than using supplementary oxygen. Bed rest may be indicated in the short term, but is not normally required for 14 days. Chapter 37: Management of Patients with Musculoskeletal Trauma, Fracture Healing and Complications, p. 1164.

A client undergoes open reduction with internal fixation to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan? Turning the client from side to side every 2 hours Performing passive range-of-motion (ROM) exercises on the client's legs once each shift Keeping a pillow between the client's legs at all times Maintaining the client in semi-Fowler's position

Keeping a pillow between the client's legs at all times Explanation: After open reduction with internal fixation, the client must keep the affected leg abducted at all times; placing a pillow between the legs reminds the client not to cross the legs and to keep the leg abducted. Passive or active ROM exercises shouldn't be performed on the affected leg during the postoperative period, because this could damage the operative site and cause hip dislocation. Most clients should be turned to the unaffected side, not from side to side. After open reduction with internal fixation, the client must avoid acute flexion of the affected hip to prevent possible hip dislocation; therefore, semi-Fowler's position should be avoided. Chapter 37: Management of Patients with Musculoskeletal Trauma, Fractures of Specific Sites, p. 1184.

The nurse suspects "compartment syndrome" for a casted extremity. What characteristic symptoms would the nurse assess that would confirm these suspicions? (Select all that apply.) Loss of motion Capillary refill less than 3 seconds Decreased sensory function Excruciating pain 2+ peripheral pulses in the affected distal pulse

Loss of motion Decreased sensory function Excruciating pain Explanation: Clinical manifestations include dusky, pale appearance of the exposed extremity; cool skin temperature; delayed capillary refill; paresthesia; and unrelenting pain not relieved by position changes, ice, or analgesia. A hallmark sign is pain that occurs or intensifies with passive range of motion (Johnston-Walker & Hardcastle, 2011). The patient may complain that the cast, brace, or splint is too tight. The primary provider must be notified immediately. Chapter 37: Management of Patients with Musculoskeletal Trauma, Fractures, pp. 1162-1163.

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? Encourage the client to perform range-of-motion (ROM) exercises to the right leg. Provide feedback on the client's strengths and available resources. Provide wound care without discussing the amputation. Request a referral to occupational therapy.

Provide feedback on the client's strengths and available resources. Explanation: The nurse should encourage the client to look at, and assist with, care of the residual limb. Providing feedback on the client's strengths and resources may allow the client to start to adapt to the body image and lifestyle change. The nurse should also allow time for the client to discuss their feelings related to the amputation. Requesting a referral to occupational therapy and encouraging the client to perform ROM exercises are appropriate but do not address the emotional aspect of losing an extremity. Chapter 37: Management of Patients with Musculoskeletal Trauma, Radial and Ulnar Shafts, p. 1181.

A nurse is planning the care of a client who will require a prolonged course of skeletal traction. When planning this client's care, the nurse should prioritize interventions related to what risk nursing diagnosis? Risk for Falls Risk for Imbalanced Fluid Volume Risk for Impaired Skin Integrity Risk for Aspiration

Risk for Impaired Skin Integrity Explanation: Impaired skin integrity is a high-probability risk in clients receiving traction. Falls are not a threat, due to the client's immobility. There are not normally high risks of fluid imbalance or aspiration associated with traction. Chapter 37: Management of Patients with Musculoskeletal Trauma, The Patient in Traction, p. 1176.

While assessing a client who has had knee replacement surgery, the nurse notes that the client has developed a hematoma at the surgical site. The affected leg has a decreased pedal pulse. What would be the priority nursing diagnosis for this client? Unilateral Neglect Related to Hematoma Risk for Infection Disturbed Kinesthetic Sensory Perception Risk for Ineffective Peripheral Tissue Perfusion

Risk for Ineffective Peripheral Tissue Perfusion Explanation: The hematoma may cause an interruption of tissue perfusion. There is also an associated risk for infection because of the hematoma, but impaired perfusion is a more acute threat. Unilateral neglect and impaired sensation are lower priorities than tissue perfusion. Chapter 37: Management of Patients with Musculoskeletal Trauma, Fractures, p. 1159.

Which statement describes external fixation? The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. The bone is restored to its normal position by external manipulation. The surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. The bone is surgically exposed and realigned.

The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. Explanation: In external fixation, the surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. In internal fixation, the surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. In closed reduction, the bone is restored to its normal position by external manipulation. In open reduction, the bone is surgically exposed and realigned. Chapter 37: Management of Patients with Musculoskeletal Trauma, The Patient with an External Fixator, p. 1172.

A client with a right leg fracture is returning to the orthopedist to have the cast removed. During cast removal, it is important for the nurse to assure: the client that he or she won't be cut. that pedal pulses are present. that the leg will be as good as new. that the cast cutter blade is new.

the client that he or she won't be cut. Explanation: Casts are removed with a mechanical cast cutter. Cast cutters are noisy and frightening but the blade does not penetrate deep enough to cut the client. The client needs reassurance that the machine will not cut into the skin. The other options are either irrelevant or not something the nurse knows for certain at this time. Chapter 37: Management of Patients with Musculoskeletal Trauma.