A&C - Module 8

cauda equina syndrome

*medical emergency* multiple nerve root compression, damage to the lumbar and sacral nerves

muscular dystrophies

- *X-linked, males are affected* - deterioration of muscle fibers - symmetric wasting of skeletal muscle - loss of strength - *no neurologic involvement* - Dystrophin gene mutation (protein product in skeletal muscle)

nursing mgmt: reducing cardiac workload for bedrest pts

- *avoid* Valsalva maneuver when moving up in bed, defecating, or lifting

nursing mgmt: preventing thrombus formation in bedrest pts

- *early ambulation*, proper positioning, ROM exercises (ankle pumps, foot circles, knee flexion) - pharmacological VTE prophylaxis - use of mechanical prophylaxis when bleeding risk is unacceptable

clinical manifestations: fractures

- *immediate localized pain* - edema - *dec function* - bruising - inability to bear weight or bear weight to the affected part - bone deformity may be present

s/s: gout

- *inflammation of great toe* - extremely painful/tender joints - symptoms occur at night w/ sudden swelling - attack usually ends 2-10 days

s/s: DDD

- *low back pain* - paresthesia - radicular pain down the buttock and below the knee

Duchenne Muscular Dystrophy

- *most common and most severe* - muscle weakness appears in early childhood and worsens rapidly

6 Ps of compartment syndrome

- *pain* out of proportion to the injury that is not managed by opioid analgesics or on passive stretch of muscle in the compartment - *pressure* in the inc compartment - *paresthesia* - *pallor*, coolness, and loss of normal color of the extremity - *paralysis* or loss of function - *pulselessness* (decreased or absent peripheral pulses)

What is the purpose of traction?

- *prevent or reduce pain or muscle spasm* - immobilize a joint - reduce a fracture - treat a pathological condition

fracture healing: callus formation

- 14-28 days - new bone matrix that is an unorganized network of bone is formed and removal of dead bone by osteoclasts

fracture healing: ossification

- 3 wks-6 mo - continual callus formation

fracture healing: granulation tissue

- 3-14 days - hematoma converts to granulation tissue (new blood vessels, fibroblasts, and osteoblasts)

fracture healing: consolidation

- 6mo-1yr - distance btwn bone fragments dec and eventually close

dx evaluation: scoliosis

- Adams forward bend test - definitive dx by radiograph

A nurse is caring for a 34-year-old client who has been immobile for 3 days following a back surgery. The nurse should include which interventions when planning care for this client? Choose all that apply. - Assess for lower extremity edema, peripheral pulses, and skin coloration bilaterally. - Coach the client to take a breath with the incentive spirometer at least once each hour. - Perform range-of-motion exercises hourly while the client is awake. - Assess the client's sleep-wake patterns, observing for irregularities.

- Assess for lower extremity edema, peripheral pulses, and skin coloration bilaterally. - Perform range-of-motion exercises hourly while the client is awake. - Assess the client's sleep-wake patterns, observing for irregularities.

Immobilization of a client causes many changes in the physiological processes of the body. Which of the following are physiological changes in the respiratory system that occur during immobilization (Select all that apply)? - Increased respiratory secretions. - Atelectasis - decreased lung expansion - Pooling of respiratory secretions - Weakened cough. - Increased air movement in and out.

- Atelectasis - decreased lung expansion - Pooling of respiratory secretions - Weakened cough.

What are the two types of muscular dystrophies?

- Duchenne muscular dystrophy - Becker muscular dystrophy

Which of the following should the nurse include in the teaching plan of a child with a brace or prosthesis? Choose all that apply. - Frequent assessment of all areas in contact with the brace for signs of skin irritation. - Use of powder under and around the brace after each diaper change. - Removal of the brace periodically throughout the day to maintain circulation. - Use of protective clothing under the brace. - Placement of diaper under the straps of the brace.

- Frequent assessment of all areas in contact with the brace for signs of skin irritation. - Use of powder under and around the brace after each diaper change. - Use of protective clothing under the brace. - Placement of diaper under the straps of the brace.

Correct nursing knowledge related to antiinflammatory medications includes which of the following? Choose all that apply. - GI irritation is a problem with salicylate injection. - Enteric-coated tablets have a sparing effect on the GI - NSAID drugs inhibit synthesis of prostaglandins. - Higher doses of corticosteroids should be stopped as soon as possible.

- GI irritation is a problem with salicylate injection. - Enteric-coated tablets have a sparing effect on the GI - NSAID drugs inhibit synthesis of prostaglandins. - Higher doses of corticosteroids should be stopped as soon as possible.

What two deformities can occur with osteoarthritis?

- Herberdens nodes - Bouchards nodes

Treatment of clubfoot includes what? Choose all that apply. - Correction of the deformity by surgical fracturing & repair of the ankles. - Maintenance of the correction until normal muscle is gained, often accomplished - Follow-up observation to detect possible recurrence of the deformity. - Use of a Pavlik harness to maintain hip abduction.

- Maintenance of the correction until normal muscle is gained, often accomplished - Follow-up observation to detect possible recurrence of the deformity.

interprofessional care: osteoarthritis

- NO CURE - *manage pain and inflammation* - prevent disability - promote rest and joint protection - use heat and cold - nutritional therapy and exercise - Tylenol - NSAIDs - wt loss and exercise can help w/ pain

therapeutic mgmt: gout

- NSAIDs - avoid ETOH and foods high in purines - avoid red and organ meat - supportive care of inflamed joints meds: colchicine allopurinol

diagnostic tests: DDH

- Ortolani test - Barlow test - >6 mo xray can confirm the dx - ultrasound not recommended until 4th-6th month and w/ adjunct physical exam

Health promotion for sprains/strains

- STRETCH before exercise - strength, balance, endurance exercises

developmental dysplasia of the hip (DDH)

- abnormal development of hip - infancy to childhood

fracture immobilization

- achieved w/ casts, braces, splints, immobilizers, and external and internal fixation devices

How are adults affected by bedrest?

- all physiological systems are at risk - role of adult often changes in regard to the family or social structure

How does bed rest affect urinary elimination?

- alters urinary elimination - urinary stasis - renal calculi (most common kidney stone is calcium oxalate)

complications of fracture healing

- angulation - delayed union - malunion - nonunion - myositis ossificans (inflammation) - pseudoarthritis (arthritis pain) - refraction

nursing mgmt: psychosocial health in bedrest pts

- anticipate changes in psychosocial status and provide routine and informal socialization - assess pts feelings and motivation, focus on what is important to the pt - involve family/significant others - avoid scheduling nursing care btwn 10pm-7am - *combine activities* - spend time in room talking/listening - involve pt in care plan when possible - encourage pt to wear glasses, dentures, shave, apply makeup for sense of routine

s/s DDH

- asymmetric thigh and gluteal folds - shortening of the limb on the affected side

nursing mgmt: fractures

- brief history, if a fracture is suspected, the extremity is immobilized - thorough neurovascular assessment (assess color, temp, cap refill, pulses, edema-especially distal to cast, paresthesia, or decrease sensation)

CRP dx test

- c-reactive protein - inflammation factor

What is the cause of clubfoot?

- cause unknown - strong familial tendency or congenital - 1 per 1,000 live births

preoperative Care: fractures

- client must be prepared for surgery - teach about the type of immobilization and assistive devices - discuss expected activity limitations - assure that nursing staff will help meet their personal needs until they resume self care - review pain mgmt strategies

dx studies: muscular dystrophy

- clinical manifestations and genetic testing - *elevated creatinine kinase*

Hip fracture facts

- common in older adults - 95% result from fall - .320,000 annually admitted to hospital - 37% mortality rate w/in 1 year of injury - >65 y/o occur more often in women - many older adults develop disabilities that require long-term care - by age 90, 33% of all women and 17% of men will have had hip fracture

indirect fracture complication

- compartment syndrome - fat embolism syndrome (esp w/ hip fracture) - VTE - rhabdomyolysis - hypovolemic shock

interprofessional care: DDD

- conservative therapy (brace, hot/cold therapy, TENs, NSAIDs) - when symptoms subside, begin back strengthening exercises (core exercises)

What are the benefits of bed rest?

- dec O2 needs of the body - dec cardiac workload and pain - rest for debilitated pt - helps to regain strength - provides for uninterrupted sleep

How is the GI system impacted with bedrest?

- dec appetite and slowing peristalsis - constipation - pseudodiarrhea

risk factors: osteoarthritis

- dec estrogen at menopause - obesity - sports injuries - work that requires frequent kneeling

How is the endocrine system impacted w/ bed rest?

- dec metabolic rate by altering the metabolism of carbs, fats, proteins, fluid/electrolyte balances

What nursing interventions can promote lung expansion and removal of pulmonary secretions?

- deep breathing exercises ever 1-2 hrs - incentive spirometry 10 x per hour - controlled coughing every 1-2 hrs - adequate fluid intake (at least 1100-1400 ml) - semi-fowler position - alternate side-to-side lying position

nutritional therapy: fractures

- dietary requirement of protein (1g/1kg body weight) - Vit such as B, C, D, calcium, phosphorus, magnesium - fluid intake 2-3 liters/day

Spica Cast

- difficulty maintaining stable reduction - cast is changed periodically to accommodate growth

What is a musculoskeletal consequence of bedrest?

- disuse atrophy - most vulnerable population is older adults - muscle deconditioning can be apparent in a matter of days

interprofessional care: RA

- education, nutritional therapy - NSAIDs - *methotrexate* - Plaquenil - enbrel, remicade (immunomudulators)

gout

- elevation in uric acid (hyperuricemia)

Psychosocial effects of bedrest

- emotional and behavioral responses - sensory alterations - *changes in coping* - social isolation and loneliness - depression - worrying/anxiety

How often is the tetanus vaccine given?

- every 10 years routinely - within 5 years w/ a puncture injury

fracture healing: remodeling (complete union)

- excess bone is resorbed - gradual return to the preinjury state - bone remodels in response to physical loading stress (weight-bearing activity)

strain

- excessive stretching of muscle and its fascial sheath, often involving the tendon - most strains occur in the large muscle groups of the lower back, hamstring, and calf

s/s hip fracture

- external rotation of hip - muscle spasms - shortening of the affected extremity - pain, tenderness

Pt Education: Hip fractures Don'ts

- flex hip >90 degrees - adduct hip - internally rotate hip - cross legs at knees or ankles - put on own shoes or stockings w/o assistive device - sit on chairs w/o arms

malunion

- fracture heals in expected time but in unsatisfactory position - may cause deformity or dysfunction

Steps of fracture healing

- fracture hematoma - granulation tissue - callus formation - ossification - consolidation - remodeling

eitiology/pathophysiology: RA

- genetic and environmental triggers - autoimmune cause is the most widely accepted, immune response to an antigen that triggers abnormal activation of inflammatory response

Nursing mgmt: RA

- health promotion: education - rest (alternate rest w/ activity) - Joint protection (don't over do activity/exercise) - cold/heat therapy - exercise - psychologic support

Nutrition needs to a pt on bed rest

- high protein, high-calorie diets - supplements of Vit B and C when necessary Nutrition is given parenterally or enterally if pt is unable to eat

How are infants, toddlers, and preschoolers affected by bedrest?

- immobilized *usually because of trauma* or the need to *correct a congenital skeletal abnormality* - may affect gross motor skills, intellectual development, and musculoskeletal development

hypostatic pneumonia

- inflammation of the lung from stasis or pooling of secretions - inc particularly when pt is *supine, prone, or lateral position*

causes: osteoarthritis

- inflammation to the joint - joint instability - mechanical stress to the joints - skeletal deformities - trauma - drugs

sprain

- injury to the ligaments surrounding a joint - wrenching and twisting - most occur in the ankle, wrist, and knee joint

s/s compartment syndrome

- ischemia can occur after 4-8 hrs after onset - 6 Ps

s/s: osteoarthritis

- joint pain - joint stiffness w/ rest - early morning stiffness - crepitation - asymmetrical

scoliosis

- lateral curvature of the spine - rib asymmetry

pressure injury

- localized damage to the skin and underlying soft tissue - preventing is much less expensive than tx - sitting uninterrupted in a chair is limited to 1 hr

post-spinal surgery care

- logrolling when changing positions - maintain proper alignment w/ pillows - opioids - neuro checks

skeletal traction

- long0term pull - pin or wires into the bone - weight for skeletal traction from 5-45 lbs - traction must be maintained continuously - watch for infection at the pin site

Degenerative Disc Disease (DDD)

- loss of fluid in the intervertebral discs w/ aging - discs lose their elasticity, flexibility, and shock absorbing abilities - can affect the cervical, thoracic, and lumbar spine - when the disc is damaged, the nucleus pulposus may seep through, called a herniated disk

Nursing mgmt: supporting bedrest pts w/ elimination

- maintain optimal urinary function by keeping pt well hydrated and preventing urinary stasis, calculi, and infections - normal hydration of *noncaffeinated* fluids - monitor I/O - *diet of fruits, veggies, and fiber* to facilitate normal peristalsis - stool softeners or enemas prn

external fixation

- metal pins and wires inserted into bone and attached to external rods

tx for sprains and strains

- mild sprains/strains are self-limiting - RICE - encourage use of limb if the joint is protected by a brace, splint, or taping - children need to take a break from sports for at least one wk

nursing mgmt: Enbrel, Remicade (immunomodulators)

- monitor for infection - inc risk of TB - no live vaccines - monitor CBC - monitor liver function

Pavlik Harness

- most widely used tx for DDH - worn continuously

Becker Muscular Dystrophy

- muscle weakness appears later in childhood and worsens slower

therapeutic mgmt: muscular dystrophy

- no curative tx - corticosteroids may increase muscle bulk/power - maintaining the optimum function of muscles - parent teaching (home safety and prevention of falls)

s/s: RA

- nonspecific manifestations include: fatigue, anorexia, wt loss, generalized stiffness - specific joint involvement: pain, stiffness, limited motion, inflammation - *extraarticular manifestations*

passive ROM exercises

- not able to or not permitted to move a body part - outside force causes the movement

s/s scoliosis

- noticeable in preadolescence growth spurt - poorly fitting jeans

assessment: compartment syndrome

- notify HCP if any of the 6Ps - do not elevate the extremity above the heart - do not apply cold compresses - watch for infection

fracture healing: fracture hematoma

- occurs w/in 72 hrs - bleeding creates hematoma

How are older adults affected by bed rest?

- often experience functional status changes - increase physical dependence on others

clinical manifestations

- pain, edema, dec function, and bruising

internal fixation

- pins, plates, rods, and screws are surgically inserted

dx studies: RA

- positive RF, ESR, CRP - antibodies to citrullinated peptide (anti-CCP) *more specific than RF*

dx testing: clubfoot

- prenatal ultrasonography - deformity apparent at birth

direct fracture complications

- problems w/ bone infection - bone union - avascular necrosis

s/s muscular dystrophy

- progressive weakness - wasting of symmetric muscle groups - insidious loss of strength

causes: gout

- purine foods - ethanol use - acidosis - renal impairment - use of drugs (ace inhibitors and thiazide drugs)

What is the overall goal of interprofessional care of fractures?

- realignment of bone fragments through reduction - immobilization to maintain realignment - restoration of normal or near-normal function

Other complications of prolonged bed rest

- respiratory (chest infection, PE, *atelectasis, hypostatic pneumonia*) - Cardiovascular (DVT, postural hypotension) - Musculoskeletal (disuse atrophy, contractures, dec endurance) - psychological (depression, anxiety, confusion, loss of self-esteem) - skin (bed sores) - bladder & bowel (incontinence, UTI, constipation)

How does bed rest affect calcium levels?

- risk of hypERcalcemia - calcium is lost from bones and released into the circulation

dx testing: gout

- serum uric acid levels >6 mg/dl - *synovial fluid aspiration* (Gold standard)

s/s: Cauda Equina Syndrome

- severe low back pain - progressive weakness - inc pain - saddle anesthesia - bowel and/or bladder incontinence or retention

skin traction (Murphy straps)

- short term use (48-72 hrs) - tape, boots, splints applied to the skin - weight for skin traction from 5-10 lbs - *regular assessment of skin, assess every 2-4 hrs*

nursing mgmt: clubfoot

- skin care - circulation - pt/family teaching

osteoarthritis

- slow, progressive, non-inflammatory disorder of the *synovial* joints - affects 30 mil Americans - - gradual loss of articular cartilage w/ the formation of osteophytes

drug therapy: fractures

- soma, flexeril, and robaxin for muscle spasms - tetanus and diphtheria toxoid or tetanus immunoglobulin for open fractures - bone penetrating antibiotics (cephalosporins) used prophylactically before surgery

When should exercises be scheduled?

- specific times during another nursing activity

dx studies: DDD

- straight leg raise - X-ray - myelogram - MRI

casts

- temporary use - immobilizes the joint above (proximal) and below (distal) a fracture

Ortolani Test

- test for DDH - abducting the thighs and placing anterior pressure at the hip to see if the femoral head slips forward into the acetabulum

Barlow test

- test for DDH - the thigh is adducted and light pressure is applied to see if the femoral head can be felt to slip posteriorly out of the acetabulum

How does bed rest affect nutrition?

- there is a deficiency in calories and proteins - the body often excretes more nitrogen than it ingests in proteins leading to a *negative nitrogen balance*

therapeutic mgmt: scoliosis

- thoracolumbosacral orthotic (TLSO) bracing for moderate curves - surgical intervention for (45-50 degrees or multiple curves)

What are causes of sprains and strains?

- trauma - incidence has increased because people have become more involved in sports and fitness programs

angulation

- type of malunion - fracture heals in abnormal position in relation to midline of structure

What is the cause of developmental dysplasia of the hip (DDH)?

- unclear cause - likely multifactorial - family history inc risk

Pt Education: Hip fractures Dos

- use an elevated toilet seat - shower chair - *pillow btwn legs for first 6 wks after surgery when lying on nonoperative side when supine* - keep hip in neutral, straight position when sitting, walking, lying - notify HCP if severe pain, deformity, loss of function - discuss risk factors for prosthetic joint infection w/ HCP and dentist before dental work

postoperative care: fractures

- vital signs, frequent neurovascular assessment - minimize pain/discomfort through proper alignment and positioning - frequently observe dressing/casts for any signs of bleeding or drainage - report inc or purulent drainage to HCP - prevent constipation - maintain a high fluid intake of more than 2500 ml/day - have pt sit on side of bed/let legs dangle (if not contraindicated) - assess for signs of VTE/DVT

displaced fracture

2 ends of the broken bone are separated from each other and their normal positions

How long does it take to begin losing muscle mass?

24 hours

moderate scoliosis curves

25-40 degrees

How long after a sprain/strain does it take to return to full function?

3-6 wks

severe scoliosis curves

45-50 degrees or multiple curves

Braden Scale

A tool for predicting pressure injury risk

Which symptoms most clearly relate to kidney stones in the immobilized patient? A. Tachycardia and shortness of breath. B. Hematuria and flank pain. C. Abdominal pain and positive Homan's sign. D. Urinary retention after voiding.

B. Hematuria and flank pain.

Negative nitrogen balance results when: A. More nitrogen is gained than is lost. B. More protein is excreted than consumed. C. Albumin levels are depleted. D. Plamsa protein level exceeds 10 mcg/100cc blood.

B. More protein is excreted than consumed.

bulging disc

Bulge in anulus fibrosus Invades vertebral canal

A 52-year-old patient has gout and he takes colchincine. A nurse is reviewing the teaching plan with him. Which statement indicates that he understands the action of colchicine? He tells the nurse that the drug A. removes the uric acid from his body through the feces. B. blocks the formation of uric acid. C. decreases pain by decreasing inflammation. D. replaces lost uric acid.

C. decreases pain by decreasing inflammation.

dx studies: osteoarthritis

CT, MRI X-Ray

What is a complication of degenerative disc disease?

Cauda Equina Syndrome

The physician orders bed rest for a client after surgery. The nurse is aware that the most beneficial method of preventing skin break- down while the client is confined to bed is to A. Massage the skin with cream. B. Use a sheepskin pad on the bed. C. Promote passive range of motion. D. Encourage independent movement.

D. Encourage independent movement.

At what percentage is muscle strength lost per day during bed rest?

Muscle strength is lost from baseline levels at a rate of 3% per day

When performing ROM exercises, what should never be done?

NEVER force a joint beyond the point of resistance

How does physical therapy help w/ fracture recovery?

PT helps gain back pre-injury mobility as well as decreases the likelihood that they will need opioids for long-term pain

tx: clubfoot

Ponseti Method: Serial casting - weekly gentle manipulation/stretching of foot - extremity is cased until max correction is achieved (usually 6-10 wks) - percutaneous heel cord tenotomy performed (majority of the time) at the end of casting to correct equinus deformity - long leg cast after tenotomy for 3 wks - after casting is completed, children are transitioned to Ponseti sandals - surgical intervention if Ponseti method fails

trochanter roll

Rolled towel support placed against the hips and upper leg to prevent external rotation of the legs. a safety device that helps to support hips and legs so that the femur does not rotate outward

parenteral nutrition

TPN (total parenteral nutrition) given through central line or peripheral IV - used cautiously - hard on kidneys - goal is to NOT be on TPN for extended period of time

What is a complication of gout?

Tophi (painless nodules filled w/ uric acid crystals)

Equinus deformity

a condition characterized by limited upward bending of the ankle joint and ankle rigidity

intracapsular hip fracture

a fracture of the proximal upper third of femur *within the joint capsule*

herniated disc

a spinal disc bulges outward between the vertebrae aka "slipped disc"

pathologic fracture

a spontaneous fracture at the site of a diseased bone

fasciotomy

a surgical incision through the fascia to relieve tension or pressure

7. A patient with osteoporosis shows an understanding of appropriate self-care when they state a. "I should remove trip hazards such as throw rugs in my house to make it safer." b. "I am not using the cane my HCP recommended. I don't want to look that old!" c. "I can continue to go downhill skiing as long as I'm careful and don't ever fall." d. "I need to take up running to help strengthen my bones. Walking is just not enough."

a. "I should remove trip hazards such as throw rugs in my house to make it safer."

4. Which persons are at high risk for chronic low back pain? (select all that apply) a. A 63-year-old man who is a long-distance truck driver b. A 30-year-old nurse who works on an orthopedic unit and smokes c. A 55-year-old construction worker who is 6 ft, 2 in and weighs 250 lb d. A 44-year-old female chef with prior compression fracture of the spine e. A 28-year-old female yoga instructor who is 5 ft, 6 in and weighs 130 lb

a. A 63-year-old man who is a long-distance truck driver b. A 30-year-old nurse who works on an orthopedic unit and smokes c. A 55-year-old construction worker who is 6 ft, 2 in and weighs 250 lb d. A 44-year-old female chef with prior compression fracture of the spine

5. The nurse obtained a health history of a patient with a fracture. Which problem, if reported by the patient, would most concern the nurse? a. Diabetes b. Hypertension c. Chronic bronchitis d. Nephrotic syndrome

a. Diabetes

1. A patient with acute osteomyelitis is being discharged on antibiotic therapy. What would the nurse include in the teaching plan? (select all that apply) a. It is important to finish all the antibiotics even if you feel better. b. You will need to schedule periodic through bone scans and ESR testing. c. If the infection comes back, you must contact the HCP to schedule surgery. d. Signs such as fever and night sweats may be present but are usually not severe. e. Contact the HCP if signs of infection such as pain and swelling at the site occur.

a. It is important to finish all the antibiotics even if you feel better. b. You will need to schedule periodic through bone scans and ESR testing. d. Signs such as fever and night sweats may be present but are usually not severe. e. Contact the HCP if signs of infection such as pain and swelling at the site occur.

4. The increased risk for falls in the older adult is likely due to (select all that apply) a. changes in balance. b. decrease in bone mass. c. loss of ligament elasticity. d. erosion of articular cartilage. e. decrease in muscle mass and strength.

a. changes in balance. b. decrease in bone mass. c. loss of ligament elasticity. e. decrease in muscle mass and strength.

6. The nurse would monitor a patient with a pelvic fracture for a. changes in urine output. b. petechiae on the abdomen. c. a palpable lump in the buttock. d. sudden increase in blood pressure.

a. changes in urine output.

3. A patient with a torn ligament in the knee asks what the ligament does. The nurse would respond that ligaments a. connect bone to bone. b. provide strength to muscle. c. lubricate joints with synovial fluid. d. relieve friction between moving parts.

a. connect bone to bone.

A nurse is caring for a client who is bedrest for therapeutic reasons. What does this mean to the nurse? The client has: a. decreasing oxygen needs of the body. b. increased the cardiac workload and pain. c. to decrease the ability of strength. d. inability to move his whole body or a part of his body.

a. decreasing oxygen needs of the body.

2. When performing passive range of motion for a patient, the nurse puts the elbow joint through the movements of (select all that apply) a. flexion and extension. b. inversion and eversion. c. pronation and supination. d. flexion, extension, abduction, and adduction. e. pronation, supination, rotation, and circumduction.

a. flexion and extension c. pronation and supination.

2. A patient with a humeral fracture is returning for a 4-week checkup. The nurse explains that initial evidence of healing on x-ray is indicated by a. formation of callus. b. complete bony union. c. hematoma at the fracture site. d. presence of granulation tissue.

a. formation of callus.

7. The nurse teaches the patient with an above-the-knee amputation that the residual limb should not be routinely elevated because this position promotes a. hip flexion contracture. b. clot formation at the incision. c. skin irritation and breakdown. d. increased risk for wound dehiscence.

a. hip flexion contracture.

What is the goal of clubfoot treatment?

achieve painless, plantigrade, functional foot

Colchicine

acute gout medication

greenstick fracture

an incomplete fracture w/ 1 side splintered and the other side bent

traction

application of a pulling force

2. A patient with history of colon cancer is diagnosed with rib fractures, and the HCP orders a bone scan. The nurse determines the patient understands teaching about the purpose of the procedure when they state a. "The bone scan will cure my rib fractures." b. "The bone scan will see if my colon cancer may have spread." c. "My colon cancer was cured so I really don't think this is necessary." d. "The results of the bone scan will only just confirm that I have a rib fracture."

b. "The bone scan will see if my colon cancer may have spread."

In caring for a patient after a spinal fusion, the nurse would report which finding to the health care provider? a. The patient has a single episode of emesis. b. The patient is unable to move the lower extremities. c. The patient is nauseated and has not voided in 4 hours. d. The patient reports of pain at the bone graft donor site.

b. The patient is unable to move the lower extremities.

8. A patient with osteoarthritis is scheduled for total hip arthroplasty. The nurse explains the purpose of this procedure is to (select all that apply) a. fuse the joint. b. replace the joint. c. prevent further damage. d. improve or maintain ROM. e. decrease the amount of destruction in the joint.

b. replace the joint. d. improve or maintain ROM.

6. A patient who ran his first marathon had heel pain that would not resolve and was diagnosed with calcaneus stress fracture. The nurse will teach the patient to (select all that apply) a. resume running in 1 week. b. rest and refrain from running. c. wear a shoe heel pad when ambulating. d. walk barefoot to decrease pressure on the heel. e. apply ice to the heel and take NSAIDs as directed by HCP.

b. rest and refrain from running. c. wear a shoe heel pad when ambulating. e. apply ice to the heel and take NSAIDs as directed by HCP.

7. An abnormal assessment finding of the musculoskeletal system is a. equal leg length bilaterally. b. ulnar deviation and subluxation. c. full range of motion in all joints. d. muscle strength of 5/5 in all muscles.

b. ulnar deviation and subluxation.

flexion

bending of joint from muscle contraction that causes dec angle between 2 bones

An incomplete fracture is often the result of what type of injury?

bending or crushing forces applied to the bone

How does Methotrexate treat RA?

bone marrow suppression nursing mgmt: - monitor CBC - monitor renal/liver function

osteophytes

bony outgrowths, bone spurs, "bone fluff"

Are girls or boys more affected with clubfoot?

boys are affected twice as often as girls

incomplete fracture

break occurs partly across a bone shaft, but bone is still in tact

degenerated disc

breakdown of fibrocartilage and shrinkage of nucleus pulposus

rhabdomyolysis

breakdown of skeletal muscle

What intrauterine position is related to hip dysplasia?

breech

8. A patient is scheduled for a bone scan. The nurse explains that this diagnostic test involves a. incision or puncture of the joint capsule. b. insertion of small needles into certain muscles. c. administration of a radioisotope before the procedure. d. placement of skin electrodes to record muscle activity.

c. administration of a radioisotope before the procedure.

4. The nurse suspects a neurovascular problem based on assessment of a. exaggerated strength with movement. b. increased redness and heat below the injury. c. decreased sensation distal to the fracture site. d. purulent drainage at the site of an open fracture.

c. decreased sensation distal to the fracture site.

3. A patient with a comminuted fracture of the tibia is to have an open reduction with internal fixation (ORIF) of the fracture. The nurse explains that ORIF is indicated when a. the patient cannot tolerate prolonged immobilization. b. the patient cannot tolerate the surgery for a closed reduction. c. other nonsurgical methods cannot achieve adequate alignment. d. a temporary cast would be too unstable to provide normal mobility.

c. other nonsurgical methods cannot achieve adequate alignment.

A patient with a comminuted fracture of the tibia is to have an open reduction with internal fixation (ORIF) of the fracture. The nurse explains that ORIF is indicated when a. the patient is unable to tolerate prolonged immobilization. b. the patient cannot tolerate the surgery for a closed reduction. c. other nonsurgical methods cannot achieve adequate alignment. d. a temporary cast would be too unstable to provide normal mobility.

c. other nonsurgical methods cannot achieve adequate alignment.

rheumatoid arthritis (RA)

chronic, systemic *autoimmune* disease characterized by inflammation of synovial joints - characterized by periods of exacerbation and remission - *incidence inc w/ age, peaking btwn 30-50 yrs* - almost 3x as many women

circumduction

circular motion

disckectomy

complete excision of an intervertebral disk

open reduction

correction o bone alignment through a surgical incision

5. When caring for a patient after lumbar spinal surgery, the nurse would immediately report which finding to the HCP? a. The patient reports mild low back pain. b. The patient has a single episode of emesis. c. The patient is nauseated and has not voided in 4 hours. d. The patient has loss of sensation to the perineum, buttocks, inner thighs, and back of the legs.

d. The patient has loss of sensation to the perineum, buttocks, inner thighs, and back of the legs.

6. When grading muscle strength, the nurse records a score of 3/5, which indicates a. no detection of muscular contraction. b. a barely detectable flicker of contraction. c. active movement against full resistance without fatigue. d. active movement against gravity but not against resistance.

d. active movement against gravity but not against resistance.

9. A patient is scheduled for total ankle replacement. The nurse should tell the patient that after surgery he should avoid a. lifting heavy objects. b. sleeping on the back. c. abduction exercises of the affected ankle. d. bearing weight on the affected leg for 6 weeks.

d. bearing weight on the affected leg for 6 weeks.

3. The nurse provides counseling to a family of a patient with Duchenne muscular dystrophy with the knowledge that a. patients are usually female. b. all daughters of a carrier will be carriers. c. genetic testing can help determine treatment. d. only males can pass the gene to their offspring.

d. only males can pass the gene to their offspring.

1. The bone cells that function in the formation of new bone tissue after a patient sustains a fracture are called a. osteoids. b. osteocytes. c. osteoclasts. d. osteoblasts.

d. osteoblasts.

5. A patient with a stable, closed humeral fracture has a temporary splint with bulky padding applied with an elastic bandage. The nurse suspects early compartment syndrome when the patient has a. increasing edema of the limb. b. muscle spasms of the lower arm. c. bounding pulse at the fracture site. d. pain when passively extending the fingers.

d. pain when passively extending the fingers.

A patient with suspected disc herniation has acute pain and muscle spasms. The nurse's responsibility is to a. encourage total bed rest for several days. b. teach principles of back strengthening exercises. c. stress the importance of straight-leg raises to decrease pain. d. promote use of cold and hot compresses and pain medication.

d. promote use of cold and hot compresses and pain medication.

1. The nurse in urgent care suspects an ankle sprain when a patient describes a. being hit by another soccer player during a game. b. having ankle pain after sprinting around the track. c. dropping a 10-lb weight on his lower leg at the health club. d. twisting his ankle while running bases during a baseball game.

d. twisting his ankle while running bases during a baseball game.

atrophy

dec size and strength of muscle leading to dec function and tone

myositis ossificans

deposition of calcium in muscle tissue at site of significant blunt muscle trauma or repeated muscle injury

fracture

disruption or break in the continuity of a bone - caused by trauma or is secondary to a disease process

DIP joint

distal interphalangeal joint

How long does bedrest last?

duration depends on the illness or injury and the pts prior state of health

DDH: dysplasia

dysplasia where the head of the femur is shown slightly out of the acetabulum

ESR dx test

erythrocyte set rate - general rate of inflammation

hyperextension

extension in which angle exceeds 180 degrees

Boutonniere deformity

flexion of PIP joint and hyperextension of DIP joint

plantar flexion

flexion of the ankle and toes toward the plantar surface of the foot "toes pointed"

dorsiflexion

flexion of the ankle and toes toward the shin

atelectasis

fluid in lung that causes collapse of alveoli entire lung or partial lung sometimes collapse keep HOB at least 30 degrees

Clubfoot

foot adduction, supination, bone deformity, malposition, contracture

nonunion

fracture does not heal despite treatment - No x-ray evidence of callus formation

delayed union

fracture healing progresses more slowly than expected - healing eventually occurs

extracapsular hip fracture

fracture of the proximal upper third of femur *outside the joint space*

comminuted

fracture w/ more than two fragments typically a crush injury

nucleus pulposus

gelatinous center of the disc

myalgia

general muscle tenderness and pain

Are girls or boys more affected with hip dysplasia?

girls

podagra

gout in the big toe

Why does O2 consumption inc during bedrest?

gravity does not help w/ circulation of oxygenated blood - body has to pump harder to push oxygenated blood out to the body

DDH: subluxation

half of head of the femur out of the acetabulum representing subluxation

DDH: dislocation

head of the femur completely out of the acetabulum and shifted upward = dislocation

swan neck deformity

hyperextension of PIP joint and flexion of DIP joint

What is the cause of scoliosis?

idiopathic, possibly genetic

isometric contractions

inc the tension within a muscle but do not produce movement

The region where fibrous tissue binds joints connecting bones to cartilage are tendons cartilages ligaments muscles.

ligaments

disuse osteoporosis

loss of calcium/bone density due to lack of movement

allopurinol

maintenance drug for gout tx

Nursing mgmt: orthostatic hypotension related to bedrest

mobilize the pt as soon as physical condition allows - i.e., dangle legs at the bedside before standing

skeletal traction (balanced suspension)

most commonly used for fractures of the femur, hip, and lower leg

external rotation

movement along longitudinal axis away from midline of body

internal rotaion

movement along longitudinal axis toward midline of body

abduction

movement away from midline of body

adduction

movement toward midline of body

active assisted ROM exercises

needs assistance w/ movement from an external force ( i.e., manual support of an extremity, positioning to use the effects of gravity)

refracture

new fracture occurs at original fracture site

nursing mgmt: DDH

newborn-6 mo - Pavlik Harness - Spica cast Teach parents to apply and maintain reduction device, checking skin 2-3 times a day for irritation

closed reduction

nonsurgical manual realignment of bone fragments

paresthesia

numbness and tingling "pins and needles"

enteral nutrition

nutrition given through NG tube, Gastrostomy, jejunostomy

Herberden's nodes

occur in the DIP joints due to osteophyte formation and loss of joint space often red, swollen, and tender

Bouchard's nodes

occur on the PIP joints due to osteophyte formation and loss of joint space often red, swollen, and tender

stress fracture

occurs in bone that is subject to repeated stress (i.e., jogging, running)

disuse atrophy

pathological reduction in the normal size of muscle fibers after prolonged inactivity

active ROM exercises

performed independently

nursing mgmt: hip fracture

preop care: - H&P, analgesics postop care: - VS, I/O - respiratory function, encourage deep breathing, coughing (every hour while pt is awake to prevent pneumonia, and to assess for possible PE) - assess pain - observe dressing/incision - neurovascular assessment (color, temp, cap refill, distal pulses, edema, motor function) - PT

PIP joint

proximal interphalangeal joint

What occurs as RA progresses?

pt may get deformities such as: - subluxation - ulnar drifts - *swan neck* - boutonniere deformity - Hallux valgus

What type of foods contain purines?

red meats, organ meats, aged cheeses

bone remodeling

removal of old bone by osteoclasts and the deposit of new bone by osteoblasts

contracture

resistance of movement of muscle or joint due to fibrosis of supporting soft tissues

RF dx test

rheumatoid factors/antigens

nursing mgmt: Plaquenil

risk of vision loss monitor CBC monitor liver function

What is the most common spinal deformity?

scoliosis

What is a symptom of CSF leakage?

severe headache

isotonic contrations

shorten a muscle to produce movement

antalgic gait

shortened stride w/ minimal weight bearing on the affected side, resulting in a limp

open fracture (compound)

skin is broken and bone is exposed

closed fracture (simple)

skin is intact

How are adolescents affected by bedrest?

social isolation is a concern

ataxic gait

staggering, uncoordinated gait, often w/ sway

ankylosis

stiffness and fixation of a joint

extension

straightening of joint that inc angle between two bones

complete fracture

the break goes completely through the bone

ossification

the deposit of new bone by osteoblasts

Wolf's Law

the effect of decreased weight on the bone as the bone becomes less dense and weaker

oblique fracture

the line of the fracture extends across and down the bone

transverse fracture

the line of the fracture extends across the bone shaft at a right angle to the longitudinal axis

spiral fracture

the line of the fracture extends in a spiral direction along the bone shaft often seen in abuse

resorption

the removal of old bone by osteoclasts

laminectomy

the surgical removal of a lamina, or posterior portion, of a vertebra

pronation

turning of palm downward

supination

turning of palm upward

inversion

turning of sole inward toward midline of body

eversion

turning of sole outward away from midline of body

pseudoarthritis

type of nonunion occurring at fracture site in which a false joint is formed w/ abnormal movement at site

Where does uric acid come from?

uric acid is a major product of purine catabolism

Virchow's Triad

venous stasis, endothelial injury, hypercoagulable state

Soma

very addictive, rarely prescribed

pseudodiarrhea

watery diarrhea goes around a bowel obstruction....not actual diarrhea

What is the best way to prevent disuse osteoporisis?

weight bearing activity