Ch. 41 Musculoskeletal care modalities

Following a total knee replacement, the surgeon orders a continuous passive motion (CPM) device. The client asks about the purpose of this treatment. The best response by the nurse is:

"CPM increases range of motion of the joint."

When discussing physical activities with the client who has just undergone a right total hip replacement, which instruction should the nurse provide?

"Limit hip flexion to 90 degrees."

The nurse is providing instructions to the client who is being prepared for skeletal traction. Which statement by the client indicates teaching was effective?

"Metal pins will go through my skin to the bone."

A client has a plaster cast applied to the left leg. Which of the following comments by the client following the procedure should the nurse address first?

"My toes are stiff."

Which instruction should the nurse include when teaching the client following hip replacement surgery? (Select all that apply.)

"Place pillows between your legs when you lay on your side." "Use a raised toilet seat and high-seated chair." "Avoid bending forward when sitting in a chair."

Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education?

"The client is receiving physical therapy twice per day, so he doesn't need a continuous passive motion device."

A patient diagnosed with a right ulnar fracture asks why the cast needs to go all the way up the arm. What is the best response by the nurse?

"The joint above the fracture and below the fracture must be immobilized."

Which interventions should a nurse implement as part of initial pain relief measure for the patient with a cast? Select all that apply.

Application of cold packs. Administration of analgesics. Elevation of the involved part.

A client's cast is removed. The client is worried because the skin appears mottled and is covered with a yellowish crust. What advice should the nurse give the client to address the skin problem?

Apply lotions and take warm baths or soaks.

A nurse is caring for a client with a cast on his left arm after sustaining a fracture. Which assessment finding is most significant for this client?

Fingers on the left hand are swollen and cool

All of the following are guidelines for avoiding hip dislocation after replacement surgery. Select the answer that is not.

You may flex at the hip to put on clothing such as pants, stockings, socks, or shoes.

Teaching point most important for patient going home with a cast

reporting signs of impaired circulation

Laceration with sutures on fractured arm, why splint and not cast it?

to monitor the status of the laceration to the sure it doesnt get infected.

Which of the following statements is accurate regarding care of a plaster cast?

The cast can be dented while it is damp.

Which of the following statements 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.

A client has severe osteoarthritis in the left hip and is having surgery to replace both articular surfaces of the hip. What type of surgical procedure will the nurse prepare the client for?

Total arthroplasty

A patient is being discharged home with a long arm cast. What education should the nurse include to prevent disuse syndrome in the arm?

Use of isometric exercises

The nurse is checking the traction apparatus for a client in skin traction. Which finding would require the nurse to intervene?

Weights hanging and touching the floor

After a cast removal, what do you expect the doctor to prescribe?

physical therapy

A patient in the emergency department is being treated for a wrist fracture. The patient asks why a splint is being applied instead of a cast. What is the best response by the nurse?

"A splint is applied when more swelling is expected at the site of injury."

Which evaluation finding requires follow up by the nurse caring for a client with a total knee replacement? Select all that apply.

650 ml bloody drainage in drain wound. Knee flexion at 30 degrees.

The client displays manifestations of compartment syndrome. The nurse expects the client to be scheduled for:

A fasciotomy

Which of the following would be an inconsistent initial pain relief measure for the patient with a cast?

Application of a new cast

A patient with a long arm cast continues to complain of unrelieved throbbing pain even after receiving opioid pain medication. Which of the following is the priority action by the nurse?

Assess for complications.

A client has a Fiberglas cast on the right arm. Which action should the nurse include in the care plan?

Assessing movement and sensation in the fingers of the right hand

A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority?

Assessing the extremity for neurovascular integrity

Which action would be most important postoperatively for a client who has had a knee or hip replacement?

Assisting in early ambulation.

A group of students are reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast?

Better molding to the client

Example of a skin traction

Buck's

A client who is undergoing skeletal traction complains of pressure on bony areas. Which action would be most appropriate to provide comfort for the client?

Changing the client's position within prescribed limits.

The nurse is assisting with the application of a cast. Which of the following would the nurse expect to be done first?

Cleaning the skin surface.

Which of the following would be inconsistent as a component of self-care activities for the patient with a cast?

Cover the cast with plastic to insulate it

A client sustained a stable fracture of the cervical spine and is having skeletal traction applied. What type of traction does the nurse educate the client about?

Crutchfield tongs

Which would be consistent as a component of self-care activities for the patient with a cast?

Cushioning rough edges of the cast with tape

A client has a cast applied to the leg for treatment of a tibia fracture and also has a wound on the leg that requires dressing changes due to drainage. For what should the nurse prepare the client?

Cutting a cast window

A patient not ready to ambulate after total hip replacement surgery the following day. What should the nurse do?

Discuss the complications the patient will experience if they don't cooperate

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 of the following complications?

Dislocation of the hip

The physician is preparing to bivalve the client's cast. Which supplies should the nurse assemble?

Elastic compression bandages

Mr. Williams returned to the nursing unit following orthopedic surgery and is complaining of pain. Which of the following interventions will help relieve pain?

Elevate the affected extremity and use cold applications.

Which of the following definitions describes the hip spica cast?

Encloses the trunk and a lower extremity

The patient 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

A patient with a fractured ankle is having a fiberglass cast applied. The patient starts yelling, "My leg is burning, take it off." What action by the nurse is most appropriate?

Explain that the sensation being felt is normal and will not cause burns to the patient.

Surgical procedure that releases constricting muscle fascia which also relieves muscle tissue pressure

Fasciotomy

Of the definitions for surgical procedures to correct joint deformities listed as follows, which describes arthrodesis?

Fusion of a joint (most often the wrist or knee) for stabilization and pain relief

A client has just undergone a leg amputation. The nurse would closely monitor the client for which of the following during the immediate postoperative period?

Hematoma

Which type of cast encloses the trunk and a lower extremity?

Hip spica

The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Nursing assessment findings include temperature 100.8 degrees Farenheit, heart rate 112 beats per minute, respiratory rate 28 breaths per minute, and blood pressure 86/58. There is no urine in the Foley catheter collection bag. The nurse interprets these findings as indicating which of the following complications?

Hypovolemic shock

To reduce the incidence of complications in a client in traction, which intervention should be included in the care plan?

Increase fiber intake.

The client with a fractured femur is upset and agitated that skeletal traction will be necessary for 6 to 8 weeks. The client states, "How can I stay like this for weeks? I can't even move!" Based on these statements, the nurse would identify which of the following as the most appropriate nursing diagnosis?

Ineffective Coping related to prolonged immobility

Which intervention should the nurse implement with the client who has undergone a hip replacement?

Instruct the client to avoid internal rotation of the leg.

Which of the following statements describe open reduction of a fracture?

It is performed in the operating room. The bone is surgically exposed and realigned.

Which of the following is a benefit of a continuous passive motion (CPM) device when applied after knee surgery?

It promotes healing by increasing circulation and movement of the knee joint.

A client has undergone an external fixation. Which actions would be the priority for this client?

Maintaining pin care.

After a traumatic back injury, a client requires skeletal traction. Which intervention takes priority?

Maintaining traction continuously to ensure its effectiveness

The nurse is caring for a client who has had a fracture reduction using a cast. Which of the following would be most important for the nurse to assess?

Neurovascular status

How to avoid hip dislocation after replacement surgery

Never cross the affected leg when seated

The nurse is caring for a client with an external fixator that requires pin care twice a day. The nurse observes that there is a new purulent draina"My toes are stiff." around one of the pins. What intervention should the nurse anticipate doing?

Obtaining a culture

A client's fracture was reduced by surgically exposing the bone and realigning it. The nurse identifies this as which of the following?

Open reduction

A variety of complications can occur after a leg amputation. All of the following are possibilities in the immediate postoperative period, except?

Osteomyelitis

The client presents with nausea and vomiting, sluggish bowel sounds, and abdominal distention. The nurse interprets these findings as suggestive of:

Physiologic cast syndrome

A patient with a short arm cast is suspected to have compartment syndrome. What actions should the nurse include in the plan of care? Select all that apply.

Prepare for cast removal. Provide support to the injured extremity.

Which action by the nurse would be inappropriate for the client following casting?

Protect the cast by covering with a sheet.

Which nursing assessment finding indicates the client with traction has not met expected outcomes?

Right calf warm and swollen

A client is brought to the emergency department by a softball team member whostates the client and another player ran into each other, and the client is having severe pain in the right shoulder. What symptoms of a fractured clavicle does the nurse recognize?

Right shoulder slopes downward and droops inward.

Nursing diagnosis for a patient who lives alone after a total knee replacement

Risk for ineffective therapeutic regimen management

A client is about to have a cast applied to his left arm. The nurse would alert the client to which of the following as the cast is applied?

Sensation of warmth or heat with application

Which of the following principles apply to the patient in traction?

Skeletal traction is never interrupted

Which of the following devices is designed specifically to support and immobilize a body part in a desired position?

Splint

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?

Teach the client how to prevent problems caused by immobility.

Benefit of porous-cementless joiny components

allows the bone to grow into the prosthesis and securely fix the joint replacement in place

Medication therapy after total knee arthroscopy

anticoagulation therapy

Preventing deep vein thrombosis after orthopedic surgery

applying antiembolism stockings

Which of the following is an inaccurate principle of traction? a) The weights are not removed unless intermittent treatment is prescribed. b) The patient must be in good alignment in the center of the bed. c) Skeletal traction is interrupted to turn and reposition the patient. d) The weights must hang freely.

c) Skeletal traction is interrupted to turn and reposition the patient.

Indication of compartment syndrome

capillary refill greater than 3 seconds

Which type of surgery is done to correct and align a fracture after surgical dissection and exposure of the fracture?

open reduction

Menisectomy refers to?

excision of a damaged joint fibrocarilage

Important discharge teaching after total hip replacement

exploring factors related to home environment

Primary intervention for Spica cast

keep cast clean and dry

A nurse is caring for a client who recently underwent a total hip replacement. The nurse should:

limit hip flexion of the client's hip when he sits.

Plan of care for Buck's traction

maintain correct body alignment