Ch 43 Musculoskeletal trauma
Which type of fracture involves a break through only part of the cross-section of the bone? a) Open b) Comminuted c) Incomplete d) Oblique
Incomplete An incomplete fracture involves a break through only part of the cross-section of the bone. A comminuted fracture is one that produces several bone fragments. An open fracture is one in which the skin or mucous membrane wound extends to the fractured bone. An oblique fracture runs across the bone at a diagonal angle of 45 to 60 degrees.
Colles' fracture occurs in which of the following areas? a) Distal radius b) Clavicle c) Elbow d) Humeral shaft
Distal radius A Colles' fracture is a fracture of the distal radius (wrist). It is usually the result of a fall on an open, dorsiflexed hand.
A patient asks the nurse why his residual limb cannot be elevated on a pillow. What is the best response by the nurse? a) "Elevating the leg might lead to a flexion contracture." b) "Elevating the extremity may increase your chances of compartment syndrome." c) "You need to turn yourself side to side. If your leg is on a pillow, you would not be able to do that." d) "I am sorry. We ran out of pillows. I can elevate it on a few blankets."
"Elevating the leg might lead to a flexion contracture." Elevating the residual limb on a pillow may lead to a flexion contracture; this could jeopardize the patient's ability to use a prosthesis. The patient does need to turn to both sides, but might still be able to do it with his extremity elevated. Elevating the extremity would not increase the risk for compartment syndrome. The limb should not be elevated on pillows or blankets.
A client is to undergo surgery to repair a ruptured Achilles tendon and application of a brace. The client demonstrates understanding of his activity limitations when he states that he will need to wear the brace for which length of time? a) 6 to 8 weeks b) 10 to 12 weeks c) 2 to 4 weeks d) 14 to 16 weeks
6 to 8 weeks Following surgical repair for a ruptured Achilles tendon, the client wears a brace or cast for 6 to 8 weeks.
When reviewing the history of a female client with a ganglion cyst, which factor would the nurse identify as most likely contributing to the client's current condition? a) Participation as a softball pitcher b) Age below 50 years c) Employment as a cashier d) Recurrent dislocations
Age below 50 years Ganglion cysts form through defects in the tendon sheath or joint capsule and occur most commonly in women younger than 50 years of age. Being a softball pitcher would increase the client's risk for epicondylitis. Employment as a cashier would be a possible risk factor for carpal tunnel syndrome. Recurrent dislocations are the result of insufficient collagen deposits during the repair stage of a dislocation.
A client comes to the Emergency Department complaining of localized pain and swelling of his lower leg. Ecchymotic areas are noted. History reveals that the client got hit in the leg with a baseball bat. Which of the following would the nurse suspect as most likely? a) Strain b) Fracture c) Sprain d) Contusion
Contusion The client's description of blunt trauma by a baseball bat and localized pain in conjunction with swelling and ecchymosis would most likely suggest a contusion. A fracture would be manifested by pain, loss of function, deformity, swelling, and spasm. A sprain would be manifested by pain and swelling; ecchymosis may appear later. A strain is characterized by inflammation, local tenderness, and muscle spasms
A 39-year-old softball player has been brought to the ED by his teammates. The client was fielding a fly ball, fell, and injured his hip. He cannot place weight on the leg and is in significant pain. After radiographs indicate intact yet malpositioned bones, what repair would you expect the physician to perform? a) Analgesia and immobilization b) Heat and immobilization c) Ice and immobilization d) Joint manipulation and immobilization
Joint manipulation and immobilization The physician manipulates the joint or reduces the displaced parts until they return to normal position, then immobilizes the joint with an elastic bandage, cast, or splint for several weeks.
The nurse is caring for an older woman with a hip fracture. The nurse recognizes that an incorrect risk factor for hip fracture is: a) Anemia b) Female gender c) Muscular agility d) Osteoporosis
Muscular agility Muscular agility decreases the risk for hip fracture. The other choices are all risk factors for hip fracture.
Which of the following terms refers to failure of fragments of a fractured bone to heal together? a) Subluxation b) Malunion c) Nonunion d) Dislocation
Nonunion When nonunion occurs, the patient complains of persistent discomfort and movement at the fracture site. Dislocation refers to the separation of joint surfaces. Subluxation refers to partial separation or dislocation of joint surfaces. Malunion refers to growth of the fragments of a fractured bone in a faulty position, forming an imperfect union.
Elderly clients who fall are most at risk for which injuries? a) Wrist fractures b) Humerus fractures c) Pelvic fractures d) Cervical spine fractures
Pelvic fractures Elderly clients who fall are most at risk for pelvic and lower extremity fractures. These injuries are devastating because they can seriously alter an elderly client's lifestyle and reduce functional independence. Wrist fractures usually occur with falls on an outstretched hand or from a direct blow. Such fractures are commonly found in young men. Humerus fractures and cervical spine fractures aren't age-specific.
A client is admitted to the hospital for a fracture of the right femur. Which clinical manifestation supports the diagnosis? a) Hematoma over the right trochanter b) Right leg shorter than left c) Swelling of the right leg d) Pain in the right thigh
Right leg shorter than left A fractured lower extremity is often shorter than the unaffected one.
A 19-year-old patient presents to the emergency room with an injury to her left ankle that occurred during a high school basketball game. She complains of limited motion and pain on walking, which increased over the last 2 hours. The nurse knows that her diagnosis is most likely which of the following? a) First-degree strain b) Second-degree sprain c) Third-degree sprain d) Third-degree strain
Second-degree sprain A sprain is the result of an injury to ligaments that is caused by a twisting motion. A second-degree sprain is an incomplete tear of the ligament that results in painful weight bearing. A third-degree sprain involves a complete ligament tear with loss of weight-bearing function.
Which of the following may occur if a client experiences compartment syndrome in an upper extremity? a) Whiplash injury b) Volkmann's contracture c) Callus d) Subluxation
Volkmann's contracture If compartment syndrome occurs in an upper extremity, it may lead to Volkmann's contracture, a clawlike 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.
A nurse advises a patient with a casted femur fracture to check for signs of a fat embolism. She tells the patient that the onset of symptoms for FES occur: a) Immediately after the fracture heals, when activity begins. b) Within 12 to 48 hours. c) 1 to 2 weeks after the fracture is set. d) About 4 weeks after the bone fragments solidify.
Within 12 to 48 hours. The onset of symptoms for a fat embolism is rapid, usually within 12 to 48 hours after injury, but may occur up to 10 days after injury.
When joint manipulation is unsuccessful for a client, he is taken to surgery for surgical repair of his hip injury. He is brought to the ICU where you practice nursing for postoperative recovery. After surgery, the nurse implements measures to prevent complications. Select all of the following which are complications that the nurse seeks to prevent. a) Wound infection b) Skin breakdown c) Pneumonia d) Diarrhea
• Pneumonia • Skin breakdown • Wound infection After surgery, the nurse implements measures to prevent skin breakdown, wound infection, pneumonia, constipation, urinary retention, muscle atrophy, and contractures.
A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction? a) "Apply heat packs for the first 24 to 48 hours." b) "Apply ice packs for the first 12 to 18 hours." c) "Apply ice packs for the first 24 to 48 hours, then apply heat packs." d) "Apply heat packs for the first 24 hours, then apply ice packs for the next 48 hours."
"Apply ice packs for the first 24 to 48 hours, then apply heat packs." The nurse should instruct the client to apply ice packs to the injured area for the first 24 to 48 hours to reduce swelling and then apply heat to increase comfort, promote reabsorption of blood and fluid, and speed healing. Applying ice for only 12 to 18 hours may not keep swelling from recurring. Applying heat for the first 24 to 48 hours would worsen, not ease, swelling. Applying ice 48 hours after the injury would be less effective because swelling already has occurred by that time.
A patient has stepped in a hole in the yard, causing an ankle injury. The ankle is edematous and painful to palpation. How long should the nurse inform the patient that the acute inflammatory stage will last? a) Less than 24 hours b) At least 1 week c) About 72 hours d) Between 24 and 48 hours
Between 24 and 48 hours After the acute inflammatory stage (e.g., 24 to 48 hours after injury), intermittent heat application (for 15 to 30 minutes, four times a day) relieves muscle spasm and promotes vasodilation, absorption, and repair.
Which of the following is one of the most common causes of death in patients diagnosed with fat emboli syndrome? a) MI b) PE c) Stroke d) ARDS
ARDS Acute pulmonary edema and ARDS are the most common causes of death.
An x-ray demonstrates a fracture in which a bone has splintered into several pieces, which type of fracture is this? a) Comminuted b) Depressed c) Compound d) Impacted
Comminuted A comminuted fracture may require open reduction and internal fixation. A compound fracture is one in which damage also involves the skin or mucous membranes. A depressed fracture is one in which fragments are driven inward. An impacted fracture is one in which a bone fragment is driven into another bone fragment.
General nursing measures employed when caring for the client with fracture include all of the following, except? a) Cranial nerve assessment b) Administering analgesics c) Assisting with ADLs d) Providing comfort measures
Cranial nerve assessment 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.
Which of the following would lead a nurse to suspect that a client has a rotator cuff tear? a) Increased ability to stretch arm over the head b) Difficulty lying on affected side c) Minimal pain with movement d) Pain worse in the morning
Difficulty lying on affected side 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.
Which of the following is a factor that inhibits fracture healing? a) Immobilization of the fracture b) Increased vitamin D and calcium in the diet c) History of diabetes d) Patient age of 35
History of diabetes Factors that inhibit fracture healing include diabetes, smoking, local malignancy, bone loss, extensive local trauma, age greater than 40, and infection. Factors that enhance fracture healing include proper nutrition, vitamin D and calcium, exercise, maximum bone fragment contact, proper alignment, and immobilization of the fracture.
Pulselessness, a very late sign of compartment syndrome, may signify which of the following? a) Nerve involvement b) Venous congestion c) Diminished arterial perfusion d) Lack of distal tissue perfusion
Lack of distal tissue perfusion Pulselessness is a very late sign that may signify lack of distal tissue perfusion. The other answers do not apply.
A patient with a traumatic amputation of the right lower leg is refusing to look at the leg. Which of the following actions by the nurse is most appropriate? a) Provide feedback on the patient's strengths and available resources. b) Request a referral to occupational therapy. c) Provide wound care without discussing the amputation. d) Encourage the patient to perform range-of-motion (ROM) exercises to the right leg.
Provide feedback on the patient's strengths and available resources. The nurse should encourage the patient to look at, and assist with, care of the residual limb. Providing feedback on the patient's strengths and resources may allow the patient to start to adapt to the body image and lifestyle change. The nurse should also allow time for the patient to discuss his or her feelings related to the amputation. Requesting a referral to occupational therapy and encouraging the patient to perform ROM exercises are appropriate, but do not address the emotional aspect of losing an extremity.
A 45-year-old softball player arrives at the emergency department following his injury while sliding into a base during a game. After his examination and radiographs, the physician diagnoses muscle strain and prescribes appropriate treatment. What does the physician mean with the term "strain"? a) Injuries to ligaments surrounding a joint b) Subluxation of a joint c) Injury resulting from a blow or blunt trauma d) Stretched or pulled beyond its capacity
Stretched or pulled beyond its capacity A strain is an injury to a muscle when it is stretched or pulled beyond its capacity.
Which of the following is a hallmark sign of compartment syndrome? a) Pain b) Weeping skin surfaces c) Edema d) Motor weakness
Pain A hallmark sign of compartment syndrome is pain that occurs or intensifies with passive ROM.
A patient sustains a fracture of the arm. When does the nurse anticipate pendulum exercise should begin? a) In 2 to 3 weeks, when callus ossification prevents easy movements of bony fragments b) As soon as tolerated, after a reasonable period of immobilization c) In about 4 to 5 weeks, after new bone is well established d) In 2 to 3 months, after normal activities are resumed
As soon as tolerated, after a reasonable period of immobilization Many impacted fractures of the surgical neck of the humerus are not displaced and do not require reduction. The arm is supported and immobilized by a sling and swathe that secure the supported arm to the trunk (Fig. 43-10). Limitation of motion and stiffness of the shoulder occur with disuse. Therefore, pendulum exercises begin as soon as tolerated by the patient. In pendulum or circumduction exercises, the physical therapist instructs the patient to lean forward and allow the affected arm to hang in abduction and rotate. These fractures require approximately 4 to 10 weeks to heal, and the patient should avoid vigorous arm activity for an additional 4 weeks. Residual stiffness, aching, and some limitation of ROM may persist for 6 months or longer (NAON, 2007).
An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this? a) Impacted b) Depressed c) Comminuted d) Compound
Comminuted A comminuted fracture may require open reduction and internal fixation. A compound fracture is one in which damage also involves the skin or mucous membranes. A depressed fracture is one in which fragments are driven inward. An impacted fracture is one in which a bone fragment is driven into another bone fragment.
The femur fracture that commonly leads to avascular necrosis or nonunion because of an abundant supply of blood vessels in the area is a fracture of the: a) Condylar area. b) Femoral neck. c) Shaft of the femur. d) Trochanteric region.
Femoral neck. A fracture of the neck of the femur may damage the vascular system and the bone will become ischemic. Therefore, a vascular necrosis is common.
After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client? a) With the affected hip rotated externally b) With the affected hip flexed acutely c) With the leg on the affected side adducted d) With the leg on the affected side abducted
With the leg on the affected side abducted The nurse must keep the leg on the affected side abducted at all times after hip surgery to prevent accidental dislodgment of the affected hip joint. Placing a pillow or an A-frame between the legs helps maintain abduction and reminds the client not to cross the legs. The nurse should avoid acutely flexing the client's affected hip (for example, by elevating the head of the bed excessively), adducting the leg on the affected side (such as by moving it toward the midline), or externally rotating the affected hip (such as by removing support along the outer side of the leg) because these positions may cause dislocation of the injured hip joint.
A nurse suspects that a client with a recent fracture has compartment syndrome. Assessment findings may include: a) inability to perform active movement and pain with passive movement. b) body-wide decrease in bone mass. c) inability to perform passive movement and pain with active movement. d) a growth in and around the bone tissue.
inability to perform active movement and pain with passive movement. With compartment syndrome, the client can't perform active movement, and pain occurs with passive movement. A body-wide decrease in bone mass is seen in osteoporosis. A growth in and around the bone tissue may indicate a bone tumor.
A nurse is developing a teaching plan for a client who must undergo an above-the-knee amputation of the left leg. After a leg amputation, exercise of the remaining limb: a) isn't necessary. b) should begin the day after surgery. c) should begin immediately postoperatively. d) begins at a rehabilitation center.
should begin the day after surgery. Exercise of the remaining limb should begin the day after surgery. Exercise is necessary to maintain the muscle tone of the remaining limb. Immediately after surgery, the client usually isn't alert enough to participate and may be in too much pain. Exercise needs to begin before discharge to a rehabilitation center.
A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching? a) "I don't know if I'll be able to get off that low toilet seat at home by myself." b) "I'll need to keep several pillows between my legs at night." c) "The occupational therapist is showing me how to use a sock puller to help me get dressed." d) "I need to remember not to cross my legs. It's such a habit."
"I don't know if I'll be able to get off that low toilet seat at home by myself." The client requires additional teaching if he is concerned about using a low toilet seat. To prevent hip dislocation after a total hip replacement, the client must avoid bending the hips beyond 90 degrees. The nurse should instruct the client to use assistive devices, such as a raised toilet seat, to prevent severe hip flexion. Using an abduction pillow or placing several pillows between the legs reduces the risk of hip dislocation by preventing adduction and internal rotation of the legs. Teaching the client to avoid crossing the legs also reduces the risk of hip dislocation. A sock puller helps a client get dressed without flexing the hips beyond 90 degrees.
A 78-year-old client is in the emergency department following involvement in a motor vehicle collision. Radiographs indicate a fractured humerus; the client is awaiting the casting of her upper extremity and admission to the orthopedic unit. Other than her bone, what other physical structures could be affected by this injury? a) Blood vessels b) Muscles c) Nerves d) All options are correct.
All options are correct. A fractured bone or other injury can potentially cause dysfunction to the surrounding muscle and injury to the blood vessels and nerves.
A patient suffered an open fracture to the left femur during a horse-riding accident. For which of the following complications is this patient at highest risk? a) Infection b) Malunion c) Complex regional pain syndrome d) Depression
Infection This patient is at the highest risk for infection because of the open fracture that was obtained while horseback riding. Infection that enters the body and affects the bone can lead to osteomyelitis. The treatment may involve long-term antibiotics and may even result in fatality. The patient is still at risk for malunion, but this is a slight risk because the bone can be visualized (either through the wound or surgical intervention) and returned to anatomical position. The other options are possible consequences of this type of injury, but do not represent the most serious complication.
A client with a fractured femur is admitted to the nursing unit. Which assessment finding requires follow up by the nurse? Select all that apply. a) "I have a pins-and-needles sensation in my toes." b) "I cannot seem to catch my breath." c) Dorsiplantar weak and unequal bilaterally d) Both feet warm with capillary refill < 3 seconds e) T 101.2 degrees F; HR 110; RR 28; pulse oximetry 90%
• "I have a pins-and-needles sensation in my toes." • T 101.2 degrees F; HR 110; RR 28; pulse oximetry 90% • Dorsiplantar weak and unequal bilaterally • "I cannot seem to catch my breath." Fat embolism syndrome and compartment syndrome are complications of a fracture, especially of the long bones. Dyspnea, tachycardia, tachynea, fever, and low pulse oximetry would be indicators of fat embolism syndrome. Paresthesia (pins-and-needles sensation), limited motion, and motor weakness would be indicators of compartment syndrome. Capillary refill less than 3 seconds is a normal finding.
A patient sustained an open fracture of the femur 24 hours ago. While assessing the patient, the nurse observes the patient is having difficulty breathing, and oxygen saturation decreases to 88% from a previous 99%. What does the nurse understand is likely occurring with this patient? a) Spontaneous pneumothorax b) Pneumonia c) Cardiac tamponade d) Fat emboli
Fat embolism 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.
Which nursing intervention is appropriate for a patient with a closed reduction extremity fracture? a) Administering prescribed enema to prevent constipation b) Using frequent dependent positioning to prevent edema c) Promoting intake of omega-3 fatty acids d) Encouraging participation in ADLs
Encouraging participation in ADLs General nursing measures for a patient 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 patient for self-care. Omega-3 fatty acids have no implications on the diet of a patient with a fracture reduction. Dependent positioning may increase edema since the extremity is below the level of the heart. While some pain medications may contribute to constipation, this intervention would be reserved for a patient experiencing constipation and not as a preventative measure.
Which nursing intervention is essential in caring for a client with compartment syndrome? a) Wrapping the affected extremity with a compression dressing to help decrease the swelling b) Starting an I.V. line in the affected extremity in anticipation of venogram studies c) Removing all external sources of pressure, such as clothing and jewelry d) Keeping the affected extremity below the level of the heart
Removing all external sources of pressure, such as clothing and jewelry Nursing measures should include removing all clothing, jewelry, and external forms of pressure (such as dressings or casts) to prevent constriction and additional tissue compromise. The extremity should be maintained at heart level (further elevation may increase circulatory compromise, whereas a dependent position may increase edema). A compression wrap, which increases tissue pressure, could further damage the affected extremity. There is no indication that diagnostic studies would require I.V. access in the affected extremity.
Which discharge instruction should a nurse give a client who's had surgery to repair a hip fracture? a) "Don't flex your hip more than 120 degrees, don't cross your legs, and have someone help you put your shoes on." b) "Don't flex your hip more than 30 degrees, don't cross your legs, and have someone help you put your shoes on." c) "Don't flex your hip more than 90 degrees, don't cross your legs, and have someone help you put your shoes on." d) "Don't flex your hip more than 60 degrees, don't cross your legs, and have someone help you put your shoes on."
"Don't flex your hip more than 90 degrees, don't cross your legs, and have someone help you put your shoes on." Falls in the home cause most injuries among the elderly. Elderly clients should take measures to decrease the clutter that can contribute to falls, such as removing objects such as throw rugs from the floor. Elderly clients should also install grab bars in the shower and next to the toilet. The threat of fire makes burglar bars on every window impractical.
Which of the following terms refers to a fracture in which one side of a bone is broken and the other side is bent? a) Avulsion b) Oblique c) Spiral d) Greenstick
Greenstick A greenstick fracture is a fracture in which one side of a bone is broken and the other side is bent. A spiral fracture is a fracture twisting around the shaft of the bone. An avulsion is the pulling away of a fragment of bone by a ligament or tendon and its attachment. An oblique is a fracture occurring at an angle across the bone.
Which of the following is a factor that inhibits fracture healing? a) Maximum bone fragment contact b) Exercise c) Vitamin D d) Local malignancy
Local malignancy Factors that inhibit fracture healing include local malignancy, bone loss, and extensive local trauma. Factors that enhance fracture healing include proper nutrition, vitamin D, exercise, and maximum bone fragment contact.
A client who has suffered a compound fracture is preparing for discharge to home. During the teaching session, the client asks why he needs antibiotics for a broken bone. Which response by the nurse is most appropriate? a) "The antibiotics will help the bone to heal." b) "If your temperature is normal for 48 hours, you may discontinue the medication." c) "Antibiotic therapy has been prescribed as a precaution because your bone was exposed to the environment at the time of your injury." d) "You may discuss your prescriptions with your physician at your follow-up appointment."
"Antibiotic therapy has been prescribed as a precaution because your bone was exposed to the environment at the time of your injury." The nurse should tell the client that antibiotics are prescribed as a preventive measure for a client with a compound fracture because such fractures expose the bone to the environment and possible infection. Telling the client to discuss his medications with the physician at his follow-up appointment doesn't address the client's questions or immediate needs. The client needs this medication regardless of his body temperature. Antibiotics don't help a bone fracture to heal.
A patient sustains an open fracture with extensive soft tissue damage. The nurse determines that this fracture would be classified as what grade? a) IV b) III c) I d) II
III 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.
Which nursing diagnosis takes highest priority for a client with a compound fracture? a) Impaired physical mobility related to trauma b) Imbalanced nutrition: Less than body requirements related to immobility c) Activity intolerance related to weight-bearing limitations d) Risk for infection related to effects of trauma
Risk for infection related to effects of trauma A compound fracture involves an opening in the skin at the fracture site. Because the skin is the body's first line of defense against infection, any skin opening places the client at risk for infection. Imbalanced nutrition: Less than body requirements is rarely associated with fractures. Although Impaired physical mobility and Activity intolerance may be associated with any fracture, these nursing diagnoses don't take precedence because they aren't as life-threatening as infection.
Which patient(s) is most likely to have compartment syndrome after sustaining a fracture? Select all that apply. a) The patient using ice for pain control in the extremity b) The patient with hemorrhage in the site of injury c) The patient with a plaster cast applied immediately after injury d) The patient who sustained a clavicle fracture e) The patient with elevated pressure level within the muscles
• The patient with elevated pressure level within the muscles • The patient with a plaster cast applied immediately after injury • The patient with hemorrhage in the site of injury Compartment syndrome occurs when the normal pressure of a compartment is altered in cases of fracture by the force of the injury itself, by development of edema, or by hemorrhaging at the site of the injury, which increases the contents of the compartment, or from outside pressure caused by constriction from a dressing or cast. A patient with elevated muscle pressure is at risk for compartment syndrome. The application of a plaster cast immediately after the injury places the patient at risk for compartment syndrome because the cast will not allow for edema and therefore will compress the tissue. Clavicle fractures are not a risk factor for compartment syndrome due to the location of the fracture. Ice will assist in decreasing the edema and may help prevent compartment syndrome.
A client is being discharged from the Emergency Department after being diagnosed with a sprained ankle. Which client statement indicates the client understands the discharge teaching? a) "I'll make sure to keep my ankle elevated as much as possible." b) "I'll get the prescription filled for the narcotic pain reliever." c) "I'll start with ice for the first couple of hours and then apply heat." d) "I need to stay off my ankle for at least the next 3 to 4 weeks."
"I'll make sure to keep my ankle elevated as much as possible." Treatment consists of applying ice or a chemical cold pack to the area to reduce swelling and relieve pain for the first 24 to 48 hours. Elevation of the part and compression with an elastic bandage also may be recommended. After 2 days, when swelling no longer is likely to increase, applying heat reduces pain and relieves local edema by improving circulation. Full use of the injured joint is discouraged temporarily, not necessarily three to four weeks. Nonsteroidal anti-inflammatory drugs (NSAIDs) are typically recommended; narcotic analgesics typically are not prescribed.
The nurse is caring for a client who was involved in an automobile accident and sustained multiple trauma. The client has a Volkmann's contracture to the right hand. What objective data does the nurse document related to this finding? a) Extension of the fingers of the right hand b) Clawlike deformity of the right hand without ability to extend fingers c) Nodules on the knuckles of the third and fourth finger d) Dislocation of the fingers
Clawlike deformity of the right hand without ability to extend fingers A Volkmann's contracture is a claw like deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. The client is unable to extend the fingers and complains of unrelenting pain, particularly if attempting to stretch the hand. Nodule on the knuckles and dislocation are not indicative of Volkmann's contracture.
Radiographic evaluation of a client's fracture reveals that a bone fragment has been driven into another bone fragment. The nurse identifies this as which type of fracture? a) Impacted b) Greenstick c) Comminuted d) Compression
Impacted An impacted fracture is one in which a bone fragment is driven into another bone fragment. A comminuted fracture is one in which the bone has splintered into several fragments. A compression fracture is one in which bone has been compressed. A greenstick fracture is one in which one side of the bon is broken and the other side is bent.
A client with metastatic bone cancer sustained a left hip fracture without injury. What type of fracture does the nurse understand occurs without trauma or fall? a) Compound fracture b) Pathologic fracture c) Transverse fracture d) Impacted fracture
Pathologic fracture A pathologic fracture is a fracture that occurs through an area of diseased bone and can occur without trauma or a fall. An impacted fracture is a fracture in which a bone fragment is driven into another bone fragment. A transverse fracture is a fracture straight across the bone. A compound fracture is a fracture in which damage also involves the skin or mucous membranes.
A patient falls while skiing and sustains a supracondylar fracture. What does the nurse know is the most serious complication of a supracondylar fracture of the humerus? a) Volkmann's ischemic contracture b) Paresthesia c) Malunion d) Hemarthrosis
Volkmann's ischemic contracture The most serious complication of a supracondylar fracture of the humerus is Volkmann contracture (an acute compartment syndrome), which results from antecubital swelling or damage to the brachial artery (Chart 43-3).
A fracture is termed pathologic when the fracture a) presents as one side of the bone being broken and the other side being bent. b) results in a pulling away of a fragment of bone by a ligament or tendon and its attachment. c) occurs through an area of diseased bone. d) involves damage to the skin or mucous membranes.
occurs through an area of diseased bone. Pathologic fractures can occur without the trauma of a fall. An avulsion fracture results in a pulling away of a fragment of bone by a ligament or tendon and its attachment. A greenstick fracture presents as one side of the bone being broken and the other side being bent. A compound fracture involves damage to the skin or mucous membranes.
When providing discharge teaching to a client with a fractured toe, the nurse should include which instruction? a) Perform ankle dorsiflexion three times per day. b) Apply heat to the fracture site. c) Use crutches for 1 week. d) Apply ice to the fracture site.
Apply ice to the fracture site. Applying ice to the injury site soon after an injury causes vasoconstriction, helping to relieve or prevent swelling and bleeding. Applying heat to the fracture site may increase swelling and bleeding. Ankle dorsiflexion has no therapeutic use after a toe fracture. It's unlikely the client would need crutches after a toe fracture.
Emergency medical technicians transport a client to the emergency department. They tell the nurse, "He fell from a two-story building. He has a large contusion on his left chest and a hematoma in the left parietal area. He has a compound fracture of his left femur and he's comatose. We intubated him and he's maintaining an arterial oxygen saturation of 92% by pulse oximeter with a manual-resuscitation bag." Which intervention by the nurse has the highest priority? a) Assessing the pupils b) Assessing the left leg c) Assessing level of consciousness (LOC) d) Placing the client in Trendelenburg's position
Assessing the left leg In this scenario, airway and breathing have been established, so the nurse's priority should be circulation. With a compound fracture of the femur, there is a high risk of profuse bleeding; therefore, the nurse should assess the left leg. Neurologic assessment of the pupils and LOC are secondary concerns to airway, breathing, and circulation. The nurse doesn't have enough data to warrant putting the client in Trendelenburg's position.
