chapter 41

pagets dx can be identified visually by _____?

-Bowing of the legs -Gait- 1 step then sideways -To dx need a bone biopsy -Xrays

TX of a pagets disease

-NSAIDs, -Calcitonin: slows down bone turnover -bisphosphonates (Fosamax)- rapid reduction in bone turnover and relief of pain -Calcium & Vitamin D - ideal body weight

pain in osteomyelitits is?

-constant/pulsating -worse with movement & better with rest.

Nursing interventions for pt that has undergone surgery to tx lower extremity condition

1-Promoting tissue Perfusion to foot 2-Relieving pain 3-Activity 4-Preventing infection (osteomyelitis) 5-Promoting home and community-based care

causes of osteomyelitits?

1-direct bone contamination 2-hematogeneous (bloodborne spread)spread 3-extension of soft tissue infection

After IV ABX, provider may order ABX orally for up to an additional ____?

3 months

calcitonin TX is evident in ______ through the reduction of bone loss & pain

3-6months

the duration of IV ABX treatment in osteomyelitits is?

3-6wks

if this location is not treated properly tissue death due to anoxia can occur this would be documented as which of the following A avascular necrosis B hetero topic ossification C subluxation D osteomyelitis

A avascular necrosis

which of the following are associated with compartment syndrome select all that apply A cast B crushing injuries C type bandages D surgery E from an accident

A cast B crushing injuries C type bandages D surgery E from an accident

the nurse is assessing a patient's knee the area has a grating sensation this would be documented as which of the following A crepitus B false motion C dislocation D shortening

A crepitus

a bone graft may be used for which of the following reasons select all that apply A defect filling B joint stabilization C reduction of a fracture D stimulation of bone healing in E and provement of motion

A defect filling B joint stabilization D stimulation of bone healing in

which of the following surgical procedures may need to be done if removing a cast or bandage does not restore circulation to the extent extremity A fasciotomy B hemiarthroplasty C bone graph to D open reduction with internal fixation

A fasciotomy

which of the following would be included in the teaching plan for a patient who has undergone a hip replacement A never cross legs when seated B keep the knees together at all times C been straightforward to pick up an object on the floor D avoid using a pillow between the legs when sleeping

A never cross legs when seated

tetanus prophylaxis will be administered in the emergency department if the last known booster it was within which time frame A over 5 years ago B over 3 years ago C over 4 years ago. D Over 2 years ago

A over 5 years ago

Morton's neuroma is

A swelling of the third (lateral) branch of the median plantar nerve

which of the following is a clinical manifestation of a pulmonary emboli A tachycardia B bradycardia C hypothermia D braidypnea

A tachycardia

Which of the following places the pt at risk for impaired wound healing after surgery for a primary bone cancer? (select all that apply) A. radiation therapy ̈B. prealbumin level 28 mg/dL ̈C. weight loss of 18% over the previous 3 months D. anorexia

A, C, D

• Plantar fasciitis is :

An inflammation of the foot-supporting fascia

which of the following musculoskeletal injuries is manifested by Acro Neo clavicle joint pain A acute compartment syndrome B rotator cuff tears C epicondylitis D heterotrophic ossification

B rotator cuff tears

the majority of cases of osteomyelitis are caused by which of the following organisms A proteus B staphylococcus aureus C pseudomonas D escheria coli

B staphylococcus aureus

A 25 yr old woman experienced an open fracture of the right fibula with major soft tissue damage of her lower leg in a motor vehicle accident. Surgical reduction and fixation of the fibula were performed with debridement of a nonviable tissue and drain placement in the damaged soft tissue. Which of the following complications is this pt at risk for? a) Osteoporosis b) Osteomyelitis c) Fat embolism d) Compartment syndrome

B, C.

Which of the following assessment findings may indicate to the nurse an acute peripheral neurovascular dysfunction for the pt recovering from surgery of the foot? A. pale skin, atrophy of the limb, with cap refill of 2 seconds B. absence of feeling, cap refill of 4-5 seconds, and cool skin C. atrophy of limb, increased motion, and thickened toe nails D. pale skin, weakness in motion and loss of toe hair `

B. absence of feeling, cap refill of 4-5 seconds, and cool skin

patients who have open fractures should have systemic antibiotics ordered an administered within which time frame from time of energy A 5 hours B 6 hours C 3 hours D 4 hours

C 3 hours

which of the following Solutions maybe the most effective and cleansing pin sights A hibiclens B peroxide C chlorhexidine D alcohol

C chlorhexidine

which type of fracture produces several bone fragments A oblique B incomplete C open D comminuted

D comminuted

which of the following is a term used to describe a soft tissue injury produced by A blunt force a sprained B Hematoma C strain D contusion

D contusion

which of the following types of fractures is associated with osteoporosis A oblique B stress C simple D decompression

D decompression

which of the following disorders result in widespread Hemorrhage in micro thrombosis with ischemia A complex regional pain syndrome B fat embolism syndrome C a vascular necrosis or D disseminated intravascular coagulation

D disseminated intravascular coagulation

when evaluating the hypovolemic shock the nurse should be aware of which of the following clinical manifestations A hypertension B bradycardia C bounding pulse D hypotension

D hypotension

which type of fracture involves a breakthrough only part of the cross section of the bone A open B, nuded C oblique D incomplete

D incomplete

The infectious process that characterizes osteomyelitis is frequently exacerbated by inadequate calcium and/or vitamin D intake.

FALSE good for bone health but not the infectious process

true or false The infectious process that characterizes osteomyelitis is frequently exacerbated by inadequate calcium and/or vitamin D intake.

FALSE-good for bone health but not the infectious process

causes of hallux valgus?

Ill fitting shoes Heredity Aging

_________is A disorder of localized rapid bone turnover, most commonly affecting the skull, & Long bones (femur, tibia, pelvic bones, and vertebrae)

Paget's Disease

Symptoms of mortons neuroma?`

Throbbing burning pain in the foot that is Relieved at rest

Paget's Disease is caused by

a primary proliferation of osteoclasts

Which client is at highest risk for the development of plantar fasciitis? a) Marathon runner b) Teenager who plays baseball c) Older adult who walks with a walker QID d) Adult client confined to a wheelchair

a) Marathon runner

The pt diagnosed with plantar fasciitis is given what instructions regarding self care for this condition? a) Perform gentle stretching exercises b) Wear loose or open toed shoes as often as possible c) Rest, elevate the lower extremities and use warm packs d) Do not use orthotics

a) Perform gentle stretching exercises

with plantar fascitis pts report _____ pain that is worse ____

acute onset heel pain; worse in the morning

The pt is having diagnostic testing to determine the probability of Paget's disease. If the disease is present, which laboratory result does the nurse expect to see? a) slightly decreased serum calcium level b) increased serum alkaline phosphate (because of overactive osteoclasts) c) decreased pyridinium d) absence of osteocalcin

b) increased serum alkaline phosphate (because of overactive osteoclasts)

The nurse is assessing the pt who reports moderate bone pain in the hip and has a family history of Paget's disease. In performing a musculoskeletal assessment, the nurse pays particular attention to which element? a) size and shape of the skull b) long-bone bowing in the legs c) asymmetrical deformity of the upper extremities d) loose teeth and difficulty chewing

b) long-bone bowing in the legs

a hallux valgus is a ____?

bunion

The nurse is caring for the pt with osteomyelitis. Which laboratory results are of primary concern for this disorders? a) bone specific alkaline phosphatase and osteocalcin b) serum calcium level and alkaline phosphatase c) WBC count and ESR d) Thyroid function and uric acid levels

c) WBC count and ESR

The RN is teaching the pt about abx therapy for osteomyelitis. What information does the nurse give to the pt? a) single agent therapy is the most effective b) chronic osteo. May require 1 month of abx therapy c) pt usually remain hospitalized to complete the full course of abx d) the infected wound may be irrigated with one or more types of abx solution

d) the infected wound may be irrigated with one or more types of abx solution

hallux valgus (bunion) is ?

deformity where great toe deviates laterally

Symptoms of Paget's disease

elevated ALP

if plantar fascitis is left untreated it can result in ____?

heel spurs

Which assessment finding would the nurse expect in a client diagnosed with acute osteomyelitis? A. leukocytosis and localized bone pain ̈B. leukopenia and elevated SED rate ̈C. leukopenia and elevated fever ̈D. petechia over the chest and abnormal ABG results

localized bone pain, elevated sed rate, fever

_____ is an Infection of the bone

osteomyelitis

Symptoms of osteomyelitis

red/swelling/pain -elevated WBC (except in elderly & immunocomprimised) -constant pulsating pain

calcitonin is administered ___ or ___?

subQ or intranasally

A bunion that fails to respond to conservative treatment often requires surgical correction.

true

The pt comes to the ED after accidentally puncturing his hand with a automatic nail gun. Which disorder is this pt at risk for? • A. osteoporosis • B. osteomyelitis • C. osteomalacia • D. Dupuytren's contracture

• B. osteomyelitis