Iggy Mobility

What is the typical pattern seen on an x-ray for an osteosarcoma?

A "sunburst" pattern; the center of the tumor is sclerotic, and surrounding tissue involvement extends into and through the bone cortex creating a sunburst appearance.

What physiologic process occurs in a patient with acute compartment syndrome? SELECT ALL THAT APPLY: a. release of histamine b. pressure on nerve endings c. decrease of capillary pressure d. decrease in lactic acid production e. increase in compartment pressure

A, B, E

The nurse is assessing a patient diagnosed with acute osteomyelitis. When assessing the patient, which of the following symptoms does the nurse expect to find? a. Temperature greater than 101* F. b. Drainage from the affected area c. Swelling around the affected area d. Erythema around the affected area e. Pulsating pain that worsens with movement f. Ulceration of the skin resulting in a sinus tract

A, C, D, E (B and F are symptoms of *chronic* osteomyelits)

A patient with chronic osteomyelitis is being discharged from the hospital. What information is important for the nurse to teach this patient and family? SELECT ALL THAT APPLY a. Adherence to the antibiotic regimen b. Correct IM injection technique c. Eating high-protein and high-carbohydrate foods d. Keeping daily follow-up appointments e. Proper use of the IV equipment

A, C, E: The patient with chronic osteomyelitis will be going home on a long-term antibiotic regimen. First, it will be IV, then it will transition to oral. Patient needs to know IV care and administration. Follow ups will not be daily. Antibiotics are not administered IM.

What physiologic change related to acute compartment syndrome is responsible for symptoms of flexed posture and unequal pulses in a patient? a. Increased production of lactic acid. b. Anaerobic metabolism c. Pressure on nerve endings d. Increased capillary permeability

A. Increased production of lactic acid may create these symptoms.

A patient has a metastatic bone tumor in the left leg. What action by the nurse is appropriate? a. Administer pain medication as prescribed. b. Elevate the extremity and apply moist heat. c. Teach the patient about amputation care. d. Place the client on protective precautions.

A. Pain medication should be given to control metastatic bone pain. Elevation/heat may not be helpful. Protective precautions are not needed for this patient.

A patient who had a fractured femur repair reports new-onset shortness of breath and increased respirations. Which is the nurse's FIRST action? a. Place the patient in High Fowler's position. b. Document the client's oxygen saturation level. c. Start oxygen therapy at 2L/min via nasal cannula d. Contact the primary health care provider.

A. The client is experiencing respiratory distress which could be caused by fat embolus, anxiety, or pulmonary embolus.

A patient had an arthroscopy 1 hour ago on the L knee. The nurse finds the lower L leg to be pale and cool, with a +1 pedal pulse. What action would the nurse perform *first*? a. Assess the neurovascular status of the R leg. b. Document the findings in the patient's chart. c. Elevate the left leg on at least 2 pillows. d. Notify the primary health care provider immediately.

A. The nurse would compare the findings of the two legs as these findings MAY be normal for the patient. If a difference is observed, the nurse would THEN notify the PCP. Elevating the L leg will not improve perfusion if there is a problem.

What is a complication from a long bone fracture with an order of "no weight bearing?"

Anemia: long bones need weight to stimulate the production of red blood cells. Without the weight, the blood cell production drastically reduces.

Which complication can result from a fracture? SELECT ALL THAT APPLY: a. swelling b. infection c. hemorrhage d. callus formation e. inadequate arterial perfusion f. acute compartment syndrome

B, C, E, F: Callus formation is a normal stage in bone remodeling and not a complication. Swelling is common in fracture trauma, but not a complication.

What is a common sign associated with compartment syndrome that has progressed to the point of muscle/nerve cell destruction? a. Shortness of breath b. Tingling of extremities c. Dark reddish brown urine d. Tachycardia

C. Dark reddish brown urine develops as a result of myoglobinemia, which is caused by the destruction of muscle and nerve cells. Myoglobinemia obstructs the renal tubules which causes Acute Kidney Injury and Acute Tubular Necrosis in the kidneys.

What type of diet would be suggested for a patient with a bone fracture to promote healing? a. Low-fat, high fiber b. Low-fat, High protein c. High protein, high calcium d. High calcium, high carbohydrate

C. High protein and high calcium promote tissue and bone healing.

A patient has sustained a closed fracture and has just had a cast applied to the affected arm. The patient is complaining of intense pain. The nurse elevates the limb, applies an ice pack, and administers an analgesic, with little relief. Which problem may be causing this pain? a. Infection under the cast b. The anxiety of the patient c. Impaired tissue perfusion d. The recent occurrence of the fracture

C. Most pain associated with fractures can be minimized with rest, elevation, application of cold, and administration of analgesics. Pain that is not relieved by these measures should be reported to the PCP because pain unrelieved by medications and other measures may indicate neurovascular compromise.

A nurse is caring for four patients. After the hand-off report, which patient would the nurse see first? a. Patient with osteoporosis and a WBC count of 27,000/mm3 b. Patient with osteoporosis and a bone fracture who requests pain medicine. c. Post-microvascular bone transfer client whose distal leg is cool and pale. d. Patient with suspected bone tumor who just returned from having a spinal CT.

C. Patient C is the priority because the assessment findings indicate a critical lack of perfusion. A high WBC count is expected in a patient with osteoporosis.

Characterized by dull pain and swelling for long periods of time, this type of primary tumor is drug resistant, affects pelvis and proximal femur areas; destroys bone and calcifies, affects children or middle age/older adults.

Chondrosarcoma

Denosumab is a RANKL inhibitor approved for metastatic bone disease. What important education does the nurse need to provide regarding this medication? a. Use SPF if you are going to be outside b. Medication may cause photophobia. c. Patient should return for follow up visit every 6 months for injection of medication d. Do not drink grapefruit juice on this medication.

Come back every 6 months for the injection.

Rhabdomyelitis, Amputation, Myoglobinuria Renal Failure are all complications that can arise from which syndrome?

Compartment Syndrome

What type of injury is the most at risk for compartment syndrome?

Crush injuries

Which action would the nurse take for a patient with osteomyelitis who recently underwent a sequestrectomy with bone grafts? a. Assess the apical pulse every shift. b. Assess pain level every shift. c. Place the affected extremity flat on the bed. d. Perform frequent neurovascular checks.

D. Patient will experience increased swelling after the surgical procedure; nurse will need to make sure that swelling does not create a complication.

What are the two ways compartment syndrome can occur?

Decreased compartment size related to restrictive dressings, splints, or casts, excessive traction, premature closure of fascia; Increased compartment contents related to bleeding, inflammation, edema, or IV infiltration.

What are three procedures that can be done for non-union of bone?

Electrical bone stimulation, bone graft, low-intensity pulsed ultrasound.

Known as the most malignant primary tumor; it affects the pelvis and lower extremities (or the medullary areas of long bones); affects age group of kids to early 20s; common symptoms are fatigue, pallor, pain, swelling, low-grade fever, leukocytosis, and anemia.

Ewing sarcoma

True or False: A wide resection is the removal of lesion and entire muscle, bone, and other tissues involved in the bone cancer.

False: A RADICAL resection is described, which is used for high-grade tumors. A wide resection is the removal of the lesion plus intact cuff of normal tissue with 6-7cm margin. This is for low grade tumors only.

True or false: Microwave ablation is used as a curative measure for bone cancer.

False: MWA kills targeted tissue with microwaves and generates only pain relief or control. It is a palliative treatment, not curative.

This tumor has gradual presentation without symptoms. When symptoms do manifest, there will be localized tenderness, possibly a palpable mass, and it will affect the long bones of the legs.

Fibrosarcoma; the MFH or malignant fibrous histiocytoma is the most malignant of this class of tumor.

What are the three chemotherapy drugs used in the treatment of bone cancer?

Methotrexate, Cisplatin, Doxorubicin

Fifty percent (50%) or better of all cases of this type of bone tumor occur in the distal femur, proximal tibia, and humerus. Tumor is large, with acute pain and swelling; the involved area is warm.

Osteosarcoma

What is the most common metastatic bone tumor?

Osteosarcoma

What symptom differentiates a fat emboli from a venous emboli?

Petechiae

What are the six P's of neurovascular checks?

Pulselessness, Pallor, Paresthesia, Paralysis, Pain, Pressure. PAIN is the first symptom!

What diagnostic test would be conducted to test specifically for bone cancer? What lab test results would indicate bone cancer?

Radionuclide bone scan--these are done when the primary lesion is identified to detect metastatic lesions BEFORE they are visible on x-ray; increased levels of ALP and calcium

What is a contraindication to a radionuclide bone scan?

Shellfish, seafood, or iodine allergy

True or False: Bone-seeking cancers are prostate, breast, kidney, thyroid and lung

True

True or false: Bone tumors are more likely to be seen as secondary than primary cancers.

True: Bone tumors are usually the result of the metastasis of other cancers.

The nurse is caring for a client being treated for fat embolus after multiple fractures. Which data would the nurse evaluate as *most* favorable of the resolution of the fat embolus? a. Clear mentation b. Minimal dyspnea c. Oxygen saturation of 85% d. Arterial oxygen level of 78mmHg

a. An altered mental state is an early indication of fat emboli; therefore, clear mentation is a good indicator that a fat embolus is resolving. Eupnea, not minimal dyspnea, is a normal sign. Arterial oxygen levels should be 80-100mmHg, Oxygen saturation levels should be higher than 95%.

Which is a key feature of acute osteomyelitis? a. fever b. foot ulcer c. localized pain d. sinus tract formation

a. Fever above 101*F, swelling around the affected area, and erythema of the affected area are some of the key features of *acute* osteomyelitis. Foot ulcers, localized pain, and sinus tract formation are features of *chronic* osteomyelitis.

A patient with bone cancer is hospitalized for a limb salvage procedure. How can the nurse best address the patient's psychosocial needs? a. Assess the patient's coping skills and support system. b. Explain that the surgery leads to longer life expectancy. c. Refer the patient to the hospital social worker or chaplain. d. Reinforce physical therapy to aid with ambulating normally.

a. The first step in the nursing process is assessment!

A nurse assesses an older patient who was admitted 2 days ago with a fractured hip. The nurse notes the patient is confused and restless with an oxygen saturation level of 88%. Which action would the nurse take *first*? a. Administer oxygen via nasal cannula. b. Re-position to a semi-Fowler's postion. c. Increase the IV flow rate. d. Assess response to pain medication.

a. The patient is at high risk for fat embolus or pulmonary embolus. Although both are life-threatening emergencies, the nurse would first apply oxygen then notify the PCP. Oxygen admin can reduce the potential for brain damage associated with hypoxia.

A 30 year old patient sustains a fractured hip and experiences hypoxemia, dyspnea, and crackles. Which complication does the nurse suspect from these findings? a. Venous thromboembolism (VTE) b. Fat embolism syndrome (FES) c. Acute compartment syndrome (ACS) d. Complex regional pain syndrome (CRPS)

b. Fat embolism syndrome. The other options do not have hypoxemia, dyspnea, or crackles as symptoms.

The nurse cares for a patient with a recently fractured tibia. Which assessment would alert the nurse to take *immediate* action? a. Pain of 4 on a 1-10 scale b. Numbness in the extremity c. Swollen extremity at the injury site d. Feeling cold while lying in bed.

b. The patient with numbness and/or tingling of the extremity may be exhibiting the first signs of acute compartment syndrome.

What physiologic change causes PALLOR in acute compartment syndrome? a. increased tissue pressure b. decreased oxygen to tissues c. pressure on nerve endings d. increased capillary permeability

b. pallor results from decreased oxygen to tissues.

How soon does ischemia start to develop after the onset of compartment syndrome? a. 30 minutes b. 1-2 hours c. 4-8 hours d. 24-72 hours

c. 4-8 hours; edema creates obstructive pressure, blocking circulation and causing venous occlusion, ischemia develops from reduced blood flow.

What complication of osteomyelitis is *most* likely to occur? a. Pathologic fractures b. Development of malignancies c. Formation of bone abscesses d. Secondary arthritic changes

c. Formation of bone abscesses

The nurse is assessing a patient with Ewing sarcoma. Which finding does the nurse expect to observe? a. High fever b. Bradycardia c. Leukocytosis d. Migraine headaches

c. Leukocytosis

What occurrence is an early manifestation of fat embolism syndrome? (FES) a. Lethargy b. Headache c. Low Arterial Oxygen d. Petechiae

c. Low arterial oxygen

A patient is scheduled for a right upper extremity amputation. Which statement by the patient's husband indicates an effective coping strategy? a. "I'll try to limit her visitors." b. "The family will avoid direct discussion of my wife's amputation." c. "I'll have to find ways to help my wife focus on positive aspects of her body." d. "My family will use diversional methods to help her not focus on the amputation."

c. Planning to help the patient focus on positive aspects of her body illustrates that the husband is coping with the change in his wife's body image in a positive way.

The nurse is assessing the casted extremity of a client. Which sign is indicative of infection? a. dependent edema b. diminished distal pulse c. presence of "hot spot" on the cast d. coolness and pallor of the extremity.

c. Signs of infection under a casted area include odor or purulent drainage from the cast or the presence of "hot spots" which are areas of the cast that are warmer than others. The primary health care provider should be notified if any of these occur. Signs of impaired circulation in the distal limb include coolness and pallor of the skin, diminished distal pulse, and edema.

The nurse is caring for a patient who had a closed reduction of the left arm and notes a large wet area of drainage on the cast. What is the nurse's *priority* action? a. Cut off the cast b. Document the assessment c. Notify the PCP d. Wrap the cast with gauze

c. The PCP should be notified to come examine the patient and assess the source of the drainage.

The nurse is admitting a client with multiple trauma injuries to the nursing unit. The client has a leg fracture and had a plaster cast applied. Which position would be *best* for the casted leg? a. Elevated 3H, then flat 1H b. Flat for 3H, then elevated 1H c. Flat for 12H, then elevated for 12H d. Elevated on pillows continuously for 24-28H

d. A casted extremity is elevated continuously for the first 24-48H to minimize swelling and promote venous drainage.

In which type of sarcoma does the patient experience dull pain and swelling for a long period of time? a. fibrosarcoma b. osteosarcoma c. Ewing sarcoma d. chondrosarcoma

d. A chondrosarcoma is one of the most common bone sarcomas seen in adulthood. It is usually associated with dull pain and swelling for a long period of time.

With an external fixator, how often are the pin sites assessed? a. Every 2-4 hours b. Every 4-6 hours c. Every 6-8 hours d. Every 8-12 hours

d. Pins should be assessed every shift. Drainage should be clear, and begins to crust in the first 48-72 hours and SHOULD NOT be removed in order to keep the patient infection free.