musculoskeletal & cast care study cards exam 4

Is it normal for your liver and kidneys to decline with age?

Yes; resulting in reduced metabolism and excretion of drugs =greater peak effect and longer duration of analgesics.

Prior too puberty, what does overly secretion and under secretion of growth hormone cause?

too much=gigantism too little=dwarfism

Impaired ______________ is a major threat to mobility and physical safety and contributes to a fear of falling and self-imposed activity restrictions.

balance

_______ casts encircles the trunk of the body.

body

Vitamin D is a hormone that controls ___________ levels in the blood.

calcium *Vitamin D is essential to the proper ABSORPTION of calcium. -they work together, with levels that rise and fall TOGETHER. Calcium and Vit D are a team.

calcium and PTH(parathyroid hormone) are used to balance out _____________ and ___________ levels in the blood.

calcium and phosphorus *if serum calcium is low, pth is increased, causing calcium to leave bone(by stimulating osteoclasts to break down calcium from bone) and enter blood stream. ORRRR pth can reduce the renal excretion of calcium and facilitates its absorption from the *INTESTINE*. *if too much calcium is in the blood, calcitonin is increased which will cause calcium to be excreted from the body via kidneys(also prevents calcium bone resorption).

Who has an increased risk for impaired skin integrity due to the loss of elasticity of the skin and decreased sensations?

Elderly/Old adult

3 types of joints & describe them giving one example each:

(synarthrodial) immovable-cranium (amphiarthrodial) slightly movable-pelvis (diarthrodial-synovial) freely movable-elbow and knee

Knock-knee vs Bowlegs:

*Both conditions are caused by Rickets* ~Knock-Knee=legs curved inward so knees come together as person walks. ~Bowlegs(genuvarum)=one or both legs bent outward at knee, which is normal until 2-3 years of age.

___________ pain is ongoing or recurrent pain that lasts beyond the usual course of an acute illness or the healing of an injury and that adversely affects an individual's well-being.

*Chronic pain* -It does not always have an identifiable cause and leads to great person suffering.

#1 Nursing intervention with a patient who is showing signs of skin breakdown: what should be increased.

*Increase frequency of turning and repositioning.* ~Place a turn schedule above patients bed.

Health promotion and disease prevention r/t fractures.

*Similar to osteoporosis.* -Ensure good intake of calcium and vit D. -weight bearing exercises=good -monitor for development of osteoporosis, especially in post menopausal clients and clients who have a thyroid disorder. -prevent injuries by keeping home life clean/free of obstacles and wear seat belts and helmets when necessary.

Immobile Osteoporotic Patients R/t Cardiovascular system: Immobilization frequently results in Orthostatic Hypotension. What is Orthostatic Hypotention?

- a drop in either 20 systolic or 10 diastolic (remember 20/10) within 3 minutes of rising to an upright position.

Complete versus incomplete fracture: describe

-A complete fracture goes through the entire bone dividing it into two parts. -An incomplete fracture goes through part of the bone.

R/T Immobile patients: Valsalva's Maneuver HURTS Patients

-A nursing intervention that reduces cardiac workload involves instructing patients to AVOID using a Valsalva's Maneuver when moving up in bed, defecating, or lifting household objects. During Valsalva maneuver a patient *holds his or her breath and strains*, which increases intrathoracic pressure and in return decreases venous return and cardiac output immediately increase, and systolic blood pressure and pulse pressure rise. This pressure changes produce a reflex BRADYCARDIA and possible DECREASE IN BP that can result in CARDIAC DEATH in patients with *heart disease*. -Valsalva's maneuver=holding breath during activities or poopy time=increased heart workload, low pulse and low BP=death for cardiac patients.

What is fitted underneath of the plaster cast? && what is placed over the affected area to maintain skin integrity r/t any cast?

-A stockinette is fitted/placed under the plaster cast. -A web roll is placed over the affected area to maintain skin integrity.

Pre-op nursing care for a patient with a bone fracture includes: R/T neuro checks and pain meds.

-Assess pain frequently and follow pain management protocols, both pharmacological and nonpharmacological. -*perform neuro checks at least every hour & report any neuro status change to the provider immediately*

Describe grade 1 grade 2 & grade 3 open (compound) fracture:

-Grade 1: minimal skin damage. -Grade 2: damage include skin and muscle contusions but without extensive soft tissue injury. -Grade 3: damage is excessive to skin muscles nerves and blood vessels.

List long-term ways that chronic pain can affect a persons lifestyle.

-It can affect a persons activity(eating, sleeping, socialization), thinking (confusion, forgetfulness), emotions (anger, depression, irritability), quality of life, and productivity. *Encourage your patients to accept pain-management therapies so that they remain active and continue to maintain daily activities.

How does effective pain management relate to a surgical patient becoming mobile again?

-It has been proven to help patients to achieve earlier mobilization and return to their baseline functional activity levels. Pain Management=Good Thing to improve patients condition more quickly.

After getting cast put on, what care should be given r/t neuro checks and ice/heat?

-Neuro checks should be given every hour for the first 24 hours. *ICE* should be applied for first 24-48 hours.

How do albumin levels being low affect elderly people when it comes to taking analgesics?

-Older adults frequently eat poorly, which results in low-albumin levels. Many analgesics are protein bound. (remember albumin is a protein found in the liver) -In the presence of low serum albumin, more free drug is available, thus increasing the risk for side effects or toxic effects.

Skeletal vs bucks traction:

-Skeletal traction=applied surgically for long bone alignment (femur/tibia) . -bucks traction=temporarily applied to align hip fracture.

R/T Patient centered care; how should a fractured/injured limb be treated/placed?

-Splint above and below affected fracture. -maintain proper alignment of the affected extremity. -Elevate the limb above the heart and APPLY ICE. -Assess for bleeding and apply PRESSURE if needed. -Cover open wounds with STERILE dressing.

Capsaicin: what is it, how and when is it applied & how frequently?

-Topical cream that is applied 3 to 4 times daily, Provides temporary pain relief by blocking some pain impulses. Causes brief burning sensation after applications so avoid touching face and eyes and wear gloves during application.

What is traction used for? What should be included in the prescription?

-Traction uses a pulling force to promote and maintain alignment of the injured areas. -Traction prescriptions should include the type of traction, amount of weight, and whether traction can be removed for nursing care.

What is a joint contracture, and how can they be caused?

-an abnormal and possibly permanent condition characterized by fixation of a joint. -can be caused by disuse, atrophy, and shortening of the muscle fibers. *Early prevention of contractures is essential*

Displaced vs Nondisplaced fracture: define

-displaced fracture=bone fragments that are NOT in alignment. -nondisplaced fracture=bone fragments fragments that remain in alignment.

plaster cast vs synthetic fiberglass cast

-plaster cast sucks-heavy-not waterproof-takes 1-3 days to dry. -fiberglass cast=good-water proof-light weight-most commonly used-dries in 30 minutes

A nurse is helping a patient perform active assisted range of motion in the right elbow. Which statement describes the correct technique? 1. Support elbow by holding distal part of extremity. 2. Grasp joint with fingers to provide support. 3. Have patient move joint freely. 4. Move the joint past the point of resistance. 5. Perform the exercise a few times only, and gradually build up to more.

1 1. Support elbow by holding distal part of extremity.

how many fingers width should be able to fit between a cast and the body?

1 finger width between cast and skin *cast should not be too tight*

What are the 4 physiological processes of nociception? List and give an example of each

1) Transduction: Exposure to pressure or heat. 2) Transmission: Occurs after Transduction. Takes that first pain and turns into a new/second pain. After a few seconds the burnt finger began to throb(second pain). 3) Perception: When a person realizes they are hurt and are taking into account of how much and where they are hurt. *when a person is giving awareness and meaning to pain, resulting in a reaction* 4) Modulation: When you're hurt, realize you're hurt and now you're brain is either letting you feel a portion of pain or more pain than you should be feeling. *it's the last phase of feeling pain-when the fight or flight initial "ahh-ohh-f*ck-hot" feeling is over, when your brain is responding to normal stimuli.*

Nursing Intervention for a patient who is developing contractures or has contractures that are worsening?

1)Increase frequency of ROM exercises to affected and immobilized areas *you don't use it you lose it!* 2)Consider physical therapy consult for different positioning.

Goals of Traction (4)

1)Prevent soft tissue injury 2)Realign of bone fragments 3)Decrease muscle spasms and pain 4)Correct or prevent further deformities

The efforts of immobility on the cardiac system include which of the following?(Select all that apply) 1. Thrombus formation 2. Increased cardiac workload 3. Weak peripheral pulses 4. Irregular heartbeat 5. Orthostatic hypotension

1, 2,5 1. Thrombus formation 2. Increased cardiac workload 5. Orthostatic hypotension

A patient is receiving 40 mg of enoxaparin subcutaneously every 12 hours while on prolonged bed rest to prevent thrombophlebitis. Because bleeding is a potential side effect of this medication, the nurse should continually assess the patient for what signs of bleeding? (Select all that apply) 1. Bruising 2. Pale yellow Urine 3. Bleeding gums 4. Coffee ground-like vomitus 5. Light brown stool

1, 3, 4 (bruising, bleeding gums, and coffee ground-like vomitus).

A middle-aged adult patient has limited mobility following a total knee arthroplasty. During assessment, the nurse notes that the patient is having difficulty breathing while lying supine. Which assessment data support a pulmonary issue related to immobility? (Select all that apply) 1. Oxygen saturation of 89% 2. Irregular radial pulse 3. Diminished breath sounds bilateral bases on auscultation 4. BP: 132/84 5. Pain reported at 3 on a scale of 0-10 following medication 6. Respiratory rate of 26

1, 3, 6 1. Oxygen saturation of 89% 3. Diminished breath sounds bilateral bases on auscultation 6. Respiratory rate of 26

A patient has been on bed rest for over 5 days. Which of these findings during the nurse's assessment may indicate a complication of immobility? 1) Decreased Peristalsis 2) Decreased Heart Rate 3) Increased Blood Pressure 4) Increased Urinary Output

1. Decreased Peristalsis

Fat embolism can occur after injury, usually within ___-___ hr following LONG bone fractures or with total joint arthroplasty.

12-48 hours *fat globules From the bone marrow are released into the vasculature and travel to the small blood vessels including those in the lungs, resulting in acute respiratory insufficiency and impaired organ perfusion.

A 46-year old patient is admitted to the ER following an automobile accident. The patient has a pelvic fracture and is ordered on bed rest and placed in an immobilization device to limit further injury until the fracture can safely be repaired. Which measures would be appropriate for this patient to prevent complications of bed rest? (Select all that apply) 1. Administer IV analgesic as ordered 2. Have patient perform incentive spirometer 3. Support patient in active ROM exercises of upper extremities 4. Provide patient a low-calorie diet 5. Apply sequential compression devices to legs

2, 3,5 2. Have patient perform incentive spirometer 3. Support patient in active ROM exercises of upper extremities 5. Apply sequential compression devices to legs

A patient has an order for application of compression stockings. Place the following steps for application of the stockings in the correct order: 1) Place patient's toes into foot of stocking up to the heel; keep smooth. 2) Use tape measure to measure patient's leg for prosper stocking size. 3) Slide stocking up over patient's calf until sock is completely extended. 4) Turn elastic stocking inside out, keeping hand inside holding heel. 5) Slide remaining portion of stocking over patient's foot, covering toes. Be sure foot fits into toe and heel of stocking.

2,4, 1, 5,3 2) Use tape measure to measure patient's leg for prosper stocking size. 4) Turn elastic stocking inside out, keeping hand inside holding heel. 1) Place patient's toes into foot of stocking up to the heel; keep smooth. 5) Slide remaining portion of stocking over patient's foot, covering toes. Be sure foot fits into toe and heel of stocking. 3) Slide stocking up over patient's calf until sock is completely extended.

After getting cast put on, elevate the cast during the first ___ to ___ hours to prevent edema of the affected extremity.

24-48 hours. *elevate arm casts above level of heart* *elevate leg cast on several pillows while resting*

"Virchows Triad" R/T Osteoporosis

3 different ways a thrombus can form and affect a patient. *especially an immobile patient with osteoporosis* -Triad includes: 1)damage to the vessel wall(ex:from surgery) 2)alterations in blood flow(from bedrest) 3)alterations in blood constitute(ex:change in clotting factors or increased platelet activity)

ROM: List 3 types and what importance is of knowing and monitoring clients ROM.

3 types: Active, Active-Assist, and Passive * Assessment of ROM is an important baseline measurement that compares and evaluates whether loss in joint mobility is developing or has occurred. *Collaborate w/physical therapist to set goals and reduce complications.*

An older adult is admitted following a hip fracture and surgical repair. Before ambulating the patient postoperatively on the evening of surgery, which of the following would be the most important to assess? (Select all that apply) 1. Patient's usual dietary intake 2. Time and date of the patient's last Bowel Movement 3. Preadmission activity tolerance 4. Baseline heart rate 5. Patient's home living situation

3, 4 3. Preadmission activity tolerance 4. Baseline heart rate

Place the following steps in the correct order for positioning a patient in the 30-degree lateral side-lying position. 1. Raise side rail and got to the opposite of bed. 2. Lower side rail and flex patient's knee that will not be next to mattress. Keep foot on mattress and place one hand on patient's upper bent leg near hip and other hand on shoulder. 3. Lower HOB flat if patient can tolerate it. 4. Roll patient onto side towards you. 5. Lower side rail and position patient on side of bed opposite the direction towards which patient is to be turned. 6. Place hands under patient's dependent shoulder and bring shoulder blade forward. 7. Place hands under patient's dependent hip and bring hip slightly forward so that angle from hip to mattress is approximately 30 degrees.

3, 5, 1, 2, 4, 6,7 3. Lower HOB flat if patient can tolerate it. 5. Lower side rail and position patient on side of bed opposite the direction towards which patient is to be turned. 1. Raise side rail and got to the opposite of bed. 2. Lower side rail and flex patient's knee that will not be next to mattress. Keep foot on mattress and place one hand on patient's 4. Roll patient onto side towards you. 6. Place hands under patient's dependent shoulder and bring shoulder blade forward. 7. Place hands under patient's dependent hip and bring hip slightly forward so that angle from hip to mattress is approximately 30 degrees.

What is the medication of choice for managing OA(osteoarthritis)? What daily limit should be applied for this drug?

3000 mg of Tylenol max daily. *make sure client education is provided for the fact of Tylenol being in lortabs & should be included in daily Tylenol intake, and can cause the liver damage if daily intake limit is exceeded.

An older-adult patient has been bedridden for 2 weeks. Which of these complaints by the patient indicates to the nurse that he or she is developing a complication of immobility? 1) Increase of appetite 2) Gum soreness 3) Difficulty in swallowing 4) Left ankle joint stiffness

4. Left ankle joint stiffness

A nurse is caring for a client who has a pelvic fracture. The client reports SOB, stabbing chest pain, and feelings of doom. The nurse should identify that the client is experiencing which of the following complications? A) Pneumonia B) Pulmonary embolism C)Tension pneumothorax D)TB

= B) Pulmonary embolism -Immobility following musculoskeletal trauma places the client at an increased risk for pulmonary embolism. The client might also exhibit tachycardia, chest petechiae, and have a decreased SaO2. The nurse should notify the rapid response team immediately.

A nurse is caring for a client who had a below the knee amputation for gangrene of the right foot. The client reports sensations of burning and crushing pain in the toes of the right foot. Which of the following statements should the nurse make? A) This type of pain usually decreases over time as the limb becomes less sensitive. B) Try to look at the surgical would as a reminder that the limb is gone. C) Use a cold compress intermittently to decreases these pain sensations. D) Grief over the lost limb can sometimes cause denial that the limb is gone.

=A) This type of pain usually decreases over time as the limb becomes less sensitive. - The nurse should recognize that the client is reporting phantom limb pain, a frequent complication following amputation. The nurse should instruct the client that the sensation should decrease over time. The nurse should recognize the pain, and handle the limb gently to decrease the risk of triggering pain.

A nurse is assessing a client who is 48 hours post-op following open reduction and internal fixation of a fractured tibia. Which of the following findings should the nurse report to the provider? A) Toes cold to touch B) Serous drainage from the pin sites C) Blanching of the toenail beds with pressure D) Pink tissue around the fixator insertion sites

=A) Toes cold to touch The nurse should monitor for and report manifestations of compartment syndrome following internal fixation. Therefore, the nurse should contact the provider immediately if the client's toes are cold to touch.

Which assessment data are factors that increase the risk for osteoporosis in an older Euro-American female? (select all that apply) A. Drinks 3 to 4 glasses of wine each day B. Sits at a desk all day at her job C. Smokes a pack of cigarettes each day D. Takes a mile-long walk 5 days a week E. Takes 1000 mg acetaminophen for arthritis F. Weighs 110 pounds

=A, B, C, F A. Drinks 3 to 4 glasses of wine each day B. Sits at a desk all day at her job C. Smokes a pack of cigarettes each day F. Weighs 110 pounds *over 3 glasses of wine a day, sedentary lifestyle, smoking, and smaller frame/weight body is more at risk for osteoporosis.

A nurse is assessing a client who has a new diagnosis of osteoarthritis. Which of the following findings should the nurse expect? (Select all that apply) A. Crepitus with joint movement B. Decreased range of motion of the affected side C. Involvement of smaller joints of the body D. Spongy tissue over the joints E. Joint pain that resolves with rest

=A, B, E A. Crepitus with joint movement B. Decreased range of motion of the affected side E. Joint pain that resolves with rest *Reflect: smaller joints/bones are associated with *Osteoporosis*-whereas OsteoARTHRITIS is associated with larger JOINTS, such as the hips and knees. D-spongy tissue is an expected finding of RA(rheumatoid arthritis), which is an inflammatory disease.

A nurse is caring for a client who is in skeletal traction following a femur fracture. The nurse finds the client has slid down toward the foot of the bed and the traction weight is resting on the floor. Which of the following actions should the nurse take? A) Remove some of the weight temporarily to reposition the client to the correct alignment in bed. B) Have the client use a trapeze to pull himself up while ensuring the weight hangs freely. C) Lift the rope off the pulley while the client rocks back and forth to reposition. D) Lift the weight manually while another staff member moves the client up in bed.

=B) Have the client use a trapeze to pull himself up while ensuring the weight hangs freely. -The nurse should ensure that traction weight is hanging freely. The client can use an overhead trapeze bar to move up in bed, or the nurse can assist the client up, making sure to maintain proper alignment of the extremity.

A nurse is assessing a client with RA (Rheumatoid Arthritis). Which of the following assessment findings should the nurse expect? A. Unilateral Joint Involvement B. Ulnar Deviation C. Fractures of the spine D. Decreased sedimentation rate

=B. Ulnar Deviation ~Inflammation in hand joints can make client with RA susceptible to deformity from daily use. ~Ulnar deviation, or lateral deviation of fingers, can occur from opening jars and other similar motions. *remember A described Osteoarthritis-one side affected. RA affects joints bilaterally and symmetrical.

A nurse is providing preoperative teaching for a client who is scheduled for total knee arthroplasty. Which of the following statements by the client should the nurse identify as understanding of the teaching? A) "I will wear a continuous movement machine on my knee for 24 hours" B) "I should avoid taking NSAID medication for pain after surgery" C) "I should wear elastic stockings on both of my legs" D) "I will begin exercising my legs the day after surgery"

=C) "I should wear elastic stockings on both of my legs" -The purpose of elastic stockings is to prevent venous thromboembolism, which is a common complication following orthopedic surgery. Therefore, the nurse should identify this statement as understanding of the teaching. *Side note-post-op exercises should start immediately-even if its with those heel pumps-should not wait a whole day for exercise.

A nurse is caring for a client who is post-op following a total knee arthroplasty and is prescribed a continuous passive motion (CPM) machine and PCA. The client tells the nurse, "I am in so much pain". Which of the following actions should the nurse take first? A) Remind the client to push the button for the PCA device. B) Discuss activities the client may use to distract from the pain. C) Ask the client to describe the characteristics of the pain. D) Pause the PCM machine briefly to apply a cold pack to the client's knee.

=C) Ask the client to describe the characteristics of the pain. *data collection-helps form assessment*

A nurse is caring for a client who is post-op following shoulder surgery. The client has a prescription to keep the affected arm adducted. Which of the following instructions should the nurse provide the client? A) Keep your arm bent at the elbow B) Use a pillow to prop your shoulder up close to your ear C) Hold your arm against the side of your body D) Position your arm with the shoulder at a 90-degree angle

=C) Hold your arm against the side of your body -if you were moving your hands away from the side of your body, like a plane/flying, this would be aBduction. *side note: A is elbow flexion, B is shoulder elevation and D is moving the arm away from the midline of the body.

A nurse in the ER is prepared to discharge a client following a Grade 2 ankle sprain. Which of the following instructions should the nurse plan to give the client? A) Perform passive ROM exercises of the ankle hourly. B) Keep the affected extremity in a dependent position. C) Wrap a loose dressing around the affected ankle. D) Apply cold compress to the extremity intermittently.

=D) Apply cold compress to the extremity intermittently. -Cold minimizes swelling and erythema to the affected area. Therefore, the nurse should instruct the client to apply cold compresses for no more than 20 min at a time.

Subcutaneous emphysema, what is it and when is it heard?

A patient with a fracture has it-heard as air bubbles under the skin. *late finding of fracture *

Simple fracture versus comminuted fracture:

A simple fracture has one fracture line,while a comminuted fracture has multiple fracture line splitting the bone into multiple pieces.

A nurse is assessing a client who is 24 hours postoperative following an above the elbow amputation. Which of the following findings should the nurse identify as the priority? A) Report of muscle spasms B) Inability to get dressed without assistance C) Report of feelings of anger D) Refusal to look at the affected limb

A) report of muscle spasms; because according to Maslows hierarchy of needs, physiological needs are top priority=physical symptoms such as muscle spasms. (ADL's and Feelings are lower on the pyramid)

A nurse is assessing a client who has osteoarthritis of the knees and fingers. Which of the following manifestations should the nurse expect to find? A) Herberdens nodes B) Swelling of all joints C) Small body frame D) Enlarged joint size E) Limp when walking

A, D, E. *A-Herberdens nodes Are enlarged nodules on the distal inter-phalangeal joint of the hands and feet of a client who has osteoarthritis. (B-Swelling of pain of all joints is a manifestation of rheumatoid arthritis) (C-A small body frame is a risk factor for rheumatoid arthritis. Obesity is a risk factor for osteoarthritis.) *D-A client can manifest in large joints due to bone hypertrophy. *E-A client can manifest a limp when walking due to pain from inflammation in the localized joint.

A nurse is providing discharge instructions for a client who is postoperative following inner maxillary fixation with wiring. Which of the following information should the nurse include? A) Cut the wiring if emesis occurs B) Consume three meals daily as part of a low-protein diet C) Swab the mouth with hydrogen peroxide if wiring produces oral irritation D) Resume a soft diet in 3 to 5 days

A-to preserve airway

Which assessment finding will the nurse expect for the client with early-stage rheumatoid arthritis? (Select all that apply) A. Joint Inflammation B. Subcutaneous Nodules C. Severe Weight Loss D. Fatigue E. Thrombocytosis F. Anorexia

A. Joint Inflammation D. Fatigue F. Anorexia

R/T Fracture, where should the splint be placed?

ABOVE and BELOW the fracture; helps to stabilize the injured area and avoid unnecessary movement.

IADLs

AKA: Instrumental Activities of Daily Living Activities to support daily life within the home and community that often require more complex interactions than those used in ADLs(ex: shopping or cleaning the house)

Pain duration is classified as __________ or __________.

Acute(transient) or chronic(persistent)

__________ (acute/chronic) pain warns people of injury or disease.

Acute-first response pain *patients in acute pain are frightened anxious, and expect relief quickly.

Which duration of pain, is the patient more likely to predict a soon ending(healing) with, acute or chronic?

Acute-patients are optimistic that health team members will treat the problem aggressively and fix the problem that is causing pain.

What do androgens cause in men?

Androgens, such as testosterone in men, promote anabolism (body tissue building) and increase *BONE MASS*.

Lab tests done for a patient with a fracture

CBC-detect bleeding or blood volume wbc-detect infection ESR-can be increased if inflammation is present.

A patient who suffered a broken leg is having high anxiety when admitted to the ER. Should an anxiolytic be given for his anxiety and if given, should it substitute for an analgesic?

Anxiolytic should be give for his anxiety and no it cannot substitute for an analgesic medication. You give both! Calm the anxiety and help ease the pain.

Immobile Osteoporotic Patients: How do the pneumonia and atelectasis cause pulmonary acidosis?

Atelectasis and Pneumonia- secretions to block bronchioles and the bronchus; the alveoli collapses as the existing air is absorbed, producing hypoventilation. Hypoventilation/ineffective breathing leads to respiratory acidosis(due to C02 levels increasing in lungs).

What would a good diet of calcium and vitamin D include?

Calcium: Milk fortified with Vit D, green leafy vegetables & food products FORTIFIED with calcium. Vitamin D: most fish, egg YOLK, fortifieddddd milk and fortiffiieedd cereal.

A nurse in the emergency department is planning care for a client who has a right hip fracture. Which of the following immobilization devices should the nurse anticipate in the plan of care? A) skeletal traction B) bucks traction C) halo traction D) Bryant's traction

B: bucks traction-is a temporary immobilization device applied to a client who has a femur or hip fracture to diminish muscle spasms and immobilize the affected extremity until surgery is performed.

Why are caffeinated beverages a risk factor for bone diseases?

Because they include phosphorus, which works inversely with calcium. High phosphorus levels being drank=more calcium about to be peed out of body, thus causing calcium in body to be low, thus activating pth to send the osteoclasts out to break down and pull calcium from the bones, thus leaving bones more fragile.

Correct body ________ reduces strain on musculoskeletal structures, aids in maintaining adequate muscle tone, promotes comfort, and contributes to balance and conservation of energy.

Body alignment

__________ _________ describes the coordinated efforts of the musculoskeletal and nervous system.

Body mechanics

Pain that occurs sporadically over an extended period of time: A. Acute pain B. Chronic pain C. Chronic episodic pain D. Idiopathic pain

C. Chronic Episodic Pain

Spiritual beliefs, family, friends, support groups R/T pain:

Can help make the experience less stressful and possibly be used as a nice distraction method, even though the pain still exists.

___________ pain is usually caused by tumor progression and related pathological processes, invasive procedures, toxicities of chemotherapy, and infection.

Cancer

Unrelieved acute pain can progress to what kind of pain?

Chronic pain

What are common indications of acute pain: List 4 signs

Clenching the teeth, facial grimacing, holding or guarding the painful part and bent posture are common indications of acute pain.

Closed versus open fracture: describe

Closed (simple) fracture does not break through the skin surface. Open (compound) fracture disrupts the skin integrity causing an open wound and tissue injury and a risk of infection grade 1-3.

_____________ syndrome usually Affects extremities and occurs when pressure within one or more of the muscle compartments compromise circulation, resulting in and ischemia edema cycle.

Compartment syndrome -pressure can occur from an external source(such as tight cast or bulky dressing) or an Internal source(such as an accumulation of blood or fluid within the muscle compartment) can cause pressure as well.

How can fractures injure vital organs?

Due to bone fragments (fractures of pelvis or ribs), injuring vital organs. *important to monitor vital signs and neurological status as well as ask the patient about what caused the injury to determine if other internal injuries are possible*.

Diet Intake should and should not include: R/T Osteoporotic Patients

Eat protein: Chicken, Yogurt, Eggs, Green Leafy Vegetables, Milk fortified with Vitamin D and Cheese are essential. -Limit caffeine and diet drinks; alcohol doesn't help either. *and don't Don't DON'T do/smoke/chew tobacco. Studies show that tobacco worsen osteoporosis.

A ________________ fracture occurs from a loading force pressing on cancellous bones. This condition is common among older clients who have osteoporosis.

Compression

What sound is heard over a bone fracture?

Crepitus (a grating sound created by the rubbing of bone fragments)

"An unpleasant, subjective sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage"

Definition of pain

Pain and reduced movement manifests at the area of the fracture OR the area __________ (distal/proximal) to the fracture.

Distal

Before casts are dry what should you not do?

Dont do anything that would "dent" them. (no fingertips-use palms to handle them, no sharp edges-use common sense).

R/t osteoclasts and osteoblasts: Remodeling of bone occurs at ________ rate until an individual reaches their 30s.

Equal *After 30, I'll see osteoclasts outpaced the osteoblasts, increasing an individual's risk for it osteoporosis.

Osteoporosis Patient Evaluation: Review What patient knows about diet, lifestyle, and talk about their feelings

Evaluate how the client is handling handling having Osteoporosis, how it's affecting their lifestyle. Have patient describe foods they can eat and exercises they can do to help condition. Let them demonstrate the exercises to you.

(Internal/External) _______________ loci are people follow directions are are more passive in managing their pain.

External Loci

A _________ (stress) fracture results when excess strain occurs from recreational and athletic activities.

Fatigue

Role Fatigue has on pain and coping abilities.

Fatigue heightens the perception of pain and decreases coping abilities. *if dealing with pain, it's important to stay rested*

History of trauma, metabolic bone disorders, chronic conditions, and possible use of Corticosteroid therapy are expected findings for patients who suffer from having a type of __________.

Fracture

A ______________ is a break in a bone secondary to trauma or a pathological condition.

Fracture *can be caused by metastatic cancer, osteoporosis, or Paget's disease.*

_____________ is a force that occurs in a direction to oppose movement.

Friction -The greater the surface area of the object that is moved, *the greater the friction*.

Genes role in pain tolerance.

Genetic information passed on by parents are suggested to play a role with perception to pain as well as pain tolerance level.

Patient avoids moving: What should you do prior to moving them?

Give them some pain meds to help them feel better first. Once it kicks in, then move them.

______________ fracture occurs on one side (cortex) but does not extend completely through the bone (most often in children).

Greenstick

Where is growth hormone produced and what is its purpose?

Growth hormone is produced/secreted by the anterior pituitary gland and is responsible for increasing bone length and determining the amount of bone matrix formed before puberty.

When a person has pain, the family members are also affected. What can you as a nurse, teach the family?

Helping a patient and the patient's family to understand that mood, coping strategies, and the social environment can all have positive and negative influences on pain and functional outcomes is important.

Hemiplegia vs Hemiparesis

Hemiplegia=one sided paralysis Hemiparesis=one sided weakness

____ fractures are the most common injury in older adults, are usually associated with falls.

Hip

What does a hot and stinky spot under the cast indicate?

Hot=increased drainage Stinky=Infection Smell *should be reported to dr*

___________ pain is chronic pain in the absence of an identifiable physical or phycological cause or pain perceived as excessive for the extent of an organic pathological condition.

Idiopathic (think idiot whiny-baby: cries and exaggerates about pain that's source we can't identify) -still our job as nurses to treat and believe them.

Orthostatic Hypotension R/t Osteoporosis

If Osteoporotic patients aren't exercising, and participating in more of a sedentary lifestyle ~> it causes the heart to have to do more/work harder when the person does an activity, even getting out of bed. Since the heart isn't use to exercise, the increased workload tends to cause blood pressure drop when going from sitting to standing too fast. *do the dangle-dangle legs off bedside prior to standing*

Vitamin D and Calcium: Diet R/T Osteoporosis

Increase Vit. D and Calcium for osteoporotic patients=stronger bones.

(Internal/External) _____________ loci are people who like control over their lives and ask questions, desire information, and make choices about treatment.

Internal Loci

People who deal with persistent pain using POSITIVE spiritual coping practices, such as looking towards Jesus for strength and support: how does this help pain?

It has been proven to help the patients adjust to the pain levels better as well as to have a signifacantly better mental health.

R/T musculoskeletal trauma & fractures; what is ecchymosis?

It's bleeding into underlying soft tissue-expected physical assessment finding.

R/t fracture prevention: what is bisphosphonate prescribed for?

It's prescribed to slow bone resorption and treat osteoporosis.

A ________ is a space in which two or more bones come together.

Joint; aka: articulation of the joint

Urinary Tract relating to immobile patient:

Kidneys stays at level plane with ureters. Peristaltic contractions of the ureters are insufficient to cause gravity, the renal pelvis fillls before urine enters the ureters~>AKA: Urinary Stasis; *increases risk of UTI and renal calculi(kidney stones). *

Kyphosis R/t to Osteoporosis:

May occur, possibly causing patient height to decrease a couple of inches. *Check spine during assessment. *verify with source-class notes*

Explain why water loss is associated with getting older(geriatric old).

More water is in our muscles, and less water is our fat. As we get older, it's common to see muscle loss & body fat increasing=less water in our bodies.

Is pain a normal part of aging?

No it's not a normal part of aging; pain usually indicates there is a problem that should be addressed. -*on the contrary; with increase in age, increased frailty may lead to a less predictable response to analgesics, increased sensitivity to medications, and potentially harmful drug effects.

Should people with osteoarthritis be encouraged to do exercises such as jogging or contact sports?

No, encourage the patient to not be fat, wear supportive shoes, use good body mechanics and NOT to do exercises that limit repetitive strain on the joints(such as jogging).

Can you itch an itchy spot under the cast with a long cutip or dump some baby powder in there? & what can be done for itching under the cast?

No. Don't put any foreign object under the cast. Not a damn thing under that cast-otherwise you risk causing trauma or infection. *use a hair dryer and blow COOL air into the cast. *warm air to dry the cast in the beginning and cool air to relieve itching <~remember*

Can footdrop be fixed, once the foot is in its fixed position?

No. Only preventative measures can be taken, prior to the postural fixation of the foot. *prevention includes physical therapy and bracing the ankle with an AFO orthotic boot*

_____________ pain is normal stimulation of special peripheral nerve endings--called nociceptors; usually responsive to nonopioids and/or opioids.

Nociceptive pain *includes 2 types: 1)Somatic pain(pain arises from bone, joint, muscle, skin, or connective tissue) and 2)Visceral pain(pain arises from organs)

Nociceptive pain = __________ & __________ pain Neuropathic pain= pain resulting from lesion/disease that affects the _______ or _____.

Nociceptive= somatic & visceral Neuropathic= CNS & PNS

There's a burning sensation of the skin after application of capsaicin Normal or abnormal?

Normal, at the site, it will wear off. Wear gloves when applying it. If medication is to be applied to hands, wait 30 minutes after application to wash hands.

What should a nurse encourage a patient to do, who seeks pain relief from numerous doctors/facilities?

Nurses should discourage those patients from having multiple health care providers for treating pain and encourage the use of both pharmacological and nonpharmacological management. *these patients have the appearance as "drug seekers" but should be treated with respect and not labeled.

Osteoarthritis vs rheumatoid arthritis which are more likely correlated with obesity and which effect all joints on both sides of the body?

Obesity=osteoarthritis (RA is usually underweight pt) -RA affects both sides/is symmetrical (OA is not symmetrical)

How does skin relate to topical analgesics when you age into an elderly person?

Old people=less elasticity in skin/thinner=affects absorption rate of topical analgesics.

Osteoarthritis (OA) vs rheumatoid Arthritis (RA): which disease findings have pain with activity that improves at rest?

Osteoarthritis! -RA presents with swelling, redness, warmth, pain at rest or after immobility (*morning stiffness*)

Osteoblasts vs Osteoclasts R/T bones

Osteoclast cells=bone resorption=bad Osteoblast cells=bone formation=good *Osteoporosis occurs when the rate of bone resorption (osteoclast cells) exceeds the rate of bone formation (osteoblast cells) resulting in fragile bone tissue and can lead to fractures.

Read r/t disease patient centered care.

Osteoporosis-give calcium & vit D rich diet ~Osteoarthritis-drug of choice=tylenol ~Osteomalacia-give Vitamin D ~Osteomyelitis-give 3 month course of antibiotics ~Compartment Syndrome of muscle-Perform Fasciotomy (incision made to relieve pressure). ~Compartment Syndrome under cast-first attempted to relieve by univalve or bivalve cuts in cast.

Compare Osteoporosis, Osteoarthritis, and Rheumatoid Arthritis: r/t who it affects(weight/bone size) and brief description of disease.

Osteoporosis=affects smaller bones/underweight people more at risk. OsteoArthritis=Overweight-unilateral inflammation of a joint w/bone spurs-usually affected LARGER JOINTS(such as hips or knees). RheumatoidArthritis=Underweight, bilateral/*ALL* joints affected with inflammation & bone erosion present.

Osteoporosis: How can the Parathyroid play a part

Osteoporosis=caused by lack of calcium in bones Parathyroid makes calcium~> if hypothyroidism occurs then low levels of calcium will enter the blood stream, and calcium levels in bones will decrease, thus osteoporosis being the result.

Nociceptors= ________ receptors. How many physiological processes are there of "nociception"?

Pain *there are 4 processes of nociception. -these processes each have their own way of identifying pain and bringing it into awareness for a person.

A ______________ (spontaneous) fracture occurs to bone that is weak from a disease process (bone cancer or osteoporosis).

Pathological

Lungs and GI System R/t Immobile Osteoporotic Patients

Peristalsis slows=GI Blockage Prone Lungs are at risk for developing atelectasis(collapse of alveoli) and hypostatic pneumonia(stasis causing pooling of secretions)

R/T Shearing -The blood vessels in the underlying tissue are stretched and damaged, resulting in impeded blood flow to the deep tissues. Ultimately ____________ injuries often develop within the underneath tissues; the surface tissue appears less affected.

Pressure injuries.

Psychogenic Pain

Psychogenic pain is physical pain that is caused, increased, or prolonged by mental, emotional, or behavioral factors. Headache, back pain, or stomach pain are some of the most common types of psychogenic pain. (more rare example is heart break)

Break down: 3 Planes of the Body

Sagittal, Transverse, and Frontal Plane 1)Sagittal=Divided vertically from head to toe, separating right and left half of body. 2)Transverse=Divided horizontally leaving a top and bottom section. 3)Frontal=Divided into a frontal and posterior section.

*Test question* Left sided Heart Failure: one important side effect is __________ ____ _______.

Shortness of Breath

Assistive devices for casts include: _________ And ________

Sling(for arm) or boots(for leg-for walking)

What is osteomalacia?

Softening of the bone, due to lack of vitamin D.

How do cultures affect pain expression?

Some cultures believe that it is natural to be demonstrative of about pain. Others tend to be more introverted. *As a nurse, explore the impact of cultural differences on a patients pain experience and make adjustments to the plan of care.-Ask patient and family to learn their beliefs and values as well.

R/t bone fracture; Muscle ______ occur, due to the pulling forces of the bone when not aligned.

Spasms

What kind of cast are typically used on children who have congenital hip dysplasia?

Spica cast-includes a portion if the trunk and one or two extremities.

Treatment for Kyphosis: What can help if you have it?

Spine-stretching exercises, sleeping withOUT pillows, using bed board, bracing, surgical spinal fusion (based on cause and severity).

__________ is defined as excessive stretching of a ligament.

Sprain

What kind of dressing should an open wound be covered with initially?

Sterile dressing.

Is the patient's pain considered to be subjective or objective data?

Subjective because it's what the patient reports to us; we can't see or feel their pain. *Pain itself CANNOT be measured Objectively.

What is an issue that affects many patients with chronic pain conditions?

Substance use disorders *we as nurses medicate the patients anyway, we are there to believe them and help to relieve their pain*

*(this topic/? has been on a prior test for us)* Low Pain Tolerance vs High Pain Tolerance; which patient will feel a pain greater/be possibly perceived as a complainer to his/her family and friends?

The Low Pain Tolerance Patient is the complainer, but we treat them however they say they feel-it is always our job to believe them to the fullest degree. -High Pain Tolerance is a higher level of pain being accepted, before the patient speaks out to ask for relief. These patients typically require less medications to aid their pain, than the Low Pain Tolerance Patient who wants a Lortab because she got bit by an ant and it hurts like a great-fiery hell is burning at the bite site.

What is done if swelling of an extremity/underneath the cast, continues to worsten?

The cast can be cut on one side(univalve) or on both sides(bivalved).

R/T Musculoskeletal Trauma/Fracture: What should the skin temperate be at the affected/injured site post-op?

The extremity SHOULD BE warm, NOT cool, to touch. Cool skin can indicate decreased arterial perfusion.

Must we always believe our patient if they say they are in pain?

Yes. -It is not the responsibility of the patient to prove that he or she is in pain; it is your responsibility to assess a patient's condition and accept his or her subjective data.

Assessment tools(or scales) are available for use with a number of different populations, including critically ill adults, young children, or adults with advanced dementia. What is the goal in using these assessment tools?

The goal in using these tools is to identify HOW MUCH PAIN EXISTS; not how much pain they can tolerate.

Which type of joints are most commonly affected by disease or injury?

The joints that can move the most, aka "synovial"(like the elbow or knee). *this is also the most common type of joint in the body*

What is the major function of the joint?

To provide movement and flexibility in the body.

What is the primary nursing diagnosis for a patient who is in the hospital and in a great deal of post-op pain?

To provide pain relief that allows patients to participate in their recovery, prevent complications, and improve functional status.

Pain perception requires consciousness and an intact central nervous system. Common factors that disrupt the pain process include: (list some)

Trauma, Drugs, Tumor Growth and Metabolic Disorders.

treatment for fat embolism/globules includes:

Treating the symptoms: maintain bed rest, immobilize fracture, 02 provided for resp compromise, fluid replacement for shock, pain and antianxiety meds given and corticosteroids for cerebral edema.

What should you use if swelling from a musculoskeletal injury has a pulse site unable to palpate by hand?

Use a doppler.

_____________ is the force exerted on a body by gravity.

Weight -The force of weight is always directed downward, which is why an unbalanced object falls.

What kind of exercises should someone with osteoporosis do?

Weight Bearing Exercises. *if you don't use it you'll lost it* AKA: they have to do the weight bearing exercises or else their bones will start to stiffen up.

When should you as a nurse, explain to your patient the anticipated pain to be felt post op and ways to help it?

You should do it before surgery; you MUST explain what is to be expected beforehand so the patient is more prepared instead of just Wam-Bam-Thank-You-Mam pain felt postoperatively and freaking out because they had no freakin clue. Then they wont focus on their breathing exercises and instead be focused on something being wrong with them due to the pain. PREPARE YOUR PATIENTS!

Best nutrition r/t diet to facilitate bone healing includes high intake of ___________ and ____________.

calcium and protein *if blood loss occurred with the injury then include high iron intake as well*.

What is more effective: cast, splint, or immobilizer?

cast *because the patient cant remove them*

Splints can support fractured/injured areas until ____________ occurs and swelling is decreased. __________ is then used for post-paralysis injuries to AVOID JOINT CONTRACTURE.

casting/casting

Burning Pain felt below the spinal cord lesion reflects injury to the ___________ ___________ __________. This pain is a type of neuropathic pain.

central nervous system= burn/spinal cord pain

A ____________ assessment of pain aims to gather information about the cause of a person's pain and determine its effect on his or her ability to function.

comprehensive assessment *also includes affective, cognitive, behavioral, spiritual, and social dimensions.

R/T cast post-care: SOB, casts that become too loose, skin breakdown, or _____________ should be reported to the dr.

constipation

What can you do for casts when taking a shower?

cover it with a plastic bag.

Immobile patients: Teach patients to deep-breath, cough, or yawn every __ to __ to hours.

deep breath/cough/yawn every 1-2 hours OR they use the incentive spirometer instead *helps to prevent pneumonia* *CPT-chest physiotherapy(shake shake vests) are also encouraged to loosen secretions*.

R/T Fracture/musculoskeletal trauma: Neurovascular assessment is essential throughout immobilization. Assessments are performed every __ hour(s) for the first 24 hours, and then every __ to __ hour(s) thereafter following initial trauma to monitor neurovascular compromise related to edema and/or the immobilization device.

every 1 hour for the first 24 hours & every 1-4 hours thereafter

how often should the cast be inspected?

every 8 to 12 hours.

"Phantom pain" (ex: pain where missing limb is suppose to be): this NEUROPATHIC pain indicates injury to the _________ _________ ________.

peripheral nervous system= phantom pain

Calcium and phosphorus have an ___________ relationship in the bloodstream.

inverse -99% of the body's calcium is found in the bone -90% of body's phosphorus is found in the bone

Osteoporosis Affect ____________ (women/men) more than _______. (women/men)

more women affected than men. (affects a lot of "smaller boned" people, which includes more women than men because our bones being smaller)

_______skin is used over any rough area of the cast that can rub against the client's skin.

moleskin

R/T Musculoskeletal Trauma/Fracture: Assess for numbness or tingling of the extremity. Loss of sensation can indicate _______ damage.

nerve

____________________ Is a degenerative joint disease, a disorder characterized by progressive deterioration of the articular cartilage.

osteoarthritis (OA) *disease process: cartilage destruction with BONE SPUR growth at joint ends; degenerative.

Estrogens stimulate ____________ (osteoblast/osteoclast) activity.

osteoblast

neuropathic pain

pain that results as a direct consequence of a lesion or disease affecting abnormal functioning of the peripheral nervous system (PNS) or central nervous system (CNS).

Osteoporosis R/T Footdrop: Immobilized Patients are seen to have "footdrop", which is described when the foot is ________ -flexed.

plantar-flexed.

A ________ ________ is an impairment of the skin as a result of prolonged ischemia (decreased blood supply) in tissues. *usually formed over bony prominences*

pressure injury

Melzack and Wall

proposed gate theory of pain -said rub your hurt spot and it makes it feel better -also said everyone is different and feels pain different

Pain that is felt distal to the site affected is called ______________ pain.

referred *actual pain is at the site, referred is felt somewhere else in the body*

Cast care-r/t drainage, what should be reported

report any NEW drainage or INCREASE of drainage. *circling drainage is an unreliable indicator of drainage amount*

A patients _______-report of pain is the single-most reliable indicator of its existence and intensity.

self-report *establish a caring therapeutic relation with the patient so they will feel comfortable talking to you about their pain.

The force exerted against the skin while the skin remains stationary and the bony structures move is called _________.

shear *Using Lifts (ex: Hoyer) help to reduce shearing incidences.

________ fracture occurs from twisting motion and is commonly seen with physical abuse.

spiral

__________ cast has a rubber walking pad on the sole of the cast.

walking -this type of cast is used in ambulating when weight bearing is allowed.

Phantom limb pain should be treated with cold compresses to stump or warm heat and massage?

warm heat and massage, along with pharmacological interventions, to manage this type of pain.

Once the cast is placed, support the cast with *gloved hands* without causing indentation or shape change. What temperature air should be used to dry cast?

warm, dry air should circulate around and under the cast.

R/T Cast care; a __________ can be placed in the area of the cast to allow for skin inspection (such as a client who has a wound under the cast), wound drainage, or checking the pulse.

window

Patients with risk of falling/who are barely mobile or using assistive devices: what patient education can you convey to them and their families prior to sending them home(r/t home environment).

~Assess need for special transfer equipment to be used in the home setting (ex: shower or toilet grab bars, hoyer lift, walker, wheelchair, hospital bed etc). ~If using a wheelchair, make sure it can fit through all walkways and doors. ~*Throw rugs, electrical cords, slippery floors are a hail-to-the no; fix it before going home. ~Teach about using the wheelchair: techniques include: *Use wheel locks when getting up or down* *Never lean forward trying to reach something that is questionably in/out of reach. *Position objects as close as you can to desired objects.

Which type is described (internal loci/external loci): A patient who does not ask for pain medication but shows behavioral signs of discomfort might require you to be more responsive in offering prn medication times.

~External Loci, the passive-trust the nurses to do their jobs so I'll just wait-type of people.

Internal loci vs External loci people: Describe them both

~Internal Loci: Are people who perceive themselves as having control over events in their lives and the outcomes such as pain. They ask questions, desire information, and make choices about treatment. ~External Loci: Are people who perceive that other factors in their lives, such as nurses, are responsible for the outcome of events. These people follow directions are are more passive in managing their pain.

Compare: Osteoarthritis (OA), Osteoporosis, Rheumatoid Arthritis, Osteomalacia, & Osteomyelitis.

~Osteoarthritis (OA): degenerative joint disease, a disorder characterized by progressive deterioration of the articular cartilage-*bone spurs*. Rheumatoid Arthritis: Synovial membrane inflammation resulting in cartilage destruction and bone erosion; inflammatory. Treated with methotrexate. ~Osteoporosis: bone loss causes significant decreased density and possible fracture. Treated with evista (raloxifene), fasomax (alendronate), & calcitonin-salmon spray. ~Osteomalacia: Softening of the bone, due to lack of vitamin D. ~Osteomyelitis: Bone infection

The following points are common Bias/Misconceptions About Pain: AKA: Not True.

~Patients who abuse substances overreact to discomforts. ~Patients with minor illnesses have less pain than those with severe physical alteration. ~Administering analgesics regularly leads to drug addiction. ~The amount of tissue damage in an injury accurately indicates pain intensity. ~Health care personnel are the best authorities on the nature of the patient's pain. ~Psychogenic pain is not real. ~Chronic pain is psychological. ~Patients who are hospitalized experience pain. ~Patients who cannot speak do not feel pain.