NUR355 Exam 5-Module 9 (Musculoskeletal)

5 treatment options for sprains and strains (REVIEW)

1. RICE (Rest, Ice, Compression (ACE), Elevate) 2. immobilization device or splint 3. brace may be required for a couple weeks 4. anti-inflammatory drugs (Ibuprofen) 5. surgery may be considered in younger, athletically active pts.

What 4 things are considered as "do not miss assessments" (red flags) for fractures? (REVIEW)

1. absent distal pulses/ poor cap. refill (compartment syndrome) 2. numbness/tingling (compartment syndrome) 3. erythema with increased pain and drainage (infection) 4. pressure (compartment syndrome)

5 nursing diagnoses for amputation (REVIEW)

1. acute pain r/t surgical amputation 2. risk for disturbed sensory perception (phantom limb pain r/t surgical amputation) 3. risk for dysfunctional grieving r/t loss of a body part 4. impaired physical mobility r/t loss of extremity 5. disturbed body image r/t amputation of a body part

compartment syndrome 6 s/s (REVIEW)

1. deep aching PAIN in arm or leg (lasts for few mins.) 2. swelling and TIGHTNESS 3. NUMBNESS 4. pins and needles type of pain 5. severe pain that increases with the stretching of muscles 6. visible muscle bulging

2 other prevention education for osteomyelitis

1. no alcohol and smoking (vasoconstriction) 2. maintain recommended weight

5 s/s of sprains (REVIEW)

1. pain 2. swelling 3. bruising 4. limited ability to move the affected joint 5. hearing or feeling a "pop" in your joint at time of injury (think sPrains go Pop)

6 s/s of strain (REVIEW)

1. pain 2. swelling 3. redness or bruising 4. limited motion 5. muscle spasms 6. muscle weakness

How much do we teach a pt. with a sprain or strain to ice the affected area?

20-30 mins. up to four times daily

A nurse is developing a teaching plan for a pt. who has Ménière's disease. Which of the following instructions should the nurse include? A. Move head slowly to decrease vertigo B. Apply warm packs to the affected ear during acute attacks C. Increase intake of foods and fluids high in salt D. Administer corticosteroids during acute attacks

A

A nurse is assessing a pt. who has a new diagnosis of osteoarthritis. Which of the following findings should the nurse expect? (SATA) A. Crepitus with joint movement B. Decreased ROM of the affected joint C. Low-grade fever D. Spongy tissue over the joints E. Joint pain that resolves with rest

A, B, E

A nurse is assessing a pt. who has rheumatoid arthritis. Which of the following findings should the nurse expect? A. Unilateral joint involvement B. Ulnar deviation C. Fractures of the spin D. Decreased sedimentation rate

B

A nurse is teaching a pt. who has multiple sclerosis and has a new prescription for glatiramer acetate. Which of the following statements indicates that the pt. understands the teaching? A. I will ask my partner to give the injection in the same spot each time B. I will avoid going to the store when it is crowded C. I will see relief of my symptoms in about 1 week D. I will exercise rigorously while taking this med.

B

A nurse is providing teaching for a pt. who is prescribed alendronate for osteoporosis. Which of the following information should the nurse include in the teaching? A. Take this med. with 240 mL (8 oz.) of milk B. Remain upright for 30 min after taking this med. C. Expect this med. to increase serum calcium levels D. Increase vitamin D intake to promote med. absorption

B (Alendronate can cause esophagitis or esophageal ulcers)

A nurse is caring for a pt. who has a spastic bladder following a spinal cord injury. Which of the following actions should the nurse take to help stimulate micturition? A. Encourage the pt. to use the Valsalva maneuver B. Stroke the pt.'s inner thigh C. Perform the Credé maneuver D. Administer a diuretic

B (other techniques include pinching the skin above the groin and providing digital anal stimulation)

A nurse is caring for a pt. who has multiple sclerosis. Which of the following findings should the nurse expect? A. Hypoactive deep-tendon reflexes B. Ascending paralysis C. Intention tremors D. Increased lacrimation

C

A nurse is providing teaching regarding a new prescription for carbidopa-levodopa for a client who has Parkinson's disease. Which of the following pt. statements indicates an understanding of the teaching? A. I should expect a slight increase in my BP while taking this med. B. I should take this med. 2 hrs. after meals to increase absorption C. I should expect that this med. can cause me to be drowsy D. I should expect this med. to be effective within 48 hrs.

C

A nurse is caring for a pt. who is 72 hr. postop. following an above-the-knee amputation and reports phantom limb pain. Which of the following actions should the nurse take? A. Remind the pt. that the limb has been removed B. Change the dressing on the pt.'s residual limb C. Request a prescription for Gabapentin for the pt. D. Elevate the pt.'s residual limb above heart level.

C (Gabapentin is an oral antiepileptic med. that is effective for treating sharp, burning, phantom limb pain)

A nurse is caring for a client in balanced suspension skeletal traction who reports intermittent muscle spasms. Which of the following actions should the nurse take first? A. Reposition the pt. B. Provide distraction C. Administer a muscle relaxant D. Check the position of the weights and ropes

D

A nurse is planning to teach a pt. who has epilepsy and a new prescription for phenytoin. Which of the following instructions should the nurse include in the pt.'s medication teaching plan? A. Rinse with antiseptic mouthwash in place of using dental floss B. Use an OTC antihistamine if a rash develops C. Slowly taper the medication after 6 consecutive months without seizure activity D. Take meds. at a consistent time each day to maintain therapeutic blood levels

D

A nurse is teaching an AP about care of a pt. following a total hip arthroplasty. Which of the following instructions should the nurse include? A. Avoid applying anti-embolism stocking to the affected limb B. Have the pt. lean forward when moving from a sitting to a standing position C. Discourage the pt. from sitting in a wheelchair with the back reclined D. Place an abductor pillow between the pts. legs when turning the client

D (Pt. should maintain the hip in abduction following surgery to reduce the risk of dislocating the affected hip)

A nurse is assessing a pt. who is quadriplegic secondary to a cervical fracture at vertebral level C5. The pt. reports a throbbing HA and nausea. The nurse notes facial flushing and a BP of 220/110 mm Hg. Which of the following actions should the nurse take first? A. Administer hydralazine via IV bolus B. Loosen the pt.'s clothing C. Empty the pt.'s bladder D. Elevate the head of the pt.'s bed.

D (assessment findings indicate autonomic dysreflexia and is at greatest risk for possible rupture of a cerebral vessel or increased intracranial pressure; elevating HOB will result in rapid postural hypotension)

A nurse is caring for a pt. who has viral meningitis. Which of the following actions should the nurse take? A. Assess the pt.'s neurologic status every 8 hr. B. Maintain the pt. on droplet precautions C. Place the pt. in a well-lit environment D. Check capillary refill at least every 4 hr.

D (important to monitor for vascular compromise)

A nurse is caring for a pt. who was admitted for status epilepticus and is on seizure precautions. Which of the following actions should the nurse plan to take? A. Assess hourly for a spike in BP B. Maintain the pt. on bed rest C. Keep a padded tongue blade at the bedside D. Establish IV access

D (plan to establish IV access with a large-bore catheter and administer 0.9% NaCl if seizures are imminent)

compartment syndrome (REVIEW)

EMERGENCY CONDITION increased pressure in muscle compartment (grouping of muscles, nerves, and blood vessels) causing muscle and nerve damage along w/ pain

meds. for OA (REVIEW)

NSAIDs Duloxetine (Cymbalta) Acetaminophen (not best option if no contraindications to an NSAID; meds. should be taken cautiously d/t liver effects for Tylenol and GI/kidney issues with too much IBU)

lordosis (REVIEW)

abnormal anterior curvature of the lumbar spine (sway-back condition)

scoliosis (REVIEW)

abnormal lateral curvature of the spine

What is the most important action during osteomyelitis dressing changes to prevent infection? (REVIEW)

aseptic technique b/c we do not want to cause infection

osteoporosis (REVIEW)

bone becomes weak and brittle d/t loss of bone density (fall or even mild stresses such as bending over or coughing could cause fracture)

displaced fracture

bone ends of fracture do not align

Why do we use a splint and then a cast for fractures?

period to wait for swelling to decrease

grade I (primary) sprain

stretching of ligament or very mild tear little or no instability at joint

treatment of fat embolism syndrome (REVIEW)

supportive care (O2, IV fluids, and blood products to increase blood volume and get rid of fatty acids)

skeletal traction (REVIEW)

system where a combo. of pulleys, pins, and weights are used to stabilize and realign bone fragments (most commonly the leg or spine, not done as often d/t improvements of ORIF)

stress fracture

tiny cracks in bone, commonly weight-bearing bones of lower leg or foot, caused by repetitive force or overuse

skin traction (REVIEW)

traction limits movement to help decrease pain, muscle spasms, and swelling

5 physical assessments of sprains, strains, and fractures (REVIEW)

1. posture 2. gait 3. PULSES/CAP. REFILL 4. muscle tone and strength 5. JOINT MOBILITY

fat embolism syndrome 4 s/s (REVIEW)

1. rapid breathing/ respiratory distress 2. mental confusion 3. restlessness 4. SOB

11 nursing diagnoses for fractures (REVIEW)

1. risk for falls 2. acute pain 3. risk for peripheral neurovascular dysfunction 4. risk for impaired gas exchange (PNA from surgery) 5. impaired physical mobility 6. impaired skin integrity 7. risk for infection 8. deficient knowledge 9. risk for injury 10. self-care deficit 11. constipation

3 treatment options for fractures (REVIEW)

1. splinting/casting/repair 2. closed reduction 3. surgical repair (open reduction) 4. ORIF

2 assessments for scoliosis (REVIEW)

1. standing assessment (shoulder uneven, prominent shoulder blade, visible curve, hips uneven, waist asymmetrical) 2. forward bending assessment (upper and/or lower back hump)

osteomyelitis 4 s/s (REVIEW)

1. swelling, warmth, TENDERNESS AND/OR REDNESS OVER AREA OF INFECTION 2. PAIN IN INFECTED PART OF BONE, worsens w/ movement 3. high fever and/or chills, MALAISE 4. INCREASED WBCS AND ESR

sprain and strain pt. education (REVIEW; 4)

1. what is sprain/strain? 2. course of healing 3. home care and why? (why ice?-brings down inflammation by constricting blood vessels; why elevate?-return of blood flow; why ACE?-inhibits swelling why rest?) 4. when to follow-up

A nurse in the emergency department is caring for a pt. after suddenly losing consciousness and falling in her home. The provider determines the pt. had an embolic stroke. Which of the following meds. should the nurse administer? A. Tissue plasminogen activator B. Recombinant factor VIII C. Nitroglycerin D. Lidocaine

A (Thrombolytic agent that should dissolve the blood clot that caused the stroke)

A nurse is caring for a pt. who has advancing amyotrophic lateral sclerosis. Which of the following interventions is the nurse's priority? A. Provide for frequent rest periods throughout the day B. Medicate for pain on a regular schedule C. Monitor pulse oximetry findings D. Administer baclofen for spasticity.

C (greatest risk to pt. is respiratory comprise d/t progressive paralysis of respiratory muscles)

A nurse is planning care for a pt. following a lumbar puncture. Which of the following actions should the nurse plan to take? A. Apply a pressure dressing to the site for 8 hr. B. Restrict the pts. fluid intake for 24 hr. C. Ensure that the pt. lies flat for up to 12 hr. D. Inform the pt. that neck stiffness is an expected outcome of the procedure

C (this prevents cerebrospinal fluid leakage from the puncture site which can cause HA)

open fracture (REVIEW)

bone fragments extend through muscle and skin, which is potentially infected (abxs are ALWAYS given for OPEN fractures)

grade III (tertiary) sprain (REVIEW)

completely torn or ruptured ligament often impossible to put weight on joint or use affected limb b/c joint is not stable (surgical repair may be needed)

kyphosis (REVIEW)

excessive outward curvature of the spine, causing hunching of the back

complication of fractures (REVIEW)

fat embolism syndrome (fat lodges in blood vessel and blocks blood flow; COMMONLY OCCURS AFTER FRACTURES OF LOWER BODY SUCH AS FEMUR, tibia, and pelvis)

closed reduction treatment for fractures (REVIEW)

for closed, non or minimally displaced or easily manipulated fractures

ORIF treatment for fractures (REVIEW)

for open or displaced fractures

closed fracture

fracture does not extend through skin

complete fracture

fracture line involves entire cross section of bone and bone fragments are usually displaced

pathological fractures (REVIEW)

fracture occurs in diseased bone such as cancer or osteoporosis with no or only minimal trauma

ESR measures?

inflammation

sprain (REVIEW)

injury to ligaments (connects to bone)

strain (REVIEW)

injury to tendon or muscle (Think sTrain is an injury to the Tendon)

goniometer

instrument used to measure joint angles

grade II (secondary) sprain (REVIEW)

more serious but still incomplete tear some looseness in joint

Who is at highest risk for osteoporosis? (REVIEW)

older women who are past menopause and white and Asian women

incomplete fracture (REVIEW)

only a portion of cross section of bone; one side breaks while the other usually bends (greenstick)