Lesson 8G Musculoskeletal System
A 70-year-old male is recently diagnosed with osteoporosis. The nurse is teaching the client about this disease. Which of the following client responses requires further education by the nurse? (Select all that apply.) a. "I don't believe the doctor because I heard that only women can get osteoporosis." b. "Exercising in an aquatics class will make my bones much stronger." c. "It sounds like I'll need to drink more milk and eat more cheese and yogurt." d. "I should ask for help to clean the gutters instead of climbing a ladder." e. "I need to stop smoking."
a. "I don't believe the doctor because I heard that only women can get osteoporosis." b. "Exercising in an aquatics class will make my bones much stronger." Osteoporosis is commonly thought of as a "woman's problem", but after age 65 men and women are losing bone mass at about the same rate and calcium absorption decreases. Treatment for osteoporosis includes regular weight-bearing exercises, such as walking, in which bones and muscles work against gravity; aqua aerobics will not make bones stronger. The client needs adequate intake of calcium and vitamin D; while supplements may be needed, calcium is best absorbed from natural food sources. There is a direct link between tobacco use and decreased bone density.
The nurse is assessing a client after a traumatic femur fracture. Which of the following assessment findings of the affected area require the nurse's immediate action? (Select all that apply.) a. Paresthesia. b. Weak pulse. c. Pallor. d. Peristalsis. e. Pain. f. Cyanosis.
a. Paresthesia. b. Weak pulse. c. Pallor. e. Pain. Compartment syndrome is a complication after a traumatic injury involving the long bones. It is defined as swelling (edema) within a defined space (compartment) such as an extremity, which will put pressure on nerves and blood vessels, possibly leading to irreversible muscle and nerve ischemia. One or more of the six Ps are often seen with compartment syndrome: Pain, (increasing) Pressure in the affected extremity/area, Paresthesia (numbness, tingling), Pallor (coolness and loss of color), Paralysis and weak, diminished or absent Pulse (pulselessness). Cyanosis is seen with hypoxia and occurs more systemically in nail beds, face, lips and mucus membranes. Peristalsis refers to the rhythmic waves of involuntary muscle contractions of the intestines or other parts of the gastrointestinal system.
A client is in the acute phase of RA. Which of the following should the nurse identify as highest priority in the plan of care? (Select all that apply.) a. Relieving pain b. Preserving joint function c. Maintaining usual ways of accomplishing tasks d. Preventing joint deformity e. Assessing body image issues
a. Relieving pain b. Preserving joint function d. Preventing joint deformity Pain relief is a high priority during the acute phase because the pain is typically severe and interferes with the client's ability to function. Preserving joint function and preventing joint deformity are high priorities during the acute phase to promote an optimal level of functioning and reduce the risk of contractures. Maintaining usual ways of accomplishing tasks would be the lowest priority during the acute phase. Rather, the focus is on developing less stressful ways of accomplishing routine tasks.
The nurse is providing discharge teaching to a client who has just undergone total hip replacement surgery. Which statement by the client would indicate to the nurse the need for further teaching? a. "I cannot drive a car for probably six weeks." b. "I should not sit in one position for more than four hours." c. "I need to wear a support stocking on my unaffected leg." d. "I need to place a pillow between my knees when I lie down."
b. "I should not sit in one position for more than four hours." The client needs to be instructed to not sit continuously for more than one hour. The client should be instructed to stand, stretch and take a few steps periodically. The client cannot drive a car for six weeks after surgery unless allowed to do so by a physician. A support stocking should be worn on the unaffected leg. An Ace bandage usually is prescribed for the affected leg and should be worn until there is no swelling in the legs and feet and full activities are resumed. The legs are abducted by placing a pillow between them when the client lies down.
A nurse is assessing a 3-week-old infant for possible development dysplasia of the right hip. Which finding should the nurse expect with this condition? a. Even right and left gluteal folds b. Clicking sound from affected hip c. Downward pelvic tip upon observation d. Negative Barlow maneuver
b. Clicking sound from affected hip Developmental hip dyspepsia will present with uneven gluteal folds and thigh creases. A nurse will be able to hear a clicking sound when when the infant is placed on their back, leg flexed and the affected hip is moved to abduction. This is typically seen in infants less than 4 weeks old and is refereed to as a positive Ortolani's sign. Additionally, the nurse will assess for a positive Barlow maneuver (abducting the hip while applying pressure on the knee will cause the hip to dislocate from the socket). Finally, a pelvic downward tip is not a finding a nurse will find with possible development dyspepsia.
The nurse notices body outgrowths on the distal interphalangeal joints. The nurse documents these findings as: a. Bouchard's Nodes b. Heberden's Nodes c. Neurofibromatosis d. Dermatofibromas
b. Heberden's Nodes Bony outgrowths found on the DISTAL interphalangeal joint (closest to the fingernail and furthest away from the body) are called Heberden's Nodes. If the bony outgrowth was found on the PROXIMAL interphalangeal joint (middle joint of the finger...closest to the body) they are called Bouchard's Nodes.
A client is receiving an antibiotic infusion for acute osteomyelitis of the left femur. Which nursing intervention will be included in the plan of care? a. Encourage weight-bearing exercise b. Immobilization of the left leg c. Limit the administration of NSAIDs d. Maintain the left leg in a flexed position
b. Immobilization of the left leg Immobilization of the affected leg helps to decrease pain and reduce the risk for pathologic fractures. Weight-bearing exercise increases the risk for pathologic fractures. NSAIDs are frequently prescribed to treat pain. Avoid flexing the affected limb to prevent contractures.
A 85-year-old client fell while going to the bathroom. It appears he may have a bone fracture in his right leg. The nurse observes a deformity in the affected leg and the client is unable to move it. He is alert and oriented but in pain. Which is the FIRST nursing action to take after confirming the patient is safe and stable? a. Apply an ice pack covered with a towel to the site b. Immobilize the fracture with a splint c. Administer pain medication d. Elevate the extremity above heart level
b. Immobilize the fracture with a splint After confirming the patient is safe and stable, the nurse will immobilize the fracture with a splinting device. This will prevent movement of the extremity by the client. Immobilization prevents further pain or bleeding along with decreasing the risk of more damage that can occur to the surrounding tissues. In addition, if a bone is not immobilized and the extremity is moved after it has been fractured, this can alter the way the bone heals.
For a client with osteoporosis, the nurse should provide which dietary instruction to help slow the progression down? a. "Decrease your intake of foods that contain vitamin D." b. "Decrease your intake of nuts and seeds." c. "Eat more bananas to increase your potassium intake." d. "Eat more dairy products to increase your calcium intake."
d. "Eat more dairy products to increase your calcium intake." Osteoporosis causes a severe, general reduction in skeletal bone mass. To offset this reduction, the nurse should advise the client to increase calcium intake by consuming more dairy products, which provide about 75% of the calcium in the average diet. Decreasing your vitamin D intake is incorrect as vitamin D helps facilitate calcium. None of the other options would stop osteoporosis from worsening.
The nurse manager is conducting rounds on the floor. Which of these findings would require immediate corrective action and further instruction to the assigned nurse about proper care? a. The weights of a client in skin traction are hanging several inches above the floor b. The legs of a client who underwent hip replacement surgery yesterday are adducted c. The assigned staff nurse picks up the frame of an external fixation device to move a client's extremity d. A client in skeletal traction states, "The other nurse said that clear, yellow and crusty drainage around the pin site is a good sign."
d. A client in skeletal traction states, "The other nurse said that clear, yellow and crusty drainage around the pin site is a good sign." After having a total hip replacement, the client is positioned with an abduction wedge or pillow(s) between the legs. The abduction pillow helps prevent adduction and internal rotation of the affected leg, which could cause dislocation of the hip prosthesis. Some surgeons recommend clients use an abduction wedge for as long as 6-12 weeks postoperatively.
A client with a fractured lower right leg is medicated for pain with meperidine (Demerol) 100 mg and hydroxyzine hydrochloride (Vistaril) 50 mg IM. One hour later the client reports the pain is getting worse. What should the nurse recognize as a potential reason for the unrelieved pain? a. Osteomyelitis b. Thromboembolic complications c. Fatty embolism d. Compartment syndrome
d. Compartment syndrome Increasing pain that is not relieved by narcotic analgesics may be an indication of compartment syndrome. The nurse should immediately inform the charge nurse and emergency intervention will be required. Thromboembolic complications include deep vein thrombosis and pulmonary embolism, which are not characterized by increasing pain at the site of injury. Both pulmonary embolism and fat embolism present with sudden respiratory findings. Osteomyelitis is a bone infection that could occur some time after the initial injury, usually after at least 48-72 hours.
A client is admitted with severe pain in the knees. Which form of arthritis is characterized by urate deposits and joint pain, usually in the feet and legs, and occurs primarily in men? a. Septic arthritis b. Traumatic arthritis c. Seasonal arthritis d. Gouty arthritis
d. Gouty arthritis Gouty arthritis is characterized by urate deposits and pain in the joints, especially those in the feet and legs. Urate deposits don't occur in septic or traumatic arthritis. Septic arthritis results from bacterial invasion of a joint and leads to inflammation of the synovial lining. Traumatic arthritis results from blunt trauma to a joint or ligament. Seasonal arthritis is not a condition.
A 70-year-old woman is evaluated in the emergency department for a wrist fracture of unknown cause. During the admission process, which of the following findings should the nurse identify as being the client's greatest risk factor for developing osteoporosis? a. Inactive lifestyle for the past 10 years b. History of menopause at age 50 c. Two glasses of red wine each day for the past 30 years d. History of oral corticosteroid use for 20 years to treat chronic lung problems
d. History of oral corticosteroid use for 20 years to treat chronic lung problems The use of oral corticosteroids for a long period of time increases the risk for developing osteoporosis. Being postmenopausal and physically inactivity may also contribute, but are less significant. Other factors that increase the risk for osteoporosis and fracture include low bone mass and poor calcium absorption. However, long-term steroid treatment is the most significant risk factor.