Muscle-skeletal & EKG + Neuro
When reinforcing health teaching about the management of osteoarthritis, the nurse determines that the patient needs additional instruction after making which statement?
"A cold shower in the morning will help relieve the stiffness I have when I get up."
When treating a patient with compartment syndrome, what measures should the nurse consider to be contraindicated?
Application of cold compresses. Elevation of the limb above heart level Elevation of the extremity may lower venous pressure and slow arterial perfusion.
The nurse is reinforcing general health teaching for a patient with osteoarthritis of the knees. Which statement by the patient demonstrates correct understanding of osteoarthritis?
"Osteoarthritis is more common with aging, but usually it remains confined to a few joints and does not cause crippling."
A patient who has been prescribed the antiparkinsonian medication carbidopa/levodopa, asks the healthcare provider, "Why am I getting these two medications?" How should the healthcare provider respond? Please choose from one of the following options.
"The carbidopa prevents the breakdown of the levodopa." Carbidopa prevents the breakdown (decarboxylation) of levodopa in the intestine and peripheral tissues so more levodopa can travel to the brain, cross the blood brain barrier, where it is converted into Dopamine.
The nurse is wrapping the residual limb of a person with a BKA. The patient asks her why she is wrapping in a figure eight instead of just a horizontal wrap. What is the nurse's best response?
"This type of wrap minimizes edema and promotes a good shape to help with wearing a prosthesis."
A female client with Guillain-Barré syndrome has paralysis affecting the respiratory muscles and requires mechanical ventilation. When the client asks the nurse about the paralysis, how should the rehab nurse respond?
"You may have difficulty believing this, but the paralysis caused by this disease may be temporary."
Osteoarthritis destruction may actually begin between ages?
20-30 with majority of adults affected by age 40.
The rehab nurse knows that among the chronic neurological disorders in question, which disorders manifest muscle weakness but sensory functions remain intact.
ALS and MG Myasthenia Gravis and Amyotrophic Lateral sclerosis are both chronic neurological diseases that have motor function loss but sensory functions remain intact. ALS - Rare progressive neuromuscular disorder characterized by loss of upper and lower MOTOR neurons without inflammation, leading to eventual wasting and atrophy of all voluntary muscles, including respiratory muscles. Myasthenia gravis - Autoantibodies block the skeletal muscle receptor sites, preventing acetylcholine from attaching to them. Because not enough acetylcholine is attached to the receptor sites, muscle contraction does not occur
A social services worker assist the patient in?
Accessing services and education related to their health condition.
Which of these is the strongest risk factor for developing the Alzheimer's disease?
Age Although some studies have shown an association between certain modifiable lifestyle factors and a reduced risk for Alzheimer's disease, the National Institutes of Health says that age is the strongest known risk factor where most people receive the diagnosis after age 60. An early onset familial form can also occur, although it is rare.
Which postoperative care, given by the nurse to the patient after a total hip replacement surgery, indicates an effective intervention?
Allowing the patient to use a pillow between the legs for the first six weeks after surgery. It should be used when lying on the nonoperative side or when in a supine position to maintain the joint in abduction and prevent dislocation of the new joint.
Antidysrhythmic Drugs
Amiodarone is an antidysrhythmic drug that is part of the advanced cardiac life support (ACLS) protocol for ventricular fibrillation.
Which surgery is considered to be the most appropriate in a patient with osteoarthritis and complete loss of function in the knee joint?
Arthro-plasty A patient with osteoarthritis with a complete loss of function in the knee joint needs an arthroplasty to replace the joint. Osteotomy is a surgical procedure in which a part of the bone is sliced to change alignment, correcting deformity and relieving chronic pain. Arthrodesis is the surgical fusion of a joint and is performed only when the joint is severely infected or if reconstructive surgery fails. Synovectomy is used as a prophylactic measure and as a palliative treatment for rheumatoid arthritis (RA)
The nurse that is monitoring the electrocardiogram (ECG) of a patient with hyperthyroidism observes regular, sawtooth-shaped flutter waves with an atrial rate 250 beats/minute. How should the nurse document this pattern?
Atrial flutter
A patient on the cardiac telemetry unit goes into ventricular fibrillation and is unresponsive. Following initiation of the emergency call system ( code blue), what is the next priority for the nurse in caring for the patient?
Begin CPR Until the defibrillator is available, the patient needs CPR.
Osteoarthritis is a results of?
Cartilage destruction which is not a normal part of aging.
After synchronized cardioversion, a patient's electrocardiogram (ECG) tracing reveals the following. What is the nurse next immediate priority? (photo) ventricular fibrillation
Check for a pulse Patient rhythm is ventricular fibrillation. This is not a perfusing rhythm. Next priority is defibrillation and apply effective chest compressions.
A patient with a hip fracture has been treated with insertion of a prosthesis. What findings indicate dislocation of this prosthesis? Select all that apply.
External rotation rotation of the limb A lump in the buttock Limb shortening. This requires a closed reduction with conscious sedation or open reduction to realign the femoral head in the acetabulum.
A patient's electrocardiogram (ECG) has changed from a normal sinus rhythm to the following rhythm. The nurse assesses the patient who was sleeping. The patient's respirations are 16 and unlabored, and the blood pressure has dropped from 110/70 to 104/68. What action should the nurse take?
Continue monitoring the patient Sinus bradycardiaLinks to an external site. can be a normal finding for athletes or patients when they sleep. Sinus bradycardia becomes clinically significant if the patient is symptomatic (hypotensive, chest pain, shortness of breath, change of level of consciousness). Because the respiratory status of the patient is stable and the blood pressure is only slightly lower because the patient is sleeping, the nurse should continue monitoring the patient.
What anti-coagulation medication is used in patients with chronic A. fib?
Coumadin (Warfarin) often is prescribed
A nurse is assessing a patient with osteoarthritis. What finding would be expected with this disorder?
Crepitation in the weight-bearing joints. OsteoarthritisLinks to an external site. primarily affects the weight-bearing joints; therefore crepitation (a cracking or clicking sound heard in joint movement) may be present in affected individuals. Fever and malaise and increased sedimentation rate are manifestations of rheumatoid arthritis. Morning stiffness of all joints may appear in OA, but usually resolves within 30 minutes instead of lasting all day.
A patient has osteoarthritis of the knees. What finding would the nurse assess on examination of the patient's knees?
Crepitus upon movement of knee joints Osteoarthritis is characterized predominantly by joint pain and crepitus on movement. Stiffness worse in the morning, swollen joints, and swan neck deformity are consistent with rheumatoid arthritis.
A patient reports a sudden onset of dizziness. The nurse records the following electrocardiogram (ECG) tracing. The nurse suspects that the dizziness is most likely a result of what? -Pic (paroxysmal supraventricular tachycardia (PSVT)
Decreased cardiac output
While the nurse is administering furosemide via intravenous push (IVP), a patient becomes unresponsive. The patient's electrocardiogram (ECG) tracing shows the following. What action should the nurse perform first? Ventricular tachycardia can either be with pulse or pulseless.
Defibrillate The treatment algorithm depends on whether the patient has a pulse or not. Therefore, checking for a pulse is a priority. If the patient does not have a pulse, defibrillation is the priority. If the patient has a pulse, cardioversion and/or drug therapy is the priority. Oxygen may be administered, but it is not a priority.
A nurse is caring for a patient with osteoarthritis (OA). In assessing the patient's understanding of this disorder, the nurse concludes teaching has been effective when the patient uses which description of the condition?
Degeneration of articular cartilage in synovial joints. OA is not an autoimmune disease.
Rose is in the second stage of Alzheimer's disease who appears to be in pain. Which question by Nurse Jenny would best elicit information about the pain?
Do you hurt? (pause) "Do you hurt?"
Corticosteroid therapy
Drug-drug interactions, moon face and weight gain, and diabetes and mood swings are side effects that can be monitored.
Which of the following adverse effects should the healthcare provider inquire about when assessing a patient who is receiving an anticholinergic medication for the treatment of Parkinson's disease? Select all that apply.
Dry eyes, urinary retention, dry mouth, pupillary dilatation (mydriasis)
Compartment Syndrome
Edema of the limb and a weak pulse
Physical Therapy is used to?
Improve mobility, strength, and flexibility.
A patient has undergone amputation just below the level of the elbow in the right upper limb. The patient states that there is still the sensation of pain in the missing portion one day after surgery. What should the nurse inform the patient?
It is normal to feel this way After an amputation, the patient may still feel the presence of the amputated part. The nurse should explain to the patient that it is normal to feel this way. This phenomenon, termed phantom limb sensation, occurs in many amputees. Such a sensation is not illusion, delusion, or hallucination.
A patient is experiencing osteoarthritis. Which finding on the x-ray report of a patient experiencing osteoarthritis indicates that the patient is developing a permanent limitation of motion?
Joint-space narrowing
The patient is three days postoperative from total hip arthroplasty (THA) and preparing for discharge. The nurse caring for the patient notes that the patient is having increased pain ratings, decreased willingness to work with physical therapy, and an oral temperature of 101.5°F. What is the most appropriate nursing intervention?
Notify the surgeon that there is a potential postoperative infection.
A patient with rheumatoid arthritis (RA) requires interventions to increase independence with assistive devices. Which interdisciplinary team member would best be able to assist with simplifying these tasks?
Occupational therapy is utilized to increase the patient's independence by simplifying tasks such as the use of assistive devices and modifying eating utensils.
A patient with cancer who is receiving methotrexate therapy has developed anemia. The nurse recognizes that which therapies may benefit this patient?
Oral Folic acid and Epoetin alfa Epoetin alfa is used to treat anemia related to cancer and its therapies. Methotrexate leads to folic acid deficiency resulting in megaloblastic anemia.
An older adult patient is receiving corticosteroid therapy for rheumatoid arthritis. What should the nurse inform the patient a complication of this therapy might be?
Osteopenia The major concern is corticosteroid-induced osteopenia, which can add to the problem of decreased bone density related to age and inactivity in older patients. It also increases the risk of pathological fractures, especially compression fractures, especially compression fx
The 6 P's of Compartment Syndrome
Pain Paresthesias Pallor Pressure Paralysis Pulselessness The usual signs include weakness and paralysis of the arm, absence of peripheral pulses, and pain that is not relieved by opioids. These signs are due to decreased compartment size resulting from an injury.
While examining a patient with an injury to the distal humerus, the nurse suspects that the patient has compartment syndrome. What findings in the patient could have raised this suspicion? Select all that apply.
Pain unrelieved by opioids Absence of the peripheral pulse Paralysis of the arm
The nurse is admitting a patient who is scheduled for knee arthroscopy related to osteoarthritis (OA). Which finding should the nurse expect to be present on assessment of the patient's knees?
Pain with joint movement OA is characterized predominantly by joint pain upon movement and is a classic feature of the disease. Ulnar drift occurs with rheumatoid arthritis (RA), not osteoarthritis. Not all joints are reddened or swollen. Stiffness decreases with movement.
A rehab nurse is conducting an awareness program to prevent limb amputations. When explaining the risk of amputation, which population group would the nurse indicate as at high risk for amputation? Select all that apply.
Patient with DM Patient with peripheral vascular disease Patient with chronic osteomyelitis
A female client with amyotrophic lateral sclerosis (ALS) tells the nurse, "Sometimes I feel so frustrated. I can't do anything without help!" This comment best supports which nursing diagnosis?
Powerlessness
A nurse caring for a patient with osteoarthritis instructs the patient about the various nonpharmaceutical interventions for the management of pain. Which information should the nurse include in these instructions? Select all that apply.
Regulation of a normal body mass index (BMI) Use of crutches or walker if required Use of paraffin baths or hot packs Pain management in osteoarthritis involves regulation of a normal body mass index, because an increase in weight may pose stress on the joints. Paraffin baths or hot packs may be used to relieve the associated pain by reducing inflammation. The use of assistive devices like a walker or crutches can ease mobility while avoiding undue excessive pressure on the affected joint.
Osteotomy
Removes a wedge or slice of bone to restore alignment and shift weight-bearing, thus relieving pain.
A debridement procedure
Removes degenerative debris from the join to relieve pain and promote mobility.
How should the nurse reduce periods of acute inflammation in Osteoarthritis patient's while exercising
Rest
A patient with fever reports fatigue, joint pain, and stiffness especially in the morning lasting approximately 3 hours. Which condition does the nurse suspect the patient may have?
Rheumatoid arthritis The nurse should suspect rheumatoid arthritisLinks to an external site. in this patient, since systemic manifestations such as fatigue and fever are not present in osteoarthritis, gout, and ankylosing spondylitis.
What results in destabilization of a prosthesis?
Sitting on chairs without arms will lead to a sudden flexing of the body more than 90°. Performing daily activities such as putting on shoes and socks that require flexing the body more than 90 °, will lead to damage of the soft tissue. Therefore it should be avoided till at least six weeks after the surgery. Crossing of the legs at the knees or ankles affects healing of the soft tissue of the hip joint, leading to predisposition of the joint.
Which are characteristics specific to rheumatoid arthritis (RA)? Select all that apply.
Stiffness lasting an hour to all day and young to middle-age onset
Atrial fibrillation increases a patient's risk for?
Stroke is clot formation in the atria caused by altered blood flow through the heart.
Hyperkalemia is characterized by a peaked
T wave
A patient with profound osteoarthritis is recommended for total hip arthroplasty (THA). The patient asks why this will relieve the discomfort. What is the nurse's best response?
THA can provide significant pain relief for patients with joint deterioration from arthritis by replacing the ball-and-socket joint as well as the upper shaft of the femur.
The nurse is teaching the female client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. The nurse tells the client that this is most effectively done by:
Taking medications on time to maintain therapeutic blood levels. Clients with myasthenia gravis are taught to space out activities over the day to conserve energy and restore muscle strength. Taking medications correctly to maintain blood levels that are not too low or too high is important. Muscle-strengthening exercises are not helpful and can fatigue the client. Overeating is a cause of exacerbation of symptoms, as is exposure to heat, crowds, erratic sleep habits, and emotional stress.
After synchronized cardioversion, a patient's electrocardiogram (ECG) tracing reveals the following. How should the nurse interpret the findings? Normal sinus rhythm (photo)
The cardioversion was successful.
Taking methotrexate for (RA) the patient should be advised to?
The patient should be advised to stay well hydrated while taking methotrexate; the patient should not be told to decrease fluid intake.
A rehab nurse is planning care for a patient diagnosed with Parkinson disease (PD), which of these patient outcomes should receive priority in the patient's plan of care?
Toileting and bathing independently Being able to perform such tasks as toileting and bathing is important in maintaining some degree of independence and quality of life, so this is the priority outcome.
A patient is hospitalized with heart failure. The patient has the following electrocardiogram (ECG) tracing, is experiencing chest pain, shortness of breath, and has a blood pressure of 70/40. The nurse anticipates that what will be included on the patient's plan of care?
Trans-cutaneous pacing HR bradycardia The patient is in a third-degree atrioventricular (AV) block and requires some type of pacemaker
A 30-year-old female patient with severe rheumatoid arthritis (RA) is prescribed methotrexate for disease management. What should the nurse instruct the patient to do?
Use effective contraception during and three months after treatment with methotrexate. Contraceptives should not be avoided since methotrexate has been linked to teratogenic effects.
An injured soldier had an amputation of the left leg and is reporting shooting pain and heaviness in the area of the missing leg. What would be the best response by the nurse for this patient?
Use mirror therapy Mirror therapy has been shown to reduce phantom limb pain in some patients.
The nurse is assessing a 37-year-old client diagnosed with multiple sclerosis. Which of the following symptoms would the nurse expect to find?
Vision changes Vision changes, such as diplopia, nystagmus, and blurred vision, are symptoms of multiple sclerosis. Deep tendon reflexes may be increased Babinski sign may be positive Intentional tremors, or those occuring with purposeful voluntary movement are common in patients with MS. Affected muscles are spastic, rather than flaccid.
Accelerated Junctional rhythm is characterized by an
absent P wave
Osteoarthritis can be managed with a combination of?
exercise, diet, and medication.
