Nur 236 chapters 31 and 32 muscle skeletal

The nurse is caring for a patient who has had an arthrocentesis. The nurse has completed discharge instructions. Which statement indicates the patient needs further instruction?

"I should avoid moving my knee for at least 2 weeks." The patient with the arthrocentesis will be instructed to avoid overuse of the joint; however, it may be moved in moderation. Steroids will be prescribed to limit inflammation. Pain is anticipated and analgesics will likely be prescribed. Elastic bandages are frequently worn for 2 to 3 days

The nurse is discussing actions that can be taken to best prevent osteoporosis with a patient. Which information should the nurse include?

Exercise throughout life. A lifetime of even mild daily exercise will delay or prevent osteoporosis.

The nurse is instructing the patient on quadriceps and gluteal muscle exercises. Which instructions should the nurse include?

In a supine position, straighten the leg and tense leg muscles while raising heel. The quad setting exercise is to straighten the leg and tense the leg muscles while raising the heel

What does goniometry measure?

Range-of-motion (ROM) Goniometry measures joint mobility, described as the number of degrees that the joint can move from the 0-degree mark.

bone scan

after procedure, monitor site of venipuncture for signs of inflammation and hematoma

The nurse is assigned to care for several orthopedic patients. In planning care, it is appropriate to assign which task to unlicensed assistive personnel?

take vital signs on each patient who has returned from a procedure

-------------- exercise is helpful in preventing osteoporosis.

weight bearing

instructions for a person on crutches to sit down

-Turn slowly and touch back of legs to seat of chair. - Transfer both crutches to the side of injury -With weight on good leg, reach back, and gasp chair arm -Using crutch and chair arm for support, slowly sit on chair -sit back in chair.

MRI (magnetic resonance imaging) is used to help diagnose a variety of musculoskeletal problems. What instructions would you give the patient who is to undergo an MRI?

-You must remove all metal from your body -You will need to remain perfectly still for 15 to 60 minutes. -If you are claustrophobic, you may ask for a sedative beforehand.

Measures that can help prevent musculoskeletal disorders.

-consuming adequate amounts of calcium and vitamin D through sunlight and supplemental sources. -Refrain from using steroids on a long term basis -Weight training and weight bearing exercise throughout life -Learning to lift and move objects correctly -Using seat belts, safety helmets, consuming adequate protein and not smoking.

A patient presents to the emergency department immediately after an injury. An x-ray has been ordered for a suspected dislocation. Before confirmation by x-ray, which finding(s) support the potential diagnosis? (select all that apply.)

-history of forceful injury -Severe pain, aggravated by motion -muscle spasm -Abnormal appearance of joint A dislocation will be evidenced by severe pain aggravated by motion, muscle spasm, and an abnormal-appearing joint after the history of a forceful injury. A hematoma, if it forms, will not be evident for a few hours.

Which age-related change(s) occur(s) in the musculoskeletal system? (select all that apply.)

-increased brittleness and fragility of bones -Decreased healing times -Decreased muscle mass -Tendon sclerosis Age-related musculoskeletal changes include increased fragility, decreased healing times and muscle mass, and tendon sclerosis. Bone density usually decreases with aging.

What significant findings the nurse might record when taking a history during assessment of a patient with a complaint of back pain.

-joint stiffness -Personal history of degenerative bone disease, blood dyscrasias (sickle cell disease) psoriasis -Family history of bone, joint or skin disease -Characteristics and location of pain -Loss of sensation

Which statement(s) accurately describe the advantage(s) of fiberglass casts? (select all that apply.)

-lighter weight -allowance of weight bearing after 30 minutes -Dries more quickly Fiberglass casts are lighter and dry quickly, allowing weight bearing in as little as 30 minutes. Fiberglass casts are very expensive and do not lend themselves to molding to body parts. The surface is very rough and often abrades the skin.

When the nurse plans for the progressive mobilization of a hemiplegic, the nurse will consider the patient's ability to perform which function(s)? (select all that apply.)

-move limbes -change position in bed independently -Transfer self from bed to chair -walk Progressive mobilization is assessing the patient's ability to move their limbs, turn themselves in bed, transfer themselves from bed to chair and back again, and stand and walk. These measurable signs of independent movement represent various stages to which the patient can gradually progress. According to the Joint Commission's National Patient Safety Goals, it is a nursing responsibility to recognize that these patients are at risk for falls while they are learning to regain mobility. Progressive mobilization does not require that the patient perform all ADLs independently.

The nurse adds interventions for range-of-motion (ROM) and isometric exercises for the new patient with a stroke. The nurse's reasoning stems from her awareness that contracture formation may begin with how many days of immobilization?

3 days Contracture-related muscle changes occur as early as 3 days of immobilization.

The patient in a long arm cast (from below the shoulder to the wrist, with a 90-degree elbow flexion) complains of a burning sensation over the elbow. The nurse's initial intervention should be:

Check to see if the cast is properly supported The initial intervention should be to assess for adequate support to the cast, then elevate the limb for 30 minutes. If the pain has not diminished, document the intervention and notify the charge nurse.

Bone shattered in more than two pieces

Comminuted fracture

Bone that is in two distinct pieces

Complete fracture

Fracture bone end protruding through skin

Compound fracture

Positioning and range-of-motion (ROM) exercises most help the immobilized patient to prevent which complication?

Contractures Although positioning may help decrease pain and increase circulation, anatomical alignment and ROM exercises are most helpful in preventing contractures in the immobilized patient. Pressure ulcers are prevented by frequent position changes.

Bone is partially broken and partially bent

Greenstick fracture

A patient at risk for the development of osteoporosis has reported plans to increase calcium intake. Which meal choice is most appropriate for this patient?

Grilled salmon, green beans, and milk In addition to dairy products, sources of calcium include canned sardines or salmon, tofu, figs, and green vegetables.

The nurse is caring for an older adult patient. Which age-related factor increases this patient's risk for falls?

Increased postural sway Approximately 30% to 40% of inpatient safety incidents are related to falls, and older adults are particularly vulnerable because of changes related to aging such as decreased strength, unsteady balance, loss of endurance, slow reflexes, gait disturbances, and increased postural sway, and chronic diseases such as arthritis. Lines and tubes, room clutter, and pain medications are risk factors for falls regardless of age.

An elderly patient wit arthritis has a nursing diagnosis of Functional incontinence. Which intervention should the nurse use?

Instruct the patient to call for assistance in getting to the toilet

Reduction of fracture through surgical incision

Internal fixation

Used with older adults when brittle bones do not heal quickly

Internal fixation

Goniometry

Measurement of frame of motion of a joint

Carpal tunnel syndrome (CTS) is caused when the carpal tunnel compresses which location?

Median nerve When the median nerve is compressed by the carpal tunnel to the point that numbness, pain, and tingling occur, the result is CTS

If muscles are not regularly stretched and contracted, how will the muscles be effected?

Muscles will become shorter and less elastic The formation of contractures (shortening of skeletal muscle tissue causing deformity), loss of muscle tone, and fixation of joints can be prevented in most cases by consistent nursing intervention. The major components of the intervention are gradual mobilization, an exercise program, proper positioning, and instruction of the patient and family. Within a matter of a few days, the structures of immobilized muscles and joints begin to undergo changes. If no effort is made to prevent these changes, the patient will become permanently disabled.

A patient in Russell traction with a Pearson attachment for a fracture of the tibia complains of intense pain at the fracture site. The nurse assesses a temperature of 102° F and increased swelling at the fracture site. Which complication do these findings suggest?

Osteomyelitis Osteomyelitis is a bacterial infection of the bone. The causative organism is most often Staphylococcus aureus, which enters the bloodstream from a distant focus of infection, such as a boil or furuncle, or from an open wound, as in an open (compound) fracture. It is usually found in the tibia or fibula, in vertebrae, or at the site of a prosthesis. Osteomyelitis has a sudden onset with severe pain and marked tenderness at the site, high fever with chills, swelling of adjacent soft parts, headache, and malaise. These findings are not consistent with fat embolisms, traction misalignment, or nonunion of the fracture.

The nurse is performing morning care for a patient who sustained a fractured pelvis and bilateral femur fractures yesterday in a motorcycle collision. The patient complains of shortness of breath. Assessment reveals audible wheezes and oxygen saturation of 76%. What action should the nurse take first?

Raise patient to high Fowler position. Fat embolism is a rare but serious complication of a fracture of a bone that has an abundance of marrow fat (e.g., the long bones, pelvis, and ribs). In the early postinjury period, patients with multiple fractures resulting from severe trauma are at risk for this complication. Signs and symptoms of fat embolism include a change in mental status, respiratory distress, tachypnea, crackles and wheezes on auscultating the lungs, rapid pulse, fever, and petechiae (a fine red rash over the chest, neck, upper arms, or abdomen). The nurse should stay with the patient; put him in a high Fowler position, use a nonre-breather mask to give high-flow oxygen, and establish a peripheral IV line. The nurse should also summon the provider immediately as there is about an 80% mortality rate from this complication. Raising the patient to high Fowler position is the best initial intervention as it can be done immediately. The nurse should then verify patent IV access, notify the charge nurse and provider, and update the family on the patient's status change.

When preparing a patient for electromyography (EMG), which instructions should the nurse include?

Refrain from caffeine drinks for 3 hours before the test Electromyography (EMG) is used to detect abnormal nerve transmission to the muscle and abnormal muscle function, and to assess the rehabilitation progress. Before the test, smoking and use of caffeine should be ceased for 3 hours. The test usually takes 1 hour.

A patient is learning to use crutches on the stairs. Which action indicates that the patient needs further instruction?

The patient places the good leg on the step to be climbed first. When climbing stairs with crutches, the patient should first stand at the foot of the stairs with weight on the good leg and crutches, put weight on the crutch handles, and then lift the good leg up onto the first step of the stairs. Weight should be placed on the good leg to lift the injured leg and crutches up to that step.

The nurse is performing an assessment on the patient who is in bilateral Buck traction. Which finding indicates the need to reposition the patient?

The patient's feet are against the footboard When the patient's feet are against the footboard, the traction is ineffective. The heels should be off the surface of the mattress to reduce the threat of pressure ulcer. The weights should be hanging free.

The nurse encourages the patient to use the four-point crutch gait technique. Which statement indicates that the patient accurately understands the nurse's teaching?

This way of walking is the most stable gait." The four-point crutch gait is the most stable, requires that there may be partial weight bearing on both legs, and does not mimic normal walking pattern.

Which vitamin is essential in treating osteoporosis?

Vitamin D Standard treatments for osteoporosis include vitamin D and calcium supplementation, along with weight-bearing exercise. Vitamins A, B12, and C are not included in the standard treatment regimen for osteoporosis.

Arthroscopy

after procedure, watch for signs of infection, hemarthrosis, swelling, and injury to joint or loss of feeling

When a joint is obliterated by bony overgrowth, the joint is said to be _________.

ankylosed Ankylosis occurs when the joint is overgrown with bony overgrowth.

When a walker is used for ambulation, it is important that it be appropriate height for the patient. Most walkers have adjustable legs. When walking with it, the walker height is correct when the patient's elbow is:

bent at 15 - 30 degrees

If ankylosis of a joint is unavoidable, the joint is ------------- so that the extremity will have maximum function.

braced

The bones of the elderly break more easily because they are ------------ and -------------.

brittle compact

The nurse explains that the "C" in the acronym RICE for sprain treatment stands for _______.

compression RICE stands for Rest, Ice, Compression, and Elevation.

The patient is selecting foods from a menu to demonstrate knowledge of dietary calcium sources. Which selection indicates that the patient needs additional information about the absorption of calcium from food sources.

green leafy vegetables

The canal system that runs through the bone and contains the blood and lymph vessels is called the ____________.

haversian system The haversian system is the canal system that runs through the bone to carry blood and lymph vessels.

As we age, bone density decreases because of

reabsorption of minerals

The nurse uses a visual aid to show the difference between a complete dislocation and a partial dislocation, which is also called a(n) __________.

subluxation A subluxation is a partial dislocation

Describe how you would teach the patient to go up and down stairs, and what are the safety measures you would teach?

walking up stairs: Stand at the foot of the stairs with weight on the good leg and crutches. Put weight on the crutch handles and then lift the good leg up onto the first step of the stairs. Put weight on the good leg and lift the injured leg and crutches up to that step. Repeat for each step. walking down stairs:Stand at the top of the stairs with weight on the good leg and crutches. Shift weight completely onto the good leg and put the crutches down on the next step. Put weight on the crutch handles and transfer the injured leg down on the step with the crutches. Bring the good leg down to that step. Repeat for each stair step. Teach the patient to inspect the rubber tips on the crutches frequently and to replace them if they appear worn. Teach not to rest the axillae on the tops of the crutches as it may cause compression of the nerves and circulation. Caution to watch for wet places and to avoid crutch walking through them. Caution to rest if becomes tired.

Which component(s) is/are functions of the musculoskeletal system? (select all that apply.)

-motion -support -protection of organs -body shape Musculoskeletal system functions include motion, support, organ protection, and retention of body shape. The musculoskeletal system does not fight infections.

Proper exercise and positioning of joints for an immobile patient is extremely important because a contracture can begin to occur within as little as ----------------.

3 to 7 days.

What is the difference between a sprain and a strain?

A sprain involves stretching or tearing of ligaments around a joint. A strain involves pulling and tearing of a muscle or a tendon or both.

An elderly orthopedic patient refuses to perform the coughing and deep breathing exercises. He says, I have a broken hip. There is nothing wrong with my breathing. What should the nurse do first?

Explain how immobility contributes to developing pneumonia or atelectasis

Reduction of fracture and fixation to device that maintains alignment

External fixation

Used with infected fractures that do not heal properly

External fixation

Muscle strength

Grading ranges from (0-paralysis) to (5 is normal)

Which major advantage is specific to external fixation devices?

Greater freedom of movement The external device for fracture reduction allows greater freedom of movement, decreasing the problems of immobility. Healing time and pain are the same as with any other fracture reduction method.

Metal appliances are used to stabilize pieces of fracture

Internal fixation

The patient has suffered a fracture of the humerus in an accident and has a new cast. Compartment syndrome is a potential complication. A typical sign or symptom would be:

pain unrelieved by analgesia

A way to try to prevent musculoskeletal disorders including rheumatoid arthritis is:

refrain from smoking or stop smoking

Disease modifying antirheumatic drugs prevent joint and cartilage destruction by:

suppressing the immune system

The nurse observes that an elderly patient has decreased strength, unsteady balance, slow reflexes, and a gait disturbance. What is the priority problem?

Potential for falls.

Stiffness and crepitation in the joints is a result of joint ---------------- and erosion from ------------.

cartilage thinning years of use

The nurse uses a visual aid to show the pathologic muscle tone changes that result in foot drop. Which changes should the nurse include?

The stretching of flexor muscles The most frequent contractures occurring in patients immobilized for long periods are "foot drop," knee and hip flexion contractures, "wrist drop," and contractures of the fingers and arms. Calf muscles contract and flexor muscles are stretched, allowing the unbraced foot to drop toward the surface of the bed.

Posture description:

erect, slumped, rounded shouldered, straight

Nighttime muscle cramping in the elderly is increased because of ----------- and accumulation of -------------.

impaired circulation metabolic wastes

Kyphosis in the elderly is because of thinning of the ------------- and collapse of the -------------.

intervertebral cartilage Vertebrae in the cervical and thoracic spine

Cleaning of pin sites

Should be done daily with a 2 mg/ml chlorhexidine solution

Gait description:

normal, rolling, heel toe, toe heel, ataxic, ambling, slow, rapid, bouncy

The nurse is caring for a patient who works as a legal secretary. The patient asks the nurse about ways to avoid developing carpal tunnel syndrome (CTS). Which action should the nurse suggest?

"Acquire a pad to support your wrists while typing." Elevating the wrist with a firm support eliminates the need to keep the wrists flexed for long periods of time. This wrist support will help prevent CTS. Repetitive motion increases risk for carpal tunnel. Wrapping the wrists or applying warm compresses do not lessen risk of developing carpal tunnel.

The patient's plan of care includes using the continuous passive motion (CPM) machine. Which statement indicates the patient needs for further teaching?

"I can make my new knee stronger if I reset this thing to go faster and flex my knee more." The continuous passive motion (CPM) machine is used to provide movement to a joint in recovery. The apparatus is driven by a motor and requires no effort on the part of the patient or nurse to move the limb. It is usually left on all day and is discontinued at night while the patient sleeps. CPM is preset as to speed and the degree of flexion that is determined by the physician and should not be adjusted by the patient.

Which statement indicates that the patient needs further instruction about application of ice to a sprain?

"I will keep the ice on this knee for the rest of the day." Ice should be applied for 20 minutes of each hour for the first 24 hours.

When the clinic nurse starts to take the "air cast" off the grade 2 sprain, the patient asks why it is being removed since he still has pain. Which explanation is best?

"Long-term immobilization can cause permanent disability." Air casts, braces, or supports are used only until a joint has been strengthened. If a joint is immobilized too long and muscles are not exercised, muscle atrophy—which begins in a matter of days—can cause permanent disability

The patient with osteoporosis calls the nurse in the doctor's office to report that she should have taken but has forgotten to take her weekly bisphosphonate (alendronate [Fosamax]) that was due 2 days ago. How should the nurse advise the patient?

"Skip this week and pick up the schedule next week." If 2 or more days have passed since the regular dose time, this week's dose should be skipped and the weekly schedule should be picked up next week.

The nurse is educating a patient going home with a short arm synthetic cast. Which instructions should the nurse include in the teaching plan? (select all that apply.)

-Cover the cast with a plastic bag when taking a shower -Observe skin at the edge of the cast to relieve itching -Check circulation and sensation in the fingers frequently -Move and flex the fingers to stimulate circulation

The patient is returning to the unit with a wet long leg cast. To prevent damage to the wet cast, what action(s) should the nurse take? (select all that apply.)

-Determine the cast material -Support the cast with the palms of the hands rather than holding it with the fingers. -Assess heat generated from the drying cast Determining the cast material will inform the nurse of how quickly the cast can be expected to dry. The cast should be supported with the palms of the hands rather than holding it with the fingers. The heat of the drying cast should be evaluated to prevent skin irritation. A grayish color indicates that the cast is still wet.

The nurse suspects compartment syndrome in a patient with a side arm cast and traction when observing which finding(s)? (select all that apply.)

-Intense pain in hand and fingers -Edema of fingers -Weak radial pulse -Tingling and numbness Compartment syndrome is a restriction of blood flow that occurs in one or more muscle compartments of the extremities. Compartment syndrome is caused by external or internal pressure. The main sign of compartment syndrome is severe, unrelenting pain that is out of proportion to the injury and unrelieved by narcotics. Decreased sensation, numbness and tingling, paleness of the skin, and weakness of the extremity are other signs. Warm, rosy fingers would be assessed as a sign of adequate perfusion.

Soft-tissue injuries require the nurse to assist with or instruct about the importance of which components of care? (select all that apply.)

-Pain control -Immobilization -Activity restrictions -Prevention of recurrence Pain control, immobilization, activity restrictions, and prevention of recurrence are part of the care to a patient with a soft-tissue injury. Bed rest is not warranted with this type of injury.

When assessing whether crutches have been fitted to the patient properly, you know that when walking with them the....

-axillary bar should be two finger breadths below the axo;;a -elbow should be flexed at a 30 degree angle -crutches should be about 16 inches shorter than the patient's height

Malignant tumors can contribute to musculoskeletal disorders in two ways:

-by placing a large nutritional demand on the body -by invading bone and causing fractures and causing muscle wasting

Observations the nurse can make about a patient's ability to move and walk.

-complaints of joint pain -awkward gait -limping -difficulty with arising or walking -poor posture -wincing upon movement or difficulty with balance or strength

When checking the joints during a focused assessment, you should:

-palpate them for tenderness -inspect them for swelling or deformity -assess for warmth over the joint -determine range of motion without pain

Patients with rheumatoid arthritis who are receiving Enbrel or other biologic response modifiers must be watched for complications such as:

-serious infection -blood dyscrasias -signs of demyelination

When a patient with a new hip is being prepared for discharge, you should give which instructions to avoid dislocation of the prosthesis?

-used a raised toilet seat -Use a pillow between your knees when lying down -Do not cross your legs at the knee or ankle -Be careful not to bend at the hip more than 90 degrees.

Because the patient is immobilized, the health care provider has ordered Lovenox, low molecular weight heparin injections. The prescription reads: enoxaparin sodium 60 mg sbcu per day in 2 divided doses. On hand is enoxaparin sodium 30 mg/ ml. How much medication would you draw up for each injection?

1ml

With the pain of chronic osteoarthritis, the patient should not take more than -------------- mg of acetaminophen a day.

3000

What is the name for the anatomical structure that joins the bones of a joint together?

A ligament Ligaments hold the bones of a joint together. Tendons are connective tissues that provide joint movement. Cartilage is a type of connective tissue in which fibers and cells are embedded in a semisolid gel material.

The physician has prescribed isometric exercises for a patient. For which patient should the nurse question this order?

A patient experiencing an acute exacerbation of congestive heart failure Isometric exercises are based on the energy of opposing muscles working against each other. Isometric exercise may be contraindicated in patients with hypertension, increased intracranial pressure, or congestive heart failure, as there is a significant increase in blood pressure and heart rate during isometric exercise

A patient is in her first postoperative day after a total hip replacement as treatment for degenerative arthritis. The patient's operated limb ust be kept in what position?

Abduction

When caring for a patient who has an abductor wedge in place after a total hip replacement, for which finding should the nurse assess?

Alteration in peripheral circulation Pressure from the abductor wedge can interrupt arterial blood supply and compress the peroneal nerve

Arthrocentesis

Apply ice or cold packs, support joint with pillows

When the patient returns to the unit from having had an arthrogram, which intervention should the nurse perform first?

Apply ice packs to the knee Ice packs applied to the knee will reduce swelling. The patient will ambulate at some point but not before the application of ice. There is not going to be a significant loss of mobility for the patient, so ROM exercises will not likely be included in the plan of care. There is no indication that an elastic bandage is needed.

The nurse is caring for a patient with a newly applied cast to the lower extremity. The patient continues to complain of pain despite medication and repositioning. What should the nurse do first?

Assess the temperature of the toes, sensation to touch, and capillary refill.

The industrial nurse examines an employee who complains of right shoulder pain on abduction. He points with one finger to the exact location of the pain and mentions that he won a racquetball tournament yesterday. The nurse suspects the employee is suffering from which problem?

Bursitis Bursitis occurs after overuse, with pain in the joint on activity with no erythema and little, if any, swelling. Dislocations are very painful and the pain is spread all over the shoulder. The shoulder also looks misshapen in a dislocation. Rotator cuff tear would prevent the patient from abducting his shoulder.

An 80-year-old man falls and suffers a compound fracture of the femur. Which immediate action is most appropriate?

Carefully splint the leg as it is. Any fracture, even a compound one, should be immobilized in position to avoid further injury to the soft tissue attached to the bones. Any other initial action may cause further injury.

What is the purpose of cartilage?

Cartilage provides a cushion between the ones of the joint .

The nurse is changing the position of a person with flaccid paralysis. Which action is most important?

Change the patient's joint position frequently. Frequent changes in joint position reduce the incidence of ankylosis.

Fracture that has not broken through skin

Closed fracture

Manual reduction and manipulation of bones into alignment

Closed reduction

An older adult has fallen and sprained his ankle in a local park. Which action should the responder perform first?

Elevate the foot Elevation to reduce swelling is the most important initial intervention. Elevation may be done immediately. The responder will have to acquire the ice and pain medication, but should do so as quickly as possible. The responder should not attempt to ambulate the patient at this time

Culture

Examination of bone tissue to identify infecting organism

steps of the process of fracture healing in proper order.

Hematoma is formed between broken ends of bone. Granulation tissue is formed Callus is formed Mature bone cells form ossification Medullary canal is reconstructed

A patient is discharged with a synthetic cast applied. What will he need to know to take care of himself and the the cast?

How to assess the neurovascular status of the part encased in the cast -how to dry the cast if it becomes wet -signs of infection under the cast -Importance of reporting a broken or loose cast

The nurse is at a park and observes a workman who sustains an accidental amputation of a finger. The nurse would intervene if a bystander performs which action?

Immerses the digit in a cup of cold water.

What is the difference between a tendon and a ligament?

Ligaments hold the joint together. Tendons anchor muscle to bone.

A patient has come to the ambulatory care clinic with a sprain. The nurse correctly differentiates a grade 2 sprain from a grade 3 sprain with the assessment of which finding?

Minor loss of function The minor loss of function is the differentiating factor. Pain, swelling, and bleeding into the joint are true of both grade 2 and grade 3 sprains. A grade 3 sprain has loss of function of the joint.

Synovial analysis

Normal findings are clear, viscous fluid containing no or very few blood cells

Which bodily component constantly renews bone?

Osteoblasts Osteoblasts build bone as the old bone is reabsorbed into the body.

The nurse is caring for several patients with hip or femur fractures on an orthopedic unit. Which patient should the nurse attend to first?

Patient complains of difficulty breathing, feeling very hot, and fine red rash on the chest.

The nurse is instructing a patient with rheumatoid arthritis about a prescribed exercise program. Which information should the nurse include?

Perform exercises every day, 3 to 10 times for every joint Exercises are essential to preserve joint function and should be done every day 3 to 10 times per joint. Exercises should be omitted if there is inflammation present and should not be taken past the point of pain, or made up the next day.

Joint mobility is maintained by regularly performing ------------- exercises.

Range of Motion

The nurse is caring for a patient who just returned from surgical decompression of the carpal tunnel. Which finding requires the nurse's immediate action?

The capillary refill time is 8 seconds. A capillary refill of over 5 seconds is an indication of diminished perfusion. Pain and swelling are to be expected, and pink but cool fingers bilaterally do not indicate circulatory compromise.

The nurse is assessing the patient's crutches. Which observation confirms that the crutches are sized correctly?

The crutches are approximately 16 inches shorter than the patient's height Crutches should be about 16 inches (40 cm) shorter than the patient's height. When in the standing position with axillary crutches, the axillary bar should be two finger breadths below the axilla. The elbow should be flexed at a 30-degree angle when the palms of the hands rest on the handgrip. It is important that the patient not rest the body at the axilla on the top of the crutch; body weight should be borne by the arms on the hand rests of the crutches. If crutches are too long, pressure on the axilla will occur and can cause nerve and circulatory impairment.

The nurse is assessing the patient's cane for appropriate length. Which observation affirms that an appropriate cane has been selected?

The handgrip is at hip level. The handgrip should be at hip level to allow for proper flexion of the arm to bear weight. The cane tip should be placed 6 inches from the good foot. The elbow angle should be 30 degrees

How often should range-of-motion (ROM) exercises be performed?

Three to four times a day ROM exercises, both passive and active, are planned and carried out as soon as feasible after immobilization occurs as a result of disease, injury, or surgery. The exercises are done to maintain functional connective tissue within the joint and thereby ensure that every joint retains its function and mobility. ROM exercises should be done three to four times a day.

Poor nutrition can contribute to musculoskeletal problems because there may be ---------------.

To little calcium and phosphorus or inadequate protein

Subluxation is a partial dislocation that usually occurs from ---------------.

Trauma

What are some objectives data the nurse might collect when assessing a patient with arthritis?

a. Evidence of swelling, redness, deformity in joints b. Limited range of motion; in what joints; how much c. Gait d. Posture e. Evidence of improper use of crutches or cane, inappropriate shoes

What are some questions a nurse might ask when assessing the status of a patient with arthritis.

a. Have you had an injury, systemic illness, immunization, or sudden change in physical activity recently? b. When did joint pain first begin? Was onset sudden or gradual? c. What seems to relieve the pain? d. What makes joint pain worse? Does it come and go? When is it worse? When is it better? Is there a pattern to the appearance of the pain and its abatement?

What are some interventions for a patient with arthritis and a nursing problem of altered activity tolerance.

a. Rest of the whole body is as important as rest of the inflamed joints. b. Take a rest before you become too tired. c. During rest, be sure your body is in good position. No pillows under the knees or any other support that keeps the joints flexed. d. Always stop exercises at the point of real pain. e. Use your biggest muscles to do the work. f. Learn to conserve your energy to do the things you really want to do. g. Let swollen, red, and inflamed joints rest as much as possible. h. Change your body position frequently

You must watch the patient with a fracture of the femur for a fatembolism. s/s include?

altered mental status, petechiae on chest, and dyspnea

Lengthy immobilization tends to cause muscle to ------------ (loss of tone)

atrophy

A patient who is immobilized for a long period of time loses -------- from his bones.

calcium

Range of motion description:

full, limited, diminished, little, restricted

The most common cause of below the knee amputation is

gangrene

Skeletal muscles description:

good tone, well developed, underdeveloped, tense, hard, soft, poor tone, atrophic, painful.

The muscles most commonly afflicted with muscle strain are the --------------, ---------------, and ------------- muscles.

hamstring quadriceps calf

Tachypnea, disorientation, crackles, and wheezing, and rash with lesions that do not blanch with pressure.

notify the health care provider promptly; this is symptomatic of fat embolism. This is a rare but potentially fatal condition.

Spine description:

normal curve, S-shaped, abnormally curved, tender, rounded

Joints description:

normal, reddeded, swollen, painful, deformed , immovable, contracted, freely movable

Inadequate immobilization

patient complains of grating sensation and unrelenting pain, especially with motion.

Infection of a pin site or fracture site

presents as dull pain that becomes progressively worse, fever, purulent drainage, foul odor. Initiate wound and skin precautions.

The most common cause of osteomyelitis is

staphylococcus aureus

Swelling and increased pressure within a fascial compartment

test for sensation and do a capillary refill time test

In addition to increasing calcium and vitamin D, one of the best ways for women to prevent osteoporosis is to preform

weight bearing exercise