PrepU Chapter 40: Musculoskeletal Care, CH 40, Safety

Accidental Poisoning treatment

1.Assess the Victim 2.Terminate Exposure 3.Identify the poison 4.Prevent poison absorption

the environmental safety measures for the protection of adults apply to children what are the measurements

Bed in lowest position, dry floor, non-skid socks, call bell within reach

Plaster casts are cheaper and

achieve a better mold compared to fiber glass however the reaction of heat activated by water (exothermic raction) can cause serious burns

Unintentional poisoning deaths doubled for

adolescents 15-19 years old.

3. Simple or closed -

bone broken, skin intact.

2. Transverse -

break across the bone.

Numbness, tingling, or paralysis may be present due to

to neurologic involvement.

RN can Assigns duties to other RN's delegates tasks to____ what are their task

●LPN, NA, UC, Transporters ●Analyzes collected data ●Participates in patient care

Which assessment finding would cause the nurse to suspect compartment syndrome in the client following a bone biopsy? a) Toes move freely without pain b) Bounding dorsalis pedis pulses c) Capillary refill < 3 seconds d) Increased diameter of the calf

Increased diameter of the calf Explanation: Increasing diameter of the calf can be indicative of bleeding into the muscle. The other findings are within normal limits.

The client presents with an exaggeration of the lumbar spine curve. The nurse interprets these findings as indicative of: a) Scoliosis b) Lordosis c) Dowager's hump d) Kyphosis

Lordosis Explanation: Lordosis is an exaggeration of the lumbar spine curve.

The nurse is caring for a client who experienced a crushing injury of the lower extremities. Which of the following symptoms is essential to be reported to the physician? a) Coolness b) Pulselessness c) Ischemia d) Pain

Pulselessness Explanation: Neurovascular checks (circulation, sensation, motion) are essential with a crushing injury. The absence of a pulse is a critical assessment finding to report to the physician. The other options are symptoms that need regular assessment.

6. Fracture with displacement -

bone fragments have separated at the point of fracture.

5. Fracture without displacement -

bone is broken; bone fragments are in alignment in normal position.

Heavy Metal Poisoning can occur from ingestion

of substances, most commonly ingested substance is lead.Mercury toxicity is a rare form of heavy metal toxicity

2. Incomplete - .

partial break without separation

how does Estrogen replacement therapy work ?

prevents osteoporotic fractures by 50 percent or more but must be continued indefinitely. This treatment raises the risk of breast or endometrial cancer & VTE

An example of a flat bone is the a) vertebra. b) sternum. c) metacarpals. d) femur.

sternum. Explanation: An example of a flat bone is the sternum. A short bone is a metacarpal. The femur is a long bone. The vertebra is an irregular bone.

flat bones are located where extensive protection of underlying

structures is needed (

If you discover a problem, inform your

team leader or manager immediately

4. Compound or open -

the fractured parts extend through the skin.

A client undergoes an invasive joint examination of the knee. The nurse would closely monitor the client for which of the following? a) Lack of sleep and appetite b) Signs of depression c) Signs of shock d) Serous drainage

Serous drainage Explanation: When the client undergoes an invasive knee joint examination, the nurse should inspect the knee area for swelling, bleeding, and serous drainage. An invasive joint examination does not cause lack of sleep or appetite, depression, or shock. The client may be in shock due to the injury itself.

Democratic leadership

Shares leadership. Important plans and decisions are made with the team

Which would be an inappropriate initial pain relief measure for the client with a cast? -Application of cold packs -Application of a new cast -Administration of analgesics -Elevation of the involved part

-Application of a new cast Most pain can be relieved by elevating the casted part of the body, and by applying cold packs as prescribed and administering analgesics. Application of a new cast is usually not necessary.

Which action by the nurse would be inappropriate for the client following casting? -Protect the cast by covering with a sheet. -Handle the cast with the palms of hands. -Circulate room air with a portable fan. -Petal and smooth the edges of the cast.

-Protect the cast by covering with a sheet. The nurse performs actions to facilitate drying of the cast. The cast should be exposed to air. Portable fans can be used to dry the cast. Pressure on the cast should be avoided.

The nurse is caring for a patient who had a total hip replacement. What lethal postoperative complication should the nurse closely monitor for? -Atelectasis -Hypovolemia -Pulmonary embolism -Urinary tract infection

-Pulmonary embolism Patients having orthopedic surgery are particularly at risk for venous thromboembolism, including deep vein thrombosis and pulmonary embolism.

A client has undergone arthroscopy. After the procedure, the site where the arthroscope was inserted is covered with a bulky dressing. The client's entire leg is also elevated without flexing the knee. What is the appropriate nursing intervention required in caring for a client who has undergone arthroscopy? a) Apply a cold pack at the insertion site. b) Provide a gentle massage. c) Assist with performing ROM exercises. d) Apply warm compresses to the insertion site.

Apply a cold pack at the insertion site. Explanation: After covering the arthroscope insertion site with a bulky dressing and elevating the client's entire leg, the nurse needs to apply a cold pack at the site to minimize any chances of swelling.

Which of the following would be most important for the nurse to include in the teaching plan for a client who has undergone arthrography? a) Avoid sunlight or harsh, dry climate. b) Gently massage joints with any crackling or clicking joint noises. c) Avoid intake of dairy products. d) Report joint crackling or clicking noises occurring after the second day.

Report joint crackling or clicking noises occurring after the second day. Explanation: After undergoing arthrography, the client must be informed that he or she may hear crackling or clicking noises in the joints for up to 2 days, but if noises occur beyond this time, they should be reported. These noises may indicate the presence of a complication, and therefore should not be ignored or treated by the client. Massage is not indicated. The client need not be asked to avoid sunlight or dairy products.

Skull sutures are an example of which type of joint? a) Amphiarthrosis b) Aponeuroses c) Diarthrosis d) Synarthrosis

Synarthrosis Explanation: Skull sutures are considered synarthrosis joints and are immovable. Amphiarthrosis joints allow limited movement, such as a vertebral joint. Diarthrosis joints are freely movable joints such as the hip and shoulder. Aponeuroses are broad, flat sheets of connective tissue.

internal fixation

Various orthopedic hardware such as plates, pins, screws, rods and wires are used to internally fix the bone fragments into correct alignment.

Which medication taken by the client in the previous 24 hours would be of greatest concern to the nurse caring for a client undergoing a bone biopsy? a) furosemide b) aspirin c) digoxin d) NPH insulin

aspirin Explanation: Aspirin has anti-clotting properties, and bone is a very vascular tissue. The client taking aspirin in close proximity to a bone biopsy is at increased risk for excessive bleeding.

Transdermal patches and Cough-Suppressant Lozenges can pose great risks to

children.

1. Complete -

complete separation of the bone.

Fat Embolism is what ?

is a complex alteration of homeostasis that occurs as an infrequent complication of the pelvis and long bones. It manifests itself clinically as acute respiratory insufficiency and usually occurs 2 - 3 days following injury. It is most common in young men with long bone fractures

4. Spiral -

line of fracture encircles the bone. Compressed - bone had been compressed (crushed) vertebral fractures

immobility Metabolic system assessment

nAnthropometric measurements nFluid Intake and Output measurements nLab tests for electrolyte imbalances/ nutritional status nAssess ability to heal and fight infection

Immobility of the Cardiovascular System effects

nOrthostatic hypotension nIncreased cardiac workload nThrombus formation oMay become emboli oMost dangerous complication of bedrest nValsalva maneuver

The balance between bone resorption (removal or destruction) and formation is influenced by what factors

physical activity; dietary intake of certain nutrients, especially calcium; and several hormones, including calcitriol (i.e., activated vitamin D), parathyroid hormone (PTH), calcitonin, thyroid hormone, cortisol, growth hormone, and the sex hormones estrogen and testosterone

Five Rights of Delegation

right task right circumstance right person right direction/communication right supervision/evaluation

1. Greenstick -

splintering of one side of the bone. One side is broken and the other side is bent. Occurs more often in children.

Motor Vehicle Injuries are the leading cause of accidental deaths in children over the age of

1

A client is experiencing muscle weakness in the upper extremities. The client raises an arm above the head but then loses the ability to maintain the position. Muscular dystrophy is suspected. Which diagnostic test would evaluate muscle weakness or deterioration? a) A serum calcium test b) A magnetic resonance imaging (MRI) c) An electromyography d) An arthroscopy

An electromyography Explanation: An electromyography tests the electrical potential of muscles and nerves leading to the muscles. It is done to evaluate muscle weakness or deterioration. A serum calcium test evaluates the calcium in the blood. An arthroscopy assesses changes in the joint. An MRI identifies abnormalities in the targeted area.

Which of the following diagnostic studies are done to relieve joint pain due to effusion? a) Electromyography (EMG) b) Arthrocentesis c) Biopsy d) Bone scan

Arthrocentesis Explanation: Arthrocentesis (joint aspiration) is carried out to obtain synovial fluid for purpose of examination or to relieve pain due to effusion. EMG provides information about the electrical potential of the muscles and the nerves leading to them. A bone scan is performed to detect metastatic and primary bone tumors, osteomyelitis, certain fractures, and aseptic necrosis. A biopsy may be performed to determine the structure and composition of bone marrow, bone, muscle, or synovium to help diagnose specific diseases.

Place an "X" on the figure where the nurse would assess for lordosis.

Click on the lumbar part of the spine. Explanation: Lordosis, also known as swayback, is an exaggeration of the lumbar curve of the spine.

Place an "X" on the figure where the nurse would assess for kyphosis.

Click on the thoracic part of the spine. Explanation: Kyphosis is an increased convexity of roundness of the thoracic curve of the spine.

Which of the following is a neurovascular problem caused by pressure within a muscle area that increases to such an extent that microcirculation diminishes? a) Compartment syndrome b) Remodeling c) Hypertrophy d) Fasciculation

Compartment syndrome Explanation: Compartment syndrome is caused by pressure within a muscle area that increase to such an extent that microcirculation diminishes. Remodeling is a process that ensures bone maintenance through simultaneous bone resorption and formation. Hypertrophy is an increase in muscle size. Fasciculation is the involuntary twitch of muscle fibers.

Which diagnostic test does the nurse expect the client with osteoporosis to undergo? a) Arthrocentesis b) Arthroscopy c) Dual-energy x-ray absorptiometry d) Bone biopsy

Dual-energy x-ray absorptiometry Explanation: Osteoporosis is characterized by decreased bone density. Dual-energy x-ray absorptiometry can determine the extent of bone loss.

The nurse is performing a neurovascular assessment of a client's injured extremity. Which of the following would the nurse report? a) Dusky or mottled skin color b) Skin warm to touch c) Capillary refill of 3 seconds d) Positive distal pulses

Dusky or mottled skin color Explanation: Normally, skin color would be similar to the color in other body areas. Pale or dusky skin color indicates an abnormality that needs to be reported. Presence of pulses, capillary refill of 3 seconds, and warm skin are normal findings.

Casts function

Functions 1. Immobilize 2. Prevent or correct deformities 3. Maintain, support, and protect realigned bone 4. Promote healing and early weight bearing.

Qualities of Effective Leaders

Integrity Perseverance Courage Balance Initiative Ability to handle stress Energy Self-awareness Optimism

After a fracture, during which stage or phase of bone healing is devitalized tissue removed and new bone reorganized into its former structural arrangement? a) Inflammation b) Remodeling c) Reparative d) Revascularization

Remodeling Explanation: Remodeling is the final stage of fracture repair. During inflammation, macrophages invade and debride the fracture area. Revascularization occurs within about 5 days after the fracture. Callus formation occurs during the reparative stage but is disrupted by excessive motion at the fracture site.

Aspirin use in young children has been associated with

Reye's Syndrome, and it should not be used in children younger than

Closed reduction treatment

The alignment of bone fragments using manual manipulation and/or traction (reduction of joint dislocations and simple fractures of the forearm, hand, leg or foot are usually accomplished in a closed manner with or without anesthesia). To maintain reduction immobilization is usually required by the use of casts splints braces or traction.

In the last decade, suffocation deaths among infants younger than one year old has

increased◦Wedging between a wall and mattress, crib, or collapsed play yard wall can cause this to occur. ◦Play objects need to be chosen based on the child's age and maturity level.

Salicylates toxicity

Acute Poisoning {Early Symptoms}Clinical Manifestations: Nausea, Hyperventilation, Vomiting, Tinnitus. ◦Acute Poisoning {Later Symptoms} Clinical Manifestations: Hyperactivity, Fever, Confusion, Respiratory Failure, Renal Failure, Seizures Chronic Poisoning has the same symptoms as acute poisoning and often mistaken for viral illness, bleeding tendencies may also be present Treatment: Activated charcoal

The nurse is conducting the admission assessment for the client who is to undergo an arthrogram. What is the priority question the nurse should ask? a) "When did you last urinate?" b) "Are you claustrophobic?" c) "Do you have any allergies?" d) "When did you last eat?"

"Do you have any allergies?" Explanation: Many contrast dyes contain iodine. Therefore, it is essential for the nurse to determine whether the client has any allergies, especially to iodine, shellfish, and other seafood.

A client with a sports injury undergoes a diagnostic arthroscopy of the left knee. Which of the following comments by the client following the procedure should the nurse address first? a) "My feet are cold." b) "My foot is swollen." c) "My toes are numb." d) "My knee aches."

"My toes are numb." Explanation: Numbness would indicate neurological compromise of the extremity and requires immediate intervention to prevent permanent damage.

The older client asks the nurse how best to maintain strong bones. The best response by the nurse is: a) "Weight-bearing exercises can strengthen bones." b) "Weight-resistance exercises can strengthen bones." c) "Cardio-training is the best way to build bones." d) "Range of motion exercises build bone mass."

"Weight-bearing exercises can strengthen bones." Explanation: Weight-bearing exercises maintain bone mass. Weight-resistance exercises maintain and strengthen muscles. Cardio-training is important for heart health and weight maintenance/reduction. Range of motion exercises are essential for joint mobility.

Traction

- the steady pull on a part of the body to v Reduce or immobilize fractures v Overcome muscle spasms v Correct certain deformities v Stretch adhesions v Maintain correct alignment of bone fragments during healing v Immobilize a limb while soft tissue healing takes place.

A client in the emergency department is being treated for a wrist fracture. The client asks why a splint is being applied instead of a cast. What is the best response by the nurse? -"You would have to stay here much longer because it takes a cast longer to dry." -"A splint is applied when more swelling is expected at the site of injury." -"It is best if an orthopedic doctor applies the cast." -"Not all fractures require a cast."

-"A splint is applied when more swelling is expected at the site of injury." Splints are noncircumferential and will not compromise circulation when swelling is expected. A splint is applied to support and immobilize the injured joint. A fracture will swell as part of the inflammation process. The client would not have to stay longer if a fiberglass cast is applied. Fiberglass cast dry in approximately 30 minutes. An orthopedic doctor is not needed to apply the cast. Many nurses and technicians are trained in proper application of a cast. Some fractures may not be treated with a cast but it would not be appropriate to answer with this response because it does not reflect the actual reason for a splint being applied.

Following a total knee replacement, the surgeon orders a continuous passive motion (CPM) device. The client asks about the purpose of this treatment. What is the best response by the nurse? -"CPM increases range of motion of the joint." -"CPM strengthens the muscles of the leg." -"CPM delivers analgesic agents directly into the joint." -"CPM prevents injury by limiting flexion of the knee."

-"CPM increases range of motion of the joint." CPM increases circulation and range of motion of the knee joint.

When discussing physical activities with the client who has just undergone a right total hip replacement, which instruction should the nurse provide? -"Limit hip flexion to 90 degrees." -"Perform rotation exercises each day." -"Intermittently cross and uncross your legs several times each day." -"Avoid weight bearing until the hip is completely healed."

-"Limit hip flexion to 90 degrees." The client should avoid all activities that can result in dislocation of the hip. The affected leg should not cross midline or be turned inward. The hip should not bend more than 90 degrees. Ambulation begins the day following surgery, and weight bearing ambulation may not be restricted, depending on the type of prosthesis.

The nurse is providing instructions to the client who is being prepared for skeletal traction. Which statement by the client indicates teaching was effective? -"Metal pins will go through my skin to the bone." -"I will wear a boot with weights attached." -"A belt will go around my pelvis and weights will be attached." -"The traction can be removed once a day so I can shower."

-"Metal pins will go through my skin to the bone." In skeletal traction, metal rods or pins are used to apply continuous traction directly to the bone. Weights are used to apply the traction. Casts, external fixators, or splints are used when the traction is discontinued.

A client has a plaster cast applied to the left leg. Which comment by the client following the procedure should the nurse address first? -"My toes are stiff." -"My toes are pink." -"My cast is still wet." -"My pain is a 3."

-"My toes are stiff." Compartment syndrome is characterized by neurovascular compromise. Stiffness of the toes may be a preliminary finding that the client is having trouble with motor function.

An older adult patient had a hip replacement. When should the patient begin with assisted ambulation with a walker? -24 hours -72 hours -1 week -2 to 3 weeks

-24 hours Following hip arthroplasty (total hip replacement), patients begin ambulation with the assistance of a walker or crutches within a day after surgery.

Which nursing action would help prevent deep vein thrombosis in a client who has had an orthopedic surgery? -Instruct about using client-controlled analgesia, if prescribed -Instruct about exercise, as prescribed -Apply antiembolism stockings -Apply cold packs

-Apply antiembolism stockings Applying antiembolism stockings helps prevent deep vein thrombosis (DVT) in a client who is immobilized due to orthopedic surgery. Regular administration of analgesics controls and prevents escalation of pain, while ROM exercises help maintain muscle strength and tone and prevent contractions. On the other hand, cold packs are applied to help reduce swelling; cold does not prevent deep vein thrombosis.

A client's cast is removed. The client is worried because the skin appears mottled and is covered with a yellowish crust. What advice should the nurse give the client to address the skin problem? -Consult a skin speciaqlist. -Scrub the area vigorously to remove the crust. -Apply lotions and take warm baths or soaks. -Avoid exposure to direct sunlight.

-Apply lotions and take warm baths or soaks. The client should be advised to apply lotions and take warm baths or soaks. This will help in softening the skin and removing debris. The client usually sheds this residue in a few days so the client need not consult a skin specialist. It is not advisable to scrub the area vigorously. The client need not avoid exposure to direct sunlight because the area is not photosensitive.

A client has a Fiberglass cast on the right arm. Which action should the nurse include in the care plan? -Keeping the casted arm warm by covering it with a light blanket -Avoiding handling the cast for 24 hours or until it is dry -Evaluating pedal and posterior tibial pulses every 2 hours -Assessing movement and sensation in the fingers of the right hand

-Assessing movement and sensation in the fingers of the right hand The nurse should assess a casted arm every 2 hours for finger movement and sensation to make sure the cast isn't restricting circulation. To reduce the risk of skin breakdown, the nurse should leave a casted arm uncovered, which allows air to circulate through the cast pores to the skin below. Unlike a plaster cast, a Fiberglass cast dries quickly and can be handled without damage soon after application. The nurse should assess the brachial and radial pulses distal to the cast — not the pedal and posterior tibial pulses, which are found in the legs.

A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority? -Assessing the extremity for neurovascular integrity -Keeping the client from sliding to the foot of the bed -Keeping the ropes over the center of the pulley -Ensuring that the weights hang free at all times

-Assessing the extremity for neurovascular integrity Although all measures are correct, assessing neurovascular integrity takes priority because a decrease in neurovascular integrity could compromise the limb. The pull of the traction must be continuous to keep the client from sliding. Sufficient countertraction must be maintained at all times by keeping the ropes over the center of the pulley. The line of pull is maintained by allowing the weights to hang free.

Which cleansing solution is the most effective for use in completing pin site care? -Betadine -Chlorhexidine -Hydrogen peroxide -Alcohol

-Chlorhexidine Chlorhexidine solution is recommended as the most effective cleansing solution; however, water and saline are alternate choices. Hydrogen peroxide and betadine solutions have been used, but they are believed to be cytotoxic to osteoblasts and may actually damage healthy tissue.

Which would be contraindicated as a component of self-care activities for the client with a cast? -Cover the cast with plastic to insulate it -Cushioning rough edges of the cast with tape -Elevate the casted extremity to heart level frequently -Do not attempt to scratch the skin under a cast

-Cover the cast with plastic to insulate it The cast should be kept dry, but do not cover it with plastic or rubber because this causes condensation, which dampens the cast and skin. The other activities are consistent with cast care.

A client has a cast applied to the leg for treatment of a tibia fracture and also has a wound on the leg that requires dressing changes due to drainage. For what should the nurse prepare the client? -Cutting of a bivalve cast -Cutting a cast window -Removal of the cast -Insertion of an external fixator

-Cutting a cast window After the cast dries, a cast window, or opening, may be cut. This usually is done when the client reports discomfort under the cast or has a wound that requires a dressing change. The window permits direct inspection of the skin, a means to check the pulse in a casted arm or leg, or a way to change a dressing. A bivalve cast is when the cast is cut in two if the leg swells or if the client is being weaned from a cast, when a sharp x-ray is needed, or as a splint for immobilizing painful joints when a client has arthritis. The cast should not be removed due to the instability of a fracture. The client's condition does not indicate an external fixator is required.

A client is reporting pain following orthopedic surgery. Which intervention will help relieve pain? -Elevate the affected extremity and use cold applications. -Breathe deeply and cough every 2 hours until ambulation is possible. -Do ROM exercises as indicated. -Apply antiembolism stockings as indicated.

-Elevate the affected extremity and use cold applications. Elevating the affected extremity and using cold applications reduce swelling. Deep breathing and coughing helps with maintenance of effective respiratory rate and depth. ROM exercises maintain full ROM of unaffected joints. Antiembolism stockings help prevent deep vein thrombosis (DVT).

Which intervention would the nurse implement with the client in skeletal traction? Select all that apply. -Apply 8-pound weight to the rope. -Ensure the pins or wires are covered with caps. -Remove foam boot and inspect skin daily. -Position trapeze within the client's reach. -Instruct the client on isometric exercises for immobilized extremity.

-Ensure the pins or wires are covered with caps. -Position trapeze within the client's reach. -Instruct the client on isometric exercises for immobilized extremity. Nursing care of the client in skeletal traction includes ensuring the trapeze is within the client's reach and the pins or wires are covered with caps. The nurse instructs the client on isometric exercises for the immobilized extremity. A foam boot is used with Buck's traction (skin traction) not skeletal traction. An 8-pound weight is used with Buck's traction, whereas a 15- to 25-pound weight is applied in skeletal traction.

A 68-year-old female client who had a total hip replacement is to be discharged because her healing is almost complete. Which of the following would be most important for this client? -Advising the client to avoid red meat -Urging her to keep the affected limb in an elevated position -Educating the client about the effects of menopause -Exploring factors related to the client's home environment

-Exploring factors related to the client's home environment Exploring factors related to the older adult client's home environment and determining a plan for continued rehabilitation before discharge is most important. The client should be encouraged to eat foods rich in protein, calcium, and vitamin D. Because the healing is almost complete, the client need not always keep the affected limb elevated unless prescribed to do so. Because the client is in her late 60s, she is most likely to have already undergone menopause. Therefore, educating her about the effects of menopause is not as important.

The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Nursing assessment findings include temperature 100.8 degrees Farenheit, heart rate 112 beats per minute, respiratory rate 28 breaths per minute, and blood pressure 86/58. There is no urine in the Foley catheter collection bag. The nurse interprets these findings as indicating which complication? -Hypovolemic shock -Osteomyelitis -Urinary retention -Atelectasis

-Hypovolemic shock Indicators of hypovolemic shock include a heart rate greater than 100 beats per minute, a blood pressure less than 90/60 mm Hg, and urine output less than 30 ml per hour.

Which intervention should the nurse implement with the client who has undergone a hip replacement? -Instruct the client to avoid internal rotation of the leg. -Place the client in high Fowler's position for meals. -Have the client bend forward to rise from the chair. -Adduct the legs by placing a pillow between the legs.

-Instruct the client to avoid internal rotation of the leg. The client should avoid all activities that can result in dislocation of the hip. The affected leg should not cross midline or be turned inward. A pillow is used to keep the legs in abduction. The hip should not bend more than 90 degrees when seated. The head of bed should be kept at 60 degrees or less.

The nurse is caring for a client with a spica cast. What is the nurse's priority intervention? -Keep the cast clean and dry. -Position the client on the affected side. -Promote elimination with a regular bedpan. -Keep the legs in abduction.

-Keep the cast clean and dry. Keeping the cast clean and dry around the perineal opening is a priority. A spica cast has a built-in abduction bar. The client should be positioned on the unaffected side every 2 hours and prone twice a day. A fracture bedpan is easier to use for the client with a spica cast.

A client is seen in the orthopedic clinic for complaints of severe pain in the left hip. After a series of diagnostic tests, the client is diagnosed with severe degenerative joint disease of the left hip and suggested to have the hip reconstructed. What procedure will the nurse schedule the client for? -Left hip arthroplasty -Left hip arthroscopy -Open reduction and internal fixation of the left hip. -Closed reduction of the left hip.

-Left hip arthroplasty Clients with arthritis, trauma, hip fracture, or a congenital deformity may have an arthroplasty, or reconstruction of the joint. This procedure uses an artificial joint that restores previously lost function and relieves pain. An arthroscopy is not used to reconstruct a diseased hip. A closed reduction is not an invasive surgical procedure and would not be used to reconstruct the hip. An open reduction and internal fixation is not the treatment for reconstruction of the hip related to a diseased hip.

The nurse assesses a clientafter total right hip arthroplasty and observes a shortening of the extremity. The client reports severe pain in the right side of the groin. What is the priority action of the nurse? -Apply Buck's traction. -Notify the health care provider. -Externally rotate the extremity. -Bend the knee and rotate the knee internally.

-Notify the health care provider. If any clinical manifestations of dislocation of the prosthesis occur, including acute groin pain in the affected hip or shortening of the affected extremity, the nurse (or the client, if at home) must immediately notify the surgeon, because the hip must be reduced and stabilized promptly so that the leg does not sustain circulatory and nerve damage. After closed reduction, the hip may be stabilized with Buck's traction or a brace to prevent recurrent dislocation. As the muscles and joint capsule heal, the chance of dislocation diminishes. Stresses to the new hip joint should be avoided for the first 8 to 12 weeks, when the risk of dislocation is greatest.

A client's fracture was reduced by surgically exposing the bone and realigning it. What type of treatment does the nurse identity this as? -Buck's traction -Skeletal traction -Internal fixation -Open reduction

-Open reduction In an open reduction, the bone is surgically exposed and realigned. Buck's traction is a type of skin traction that provides pulling on the structures. Skeletal traction is applied directly to the bone using a wire, pin, or cranial tongs. Internal fixation involves the use of metal screws, plates, rods, nails or pins to stabilize a reduced fracture.

Which actions by the nurse demonstrate an understanding of caring for a client in traction? Select all that apply. -Placing a trapeze on the bed -Ensuring that the weights are hanging freely -Assessing the client's alignment in the bed -Removing skeletal traction to turn and reposition the client -Frequently assessing pain level

-Placing a trapeze on the bed -Ensuring that the weights are hanging freely -Assessing the client's alignment in the bed -Frequently assessing pain level The weights must hang freely, with the client in good alignment in the center of the bed. The nurse should frequently monitor pain, as uncontrolled pain may be a sign of a complication. The client will be able to assist with alignment and bed mobility if a trapeze is placed on the bed. Skeletal traction should never be interrupted.

The nurse is caring for a client who lives alone and had a total knee replacement. An appropriate nursing diagnosis for the client is: -Risk for ineffective therapeutic regimen management -Disturbed body image -Situational low self-esteem -Risk for avascular necrosis of the joint

-Risk for ineffective therapeutic regimen management The client without adequate support and resources is at risk for ineffective therapeutic regimen management. A total knee replacement may be used to treat avascular necrosis. While an orthopedic client is at risk for disturbed body image and situational low self-esteem, there is no evidence that these exist for this client.

A client is having a cast applied for a fractured leg that extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. What type of cast is the client having applied? -Short leg cast -Long leg cast -Walking cast -Hip spica cast

-Short leg cast A short leg cast extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. A long leg cast extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed. A walking cast is a short or long leg cast reinforced for strength. A hip spica cast encloses the trunk and a lower extremity.

Which of the following terms refers to moving away from midline? a) Adduction b) Abduction c) Inversion d) Eversion

Abduction Explanation: Abduction is moving away from midline. Adduction is moving toward midline. Inversion is turning inward. Eversion is turning outward.

A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's care plan? -Apply the traction straps snugly. -Assess the client's level of consciousness. -Remove the traction at least every 8 hours. -Teach the client how to prevent problems caused by immobility.

-Teach the client how to prevent problems caused by immobility. By teaching the client about prevention measures, the nurse can help prevent problems caused by immobility, such as hypostatic pneumonia, muscle contracture, and atrophy. The nurse applies traction straps for skin traction — not skeletal traction. For a client in skeletal traction, the nurse should assess the affected limb, rather than assess the level of consciousness. Removing skeletal traction is the physician's responsibility — not the nurse's.

A patient had a total left hip arthroplasty. What clinical manifestation would indicate to the nurse that the prosthesis is dislocated? -The left leg is internally rotated. -The leg length is the same as the right leg. -The patient has discomfort when moving in the bed. -Diminished peripheral pulses on the affected extremity

-The left leg is internally rotated. The nurse must monitor for signs and symptoms of dislocation of the prosthesis, which include abnormal external or internal rotation of the affected extremity.

Which statement describes external fixation? -The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. -The surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. -The bone is restored to its normal position by external manipulation. -The bone is surgically exposed and realigned.

-The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. In external fixation, the surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. In internal fixation, the surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. In closed reduction, the bone is restored to its normal position by external manipulation. In open reduction, the bone is surgically exposed and realigned.

A variety of complications can occur after a leg amputation. Which is not a possibility in the immediate postoperative period? -osteomyelitis -hematoma -hemorrhage -infection

-osteomyelitis Chronic osteomyelitis may occur after persistent infection in the late postoperative period. Hematoma, hemorrhage, and infection are potential complications in the immediate postoperative period.

A client with a right leg fracture is returning to the orthopedist to have the cast removed. What would the physician prescribe as further treatment? -physical therapy -discontinue use of crutches -cold compresses to leg for swelling -No options are correct.

-physical therapy For some time, the limb will need support. An elastic bandage may be wrapped on a leg, the client may use a cane, and an arm may be kept in a sling until progressive active exercise and physical therapy help the client regain normal strength and motion.

Casts Indications

1. Fractures (encompasses the joint above and below injury). 2. Post op to provide protection and support. 3. Serial casts to help decrease the pain of a severe sprain or strain. 4. Immobilization for tendon transfer ,and preparation of a residual limb for prosthesis

what is the mim urine output

30ml if below danger

Household water temperature should be limited to less than

49 degrees Celsius 9120 degrees Fahrenheit)Full-thickness burns can occur with a water temperature of 54 degrees Celsius/ 130 degrees Fahrenheit Nurses should provide teaching to parents to adjust water temperature to prevent full-thickness burns

Smoke detectors should be installed in every home with working batteries that are changed every

6 months

The nurse is conducting a community education program on hip fracture risk. The nurse evaluates that the participants understand the program when the program determines that the person at highest risk for a hip fracture is which of the following? a) High school football player b) 30-year-old pregnant woman c) Toddler just starting to walk d) 80-year-old widow

80-year-old widow Explanation: Hip fracture occurs with greater incidence in elderly people and is often a life-altering event that has a negative impact on the person's mobility and quality of life.

Which of the following nursing actions is most important in caring for the client following an arthrogram? a) Assist the client with passive range of motion. b) Apply ice to the joint. c) Keep the joint below the level of the heart. d) Administer morphine sulfate.

Apply ice to the joint. Explanation: Ice is applied to minimize edema and provide analgesia to the joint. The joint is elevated to minimize edema. Mild analgesics are sufficient to control pain. The joint is usually rested for 12 hours post-procedure.

Which of the following is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip or wrist? a) Arthrography b) EMG c) Bone densitometry d) Meniscography

Arthrography Explanation: Arthrography is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or waist. Bone densitometry is used to estimate bone mineral density. An EMG provides information about the electrical potential of the muscles and nerves leading to them. Meniscography is a distractor for this question.

The nurse would include which of the following in a neurological assessment? a) Inspect the foot for edema. b) Capillary refill of the great toe. c) Ask the client to plantar flex the toes. d) Palpate the dorsalis pedis pulse.

Ask the client to plantar flex the toes. Explanation: A neurological assessment evaluates sensation and motion. Assessing plantar flexion of the toes would be included in a neurological assessment. Capillary refill, palpation of pulses, and inspecting for edema would be included in a vascular assessment.

The nurse is performing a musculoskeletal assessment of a patient in a nursing home who had a stroke 2 years ago and who has right-sided hemiplegia. The nurse notes that the girth of the patient's right calf is 2 inches less in diameter than the left calf. The nurse attributes the decreased girth to which of the following? a) Atrophy of right calf muscle b) Edema in left lower extremity c) Bruising in right lower extremity d) Increased use of left calf muscle

Atrophy of right calf muscle Explanation: Girth of an extremity may increase due to exercise, edema, or bleeding into the muscle. However, a patient with right-sided hemiplegia is unable to use the right lower extremity. This patient may experience atrophy of the muscles from lack of use, which will result in a subsequent decrease in the girth of the calf muscle.

. If a patient dies within 24 hours of removal of restraints this needs to be reported to

CMS( Center for Medicare and Medicaid Services)

The nurse is preparing an education program on risk factors for musculoskeletal disorders. Which of the following would be inappropriate risk factor for the nurse to include in the teaching program? a) Age b) Menopause c) Bedrest d) Calcium-rich diet

Calcium-rich diet Explanation: A diet rich in calcium is beneficial in maintaining bone and muscle. Increasing age, menopause, and immobility (such as bedrest) increase the risk for musculoskeletal disorders.

Which of the following is an example of a gliding joint? a) Knee b) Carpal bones in the wrist c) Joint at base of thumb d) Hip

Carpal bones in the wrist Explanation: Gliding joints allow for limited movement in all directions and are represented by the joints of the carpal bones in the wrist. Hinge joints permit bending in one direction only and include the knee and elbow. The hip is a ball-and-socket joint. The joint at the base of the thumb is a saddle joint.

Which of the following would be a circulatory indicator of peripheral neurovascular dysfunction? a) Cool skin b) Paralysis c) Weakness d) Paresthesia

Cool skin Explanation: Indicators of peripheral neurovascular dysfunction related to circulation include pale, cyanotic or mottled skin with a cool temperature. The capillary refill is more than 3 seconds. Weakness and paralysis is related to motion. Paresthesia is related to sensation.

The nurse is reading the admission note of a patient with a bone fracture that requires surgery. The note indicates the presence of crepitus. The nurse interprets this as being which of the following? a) Closed fracture b) Bleeding c) Crackling sound d) Ecchymosis

Crackling sound Explanation: Crepitus is a sound or sensation elicited by the rubbing together of fragments of bone, as in a fracture, or in irregular joint surfaces. The sound/sensation can be described as "grating" or "crackling."

The nurse working in the ER receives a call from the x-ray department communicating that the patient the nurse is caring for has a fracture in the shaft of the tibia. The nurse tells the physician that the patient's fracture is which of the following? a) Epiphysis b) Lordosis c) Scoliosis d) Diaphysis

Diaphysis Explanation: The diaphysis is primarily cortical bone. An epiphysis is an end of a long bone. Lordosis refers to an increase in lumbar curvature of spine. Scoliosis refers to lateral curving of the spine.

Hip fractures are most prevalent in the elderly due to a combination of risk factors what are them

Diminished equilibrium Slowed reflexes Muscular atrophy Diminishing bone tensile strength associated with osteoporosis Decreased estrogen level low levels of physical activity low dietary, calcium and inadequate Vitamin D intake

RN you do not delegate

E-evaluation A-Assessment T-teaching -A LPN can provide care for stable patients -UAP will typically be assigned ADLs to stable patients. Remember: If a patient is critical, fresh post-operatively, or there is a change in the patient's status nursing tasks should not be delegated

The nurse is reporting on the results of client blood work to the oncoming nurse. Upon reviewing the data, it is noted that the client has an elevated uric acid level. Which inflammatory process would the nurse screen for on shift rounds? a) Osteoporosis b) Lupus erythematosus c) Gout d) Rheumatoid arthritis

Gout Explanation: Gout is a medical condition with symptoms of acute inflammatory arthritis that is caused by high levels of uric acid in the blood. The client has uric acid crystal deposits in the joint. The nurse would assess joint areas for pain, redness, and swelling. Rheumatoid arthritis is a chronic disease of joint inflammation and pain. Lupus erythematous is a chronic tissue disorder of the connective tissue and is known to have an elevated antinuclear antibody level. Osteoporosis has a deficiency in the serum calcium level.

Fat Embolism Assessment

Includes an injury appropriate history and the presence of the cardinal signs of confusion, dyspnea chest pain and apprehension. Responses may include: v Neurological and behavioral changes - such as restlessness, apprehension, agitation, irritability, confusion, lethargy, stupor and coma v Respiratory assessment - may include tachypnea (> 30/min), dyspnea, diffuse rales, and rhonchi that increase with time becoming frank rales. v Circulatory - Increased heart rate often greater than 140 beats per minute. v Integumentary changes - petechiae on the chest, axilla, conjunctiva, clavicular fossa, soft palate, flanks and abdomen.

Which of the following is a fibrous sheath that surrounds the articulating bones? a) Joint capsule b) Ligament c) Bursa d) Synovium

Joint capsule Explanation: A tough, fibrous sheath called the joint capsule surrounds the articulating bones. Synovium secretes the lubricating and shock-absorbing synovial fluid into the joint capsule. Ligaments bind the articulating bones together. A bursa is a sac filled with synovial fluid that cushions the movements of tendons, ligaments, and bones at a point of friction.

Which of the following is the most common site of joint effusion? a) Elbow b) Shoulder c) Hip d) Knee

Knee Explanation: The most common site for joint effusion is the knee. If inflammation or fluid is suspected in a joint, consultation with a provider is indicated. The elbow, hip, and shoulder are not the most common site of joint effusion.

Which of the following is an example of a hinge joint? a) Joint at base of thumb b) Carpal bones in the wrist c) Knee d) Hip

Knee Explanation: Hinge joints permit bending in one direction only and include the knee and elbow. The hip is a ball-and-socket joint. The joint at the base of the thumb is a saddle joint. Gliding joints allow for limited movement in all directions and are represented by the joints of the carpal bones in the wrist.

Which of the following deformity causes a exaggerated curvature of the lumbar spine? a) Steppage gait b) Lordosis c) Scoliosis d) Kyphosis

Lordosis Explanation: Lordosis is an exaggerated curvature of the lumbar spine. Scoliosis is a lateral curving deviation of the spine. Kyphosis is an increased forward curvature of the thoracic spine. Steppage gait is not a type of spinal deformity.

The nurse is caring for a client who has a deficiency in the formation of cartilage in joints. Which essential substance is absent? a) Myofibrils b) Matrix c) Osteoblasts d) Sarcomeres

Matrix Explanation: Cartilage is a firm, dense type of connective tissue that consists of cells embedded in a substance called matrix. The matrix is firm and compact. Cartilage is essential in reducing friction between articular surfaces and absorbs shock. Osteoblasts build bone. Sarcomeres assist in contracting muscle. Skeletal muscles are composed of myofibrils.

The nurse is assessing the client who states a decline in muscle strength. Which is the primary source essential to allow muscle contraction? a) Sarcomeres b) Acetylcholine c) Myofibrils d) Actin and myosin

Myofibrils Explanation: Skeletal muscles are made up of muscle cells or fibers called myofibrils. Without muscle fibers, there can be no muscle contraction. Sliding filaments called sarcomeres make up the myofibrils. Acetylcholine stimulates the motor neuron, which innervated the muscle. Actin and myosin in the sarcomere slide together, resulting in muscle contraction.

After a person experiences a closure of the epiphyses, which statement is true? a) The bone grows in length but not thickness. b) The bone increases in thickness and is remodeled. c) Both bone length and thickness continue to increase. d) No further increase in bone length occurs.

No further increase in bone length occurs. Explanation: After closure of the epiphyses, no further increase in bone length can occur. The other options are inappropriate and not related to closure of the epiphyses.

A nurse is caring for a client with an undiagnosed bone disease. When instructing on the normal process to maintain bone tissue, which process transforms osteoblasts into mature bone cells? a) Remodeling b) Resorption c) Epiphyses and diaphysis formation d) Ossification and calcification

Ossification and calcification Explanation: Ossification and calcifications the body's process to transform osteoblasts into mature bone cells called osteocytes. Osteocytes are involved in maintaining bone tissue. Resorption and remodeling are involved in bone destruction. Epiphyses and diaphysesare bone tissues that provide strength and support to the human skeleton.

Which nerve is being assessed when the nurses asks the patient to dorsiflex his ankle and extend his toes? a) Ulnar b) Radial c) Median d) Peroneal

Peroneal Explanation: The motor function of the peroneal nerve is assessed by asking the patient to dorsiflex the ankle and to extend the toes, while pricking the skin between the great toe and center toe assesses the sensory function. The radial nerve is assessed by asking the patient to stretch out the thumb, then the wrist, and then the fingers at the metacarpal joints. The median nerve is assessed by asking the patient to touch the thumb to the little finger. Asking the patient to spread all fingers allows the nurse to assess motor function affected by ulnar innervation.

Which of the following is an appropriate priority nursing diagnosis for the client following an arthrocentesis? a) Activity intolerance b) Chronic pain c) Risk for infection d) Deficient knowledge: procedure

Risk for infection Explanation: The priority nursing diagnosis following an arthrocentesis is risk for infection. The client may experience acute pain. The client needs adequate information before experiencing the procedure. Activity intolerance would not be an expected nursing diagnosis.

Which type of gait correlates with Parkinson's disease? a) Steppage b) Scissors c) Spastic hemiparesis d) Shuffling

Shuffling Correct Explanation: A variety of neurologic conditions are associated with abnormal gaits, such as spastic hemiparesis gait (stroke), steppage gait (lower motor neuron disease), and shuffling gait (Parkinson's disease). Scissors gait is seen in cerebral palsy.

AcetaminophenToxicity Clinical Manifestations

Stage 1: Nausea, Vomiting, Sweating, Pallor Stage 2: Patient starts to improve; may have right upper quadrant pain Stage 3: Pain in right upper quadrant, jaundice, vomiting, confusion, stupor (lack of critical mental function), coagulation abnormalities, sometimes renal failure, pancreatitis Stage 4: More than 5 days: Resolution of hepatoxicity or progress to multiple organ failure, may be fatal

Bone Remodeling

The process in which old bone is removed and new bone is added to the skeleton (formation). -Bones become larger, heavier, and denser. This continues until peak bone mass is reached, typically by age 20 years.

Which of the following data is most important for the nurse to record while assessing a client with an open wound? a) Time and place of the injury b) Time when the client last received a tetanus immunization c) Vital signs of the client d) Degree of movement and range of motion

Time when the client last received a tetanus immunization Explanation: If the client has an open wound, the nurse ascertains when the client last received a tetanus immunization. This vital information helps in assessing the risk of infection in a client with an open wound.

counter traction

force equal to that of the traction which pulls in the opposite direction Traction is achieved by a system of ropes, pulleys and weights connected to a metal frame attached to a bed.

A baseline neurovascular assessment should be obtained as soon as the

fracture is stabilized Assess for the 5 Ps Pain, Pallor, Paralysis, Paresthesia, and Pulselessness. ( This is very IMPORTANT)

Which clinical manifestation would the nurse recognize as an indicator of peripheral neurovascular dysfunction? Select all that apply. a) Dorsiplantar flexion strong b) Capillary refill less than 3 seconds c) Complaints of pins and needles in feet d) Toes mottled and cool e) Absence of pain

• Toes mottled and cool • Complaints of pins and needles in feet Explanation: Clinical manifestations of peripheral neurovascular dysfunction include coolness, mottling, weakness, complaints of paresthesia or a pins and needles sensation, and unrelenting pain. Capillary refill of less than 3 seconds is a normal finding.

Reye's syndrome

potentially serious or deadly disorder in children that is characterized by vomiting and confusion

Acetaminophen. Toxicity

◦occurs from acute ingestion; toxic dose is 150mg/kg or greater in children. ◦ ◦THIS IS THE MOST COMMON ACCIDENTAL DRUG POISONING IN CHILDREN! Four stages of post ingestion ◦Stage 1: 0-24 hours ◦Stage 2: 24-72 hours ◦Stage 3: 72-96 hours ◦Stage 4: More than 5 days

The nurse is preparing the client for computed tomography. Which information should be given by the nurse? a) "Fluid will be removed from you affected joint." b) "You must remain very still during the procedure." c) "A small bit of tissue will be removed and sent to the lab." d) "A radioisotope will be given through an IV."

"You must remain very still during the procedure." Explanation: In computed tomography, a series of detailed x-rays are taken. The client must lie very still during the procedure. A contrast agent, not a radioisotope, may or may not be injected. Arthrocentesis involves the removal of fluid from a joint. A small bit of tissue is removed with a biopsy.

immobility Metabolic system oMetabolic assessment

nAnthropometric measurements nFluid Intake and Output measurements nLab tests for electrolyte imbalances/ nutritional status Assess ability to heal and fight infection

Which of the following terms refers to the shaft of the long bone? a) Scoliosis b) Lordosis c) Diaphysis d) Epiphysis

Diaphysis Explanation: The diaphysis is primarily cortical bone. An epiphysis is an end of a long bone. Lordosis refers to an increase in lumbar curvature of spine. Scoliosis refers to lateral curving of the spine.

Skin traction (Buck's traction)

For hip and knee contractures, muscle spasms, and alignment of hip fractures Weight used during skin traction should not be more than 5 to 10 pounds to prevent injury to the skin achieved by applying wide bands of moleskin, adhesive or other devices to the skin and attaching weights. Pull of weights is transmitted indirectly to the involved bone.

Mr. Roland is in your clinic undergoing an orthopedic assessment. It is noted that he has an exaggerated convex curvature of the thoracic spine. What is this condition called? a) Kyphosis b) Scoliosis c) Lordosis d) Diaphysis

Kyphosis Explanation: Kyphosis is an exaggerated convex curvature of the thoracic spine. Lordosis is an excessive concave curvature of the lumbar spine. Scoliosis is a lateral curvature of the spine. Diaphyses are the long shafts of bones in the arms and legs.

The nurse is working on an orthopedic floor caring for a client injured in a football game. The nurse is reviewing the client's chart noting that the client has previously had an injured tendon. The nurse anticipates an injury between the periosteum of the bone and which of the following? a) Joint b) Muscle c) Cartilage d) Ligament

Muscle Explanation: Tendons attach muscles to the periosteum of bone. Joints are a junction between two or more bones. Ligaments connect two freely movable bones. Cartilage is a dense connective tissue used to reduce friction between two structures.

An instructor is describing the process of bone development. Which of the following would the instructor describe as being responsible for the process of ossification? a) Cortical bone b) Cancellous bone c) Osteoblasts d) Osteoclasts

Osteoblasts Explanation: Osteoblasts secrete bone matrix (mostly collagen), in which inorganic minerals, such as calcium salts, are deposited. This process of ossification and calcification transforms the blast cells into mature bone cells, called osteocytes, which are involved in maintaining bone tissue. Cortical bone is dense hard bone found in the long shafts; cancellous bone is spongy bone found in the irregular rounded edges of bone.

Which serum level indicates the rate of bone turnover? a) Aspartate aminotransferase b) Myoglobin c) Osteocalcin d) Creatinine kinase

Osteocalcin Explanation: Serum osteocalcin (bone GLA protein) indicates the rate of bone turnover. Serum myoglobin is assessed to evaluate muscle trauma. Serum enzyme levels of creatinine kinase and aspartate aminotransferase become elevated with muscle damage.

Which serum level indicates the rate of bone turnover? a) Myoglobin b) Creatinine kinase c) Aspartate aminotransferase d) Osteocalcin

Osteocalcin Explanation: Serum osteocalcin (bone GLA protein) indicates the rate of bone turnover. Serum myoglobin is assessed to evaluate muscle trauma. Serum enzyme levels of creatinine kinase and aspartate aminotransferase become elevated with muscle damage.

Which cells are involved in bone resorption? a) Osteocytes b) Osteoblasts c) Osteoclasts d) Chondrocytes

Osteoclasts Explanation: Osteoclasts carry out bone resorption by removing unwanted bone while new bone is forming in other areas. Chondrocytes are responsible for forming new cartilage. Osteoblasts are bone-forming cells that secrete collagen and other substances. Osteocytes, derived from osteoblasts, are the chief cells in bone tissue.

Which of the following statements reflect the progress of bone healing? a) All fracture healing takes place at the same rate no matter the type of bone fractured. b) The age of the patient influences the rate of fracture healing. c) Adequate immobilization is essential until there is ultrasound evidence of bone formation with ossification. d) Serial x-rays are used to monitor the progress of bone healing.

Serial x-rays are used to monitor the progress of bone healing. Explanation: Serial x-rays are used to monitor the progress of bone healing. The type of bone fractured, the adequacy of blood supply, the surface contact of the fragments, and the general health of the person influence the rate of fracture healing. Adequate immobilization is essential until there is x-ray evidence of bone formation with ossification.

Lower extremity 90 -90 traction is most common ? and what is the difference with the adult version

The most common skeletal traction used continuously for the treatment of displaced femoral fractures in children and intermittently for treatment of low back pain in adults The affected hips and knees are flexed at 90-degree angle so that the upper leg is perpendicular to the bed and the lower leg is elevated but parallel to the bed. In children this traction is usually a skeletal suspension with a Steinman pin inserted into the distal femur. Traction is usually unilateral. The adult version suspends both legs from just below the popliteal space to above the Achilles tendon on a padded platform 1. Observe the pin sites for signs of inflammation or infection. 2. Pad sharp ends of pin (usually with a cork) to prevent injury to unaffected leg. This traction easily facilitates position changes, toileting and prevention of traction complications

Metabolic system immobility causes

nDecrease in BMR which causes: Altered metabolism of carbohydrates, fats, and proteins which causes nFluid, electrolyte and calcium imbalances which causes: §GI disturbances which causes: §Decrease in appetite and decrease in peristalsis

effects of Immobility

nNo body system is immune to affects of immobility nEffects depend upon a client's health, age, and degree

Immobility of the Respiratory System assessment

nObserve chest movements nAuscultate for pulmonary secretions nCheck O2 saturations Observe for respiratory difficultie

bedrest

nReduces oxygen needs nDecreases pain levels nHelps in regaining of strength nUninterrupted rest has psychological and emotional benefits

Immobility of the Respiratory System intervations

nTCDB q 2 hours nChest physiotherapy (CPT) nMaintain patent airway nIncentive spirometer

The nurse recognizes that rheumatoid arthritis is characterized by: a) Clonus b) Ballottement sign c) Ulnar deviation d) Fasciculations

Ulnar deviation Explanation: Rheumatoid arthritis is characterized by ulnar deviation of the fingers. The ballottement sign is used to detect fluid in the knee. Clonus is the rhythmic contractions of a muscle. Involuntary twitching of muscle fiber groups is called fasciculation.

What is the leading cause of death for children 1-19

Unintentional childhood injury is the leading cause of death among children 1-19 and infants unintentional death rates doubled due to suffocation.

Red bone marrow produces which of the following? Select all that apply. a) White blood cells (WBCs) b) Corticosteroids c) Estrogen d) Red blood cells (RBCs) e) Platelets

• White blood cells (WBCs) • Red blood cells (RBCs) • Platelets Explanation: The red bone marrow located within the bone cavities produces RBC, WBCs, and platelets through the process of hematopoiesis. The red bone marrow does not produce estrogen or corticosteroids.

Nursing Assistant & RESPONSIBILITIES

●Implements delegated tasks as instructed ●Collects/records data ●Makes observations and reports deviations from the norm

Osteoporosis is highest in

◦A condition in which there is a reduction in total skeletal mass or demineralization of bone, to the extent that fractures may occur with minor trauma. ◦ The highest Incidences are in post-menopausal women over It may develop as a result of an inadequate diets (one that is low in calcium, high in protein, with excessive coffee intake, endocrine dysfunction or inactivity. (Protein deficiency contributes to bone demineralization but excessive protein increases calcium loss in the urine).

Clinical Manifestations of corrosives drain, Toilet and Oven Cleaners, Dishwasher detergents, Mildew Remover, Nail Polish removers, Bleach, Denture Cleaners, Batteries

◦Aspiration of these substances cause immediate danger and even small amounts can cause disruption to airway & breathing. Clinical Manifestations include: severe burning pain in the mouth, throat stomach. Swelling of the lips tongue, and pharynx, cough, hemoptysis, inability to clear secretions, drooling and anxiety/agitation.

Which is not a guideline for avoiding hip dislocation after replacement surgery. -The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes. -Keep the knees apart at all times. -Put a pillow between the legs when sleeping. -Never cross the legs when seated.

-The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes. Guidelines for avoiding hip dislocation after replacement surgery specify that the hip should not be flexed to put on clothing such as pants, stockings, socks, or shoes. Clients should keep the knees apart at all times, put a pillow between the legs when sleeping, and never cross the legs when seated.

The nurse suspects that a client with an arm cast has developed a pressure ulcer. Where should the nurse assess for the presence of the ulcer? -Lateral malleolus -Olecranon -Radial styloid -Ulna styloid

-Ulna styloid Casts or inappropriately applied splints can put pressure on soft tissues, causing tissue anoxia and pressure ulcers. Lower extremity sites most susceptible are the heel, malleoli, dorsum of the foot, head of the fibula, and anterior surface of the patella. The main pressure sites on the upper extremity are located at the medial epicondyle of the humerus and the ulnar styloid.

A hip spica cast: -encloses the trunk and a lower extremity. -encircles the trunk. -is a short or long leg cast reinforced for strength. -extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed.

-encloses the trunk and a lower extremity. A hip spica cast encloses the trunk and a lower extremity. A double hip spica cast includes both legs. A body cast encircles the trunk. A walking cast is a short or long leg cast reinforced for strength. A long leg cast extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed.

A client undergoes an arthroscopy at the outpatient clinic. After the procedure, the nurse provides discharge teaching. Which response by the client indicates the need for further teaching? a) "I should use my heating pad this evening to reduce some of the pain in my knee." b) "Elevating my leg will reduce swelling after the procedure." c) "I may notice some bruising or swelling in my knee." d) "My physician may prescribe pain pills after the procedure."

"I should use my heating pad this evening to reduce some of the pain in my knee." Explanation: The client requires additional teaching if he states that he'll use a heating pad to reduce pain the evening of the procedure. The client shouldn't use heat at the procedure site during the first 24 hours because doing so may increase localized swelling. Ice is indicated during this time. Elevating the extremity helps reduce swelling. The client may experience some discomfort after the procedure for which the physician may order medication. Bruising and swelling are common after an arthroscopy.

The nurse is admitting a client who is to undergo an open reduction with internal fixation for a fractured femur. About which comment by the client should the nurse be most concerned? -"I was worried I would have an incision and scar." -"The surgeon is planning to use a metal plate and screws to fix my hip." -"A joint replacement or bone graft is not necessary." -"The surgeon can see the bones when putting them in correct position."

-"I was worried I would have an incision and scar." An open reduction involves a surgical dissection for the visualization of the bone ends and fragments. A metal plate and screws are used to correct and stabilize the fracture through internal fixation.

The nurse is providing instructions to the client following application of a fiberglass cast. Which statement by the client indicates further education is needed? -"Under no circumstances should I get my cast wet." -"The cast should not come in contact with other plastics." -"I should avoid touching the cast while it is wet." -"The cast will be hot while it is drying."

-"Under no circumstances should I get my cast wet." Some fiberglass casts are waterproof, allowing the client to shower or swim. A wet fiberglass cast is susceptible to denting while it is wet. Fiberglass casting involves an exothermic reaction as the cast hardens. The cast should not come in contact with other plastics as the reaction occurs.

The client displays manifestations of compartment syndrome. What treatment will the nurse expect the client to be scheduled for? -An open reduction -A fasciotomy -A total hip replacement -A total knee replacement

-A fasciotomy A treatment option for compartment snydrome is fasciotomy.

A client with a long arm cast continues to complain of unrelieved throbbing pain even after receiving opioid pain medication. Which is the priority action by the nurse? -Assess for complications. -Assess for previous opioid drug use. -Reposition the client for comfort. -Teach relaxation techniques.

-Assess for complications. Unrelieved pain can be an indicator of a complication, such as compartment syndrome. Previous opioid drug use should not influence a complete and thorough assessment. Repositioning the client for comfort may be appropriate once all indications of a complication are ruled out. It is appropriate to teach relaxation techniques to help ease the pain, but assessing for a complication remains the highest priority.

Which action would be most important postoperatively for a client who has had a knee or hip replacement? -Providing crutches to the client. -Assisting in early ambulation. -Using a continuous passive motion (CPM) machine. -Encouraging expressions of anxiety.

-Assisting in early ambulation. An anticoagulant therapy and early ambulation are important for clients who undergo a knee or hip replacement. A CPM machine or crutches may be provided when prescribed. It is important to encourage clients to express their feelings of anxiety or depression. This is more crucial for clients who undergo an amputation rather than for clients who undergo a replacement surgery.

A group of students is reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast? -Better molding to the client -Quicker drying -Longer lasting -More breathable

-Better molding to the client Plaster casts require a longer time for drying but mold better to the client and are initially used until the swelling subsides. Fiberglass casts dry more quickly, are lighter in weight, longerlasting, and breathable.

A client is about to have a cast applied to the left arm. What will nurse alert the client to as the cast is applied? -Increased in pain in left arm -Sensation of warmth or heat with application -Arm being moved to various positions -Sensation of weakness

-Sensation of warmth or heat with application When a cast is applied, the client needs to be aware that he or she may feel a sensation of warmth or heat due to the material being mixed with water. The client should not feel an increase in pain during the application. The arm will be held in place to ensure proper alignment during the application. The client should not feel weakness in the extremity. This is more commonly experiences after a cast is removed.

The nurse is reviewing the client's admission assessment and notes that crepitus of the right knee joint was documented. The nurse recognizes that crepitus is: a) Characterized by limited range of motion of a joint b) Characterized by involuntary muscle twitching of the knee c) Excessive fluid within the capsule of a joint d) A grating sound when a joint is put through range of motion

A grating sound when a joint is put through range of motion Explanation: Crepitus is a grating sound or sensation when a joint is put through range of motion.

Which of the following describes an osteon? a) A bone resorption cell b) A bone-forming cell c) A mature bone cell d) A microscopic functional bone unit

A microscopic functional bone unit Explanation: The center of an osteon contains a capillary, a microscopic functional bone unit. An osteoblast is a bone-forming cell. An osteoclast is a bone resorption cell. An osteocyte is a mature bone cell.

Which of the following statements describes paresthesia? a) Absence of muscle tone b) Absence of muscle movement suggesting nerve damage c) Abnormal sensations d) Involuntary twitch of muscle fibers

Abnormal sensations Explanation: Abnormal sensations, such as burning, tingling, and numbness are referred to as paresthesias. The absence of muscle tone suggesting nerve damage is referred to as paralysis. A fasciculation is the involuntary twitch of muscle fibers. A muscle which holds no tone is termed flaccid.

The nurse reading a patient's chart notices that the patient is documented to have paresthesia. The nurse plans care for a patient with which of the following? a) Involuntary twitch of muscle fibers b) Absence of muscle tone c) Abnormal sensations d) Absence of muscle movement suggesting nerve damage

Abnormal sensations Explanation: Abnormal sensations, such as burning, tingling, and numbness, are referred to as paresthesias. The absence of muscle tone suggesting nerve damage is referred to as paralysis. A fasciculation is the involuntary twitch of muscle fibers. A muscle that holds no tone is termed flaccid.

The nurse is planning care for a client with a musculoskeletal injury. Which nursing diagnosis would be the highest priority? a) Ineffective Health Maintenance b) Acute Pain c) Delayed Surgical Recovery d) Risk for Impaired Tissue Perfusion

Acute Pain Explanation: The highest priority at this time is Acute Pain and nursing interventions related to decreasing pain. If the client is in pain, instruction to improve health maintenance or surgical recovery is less effective. A "Risk for" diagnosis is a potential problem not an actual problem at this time.

Which body movement involves moving toward the midline? a) Pronation b) Eversion c) Abduction d) Adduction

Adduction Explanation: Adduction is moving toward the midline. Pronation is turning inward. Abduction is moving away from the midline. Eversion is turning outward.

A client is scheduled to have an x-ray examination of his shoulder in which the synovial fluid will be aspirated and sent to the laboratory for analysis. This will be followed by administration of a contrast medium and x-rays. The nurse understands that the client will be undergoing which of the following? a) Arthroscopy b) Arthrogram c) Bone densitometry d) Arthrocentesis

Arthrogram Explanation: An arthrogram is a radiographic examination of a joint, usually the knee or shoulder. The physician first injects a local anesthetic and then inserts a needle into the joint space. Fluoroscopy may be used to verify correct placement of the needle. The synovial fluid in the joint is aspirated and sent to the laboratory for analysis. A contrast medium is then injected, and x-ray films are taken. Arthroscopy is the internal inspection of a joint using an instrument called an arthroscope. Arthrocentesis is the aspiration of synovial fluid. The client receives local anesthesia just before this procedure. The physician inserts a large needle into the joint and removes the fluid. This can be done during an arthrogram or arthroscopy. Bone densitometry estimates bone density using radiography or advanced radiographic techniques.

Which hormone inhibits bone reabsorption and increases calcium deposit in the bone? a) Calcitonin b) Sex hormones c) Growth hormone d) Vitamin D

Calcitonin Explanation: Calcitonin, secreted by the thyroid gland in response to elevated blood calcium levels, inhibits bone reabsorption and increases the deposit of calcium in the bone. The other answers do not apply.

Clinical responses of hip fracture include:

Discoloration of surrounding tissues, often extending into the groin and down affected thigh Lateral rotation and adduction of the leg external or internal depending of the force. Shortening of the affected leg as compared to the uninjured leg. Usually visibly detectable Swelling around site of injury Complaint of pressure on lateral aspect of the affected hip (greater trochanter) Inability to move the injured leg when lying supine.

what can be found near fractures

Ecchymosis and soft tissue swelling may be present due to trauma to the vascular structures near the site if injury. Crepitus may be palpable or audible related to grinding bone fragments

Immobility of the Respiratory System

Effects decreased lung expansion pooling of secretions decreased surface area for exchange of CO2 and O2 (secondary to ¯lung expansion) nMost common complication w/ respiratory system= hypostatic pneumonia

The nurse would expect which of the following diagnostic tests to be ordered for a patient with lower extremity muscle weakness? a) Biopsy b) Electromyograph (EMG) c) Arthrocentesis d) Bone scan

Electromyograph (EMG) Explanation: The EMG provides information about the electrical potential of the muscles and the nerves leading to them. The test is performed to evaluate muscle weakness, pain, and disability. An arthrocentesis, bone scan, and biopsy does not measure muscle weakness.

-Swelling may be noted after cast application which is why the cast should be place?

Elevating affected limb to heart level (promotes venous return) and ice/cold packs if ordered by provider should help to alleviate swelling.

Which of the following terms refers to mature compact bone structures that form concentric rings of bone matrix? a) Trabecula b) Endosteum c) Lamellae d) Cancellous bone

Lamellae Explanation: Lamellae are mineralized bone matrices. Endosteum refers to the marrow cavity lining of hollow bone. Trabecula refers to latticelike bone structure. Cancellous bone refers to spongy, latticelike bone structure.

Which of the following is an age-related change to the musculoskeletal system? a) Increased elasticity of tendons b) Thickening of the vertebral discs c) Loss of bone mass d) Decrease in collagen

Loss of bone mass Explanation: Age-related changes include loss of bone mass, an increase in collagen and resultant fibrosis, thinning of the vertebral discs, and decreased elasticity of tendons.

The nurse is employed at a long-term care facility caring for geriatric clients. Which assessment finding is characteristic of an age-related change? a) Cognitive decline b) Increased muscle mass c) Loss of height d) Depressive symptoms

Loss of height Explanation: A common age-related change is the loss of height due to the loss of bone mass and vertebral collapse. Cognitive decline is not an age-related change. Depression occurs in all age groups. Geriatric clients have a decrease in muscle mass.

A group of students are reviewing information about bones in preparation for a quiz. Which of the following indicates that the students have understood the material? a) Osteocytes are transformed into osteoblasts or mature bone cells. b) The yellow marrow is responsible for manufacturing red blood cells. c) Osteoclasts are involved in the destruction and remodeling of bone. d) Long bones typically contain more red bone marrow than yellow.

Osteoclasts are involved in the destruction and remodeling of bone. Explanation: Osteoclasts are the cells involved in the destruction, resorption, and remodeling of bone. Red bone marrow is responsible for manufacturing red blood cells. Long bones contain yellow bone marrow; the sternum, ileum, vertebrae, and ribs contain red bone marrow. Osteoblasts are transformed into osteocytes, mature bone cells.

Hip Pre-operative Assessment Primary nursing goals include

Primary nursing goals include: Immobilization of the leg to maintain proper alignment Alleviation of pain Relieve anxiety Complete total assessment of the patient Assure that necessary preoperative diagnostics are completed Pre-op teaching needs to be done.

What is the term for a lateral curving of the spine? a) Lordosis b) Scoliosis c) Epiphysis d) Diaphysis

Scoliosis Explanation: Scoliosis is a lateral curving of the spine. Lordosis is an increase in the lumbar curvature of the spine. Diaphysis is the shaft of a long bone. Epiphysis is the end of a long bone.

When assessing the client for scoliosis, the nurse: a) Stands behind the client and asks the client to bend forward at the waist b) Stands in front of the client and asks the client to bend forward at the waist c) Asks the client to walk away from the nurse for a short distance d) Stands to the side of the client and observes the client's spinal curvatures

Stands behind the client and asks the client to bend forward at the waist Explanation: Scoliosis is characterized by a lateral curvature of the spine. The nurse stands behind the client and asks the client to bend forward at the waist.

A client experiences a musculoskeletal injury that involves the structure that connects a muscle to the bone. The nurse understands that this injury involves which of the following? a) Joint b) Cartilage c) Tendon d) Ligament

Tendon Explanation: Tendons are cordlike structures that attach muscles to the periosteum of the bone. Ligaments consisting of fibrous tissue connect two adjacent, freely movable bones. Cartilage is a firm dense type of connective tissue that reduces friction between articular surfaces, absorbs shock, and reduces the stress on joint surfaces. A joint is the junction between 2 or more bones.

The emergency room nurse is reporting the location of a fracture to the client's primary care physician. When stating the location of the fracture on the long shaft of the femur, the nurse would be most correct to state which terminology locating the fractured site? a) The fracture is on the diaphysis. b) The fracture is on the tuberosity. c) The fracture is ventrally located. d) The fracture is on the epiphyses.

The fracture is on the diaphysis. Explanation: A fracture that is on the diaphysis is understood to be chiefly found in the long shafts of the arms and legs. The epiphyses are rounded, irregular ends of the bones. Saying a fracture is ventrally located does not assist in providing adequate details of the location of the fracture. A tuberosity is a projection from the bone or a protuberance.

A client, age 50, visits the physician for a routine checkup. The history reveals that the client was diagnosed with a spinal curvature at age 45. The nurse knows that life-threatening complications can occur if the progressive spinal curvature exceeds 65 degrees. Which region of the spine should the nurse assess for complications? a) Thoracic b) Cervical c) Lumbar d) Sacral

Thoracic Explanation: The nurse should assess the thoracic region of the spine because a progressive curvature of more than 65 degrees in this region may lead to cardiopulmonary failure as well as less serious signs and symptoms, such as fatigue, back pain, decreased height, and cosmetic deformity. Although a curvature may affect any part of the spine, life-threatening complications aren't associated with curvature of the cervical, lumbar, or sacral regions.

A client is recovering from a fractured hip. The nurse would suggest that the client increase intake of which of the following to facilitate calcium absorption from food and supplements? a) Vitamin D b) Vitamin B6 c) Amino acids d) Dairy products

Vitamin D Explanation: The nurse must advise a client recovering from a fractured hip to increase the intake of vitamin D, because vitamin D protects against bone loss and decreases the risk of recurring fracture by facilitating calcium absorption from food and supplements. Amino acids and vitamin B6, though important, do not facilitate the absorption of calcium. Dairy products also do not facilitate the absorption of calcium; however, the exception to this is vitamin D-fortified milk.

Long bones are designed for weight bearing and movement and tend to be composed primarily of

cortical bone, whereas flat bones, which are important sites of hematopoiesis and frequently protect vital organs, are made of cancellous bone layered between compact bone.

Bucks traction is often ordered preoperatively to

decrease muscle spasms and immobilize the leg. Surgery should be scheduled with 24 hours of the time the patient arrives in the emergency room to minimize morbidity and mortality.

What does calcitonin do?

decreases bone resorption(the process in which osteoclasts break down the tissue in bones and release the minerals resulting in a transfer of calcium from bone tissue to the blood) and increases the deposit of calcium in the bones

laissez-faire leadership

does little planning or decision making and fails to encourage others to do so

Elderly women have a higher incidence of

fractured hips than men. It is estimated that nearly one-half of elderly clients who sustain a hip fracture die within one year after injury from medical complications caused by the fracture or by immobility that occurs after fracture.

Immobility metabolic Interventions

high protein, high-calorie diet supplemental vitamin C vitamin B complex

external fixation

immobilization and/or realignment of fracture fragments by external application of a series of interconnected rods and wires through the bone at the fracture site. (Though internal fixation is preferred; external fixation may be used when there are concomitant severe life-threatening injuries or where soft tissue damage is significant and the fracture is opened and contaminated.)

NSAIDs

nonsteroidal anti-inflammatory drugs make sure to take with food may cause GI disruption

Majority of the deaths are caused by injuries sustained when restraints are

not in use or not used properly

Genitourinary System effect of immobility assessment and interventions

oAssessment nAnalysis of Intake and Output (I & O) nProper perineal care nSigns and symptoms of UTI oInterventions nForce fluids nRecord I & O nStrain urine if there are stones

Genitourinary System effect of immobility

oEffects nUrinary Stasis nRenal Calculi nUTI

The most common piece of medical equipment, the stethoscope can be a

potent source of harmful microorganisms and nosocomial (hospital-acquired) infections

Fosomax (diphosphate alendronate) for hip facture should be taken

should be taken the first thing in the morning with 8 ounces of water. Remain sitting in an upright position and NPO for at least 30 minutes after administration. This medication helps to reduce hip fractures by 50%. (These are things you would need to teach your patient about!) Know this!

Most important principle is assessment of child who been poison

treat the child first, not the poison. Treatment: Contact PCC (Poison Control Center) ; may be appropriate to dilute with milk or water Syrup of IPECAC is no longer recommended for routine treatment of poisonous ingestions

. Compartment syndrome may develop within

within 1 - 2 hours post trauma or within 5 - 6 days. If the cycle lasts more than 6 hours, neuromuscular damage becomes irreversible. Within 24 - 48 hours, neuromuscular function can be lost and the limb paralyzed.

The nurse is preparing the client with a right neck mass for magnetic resonance imaging (MRI). Which question should the nurse ask? Select all that apply. a) "Did you take your medications this morning?" b) "When is the last time you had food or drink?" c) "Are you wearing any jewelry?" d) "Do you have a pacemaker?" e) "Have you removed your hearing aid?"

• "Are you wearing any jewelry?" • "Do you have a pacemaker?" • "Have you removed your hearing aid?" Explanation: Magnetic resonance imaging (MRI) is a noninvasive imaging technique that uses magnetic fields, radiowaves, and computers to demonstrate abnormalities of soft tissue. Individuals with any metal implants, clips, or pacemakers are not candidates for MRI. Individuals do not need to be NPO and can take usual medications.

The RN cannot delegate

●Assessments ●Nursing Diagnosis ●Development of the plan of care ●Evaluation of care outcomes

LPN role and responsibilities

●Data Collection ●Implements delegated tasks and maintains collaboration with the RN ●Participates in patient care ●Contributes to patient care decisions ●Documents patient care provided

common alterations in mobility

◦Fractures ◦Slipped femoral capital epiphyses ◦Abnormal Spinal Curves (Scoliosis) ◦Osteogenisis Imperfecta ◦Osteomyelitis ◦Osteoporosis ◦Osteoarthritis ◦Amputations

Osteoporosis treatment

◦Special diet, hormone preparations and exercise ◦ ◦Rich Sources of Calcium ◦ ◦Antacids like Tums, Rolaids ◦ ◦Weight bearing exercise Food Supplement Four glasses of milk contain 1000 - 1200 mg of calcium. Other rich sources of calcium are Kale, broccoli, collard greens, tofu, canned sardines, and canned salmon with bones. (Very important, because you will educate your patients on

Which instruction should the nurse include when teaching the client following hip replacement surgery? (Select all that apply.) -"You may cross your legs at the ankles only." -"Place pillows between your legs when you lay on your side." -"Avoid bending forward when sitting in a chair." -"Use a raised toilet seat and high-seated chair." -"It is okay to briefly flex the hip to put on your clothes."

-"Place pillows between your legs when you lay on your side." -"Avoid bending forward when sitting in a chair." -"Use a raised toilet seat and high-seated chair." The client following post hip replacement should not cross the legs, even at the ankle. He or she should avoid bending forward when sitting in a chair, avoid flexing the hip when dressing, and use a raised toilet seat. A pillow should be placed between the legs when side-lying.

Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education? -"The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device." -"The continuous passive motion device can decrease the development of adhesions." -"Bleeding is a complication associated with the continuous passive motion device." -"Monitoring skin integrity is important while the continuous passive motion device is in place."

-"The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device." Further staff education is needed when the nurse states that the continuous passive motion device isn't needed because the client receives physical therapy twice per day. The continuous passive motion device should be used in conjunction with physical therapy because the device helps prevent adhesions. Bleeding is a complication associated with the continuous passive motion device; skin integrity should be monitored while the device is in use.

A client diagnosed with a right ulnar fracture asks why the cast needs to go all the way up the arm. What is the best response by the nurse? -"This allows for the strength in the arm to remain consistent." -"The joint above the fracture and below the fracture must be immobilized." -"When a spica cast is ordered, the arm must be immobilized." -"The method allows for the fastest healing time and the greatest mobility."

-"The joint above the fracture and below the fracture must be immobilized." Generally, the joints proximal and distal to the fracture are immobilized to promote healing. The purpose is not for the strength to remain consistent; most clients will lose strength. A spica cast would not be ordered for an ulnar fracture. Although immobilizing the joints above and below fractures may shorten healing time, it does not allow for increased mobility.

A client is seen in the emergency department for an injury acquired from falling off of a bicycle and fracturing the arm. The client also has a long laceration that has been sutured in the same area. The client asks the nurse why a splint is applied and not a cast. What is the best explanation by the nurse? -"We will need to monitor the status of the laceration to be sure it does not get infected." -"The arm does not require the same immobilization that a leg fracture would." -"You will be able to wear the splint longer than you would a cast." -"The splint is less expensive than the cast."

-"We will need to monitor the status of the laceration to be sure it does not get infected." A splint would be used when there is special skin treatment or observation that is required. The arm fracture would require the same form of immobilization that a leg fracture does. The length of time the splint can be worn is equal to that of a cast to immobilize the fracture. The cost of the splint and cast would be similar.

A group of students is studying for a test on traction. The students demonstrate understanding of the types of traction when they identify which of the following as an example of skin traction? -Crutchfield tongs -Thomas splint -Buck's -Balanced suspension

-Buck's An example of skin traction is Buck's traction. Crutchfield tongs, a Thomas splint, or balanced suspension traction are types of skeletal traction.

A client who is undergoing skeletal traction reports pressure on bony areas. Which action would be most appropriate to provide comfort for the client? -Assisting with range-of-motion and isometric exercises. -Changing the client's position within prescribed limits. -Administering prescribed analgesics. -Applying warm compresses.

-Changing the client's position within prescribed limits. Changing the position of a client within prescribed limits helps relieve pressure on bony areas and promotes comfort. Analgesics help to relive pain but may not help relieve pressure on bony areas. Warm compresses aid blood circulation. The client should not exercise while on traction unless prescribed to regain strength in the affected limb.

The nurse suspects "compartment syndrome" for a casted extremity. What characteristic symptoms would the nurse assess that would confirm these suspicions? (Select all that apply.) -Decreased sensory function -Excruciating pain -Loss of motion -Capillary refill less than 3 seconds -2+ peripheral pulses in the affected distal pulse

-Decreased sensory function -Excruciating pain -Loss of motion Clinical manifestations include dusky, pale appearance of the exposed extremity; cool skin temperature; delayed capillary refill; paresthesia; and unrelenting pain not relieved by position changes, ice, or analgesia. A hallmark sign is pain that occurs or intensifies with passive range of motion (Johnston-Walker & Hardcastle, 2011). The patient may complain that the cast, brace, or splint is too tight. The primary provider must be notified immediately.

The nurse teaching the client with a cast about home care includes which instruction? -Cover the cast with plastic or rubber -Keep the cast below heart level -Fix a broken cast by applying tape -Dry a wet fiberglass cast thoroughly to avoid skin problems

-Dry a wet fiberglass cast thoroughly to avoid skin problems Instruct the client to keep the cast dry, to dry a wet fiberglass cast thoroughly to avoid skin problems, and not to cover it with plastic or rubber. A cast should be kept dry, but do not cover it with plastic or rubber because this causes condensation, which dampens the cast and skin. A casted extremity should be elevated frequently to heart level to prevent swelling. A broken cast should be reported to the physician and the client should not attempt to fix it.

The client is scheduled for a meniscectomy of the right knee. The nurse would plan postoperative care based on what surgical procedure? -Replacement of one of the articular surfaces of a joint -Incision and diversion of the muscle fascia -Excision of damaged joint fibrocartilage -Replacement of knee with artificial joint

-Excision of damaged joint fibrocartilage The most common site for meniscectomy is the knee; the procedure refers to the excision of damaged joint fibrocartilage. Fasciotomy refers to the incision and diversion of the muscle fascia to relieve muscle constriction. Hemiarthroplasty refers to the replacement of one of the articular surfaces of a joint. Total joint arthroscopy is the replacement of a joint with synthetic material.

A client with a fractured ankle is having a fiberglass cast applied. The client starts yelling, "My leg is burning, take it off." What action by the nurse is most appropriate? -Explain that the sensation being felt is normal and will not burn the client. -Remove the cast immediately, notifying the physician. -Administer antianxiety and pain medication. -Call for assistance to hold the client in the required position until the cast has dried.

-Explain that the sensation being felt is normal and will not burn the client. A fiberglass cast will give off heat when applied. The reaction is a normal, temporary sensation. Heat given off during the application phase of the cast does not burn the skin. By explaining these principles to the client, the nurse can alleviate any anxiety associated with the application of the cast. Because this is a known reaction to the application of the fiberglass cast, it is not necessary to remove the cast. Holding the client may cause more harm to the injury. Antianxiety medications are generally not needed when applying a cast.

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign? -Have the patient extend both hands while the nurse compares the volume of both radial pulses. -Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. -Have the patient plantar flex both feet while the nurse performs the blanch test on all of the patient's toes. -Have the patient squeeze the nurse's hands with his or her hands to evaluate any difference in strength.

-Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. The nurse should assess for pain on passive flexion of each foot, which could indicate deep vein thrombosis.

A client has just undergone a leg amputation. What will the nurse closely monitor the client for during the immediate postoperative period? -Neuroma -Hematoma -Chronic osteomyelitis -Unexplainable burning pain (causalgia)

-Hematoma Hematoma, hemorrhage, and infection are potential complications in the immediate postoperative period. Sleeplessness, nausea, and vomiting may occur but are adverse reactions, not complications. Chronic osteomyelitis and causalgia are potential complications that are likely to arise in the late postoperative period. A neuroma occurs when the cut ends of the nerves become entangled in the healing scar. This would occur later in the postoperative course.

Which type of cast encloses the trunk and a lower extremity? -Body cast -Hip spica -Long-leg -Short-leg

-Hip spica A hip spica cast encloses the trunk and a lower extremity. A body cast encloses the trunk. A long-leg cast extends from the junction of the upper and middle third of the thigh to the base of the toes. A short-leg cast extends from below the knee to the base of the toes.

The client with a fractured femur is upset and agitated that skeletal traction will be necessary for 6 to 8 weeks. The client states, "How can I stay like this for weeks? I can't even move!" Based on these statements, the nurse would identify which of the following as the most appropriate nursing diagnosis? -Ineffective Coping related to prolonged immobility -Impaired Physical Mobility related to traction -Deficient Diversional Activity related to prolonged hospitalization -Activity Intolerance related to impaired mobility

-Ineffective Coping related to prolonged immobility The client is displaying clinical manifestations of anxiety and ineffective coping.

Which is a benefit of a continuous passive motion (CPM) device when applied after knee surgery? -It provides active range of motion. -It promotes healing by increasing circulation and movement of the knee joint. -It promotes healing by immobilizing the knee joint. -It prevents infection and controls edema and bleeding.

-It promotes healing by increasing circulation and movement of the knee joint. A CPM device applied after knee surgery promotes healing by increasing circulation and movement of the knee joint.

A client has undergone an external fixation. Which actions would be the priority for this client? -Maintaining pin care. -Planning the client's diet. -Monitoring the client's urine output. -Monitoring the client's blood pressure.

-Maintaining pin care. Pin care is a priority for a client with external fixation, because pin sites are entry points for infection. The nurse should also monitor redness, drainage, and tenderness at the site. Planning the client's diet and monitoring the client's urine output and blood pressure, although necessary, are not as important as maintaining pin care.

After a traumatic back injury, a client requires skeletal traction. Which intervention takes priority? -Monitoring the client for skin breakdown -Maintaining traction continuously to ensure its effectiveness -Supporting the traction weights with a chair or table to prevent accidental slippage -Restricting the client's fluid and fiber intake to reduce the movement required for bedpan use

-Maintaining traction continuously to ensure its effectiveness The nurse must maintain skeletal traction continuously to ensure its effectiveness. The nurse should assess skin for breakdown; however, maintaining skeletal traction takes priority. Traction weights must hang freely to be effective; they should never be supported. The nurse should increase, not restrict, the client's fluid and fiber intake (unless contraindicated by a concurrent illness) to prevent constipation associated with complete bed rest.

A client is brought to the emergency department by a softball team member who states the client and another player ran into each other, and the client is having severe pain in the right shoulder. What symptoms of a fractured clavicle does the nurse recognize? -Client complains of tingling and numbness in the right shoulder. -Right shoulder is elevated above the left. -Client complains of pain in the unaffected shoulder. -Right shoulder slopes downward and droops inward.

-Right shoulder slopes downward and droops inward. The client with a fractured clavicle has restricted motion, and the affected shoulder appears to slope downward and droop inward. The client will have pain, not typically tingling and numbness in the right shoulder. Pain is not felt in the unaffected shoulder.

A patient arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the patient to describe the pain? -A dull, deep, boring ache -Sharp and piercing -Similar to "muscle cramps" -Sore and aching

-Sharp and piercing The nurse must carefully evaluate pain associated with the musculoskeletal condition, asking the patient to indicate the exact site and to describe the character and intensity of the pain using a pain rating scale. Most pain can be relieved by elevating the involved part, applying ice or cold packs, and administering analgesic agents as prescribed. Pain associated with the underlying condition (e.g., fracture, which is sharp and piercing) is frequently controlled by immobilization. Pain due to edema that is associated with trauma, surgery, or bleeding into the tissues can frequently be controlled by elevation and, if prescribed, intermittent application of ice or cold packs. Ice bags (one third to one half full) or cold application devices are placed on each side of the cast, if prescribed, making sure not to indent or wet the cast. Unrelieved or disproportionate pain may indicate complications. Pain associated with compartment syndrome is relentless and is not controlled by modalities such as elevation, application of ice or cold, and usual dosages of analgesic agents. Severe burning pain over bony prominences, especially the heels, anterior ankles, and elbows, warns of an impending pressure ulcer. This may also occur from too-tight elastic wraps used to hold splints in place.

Which is an inaccurate principle of traction? -The weights are not removed unless intermittent treatment is prescribed. -The weights must hang freely. -The client must be in good alignment in the center of the bed. -Skeletal traction is interrupted to turn and reposition the client.

-Skeletal traction is interrupted to turn and reposition the client. Skeletal traction is never interrupted. The weights are not removed unless intermittent treatment is prescribed. The weights must hang freely, with the client in good alignment in the center of the bed.

Which principle applies to the client in traction? -Weights should rest on the bed. -Skeletal traction is never interrupted. -Knots in the ropes should touch the pulley. -Weights are removed routinely.

-Skeletal traction is never interrupted. Skeletal traction is applied directly to the bone and is never interrupted. To be effective, the weights must hang freely and not rest on the bed or floor. Knots in the rope or the footplate must not touch the pulley or the foot of the bed. Traction must be continuous to be effective in reducing and immobilizing fractures.

Which device is designed specifically to support and immobilize a body part in a desired position? -Brace -Continuous passive motion (CPM) device -Splint -Trapeze

-Splint A splint may be applied to a fractured extremity initially until swelling subsides. A brace is an externally applied device to support a body part, control movement, and prevent injury. A CPM device is an instrument that moves a body part to promote healing and circulation. A trapeze is an overhead device to promote client mobility in bed.

Which device is designed specifically to support and immobilize a body part in a desired position? -Brace -Sling -Splint -Traction

-Splint A splint may be applied to a fractured extremity initially until swelling subsides. A brace is an externally applied device to support a body part, control movement, and prevent injury. A sling is used to support an arm, and traction is the use of a pulling force on a body part.

Which statement is accurate regarding care of a plaster cast? -The cast must be covered with a blanket to keep it moist during the first 24 hours. -The cast will dry in about 12 hours. -The cast can be dented while it is damp. -A dry plaster cast is dull and gray.

-The cast can be dented while it is damp. The cast can be dented while it is damp. A dry plaster case is white and shiny. The cast will dry in 24 to 72 hours. A freshly applied cast should be exposed to circulating air to dry and should not be covered with clothing or bed linens or placed on plastic-coated mats or bedding.

A client has severe osteoarthritis in the left hip and is having surgery to replace both articular surfaces of the hip. What type of surgical procedure will the nurse prepare the client for? -Arthrodesis -Hemiarthroplasty -Total arthroplasty -Osteotomy

-Total arthroplasty A total arthroplasty is a replacement of both articular surfaces within one joint. An arthrodesis is a fusion of a joint for stabilization and pain relief and is usually done on a wrist or knee. A hemiarthroplastyis the replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. An osteotomy is the cutting and removal of a wedge of bone to change the bone's alignment, thereby improving function and relieving pain.

The nurse is checking the traction apparatus for a client in skin traction. Which finding would require the nurse to intervene? -Body aligned opposite to line of traction pull -Weights hanging and touching the floor -Pulleys without evidence of the obstruction -Ropes freely moving over pulleys

-Weights hanging and touching the floor When checking traction equipment, the weights should be freely hanging. Weights that touch the floor require the nurse to intervene. The body should be aligned in an opposite line to the pull of the traction. The ropes should be freely moving over unobstructed pulleys.

Nursing Interventions for Osteoporosis and priority

1. Create a hazard-free environment 2. keep bed in low position 3. Encourage patient to wear shoes when out of bed 4. Encourage environmental safety 5. Provide assistance with ambulation 6. Teach regular ROM exercises Promoting and assisting in exercise of the extremities become a priority in nursing care because demineralization of bones is increased (active range of motion exercises with supervision or passive range of motion exercise)

Russell Traction

A continuous balanced suspension skin traction, used both in children and adults for the treatment of knee contractures, femoral fractures, and occasionally for stabilization after total hip replacement. It features a sling under the knee and one continuous rope from the sling to the weight through four pulleys ( one each on the overhead frame and foot piece and two on the bar at the foot of the bed). Two pulling forces - one at 45 degrees angle downward by the double pulley system at the foot and the other vertical by the knee sling - produce a resulting force in line with the femoral fracture (In Russell traction the pull on the foot is twice that of the applied weight) Nursing responsibilities 1. Application of increased counter traction requires a physicians order. Usually it can be achieved by elevating the foot of the bed or by gatching the bed at the knees with the patient supine. 2. Because the position of the knee sling can alter the direction of the traction pull, a photograph or drawing of the sling should be made after the traction is applied. Nursing records should indicate whether traction was applied with a pillow under the calf. If so it must not be removed without a physician's order since the direction of force will be affected.

Bucks Traction -

A continuous longitudinal skin traction most frequently used in the pre operative immobilization of a fractured femur, fractured hip and slipped femoral capital epiphysis. May also be used to decrease disabling muscle spasms, reduce dislocated hips, immobilize pelvic injuries and prevent hip flexion contractures. Occasionally it is used bilaterally for symptomatic treatment of low back pain. - Maximum weight is 5 - 10 pounds to prevent injury to the skin. Counter traction is provided by the weight of the patient's body; however additional counter-traction can be achieved by placing the bed in trendelenburg position by elevating the foot of the bed Nursing Responsibilities 1 Because many patients in Bucks traction are elderly; it is critical that a thorough skin assessment be performed before traction application. The presence of abrasions, skin tears, vascular insufficiency, and edema is contraindications for Buck traction. 2. Major problem for patients in Bucks traction is sore, reddened heels. This can be avoided by placing a small pillow, foam pad, or bath blanket under the leg to keep the heels off the bed. 3. Assess for tightness of the boot across the dorsum of the foot or along the calf. - The peroneal nerve crosses over the fibula, through the lateral part of the lower leg and down the dorsum of the foot. Its superficial location can easily incur partial complete sensory damage with minimal external pressure. 4. Assess carefully for peroneal nerve damage by monitoring for the presence of foot drop and or extensive sensory loss to the lateral calf, lateral malleolus, dorsum of the foot, and the toes. 5. Patient may be turned 45 degrees to each side 6. Boot may be removed every eight hours to assess for skin breakdown

The nurse is providing care to a client following a knee arthroscopy. Which of the following would the nurse expect to include in the client's plan of care? a) Keeping the affected knee flexed. b) Administering the prescribed analgesic. c) Applying warm packs to the insertion site. d) Maintaining the client's NPO status.

Administering the prescribed analgesic. Explanation: After an arthroscopy, the client's entire leg is elevated without flexing the knee. A cold pack is placed over the bulky dressing covering the site where the arthroscope was inserted. A prescribed analgesic is administered as necessary. The client is allowed to resume his or her usual diet as tolerated.

Which of the following factors would the nurse need to keep in mind about the focus of the initial history when assessing a new client with a musculoskeletal problem? a) Client's life-style b) Client's age c) Any chronic disorder or recent injury d) Duration and location of discomfort or pain

Any chronic disorder or recent injury Explanation: The focus of the initial history depends on the nature of the musculoskeletal problem, whether the client has a chronic disorder or a recent injury. If the disorder is long-standing, the nurse obtains a thorough medical, drug, and allergy history. If the client is injured, the nurse finds out when and how the trauma occurred. The client's age, life-style, or duration and location of discomfort or pain, while important, have little influence on the focus of the initial history and assessment of the client.

Clinical Manifestations of Osteoporosis

Back pain is the usual complaint. It may have a sudden or insidious onset and is due to compression fractures of the lumbar spine. Kyphosis "Dowager's Hump" and loss of stature may be present as a result of the compression fractures. Pain will extend along the pathway of an involved nerve and may progress to the pelvis, chest and shoulders. (many elderly people who sustain hip fractures also have osteoporosis)

Which of the following is an indicator of neurovascular compromise? a) Capillary refill of more than 3 seconds b) Pain on active stretch c) Warm skin temperature d) Diminished pain

Capillary refill of more than 3 seconds Explanation: Capillary refill of more than 3 seconds is an indicator of neurovascular compromise. Other indicators include cool skin temperature, pale or cyanotic color, weakness, paralysis, paresthesia, unrelenting pain, pain on passive stretch, and absence of feeling. Cool skin temperature is an indicator of neurovascular compromise. Unrelenting pain is an indicator of neurovascular compromise. Pain on passive stretch is an indicator of neurovascular compromise.

Fracture Healing three phases

Certain biological factor influences the rate that bones heal. When a long bone breaks the blood vessels that circulate through the bone and periosteum are torn causing hemorrhage into the fracture site and tissue, forming a hematoma. Loss of blood supply to the bone creates bone necrosis distal to the fracture site. Bone healing occurs in three phases. Granulation Phase - Reparative osteoclast cells begin to proliferate and group at the fracture site developing a fibrous matrix of collagen. At this stage of the fracture healing, blood is supplied via medullary circulation. This stage begins within 48 to 72 hours post fracture. Reparative Phase with Callus Formation and Consolidation - Granulation tissue is matured into a callus. The callus converts to a loosely woven network of bone, cartilage and fibrous tissue with forms a bridge over the bone fragments, uniting the fractured bone. The hematoma at the fracture site is slowly brokened down and the removed by fibrinolysis and phagocytosis. This stage begins 6 - 10 days postfracture and may last for 3 -10 weeks or longer. Remodeling - the callus becomes calcified and blends into the bone through a process of reabsorption and deposition along lines of maximum stress. The medullary canal is reestablished, and bone returns to its preinjury state. This final stage may occur from 6 to 12 months postfracture. (In the young health adult healing takes about 6 weeks. In the elderly individual with reduced bone mass healing frequently takes 3 to 6 months).

Bryant's Traction

Classified as a continuous vertical suspension skin traction. It is the treatment of choice for femoral fractures or congenital hip dislocations in children under 2 year of age weighing less than 35 pounds whose weight is not sufficient to provide adequate counter-traction without additional gravitational force. It is contraindicated in heavier children because of increased positional blood pressure changes that occur in the older toddler. v Adhesive traction strips ate applied to the child's legs and secured with elastic bandages wrapped from the foot to the groin. v Child's hips are flexed at a 90 degree angle with the knees extended and the legs suspended by pulleys and weights. v Buttocks elevated slightly off the bed, legs maintained perpendicular to trunk. Remodeling and callus formation in 2 - 3 weeks (Maybe and early as 7 - 10 days).May be placed in a spica cast for another 3 - 9 weeks. Nursing Responsibilities1. Meticulous neurovascular assessments - both feet should be assessed at least every 2 hours for color, pulse, motion and temperature. 2. Traction boots or elastic bandages should be checked for displacement. 3. Children will be unable to communicate about presence of parenthesis, so the nurse must be diligent in assessing three pressure areas. - the area over the outer head and neck of the fibula - Achilles tendon - The dorsum of the foot. Both skin necrosis and contractures can occur if bandages or boots are too tight

The nurse is caring for patient scheduled to have magnetic resonance imaging (MRI). The nurse contacts the health care provider to cancel the MRI when the nurse reads which of the following in the patient's medical history? a) Colostomy b) Tumor removal c) Cochlear implant d) Skin graft

Cochlear implant Explanation: Nonremovable cochlear devices can become inoperable when exposed to MRI. Therefore, it is contraindicated for a patient with a cochlear implant to have an MRI. Also, transdermal patches (e.g., nicotine patch [NicoDerm], nitroglycerin transdermal [Transderm-Nitro], scopolamine transdermal [Transderm Scop], clonidine transdermal [Catapres-TTS]) that have a thin layer of aluminized backing must be removed before MRI because they can cause burns. The primary provider should be notified before the patches are removed. Additionally, the patient should remove all jewelry, hair clips, hearing aids, credit cards with magnetic strips, and other metal-containing objects; otherwise, these objects can become dangerous projectiles or cause burns.

Compartment syndrome

Complication Myoglobinuric renal failure - injured muscle tissue releases muscle protein into the circulation, which is filtered by the kidney causing renal vasoconstriction. Myoglobin also causes metabolic acidosis, hyperkalemia and sepsis, which may necessitate amputation. Diagnostic test Includes three types of tissue pressure measurement: injection, wick, and continuous infusion. Treatment Medical intervention is directed toward reducing the pressure and stopping the ischemia - edema cycle. If the pressure is due to external devices such as cast or dressings the cast will be bivalve (cut in two). The limb is positioned at the level of the heart. Surgical decompensation may be necessary. Nursing Diagnoses include: Potential for alteration in tissue perfusion (neurovascular status) r/t externally applied pressure Pain r/t muscle ischemia and trauma Anxiety r/t pain Potential for alteration in body image r/t neurologic deficit. Nursing Interventions Identification, documentation, and communication of any signs or symptoms related to neurovascular compromise. When assessing peripheral pulses check for amplitude, symmetry and rhythm.

The homecare nurse is evaluating the musculoskeletal system of a geriatric patient whose previous assessment was within normal limits. The nurse initiates a call to the health care provider and/or emergency services when which of the following changes are found? a) Decreased agility b) Increased joint stiffness c) Decreased flexibility d) Decreased right-sided muscle strength

Decreased right-sided muscle strength Explanation: Although symmetrical decreases in muscle strength can be a part of the aging process, asymmetrical decreases are not. The nurse should contact the health care provider when decreased right-sided muscle strength is found, as this could indicate a stroke or transient ischemic attack. Decreased flexibility, decreased agility, and increased joint stiffness are all part of the aging process and therefore do not require the nurse to contact the health care provider.

Which of the following describes a muscle that is limp and without tone? a) Atonic b) Flaccid c) Spastic d) Paralysis

Flaccid Explanation: A muscle that is limp and without tone is described as flaccid. A muscle with greater-than-normal tone is described as spastic. In conditions characterized by lower neuron destruction, denervated muscle becomes atonic (soft and flabby) and atrophies. A person with muscle paralysis has a loss of movement and possibly nerve damage.

Fat Embolism

Laboratory findings include: v Increased erythrocyte sedimentation rate (ESR) v Decreased serum albumin and calcium levels v Decreased red blood cell (RBC) and platelets counts v Increased serum lipase level v Arterial blood gases levels may be assessed v A chest x-ray will show a diffuse snowstorm pattern. Treatment Prevention of Fat Embolism is best accomplished through early immobilization of long bone fractures. Five measures are generally used to treat fat embolism. It is treated as a medical emergency. 1. Oxygen, usually 40% by mask. In minor cases, this is all that is necessary. In severe cases, mechanical ventilation may be necessary. 2. Fluid replacement may be necessary to restore adequate volume and to flush the toxic fatty substances through the system. 3. Corticosteroids may be used to stabilize cell membranes and decrease inflammation. 4. Diuretics may be used if indicated to restore fluid to the vascular space. 5. Other drugs may be used, such as heparin and low-molecular-weight dextran, and aspirin (in males only) though their effectiveness is unclear. Nursing Diagnosis Potential for alteration in mental status r/t hypoxia Altered gas exchange r/t increased respiratory secretions Impaired gas exchange r/t decrease oxygen caring ability of blood (decrease RBC) Anxiety r/t hypoxia Nursing Interventions Includes prevention of Fat Embolism by early immobilization of fractures, decreased manipulation, and support of fractured region when moving the patient the injured extremity. v Adequate ventilation may be enhanced by elevating the head of the bed, as tolerated and mobilization of lung secretions by teaching the client to turn, cough and deep breathe. v Identify and report early signs and symptoms, especially changes in behavior and level of consciousness. v Maintain oxygen delivery, monitor intake, and output, and obtain daily weights.

A client is scheduled to undergo an electromyography. The nurse understands that this test is performed to evaluate which of the following? a) Muscle composition b) Muscle weakness c) Metastatic bone lesions d) Bone density

Muscle weakness Explanation: Electromyography tests the electric potential of the muscles and nerves leading to the muscles. It is done to evaluate muscle weakness or deterioration, pain, disability, and to differentiate muscle and nerve problems. A bone biopsy is done to identify bone composition. Bone densitometry is done to evaluate bone density. A bone scan would be appropriate to detect metastatic bone lesions.

Steps for assessing for possible fractures

Obtain a history of the injury and symptoms experienced. (May complain of acute, sharp, piercing pain at the time of injury, followed by a point of tenderness, muscle spasm and increased pain on movement or with application of pressure). Numbness, tingling, or paralysis may be present due to neurologic involvement. On physical examination observe for changes in length, shape, alignment, stability, or mobility of the bone (such as abnormal movement), or associated joint. Ecchymosis and soft tissue swelling may be present due to trauma to the vascular structures near the site if injury. Crepitus may be palpable or audible related to grinding bone fragments. A baseline neurovasculsar assessment should be obtained as soon as the fracture is stabilized. Assess for the 5 Ps Pain, Pallor, Paralysis, Paresthesia, and Pulselessness, Poikilothermia ( This is very IMPORTANT)

The nurse observes the client and notes a shuffling gait. The nurse recognizes this finding is consistent with: a) Parkinson's disease b) Paget's disease c) Lower motor neuron disease d) Scoliosis

Parkinson's disease Explanation: Parkinson's disease is characterized by a shuffling gait.

Which of the following is a characteristic of fracture pain? a) Sore b) Deep c) Dull d) Piercing

Piercing Explanation: Fracture pain is sharp and piercing and is relieved by immobilization. Bone pain is characteristically described as a dull, deep ache that is "boring" in nature, whereas muscular pain is described as soreness or aching and is referred to as "muscle cramps."

There are thousands of components of the musculoskeletal system that facilitate mobility and independent function. What is the function of skeletal muscle? a) Promoting movement of skeletal bones b) Promoting involuntary function c) Promoting organ function d) All options are correct.

Promoting movement of skeletal bones Explanation: The skeletal muscles promote movement of the bones of the skeleton.

Which of the following is the final stage of fracture repair? a) Remodeling b) Angiogenesis c) Cartilage calcification d) Cartilage removal

Remodeling Explanation: The final stage of fracture repair consists of remodeling the new bone into its former structural arrangement. During cartilage calcification, enzymes within the matrix vesicles prepare the cartilage for calcium release and deposit. Cartilage removal occurs when the calcified cartilage is invaded by blood vessels and becomes reabsorbed by chondroblasts and osteoclasts. Angiogenesis occurs when new capillaries infiltrate the hematoma, and fibroblasts from the periosteum, endosteum, and bone marrow produce a bridge between the fractured bones.

The human body has 206 bones, which are classified into four categories. Which types of bones are located in the digits? a) Irregular bones b) Flat bones c) Long bones d) Short bones

Short bones Explanation: Short bones are the type that is located in the fingers and toes.

Balanced suspension traction

This traction may be used with or without skin or skeletal traction. Unless used with another traction, the balanced suspension merely suspends the leg in a desired flexed position to relax the hip and hamstring muscles and does not exert any traction directly on a body part. Patients treated with this type of traction have often sustained multiple fractures from motor vehicle accidents or falls. The major advantage of this traction is in increased patient movement in bed. This traction set up uses the following key points: 1. Skeletal traction is achieved through the insertion of a Steinman Pin or Kirschner wire attached to a U shaped traction bow. 2. A Thomas leg splint is used to elevate and support the thigh an upper leg (from groin to above the foot). Areas under the popliteal space and heel are left open to prevent pressure. 3. Pearson attachment - A padded metal frame attached to the Thomas Splint so that the lower leg can be comfortably supported. 4. Ropes, weights and pulleys - one weighted rope and pulley system is used to provide skeletal traction. - two weighted rope and pulley systems elevate, suspend and balance the skeletal traction. Nursing Responsibilities 1. Meticulous skin monitoring thorough neurovascular assessment, and careful attention to the potential complications of immobility. 2. The full or half ring at the proximal end of the Thomas Splint should be padded with sheepskin to prevent pressure to the groin. 3. Padding under the sling or metal frame of the Thomas splint and Pearson attachment are necessary to prevent peroneal nerve damage. 4. Neurovascular status should be assessed at least every 2 hours for the first 24 hours after traction is applied; thereafter every 4 hours while the patient is awake. 5. Observe the position of the leg for internal or external rotation. 6. Passive and active range of motion at least 3 times per day. 7. Head of bed flat at least 1 hour every eight hours to prevent hip flexion contractures.

Post-op Management of hip fracture

Treatment goals include: 1. complete union of the fracture (4 - 8 months) 2. prevention of deformity and contractures of the hip, knee or foot 3. restoration of weight bearing ambulation with assistive devices as necessary 4. the relief of muscle spasm, pain and fear 5. Prevention of complications related to immobility. Nursing Management Nursing care focuses on meeting the above goals. *The most important nursing observation includes assessing for signs of compromised circulation. Reinforce pre-op teaching Closely monitor vital signs Accurate measurement of intake and output (amount and type of wound drainage in drains and on dressings) Isometric leg exercises (calf pumping) should be started immediately. Total system assessment. Look for signs of thrombosis - calf tenderness, redness or warmth Reposition every two hours and massage bony prominences. Pillow should be placed between patient's legs before turning to maintain proper body alignment and prevent twisting or adduction of the involved leg. Allowable positions may be limited by physician preferences Pain management. The patient's post op activity depends on the choice of internal fixation: Stable plate and screw fixation - non weight bearing for 6 weeks to 3 months Telescoping nail fixation - minimal to partial weight bearing for 6 weeks to3 months Prosthesis total hip replacement - some position restrictions adduction for 2 weeks - 2 months, partial weight bearing for up to 2 months. Nursing Management Prostatic implants Avoidance of hip flexion beyond 60 degrees for approximately 10 days Avoid hip flexion beyond 90 degrees from 10 days to 2 months Avoid adduction of affected leg beyond midline foe 2 months. Maintain partial weight bearing 2 months Use high chair or commode with patient's legs abducted Stair climbing and stooping should be avoided for 3 months.

Casts: Materials

Two types of cast are commonly used. Natural (Plaster of Paris) and synthetic (Polyester/cotton knit gauze and fiberglass gauze) Selection of the type of material will vary with physician preference, type of injury, and the number of potential cast changes Nursing Responsibilities 1. Assess the patient's skin for areas of breakdown or open areas clean and dress these areas as needed and document appearance of skin. (to assess an underlying incision, wound, or area of pressure, the cast may be windowed) 2. Provide for drying by evaporation by exposure to circulating air. 3. Do not cover cast 4. Turn patient every 2 hours to ensure drying and prevent flattening pressure on the cast 5. If humidity is high a regular fan, cast dryer of hair dryer on cool may be helpful in cast. A hollow sound when tapped with the finger indicates that the cast is dry. 6. Handle the cast with the palms of the hands not the fingertips.

Hip fractures include those involving the upper third of the femur and are classified as

intracapsular or extracapusular, within or outside of the joint capsule, respectively

An angiogram is

is an X-ray procedure that can be both diagnostic and therapeutic. It is considered the gold standard for evaluating blockages in the arterial system. An angiogram detects blockages using X-rays taken during the injection of a contrast agent (iodine dye).

autocratic leadership

leadership style that involves making managerial decisions without consulting others

3. Oblique -

line of fracture at an oblique angle to the bone shaft.

The nurse is conducting an admission history of a client admitted with a fracture. The nurse recognizes that which of the client's medications placed the client at risk for fractures? a) prednisone (Deltasone) b) digoxin (Lanoxin) c) metoprolol (Lopressor) d) furosemide (Lasix)

prednisone (Deltasone) Explanation: Prednisone, a corticosteroid, causes increased bone resorption and decreased bone formation, resulting in increased risk for fractures.

7. Comminuted fracture -

the bone has broken in several fragments Impacted (telescoped) - Fractured bone fragment is forcibly driven into another bone fragment

Osteoarthritis is the __

the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage on the ends of your bones wears down over time. Although osteoarthritis can damage any joint in your body, the disorder most commonly affects joints in your hands, knees, hips and spine ◦Large weight bearing joints ◦Most common ◦Pain in ◦Obesity

Open reduction treatment of fracture

the realignment of fractures or dislocations using surgical intervention. Surgical incision is made to expose the fracture site.