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study guide 31&32
| Question | Answer |
|---|---|
| The nurse uses a visual aid to show the difference between a complete dislocation and a partial dislocation, which is also called a(n) | subluxation A subluxation is a partial dislocation |
| Bone is partially broken and partially bent | Greenstick fracture |
| Fracture that has not broken through skin | Closed fracture |
| Fracture bone end protruding through skin | Compound fracture |
| Bone that is in two distinct pieces | Complete fracture |
| Bone shattered in more than two pieces | Comminuted fracture |
| Reduction of fracture through surgical incision | Internal fixation |
| Metal appliances are used to stabilize pieces of fracture | Internal fixation |
| Reduction of fracture and fixation to device that maintains alignment | External fixation |
| Used with infected fractures that do not heal properly | External fixation |
| Manual reduction and manipulation of bones into alignment | Closed reduction |
| Used with older adults when brittle bones do not heal quickly | Internal fixation |
| steps of the process of fracture healing in proper order. | Hematoma is formed between broken ends of bone. Granulation tissue is formed Callus is formed Mature bone cells form ossification Medullary canal is reconstructed |
| As we age, bone density decreases because of | reabsorption of minerals |
| Kyphosis in the elderly is because of thinning of the ------------- and collapse of the -------------. | intervertebral cartilage Vertebrae in the cervical and thoracic spine |
| The bones of the elderly break more easily because they are ------------ and -------------. | brittle compact |
| Stiffness and crepitation in the joints is a result of joint ---------------- and erosion from ------------. | cartilage thinning years of use |
| Nighttime muscle cramping in the elderly is increased because of ----------- and accumulation of -------------. | impaired circulation metabolic wastes |
| Poor nutrition can contribute to musculoskeletal problems because there may be -------------- | To little calcium and phosphorus or inadequate protein |
| Malignant tumors can contribute to musculoskeletal disorders in two ways: | -by placing a large nutritional demand on the body -by invading bone and causing fractures and causing muscle wasting |
| Measures that can help prevent musculoskeletal disorders. | -consuming adequate amounts of calcium and vitamin D -Refrain from using steroids long term Weight training and weight bearing exercise -Using seat belts, safety helmets, consuming adequate protein and not smoking. |
| aftercare of a bone scan | after procedure, monitor site of venipuncture for signs of inflammation and hematoma |
| aftercare of a Arthroscopy | watch for signs of infection, hemarthrosis, swelling, and injury to joint or loss of feeling |
| aftercare of a Arthrocentesis | Apply ice or cold packs, support joint with pillows |
| Synovial analysis | Normal findings are clear, viscous fluid containing no or very few blood cells |
| Examination of bone tissue to identify infecting organism | Culture |
| Measurement of frame of motion of a joint | Goniometry |
| Muscle strength grading | ranges from (0-paralysis) to (5 is normal) |
| What significant findings the nurse might record when taking a history during assessment of a patient with a complaint of back pain. | -joint stiffness -Personal history of degenerative bone disease, blood dyscrasias (sickle cell disease) psoriasis -Family history of bone, joint or skin disease -Characteristics and location of pain -Loss of sensation |
| Observations the nurse can make about a patient's ability to move and walk. | -complaints of joint pain -awkward gait -limping -difficulty with arising or walking -poor posture -wincing upon movement or difficulty with balance or strength |
| Joint mobility is maintained by regularly performing ------------- exercises. | ROM |
| A patient who is immobilized for a long period of time loses -------- from his bones. | calcium |
| Lengthy immobilization tends to cause muscle to ------------ (loss of tone) | atrophy |
| If ankylosis of a joint is unavoidable, the joint is ------------- so that the extremity will have maximum function. | braced |
| -------------- exercise is helpful in preventing osteoporosis. | weight bearing |
| Proper exercise and positioning of joints for an immobile patient is extremely important because a contracture can begin to occur within as little as ----------------. | 3 to 7 days. |
| MRI is used to help diagnose a variety of musculoskeletal problems. What instructions would you give the patient who is to undergo an MRI? | -You must remove all metal from your body -You will need to remain perfectly still for 15 to 60 minutes. -If you are claustrophobic, you may ask for a sedative beforehand. |
| When assessing whether crutches have been fitted to the patient properly, you know that when walking with them the.... | -axillary bar should be two finger breadths below the axo;;a -elbow should be flexed at a 30 degree angle -crutches should be about 16 inches shorter than the patient's height |
| A way to try to prevent musculoskeletal disorders including rheumatoid arthritis is: | refrain from smoking or stop smoking |
| When checking the joints during a focused assessment, you should | -palpate them for tenderness -inspect them for swelling or deformity -assess for warmth over the joint -determine range of motion without pain |
| When walking with it, the walker height is correct when the patient's elbow is: | bent at 15 - 30 degrees |
| The nurse observes that an elderly patient has decreased strength, unsteady balance, slow reflexes, and a gait disturbance. What is the priority problem? | Potential for falls. |
| proper use of crutches? how to use up and down stairs | read in book |
| What is the difference between a tendon and a ligament? | Ligaments hold the joint together. Tendons anchor muscle to bone. |
| What is the purpose of cartilage? | Cartilage provides a cushion between the joint |
| What is the difference between a sprain and a strain? | A sprain involves stretching or tearing of ligaments around a joint. A strain involves pulling and tearing of a muscle or a tendon or both. |
| what are some Posture descriptions | erect, slumped, rounded shouldered, straight |
| Gait descriptions | normal, rolling, heel toe, toe heel, ataxic, ambling, slow, rapid, bouncy |
| Range of motion descriptions | full, limited, diminished, little, restricted |
| Spine descriptions | normal curve, S-shaped, abnormally curved, tender, rounded |
| Joints descriptions | normal, reddened, swollen, painful, deformed , immovable, contracted, freely movable |
| Skeletal muscles descriptions | good tone, well developed, underdeveloped, tense, hard, soft, poor tone, atrophic, painful. |
| Subluxation is a partial dislocation that usually occurs from -------------- | Trauma |
| the patient should not take more than -------------- mg of acetaminophen a day. | 3000 |
| The most common cause of below the knee amputation i | gangrene |
| In addition to increasing calcium and vitamin D, one of the best ways for women to prevent osteoporosis is to preform | weight bearing exercise |
| The most common cause of osteomyelitis is | staphylococcus aureus |
| The muscles most commonly afflicted with muscle strain are the --------------, ---------------, and ------------- muscles. | hamstring quadriceps calf |
| What are some objectives data the nurse might collect when assessing a patient with arthritis? | a. Evidence of swelling, redness, deformity in joints b. Limited range of motion; in what joints; how much c. Gait d. Posture e. Evidence of improper use of crutches or cane, inappropriate shoes |
| nursing intervention for Swelling and increased pressure within a fascial compartment | test for sensation and do a capillary refill time test |
| Cleaning of pin sites | Should be done daily with a 2 mg/ml chlorhexidine solution |
| Infection of a pin site or fracture site | presents as dull pain that becomes progressively worse, fever, purulent drainage, foul odor. Initiate wound and skin precautions. |
| Tachypnea, disorientation, crackles, and wheezing, and rash with lesions that do not blanch with pressure. | notify HCP promptly; this is symptomatic of fat embolism. This is a rare but potentially fatal condition. |
| A patient is in her first postoperative day after a total hip replacement as treatment for degenerative arthritis. The patient's operated limb ust be kept in what position? | Abduction |
| You must watch the patient with a fracture of the femur for a fat embolism. s/s include? | altered mental status, petechiae on chest, and dyspnea |
| When a patient with a new hip is being prepared for discharge, you should give which instructions to avoid dislocation of the prosthesis? | -used a raised toilet seat -Use a pillow between your knees when lying down -Do not cross your legs at the knee or ankle -Be careful not to bend at the hip more than 90 degrees. |
| A patient is discharged with a synthetic cast applied. What will he need to know to take care of himself and the cast? | How to assess the neurovascular status of the part encased in the cast -how to dry the cast if it becomes wet -signs of infection under the cast -Importance of reporting a broken or loose cast |
| The nurse is caring for several patients with hip or femur fractures on an orthopedic unit. Which patient should the nurse attend to first? | Patient complains of difficulty breathing, feeling very hot, and fine red rash on the chest. |
| after a accidental amputation of a finger which action should u perform | Immerses the digit in a cup of cold water. |
| Compartment syndrome is a potential complication. A typical sign or symptom would be: | pain unrelieved by analgesia |
| Patients with rheumatoid arthritis who are receiving Enbrel or other biologic response modifiers must be watched for complications such as: | -serious infection -blood dyscrasias -signs of demyelination |
| Disease modifying antirheumatic drugs prevent joint and cartilage destruction by: | suppressing the immune system |
| a patient refuses to perform the cough and deep breathing exercises what should the nurse do first | Explain how immobility contributes to developing pneumonia or atelectasis |
| the 6 p's | Pain, pallor, pulsessesnes, paralysis, paresthesia, pressure |
| DMARDs | Methotrexate is the first-line DMARD, if tolerated by the patient. Other medications include hydroxychloroquine, sulfasalazine, leflunomide, or a tumor necrosis factor (TNF) inhibitor. |
| Patients should be tested for tuberculosis (TB) before being started on which DMARD drug | TNF inhibitors because these drugs may exacerbate TB |
| If RA is diagnosed early_______ can be started to prevent joint delegation | DMARDs |
Created by:
snmartin
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