Musculoskeletal, Trauma, and Critical Care Review

Flashcards generated from musculoskeletal and trauma lecture notes to aid in exam preparation.

What type of bone cell is responsible for the formation of bone?

Osteoblast

How should a nurse document that a patient's muscle has decreased in size?

Atrophy

What tissue is responsible for rigidity in the shoulders, back, and hips in an older patient?

Cartilage

What best describes the periosteum?

Fibrous connective tissue covering bone

What is the function of a tendon?

Attaches muscle to bone

What joints are capable of abduction and adduction?

Hip, wrist, thumb, and shoulder

Why does decreased height occur with aging?

Vertebrae become more compressed with thinning of intervertebral discs.

What is an appropriate nursing intervention related to common changes of aging in the musculoskeletal system?

Encourage the patient to exercise to maintain muscle strength and avoid the risk for falls.

What type of medications may impair bone and muscle function?

Corticosteroids and Potassium-depleting diuretics

What muscle strength score should be given when a patient has active movement against gravity and some resistance to pressure?

4

How should the nurse further evaluate a patient with a gait disturbance?

Measure the length of the limbs and compare the muscle mass of one leg with the other.

What equipment is used to assess joint range of motion?

Goniometer

What is a lateral curvature of the spine called?

Scoliosis

What does contracture mean?

Shortening of a muscle or ligament

What is torticollis?

Exercises to increase the strength of the muscles and enough pillows to support the patient’s head comfortably

What musculoskeletal problem is indicated by a burning, sharp pain on the sole of the foot, especially in the morning?

Plantar fasciitis

How does the nurse document footdrop where the foot slaps down on the floor as the patient walks?

Steppage gait

What is the most common diagnostic test used to assess musculoskeletal disorders?

Standard x-ray

What test provides fast, precise measurement of the bone mass of the spine, forearm, and total body to evaluate osteoporosis?

Dual energy x-ray absorptiometry (DXA)

Which serologic tests would be done to evaluate rheumatoid arthritis?

Antinuclear antibody (ANA), Rheumatoid factor (RF), and Erythrocyte sedimentation rate (ESR)

What can the nurse do to assist the patient to prevent further deconditioning and decrease the risk for developing musculoskeletal problems from overall joint aches and pains?

Discuss use of over-the-counter (OTC) medications to decrease inflammation and pain so that exercise can be maintained.

What is one of the best ways to prevent musculoskeletal injuries during physical exercise?

Perform stretching and warm-up exercises before exercise.

What is an avulsion fracture?

It means that a ligament pulled a bone fragment loose.

What is a spontaneous hip fracture called?

Pathologic fracture

What kind of repetitive strain injury would be expected in a patient working on a computer 8 hours each day?

Carpal tunnel syndrome

What happens to the tissue to cause pain when bursitis occurs?

Inflammation of synovial membrane sac at friction sites

When is application of RICE (rest, ice, compression, and elevation) indicated?

Sprains and strains

What should be included in the management during the first 48 hours after an acute soft tissue injury of the ankle?

Use of elastic wrap, initial immobilization and rest, elevation of ankle above the heart, and administration of antiinflammatory drugs

How is the stage of fracture healing with clinical union documented?

Callus formation

What is happening at the remodeling stage of fracture healing?

Radiologic union, absorption of excess cells, return to preinjury strength and shape, and deposition and absorption of bone in response to stress

What is the cardinal sign of fracture?

Obvious deformity

What happens with the complication of malunion?

The fracture heals in an unsatisfactory position.

What is a disadvantage of open reduction and internal fixation of a fracture compared to closed reduction?

Infection and Complications of immobility

What should the nurse do while a hip spica cast is drying?

Turn the patient to both sides and prone to supine every 2 hours and Assess the patient frequently for abdominal pain, nausea, and vomiting.

What should the nurse question a patient about who is admitted with an open fracture of the tibia following a bicycle accident?

The status of tetanus immunization and Whether the injury was exposed to dirt or gravel

In regards to priority management, what action should the nurse take before splinting a possible fracture?

Neurovascular checks below the site of the injury

To assess for neurologic status in a patient with a fractured humerus, what should the nurse ask the patient to do?

Abduct, adduct, and oppose the fingers and pronate and supinate the hand.

What should the nurse instruct a patient to do before discharge after application of a synthetic fiberglass long arm cast?

Move the shoulder and fingers frequently.

What early sign should alert the nurse that the patient is developing compartment syndrome?

Distal pain unrelieved by opioid analgesics

What surgical treatment will the nurse prepare the patient for in the presence of compartment syndrome?

Fasciotomy

Which type of fracture occurred when there is radial nerve and brachial artery damage and the fracture is reduced with a hanging arm cast?

Fractured humerus

What type of fracture is expected from a woman with osteoporosis slipping on ice?

Colles’ fracture

What emergency considerations must be included with facial fractures?

Airway patency and Cervical spine injury

What should the nurse teach a patient with a stable vertebral fracture to do?

Logroll to keep the spine straight when turning and Take as much analgesic as needed to relieve the pain.

When is a fat embolism most likely to occur?

24 to 48 hours following a fractured tibia

How else should the nurse consider a fat embolism instead of a pulmonary embolism?

Petechiae around the neck and upper chest

Which kind of hip fracture is usually repaired with a hip prosthesis?

Intracapsular

What does the nurse assessment find when the nurse cautions an older adult woman not to put weight on her leg after falling at home?

Shortening and external rotation of the leg

What is the purpose of Buck's traction in a patient with an extracapsular hip fracture?

Reduce pain and muscle spasms before surgery

What should the nurse plan to do postoperatively in a patient with a fractured right hip with an anterior open reduction and internal fixation of the fracture?

Get the patient up to the chair on the first postoperative day

What should the nurse include in discharge instructions for the patient following a hip prosthesis with a posterior approach?

Have a family member put on the patient’s shoes and socks.

What does the nurse determine in teaching if the patient can keep their mouth moist with hard candy following fixation of a mandibular fracture?

I should use a moist swab to clean my mouth every time I eat something.

What is the first action the nurse should take after a patient has a below-the-knee amputation and the dressing has fallen off?

Cover the incision with dry gauze.

What should the nurse recognize about pain in the foot of a leg that was recently amputated?

It should be treated with ordered analgesics.

What is a priority nursing intervention following an immediate prosthetic fitting during surgery for a patient with a traumatic below-the-knee amputation?

Assess the incision for hemorrhage.

Why does a nurse position a patient with an above-the-knee amputation with a delayed prosthetic fitting prone several times a day?

To prevent flexion contractures

What is most important for the nurse to teach the patient to do who had a below-the-knee amputation?

Inspect the residual limb daily for irritation.

What joint surgery is used to arthroscopically remove degenerative tissue in joints?

Debridement

What is an arthroplasty?

Reconstruction or replacement of a joint to relieve pain and correct deformity

What is included in the activity the nurse anticipates for the patient on the patient’s first or second postoperative day after a right total hip arthroplasty with a cemented prosthesis?

Ambulation and weight bearing on the right leg with a walker

What position is important for the nurse to maintain the affected extremity in after a total hip arthroplasty with a posterior approach?

Abduction and extension

What is the purpose of a continuous passive motion machine for the affected joint following a knee arthroplasty?

To promote early joint mobility and increase knee flexion

What post-operative action is most important for the nurse to do on a patient with severe ulnar deviation of the hands who undergoes an arthroplasty with reconstruction and replacement of finger joints?

Perform neurovascular assessments of the fingers q2-4hr.

Following change-of-shift handoff, which patient should the nurse assess first?

A 68-year-old male with a new lower leg cast complaining that the cast is too tight and he cannot feel his toes

What does the nurse explain to the patient as the rationale for the surgical treatment for chronic osteomyelitis?

Formation of scar tissue has led to a protected area of bacterial growth.

What is an appropriate nursing intervention for a patient with osteomyelitis that has a nursing diagnosis of risk for injury?

Gently handle the involved extremity during movement.

What should the nurse expect testing to include to identify a possible causative agent of osteomyelitis at the site of an open fracture of the humerus?

Bone biopsy

What statement shows that additional instruction is needed for a patient being discharged from the hospital following 2 weeks of IV antibiotic therapy of acute osteomyelitis of the tibia?

I can use a heating pad on my lower leg for comfort and to promote healing.

While assessing the patient’s mouth whose wife can hardly get the patient to eat because his mouth is so sore, what should the nurse expect to find?

White, curdlike membranous lesions of the mucosa

Which type of bone tumor is a benign overgrowth of bone and cartilage and may transform into a malignant form?

Osteochondroma

Which statement describes osteosarcoma?

Very malignant and metastasizes early

What is an appropriate nursing intervention for a patient with Becker muscular dystrophy who is hospitalized with heart failure?

Reposition frequently to avoid skin and respiratory complications.

What does radicular pain that radiates down the buttock and below the knee, along the distribution of the sciatic nerve, generally indicate?

Herniated intervertebral disc

What should the nurse teach a patient recovering from an episode of acute low back pain?

Perform daily exercise as a lifelong routine.

During the postoperative period, which finding is of most concern to the nurse on a patient after a laminectomy and spinal fusion for a herniated lumbar intervertebral disc?

Urinary incontinence

Before repositioning the patient on the side after a lumbar laminectomy, what should be the nurse’s first action?

Place a pillow between the patient’s legs.

What should the nurse know about a patient diagnosed with a plantar wart?

Papilloma growth on the sole of the foot

What will the nurse know that the treatment will include for the patient that has lateral angulation of the large toe toward the second toe?

Surgery to remove the bursal sac and bony enlargement

In promoting healthy feet, what factor should the nurse recognize is associated with most foot problems?

Improperly fitting shoes

What are characteristics of Paget’s disease?

Abnormal remodeling and resorption of bone and Replacement of normal marrow with vascular connective tissue

Which female patients are at risk for developing osteoporosis?

55-year-old Asian American cigarette smoker, 68-year-old white who is underweight and inactive, and 58-year-old Native American who started menopause prematurely

Identify methods to specifically prevent osteoporosis in postmenopausal women.

Eating 8 ounces of yogurt daily, Performing weight-bearing exercise, Spending 15 minutes in the sun each day, and Taking postmenopausal estrogen replacement

What statement shows that further instruction is needed for a patient started on alendronate (Fosamax) once weekly for the treatment of osteoporosis?

I should take the drug with a meal to prevent stomach irritation.

What information should the nurse include in the best response to a 60-year-old woman who has pain on motion in her fingers and asks the nurse whether this is just a result of aging?

Changes in the cartilage and bones of joints may cause symptoms of pain and loss of function in some people as they age.

What is most likely to cause the pain experienced in the later stages of OA?

Bone surfaces rubbing together

To preserve function and the ability to perform activities of daily living (ADLs), what should the nurse teach the patient with OA?

Plan and organize task performance to be less stressful to joints.

What information should the nurse provide to a patient with OA that asks the nurse whether he could try glucosamine and chondroitin for control of his symptoms?

Some patients find these supplements helpful for relieving arthritis pain and improving mobility.

A patient taking ibuprofen (Motrin) for treatment of OA has good pain relief but is experiencing increased dyspepsia and nausea with the drug’s use. What should the nurse consult the patient’s primary care provider about doing?

Adding misoprostol (Cytotec) to the patient’s drug regimen

Which descriptions are most characteristic of osteoarthritis (OA) when compared to rheumatoid arthritis (RA)?

Not systemic or symmetric

What best describes the manifestations of OA?

Pain and immobility may be aggravated by falling barometric pressure.

During the physical assessment of the patient with early to moderate RA, what should the nurse expect to find?

Spindle-shaped fingers

What laboratory findings would the nurse expect to be present in the patient with RA?

Increased immunoglobulin G (IgG) and anti-citrullinated protein antibody (ACPA)

Which other extraarticular manifestation of RA is most likely to be seen in the patient with rheumatoid nodules?

Felty syndrome

Which drug that prevents binding of the tumor necrosis factor and inhibits the inflammatory response is used in the management of RA?

Entanercept (Enbrel)

What monoclonal antibody is used with methotrexate to best treat RA symptoms?

Certolizumab (Cimzia)

What is the major problem in the management of RA in the older adult?

Drug interactions and toxicity are more likely to occur with multidrug therapy.

What statement given by the patient shows that further instruction is needed from the therapeutic regimen for RA?

I should perform most of my daily chores in the morning when my energy level is highest.

What should the nurse do for a patient recovering from an acute exacerbation of RA if they are too tired to bathe?

Allow the patient a rest period before showering with the nurse’s help.

What statement said by the patient shows that teaching has been effective in using heat and cold therapy to relieve symptoms?

When my joints are painful, I can use a bag of frozen corn for 10 to 15 minutes to relieve the pain.

The nurse teaches the patient with RA that which exercise is one of the most effective methods of aerobic exercise?

Aquatic exercises