17.) Musculoskeletal Flashcards
What term is used to describe an abnormally increased convex angulation in the curvature of the thoracic spine?
a. ) Scoliosis
b. ) Lordosis
c. ) Kyphosis
d. ) Ankylosis
c.) Kyphosis
Kyphosis is an abnormally increased convex angulation in the curvature of the thoracic spine.
Scoliosis is a complex spinal deformity usually involving lateral curvature, spinal rotation causing rib asymmetry, and thoracic hypokyphosis.
Lordosis is an accentuation of the cervical or lumbar curvature beyond physiologic limits.
Ankylosis is the immobility of a joint.
A 17-year-old patient is returning to the surgical unit after Luque instrumentation for scoliosis repair. In addition to the usual postoperative care, what additional intervention will be needed?
a. ) Position changes are made by log rolling.
b. ) Assistance is needed to use the bathroom.
c. ) The head of the bed is elevated to minimize spinal headache.
d. ) Passive range of motion is instituted to prevent neurologic injury.
a.) Position changes are made by log rolling.
After scoliosis repair using a Luque procedure, the adolescent is turned by log rolling to prevent damage to the fusion and instrumentation. The patient is kept flat in bed for the first 12 hours and is not ambulatory until the second or third postoperative day. A urinary catheter is placed. The head of the bed is not elevated until the second postoperative day. Range of motion exercises are begun on the second postoperative day.
The nurse is teaching the girls’ varsity sports teams about the “female athlete triad.” What is essential information to include?
a. ) They should take low to moderate calcium to avoid hypercalcemia.
b. ) They have strong bones because of the athletic training.
c. ) Pregnancy can occur in the absence of menstruation.
d. ) A diet high in carbohydrates accommodates increased training.
c.) Pregnancy can occur in the absence of menstruation.
Sexually active teenagers, regardless of menstrual status, need to consider contraceptive precautions. Increased calcium (1500 mg) is recommended for amenorrheic athletes.
The decreased estrogen in girls with the female athlete triad, coupled with potentially inadequate diet, leads to osteoporosis.
Diets high in protein and calories are necessary to avoid potentially long-term consequences of intensive, prolonged exercise programs in pubertal girls.
A child with a hip spica cast is being prepared for discharge. Recognizing that caring for a child at home is complex, the nurse should include what instructions for the parents’ discharge teaching?
a. ) Turn every 8 hours.
b. ) Specially designed car restraints are necessary.
c. ) Diapers should be avoided to reduce soiling of the cast.
d. ) Use an abduction bar between the legs to aid in turning.
b.) Specially designed car restraints are necessary.
Standard seat belts and car seats may not be readily adapted for use by children in some casts. Specially designed car seats and restraints meet safety requirements.
The child must have position changes much more frequently than every 8 hours.
During feeding and play activities, the child should be moved for both physiologic and psychosocial benefit. Diapers and other strategies are necessary to maintain cleanliness.
The abduction bar is never used as an aid for turning. Putting pressure on the bar may damage the integrity of the cast.
The nurse is teaching the parents of a 1-month-old infant with developmental dysplasia of the hip about preventing skin breakdown under the Pavlik harness. What statement by the parent would indicate a correct understanding of the teaching?
a. ) “I should gently massage the skin under the straps once a day to stimulate circulation.”
b. ) “I will apply a lotion for sensitive skin under the straps after my baby has been given a bath to prevent skin irritation.”
c. ) “I should remove the harness several times a day to prevent contractures.”
d. ) “I will place the diaper over the harness, preferably using a superabsorbent disposable diaper that is relatively thin.”
a.) “I should gently massage the skin under the straps once a day to stimulate circulation.”
To prevent skin breakdown with an infant who has developmental dysplasia of the hip and is in a Pavlik harness, the parent should gently massage the skin under the straps once a day to stimulate circulation.
The parent should not apply lotions or powder because this could irritate the skin. The parent should not remove the harness, except during a bath, and should place the diaper under the straps.
A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, what should the nurse explain?
a. ) Traction is tried first.
b. ) Surgical intervention is needed.
c. ) Frequent, serial casting is tried first.
d. ) Children outgrow this condition when they learn to walk.
c.) Frequent, serial casting is tried first.
Serial casting is begun shortly after birth, before discharge from the nursery. Successive casts allow for gradual stretching of skin and tight structures on the medial side of the foot. Manipulation and casting of the leg are repeated frequently (every week) to accommodate the rapid growth of early infancy. Serial casting is the preferred treatment. Surgical intervention is done only if serial casting is not successful. Children do not improve without intervention.
What statement is true concerning osteogenesis imperfecta (OI)?
a. ) It is easily treated.
b. ) It is an inherited disorder.
c. ) Braces and exercises are of no therapeutic value.
d. ) Later onset disease usually runs a more difficult course.
b.) It is an inherited disorder.
OI is a heterogeneous, autosomal dominant disorder characterized by fractures and bone deformity.
Treatment is primarily supportive.
Several investigational therapies are being evaluated.
The primary goal of therapy is rehabilitation.
Lightweight braces and splints help support limbs, prevent fractures, and aid in ambulation. The disease is present at birth. Prognosis is affected by the type of OI.
A preadolescent has been diagnosed with scoliosis. The planned therapy is the use of a thoracolumbosacral orthotic. The preadolescent asks how long she will have to wear the brace. What is the appropriate response by the nurse?
a. ) “For as long as you have been told.”
b. ) “Most preadolescents use the brace for 6 months.”
c. ) “Until your vertebral column has reached skeletal maturity.”
d. ) “It will be necessary to wear the brace for the rest of your life.”
c.) “Until your vertebral column has reached skeletal maturity.”
Bracing can halt or slow the progress of most curvatures. They must be used continuously until the child reaches skeletal maturity. Telling the child “for as long as you have been told” does not answer the child’s question and does not promote involvement in care.
Six months is unrealistic because skeletal maturity is not reached until adolescence. When skeletal growth is complete, bracing is no longer effective.
What finding is characteristic of fractures in children?
a. ) Fractures rarely occur at the growth plate site because it absorbs shock well.
b. ) Rapidity of healing is inversely related to the child’s age.
c. ) Pliable bones of growing children are less porous than those of adults.
d. ) The periosteum of a child’s bone is thinner, is weaker, and has less osteogenic potential compared to that of an adult.
b.) Rapidity of healing is inversely related to the child’s age.
Healing is more rapid in children. The younger the child, the more rapid the healing process. Nonunion of bone fragments is uncommon except in severe injuries.
The epiphyseal plate is the weakest point of long bones and a frequent site of injury during trauma.
Children’s bones are more pliable and porous than those of adults. This allows them to bend, buckle, and break. The greater porosity increases the flexibility of the bone and dissipates and absorbs a significant amount of the force on impact. The adult periosteum is thinner, is weaker, and has less osteogenic potential than that of a child.
A 14-year-old is admitted to the emergency department with a fracture of the right humerus epiphyseal plate through the joint surface. What information does the nurse know regarding this type of fracture?
a. ) It will create difficulty because the child is left handed.
b. ) It will heal slowly because this is the weakest part of the bone.
c. ) This type of fracture requires different management to prevent bone growth complications.
d. ) This type of fracture necessitates complete immobilization of the shoulder for 4 to 6 weeks.
c.) This type of fracture requires different management to prevent bone growth complications.
This type of fracture can cause problems with growth in the affected limb. Early and complete assessment is essential to prevent angular deformities and longitudinal growth problems. The difficulty for the child does not depend on the location at the epiphyseal plate. Any fracture of the dominant arm presents obstacles for the individual.
Healing is usually rapid in the epiphyseal plate area. Complete immobilization is not necessary. Often these injuries are surgically repaired with open reduction and internal fixation.
When does idiopathic scoliosis become most noticeable?
a. ) In the newborn period
b. ) When the child starts to walk
c. ) During the preadolescent growth spurt
d. ) During adolescence
c.) During the preadolescent growth spurt
Idiopathic scoliosis is most noticeable during the preadolescent growth spurt. It is seldom apparent before age 10 years.
