BN Ch.77 Musculoskeletal Disorders

Question 1

__________ of the spine is known as Pott disease.

Answer 1

Tuberculosis

Question 2

The process of loosening of fragments of dead bone is called ___________.

Answer 2

sequestration

Question 3

Repair or replacement of a joint is called ___________.

Answer 3

arthroplasty

Question 4

The halo device is a form of __________ fixation device.

Answer 4

external

Question 5

The procedure of covering the rough edges of a cast with tape is called __________.

Answer 5

petaling

Question 6

X-Ray study of a joint after injection of a contrast medium or air

Answer 6

Arthrogram

Question 7

X-Ray examination of spinal cord after injection of contrast medium or air

Answer 7

Myelogram

Question 8

Aspiration of synovial fluid, blood, or pus from a joint cavity

Answer 8

Arthrocentesis

Question 9

An invasive procedure using a special endoscope to view joints

Answer 9

Arthroscopy

Question 10

Write the correct sequence that occurs during open reduction and internal fixation.

1. Reduction of the fracture ends.
2. Insertion of a pin, wire, or screw into the bone.
3. Debridement of the dead and damaged tissue.
4. Splinting of the fractured area.

Answer 10

3. Debridement of the dead and damaged tissue.
4. Reduction of the fracture ends.
5. Insertion of a pin, wire, or screw into the bone.
6. Splinting of the fractured area.

Question 11

What are hip fractures, and what are their common complications in older adults?

Answer 11

• Hip fractures include fractures of the head and neck of the femur or of the trochanter.
• These fractures often heal poorly because the healing process in such large bones disrupts nutrition to the bone matrix.
• Hip fractures are more common in older adults, in whom the bones heal slowly and who are more likely to develop osteoporosis (particularly older women).
• An elderly client undergoing treatment after a hip fracture is likely to develop complications due to immobility and irritation and breakdown of the skin.

Question 12

What are the advantages of a synthetic cast?

Answer 12

• Synthetic casts are light in weight and more convenient to use than plaster casts.
• Synthetic casts are more durable and take less time to dry.
• These casts are stronger than plaster casts and can also be exposed to water without damaging or disturbing the integrity of the cast.
• Radiographic studies can be made through synthetic casts without disturbing the image.

Question 13

What are strains and how are they treated?

Answer 13

• A strain is a less severe injury than a sprain.
• It generally involves damage to the muscle and sometimes to the attached tendon.
• The various signs and symptoms of strain include pain, swelling, ecchymosis, loss of function, and muscle spasm.
• Treatment includes application of ice packs for 24 to 48 hours, elevation of the affected part, and rest.
• Surgical repair may be needed

Question 14

What is the difference between rickets and osteomalacia?

Answer 14

• Rickets is a disease that results from a deficiency of vitamin D during childhood;
• Osteomalacia is the adult form of vitamin D deficiency that results in softening of the bones.
  
  • In children with rickets, the bones remain soft and become distorted as the child grows, resulting in severely bowed legs.

Question 15

What are the signs and symptoms of gout?

Answer 15

• Clients with gout experience swelling, redness, and severe pain in the joints.
• Unbearable pain is felt with the slightest touch or weight on the joint.
• The client may also experience fever, tachycardia (rapid heartbeat), and anorexia.
• An attack of gout lasts for 3 to 14 days, after which it suddenly disappears.
• Repeated attacks on the joint may permanently damage the joint and limit its movement.
• Clients can eventually develop renal and vascular damage (especially arteriosclerosis)

Question 16

A 56-year-old client is diagnosed with arthritis. The client and family are apprehensive about the condition and want to know how they can
assist in reducing the pain. They would also like to know how to exercise with arthritis.

a. What are the clinical features of arthritis?

Answer 16

The clinical features of arthritis include the following:

• Persistent pain and stiffness on arising for 6 weeks or longer;
• Stiffness aggravated by damp weather or strenuous activity
• Pain or tenderness in the joints, often symmetrical
• Swelling in the joints
• Recurrence of symptoms, particularly if more than one joint is involved
• Obvious redness and warmth in a joint
• Unexplained weight loss, fever, or weakness combined with joint pain
• Bouchard nodes or Heberden nodes with degenerative joint disease

Question 17

Which explanation would the nurse provide regarding management of pain in a client with arthritis?

Answer 17

The nurse should access pain on a scale of 1 to 10 and assist in managing pain through the following methods:

• Splinting, casting, night splinting, or traction
• Proper positioning of the client
• Application of heat (paraffin baths, diathermy) and cold (ice packs)
• Physical therapy
• Massaging over the joint (if the joint is not acutely inflamed)
• Administration of medications (most commonly salicylates and nonsteroidal antiinflammatory drugs)
• Performing low-impact exercises and isometric exercises (which improve muscle strength without overexerting joints)
• Taking adequate rest (physical and emotional)
• Avoiding fatigue and overexertion (10 or more hours of rest daily)
• Sleeping on a firm bed
• Positioning of the bed and chair at the same level, to facilitate transfer; a chair that helps the client to stand may be necessary
• Positioning of the chair 3 to 4 in higher than a regular chair to avoid bending too much at hips (avoid having a pillow in the chair, because it promotes slouching, which is tiring)
• Providing emotional support
• Application of adaptive devices to make activities of daily living easier to perform

Question 18

Which information would the nurse provide this client with regard to exercising?

Answer 18

The nurse can employ the following steps to help an arthritic client to exercise:

• Instruct the client to keep the body in the best possible physical condition by controlling weight, rest, and exercise.
• Instruct the client to perform regular, specific exercises every day, even if pain persists.
• Advise application of heat before exercise to reduce the pain.
• Instruct the client to begin exercise with gentle stretching.
• Encourage the client to perform active exercise as much as possible.
• If active exercise is not possible, perform isometrics exercises or take the assistance of another person for passive exercise.
• Encourage the client to engage in low-impact exercises, such as swimming, slow walking, or bicycling.
• Instruct the client to stop exercising if pain becomes too severe.
• Assist the client in using an adaptive brace or corrective corset or brace as needed.
• Educate the client about preventing contractures by turning door knobs to the radial (thumb) side whenever possible.
• Ask the client to flatten the hand as much as possible.

Question 19

A 25-year-old client involved in an accident is diagnosed with a simple fracture in the tibia of the left leg. A plaster cast is applied to
the client’s left leg. The client is apprehensive about the cast being applied and complains of discomfort.

Which information would the nurse provide regarding the advantages of applying a cast to a fractured limb?

Answer 19

• The nurse should reassure the client and explain the need for applying a cast and the procedure to be followed.
• The nurse should explain that the advantages of cast application for a fractured limb are that it immobilizes the fracture area, relieves pain through rest, and assists in stabilizing the fracture segments until they are joined.

Question 20

Which instructions would the nurse provide to the client about care of the cast?

Answer 20

The nurse should provide the following information regarding the care of the cast:

• Follow the healthcare provider’s instructions regarding physical activity and limitations.
• Exercise the muscles of the affected limb by moving the fingers and toes frequently to reduce swelling, prevent joint stiffness, and maintain muscle strength.
• Perform muscle-setting exercises by contracting and relaxing without movement inside the cast to maintain muscle mass, tone, and strength.
• Wear a cast walking shoe at all times, except when sleeping or showering.
• Elevate the casted extremity to prevent swelling.
• Avoid bumping the cast.
• Never stick anything inside the cast, because this can result in itching, infection, or decreased circulation.
• Never trim or cut back the cast.
• Keep the plaster cast dry.
• When resting the cast on furniture, protect the furniture with a pad.
• Contact the healthcare provider if any of the following problems develop:
  
  • Unrelenting itching;
  • Foul odor from cast;
  • Drainage present through or around cast;
  • Pain unrelieved by medication;
  • Cast that feels very tight or too loose;
  • Cast that breaks, cracks, or becomes dented
  • Painful rubbing or pressure inside the cast, especially in one particular place
  • Limb that constantly feels cold
  • Fingers or toes that are numb or tingling
  • Fingers or toes that are white, or blue, or in which the color does not return when pressed.

Question 21

Which instructions would the nurse provide to the client before removal of the cast?

Answer 21

The following information must be provided to the client before removal of the cast:

• Explain the procedure and show the client the cast saw before removal of the cast, because the procedure can be frightening for the client.
• Educate the client about the implications and procedure for cast removal
• Apply protective eyewear and a mask to avoid irritation and inhalation of small dust particles.
• Explain to the client that the skin under the cast may be covered with scales or crusts of dead skin.
• Inform the client that the muscles may appear atrophied and that the limb may be weak or stiff.
• After cast removal, teach the client therapeutic exercises for the affected body part.