Brunner's Ch 40: Musculoskeletal Care Modalities Flashcards
A nurse is caring for a patient who has had a plaster arm cast applied. Immediately postapplication, the nurse should provide what teaching to the patient?
A) The cast will feel cool to touch for the first 30 minutes.
B) The cast should be wrapped snuggly with a towel until the patient gets home.
C) The cast should be supported on a board while drying.
D) The cast will only have full strength when dry.
D) The cast will only have full strength when dry.
A cast requires approximately 24 to 72 hours to dry, and until dry, it does not have full strength. While drying, the cast should not be placed on a hard surface. The cast will exude heat while it dries and should not be wrapped.
A patient broke his arm in a sports accident and required the application of a cast. Shortly following application, the patient complained of an inability to straighten his fingers and was subsequently diagnosed with Volkmann contracture. What pathophysiologic process caused this complication?
A) Obstructed arterial blood flow to the forearm and hand
B) Simultaneous pressure on the ulnar and radial nerves
C) Irritation of Merkel cells in the patients skin surfaces
D) Uncontrolled muscle spasms in the patients forearm
A) Obstructed arterial blood flow to the forearm and hand
Volkmann contracture occurs when arterial blood flow is restricted to the forearm and hand and results in contractures of the fingers and wrist. It does not result from nerve pressure, skin irritation, or spasms.
A patient is admitted to the unit in traction for a fractured proximal femur and requires traction prior to surgery. What is the most appropriate type of traction to apply to a fractured proximal femur? A) Russells traction B) Dunlops traction C) Bucks extension traction D) Cervical head halter
C) Bucks extension traction
Bucks extension is used for fractures of the proximal femur. Russells traction is used for lower leg fractures. Dunlops traction is applied to the upper extremity for supracondylar fractures of the elbow and humerus. Cervical head halters are used to stabilize the neck
A nurse is caring for a patient who is in skeletal traction. To prevent the complication of skin breakdown in a patient with skeletal traction, what action should be included in the plan of care?
A) Apply occlusive dressings to the pin sites.
B) Encourage the patient to push up with the elbows when repositioning.
C) Encourage the patient to perform isometric exercises once a shift.
D) Assess the pin insertion site every 8 hours.
D) Assess the pin insertion site every 8 hours.
The pin insertion site should be assessed every 8 hours for inflammation and infection. Loose cover dressings should be applied to pin sites. The patient should be encouraged to use the overhead trapeze to shift weight for repositioning. Isometric exercises should be done 10 times an hour while awake.
A nurse is caring for a patient who is postoperative day 1 right hip replacement. How should the nurse position the patient?
A) Keep the patients hips in abduction at all times.
B) Keep hips flexed at no less than 90 degrees.
C) Elevate the head of the bed to high Fowlers.
D) Seat the patient in a low chair as soon as possible.
A) Keep the patients hips in abduction at all times.
The hips should be kept in abduction by an abductor pillow. Hips should not be flexed more than 90 degrees, and the head of bed should not be elevated more than 60 degrees. The patients hips should be higher than the knees; as such, high seat chairs should be used.
While assessing a patient who has had knee replacement surgery, the nurse notes that the patient has developed a hematoma at the surgical site. The affected leg has a decreased pedal pulse. What would be the priority nursing diagnosis for this patient?
A) Risk for Infection
B) Risk for Peripheral Neurovascular Dysfunction
C) Unilateral Neglect
D) Disturbed Kinesthetic Sensory Perception
B) Risk for Peripheral Neurovascular Dysfunction
The hematoma may cause an interruption of tissue perfusion, so the most appropriate nursing diagnosis is Risk of Peripheral Neurovascular Dysfunction. There is also an associated risk for infection because of the hematoma, but impaired neurovascular function is a more acute threat. Unilateral neglect and impaired sensation are lower priorities than neurovascular status.
A patient was brought to the emergency department after a fall. The patient is taken to the operating room to receive a right hip prosthesis. In the immediate postoperative period, what health education should the nurse emphasize?
A) Make sure you dont bring your knees close together.
B) Try to lie as still as possible for the first few days.
C) Try to avoid bending your knees until next week.
D) Keep your legs higher than your chest whenever you can.
A) Make sure you dont bring your knees close together.
After receiving a hip prosthesis, the affected leg should be kept abducted. Mobility should be encouraged within safe limits. There is no need to avoid knee flexion and the patients legs do not need to be higher than the level of the chest.
A patient with a fractured femur is in balanced suspension traction. The patient needs to be repositioned toward the head of the bed. During repositioning, what should the nurse do?
A) Place slight additional tension on the traction cords.
B) Release the weights and replace them immediately after positioning.
C) Reposition the bed instead of repositioning the patient.
D) Maintain consistent traction tension while repositioning.
D) Maintain consistent traction tension while repositioning.
Traction is used to reduce the fracture and must be maintained at all times, including during repositioning. It would be inappropriate to add tension or release the weights. Moving the bed instead of the patient is not feasible.
A patient with a total hip replacement is progressing well and expects to be discharged tomorrow. On returning to bed after ambulating, he complains of a new onset of pain at the surgical site. What is the nurses best action?
A) Administer pain medication as ordered.
B) Assess the surgical site and the affected extremity.
C) Reassure the patient that pain is a direct result of increased activity.
D) Assess the patient for signs and symptoms of systemic infection.
B) Assess the surgical site and the affected extremity.
Worsening pain after a total hip replacement may indicate dislocation of the prosthesis. Assessment of pain should include evaluation of the wound and the affected extremity. Assuming hes anxious about discharge and administering pain medication do not address the cause of the pain. Sudden severe pain is not considered normal after hip replacement. Sudden pain is rarely indicative of a systemic infection.
A nurse is caring for a patient who has a leg cast. The nurse observes that the patient uses a pencil to scratch the skin under the edge of the cast. How should the nurse respond to this observation?
A) Allow the patient to continue to scratch inside the cast with a pencil but encourage him to be cautious.
B) Give the patient a sterile tongue depressor to use for scratching instead of the pencil.
C) Encourage the patient to avoid scratching, and obtain an order for an antihistamine if severe itching persists.
D) Obtain an order for a sedative, such as lorazepam (Ativan), to prevent the patient from scratching.
C) Encourage the patient to avoid scratching, and obtain an order for an antihistamine if severe itching persists.
Scratching should be discouraged because of the risk for skin breakdown or damage to the cast. Most patients can be discouraged from scratching if given a mild antihistamine, such as diphenhydramine, to relieve itching. Benzodiazepines would not be given for this purpose.
The nurse is caring for a patient who underwent a total hip replacement yesterday. What should the nurse do to prevent dislocation of the new prosthesis?
A) Keep the affected leg in a position of adduction.
B) Have the patient reposition himself independently.
C) Protect the affected leg from internal rotation.
D) Keep the hip flexed by placing pillows under the patients knee.
C) Protect the affected leg from internal rotation.
Abduction of the hip helps to prevent dislocation of a new hip joint. Rotation and adduction should be avoided. While the hip may be flexed slightly, it shouldnt exceed 90 degrees and maintenance of flexion isnt necessary. The patient may not be capable of safe independent repositioning at this early stage of recovery.
A patient is complaining of pain in her casted leg. The nurse has administered analgesics and elevated the limb. Thirty minutes after administering the analgesics, the patient states the pain is unrelieved. The nurse should identify the warning signs of what complication? A) Subcutaneous emphysema B) Skin breakdown C) Compartment syndrome D) Disuse syndrome
C) Compartment syndrome
Compartment syndrome may manifest as unrelenting, uncontrollable pain. This presentation of pain is not suggestive of disuse syndrome or skin breakdown. Subcutaneous emphysema is not a complication of casting.
The nurse educator on an orthopedic trauma unit is reviewing the safe and effective use of traction with some recent nursing graduates. What principle should the educator promote?
A) Knots in the rope should not be resting against pulleys.
B) Weights should rest against the bed rails.
C) The end of the limb in traction should be braced by the footboard of the bed.
D) Skeletal traction may be removed for brief periods to facilitate the patients independence.
A) Knots in the rope should not be resting against pulleys.
Knots in the rope should not rest against pulleys, because this interferes with traction. Weights are used to apply the vector of force necessary to achieve effective traction and should hang freely at all times. To avoid interrupting traction, the limb in traction should not rest against anything. Skeletal traction is never interrupted.
The orthopedic surgeon has prescribed balanced skeletal traction for a patient. What advantage is conferred by balanced traction?
A) Balanced traction can be applied at night and removed during the day.
B) Balanced traction allows for greater patient movement and independence than other forms of traction.
C) Balanced traction is portable and may accompany the patients movements.
D) Balanced traction facilitates bone remodeling in as little as 4 days.
B) Balanced traction allows for greater patient movement and independence than other forms of traction.
Often, skeletal traction is balanced traction, which supports the affected extremity, allows for some patient movement, and facilitates patient independence and nursing care while maintaining effective traction. It is not portable, however, and it cannot be removed. Bone remodeling takes longer than 4 days.
The nursing care plan for a patient in traction specifies regular assessments for venous thromboembolism (VTE). When assessing a patients lower limbs, what sign or symptom is suggestive of deep vein thrombosis (DVT)? A) Increased warmth of the calf B) Decreased circumference of the calf C) Loss of sensation to the calf D) Pale-appearing calf
A) Increased warmth of the calf
Signs of DVT include increased warmth, redness, swelling, and calf tenderness. These findings are promptly reported to the physician for definitive evaluation and therapy. Signs and symptoms of a DVT do not include a decreased circumference of the calf, a loss of sensation in the calf, or a pale-appearing calf.
A nurse is providing discharge education to a patient who is going home with a cast on his leg. What teaching point should the nurse emphasize in the teaching session?
A) Using crutches efficiently
B) Exercising joints above and below the cast, as ordered
C) Removing the cast correctly at the end of the treatment period
D) Reporting signs of impaired circulation
D) Reporting signs of impaired circulation
Reporting signs of impaired circulation is critical; signs of impaired circulation must be reported to the physician immediately to prevent permanent damage. For this reason, this education is a priority over exercise and crutch use. The patient does not independently remove the cast.