Families exam 4 - musculoskeletal

Question 1

What are manifestations of a fracture?

Answer 1

• pain
• crepitus
• deformity
• edema
• ecchymosis
• warmth
• redness
• not using the affected area

Question 2

What does a neurovascular assessment include?

Answer 2

• sensation
• skin temp
• skin color
• cap refill
• pulses
• movement

Question 3

What type of fractures needs a supine position?

Answer 3

• distal arm
• pelvis
• lower extremities

Question 4

What type of fractures needs a sitting position?

Answer 4

• shoulder
• upper arm

Question 5

What should be assessed when a pelvic fracture is present?

Answer 5

blood in the urine

Question 6

What should be done to relieve pain with a fracture?

Answer 6

• elevate
• apply ice packs (no > 30 mins)
• analgesics

Question 7

How long should an extremity be elevated with a cast?

Answer 7

for the first 24-48 hours

Question 8

How long should ice be used with a cast?

Answer 8

for the first 24 hours

Question 9

What should you watch for with a cast?

Answer 9

• increased warmth
• hot spots on the cast
• drainage
• skin breakdown

Question 10

How can itching be relieved with a cast?

Answer 10

hair dryer

Question 11

How is force applied with skin traction?

Answer 11

• weights are attached by a rope to the extremity
• tape and straps are applied to the skin along with boots/cuffs

Question 12

How is force applied with skeletal traction?

Answer 12

• directly to the skeletal structure and/or specific bone
• insertion of pin/rod
• use of weights attached by a rope

Question 13

Can nurses remove weights for traction?

Answer 13

NO

Question 14

What should pin sites be assessed for?

Answer 14

• pain
• redness
• swelling
• drainage
• odor

Question 15

What type of fracture most commonly causes osteomyelitis?

Answer 15

open fracture

Question 16

What does osteomyelitis look like?

Answer 16

• swollen
• red
• constant pain that increases with movement
• tender
• warm
• tachycardia

Question 17

What type of cultures should be done for osteomyelitis?

Answer 17

• skin
• blood
• bone

Question 18

What type of biopsy should be done for osteomyelitis?

Answer 18

• joint
• bone

Question 19

What medications are given for osteomyelitis?

Answer 19

antibiotics (IV or oral)

Question 20

Should you elevate the extremity with osteomyelitis?

Answer 20

YES

Question 21

Should you elevate the extremity with compartment syndrome?

Answer 21

NO, keep at heart level

Question 22

Do pain meds help with compartment syndrome?

Answer 22

NO

Question 23

What are the 5 P’s for compartment syndrome?

Answer 23

• pain
• paresthesias
• pallor
• paralysis
• pulselessness

Question 24

What are characteristics of the skin with compartment syndrome?

Answer 24

• pale
• cold
• cyanotic nail beds

Question 25

How much space should there be between skin and cast?

Answer 25

1 finger

Question 26

What can the nurse do for compartment syndrome?

Answer 26

- loosen dressing - open cast

Question 27

What procedure can be done for compartment syndrome?

Answer 27

fasciotomy

Question 28

Where does asymmetry occur with scoliosis?

Answer 28

- scapula - ribs - flanks - shoulders - hips - legs (one is shorter than the other)

Question 29

When should a scoliosis screening be done?

Answer 29

adolescence

Question 30

What slows the progression of scoliosis?

Answer 30

bracing

Question 31

When is a spinal fusion with rod placement done with scoliosis?

Answer 31

for curvatures > 45 degrees

Question 32

What should be monitored after spinal fusion surgery?

Answer 32

- neurovascular status - skin - drain sites for infection - decreased H&H - bleeding

Question 33

What is subluxation?

Answer 33

incomplete dislocation of the hip

Question 34

What is dislocation?

Answer 34

when the femoral head does not have contact with the acetabulum

Question 35

Is DDH painful at birth?

Answer 35

no

Question 36

What is a positive trendelenburg sign, and when does it occur?

Answer 36

- when the pelvis tilts down while bearing weight on the affected side - child DDH

Question 37

What is a positive ortolan test, and when does it occur?

Answer 37

- the hip is reduced by abduction - infant DDH

Question 38

What is a positive barlow test, and when does it occur?

Answer 38

- the hip is dislocated by adduction - infant DDH

Question 39

What are characteristics of walking in a child with DDH?

Answer 39

- walking on toes on the shorter leg - walking with a limp

Question 40

What bone is shortened in an infant with DDH?

Answer 40

femur

Question 41

What happens to gluteal and thigh folds in an infant with DDH?

Answer 41

they are asymmetric

Question 42

How long is the pavlik harness worn?

Answer 42

12 weeks

Question 43

How often are the straps on the pavlik harness checked/adjusted?

Answer 43

q 1-2 weeks

Question 44

What should be worn with the pavlik harness?

Answer 44

an undershirt and knee socks

Question 45

Can lotions/powders be used with the pavlik harness?

Answer 45

NO

Question 46

How should a diaper be worn with the pavlik harness?

Answer 46

under the straps

Question 47

What type of traction should be used when adduction contracture is present?

Answer 47

bryant traction

Question 48

What is bryant traction?

Answer 48

skin traction where the hips are flexed at a 90 degree angle with the butt raised off the bed

Question 49

How should a hip spica cast be handled until it dries?

Answer 49

- elevated - with palm of hand

Question 50

Can you get a hip spica cast get wet?

Answer 50

NO

Question 51

What should be assessed with a hip spica cast?

Answer 51

- neurovascular status - skin in the diaper area - pain - hydration status - color and temp of toes

Question 52

What can prednisone cause?

Answer 52

- adrenal suppression - bone loss - hyperglycemia, glycosuria - myopathy - PUD - infection - F&E imbalances

Question 53

What should be done for adrenal suppression caused by prednisone?

Answer 53

- altered day dosing schedule - taper dose

Question 54

What should be done for bone loss caused by prednisone?

Answer 54

- weight-bearing activities - calcium and vitamin D - low dose

Question 55

What should be done for hyperglycemia and glycosuria caused by prednisone?

Answer 55

increase insulin dose

Question 56

What should be done for myopathy caused by prednisone?

Answer 56

decrease the dose

Question 57

What should be done for PUD caused by prednisone?

Answer 57

- avoid NSAIDS - report s/sx of bleeding - admin with food

Question 58

What should be done for infection caused by prednisone?

Answer 58

avoid large crowds and sick people