Musculoskeletal

Question 1

What are the clinical manifestations of fractures?

Answer 1

pain
crepitus
deformity
edema
ecchymosis
warmth/redness
decreased use of affected limb

Question 2

What assessments should be performed for fractures?

Answer 2

neurovascular checks: sensation, skin temp, skin color, cap refill, pulses, movement of the limb
monitor VS & pain

Question 3

What are the priority nursing interventions for fractures?

Answer 3

ABCs
position supine for injuries distal to the arm, pelvis, and lower extremities
position in a sitting position for injuries to the shoulder or upper arm
stabilize injured area
if pelvic fracture: assess for blood in the urine
elevate the affected limb & apply ice
admin analgesics
promote ROM of fingers, toes, & unaffected extremities

Question 4

What are the therapeutic procedures for fractures?

Answer 4

Casting & traction

Question 5

What are the nursing actions for casts?

Answer 5

assess perfusion & elevate above <3 for 1st 24-48 hrs
apply ice in the 1st 24hrs
assess skin & warmth
monitor for drainage
look for muffin top w/ a short arm cast

Question 6

What should you educate your patient on with a cast?

Answer 6

when the cast is applied it will be warm but not burn you
how to properly use crutches
do not place foreign objects in the cast (use a hairdryer for itching)
skincare
how to do neurovascular checks

Question 7

What should you report with casts?

Answer 7

pain that doesn’t go away 1 hour after pain meds
loss of neurovascular status

Question 8

What is skin traction?

Answer 8

pulling force is applied by weights
using tape and straps applied to the skin along w/ boots or cuffs, weights are attached by rope to the extremity

Question 9

What is skeletal traction?

Answer 9

Continuous pulling force that is applied directly to the skeletal structure/ specific bone
used when more force is needed
pin or rod is inserted through or into the bone
force is applied through the use of weights attached by a rope
weights are NEVER to be removed by the nurse
90/90 skeletal traction: leg is at 90 degrees

Question 10

What are the nursing actions for traction?

Answer 10

maintain body alignment
manage pain & pin sites for infection
assess for changes in elimination
monitor skin integrity & temp
maintain weights so they hand freely & the knots do not touch the pulley
provide ROM

Question 11

What should you educate your patient on regarding traction?

Answer 11

how to provide pin site care
s/sx of infection

Question 12

What findings should be reported for traction?

Answer 12

s/sx of compartment syndrome
pain not relieved by pain meds

Question 13

What are the complications of fractures?

Answer 13

Osteomyelitis & compartment syndrome

Question 14

What are the nursing interventions for osteomyelitis?

Answer 14

skin, blood, & bone cultures
joint & bone biopsy
admin IV/oral antibiotics
monitor hepatic, hematologic & renal function
Immobilize & elevate extremity
WCS: amputation

Question 15

What are the nursing interventions for compartment syndrome?

Answer 15

assess q hour for 24 hrs
space between skin & cast should be 1 finger
place extremity at heart level
loosen dressing or open cast
prepare for fasciotomy

Question 16

What findings should be reported for compartment syndrome?

Answer 16

pain nor relieved by analgesics
pain that continues to increase
numbness or tingling
change of color in the extremity

Question 17

What are the manifestations of scoliosis?

Answer 17

asymmetry in the scapula, ribs, flanks, shoulders, & hips
improperly fitting clothing (one leg shorter than the other)

Question 18

What assessments are used to diagnose scoliosis?

Answer 18

screen during adolescence
the child bends over at the waist w/ arms hanging down & observe for asymmetry of ribs & flank

Question 19

What is the plan of care for scoliosis treatment?

Answer 19

-bracing to slow the progression of the curve (assess skin)
-surgical intervention: spinal fusion w/ rod placement, used for curvatures >45 degrees
–preop: autologous blood donation
–postop: neuro checks, log roll, keep skin clean & dry, monitor drain sites for infection, monitor for dec H&H, watch for bleeding, encourage mobility ASAP

Question 20

What is the patient teaching for scoliosis?

Answer 20

emphasize the importance of PT & proper positioning of spine
how to apply the brace
self-image issues

Question 21

What are the types of Developmental Dysplasia of the hip (DDH)?

Answer 21

Acetabular dysplasia
Subluxation
Dislocation

Question 22

What is acetabular dysplasia?

Answer 22

delay in the acetabular development
-the acetabular roof is shallow & oblique

Question 23

What is a subluxation?

Answer 23

incomplete dislocation of the hip

Question 24

What is a dislocation?

Answer 24

femoral head does not have contact w/ the acetabulum

Question 25

What are the manifestations of DDH in infants?

Answer 25

asymmetry of gluteal & thigh folds
limited hip abduction
shortening of the femur
widened perineum
positive Ortolani test (hip is reduced by abduction)
positive Barlow test (hip is dislocated by adduction)

Question 26

What are the manifestations of DDH in children?

Answer 26

one leg shorter than the other
positive Trendelenburg sign
walking on toes on one foot (shorter one)
walking w/ a limp

Question 27

What is the plan of care for DDH?

Answer 27

Treatment starts as soon as dx
newborn to 6 months: Pavlik Harness
-wear for 12 weeks, check straps q 1-2 weeks for adjustment, neurovascular & skin checks
When adduction contracture is present: use Bryant Traction

Question 28

What should you teach the parent about Pavlik Harness for DDH?

Answer 28

don’t adjust straps
teach how to place the harness
skincare (wear an undershirt, wear knee socks, massage under straps, avoid lotions & powders, diaper goes under the straps)

Question 29

What is bryant traction?

Answer 29

skin traction
hips flexed at a 90 degree angle w/ the butt raised off of the bed

Question 30

What should the nurse do for a pt in bryant traction?

Answer 30

neuro checks
maintain traction & alignment
skincare

Question 31

What is a hip spica cast and what are the nursing actions?

Answer 31

needs to be changed to accommodate growth
neuro checks
ROM
assess skin in the diaper area
manage pain
hydration

Question 32

What should the nurse teach the parent about hip spica cast?

Answer 32

position cast on pillows
keep cast elevated until dry
handle cast w/ palm of hand until dry
note the color & temp on the toes
sponge baths
waterproof barrier around the genital opening

Question 33

What should you educate your patient about prednisone?

Answer 33

causes adrenal gland suppression (alt day dosing schedule & taper dose)
causes bone loss (weight-bearing activities, Ca & vit D, use a low dose)
Causes hyperglycemia & glycosuria (increase insulin)
causes myopathy (decrease dose)
causes peptic ulcer diseases (avoid NSAIDs, report s/sx of bleeding, admin w/ food)
causes infection (avoid large crowds & sick people)
causes disturbances in fluid & electrolyte balances