Musculoskeletal

Question 1

compound fracture

Answer 1

Compound fracture (open fracture) is a fracture with bone fragments protruding through the skin. Because there’s an open wound or skin breach near the fracture site, bacteria from the contaminants can enter the wound and lead to infection. It is essential to treat the open fracture early to prevent infection. The infection can progress to osteomyelitis ( bone infection) if not addressed. The following are the steps in addressing an open fracture:-

Assess: As always, the priority nursing action is to assess the injury. While assessing the injury, the nurse should also assess for any neurovascular compromise.
Protect: The nurse should cover the open wound with a clean dressing to prevent infection. Apply pressure over the surrounding wound, not over the protruding bone.
Apply an ice pack to the site above and around the fracture. Avoid applying ice directly to the skin because it may cause skin damage. Also, care should be taken not to contaminate the open wound.
Elevate: Elevate the arm to reduce the swelling; however, this may have to be done carefully in an open fracture setting without greatly mobilizing fracture fragments.
These nonpharmacological interventions will reduce swelling and pain while waiting for help. The child will need to go to the hospital for possible surgery and casting of the extremity.

Question 2

complications of fractures

Answer 2

avascular necrosi
compartment syndrome
fat embolism
infection and osteomyelitis
pulmonary embolism

Question 3

Compartment syndrome

Answer 3

Compartment syndrome occurs when pressure increases within one or more compartments, leading to decreased blood flow, tissue ischemia, and neurovascular damage. The nurse should immediately notify the physician of these findings so that the cast may be loosened or a fasciotomy can be performed.
signs and symptoms include pain, pallor, pulselessness in limb, paresthesia, and pressure.

Question 4

fat embolism syndrome

Answer 4

Fat embolism syndrome (FES) is a serious complication following a fracture that this client is experiencing. Symptoms of FES are similar to a pulmonary embolism; however, a PE does not have the manifestation of petechiae (reddish-purple spots). FES is a serious complication that usually occurs within 48-hours following a fracture.
Risk factors for FES include fractures to long bones or the pelvis. The earliest manifestation of FES is hypoxia which causes an altered mental status. The most effective way to prevent FES is aggressive immobilization of the fractured extremity. Additional treatment options include securing the airway through intubation, intravenous fluids, and potentially corticosteroids.

Question 5

Compartment Syndrome

Answer 5

✓ Signs and symptoms of compartment syndrome include pain unrelieved by an opioid and aggravated by passive exercise.

✓ One of the earliest manifestations of compartment syndrome is paresthesia.

✓ Other manifestations include –

➢ Pallor

➢ Uncontrolled pain in the affected extremity

➢ Pulselessness

➢ Paralysis

✓ Tibial fractures, recent casting, and splinting are significant risk factors for compartment syndrome.

✓ The nurse should immediately loosen any restrictive dressings if compartment syndrome is suspected and keep the extremity at the level of the heart.

✓ Prompt physician notification is essential if this complication is suspected.

Question 6

Early signs of compartment syndrome

Answer 6

painful, tinging sensation below area of compression
cool to touch
weak pulse

Question 7

late signs of compartment syndrome

Answer 7

Later signs of compartment syndrome include paralysis and the absence of pulses in the affected extremity. If not caught and treated early, compartment syndrome can result in permanent muscle and nerve damage.

Question 8

Contracture

Answer 8

The contracture describes tightness/resistance of a muscle or joint due to soft tissue fibrosis and shortening of muscles and ligaments. Contractures commonly occur due to immobility and incorrect positioning of the immobilized extremity. Performing passive range of motion exercises decreases the risk of contractures by allowing the muscles to stretch and retain flexibility.

Question 9

Guillian-Barre Syndrome supplies at bedside

Answer 9

Ascending paralysis is an attribute of Guillain-Barre syndrome; therefore, these patients are at risk for respiratory failure. An intubation tray should be kept near the patient’s bedside.

Question 10

Fall Risk Factors

Answer 10

• History of falls
• Advanced age (>60 years)
• Multiple illnesses
• Generalized weakness or decreased mobility
• Gait and postural instability
• Disorientation or confusion
• Use of drugs that can cause increased confusion, mobility limitations, or orthostatic hypotension
• Urinary incontinence
• Communication impairments
• Major visual impairment or visual impairment without correction
• Alcohol or other substance use
• Location of the client’s room away from the nurses’ station (in the hospital or nursing home)

Question 11

Avulsion Fracture

Answer 11

An avulsion fracture pulls a part of the bone from the tendon or ligament. Fractures are a common occurrence and patients often present to the emergency department for treatment. A nurse should be able to recognize different types of bone fractures and plan for appropriate nursing interventions.

Question 12

Complete Fracture

Answer 12

A fracture with which the whole cross-section of the bone is fractured is referred to as a complete fracture.

Question 13

Pathological Fracture

Answer 13

A fracture that results from an underlying disease or disorder, not physical trauma or stressors, is referred to as a pathological fracture. Such fractures are common with metastatic cancer, multiple myeloma, and osteoporosis.

Question 14

Greenstick Fracture

Answer 14

A fracture that affects only one side of the bone is referred to as a greenstick fracture.

Question 15

Which equipment should be kept at the bedside for a paitent who has just undergone lumbar fusion surgery>

Answer 15

Log rolling after a lumbar spinal fusion is likely ordered to protect the client from injury. Log rolling aims to keep the spinal column in straight alignment to prevent further injury. A minimum of three individuals is necessary to perform log rolling safely. A transfer sheet or board assists with the client being rolled as one unit.

Question 16

Correct ambulation with cane

Answer 16

When a client ambulates with a cane, the nurse should ensure that a gait belt is applied before getting out of bed. The nurse is positioned on the client’s affected (weaker) side, slightly behind the client.
Measure the height of the cane from the wrist crease or greater trochanter
The cane should be held on the unaffected (stronger) side.
The elbow should be flexed 15-30 degrees.
The cane should be advanced (6-10 inches) along with the affected (weaker) leg. Remember the mnemonic: COAL- Cane Opposite Affected Leg.
Then, the unaffected (stronger) leg should be advanced just past the cane.
A rubber tip should always be applied to a cane to ensure appropriate traction with the ground.

Question 17

the appropriate anatomical landmark for giving an IM in the vastus lateralis

Answer 17

To locate the vastus lateralis, palpate to find greater trochanter and knee joints; divide vertical distance between these two landmarks into thirds; inject into the middle third.
A key advantage of using the vastus lateralis is that an intramuscular (IM) injection may be given if the client is supine, side-lying, or sitting. Aspiration for routine injections into deltoid or vastus lateralis is not indicated because there are no large blood vessels in these locations.

Question 18

The nurse is caring for a client on bed rest for a week following a right hip fracture. Which of the following findings, if noted in the client, would indicate signs of complications due to immobility?

Answer 18

A patient on prolonged bedrest will experience complications such as decubitus ulcers (bedsores), atelectasis, and deep vein thrombosis unless preventive measures are deployed. The nurse should be aware of the signs suggestive of these complications.
A localized area of redness (usually over a bony prominence) that does not blanch (does not turn white when pressed with a finger) and with intact skin suggests a Stage I decubitus ulcer/ pressure sore. Sacral decubitus or a pressure ulcer is a common complication with immobility.
Crackles in an immobilized patient suggest atelectasis. The presence of crackles in bilateral lung bases indicates bibasilar atelectasis. Atelectasis refers to the collapse of the lung’s alveoli (tiny air sacs). In a patient confined to prolonged bed rest, the mucus pools in the lower portions of the airway. Additionally, the diameter of bronchioles decreases in the supine position. These two factors, pooled mucus, and reduced airway size, make it difficult to clear the secretions. The supine position also places weight over the ribcage and makes the breathing labored. Therefore, the patient takes fewer breaths and is not deep enough. All these factors result in a collapse of the small airways and alveoli, leading to atelectasis.
Swelling and tenderness in the calf suggest deep vein thrombosis (DVT). In an immobilized patient, venous stasis occurs, predisposing to venous thrombosis. DVT and pulmonary embolism are some of the severe complications of immobility.

Question 19

Nursing Interventions for prevention of contractures

Answer 19

Nursing Interventions to Prevention Joint Contracture

Recognize those who are at risk. These would be individuals recovering from a burn, stroke, or any neurological impairment inhibiting range of motion.
Collaborate with other disciplines such as physical and occupational therapy.
Apply splints to the hands and feet.
Reposition the client frequently
Avoid positioning the client that has extremities in extreme flexion.
Perform range of motion exercises of all extremities