Musculoskeletal Dysfunction

Question 1

Arthrodesis

Answer 1

Fusion of joints

Question 2

MUSCULAR DYSTROPHIES

Answer 2

Description - inherited degenerative diseases that affect the cells of specific muscle groups resulting in muscle atrophy and weakness.
Most common type, Duchenne muscular dystrophy, inherited as a sex-linked disorder; affects only males.

Clinical manifestations: delayed walking; wide-based waddling gait; lordosis; weak, hypertrophied leg muscles; the use of Gower’s maneuver to stand erect. Children with Duchenne muscular dystrophy lose the ability to walk by 9–12 years of age.
With Gower’s maneuver, the child places his hands on his knees and moves his hands up his legs until he’s standing erect.

The goal of treatment is aimed at maintaining mobility independence for as long as possible.

a. Nursing interventions include dietary teaching to prevent obesity and complications associated with limited mobility, coordinating healthcare services provided by physical therapy, providing emotional support to the child and family.

Question 3

Difference between strain and sprain

Answer 3

A sprain is an injury to tendinoligamentous structures surrounding a joint, usually caused by wrenching or twisting motion.

A strain is an excessive stretching of a muscle and its fascial sheath. It often involves the tendon.

Question 4

Compartment syndrome

Answer 4

Tough fascia surrounds muscle groups, forming compartments from which arteries, veins, and nerves enter and exit opposite ends.
occurs when pressure increases within one or more compartments, leading to decreased blood flow, tissue ischemia, and neurovascular impairment.
Within 4 to 6 hours after the onset of compartment syndrome, neurovascular damage is irreversible if not treated.

Assessment

a. Unrelieved or increased pain in the limb
b. Tissue that is distal to the involved area becomes pale, dusky, or edematous.
c. Pain with passive movement and joint dysfunction
d. Pulselessness, loss of sensation (paresthesia)

Interventions

a. Notify the physician immediately, prepare to assist physician.
b. If severe, assist the physician with fasciotomy to relieve pressure and restore tissue perfusion.
c. Loosen tight dressings or bivalve restrictive cast as prescribed.

Question 5

Crutch walking

Answer 5

Incorrect measurement could damage the brachial plexus.
The distance between the axillas and arm pieces on the crutches should be two to three finger widths in axilla space.
The elbows should be slightly flexed, 20 to 30 degrees, when walking.

When ambulating with the client, stand on the affected side.

Instruct the client never to rest the axilla on the axillary bars.Instruct the client to look up and outward when ambulating and place the crutches 6 to 10 inches diagonally in front of the foot. stop ambulation if numbness or tingling in hands or arms occurs.

Sitting and standing: Place unaffected leg against the front of the chair. Move the crutches to the affected side, grasp the arm of the chair with the hand on the unaffected side. Flex the knee of the unaffected leg to lower self into the chair while placing the affected leg straight out in front. Reverse the steps to move from a sitting to standing position.

Going up & down stairs
Up the stairs: move unaffected leg up first. Then move affected leg and crutches up.
Down the stairs: move crutches and affected leg down. Then move unaffected leg down.

Question 6

Canes and walkers

Answer 6

Nurse stand at affected side when ambulating.
Handle should be at the level of greater trochanter.
Elbow should be flexed at a 15- to 30-degree angle.
Instruct client to hold cane 4 to 6 inches to the side of the foot.Instruct the client to hold cane in hand on the unaffected side so that cane and weaker leg can work together with each step.
Instruct the client to move the cane at the same time as the affected leg.
Instruct the client to inspect the rubber tips regularly for worn places.

Walker
Stand adjacent to the client on the affected side.
Instruct the client to put all four points of the walker flat on the floor before putting weight on the hand pieces.
Instruct the client to move the walker forward & walk into it.

Question 7

comminuted fracture
Impacted fracture
Green stick fracture

Answer 7

comminuted fracture means that there are pieces, fragments, or splinters of bone in the area where the bone was broken.

impacted fracture is one in which the bone ends are driven together. A simple or closed fracture is one in which there is no break in the skin.

greenstick fracture involves a longitudinal split that extends partially through one side of the bone.

Question 8

Symptoms of fat embolism

Answer 8

During the first 72 hours after a traumatic injury, especially to long bones, the nurse should suspect fat embolism syndrome if the client manifests the following cluster of signs and symptoms: chest pain, dyspnea, tachycardia, tachypnea, fever, disorientation, restlessness, and petechiae over the chest, axillary folds, conjunctiva, buccal membrane, and hard palate.

Question 9

How to stop bleeding with compound fracture

Answer 9

The best method to control bleeding in the case of a compound fracture is to compress the major artery above the injury site. Direct pressure on the wound may cause additional injuries to the soft tissue surrounding the fracture. A tourniquet is only used if all other efforts to control bleeding are unsuccessful. When used, a tourniquet is periodically released to allow oxygenated blood to the distal tissue. Elevating the extremity is helpful after applying pressure on the artery, but should be done with caution to prevent further damage to the bone and soft tissue.

Question 10

Postoperative nursing care for hip replacement

Answer 10

Until healing occurs, the client’s legs must be spread outward (abducted) from the body.
Adduction of the hip or flexion greater than 90 degrees may dislocate the prosthesis from the joint. also requires using a foam wedge splint between the legs while the client is in bed, using a raised toilet seat for elimination, keeping the knees lower than the hips when sitting, and reminding the client to avoid bending forward when dressing.
Raising the head of the bed 90 degrees creates excessive hip flexion and can dislocate the hip.

Question 11

Symptoms of compartment syndrome

Answer 11

Compartment syndrome occurs when the muscle swells but the muscle tissue, blood vessels, and nerves are constricted by surrounding nonexpansive fascia or a rigid cast.
Unrelenting sharp pain that is not relieved using standard measures is the first symptom of compartment syndrome. Ischemia, the impairment of arterial blood flow that is caused by swelling of the surrounding muscle within the inelastic fascia, causes pain. Paralysis and sensory loss follow as nerves become damaged by compression and lack of blood supply.
Muscle spasms do not typically occur. The hand may appear pale or white, not reddened, and may feel cold because of inadequate arterial blood.
If the radial artery is assessed, the nurse typically finds that the pulse is weak or absent.

Question 12

What is one complication of icp?

Answer 12

Brain herniation
Increased intracranial pressure is caused by an increase in the contents of the skull either from an increase in blood volume, brain tissue, or cerebrospinal fluid. This increasing content of the skull causes an increased pressure which forces brain herniation through the foramen magnum, ultimate death if the pressure is not relieved.

Question 13

Complications of hib

Answer 13

H. influenza is a frequent cause of bacterial meningitis & pneumonia. It does not cause rheumatic fever or shingles.

Question 14

Difference between evisceration and dehiscence

Answer 14

evisceration: bowel through incision
dehiscence: separation of incision

Question 15

Rheumatoid arthritis statistics/ risk factors

Answer 15

RA affects women three times more often than men, between the ages of 20 -55 years.
Research has determined that RA occurs in clients who have had infectious disease, such as the Epstein-Barr virus. The genetic link, specifically HLA-DR4, has been found in 65% of clients with RA. People with osteoarthritis are not necessarily at risk for developing rheumatoid arthritis.

Question 16

Preop plan for hip replacement

Answer 16

Most important: Administration of antibiotics as prescribed will aid in the acquisition of therapeutic blood levels during and immediately after surgery to prevent osteomyelitis.

nurse can request that a trapeze be added to the bed.
nurse should demonstrate and have the client practice isometric exercises quadriceps and gluteal muscles.
The client will not use crutches after surgery; a physical therapy assistant will initially assist the client with walking by using a walker.
The client will not use Buck’s traction.
The client will require anti-embolism stockings and use of a leg compression device. the leg compression device is applied during surgery and maintained per physician order.

Question 17

Patient teaching about lovenox

Answer 17

advise client to report unusual bleeding or bruising, dizziness, itching, rash, fever, swelling, or difficulty breathing to healthcare provider immediately.
Instruct not to take aspirin or nonsteroidal anti-inflammatory drugs without consulting health care provider while on therapy.
A low-molecular weight heparin is considered to be a high-risk medication and should wear or carry medical identification.

The air bubble should not be expelled from the syringe because the bubble insures the client receives the full dose of the medication.

should allow 5 seconds to pass before withdrawing the needle to prevent seepage of the medication out of the site.

Question 18

Teaching after a lumbar laminectomy

Answer 18

Should avoid sitting whenever possible.
Should sit only in chairs that allow the knees to be higher than the hips and support arms to maintain correct body alignment Maintaining good body postures is most important after a lumbar laminectomy L4–5.
By 6 weeks after the surgery, the client should have regained stamina.
To maintain correct body posture, the client should also place one foot on a stepstool during prolonged standing.
Sleeping on the back with a support under the knees is effective in maintaining correct body posture.
Maintain healthy weight

Question 19

teaching plan for a scheduled for a spinal fusion

Answer 19

Typically, the donor site causes more pain than the fused site does because inflammation, swelling, and venous oozing around the nerve endings in the donor site, where the subcutaneous tissue was especially removed, occur during the first 24 to 48 hours postoperatively.
After surgery, surgeon applies a pressure dressing to the donor site to compress the veins that were transected for the removal of subcutaneous tissue but that did not stop oozing blood after surgical cauterization during the surgical procedure. Pressure on a transected vein, which is low pressure, stops the oozing and loss of blood from the venous site. When the donor site is the fibula, neurovascular checks must be performed every hour to ensure adequate neurologic function of and circulation to the area.

The surgeon, not the degree or amount of pain, specifies activity restrictions.

Question 20

Post op lumbar laminectomy

Answer 20

should not sit for prolonged periods in a chair because of the increased pressure against the nerve root and incision site. There is no limitation on the client’s participation in daily hygiene activities except for her individual response of pain, nausea, vomiting, or weakness.
Lying flat in bed is appropriate because it does not cause stress on the spinal column where the laminectomy was performed and the disc tissue was removed. Positions that should be avoided are those that would cause twisting and flexion of the spine.
Walking in the hall is an acceptable activity.
Sit-ups are not recommended for the client who has had a lumbar laminectomy because these exercises place too great a stress on the back. Knee-to-chest lifts, hip tilts, pelvic tilt exercises are recommended to strengthen back and abdominal muscles.

Question 21

What part of the arm is most of the weight supported?

Answer 21

When using crutches, the client is taught to support her weight primarily on the hands.
Supporting body weight on the axillae, elbows, or upper arms must be avoided to prevent nerve damage from excessive pressure.

Question 22

Describe each:
two-point gait with crutches 
four-point gait
 “swing to” gait
“swing through” gait.

Answer 22

Two point gait: involves partial weight bearing on each foot, with each crutch advancing simultaneously with the opposing leg.

four-point gait: Advancing a crutch on one side and then advancing the opposite foot, and repeating on the opposite side.

“swing to” gait: When the client advances both crutches together and follows by lifting both lower extremities to the same level as the crutches.

“swing through” gait: the client advances both crutches together and follows by lifting both lower extremities past the level of the crutches. Often used by paraplegic clients because it allows them to place weight on their legs while the crutches are moved one stride ahead.

Question 23

The client with a spinal cord transection above T5 is at risk for:

Answer 23

constipation due to atonia would be possible.

risk for development of a paralytic ileus because the sympathetic nerve innervation to the vagus nerve, which dominates all the vessels and organs below T5 (e.g., the intestinal tract), has been disrupted and therefore so has movement or peristalsis.

at risk for development of stress ulcers because the sympathetic nerve innervation to the stomach has been disrupted, which results in an excessive release of hydrochloric acid in the stomach, allowing contact of hydrochloric acid with the stomach mucosa. does not feel subjective signs of stress ulcers (e.g., pain, guarding, tenderness) and therefore is at increased risk for bleeding because complications of an ulcer can develop before early diagnosis.
The client with a spinal cord transection above T5 is least likely to develop diarrhea.

Question 24

Which heals faster: bone, ligament or tendon?

Answer 24

Bone is dynamic tissue that is continually growing.

Nasal fracture, sprains, and ligament tears injure cartilage, tendons, and ligaments, which are slower to heal.

Question 25

What is a bursa?

Answer 25

Bursae are fluid-filled sacs that cushion joints and bony prominences.
Fibrocartilage is a solid tissue that cushions some joints.
Bursae are a specific type of connective tissue.
The synovial membrane lines many joints but is not a bursa.

Question 26

Post op shoulder repair.

Answer 26

Physical therapy after a rotator cuff repair begins on the first postoperative day to prevent “frozen shoulder.”
A shoulder immobilizer is used immediately after the surgery, but leaving the arm immobilized for several days would lead to loss of ROM.
The drop-arm test is used to test for rotator cuff injury, but not after surgery. The Pt may be able to return to pitching after rehabilitation.

Question 27

Symptoms related to fat embolism: chest pain, tachypnea, tachycardia, and what other distinguishing sign?

Answer 27

The presence of petechiae helps distinguish fat embolism from other problems.
The other symptoms might occur with fat embolism but could also occur with other postoperative complications such as bleeding, myocardial infarction, venous thrombosis, or hypoxemia.

Question 28

Big warning post hip surgery

Answer 28

Leaning over would flex the hip at greater than 90 degrees and predispose to hip dislocation.

Question 29

Common cause of septic arthritis in young adults

Answer 29

Neisseria gonorrhoeae is the most common cause for septic arthritis in sexually active young adults.

Question 30

Live virus vaccines, such as rubella, are contraindicated for patient taking what kind of meds?

Answer 30

immunosuppressive drugs