Musculoskeletal NGN Flashcards
All the following flashcards are going to be on MSK ngn case study
A patient comes into the clinic talking about how she feels like she has become shorter. A primary health car provider schedules a bone scan for a client with suspected osteoporosis. which nursing action is beneficial for the client?
select all that apply.
(4)
- placing the client in the supine position
- informing a client that a mild sedative may be used
- verifying presence or absence of a shellfish allergy
- instructing the client to push fluids after the test
- ensuring the client does not have metal on their clothing
- instructing the client to empty their bladder before the scan
- informing the client that the post-procedure headache resolves in 2 days
- applying a jelly-like substance to the skin over the site
why do we do a bone scan?
tell me why we selected the ones that we did
tell me why we didn’t select the other options?
- placing the client in the supine position
- informing a client that a mild sedative may be used
- instructing the client to push fluids after the test
- instructing the client to empty their bladder before the scan
a bone scan is done to assess osetomyelitits, osteroporosis, primary and metastatic malignant lesions of bone, and certain fractures.
the client will need to be in a supine position for at least an 1 during the examination - dont over think it, literally you need to lay down for this test
the client is given a mild sedative in order to help relax and cooperate during the test
the medication that we give for contrast is called radionuclide, which will need be to excreted after the test by urine and feces. So its indicted that the patient needs to push/empty the bladder.
the nurse should instruct the client to empty the bladder before scanning because it can disturb results.
the client is going for a bone scan, which a shellfish allergy is not needed to be tested. if it was a CT scan tho, it will be.
there is no need to check for metal since there is no radio waves or magnetic field in a bone scan, however there is in a MRI.
we should inform the client that if a headache occurs and it resolves on its own within 2 days after the procedure it is a concern for a myelogram
there is no need to put a jelly like substance on the skin since this is not a ultrasound
Question 2 on the NGN case study talks about a patient who was scheduled for a right hip replacement surgery. Which nursing intervention would the nurse include in the plan of care for a client after a hip replacement ? Select all that apply.
(4)
- place a pillow between the clients legs
- require the client to sit in an armless chair
- cross the clients legs at the ankles and knees
- require the client to use an elevated toilet seat
- keep the client hip in a neutral, straight position
- position the client in a low chair
- keep the head of the bed at 90 degrees
- use a fracture bedpan for urinary relief
explain why we selected these and why we didn’t select the others
- place a pillow between the clients legs
- require the client to use an elevated toilet seat
- keep the clients hip in a neutral, straight position
- use a fracture bedpan for urinary relief
using a pillow between the legs provide comfort and aids with keeping the joint abducted.
using an elevated toilet seat aids for easier movement and prevents hip dislodgment.
keeping the client hip in a neutral straight position prevents pain and discomfort and hip dislocation.
for urinary relief, a fracture bedpan should be used for post-surgical hip clients.
now the wrongs and why they are wrong
a client that has had a hip replacement needs help with standing, therefore a nurse should not sit the client in a armless chair since they may experience discomfort and difficulty with standing - remember the arms are there to help them stand too.
crossing the legs at the ankles and knees after a surgery can cause pain and promote a DVT to form, so no.
a client leg should not be flexed more than 45-60degrees, therefore no low chair should be sued .
the head of the bed should be at least 45 degrees, no need to sit straight
question 3 on the ngn case study talks about an elderly women who came in for a right hip replacement, however is now coming back to the emergency department complaining about pruluant drainage from the site of incision.
which findings would the nurse associate with chronic osteomyelitis? select all that apply
(3)
- elevated white blood count
- presence of avascular scar tissue
- decreased vitamin d levels
- cold sensation at the infection site
- constant bone pain relieved by rest
- elevated erythrocyte sedimentation rate
- significantly increased temperature
- reduced levels of serum calcium
what is osteomyelitis
tell me why we didn’t select the other ones
tell me why we selected these 3?
- elevated white blood count
- presence of avascular scar tissue
- elevated erythrocyte sedimentation rate
osteomyelitis is a bone infection and presents itself with those 3 characteristics
decreased vitamin d is associated with osteoporosis
chronic osteomyelitis is warm at the infection site, not cold
there is constant bone pain with osteomyelitis, nothing is relieved by rest
a temperature that increases is associated with acute osteomyelitis, not chronic
reduced calcium is a causative factor in those with osteroposis
question 4 on the ngn case study is asking which neuromuscular assessment would the nurse plan to perform immediacy after a client has rotator cuff surgery ? select all that apply ?
(5)
- pulse rate
- skin color
- disproportionate pain
- level of orientation
- presence of edema
- movement of the hand
- sensations in the extremity
- breathing pattern
what is a rotator cuff injury?
why did we select those 5 ?
why did we not select the rest
- skin color
- disproportionate pain
- presence of edema
- movement of the hand
- sensations in the extremity
a rotator cuff injury is usually when a tendon or muscle in the shoulder is damaged or torn.
pale or dusky skin tone may indicate impaired circulation, so we must assess the skin color
pain that is disproportionate to the injury, especially with extension may be the first sign of compartment syndrome
edema may result from impaired circulation and may cause further impariment of circulation
the ability to move the area distal to surgery is indicative of adequate blood flow and integrity of nerves
paresthesia may indicate lack of vascular or nerve integrity so its important that we assess their perception of sensations
we would want to know the quality of the pulse, not the rate because if its weak or thready it may indicate impaired circulation
the level of orientation demonstrates nueorlocial function and we are doing a assessment neurovascular
post-surgical assessment would be the respiratory system but again we are doing neurovascular assessment
question 5 on the NGN case study talks about a patient who is now post op after a surgery on there right humerus.
The nurse plans to help the client get out of bed for the first time. which assessment would the nurse make before having the client sit on the side of the bed? select all the apply (4)
- presence of safe footwear
- ability to turn side to side
- status of comfort and pain
- depth of respirations
- appearance of wound and skin
- presence of tubes or lines
- intake or output amounts
- observation of walking gait
why did we choose those 4
why did we not choose the rest
- presence of safe footwear
- status of comfort and pain
- appearance of wound and skin
- presence of tubes or lines
assessment of safe footwear before beginning mobilization will help prevent the need for leaving the client to find footwear - but also help have a stronger stance to the ground
pain and comfort should always be asked before wanting to move since if youre in pain, it will be worse
the nurse should look at the appearance of the wound before moving in case of furthering damage
assessment of lines and tubes is important to sure no local injury or dislodgment of equipment can occur with moving
now the wrongs and why’s
the client should already be turning Side to side, along with coughing and deep breathing hourly, there is no need to do that before getting up, its something they should already be doing on there own
intake and output dont matter when it comes to getting up
the client gait can not be assessed until there up from the bed
question 6 on the NGN case study talks about a patient who is experiencing a fat embolism syndrome.
actions to take
- adminiter supplment oxygen
- bed rest
- fluid restriction
- request an order for aspirin
- place suction and tracheostomy kit at bedside
parameters to monitor
- mental status
- oxygen levels
- potassium level
- bowel activity
- blood glucose
which 2 for each category ^ and why ?
what is a fat embolism syndrome?
what are common symptoms of fat embolism?
How do we diagnosis FES?
what do we do to treat FES?
why did we not pick atlectasis?
why did we not pick rnhabdomylosis ?
why did we not pick hypoveolmic shock ?
actions to take
- adminiter supplment oxygen
- bed rest
parameters to monitor
- mental status
- oxygen levels
fat embolism syndrome is a serious complication that can occur after a bone fracture ; it occurs when fat globules enter the circulatory system following a fracture
symptoms of FES include chest pain, tachypnea, cyanosis, dyspnea, apphrension, tachycardia, and hypoxemia
we diagnosis FES by doing a chest x-ray which would reveal pulmonary infliatreats
administer oxygen to treat hypoxemia, bed rest and iv fluids
the reason why the nurse should monitor the clients mental status and oxygen level is due to the hypoxemia that patients can get ; the lower the oxygen in your body, the drowsier and irrigated you become
now the no’s and why
atelectasis is a respiratory complication with decreased breath sounds, not crackles
rhabdomylosis is a renal complication due to large amount of muscle breakdown with increased levels of creatinine kinase and urine myoglobin
hypovolemic shock is a complication found in clients after a bone injury, not hypervolmeia
- we would encourage to drink more fluids, not restrict them
- client may be given steroid therapy, but not aspirin
- intubation equipment should be placed at bedside, not suction or trashy equipment
- monitor for potassium is not needed
- the client does not have complications with elevated glucose or bowel activity
question 7 on the NGN case study talks about a elderly man who was cleaning out the gutters in his house. He fell off the ladder and landed on his right leg. Select the 3 findings that would require immediate follow-up?
- denies hitting his head or losing consciousness
- reports numbness and tingling in the right toes
- takes an over the counter allergy medication daily
- reports pain 9/10 in the right leg
- right leg externally rotated
- capillary refill <3 seconds in right toes
- respiratory rate: 22 breaths/min
tell me why for these 3
tell me why not for the rest
- reports numbness and tingling in the right toes
- reports pain 9/10 in the right leg
- right leg externally rotated
numbness and tingling would indicate nerve injury
pain being 9/10 is severe and needs to be addressed
right leg that externally rotates indicate the leg is fractured
now the no’s and why’s
- If they deny hitting there head, no need to do more
- allergy mediation daily does not affect the Current injury
- capillary refill <3 second is normal
- 22 breaths is expected for an older man in pain
question 8 on the NGN follows the same patient who fell off his ladder and rotated his right leg.
drag from word choices to complete the sentence
the client is most likely at risk for developing the acute complications of (3)?
- acute compartment syndrome
- fat embolism syndrome
- venous thromboembolism
- avarscaular necrosis
- complex regional pain syndrome
why those 3
why not the other 2
- acute compartment syndrome
- fat embolism syndrome
- venous thromboembolism
acute compartment syndrome causes increased pressure within one or more compartments in the legs and may be called the ischemia-edema cycle
fat embolism occurs when fat globules are released from the bone marrow into the blood stream causing an embolism
DVT can happen with a blood clot that is formed - prob from the intense fall and lack of movement after tha will occur from rest
now the no’s and why
avascular necrosis occurs when blood supply to the bone is interrupted causing decreased perfusion - this is chronic cause it causes necrosis!
complex regional pain is a persistent pain that comes even after the fracture is healed, another chronic complication nothin acute
question 9 follows the same patient with the ladder fall
choose the most likely option for the information missing from the statement by selecting from the list of options provided
the nurse first priority would be to address the clients
- pain
- consent
- heart rate
- total protein
followed by the clients
- pain
- consent
- heart rate
- total protein
why those 2 and not the rest?
- consent
- pain
before anything we wanted to do consent forms, saying you consent to help us administer pain medication
- or If surgery is needed
even though heart rate is elevated, its to be expected because they are in pain, when no more in pain, heart rate should be decreased
total protein is low, Its not the first thing we check or try to fix
question 10 is the same patient as before, however this time they want us to say which is which
osteomyelitis
wound infection
hemorrhagic shock
- erythema and heat around the affected area
- decreased blood pressure
- increased pulse
4.chills
5.bone pain
- increased temperature
- osteomyelitis & wound infection
- hemorrhagic shock
- all 3
- osteomyelitis and wound infection
- osteomyletisi
- osteomyelitis and wound infection
question 11 is the same patient as before
what interventions would you expect now? (3)
- adminiter anticoaulatns
- obtain blood for a transfusion
- initiate myocardial infarction protocol
- apply oxygen
- prepare for a fasciotomy
- place on bedrest
- start iv fluids
- assist to place on mechanical vent
- prepare for vena cava umbreaal
- obtain wound culture
- apply oxygen
- place on bed rest
- start iv fluids
you would give oxygen because his oxygen stat is low
when having FES you need bed rest
hydration is needed when having FES
now the no’s and why’s
- no need to administer anticougulans, cause thats when you have a DVT
the client is not expreicning shock or any form of blood loss so need to do a blood transfusions
the patient is having chest pain but not form a heart attack
fasciotomy is to treat acute compartment syndrome not a fat embolus
no need to do a vent or vena cava procedure cause there is no DVT
treamprure will increase from the fat emoublus, so no need to do a wound culture
question 12
was it effective or ineffective
- aching pain of 2/10 in right leg
- wiggles toes freely
- wheezing bilaterally upon lung auscultation
- oxygen saturation 94%
- absence of dyspnea
- orientated to place, person, time
- slight bluish color in toes
effective
effective
ineffective
effective
effective
effective
ineffective
