Nursing Care of Acute Musculoskeletal Disorders

Question 1

Prevention of musculoskeletal disorders include

Answer 1

public education (helmets, seat belts, DUIs) and healthy bones, joints, muscles, diet and exercise

Question 2

What laboratory tests would you assess for a pt with musculoskeletal disorder?

Answer 2

Serum ca, PO4 (phosphate), alk phos and CBC

Question 3

What diagnostic tests would you assess for a pt with musculoskeletal disorder?

Answer 3

X-ray, CT, MRI, arthroscopy and bone scans

Question 4

What other general assessment would you perform?

Answer 4

Inspection, palpation, gait analysis, use of assistive devices (canes, walkers, splints) and ROM

Question 5

What general s/sx would you see?

Answer 5

Pain, deformity (abnormal angles), swelling, loss of motor function and change in sensory fxn

Question 6

Bruise without skin break is known as

Answer 6

Contusion

Question 7

What is a strain?

Answer 7

Excessive stretching of a muscle or tendon when it is weak or unstable

Question 8

How would you manage a strain?

Answer 8

Cold and heat applications, exercise and activity limitations, anti-inflammatory drugs, muscle relaxants and possible surgery

Question 9

What is a sprain?

Answer 9

Excessive stretching of a ligament

Question 10

How would you manage a sprain?

Answer 10

1st degree: rest, ice for 24 to 48 hrs, compression bandage and elevation
2nd degree: immobilization, partial weight bearing as tear heals
3rd degree: immobilization for 4 to 6 weeks, possible surgery

Question 11

What is crush syndrome?

Answer 11

Can occur when leg or arm injury includes multiple compartments. It is characterized by acute compartment syndrome, hypovolemia, hyperkalemia, rhabdomyolosis and acute tubular necrosis

Question 12

What is the treatment for crush syndrome?

Answer 12

Adequate intervenous fluids, low dose dopamine, sodium bicarbonate, kayexalate and hemodialysis

Question 13

In an emergent situation, what would you assess for a pt in trauma?

Answer 13

Respiratory distress, bleeding and head injury

Question 14

Discontinuity or a break in the bone is known as

Answer 14

general bone fracture

Question 15

Temporary displacement of two bones and loss of contact between articular cartilage is known as

Answer 15

dislocation

Question 16

What is sublaxation?

Answer 16

Contact between articular surfaces is only partially lost

Question 17

Dislocation and sublaxation are associated with what?

Answer 17

Fractures, muscle imbalance, rheumatoid arthritis, or other forms of joint instability

Question 18

Dislocation is most common in the

Answer 18

shoulder, hip, knee and fingers

Question 19

What sequence of events occur in the healing process?

Answer 19

Hematoma formation (24-28 hrs), consolidation, fibrin mesh (10 days to 3 weeks), granulation/new bone (3-6 weeks), callus formation (3-6 months) and remodeling

Question 20

What are some of the healing variables?

Answer 20

Type and severity of fracture, nutrient supply, amount of gap, degree of immobilization, amount of infection, necrosis, age and concomitant disease

Question 21

What are the surgery options for fractures?

Answer 21

Open reduction w/ internal fixation (ORIF), amputation, application of external devices

Question 22

What are electromechanical treatments for fractures?

Answer 22

Closed reduction, splints, casts, wraps, traction, cold, elevation, ROM, weight bearing

Question 23

What are the two main complications that can occur during musculoskeletal surgery?

Answer 23

Fat embolism and venous thromboembolism

Question 24

This occurs when fat globules are released from the yellow bone marrow into the bloodstream

Answer 24

Fat embolism syndrome (FES)

Question 25

Name other complications of fracture surgeries

Answer 25

Compartment syndrome, shock, thrombophlebitis, DVT, emboli, nerve injury, infections, allergy, fracture blisters, delayed union, nonunion and malunion

Question 26

What is acute compartment syndrome?

Answer 26

It is a serious condition in which increased pressure within one or more compartments causes massive compromise of circulation to the area

Question 27

Within 4 to 6 hrs after the onset of ACS, what can happen in an emergent situation?

Answer 27

Neuromuscular damage becomes irreversible and the limb can become useless within 24 to 48 hours

Question 28

What results can occur in ACS?

Answer 28

Infection, motor weakness, Volkmann’s contractures, myoglobinuric renal failure aka rhabdomyolosis

Question 29

Other complications of fractures include

Answer 29

infection, ischemic necrosis, fracture blisters, delayed union, nonunion and malunion

Question 30

Application of a pulling force to the body to provide reduction, alignment and rest at the site is known as

Answer 30

Traction

Question 31

Traction care includes:

Answer 31

Maintain correct balance between traction pull and countertraction force, care of weights, skin inspection, pin care and assessment of neurovascular status

Question 32

This is a rigid device that immoblizes the affected body part while allowing other body parts to move

Answer 32

Cast

Question 33

What are some cast complications?

Answer 33

Infection, circulation, impairment, peripheral nerve damage and complications of immobility

Question 34

What are some common nursing diagnoses and interventions for casts?

Answer 34

Acute pain, immobility, sensory deficit r/t decreased perfusion, nerve damage, risk of injury, hemorrhage, compartment syndrome, and risk of infection

Question 35

Interventions for acute pain include:

Answer 35

reduction and immobilization of fracture, assessment of pain, drug therapy (opioid and nonopioid), complementary and alternative therapies

Question 36

Interventions for infection include:

Answer 36

Strict aseptic technique for dressing changes and wound irrigations, assess for local inflammation, report purulent drainage immediately to hcp, assess for pneumonia and UTI and administer broad spectrum ATB prophylactically

Question 37

Interventions for physical mobility include:

Answer 37

use of crutches to promote mobility, use of walkers and canes to promote mobility, CPM continuous passive mobilizers, skin care, turn Q2hrs and elevate injured area

Question 38

Interventions for imbalanced nutrition include:

Answer 38

less than body requirements, diet high in protein, calories, calcium, supplemental vitamins B and C, frequent small feedings and supplements of high protein liquids, and intake of foods high in iron

Question 39

ATB, analgesics, splints, drainage and surgery are all treatment options for

Answer 39

Osteomyelitis

Question 40

What are the indications for amputation?

Answer 40

DDD - dead, dangerous and damn nuisance

Question 41

What are some complications of amputation?

Answer 41

Hemorrhage, infection, phantom limb pain, problems associated with immobility, neuroma and flexion contracture

Question 42

This is a frequent complication of amputation

Answer 42

Phantom limb pain

Question 43

What treatment options are there for amputation?

Answer 43

Exercise, ROM to prevent flexion contractures, particularly of the hip and knee, trapeze and overhead frame, firm mattress, prone position every 3 to 4 hours and elevation of lower leg residual limb controversial