Introductory Medical-Surgical Nursing Chapter 62
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Questions and Answers

What is a common assessment finding in cases of dislocation?

  • Increased pain upon movement only
  • Abnormal joint movement
  • Popping sound during injury (correct)
  • Severe muscle swelling

    • Which management technique should be applied during the first 24 to 48 hours after a strain or sprain?

  • Active range of motion exercises
  • Immediate heat application
  • Intermittent application of cold packs (correct)
  • Immediate surgical intervention

    • Which symptom is NOT typically associated with compartment syndrome?

  • Severe pain that increases with muscle stretching
  • Numbness
  • Loss of active movement in the arm (correct)
  • Tingling or burning sensation in the skin

    • Which diagnostic method is NOT typically used for assessing strains and sprains?

    <p>MRI</p> Signup and view all the answers

    What does the acronym 'RICE' stand for in the context of managing strains and sprains?

    <p>Rest, Ice, Compress, Elevate</p> Signup and view all the answers

    What is a primary management strategy for treating dislocations or subluxations?

    <p>Manipulation and immobilization of the joint</p> Signup and view all the answers

    Which condition is characterized as a claw-like deformity?

    <p>Volkmann’s contracture</p> Signup and view all the answers

    What is the primary risk associated with dislocation that involves increased pressure in a compartment?

    <p>Compartment syndrome</p> Signup and view all the answers

    Which of the following is NOT a typical assessment finding in tendonitis?

    <p>Sensation gain</p> Signup and view all the answers

    What is a common cause of carpal tunnel syndrome?

    <p>Repetitive motion</p> Signup and view all the answers

    Which sign is associated with carpal tunnel syndrome diagnosis?

    <p>Tinel’s sign</p> Signup and view all the answers

    What is a key nursing management strategy for tendinitis?

    <p>Medication information about NSAIDs</p> Signup and view all the answers

    Which is NOT a recommended management approach for tendonitis?

    <p>Surgical intervention as the first option</p> Signup and view all the answers

    What symptom is indicated by both Tinel’s sign and Phalen’s sign?

    <p>Numbness in the wrist</p> Signup and view all the answers

    Which of the following is a non-surgical management option for tendonitis?

    <p>Physical therapy</p> Signup and view all the answers

    What is a common assessment finding in a rotator cuff tear?

    <p>Limited mobility of the shoulder</p> Signup and view all the answers

    What is the primary surgical method used for repairing a rotator cuff?

    <p>Arthroscopic tendon repair</p> Signup and view all the answers

    Which of the following is a symptom of a ruptured Achilles tendon?

    <p>Inability to plantar flex the foot</p> Signup and view all the answers

    What is a common non-surgical management strategy for a meniscal injury?

    <p>RICE protocol</p> Signup and view all the answers

    What form of diagnostic imaging can be used to assess ligament injuries?

    <p>MRI</p> Signup and view all the answers

    What type of fracture classification is primarily concerned with the type and extent of the injury?

    <p>Type and extent</p> Signup and view all the answers

    What is typically the first step in the healing process right after a bone fracture?

    <p>Formation of a hematoma</p> Signup and view all the answers

    Which procedure involves reattaching a torn tendon with a nearby tendon?

    <p>Tendon transfer</p> Signup and view all the answers

    Which of the following is a common assessment finding in fractures?

    <p>Deformity and crepitus</p> Signup and view all the answers

    What is a key component of nursing management following ligaments or meniscal injuries?

    <p>Teaching the RICE method</p> Signup and view all the answers

    What is the role of osteoblasts in bone healing?

    <p>They secrete the matrix for bone formation.</p> Signup and view all the answers

    What is a potential complication of a fracture that can result in blood clots traveling to the lungs?

    <p>Pulmonary embolism</p> Signup and view all the answers

    How long does it generally take for remodeling of a properly aligned fracture site to complete?

    <p>12 months</p> Signup and view all the answers

    Which type of fracture is characterized by a break in a straight horizontal line?

    <p>Transverse fracture</p> Signup and view all the answers

    What treatment options are included in the medical and surgical management of fractures?

    <p>Traction and casting</p> Signup and view all the answers

    What is a common symptom to monitor for in clients with fat embolism?

    <p>Respiratory distress</p> Signup and view all the answers

    Which assessment finding is NOT typically associated with a fractured femur?

    <p>Ringing in the ears</p> Signup and view all the answers

    Delayed healing of a fracture can lead to which of the following complications?

    <p>Nonunion</p> Signup and view all the answers

    What is a complication associated with hip fractures?

    <p>Pulmonary embolism</p> Signup and view all the answers

    What is a common symptom of a fractured hip?

    <p>Severe pain and external rotation of the leg</p> Signup and view all the answers

    Which surgical management option is indicated for a hip fracture?

    <p>Total hip arthroplasty</p> Signup and view all the answers

    What is a recommended safety measure to prevent falls at home?

    <p>Install handrails in bathtubs and stairs</p> Signup and view all the answers

    Which of the following is NOT a typical assessment finding in a fractured hip?

    <p>Lack of any symptoms</p> Signup and view all the answers

    What is an assessment finding that could indicate a fractured hip?

    <p>External rotation of the leg</p> Signup and view all the answers

    Which of the following scenarios could lead to a fractured hip?

    <p>Falls and trauma</p> Signup and view all the answers

    Which of the following steps can aid in the management of a fractured hip?

    <p>Pain management and ambulation</p> Signup and view all the answers

    What is a key assessment finding associated with dislocations?

    <p>Popping sound</p> Signup and view all the answers

    What is the primary purpose of applying cold packs during the first 24 to 48 hours after an injury?

    <p>To reduce swelling and manage pain</p> Signup and view all the answers

    Which of the following accurately describes a characteristic of a strain?

    <p>Involves damage to the muscle or tendon</p> Signup and view all the answers

    Which of the following injuries can lead to compartment syndrome?

    <p>Any injury that increases pressure in a compartment</p> Signup and view all the answers

    What does the management strategy of immobilization aim to achieve in injuries like strains and sprains?

    <p>To prevent damage from repeated stress</p> Signup and view all the answers

    Which symptom is most closely associated with compartment syndrome?

    <p>Severe pain that increases with muscle stretching</p> Signup and view all the answers

    What is a common assessment finding in tendonitis?

    <p>Inflammation at the joint</p> Signup and view all the answers

    Which management strategy is primarily used to prevent complications after a dislocation?

    <p>Neurovascular checks and monitoring for compartment syndrome</p> Signup and view all the answers

    What is a common cause of epicondylitis, also known as tennis elbow?

    <p>Repetitive stress and motion</p> Signup and view all the answers

    Which option is an appropriate intervention in the management of tendonitis?

    <p>Strengthening exercises after the acute phase</p> Signup and view all the answers

    Which of the following statements about Tinel’s and Phalen’s signs is correct?

    <p>Phalen’s sign helps in diagnosing carpal tunnel syndrome.</p> Signup and view all the answers

    What is the primary nursing management strategy for patients experiencing tendinitis?

    <p>Providing information about medication and ADL responsibilities.</p> Signup and view all the answers

    Which of the following treatments is NOT typically recommended for managing tendonitis?

    <p>Surgical intervention on initial diagnosis.</p> Signup and view all the answers

    In the context of carpal tunnel syndrome, which method is primarily used to confirm the diagnosis?

    <p>Electromyography to assess nerve function.</p> Signup and view all the answers

    Which nursing recommendation is crucial for alleviating pain associated with carpal tunnel syndrome?

    <p>Encouraging patients to shake their hands periodically.</p> Signup and view all the answers

    What characterizes a third-degree strain?

    <p>Severe muscle tear with loss of function and ecchymosis</p> Signup and view all the answers

    What is the primary cause of a sprain?

    <p>Twisting motion or hyperextension of a joint</p> Signup and view all the answers

    What common symptom is associated with a second-degree sprain?

    <p>Partial tearing of the ligament with joint instability</p> Signup and view all the answers

    Which stage characterizes the healing process immediately after a fracture?

    <p>Inflammatory phase</p> Signup and view all the answers

    What is a key characteristic of a first-degree sprain?

    <p>Mild edema and joint pain</p> Signup and view all the answers

    What is a common consequence of a third-degree sprain?

    <p>Complete tearing or rupture of the ligament</p> Signup and view all the answers

    Which of the following types of muscle injury occurs due to overuse or excessive stress?

    <p>Strain</p> Signup and view all the answers

    What type of strain involves significant pain and limited motion without complete loss of function?

    <p>Second-degree strain</p> Signup and view all the answers

    What is a common surgical procedure used for severe rotator cuff injuries?

    <p>Arthroscopic repair</p> Signup and view all the answers

    Which assessment finding is commonly associated with meniscal injuries?

    <p>Instability</p> Signup and view all the answers

    What initial phase of healing occurs immediately after a bone fracture?

    <p>Formation of a hematoma</p> Signup and view all the answers

    Which option is a common non-surgical management strategy for a ruptured Achilles tendon?

    <p>Casting or bracing</p> Signup and view all the answers

    What type of assessment finding is usually experienced during a ruptured Achilles tendon?

    <p>Loud pop</p> Signup and view all the answers

    Which of the following methods is effective for diagnosing ligament injuries?

    <p>MRI</p> Signup and view all the answers

    What is a key objective of nursing management for patients with shoulder injuries?

    <p>Manage pain effectively</p> Signup and view all the answers

    What common symptom indicates a possible meniscal injury?

    <p>Click or popping sound</p> Signup and view all the answers

    Which surgical option is utilized for a severe tear in the rotator cuff?

    <p>Open tendon repair</p> Signup and view all the answers

    In what condition might patients experience difficulty bearing weight due to instability?

    <p>Meniscal injury</p> Signup and view all the answers

    What is the primary goal in the medical and surgical management of fractures?

    <p>Reestablish functional continuity of the bone</p> Signup and view all the answers

    Which complication can arise from a fracture that involves insufficient blood supply?

    <p>Avascular necrosis</p> Signup and view all the answers

    In what timeframe does a callus with bone cells typically form after a fracture?

    <p>6-12 weeks</p> Signup and view all the answers

    What is the surgical procedure called that involves incision of the fascia to relieve pressure from compartment syndrome?

    <p>Fasciotomy</p> Signup and view all the answers

    What is a significant risk associated with pulmonary embolism following fracture surgery?

    <p>Fat globules travel to lungs or brain</p> Signup and view all the answers

    What is the likely outcome if a fractured bone has not been accurately aligned during healing?

    <p>Delayed healing and potential nonunion</p> Signup and view all the answers

    What are the common assessment findings of a fractured femur?

    <p>Swelling and severe pain</p> Signup and view all the answers

    What factors can influence the healing process of a fracture?

    <p>Type of fracture and location</p> Signup and view all the answers

    What are the classic symptoms of compartment syndrome that indicate increased pressure in a limb?

    <p>Classic symptoms include deep aching pain, swelling, numbness, and muscle bulging.</p> Signup and view all the answers

    How does Volkmann's contracture develop following extension injuries?

    <p>It develops due to acute compartment syndrome, leading to ischemia and subsequent muscle and nerve injury.</p> Signup and view all the answers

    What preventative measures can be taken during athletic activities to avoid tendonitis?

    <p>Implementing proper warm-up routines, using appropriate equipment, and avoiding repetitive stress can help prevent tendonitis.</p> Signup and view all the answers

    What is the role of neurovascular checks in the management of dislocation?

    <p>Neurovascular checks assess blood flow and nerve function to prevent complications like compartment syndrome.</p> Signup and view all the answers

    What are the two primary signs used to diagnose carpal tunnel syndrome?

    <p>Tinel's sign and Phalen's sign.</p> Signup and view all the answers

    What type of medication is commonly recommended for managing tendonitis?

    <p>NSAIDs (nonsteroidal anti-inflammatory drugs).</p> Signup and view all the answers

    What is the impact of repeated stress injuries like epicondylitis on joint function?

    <p>Repeated stress injuries can lead to pain, inflammation, and eventual loss of sensation or mobility in the affected joint.</p> Signup and view all the answers

    In the context of nursing management for tendonitis, what is one important comfort measure?

    <p>Rest and elevation of the affected area.</p> Signup and view all the answers

    What is the role of well-planned exercise in medical management for tendon injuries?

    <p>It promotes flexibility and strength, aiding in recovery.</p> Signup and view all the answers

    What might surgical intervention for tendon injuries address?

    <p>Tears and ruptures of the tendon.</p> Signup and view all the answers

    What are the primary assessment findings associated with a strain or sprain?

    <p>Immediate pain, swelling, ecchymoses, and joint instability are primary assessment findings.</p> Signup and view all the answers

    How does a dislocation differ from a subluxation?

    <p>A dislocation is a complete separation of the joint surfaces, while a subluxation is a partial dislocation.</p> Signup and view all the answers

    What immediate treatment methods are recommended for strains and sprains?

    <p>The RICE method, which stands for rest, ice, compression, and elevation, is recommended.</p> Signup and view all the answers

    What possible complications can arise from a dislocation due to increased compartment pressure?

    <p>Compartment syndrome can occur, leading to reduced blood supply to muscles and nerves.</p> Signup and view all the answers

    What nursing management strategies should be employed following a sprain or strain injury?

    <p>Nursing strategies include intermittent cold application, compression bandaging, and neurovascular checks.</p> Signup and view all the answers

    What is the primary difference between a strain and a sprain?

    <p>A strain involves injury to muscles or tendons, while a sprain pertains to injuries of the ligaments surrounding a joint.</p> Signup and view all the answers

    How do the grades of a strain differ in terms of injury severity?

    <p>First degree indicates mild injury, second degree indicates partial tearing, and third degree involves severe tearing with loss of function.</p> Signup and view all the answers

    Identify a common sign associated with a third-degree sprain.

    <p>A third-degree sprain typically presents with joint instability and possibly a complete tear of the ligament.</p> Signup and view all the answers

    Explain the significance of recognizing the stages of bone healing after a fracture.

    <p>Recognizing the stages aids in monitoring recovery and determining appropriate interventions to prevent complications.</p> Signup and view all the answers

    What potential complication can arise from an untreated severe strain?

    <p>An untreated severe strain may lead to significant weakness and loss of function in the affected muscle.</p> Signup and view all the answers

    Describe a common nursing management approach for clients with a sprain.

    <p>Nursing management often includes rest, ice, compression, and elevation, known as the RICE method.</p> Signup and view all the answers

    What characterizes a first-degree muscle strain in assessment findings?

    <p>A first-degree muscle strain is characterized by mild pain, some edema, and muscle spasm with no loss of function.</p> Signup and view all the answers

    What is an avulsion fracture, and how is it related to sprains?

    <p>An avulsion fracture occurs when a ligament tears completely and pulls off a fragment of bone, often seen in severe sprains.</p> Signup and view all the answers

    What are two common assessment findings in a ruptured Achilles tendon?

    <p>A loud pop and inability to plantar flex.</p> Signup and view all the answers

    What non-surgical management techniques are commonly advised for rotator cuff injuries?

    <p>NSAIDs, rest, immobilization, and progressive exercises.</p> Signup and view all the answers

    What is the initial step in the bone healing process after a fracture?

    <p>Blood seeps into the area, forming a hematoma.</p> Signup and view all the answers

    Describe a key difference between arthroscopic tendon repair and open tendon repair.

    <p>Arthroscopic repair uses small incisions, while open repair requires a larger incision.</p> Signup and view all the answers

    What role does physical therapy play in the management of ligament injuries?

    <p>It helps restore function and strength over a period of 3 to 12 months.</p> Signup and view all the answers

    What is an important nursing management strategy for patients after rotator cuff surgery?

    <p>Assessing range of motion (ROM) and managing pain.</p> Signup and view all the answers

    What is the purpose of removing a bone spur during rotator cuff surgery?

    <p>To alleviate pain and improve the range of motion in the shoulder.</p> Signup and view all the answers

    In the context of knee injuries, what does the term 'RICE' stand for?

    <p>Rest, Ice, Compression, Elevation.</p> Signup and view all the answers

    What are the typical surgical options available for managing meniscal injuries?

    <p>Arthroscopy and meniscectomy.</p> Signup and view all the answers

    What assessment finding often accompanies fractures immediately after an injury?

    <p>Muscle spasm and loss of function.</p> Signup and view all the answers

    What are the primary roles of osteoblasts in the bone healing process?

    <p>Osteoblasts form new bone by secreting the matrix for bone formation and play a crucial role in remodeling the fracture site.</p> Signup and view all the answers

    What is the typical timeframe for a callus to form after a fracture?

    <p>A callus with bone cells typically forms in 6 to 12 weeks after a fracture.</p> Signup and view all the answers

    Identify two potential complications that can arise from a fracture.

    <p>Two potential complications are pulmonary embolism and fat embolism.</p> Signup and view all the answers

    How does a fasciotomy relate to compartment syndrome?

    <p>A fasciotomy is a surgical incision of the fascia that is performed to relieve pressure resulting from compartment syndrome.</p> Signup and view all the answers

    What factors can influence the medical and surgical management of fractures?

    <p>Factors include the location and severity of the fracture, as well as the patient's age and overall physical condition.</p> Signup and view all the answers

    What is the main goal of managing fractures effectively?

    <p>The main goal is to reestablish functional continuity of the bone.</p> Signup and view all the answers

    What type of fracture is characterized by an angled break?

    <p>An oblique fracture is characterized by an angled break.</p> Signup and view all the answers

    What are the signs that may indicate the presence of a fat embolism?

    <p>Signs include respiratory distress and cerebral disturbances occurring 48-72 hours after injury.</p> Signup and view all the answers

    Study Notes

    Introductory Medical-Surgical Nursing, 13e - Chapter 62: Caring for Clients With Traumatic Musculoskeletal Injuries

    • Learning Objectives: Differentiate strains, contusions, and sprains; Define joint dislocations; Discuss nursing management of sports/work-related injuries; Identify stages of bone healing after a fracture; Describe signs/symptoms of a fracture; Explain nursing management for various fractures; Discuss methods to prevent fracture complications; Discuss potential complications of a fractured hip.

    Strains and Sprains

    • Etiology: Injury to muscles or ligaments, stretched or pulled beyond capacity. Strains result from overuse or excessive stress, causing tiny tears in muscle fibers.

    • Types of Strains:

      • First Degree: Mild; some edema and muscle spasm; no loss of function; pain with full range of motion.
      • Second Degree: Partial tearing of muscle or tendon; inability to bear weight; limited motion; edema, muscle tenderness, spasm, and bruising.
      • Third Degree: Severe muscle and/or tendon tearing; severe pain; muscle spasm; ecchymosis; edema; loss of function.

    Sprains, Contusions

    • Sprain: Injury to ligaments surrounding a joint, caused by twisting or hyperextension. Graded similarly to strains (first, second, or third degree). First degree is mild edema, edema, and joint pain. Second degree involves partial tearing of the ligament with joint instability and some loss of function. Third degree is complete ligament tears or ruptures, potentially with bone fragment detachment (Avulsion Fracture). Presents with hematoma, severe pain, edema, and abnormal joint movement.

    • Contusion: Soft tissue injury from blunt trauma; does not involve muscle.

    Dislocations/Subluxation

    • Pathophysiology and Etiology: Ligaments supporting joints are torn, stretched, or relaxed. Usually affects hip, knee, or shoulder.
    • Subluxation: Partial dislocation.
    • Assessment Findings: Popping sound; sudden instability; pain; altered shape; limited range of motion (ROM); swelling; coolness; numbness; tingling; pale or dusky color of distal tissue.
    • Risks: Compartment syndrome; increased pressure in a compartment; blood cannot supply muscles and nerves with oxygen and nutrients. Volkmann's contracture (claw-like deformity).

    Compartment Syndrome

    • Symptoms: Deep aching pain in arm or leg (short-duration); Swelling and tightness; numbness; pin-and-needle type of pain; visible muscle bulging; tingling or burning sensation in the skin; severe pain increasing with muscle stretching; difficulty in moving the foot/foot drop.

    Volkmann's Contracture

    • Causation: Severe trauma resulting in vascular injury to the elbow or forearm, with or without compartment syndrome.

    Tendonitis

    • Pathophysiology and Etiology: Trauma or repeated stress.
    • Types of Tendonitis: Recurrent injuries (e.g., epicondylitis or tennis elbow); ganglion cysts (mass near tendon sheaths); carpal tunnel syndrome (repetitive motion).
    • Assessment Findings: Pain, inflammation, sensation loss, tenderness.
    • Diagnostic findings: Electromyography; X-rays; Carpal tunnel syndrome: Tinel's sign, Phalen's sign.
    • Management: Information about medication (NSAIDs); ROM exercises, ADLs, or job responsibilities; comfort measures (rest, elevate, ice), shaking hands to reduce pain; Fluid from carpal tunnel. Medical and Surgical Management: ice +heat; rest; well-planned exercise; NSAIDs or other medications; splinting; physical therapy, surgery.

    Fractures

    • Pathophysiology and Etiology: Sudden direct force; bone weakness; bone healing process; complications.
    • Classification (See Box 62-1): Type and extent of fracture.
    • Assessment Findings: Immediately after fracture, muscles spasm; flaccid muscles; loss of function; deformity; false motion; crepitus; edema; nerve damage; pain.
    • Diagnostic Findings: Radiography; bone scan (Stop think and Respond 62-2).

    Stages of Bone Healing

    • Immediately After: Blood seeps into the area, hematoma forms.
    • 1 Week: Osteoblasts form, clot retracts.
    • 3 Weeks: Procallus forms, stabilizes fracture.
    • 6-12 Weeks: Callus (with bone cells) forms, osteoblasts begin to remodel.
    • 12 Months: Complete Remodeling (if accurately aligned).
    • Delayed healing: Nonunion; infection; avascular necrosis (bone death from insufficient blood supply).

    Complications of Fractures

    • Shock: Hypovolemic (blood loss).
    • Pulmonary Embolism (PE): Clot to the lung; common after surgery to repair fractures (especially in legs).
    • Compartment Syndrome: Tissue swelling; fasciotomy (surgical incision).
    • Fat Embolism: Fat globules from pelvis or long bones; emboli in lungs or brain.

    Medical and Surgical Management of Fractures

    • Goal: Reestablish functional continuity of bone.
    • Treatment options: Traction; closed reduction; open reduction; internal fixation; external fixation; casting.
    • Factors: Location, severity of fracture; age; overall client physical condition.

    Fractured Femur

    • Etiology: Auto accidents; falls; trauma-related multiple injuries.
    • Assessment Findings: Severe pain; swelling; ecchymosis; hip/knee immobility; compound fractures.
    • Diagnostic Findings: Radiography.
    • Medical/Surgical Management: Traction, spica cast.
    • Nursing Management: Neurovascular assessment; analgesics; comfort measures; mobility; casting.

    Types of Fractures

    • Transverse: Straight horizontal line.
    • Oblique: Angled line.
    • Spiral: Encircles the shaft.
    • Comminuted: Broken into three or more pieces.
    • Compound: Bone fragments sticking out through the skin.
    • Open: Wound penetrates to the broken bone.

    Reduction of Injury

    • Methods to realign the fractured bones (images of a person's legs/hips).

    Fractured Hip

    • Etiology: Falls; bone disorders; trauma.
    • Assessment Findings: Severe pain; shortening of the leg; external rotation; blood loss; extensive bruising; edema; contained bleeding.
    • Diagnostic Findings: Radiography.
    • Medical/Surgical Management: Total hip arthroplasty; hemiarthroplasty.
    • Nursing Management: Wound care; pain management; preventing dislocation; ambulation; Deep vein thrombosis (DVT) (Evidence-Based Practice 62-1).

    Anatomy of Hip (diagram)

    • Extracapsular area; Intracapsular area; Trochanteric region; Subtrochanteric region; Head; Neck.

    Hip Fracture (diagram)

    • Types of hip fracture surgeries: Hemiarthroplasty; Total Arthroplasty.

    Complications (Table 62-1 Summary)

    • Shock; Fat embolism; Pulmonary embolism; Deep vein thrombosis (DVT); Compartment syndrome; Delayed bone healing; Infection; Avascular necrosis.

    Safety Suggestions

    • Adjusting the home: Sleeping space and commode adjustments; elimination of tripping hazards; handrails and stairs improvements; ensuring good lighting; keeping accessible items.

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    Chapter 62: Caring for Clients With Traumatic Musculoskeletal Injuries PDF

    Description

    This quiz focuses on key concepts from Chapter 62 of Introductory Medical-Surgical Nursing, which covers the management of clients with traumatic musculoskeletal injuries. It explores the differences between strains, sprains, and fractures, along with their symptoms, nursing management strategies, and prevention methods for complications.

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