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Questions and Answers
What should the nurse know about the involvement of bone cells in bone remodeling?
What should the nurse know about the involvement of bone cells in bone remodeling?
Which individual is most at risk to develop osteomyelitis caused by Staphylococcus aureus?
Which individual is most at risk to develop osteomyelitis caused by Staphylococcus aureus?
It is important for the nurse to follow up on which statement?
It is important for the nurse to follow up on which statement?
What is a priority laboratory assessment to make before the administration of ibandronate?
What is a priority laboratory assessment to make before the administration of ibandronate?
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Which assessment finding would indicate the possible presence of osteoporosis in a 61-year-old female?
Which assessment finding would indicate the possible presence of osteoporosis in a 61-year-old female?
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What should the nurse explain about osteoporosis management?
What should the nurse explain about osteoporosis management?
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Which highest-calcium meal should a patient with osteoporosis choose?
Which highest-calcium meal should a patient with osteoporosis choose?
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Which symptom will the nurse most likely find in a patient with osteomyelitis of the tibia?
Which symptom will the nurse most likely find in a patient with osteomyelitis of the tibia?
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How will acute osteomyelitis be treated?
How will acute osteomyelitis be treated?
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What is the highest priority intervention for a patient on bed rest with osteomyelitis?
What is the highest priority intervention for a patient on bed rest with osteomyelitis?
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Which nursing intervention is most appropriate for turning a patient following spinal surgery?
Which nursing intervention is most appropriate for turning a patient following spinal surgery?
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Why are antibiotic beads used in the treatment of osteomyelitis?
Why are antibiotic beads used in the treatment of osteomyelitis?
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What symptom following spinal fusion should the nurse report to the physician?
What symptom following spinal fusion should the nurse report to the physician?
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Which nursing intervention will be included in the plan of care for a patient with a proximal humerus fracture in a left-sided long-arm cast?
Which nursing intervention will be included in the plan of care for a patient with a proximal humerus fracture in a left-sided long-arm cast?
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Which patient action requires rapid intervention by the nurse after hip replacement surgery using the posterior approach?
Which patient action requires rapid intervention by the nurse after hip replacement surgery using the posterior approach?
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What action should the nurse take first for a patient with sudden onset shortness of breath after a hip fracture?
What action should the nurse take first for a patient with sudden onset shortness of breath after a hip fracture?
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Which finding is most important for the nurse to communicate to the health care provider after a fall?
Which finding is most important for the nurse to communicate to the health care provider after a fall?
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Which nursing action can be delegated to experienced nursing assistive personnel (NAP) when planning care for a patient who has had hip replacement surgery?
Which nursing action can be delegated to experienced nursing assistive personnel (NAP) when planning care for a patient who has had hip replacement surgery?
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What should the initial nursing action be for a patient with possible left lower leg fractures?
What should the initial nursing action be for a patient with possible left lower leg fractures?
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Which priority nursing diagnosis should be developed for a patient with open reduction and internal fixation (ORIF) of a displaced fracture of the tibia?
Which priority nursing diagnosis should be developed for a patient with open reduction and internal fixation (ORIF) of a displaced fracture of the tibia?
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Which action should the nurse take first when a patient with a fractured pelvis develops acute onset confusion?
Which action should the nurse take first when a patient with a fractured pelvis develops acute onset confusion?
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Which information regarding a left femur fracture should be reported to the health care provider?
Which information regarding a left femur fracture should be reported to the health care provider?
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Before assisting a patient with ambulation the day after a total hip replacement, which action is most important for the nurse?
Before assisting a patient with ambulation the day after a total hip replacement, which action is most important for the nurse?
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In caring for a patient with left leg fractures after a motor vehicle accident, in what order will the nurse take these actions: obtain x-rays, check pedal pulses, assess lung sounds, take blood pressure, apply splint to the leg, administer tetanus prophylaxis.
In caring for a patient with left leg fractures after a motor vehicle accident, in what order will the nurse take these actions: obtain x-rays, check pedal pulses, assess lung sounds, take blood pressure, apply splint to the leg, administer tetanus prophylaxis.
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What should the nurse teach a patient who has lost 1 inch in height over the past 2 years?
What should the nurse teach a patient who has lost 1 inch in height over the past 2 years?
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Which health history information about a 67-year-old woman alerts the nurse to assess the musculoskeletal system more closely?
Which health history information about a 67-year-old woman alerts the nurse to assess the musculoskeletal system more closely?
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Which medication poses a concern for a patient's musculoskeletal status?
Which medication poses a concern for a patient's musculoskeletal status?
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What should a nurse plan before a 72-year-old patient scheduled for DXA testing?
What should a nurse plan before a 72-year-old patient scheduled for DXA testing?
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Which information indicates that a nurse should consult with a health care provider before scheduling an MRI?
Which information indicates that a nurse should consult with a health care provider before scheduling an MRI?
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What task can the nurse delegate to unlicensed assistive personnel (UAP) in the orthopedic clinic?
What task can the nurse delegate to unlicensed assistive personnel (UAP) in the orthopedic clinic?
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What is most important for the nurse to assess in a 63-year-old woman taking prednisone after a kidney transplant?
What is most important for the nurse to assess in a 63-year-old woman taking prednisone after a kidney transplant?
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Which statement indicates a 57-year-old postmenopausal woman understands the DXA procedure?
Which statement indicates a 57-year-old postmenopausal woman understands the DXA procedure?
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What are the bone cells that function in the resorption of bone tissue called?
What are the bone cells that function in the resorption of bone tissue called?
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While obtaining subjective assessment data related to the musculoskeletal system, which medical problem should the nurse especially ask about?
While obtaining subjective assessment data related to the musculoskeletal system, which medical problem should the nurse especially ask about?
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After administering a radioisotope in a patient with cellulitis and probable osteomyelitis, when should the bone scan be scheduled?
After administering a radioisotope in a patient with cellulitis and probable osteomyelitis, when should the bone scan be scheduled?
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What should the nurse teach a patient about bone scan procedures?
What should the nurse teach a patient about bone scan procedures?
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Musculoskeletal assessment is crucial for patients undergoing what type of long-term therapy?
Musculoskeletal assessment is crucial for patients undergoing what type of long-term therapy?
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What should the nurse document for a patient with rheumatoid arthritis experiencing knee stiffness and joint fixation?
What should the nurse document for a patient with rheumatoid arthritis experiencing knee stiffness and joint fixation?
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What is the best approach to assess range of motion (ROM) in an 81-year-old female patient with decreasing mobility?
What is the best approach to assess range of motion (ROM) in an 81-year-old female patient with decreasing mobility?
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While completing an admission history for a 73-year-old man with osteoarthritis admitted for knee arthroplasty, what response should the nurse expect from the patient regarding the reason for admission?
While completing an admission history for a 73-year-old man with osteoarthritis admitted for knee arthroplasty, what response should the nurse expect from the patient regarding the reason for admission?
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What should the nurse assess for in a patient with osteoarthritis who is about to undergo total knee arthroplasty?
What should the nurse assess for in a patient with osteoarthritis who is about to undergo total knee arthroplasty?
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What would be an appropriate nursing intervention for a patient following left total knee replacement who has impaired physical mobility due to decreased muscle strength?
What would be an appropriate nursing intervention for a patient following left total knee replacement who has impaired physical mobility due to decreased muscle strength?
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What should the nurse include in the care of the affected leg of a 76-year-old man who has undergone left knee arthroplasty?
What should the nurse include in the care of the affected leg of a 76-year-old man who has undergone left knee arthroplasty?
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What action should the nurse take to protect the knee joint of a patient who underwent left total knee arthroplasty and has an order to be 'up in chair today before noon'?
What action should the nurse take to protect the knee joint of a patient who underwent left total knee arthroplasty and has an order to be 'up in chair today before noon'?
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What statement by an 80-year-old male patient who underwent right total hip arthroplasty indicates the need for further instruction?
What statement by an 80-year-old male patient who underwent right total hip arthroplasty indicates the need for further instruction?
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What is the best rationale for not allowing a 21-year-old male patient with a long leg cast to use crutches?
What is the best rationale for not allowing a 21-year-old male patient with a long leg cast to use crutches?
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What should the nurse suspect if a patient with a tibial fracture and a cast presents pulseless, pale, cool feet and reports numbness?
What should the nurse suspect if a patient with a tibial fracture and a cast presents pulseless, pale, cool feet and reports numbness?
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When counseling an older patient about ways to prevent fractures, which information will the nurse include?
When counseling an older patient about ways to prevent fractures, which information will the nurse include?
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When a patient with a cast in place after fracturing the radius asks when the cast can be removed, what should the nurse instruct?
When a patient with a cast in place after fracturing the radius asks when the cast can be removed, what should the nurse instruct?
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What is the best action for a nurse assessing pressure areas on a patient with Buck's traction?
What is the best action for a nurse assessing pressure areas on a patient with Buck's traction?
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After applying a hip spica cast on a patient with a left femur fracture, which nursing intervention will be included in the care plan?
After applying a hip spica cast on a patient with a left femur fracture, which nursing intervention will be included in the care plan?
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What should the nurse avoid doing until a long-arm plaster cast has completely dried for a fractured left radius?
What should the nurse avoid doing until a long-arm plaster cast has completely dried for a fractured left radius?
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Which statement by a patient with a short-arm plaster cast indicates a good understanding of discharge teaching?
Which statement by a patient with a short-arm plaster cast indicates a good understanding of discharge teaching?
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What should the nurse do when a patient complains of constant severe pain in the leg unrelieved by morphine after an ORIF of lower leg fractures?
What should the nurse do when a patient complains of constant severe pain in the leg unrelieved by morphine after an ORIF of lower leg fractures?
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Which assessment finding should the nurse report after caring for a patient on bed rest following a complex pelvic fracture?
Which assessment finding should the nurse report after caring for a patient on bed rest following a complex pelvic fracture?
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What action will the nurse take in order to evaluate the effectiveness of Buck's traction for a patient with an intracapsular fracture of the left femur?
What action will the nurse take in order to evaluate the effectiveness of Buck's traction for a patient with an intracapsular fracture of the left femur?
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What should the nurse include in the discharge teaching for a patient with multiple forearm fractures and a long-arm cast?
What should the nurse include in the discharge teaching for a patient with multiple forearm fractures and a long-arm cast?
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What action should the nurse take when assisting a patient who has had an ORIF of a hip fracture out of bed for the first time?
What action should the nurse take when assisting a patient who has had an ORIF of a hip fracture out of bed for the first time?
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What information will the nurse include when teaching a patient who had a repair of a fractured mandible?
What information will the nurse include when teaching a patient who had a repair of a fractured mandible?
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What statement from a patient with ulnar drift caused by rheumatoid arthritis indicates a realistic expectation for surgery?
What statement from a patient with ulnar drift caused by rheumatoid arthritis indicates a realistic expectation for surgery?
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What should the nurse teach a patient with multiple forearm fractures and a long-arm cast to look out for?
What should the nurse teach a patient with multiple forearm fractures and a long-arm cast to look out for?
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Study Notes
Musculoskeletal Trauma and Orthopedic Surgery
- Common reason for knee arthroplasty is debilitating joint pain, particularly in elderly patients with osteoarthritis.
- Preoperative assessment prior to knee arthroplasty must check for infection; signs include redness, swelling, fever, and elevated white blood cell count.
- Post-surgery, isometric quadriceps-setting exercises should be encouraged to enhance recovery and mobility after total knee replacement.
- Progressive leg exercises are necessary to achieve at least 90-degree flexion post-knee arthroplasty for rehabilitation.
- A knee immobilizer is vital during initial movements post-surgery to safeguard the surgical site and prevent instability.
- After hip arthroplasty, patients must avoid crossing legs and maintaining adduction/internal rotation to prevent dislocation.
- New long leg casts require elevation above heart level for the first 24 hours to reduce edema and complications like compartment syndrome.
- Signs of compartment syndrome include the six Ps: paresthesia, pallor, pulselessness, pain, pressure, and paralysis; immediate intervention is crucial.
- For fracture prevention in older adults, using supportive, comfortable shoes and removing tripping hazards, like scatter rugs, is essential.
- Casts typically remain on for at least three weeks, as ossification doesn't start until this period after bone injury.
- Buck's traction is used to immobilize fractures; care involves monitoring for pressure areas and avoiding changes that disrupt alignment.
- Patients with external fixation devices need daily cleaning of pin sites to prevent infection; these devices allow mobility.
- Evaluating Buck's traction effectiveness is best done by assessing pain levels; muscle spasms and dislocations are less of a concern.
- Understanding discharge teaching is critical, especially regarding maintaining immobilization sequences and managing discomfort post-surgery.
- Patients undergoing arthroplasty should expect to regain function in their hands, though they will need to continue therapy for strength and flexibility.
- Awareness about cast care includes avoiding wetness and using appropriate pain management strategies post-injury.
- Hip replacement surgeries using posterior approaches require careful monitoring of patient movement to prevent dislocation.
- Sudden shortness of breath and tachypnea after hip fracture surgery could indicate serious complications such as pulmonary embolism; prompt assessment and intervention are necessary.### Pulmonary Embolus Symptoms
- Clinical manifestations indicate a possible pulmonary embolus.
- Prioritize ensuring adequate oxygenation before notifying healthcare provider.
- Pulse oximetry and assessment for fat embolus or VTE are important after initiating oxygen therapy.
Fall and Arm Injury
- Shortening of the arm post-fall suggests possible dislocation, an orthopedic emergency.
- Other findings like bruising, pain, and decreased range of motion are significant but do not require immediate intervention.
Hip Replacement Care
- Repositioning patients every 1 to 2 hours can be delegated to nursing assistive personnel (NAP).
- Teaching exercises and assessing pain or skin irritation are RN responsibilities.
Fracture Patient Care
- Assess neurovascular status (pulses) first before other actions in a suspected leg fracture.
- Splinting and elevating the leg come after assessing vascular status.
ORIF Postoperative Care
- Risk for infection due to skin integrity disruption is the primary nursing diagnosis following tibia ORIF.
Acute Confusion After Pelvic Fracture
- Acute confusion may indicate a fat embolus; oxygen saturation should be assessed immediately.
Femur Fracture Report
- Prolonged capillary refill suggests potential arterial damage or compartment syndrome; this finding requires immediate reporting.
Total Hip Replacement Ambulation
- Administer pain medication prior to ambulation to ensure patient comfort during mobility activities.
Action Order for Accident Victim
- Ensure airway, breathing, and circulation (ABCs) are intact before assessing leg injury and immobilization.
- evaluations should precede x-ray referrals.
Osteoporosis Screening
- Loss of height over two years suggests possible osteoporosis; DXA scanning is warranted.
Focused Assessment Indicators
- Family history of height loss prompts focused musculoskeletal assessments for osteoporosis.
Medication Concerns for Musculoskeletal Health
- Long-term corticosteroid use is a major risk factor for osteoporosis and related complications.
Bone Density Testing and Patient Understanding
- DXA tests are painless and focus on spinal and femoral bone density; they require no sedatives or IV contrasts.
Bone Remodeling Knowledge
- Osteoclasts breakdown bone tissue, while osteoblasts build new bone.
Assessment of Medical History
- Inquiry about diabetes is critical as it impacts the musculoskeletal system.
Timing for Bone Scan Procedure
- A bone scan should occur 2 hours post-radioisotope administration.
Patient Education on Bone Scans
- Increased fluid intake post-scan is necessary to aid isotope excretion.
Musculoskeletal Assessment Relevance
- Long-term corticosteroid therapy necessitates thorough musculoskeletal evaluations.
Joint Fixation Documentation
- Ankylosis indicates joint stiffness or fixation.
Range of Motion Assessment
- Observing a patient's unassisted ROM is the best method to assess mobility, especially in older adults.
Cell Types in Bone Remodeling
- Osteoblasts are responsible for depositing new bone during remodeling.
Osteomyelitis Risk Factors
- Patients with diabetes and pressure ulcers are at significant risk for Staphylococcus aureus osteomyelitis.
Post-Surgical Symptom Monitoring
- Clear drainage and severe headache post-spinal surgery may indicate CSF leakage, requiring immediate intervention.
Ibandronate Laboratory Assessment
- Serum phosphate is the crucial laboratory assessment before administering ibandronate for osteoporosis treatment.
Osteoporosis Indicators in Screening
- A measurable loss of height in an older female suggests potential osteoporosis presence.### Unstable Wide-Gait Ambulation and Osteoporosis
- Measurable loss of height and kyphosis are signs of osteoporosis, where bone resorption exceeds deposition.
- Bowed legs, caused by rickets or abnormal bone development, do not indicate osteoporosis.
- Calcium and Vitamin D deficiencies are risk factors but do not confirm osteoporosis.
Patient Education on Osteoporosis
- Family history does not prevent or slow osteoporosis; increased calcium intake and exercise can help.
- Continuous low-dose corticosteroids hinder bone metabolism, making them ineffective in managing osteoporosis.
- Estrogen therapy is not advisable due to linked risks of heart disease and certain cancers.
Dietary Considerations for Osteoporosis
- The meal with the highest calcium content: sardine sandwich, fruit yogurt, and skim milk.
- Other meals contain lower calcium levels, with many foods under 75 mg of calcium per 100 g.
Osteomyelitis Symptoms and Treatment
- Osteomyelitis, an infection of bone, typically presents localized pain and warmth at the infection site.
- Standard treatment for acute osteomyelitis includes several weeks of IV antibiotics, not just oral antibiotics.
Patient Management and Positioning
- For patients on bed rest, priority interventions include frequent position changes and range-of-motion exercises to prevent lung complications and contractures.
- In post-spinal surgery, turning the patient should involve placing a pillow between legs and moving the body as a unit to preserve spinal alignment.
Surgical Debridement and Antibiotic Beads
- Antibiotic beads are used to deliver direct antibiotic treatment to infected sites and serve as an adjunct to debridement and systemic antibiotics.
- These beads are vital in treating chronic osteomyelitis where vascularization is inadequate.
Monitoring After Spinal Fusion
- Post-surgery, inability to move lower extremities is a critical symptom that should be reported immediately as it indicates potential neurological issues.
- Regular assessments of mobility and sensation are essential in the postoperative care protocol following spinal fusion.
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Description
Test your knowledge on musculoskeletal trauma and orthopedic surgery concepts from Lewis Chapter 62. This quiz focuses on the assessment of a patient with osteoarthritis and the factors leading to knee arthroplasty. Dive into key considerations and clinical scenarios related to orthopedic care.
