Orthopedic Anatomy and Nursing Care

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Questions and Answers

What is the primary distinction between a sprain and a fracture?

A sprain is always more severe than a fracture.

A fracture involves a complete break in the bone, whereas a sprain involves tearing of ligaments. (correct)

Both injuries occur as a result of the same mechanism of injury.

A fracture is an injury to the soft tissues, while a sprain is an injury to the bone.

Which of the following is NOT a common site for sprains?

Shoulder (correct)

Ankle

Wrist

Knee

What is the vital aspect of postoperative care following a total knee replacement?

Initiating physical therapy to enhance mobility. (correct)

Encouraging complete bed rest for recovery.

Avoiding any weight-bearing activities for six weeks.

Administering pain relief only when requested by the patient.

What are the six Ps associated with connective tissue injuries?

Pain, Pulse, Paresthesia, Pallor, Paralysis, Pressure. Signup and view all the answers

A patient presenting with compartment syndrome would likely exhibit which of the following?

Severe pain that increases with passive stretching. Signup and view all the answers

Which of the following is an essential nursing intervention for patients with arthritis?

Encouraging regular, gentle exercise to maintain mobility. Signup and view all the answers

What is the process by which osteoporosis occurs primarily driven by?

Accelerated bone resorption exceeding formation. Signup and view all the answers

Which of the following statements regarding cast care is correct?

Patients should report any unusual odors or skin irritation under the cast. Signup and view all the answers

What is a common fracture type resulting from punching a wall?

Boxer’s fracture Signup and view all the answers

What is the primary goal in the treatment of fractures?

Restoring bone continuity Signup and view all the answers

Which of the following statements is true regarding the risk factors for fractures in older adults?

Decreased muscle tone increases fracture risk. Signup and view all the answers

What initial treatment step is crucial after a fracture occurs?

Immediate immobilization Signup and view all the answers

Which type of fracture involves the break in the skin?

Open fracture Signup and view all the answers

During which stage of fracture healing does granulation tissue form?

Second stage Signup and view all the answers

What effect do proton pump inhibitors (PPIs) have on fracture risk?

Increase risk for older adults Signup and view all the answers

What is the first step of bone healing after a fracture?

Hematoma formation Signup and view all the answers

What type of fracture involves a partial bend and partial break in the bone, often seen in children?

Greenstick fracture Signup and view all the answers

Why might calcium supplements be recommended for those taking proton pump inhibitors?

To mitigate decreased calcium absorption Signup and view all the answers

What mechanism explains the increased fracture risk due to aging?

Reduced calcium absorption Signup and view all the answers

What is a characteristic of a comminuted fracture?

Bone is broken into multiple fragments Signup and view all the answers

When should tetanus immunization be administered in case of a fracture?

If the skin was broken during the fracture Signup and view all the answers

Which type of fracture should be treated with prophylactic antibiotics?

Compound fracture Signup and view all the answers

What is the primary goal of reducing a fracture?

To align the bone fragments properly Signup and view all the answers

Which method of fracture reduction involves no surgical incision?

Closed reduction Signup and view all the answers

What type of fixation is particularly necessary for treating fractures in older adults?

Internal fixation Signup and view all the answers

Which of the following is NOT a method of stabilizing a fracture after reduction?

Open reduction Signup and view all the answers

What is commonly used in external fixation of fractures?

Heavy pins and an external frame Signup and view all the answers

What is a significant disadvantage of using synthetic casts?

They are difficult to mold to a body part. Signup and view all the answers

Which type of cast allows for weight bearing within 30 minutes of application?

Fiberglass cast Signup and view all the answers

What is a key consideration in caring for an external fixator?

Pin care should be performed regularly. Signup and view all the answers

In what situation might open reduction be necessary?

Comminuted fracture Signup and view all the answers

Which cast is typically used to support the arm and provide elevation?

Spica cast Signup and view all the answers

What is the purpose of using traction in fracture management?

To align bones and relieve muscle spasms Signup and view all the answers

What is indicated by a grayish and dull appearance on a plaster cast?

It is newly applied and still wet. Signup and view all the answers

What is the main risk when a cast is applied over a surgical site?

Infection in the surgical wound. Signup and view all the answers

What might a patient using an external fixator experience related to self-image?

Frustration about the bulky apparatus Signup and view all the answers

What is a common symptom of an ACL injury?

Loud “pop” sound at the time of injury Signup and view all the answers

Which method is primarily used for diagnosing a meniscal injury?

MRI Signup and view all the answers

What is the typical mechanism of injury for an Achilles tendon rupture?

Sudden burst of jumping or pivoting Signup and view all the answers

What is the most common joint for bursitis to occur?

Knee Signup and view all the answers

How is carpal tunnel syndrome primarily treated?

Rest, splinting, and changing wrist angles Signup and view all the answers

Which symptom is characteristic of a meniscus tear?

Localized tenderness in the knee Signup and view all the answers

What is a common non-surgical treatment for a bunion?

Corticosteroid injection in the metatarsal joint Signup and view all the answers

Which of the following is not a symptom of an Achilles tendon injury?

Consistent tingling in the fingers Signup and view all the answers

Which exercise is commonly prescribed during recovery from an ACL injury?

Isometric quadriceps setting Signup and view all the answers

What condition is characterized by the median nerve being compressed in the wrist?

Carpal tunnel syndrome Signup and view all the answers

What is the initial treatment recommended for bursitis?

Rest and activity alteration Signup and view all the answers

What is a possible cause of an Achilles tendon rupture?

Predisposing factors like diabetes Signup and view all the answers

What procedure may be necessary if carpal tunnel syndrome symptoms are long-lasting?

Surgical decompression of the median nerve Signup and view all the answers

What is the primary goal of the RICE method in treating sprains?

To protect the ligament until it heals Signup and view all the answers

Which of the following describes a Grade II sprain?

Severe pain and swelling with some loss of function Signup and view all the answers

What is the most common cause of muscle strains?

Trauma or overuse of the muscle Signup and view all the answers

How should ice be applied after a strain injury?

For 20 minutes each hour Signup and view all the answers

What is the first step in managing a dislocated joint?

Stabilize and rehabilitate after reduction Signup and view all the answers

Which of the following is NOT a symptom of a Grade I sprain?

Loss of function Signup and view all the answers

What should be done if muscle spasms are present in a strain?

Prescription of muscle relaxants Signup and view all the answers

Which condition often requires surgical repair due to the severity of injury?

Grade III sprain Signup and view all the answers

What may occur if a joint is immobilized for too long?

Muscle atrophy and permanent disability Signup and view all the answers

What factors typically contribute to an anterior cruciate ligament (ACL) injury?

Athletic activities and trauma Signup and view all the answers

In the context of joint strains, what does subluxation refer to?

A partial dislocation of the joint Signup and view all the answers

Which medication should be administered immediately for pain relief in strains or sprains?

Nonsteroidal anti-inflammatory drugs (NSAIDs) Signup and view all the answers

What type of therapy is believed to help relax muscles after extended work?

Topical application of arnica Signup and view all the answers

Which symptoms indicate that a muscle strain has likely occurred?

Soft-tissue swelling and pain at rest Signup and view all the answers

What is the primary characteristic of pannus in rheumatoid arthritis?

It is granulation tissue that destroys cartilage. Signup and view all the answers

Which of the following symptoms is characteristic of rheumatoid arthritis?

Systemic symptoms such as low-grade fever and malaise. Signup and view all the answers

What is the role of disease-modifying anti-rheumatic drugs (DMARDs) in the treatment of rheumatoid arthritis?

They prevent joint delegation and induce remission. Signup and view all the answers

Which of the following tests is NOT typically used in the diagnosis of rheumatoid arthritis?

Blood glucose levels Signup and view all the answers

Which treatment is reserved for controlling flare-ups in rheumatoid arthritis due to its serious side effects?

Steroid therapy Signup and view all the answers

Which of the following describes a common effect of rheumatoid arthritis on the joints?

Contractures and deformity Signup and view all the answers

What kind of nodules may form in patients with rheumatoid arthritis?

Over bony prominences and in other organs Signup and view all the answers

What is a significant risk when initiating treatment with tumor necrosis factor (TNF) inhibitors in rheumatoid arthritis patients?

Potential exacerbation of tuberculosis Signup and view all the answers

What is a likely consequence if rheumatoid arthritis is left untreated?

Severe joint dysfunction and deformity Signup and view all the answers

What is the primary goal in the management of rheumatoid arthritis in older adults?

Minimizing joint destruction and maintaining mobility Signup and view all the answers

What is the primary advantage of using a brace for fractures?

Can be easily removed for skin assessment. Signup and view all the answers

What is the purpose of skeletal traction?

To create a mechanical pull directly on the bone. Signup and view all the answers

What is a critical step before applying a plaster cast?

Inform the patient about warmth during setting. Signup and view all the answers

Which condition is accurately associated with osteomyelitis?

Often preceded by an open fracture or distant infection. Signup and view all the answers

What factor can delay the healing of a fracture?

Inadequate levels of vitamins and minerals. Signup and view all the answers

How does skin traction differ from skeletal traction?

It applies pull via a bandage or boot on the limb. Signup and view all the answers

What role do antibiotics play in the management of open fractures?

They are critical in preventing infection post-surgery. Signup and view all the answers

What should be monitored in a patient with skin traction to prevent complications?

Skin integrity and pressure areas. Signup and view all the answers

What is the purpose of an electrical bone growth–stimulating device in treating nonunion of fractures?

To induce electrical current for osteogenesis Signup and view all the answers

What is one of the main complications of osteomyelitis?

Severe systemic infection. Signup and view all the answers

Which symptom is NOT associated with fat embolism?

Severe, unrelenting pain Signup and view all the answers

Why are older adults particularly at risk for fat embolism after a fracture?

Higher likelihood of multiple fractures Signup and view all the answers

How often should a patient’s temperature and WBC count be checked after surgery?

Regularly to monitor for signs of infection. Signup and view all the answers

What is a key sign of compartment syndrome?

Severe pain out of proportion to injury Signup and view all the answers

What action is recommended if a plaster cast is still warm?

Allow it to cool naturally and do not cover it. Signup and view all the answers

Which preventive measures are recommended to avoid thrombus formation after a hip fracture?

Use of compression stockings and ROM exercises Signup and view all the answers

What is a characteristic of a volar splint?

Provides immobilization without full encasement. Signup and view all the answers

What is the most immediate action required when an open fracture has occurred with severe bleeding?

Apply a pressure dressing Signup and view all the answers

What factor increases the risk of infection leading to osteomyelitis?

Recent surgical procedures. Signup and view all the answers

What is typically the first step in treating osteomyelitis?

Administration of intravenous antibiotics. Signup and view all the answers

What complication arises from tight dressings or casts in a fractured limb?

Compartment syndrome Signup and view all the answers

During assessment for nerve damage in a fractured leg, which method would NOT be appropriate?

Measure the circumference of the leg Signup and view all the answers

Which sign indicates that a patient may be experiencing compartment syndrome?

Weakness of the extremity Signup and view all the answers

What is a potential treatment for compartment syndrome if conservative measures fail?

Surgical fasciotomy Signup and view all the answers

What does the 'six Ps' assessment for extremities include?

Pain, pallor, paresthesia, pulselessness, paralysis, and poikilothermia Signup and view all the answers

Why is bilateral assessment important in suspected fractures?

To examine for symmetry and potential nerve damage Signup and view all the answers

What is a common misconception about fractures?

All fractures are painful Signup and view all the answers

What is the primary reason for elevating a limb after a fracture?

To reduce swelling Signup and view all the answers

When assessing a patient with a fractured forearm, which assessment finding would most likely indicate a potential complication?

Decreased sensation and tingling Signup and view all the answers

What dietary recommendation is essential for a patient recovering from a fracture?

Adequate protein intake of 1 g/kg of body weight Signup and view all the answers

What is a defining characteristic of rheumatoid arthritis compared to osteoarthritis?

Chronic inflammation of synovial membranes Signup and view all the answers

What is the most critical action to take if a patient in a cast reports sharp localized pain?

Notify the health care provider immediately Signup and view all the answers

What is an appropriate intervention for a patient experiencing discomfort from a traction device?

Reassess body position and alignment Signup and view all the answers

At what average age is osteoarthritis most commonly diagnosed?

50–60 years Signup and view all the answers

Which symptom would likely prompt immediate assessment of a neuromuscular complication in a patient with a cast?

Increased pain during passive movement Signup and view all the answers

What type of joint involvement is characteristic of rheumatoid arthritis?

Symmetric bilateral involvement Signup and view all the answers

What is a standard practice when cleaning pin sites after surgery for external fixation?

Clean with sterile water daily Signup and view all the answers

What is the primary goal of performing a synovectomy?

Relieve pain and improve mobility Signup and view all the answers

Which medication class is primarily used to reduce inflammation and pain in rheumatoid arthritis?

Nonsteroidal antiinflammatory drugs (NSAIDs) Signup and view all the answers

Why is it important to monitor for problems of immobility in fracture patients?

To identify early signs of complications Signup and view all the answers

How often should a neurovascular assessment be performed after a fracture occurs?

Every shift and every 2 to 4 hours for fresh fractures Signup and view all the answers

What is one common symptom experienced in rheumatoid arthritis that differs from osteoarthritis?

Morning stiffness Signup and view all the answers

What would a capillary refill time of longer than 2 seconds indicate in a patient with a fracture?

Potential circulatory compromise Signup and view all the answers

What factor typically does NOT contribute to the development of osteoarthritis?

Chronic inflammation Signup and view all the answers

Upon discovering foul odors from a cast, what should be your immediate action?

Report potential signs of infection Signup and view all the answers

What is the recommended dosage limit for intra-articular steroid injections within a year?

2 to 3 doses Signup and view all the answers

What percentage of nutrients should be focused on to aid in healing after a fracture?

High protein and balanced vitamins and minerals Signup and view all the answers

What is a key nursing implication when administering NSAIDs to older adults?

Dosage may need to be reduced by half. Signup and view all the answers

What should patients be advised to do if they experience dizziness from arthritis pain medications?

Wait for dizziness to pass before walking. Signup and view all the answers

What is the main purpose of assessing a patient’s body position and alignment in relation to immobilization?

To prevent pressure sores and improve comfort Signup and view all the answers

Which of the following is NOT a typical nursing diagnosis related to patients with fractures?

Risk for obesity due to immobility Signup and view all the answers

Which type of replacement surgery is most commonly performed for patients with severe arthritis?

Joint replacement (arthroplasty) Signup and view all the answers

What is typically used in cemented press-fit prostheses for joint replacement?

Bone cement Signup and view all the answers

What complication is the greatest danger to successful joint replacement?

Infection Signup and view all the answers

In which condition are rheumatoid factors often found?

Rheumatoid arthritis Signup and view all the answers

What should be used to avoid creating impressions on a damp cast?

Palms or flat surface of the fingers Signup and view all the answers

What is the maximum duration for which the extremity should be elevated after cast application?

24 to 48 hours Signup and view all the answers

Which object should patients avoid using to scratch under the cast?

Sharp objects like pencils Signup and view all the answers

What should be done to relieve itching inside the cast?

Using a 60-mL plunger syringe to direct air Signup and view all the answers

What precaution should be taken if ice bags are used on a wet plaster cast?

Use ice bags that are only about half full Signup and view all the answers

What is a common symptom of early Lyme disease?

Bull's-eye rash Signup and view all the answers

What is the recommended treatment for early Lyme disease to prevent progression?

Antibiotics like doxycycline Signup and view all the answers

Which joint condition is characterized by flavored breakdown of cartilage?

Osteoarthritis Signup and view all the answers

Which of the following factors is NOT associated with increasing the risk of osteoarthritis?

High physical activity levels Signup and view all the answers

What should be used to inspect a cast daily?

Visual inspection for defects Signup and view all the answers

What is a potential consequence of untreated Lyme disease?

Permanent damage to joints Signup and view all the answers

After removing a cast, how should the underlying skin be treated?

Avoid scrubbing to prevent skin damage Signup and view all the answers

Which of the following is a sign that a patient might have Lyme disease?

Flu-like symptoms combined with a rash Signup and view all the answers

What should patients be instructed to do when showering with a synthetic cast?

Avoid direct water stream on the cast Signup and view all the answers

What is the primary characteristic of primary osteoarthritis?

It occurs symmetrically, especially in the hands. Signup and view all the answers

Which of the following signs is associated with rheumatoid arthritis?

Marked ulnar deviation of the wrists. Signup and view all the answers

What is a common treatment strategy for managing osteoarthritis?

Pain management and low-impact aerobic exercises. Signup and view all the answers

What is the standard maximum dose of acetaminophen recommended for most patients?

4000 mg per day. Signup and view all the answers

How can glucosamine and chondroitin affect osteoarthritis?

They may slow or halt the progression of the disease. Signup and view all the answers

Why might NSAIDs be cautioned against in older adults?

They can lead to increased bleeding and drug interactions. Signup and view all the answers

What is the role of hyaluronic acid injections in osteoarthritis treatment?

To provide lubrication and decrease pain. Signup and view all the answers

What lifestyle change can significantly reduce joint stress for osteoarthritis patients?

Maintaining a healthy weight. Signup and view all the answers

What is a potential side effect of taking too much acetaminophen?

Irreversible liver damage. Signup and view all the answers

What benefit does gentle exercise provide for osteoarthritis patients?

It helps improve joint mobility and reduces pain. Signup and view all the answers

Which of the following pain relief methods is suggested for osteoarthritis sufferers?

Yoga and massage therapy. Signup and view all the answers

What is a common injectable treatment for cartilage injury?

Autologous chondrocytes. Signup and view all the answers

What should patients taking warfarin consult their healthcare provider about?

Starting glucosamine supplements. Signup and view all the answers

Which form of arthritis is considered an autoimmune disease?

Rheumatoid arthritis. Signup and view all the answers

What is one reason older adults with decreased creatinine clearance should avoid taking allopurinol?

It can worsen kidney function. Signup and view all the answers

Which medication is suggested as a feasible treatment option for patients with both hypertension and gout?

Losartan Signup and view all the answers

What is a common result of untreated osteoporosis in older adults?

Height loss Signup and view all the answers

Which of the following statements about the diagnosis of osteoporosis is true?

Bone density is assessed using dual-energy x-ray absorptiometry (DEXA). Signup and view all the answers

What demographic is particularly at risk for developing osteoporosis shortly after menopause?

Women experiencing reduced estrogen production Signup and view all the answers

What is a significant risk factor that contributes to osteoporosis in both genders?

Chronic diseases Signup and view all the answers

What aspect of osteoporosis is often misunderstood regarding its visibility?

It is a silent disease. Signup and view all the answers

What percentage of patients who experience a hip fracture may die within one year of the injury?

21% to 30% Signup and view all the answers

What is the recommended pain level for patients before discharge on oral analgesia?

2–6/10 Signup and view all the answers

Which positioning restriction is NOT advised to prevent dislocation after total hip replacement?

Cross legs at the ankles Signup and view all the answers

Administering a medication bolus for which pain level is indicated?

6/10 Signup and view all the answers

What might excessive sedation following pain medication indicate?

Medication toxicity Signup and view all the answers

What is a critical instruction for a patient recovering from a total hip replacement during the postoperative period?

You should not cross your legs for 3 months. Signup and view all the answers

Which of the following is an example of a proper comfort measure for a patient in pain?

Providing smooth and clean linens Signup and view all the answers

What is the primary reason for using a CPM machine after knee arthroplasty?

To improve joint mobility and minimize stiffness. Signup and view all the answers

What should the patient be advised to report in order to prevent potential complications after hip surgery?

Pain in hip, buttock, or thigh Signup and view all the answers

Why is ongoing pain assessment important immediately following hip surgery?

To adjust analgesic prescriptions as the nerve block wears off. Signup and view all the answers

Which exercise should be encouraged every two hours to help prevent DVT?

Foot and calf exercises Signup and view all the answers

What is an essential nursing intervention for a patient post-total hip replacement to promote mobility?

Assist the patient in using a walker for ambulation. Signup and view all the answers

What is an important nursing intervention to assist a patient with rheumatoid arthritis?

Allowing adequate rest periods Signup and view all the answers

What nursing diagnosis would likely be appropriate for a patient recovering from total hip replacement due to pain and activity restrictions?

Altered mobility. Signup and view all the answers

Which of the following practices should be avoided for patients recovering from hip replacement surgery?

Bending the hip beyond a 90-degree angle. Signup and view all the answers

What should be ensured for a patient recovering from total hip replacement before discharge?

Patient understands movement restrictions Signup and view all the answers

Which symptom could indicate the presence of a thrombus in a post-hip replacement patient?

Warmth and swelling in the calf Signup and view all the answers

What type of patient education should be emphasized for someone recovering from knee arthroplasty?

Participation in a daily exercise program. Signup and view all the answers

What could contribute to a patient with rheumatoid arthritis experiencing frustration during treatment?

Rushed assessments Signup and view all the answers

In a patient experiencing acute pain post-surgery, what should be the immediate nursing action?

Reinforce instructions on PCA (patient-controlled analgesia) use. Signup and view all the answers

What is the primary action of corticosteroids like prednisone?

Reduce inflammation and decrease pain Signup and view all the answers

What assessment data would indicate the need for immediate attention in a patient post hip replacement?

Signs of infection at the surgical site. Signup and view all the answers

What is a potential complication that could occur in a patient post-total hip replacement aside from DVT?

Infection at the incision site Signup and view all the answers

What strategy should be employed to facilitate the patient's transition from hospital to home care after hip surgery?

Include instructions for daily exercises and mobility. Signup and view all the answers

Which type of medication is primarily used to decrease clotting ability in post-operative care?

Low-molecular-weight heparin Signup and view all the answers

Which medication requires monitoring for retinal problems as a potential side effect?

Hydroxychloroquine Signup and view all the answers

Which statement reflects a patient's understanding of hip replacement recovery after receiving discharge instructions?

I will use a pillow between my legs when turning over. Signup and view all the answers

What is a critical nursing consideration when administering biological therapies?

Monitor for serious infections Signup and view all the answers

What can help a patient with arthritis maintain independence and mobility?

Use of assistive devices Signup and view all the answers

Which of the following can result from abrupt discontinuation of corticosteroid medication?

Adrenal insufficiency Signup and view all the answers

What is a common nursing intervention for managing chronic pain in patients with arthritis?

Assessing the effectiveness of pain relief methods. Signup and view all the answers

What is one of the benefits of hip resurfacing over a traditional hip replacement?

Greater range of motion Signup and view all the answers

Which goal should be prioritized for a patient scheduled for total hip replacement rehabilitation?

Return to full mobility and independence in daily activities. Signup and view all the answers

During postoperative care for hip replacement, what should be routinely monitored to prevent dislocation?

Positioning of the abduction wedge Signup and view all the answers

What potential risk is associated with disease-modifying antirheumatic drugs (DMARDs)?

Birth defects Signup and view all the answers

Which preoperative care instruction is important for a patient undergoing hip surgery?

Use a prescribed bacteriostatic scrub before surgery Signup and view all the answers

What assessment should be performed after applying an abductor wedge to prevent complications?

Monitor circulation in the legs Signup and view all the answers

What is a common side effect of DMARDs that requires frequent monitoring?

Gastrointestinal symptoms Signup and view all the answers

What should be avoided when administering corticosteroids to prevent bruising?

Using tape on the skin Signup and view all the answers

What is a potential complication of joint replacement surgery that low-molecular-weight heparin aims to prevent?

Deep vein thrombosis (DVT) Signup and view all the answers

What element of postoperative care involves positioning to prevent displacement of the hip prosthesis?

Securing an abduction wedge or pillow Signup and view all the answers

What is the recommended time frame to take corticosteroids like prednisone for optimal efficacy?

Between 6 and 8 A.M. Signup and view all the answers

What is the most common dietary factor associated with an increased risk of gout?

High-protein diets Signup and view all the answers

Which joint is most commonly affected by gout?

Big toe Signup and view all the answers

What is the recommended duration for applying heat treatment to alleviate joint pain?

20 to 30 minutes Signup and view all the answers

Which of the following is a preventative treatment option for gout?

Allopurinol Signup and view all the answers

What is a key characteristic of the pain associated with gout?

Extreme and sudden onset Signup and view all the answers

What is the initial treatment for an acute gout attack?

Nonsteroidal anti-inflammatory drugs (NSAIDs) Signup and view all the answers

Which of the following is NOT recommended for cold treatment of inflammation?

Apply for more than 20 minutes Signup and view all the answers

Which of the following factors can lead to a secondary gout condition?

Diuretic therapy Signup and view all the answers

Which substance is commonly used as a topical treatment for muscle or joint soreness?

Menthol Signup and view all the answers

What is a potential side effect of allopurinol that requires careful monitoring?

Liver failure Signup and view all the answers

What immediate step is advised if numbness occurs during cold treatment?

Discontinue application Signup and view all the answers

What condition is characterized by the presence of calcium pyrophosphate crystals?

Pseudogout Signup and view all the answers

How much fluid intake is recommended per day for patients to help prevent kidney stones?

2000 to 3000 mL Signup and view all the answers

Which method is often used to confirm a diagnosis of gout?

Arthrocentesis Signup and view all the answers

What is recommended for patients in terms of body position while lying down?

Maintain a firm mattress and avoid flexion at joints. Signup and view all the answers

When should exercises not be performed by arthritis patients?

When joints are inflamed. Signup and view all the answers

Which method of exercise is least likely to strain joints?

Exercising in water. Signup and view all the answers

What should be done if pain persists for hours after completing an exercise?

Reassess the patient's status and revise the program. Signup and view all the answers

Which type of therapy is better suited for treating acutely inflamed joints?

Cold therapy. Signup and view all the answers

What is a key precaution when applying heat to a body part with decreased sensation?

Always place a cloth between the heat source and skin. Signup and view all the answers

Which dietary advice is appropriate for patients suffering from arthritis?

Maintain a well-balanced diet without excess or limitations. Signup and view all the answers

What is the best approach to help patients cope with chronic illness like arthritis?

Evaluate coping ability and provide support group referrals. Signup and view all the answers

How should energy be conserved for arthritis patients during daily tasks?

By breaking tasks into smaller segments and resting as needed. Signup and view all the answers

What is a common misconception about the relationship between diet and arthritis?

Certain diets can cure arthritis. Signup and view all the answers

What is important when teaching patients about joint protection?

Use larger muscles and joints for tasks. Signup and view all the answers

What role does psychological support play for arthritis patients?

Enhancing self-esteem and coping mechanisms. Signup and view all the answers

What is the primary purpose of applying heat or cold treatments?

To minimize pain and improve range of motion. Signup and view all the answers

Study Notes

Connective Tissue Disorders

Sprains: Partial or complete tearing of ligaments.
Grade I (mild): Tenderness, minimal swelling, no loss of function, no abnormal motion. Microscopic ligament tearing.
Grade II (moderate): Severe pain (especially with weight bearing), swelling, bleeding into joint, some loss of function. Partial ligament tear.
Grade III (severe): Pain (may be less severe), marked swelling, loss of function, bleeding. Complete ligament tear, joint instability.
Treatment (RICE): Rest, ice (10-20 min every 1-2 hours for 24-72 hours), compression (elastic bandage), elevation.
Long-term immobilization: Can lead to muscle atrophy, potentially permanent disability.
NSAIDs: Can decrease pain and swelling, but prolonged use may delay healing.
Surgical repair: In some cases, particularly Grade III sprains.

Strains

Strains: Pulling or tearing of a muscle or tendon (or both) from trauma, overuse, or overextension.
Common sites: Back muscles, hamstrings, quadriceps, calf muscles.
Similar to sprains: Clinically; however, affecting muscles and tendons instead of ligaments.
Treatment: Ice, compression, elevation, rest.
Heat: Can be applied after 48 hours.
Anti-inflammatory medications: Used for discomfort.
Muscle relaxants: May be prescribed if spasm is present.
Time: Crucial for healing.
Surgical repair: May be necessary.

Dislocations and Subluxations

Dislocation: Complete displacement of a bone in a joint, stretching and tearing surrounding ligaments.
Subluxation: Partial dislocation.
Common sites: Shoulder, knee, hip, ankle, temporomandibular joint.
Diagnosis: History (force, pain, muscle spasm, abnormal appearance), radiography (bone displacement).
Treatment: Reduction (under anesthesia or manually for shoulder); stabilization.
Nursing management: Pain control, rest of the affected area.

Rotator Cuff Tear

Cause: Repetitive activity (throwing, overhead motions), falls, trauma; degenerative.
Symptoms: Pain, inability to perform abduction and external rotation of the shoulder.
Treatment: Rest, sling support, NSAIDs.
Possible further treatment: Steroid or anti-inflammatory injections.
Exercises: Gentle, progressive exercises post-acute phase; heat before exercise.
Surgical repair: Sometimes needed.

ACL (Anterior Cruciate Ligament) Injury

Cause: Athletic activities, falls, motor vehicle accidents; hyperextension, internal rotation, external rotation, deceleration.
Symptoms: Loud “pop,” swelling, instability, difficulty with full leg extension.
Diagnosis: Physical examination, radiography, MRI.
Treatment: Immobilization, swelling reduction, pain management.
Possible treatment: Arthroscopy with ligament repair (tissue graft).
Recovery: CPM (continuous passive motion), long-leg brace.
Exercises: Isometric exercises (quadriceps setting, bent-knee leg exercises, foot exercises).

Meniscal Injury

Meniscus: Shock absorber in the knee, between tibia and femur.
Cause: Fixed-foot rotation in weight bearing with knee flexed during sports.
Symptoms: Mild swelling, joint pain, popping, slipping, catching, buckling.
Diagnosis: Physical examination (click, localized pain with joint movement), MRI.
Treatment: Arthroscopic repair.
Recovery: Pain management, exercise program.

Achilles Tendon Rupture

Achilles tendon: Attaches soleus, plantaris, gastrocnemius muscles to calcaneus (heel bone).
Cause: Overstretch, sports injury, falls.
Symptoms: Sudden pain at back of ankle or calf; loud “pop” or “snap”; visible/palpable depression above calcaneus; inability to point toes or stand on tiptoes.
Diagnosis: Examination, squeezing calf muscles while prone.
Treatment: Splinting, casting, or a combination with surgery.
Recovery: 6-8 weeks, followed by physical therapy.

Bursitis

Bursitis: Inflammation of bursae (sac-like structures around joints).
Cause: Injury, overuse.
Symptoms: Localized tenderness, mild-moderate aching pain (aggravated by joint activity), possible swelling.
Diagnosis: History, physical examination.
Treatment: Rest, anti-inflammatory agents, ice, massage, compression wrap.
Steroid injection: If other measures fail.

Bunion (Hallux Valgus)

Bunion: Painful swelling of bursa, great toe deviates laterally at metatarsophalangeal joint.
Cause: Hereditary, ill-fitting shoes.
Treatment: Wider shoes (soft leather, athletic), metatarsal pads.
Steroid injections: For active bursitis.
Surgery: Bone realignment to correct severe cases.

Carpal Tunnel Syndrome

Carpal tunnel syndrome: Median nerve compression in wrist’s carpal tunnel.
Cause: Repetitive hand/wrist movements (flexion), sometimes unknown.
Symptoms: Pain, numbness, tingling in hand (especially at night).
Diagnosis: Physical examination, compression test, electromyography (EMG).
Treatment: Rest, splinting, changing wrist angle during repetitive tasks, steroid injection.
Surgery: Surgical decompression of median nerve (carpal ligament transection). Post-operative care includes hourly assessments for blood flow, sensation, and edema management.

Fractures

Fractures: Breaks in bone continuity.
Cause: Trauma, pathological processes (e.g., osteoporosis).
Classification: Complete/incomplete, comminuted, closed/open (simple/compound), greenstick (common in children).
Mechanism of injury: Important for predicting tissue damage.
Treatment: Immobilization (splint it as it lies); preventing shock, hemorrhage.
Reduction: Bringing broken bone fragments into alignment (closed or open).
Stabilization: Internal fixation (pins, plates, screws), external fixation (device), casts, splints, braces.
Healing stages: Hematoma formation, granulation tissue formation, callus formation, ossification, consolidation/remodeling.
Complications: Infection (osteomyelitis), non-union, fat embolism, venous thrombosis, compartment syndrome.
Safety alert: Proton pump inhibitors (PPIs) can increase fracture risk in older adults. Weight and balance concerns are significant in older adults.

Compartment Syndrome

Compartment syndrome: Restricted blood flow in extremity muscle compartments.
Cause: External/internal pressure (e.g., tight cast, swelling).
Symptoms: Severe pain (out of proportion to injury), numbness/tingling, pallor, decreased pulses, weakness, cold to the touch.
Assessment: Note six Ps; pain, pallor, paresthesia, pulselessness, paralysis, poikilothermia.
Treatment: Bivalving cast, cutting dressings , fasciotomy (surgical incision in fascia), immediate intervention.

Musculoskeletal Patient Care: General

Assessment: Mechanism of injury, pain, swelling, discoloration, deformity, pulses, nerve function (flexion/extension, sharp/dull testing).
Post treatment: Pain control, prevent immobility complications (skin breakdown, UTIs, constipation, atelectasis, DVT), adequate nutrition/fluids.
Nutrition: Protein (1 g/kg body weight), vitamins D, B, C, calcium, fluids (2000-3000 mL/day), high fiber.

Older Adult Care Considerations (M.S.)

Increased fracture risk due to decreased reaction time, vision, agility, balance, muscle tone.
Fall precautions: Assess fall risk, provide balance exercises, assistive devices.

Inflammatory Disorders of the Musculoskeletal System

Lyme disease: Infection transmitted by ticks, causes arthritic symptoms.
Osteoarthritis: Degenerative joint disease, cartilage breakdown.
Rheumatoid arthritis (RA): Inflammatory joint disease, autoimmune response.
Gout: Arthritis caused by high uric acid levels.
Osteoporosis: Decreased bone mass, increased fracture risk.

Patient Teaching/Care (M.S.)

Cast care: Keep dry, avoid sharp objects, check for areas of pressure, monitor for signs of infection.
Traction: Monitor placement, alignment, and patient's tolerance.

Total Hip Replacement (THR)

Indications: Chronic hip pain from osteoarthritis.
Surgical approaches: Minimally invasive.
Minimally invasive procedures: Shorter hospital stays are possible.
Postoperative care: Abduction wedge/pillow, prevent dislocation, pain control, mobility, DVT prophylaxis.
Patient teaching: Positioning, exercise restrictions, weight bearing, transfers, daily activities

Total Knee Replacement

Indications: Uncontrollable knee pain from arthritis.
Care: Similar to THR, but emphasis on exercise, CPM machine, pain management.

Rheumatoid Arthritis (RA)

Management: Rest, exercise, medication for pain and inflammation (NSAIDs, DMARDs).
Medication considerations: Monitoring for side effects, especially in older adults.
Complementary/alternative therapies: Discuss safety considerations.

Gout

Treatment: NSAIDs, colchicine, corticosteroids; medication to control uric acid levels in the long term (allopurinol, probenecid)
Patient teaching: Diet management (low purine foods, limited alcohol), fluid intake.

Osteoporosis

Diagnosis: Radiography, DEXA, QCT.
Treatment: Calcium/vitamin D supplements; medications to prevent/treat bone loss.

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This quiz assesses knowledge on key topics in orthopedic nursing, including distinctions between injuries, postoperative care, and management of conditions like arthritis and osteoporosis. Test your understanding of connective tissue injuries and effective nursing interventions.