Chapter 46

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Questions and Answers

What is the primary cause of inflammation in chronic impingement syndrome?

Rheumatoid arthritis causing edema in the shoulder joint

Tear of the supraspinatus tendon from the bone

Entrapment of tendons and bursae under the acromion bone (correct)

Compression of the median nerve in the carpal tunnel

Which diagnostic method is most effective at identifying rotator cuff injuries?

Magnetic resonance imaging (MRI) of the shoulder joint (correct)

Physical examination and range of motion assessment

The Phalen test for wrist flexion related symptoms

Electromyography (EMG) to detect nerve abnormalities

What is a common symptom of carpal tunnel syndrome?

Coolness, lack of pulse, and pale skin in the affected extremity

Inflammation and limited range of motion in the shoulder

Sudden, sharp shoulder pain when lifting the arm

Progressive pain and numbness in the fingers, hand, and arm (correct)

What is the purpose of the Phalen test in diagnosing carpal tunnel syndrome?

To identify neurological compromise in the wrist through numbness with flexion (D) Signup and view all the answers

Which intervention is NOT typically used in the initial treatment of carpal tunnel syndrome?

Endoscopic or open incision surgery (A) Signup and view all the answers

A patient reports increased shoulder pain, especially at night, and weakness with certain arm movements. Which condition aligns most with these symptoms?

Rotator cuff tear secondary to chronic impingement (D) Signup and view all the answers

What is the primary reason for avoiding placing a wet cast on a pillow?

It traps heat and increases the risk of thermal injury. (C) Signup and view all the answers

How often should a patient with a wet plaster cast be repositioned to prevent flattening during the drying process?

Every 1 to 2 hours. (A) Signup and view all the answers

What is the primary focus of physical therapy after surgery for a rotator cuff injury or carpal tunnel syndrome?

To recover extremity function and range of motion (C) Signup and view all the answers

What is the main reason for using ergonomic devices in occupations with repetitive hand movements?

To minimize pressure in the wrist area, avoiding further inflammation (D) Signup and view all the answers

In the first 48 hours after cast application, what is the recommended method of reducing swelling?

Elevating the extremity above the level of the heart and icing. (D) Signup and view all the answers

What is a key intervention to maintain tissue integrity inside the cast?

Ensuring the cast edges are smooth and covered to prevent rubbing (D) Signup and view all the answers

How should a patient be instructed to manage itching inside a cast?

By blowing cool air into the cast using a blow dryer or tapping on the cast. (D) Signup and view all the answers

What does 'open reduction with internal fixation' involve?

Reducing a fractured bone through a surgical incision while using hardware for stabilization. (D) Signup and view all the answers

What is a typical cause for potentially removing internal fixation hardware in long-bone surgery?

Due to loosening or pain. (A) Signup and view all the answers

Which demographic is most affected by hip fractures?

Older adults (C) Signup and view all the answers

What is the recommended waiting period after taking the medication before the patient can take other medications?

30 minutes (B) Signup and view all the answers

What is the primary function of synthetic thyroid hormone calcitonin in osteoporosis treatment?

Decreases bone loss (C) Signup and view all the answers

Which of the following medications increases bone mass by mimicking the effects of estrogen?

Raloxifene (D) Signup and view all the answers

What dietary changes should a patient focus on to help prevent osteoporosis?

Increase calcium and vitamin D intake (C) Signup and view all the answers

How does teriparatide contribute to bone mass increase in patients?

By increasing osteoblast action and number (B) Signup and view all the answers

Which type of exercise is most beneficial for stimulating bone building?

Weight-bearing exercise (A) Signup and view all the answers

What should patients be taught to create a safer environment in their homes?

Create a hazard-free environment without obstacles (A) Signup and view all the answers

What type of medication is denosumab classified as in the context of osteoporosis treatment?

Monoclonal antibody (B) Signup and view all the answers

What is the primary goal of occupational therapy in relation to a patient's work skills?

To assess the need for changes or new training in work (D) Signup and view all the answers

Which nursing diagnoses are relevant to a patient with a bone fracture?

Impaired Physical Mobility and Bathing Self-Care Deficit (B) Signup and view all the answers

Which of the following is an expected outcome for managing fatigue in patients?

Decreased episodes of fatigue (A) Signup and view all the answers

Which action is important for a nurse to take when addressing a patient's fatigue due to chronic pain?

Ensure regular rest periods to conserve energy (A) Signup and view all the answers

What essential information should be covered in patient education for someone diagnosed with rheumatoid arthritis?

Medication management and comprehensive care plan (B) Signup and view all the answers

What resources should be informed to patients with rheumatoid arthritis regarding support?

Support groups and community resources available (D) Signup and view all the answers

What might be necessary if a patient with rheumatoid arthritis needs job training for a different occupation?

Involving a vocational counselor for assistance (D) Signup and view all the answers

Which of the following symptoms may indicate complications in a patient with rheumatoid arthritis?

Swelling and pain in the joints (C) Signup and view all the answers

What preoperative measure is taken to reassure patients concerned about receiving donor blood?

Performing a preoperative autologous blood donation (A) Signup and view all the answers

What type of intervention might be scheduled for the patient within two hours after returning to their hospital room?

Ambulation sessions with the physical and occupational therapist (C) Signup and view all the answers

What was the pain level reported after the surgery?

8 out of 10 (D) Signup and view all the answers

Which of the following is a common complication after a total hip replacement (THR)?

Hip dislocation (C) Signup and view all the answers

How can microabrasions be prevented during preoperative skin preparation?

By avoiding shaving the skin (D) Signup and view all the answers

How long after surgery did the individual start using a cane?

One month after surgery (D) Signup and view all the answers

What is indicated by an audible 'pop' and immediate pain in the hip following surgery?

Hip dislocation (D) Signup and view all the answers

What type of medication was prescribed for pain relief at home?

Acetaminophen/hydrocodone (Norco) (C) Signup and view all the answers

Which type of therapy is NOT mentioned as part of pain management post-THR?

Acupuncture (C) Signup and view all the answers

What important aspect did the nurses focus on during recovery?

Pain level assessment (B) Signup and view all the answers

What components are required for a total knee replacement?

Femoral component, tibial component, patellar button (C) Signup and view all the answers

What should a nurse obtain preoperatively that is crucial for ensuring patient safety during and after surgery?

Patient history, including allergies and medications (C) Signup and view all the answers

What is one of the primary focuses of nursing interventions after total hip replacement surgery?

Preventing complications such as dislocation (D) Signup and view all the answers

How long did it take for the individual to start driving after the surgery?

Four weeks (B) Signup and view all the answers

Which is not a concern for nursing care after total knee replacement?

Dislocation prevention (A) Signup and view all the answers

What complication is described for both total hip replacement and total knee replacement?

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

Study Notes

Learning Outcomes

Explain the pathophysiology, signs, symptoms, and complications of fractures.
Plan nursing care for patients in splints, casts, traction, or external fixation.
Describe the causes and prevention of osteomyelitis.
Plan nursing care for osteomyelitis.
Describe risk factors, pathophysiology, treatment, and nursing care for osteoporosis.
Describe the pathophysiology, treatment, and nursing care for gout.
Compare care for osteoarthritis and rheumatoid arthritis.
Plan nursing care for patients with fractured hips.
Plan nursing care for patients undergoing total joint replacement.
Explain patient teaching for patients with lower extremity amputations and prosthetics.

Bone and Soft Tissue Disorders

Strains

A strain is an excessively stretched muscle or tendon.
Causes include falls, overexertion, and heavy lifting.
Mild strains cause minimal inflammation with tenderness and swelling.
Moderate strains involve a partial tear in muscle or tendon fibers, causing pain and limited movement.
Severe strains involve a rupture of the muscle or tendon, causing significant pain and disability.
RICE (Rest, Ice, Compression, and Elevation) therapy is used for strains.
Prescription medications, such as NSAIDs and muscle relaxants, may be prescribed.

Sprains

A sprain is excessive stretching of ligaments from twisting movements.
Mild sprains involve a few torn ligament fibers causing tenderness.
Moderate sprains involve more torn fibers, but the joint remains stable.
Severe sprains cause joint instability and require surgical intervention.
RICE and NSAIDs are used for treatment.

Dislocations

A dislocation occurs when the ends of bones in a joint are out of their normal alignment, usually due to trauma or disease like rheumatoid arthritis.
Symptoms include severe pain, loss of joint range of motion, and joint deformity.

Burns

BE VIGILANT for patients with disease processes that could result in dislocation or fracture
BE SAFE! Avoid using patient's extremities in lifting/moving, use appropriate equipment
Bursae (fluid-filled sacs): cushion tendons during movement
Bursitis: inflammation of a bursa due to arthritis, gout, repetitive movement, infection or improper posture
Symptoms: pain, stiffness, swelling, redness, or burning pain over the joint area; worsens with activity, usually subsides within 1 week
Treatments: rest, ice, ultrasound, massage, NSAIDs, antibiotics (if infection)

Rotator Cuff Injuries

Short tendons connected to shoulder muscles form the rotator cuff.
Chronic impingement syndrome is a possible cause of tear in supraspinatus tendon or bursae
Symptoms: shoulder ache, increase pain with lifting, nighttime pain, weakness, limited range of motion.
Treatment: rest, ice, NSAIDs, physical therapy; severe cases may need surgery.

Carpal Tunnel Syndrome

Compression of the median nerve in the carpal tunnel results in numbness and pain.
Causes: swelling, trauma, rheumatoid arthritis, repetitive movements
Symptoms: slow-onset finger, hand, and arm pain and numbness; eventually may include muscle weakness.
Treatment: splints, NSAIDs, cortisone injections, surgery to release median nerve.

Fractures

A fracture is a break in a bone.
Causes can include falls, accidents, crushing injuries, bone diseases (e.g., osteoporosis), medications, or diet.
Symptoms can include pain, tenderness, swelling, discoloration, and loss of function.
Diagnostic tests include X-rays, CT scans, or MRIs to visualize the fracture and extent of soft tissue damage.
Treatment often involves reduction (alignment) of the bone fragments, immobilization (e.g., with a cast or splint), and potentially surgical repair.

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Description

Test your knowledge on physical therapy interventions, common injuries like rotator cuff injuries and carpal tunnel syndrome. This quiz covers diagnostic methods, symptoms, and treatment approaches related to these conditions. Improve your understanding of therapeutic practices that promote recovery and health.