PrepU Chapter 40: Musculoskeletal Care
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Questions and Answers

What is a bivalve cast?

A bivalve cast is when the cast is cut in two if the leg swells, if a sharp x-ray is needed, or as a splint for immobilizing painful joints when a client has arthritis.

What action by the nurse is most appropriate when a client with a fiberglass cast yells that their leg is burning?

  • Administer antianxiety and pain medication.
  • Remove the cast immediately, notifying the physician.
  • Explain that the sensation being felt is normal and will not burn the client. (correct)
  • Call for assistance to hold the client in the required position until the cast has dried.

    • Where should the nurse assess for the presence of a pressure ulcer in a client with an arm cast?

  • Radial styloid
  • Lateral malleolus
  • Olecranon
  • Ulna styloid (correct)

    • Which intervention takes priority for a client requiring skeletal traction?

    <p>Maintaining traction continuously to ensure its effectiveness</p> Signup and view all the answers

    Which instruction should the nurse include when teaching a client with a cast about home care?

    <p>Dry a wet fiberglass cast thoroughly to avoid skin problems</p> Signup and view all the answers

    Which type of cast encloses the trunk and a lower extremity?

    <p>Hip spica</p> Signup and view all the answers

    Which would be an inappropriate initial pain relief measure for the client with a cast?

    <p>Application of a new cast</p> Signup and view all the answers

    Which intervention should the nurse implement with a client who has undergone a hip replacement?

    <p>Instruct the client to avoid internal rotation of the leg.</p> Signup and view all the answers

    What complication should the nurse closely monitor for during the immediate postoperative period of a leg amputation?

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

    Which statement accurately describes hip spica cast?

    <p>Encloses the trunk and a lower extremity.</p> Signup and view all the answers

    Which statement accurately describes external fixation?

    <p>The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins.</p> Signup and view all the answers

    A client is having a cast applied for a fractured leg that extends from below the knee to the base of the toes. What type of cast is being applied?

    <p>Short leg cast</p> Signup and view all the answers

    Which device is designed specifically to support and immobilize a body part in a desired position?

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

    Which would be contraindicated as a component of self-care activities for the client with a cast?

    <p>Cover the cast with plastic to insulate it</p> Signup and view all the answers

    Which cleansing solution is the most effective for use in completing pin site care?

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

    When discussing physical activities with the client who has just undergone a right total hip replacement, which instruction should the nurse provide?

    <p>Limit hip flexion to 90 degrees.</p> Signup and view all the answers

    What is the nurse's priority intervention for a client with a spica cast?

    <p>Keep the cast clean and dry.</p> Signup and view all the answers

    A client who is undergoing skeletal traction reports pressure on bony areas. Which action would be most appropriate?

    <p>Changing the client's position within prescribed limits.</p> Signup and view all the answers

    What procedure refers to the excision of damaged joint fibrocartilage?

    <p>Excision of damaged joint fibrocartilage</p> Signup and view all the answers

    Why does the cast for a fractured ankle need to go all the way up the arm?

    <p>The joint above the fracture and below the fracture must be immobilized.</p> Signup and view all the answers

    What symptoms would confirm suspicions of compartment syndrome?

    <p>Decreased sensory function</p> Signup and view all the answers

    When should an older adult patient begin assisted ambulation with a walker after hip replacement?

    <p>24 hours</p> Signup and view all the answers

    What clinical manifestation indicates a dislocated prosthesis after a total left hip arthroplasty?

    <p>The left leg is internally rotated.</p> Signup and view all the answers

    Which of the following would be most important for the client?

    <p>Exploring factors related to the client's home environment</p> Signup and view all the answers

    Which is an inaccurate principle of traction?

    <p>Skeletal traction is interrupted to turn and reposition the client.</p> Signup and view all the answers

    Which principle applies to the client in traction?

    <p>Skeletal traction is never interrupted.</p> Signup and view all the answers

    Which statement by the client indicates further education is needed regarding fiberglass cast care?

    <p>Under no circumstances should I get my cast wet.</p> Signup and view all the answers

    How does the nurse expect the patient with a suspected bone fracture of the right arm to describe the pain?

    <p>Sharp and piercing</p> Signup and view all the answers

    Based on the client's anxiety about skeletal traction, which nursing diagnosis is most appropriate?

    <p>Ineffective Coping related to prolonged immobility</p> Signup and view all the answers

    How should the nurse assess for a positive Homans' sign?

    <p>Have the patient extend each leg and dorsiflex each foot.</p> Signup and view all the answers

    What is the purpose of a continuous passive motion (CPM) device after total knee replacement?

    <p>CPM increases range of motion of the joint.</p> Signup and view all the answers

    What lethal postoperative complication should the nurse closely monitor for in a patient who had a total hip replacement?

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

    Which actions would be the priority for a client with external fixation?

    <p>Maintaining pin care.</p> Signup and view all the answers

    Which intervention should the nurse include in the care plan for a client in skeletal traction?

    <p>Teach the client how to prevent problems caused by immobility.</p> Signup and view all the answers

    Which nursing intervention has the highest priority for a client in traction to treat a fractured femur?

    <p>Assessing the extremity for neurovascular integrity</p> Signup and view all the answers

    What would the physician prescribe as further treatment after cast removal for a right leg fracture?

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

    What type of surgical procedure will the nurse prepare the client for regarding severe osteoarthritis in the left hip?

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

    Which is a benefit of a continuous passive motion (CPM) device when applied after knee surgery?

    <p>It promotes healing by increasing circulation and movement of the knee joint.</p> Signup and view all the answers

    Why is a splint applied instead of a cast for arm injury?

    <p>We will need to monitor the status of the laceration to be sure it does not get infected.</p> Signup and view all the answers

    What will the nurse alert the client to as the cast is applied?

    <p>Sensation of warmth or heat with application</p> Signup and view all the answers

    Which actions by the nurse demonstrate an understanding of caring for a client in traction?

    <p>Frequently assessing pain level</p> Signup and view all the answers

    What type of treatment is identified when a client's fracture is reduced by surgically exposing the bone?

    <p>Open reduction</p> Signup and view all the answers

    Which statement by the client indicates effective teaching regarding skeletal traction?

    <p>Metal pins will go through my skin to the bone.</p> Signup and view all the answers

    What is the priority action of the nurse observing shortening of the extremity and severe pain after total right hip arthroplasty?

    <p>Notify the health care provider.</p> Signup and view all the answers

    Which interventions would the nurse implement with the client in skeletal traction? Select all that apply.

    <p>Ensure the pins or wires are covered with caps.</p> Signup and view all the answers

    Which action should the nurse include in the care plan for a client with a fiberglass cast?

    <p>Assessing movement and sensation in the fingers of the right hand</p> Signup and view all the answers

    Which complication is not possible in the immediate postoperative period after a leg amputation?

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

    Which would be contraindicated as a component of self-care activities for the client with a cast?

    <p>Cover the cast with plastic to insulate it</p> Signup and view all the answers

    Which comment by the client following plaster cast application should the nurse address first?

    <p>My toes are stiff.</p> Signup and view all the answers

    Which is an advantage of a plaster cast?

    <p>Better molding to the client</p> Signup and view all the answers

    What is the best response by the nurse when a client asks why a splint is being applied instead of a cast?

    <p>A splint is applied when more swelling is expected at the site of injury.</p> Signup and view all the answers

    What treatment will the nurse expect for a client with compartment syndrome?

    <p>A fasciotomy</p> Signup and view all the answers

    Which statement indicates the need for further education among staff nurses on the orthopedic floor?

    <p>The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device.</p> Signup and view all the answers

    Which finding requires the nurse to intervene while checking a traction apparatus?

    <p>Weights hanging and touching the floor</p> Signup and view all the answers

    Which device is designed specifically to support and immobilize a body part?

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

    Which intervention will help relieve pain following orthopedic surgery?

    <p>Elevate the affected extremity and use cold applications.</p> Signup and view all the answers

    Which nursing action helps prevent deep vein thrombosis in a client after orthopedic surgery?

    <p>Apply antiembolism stockings</p> Signup and view all the answers

    What advice should the nurse give to a client worried about mottled skin after cast removal?

    <p>Apply lotions and take warm baths or soaks.</p> Signup and view all the answers

    Which statement is accurate regarding care of a plaster cast?

    <p>The cast can be dented while it is damp.</p> Signup and view all the answers

    What symptom of a fractured clavicle should the nurse recognize?

    <p>Right shoulder slopes downward and droops inward.</p> Signup and view all the answers

    What procedure will be scheduled for the client diagnosed with severe degenerative joint disease of the left hip?

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

    Which action is most important postoperatively for a client who has had a knee or hip replacement?

    <p>Assisting in early ambulation.</p> Signup and view all the answers

    Which instruction should the nurse include when teaching the client following hip replacement surgery? Select all that apply.

    <p>Place pillows between your legs when you lay on your side.</p> Signup and view all the answers

    What is the priority action for a client with a long arm cast complaining of unrelieved throbbing pain?

    <p>Assess for complications.</p> Signup and view all the answers

    Which is not a guideline for avoiding hip dislocation after replacement surgery?

    <p>The hip may be flexed to put on clothing.</p> Signup and view all the answers

    Which action by the nurse would be inappropriate for the client following casting?

    <p>Protect the cast by covering with a sheet.</p> Signup and view all the answers

    For a tibia fracture, what should the nurse prepare the client for regarding wound management?

    <p>Cutting a cast window</p> Signup and view all the answers

    About which comment by the client regarding open reduction with internal fixation should the nurse be most concerned?

    <p>I was worried I would have an incision and scar.</p> Signup and view all the answers

    What is an appropriate nursing diagnosis for a client who lives alone and had a total knee replacement?

    <p>Risk for ineffective therapeutic regimen management</p> Signup and view all the answers

    What complication do the nursing assessment findings indicate after an open reduction with internal fixation of the right hip?

    <p>Hypovolemic shock</p> Signup and view all the answers

    Which of the following is an example of skin traction?

    <p>Buck's</p> Signup and view all the answers

    Study Notes

    Traction Principles and Management

    • Traction weights should hang freely without interruption; skeletal traction is never interrupted.
    • Positioning is critical; clients must be aligned centrally in bed to optimize traction effectiveness.
    • Trapeze bars can aid client mobility and assessment of alignment.

    Cast Care and Client Education

    • Certain fiberglass casts may be waterproof, permitting limited wet exposure.
    • Applying a splint rather than a cast often allows for monitoring accompanying skin injuries, such as lacerations.
    • Clients must avoid covering casts with plastic to prevent moisture accumulation.
    • Ineffective coping may arise in clients facing prolonged immobilization; address emotional concerns.
    • Monitor for signs of compartment syndrome post-cast application; stiffness in toes can be an early warning sign.

    Postoperative Care and Rehabilitation

    • Continuous Passive Motion (CPM) devices enhance circulation and increase knee joint range of motion after surgery.
    • Physical therapy is critical following a cast removal to regain strength and mobility in the affected limb.
    • Hypovolemic shock can present with elevated heart rates, low blood pressure, and diminished urine output in postoperative clients.

    Identifying and Treating Complications

    • Recognize manifestations such as acute groin pain and limb shortening as possible indicators of hip prosthesis dislocation.
    • Fasciotomy is a definitive treatment for compartment syndrome complications.
    • Urgency is necessary when unrelieved pain occurs after surgery; assess for complications first.

    Surgical Procedures in Orthopedics

    • Total arthroplasty involves complete joint replacement, while hemiarthroplasty replaces only one surface of the joint.
    • Open reduction and internal fixation are frequently employed for complex fractures requiring direct visualization.
    • Buck's traction is specifically classified as skin traction, while other methods such as skeletal traction involve more invasive devices.

    Special Considerations for Older Adults

    • Assess home safety and rehabilitation needs for older adults post-surgery, particularly after total hip replacements.
    • Encourage proper nutrition to aid recovery, emphasizing protein, calcium, and vitamin D intake.

    Pain Assessment in Fractures

    • Pain from fractures is typically sharp and localized, differing from other musculoskeletal pain descriptions.
    • Prompt evaluation and intervention can prevent complications from missed diagnoses following traumatic events.

    General Principles of Cast and Traction Care

    • Casts should be handled by the palms to maintain their integrity and should not be covered with sheets that inhibit drying.
    • Regular assessment of neurovascular status (movement and sensation) in casted limbs is essential to prevent complications.### Pain Management in Musculoskeletal Conditions
    • Elevate the injured area, apply ice packs, and use prescribed analgesics for pain relief.
    • Fracture pain typically requires immobilization for effective control.
    • Edema-related pain, due to trauma or surgery, can often be alleviated with elevation and cold therapy.
    • Ice packs should not indent or wet casts; apply on both sides if needed.
    • Persistent or excessive pain may indicate complications, such as compartment syndrome, which resists standard pain management techniques.
    • Observe for severe burning pain over bony prominences to prevent pressure ulcers, especially from tight elastic wraps.

    Assessing for Complications

    • Positive Homans' sign is assessed by extending each leg and dorsiflexing the foot to check for pain, indicating possible deep vein thrombosis (DVT).
    • Following total hip replacement, closely monitor for pulmonary embolism due to increased risk of venous thromboembolism.

    Care Interventions in Traction and Casts

    • Clients in skeletal traction with a Thomas leg splint need education on immobility complications.
    • Neurovascular integrity assessment of the affected extremity is crucial; maintain continuous traction.
    • Continuous Passive Motion (CPM) devices increase joint circulation and promote healing post-surgery.
    • Sensation of warmth during cast application is normal; cast should not be excessively wet.
    • Open reduction involves surgically realigning the bone, while internal fixation uses hardware for stabilization.

    Postoperative Care and Safety Guidelines

    • Antiembolism stockings are effective in preventing DVT.
    • Regular skin inspections and ensuring pins in skeletal traction are properly capped are essential.
    • Education for clients post-hip surgery includes using aids such as raised toilet seats and avoiding leg crossing.
    • Monitoring for complications post-amputation focuses on hematoma and hemorrhage, while chronic osteomyelitis is a later concern.

    Plaster Cast Care and Education

    • Plaster casts allow for better molding but take longer to dry than fiberglass casts.
    • Splints are preferred for injuries with expected swelling as they allow for adjustment.
    • Ensure casts are not covered with plastic to prevent moisture buildup.
    • Instruct clients on drying techniques for wet fiberglass casts to maintain skin integrity.

    Trauma and Injury Management

    • For knee or hip replacements, prioritize early ambulation to prevent complications.
    • Clients should recognize that flexing the hip to dress is contrary to dislocation prevention guidelines.
    • Assess for pressure ulcers at common sites, such as the ulnar styloid for upper extremities.
    • Maintaining effective skeletal traction by allowing weights to hang freely is critical for treatment success.

    Summary of Key Devices

    • Splints support and immobilize body parts, while braces offer external support.
    • CPM devices facilitate movement to enhance healing.
    • Hip spica casts encase the trunk and lower limb, while long, short, and body casts serve other immobilization purposes.### Cast Types and Applications
    • A body cast encloses the trunk, while a long-leg cast extends from the upper thigh to the base of the toes.
    • A short-leg cast is defined as extending from below the knee to the base of the toes.
    • A hip spica cast encloses the trunk and one lower extremity, with double hip spica casts enclosing both legs.

    Pain Management and Postoperative Care

    • Application of a cold pack, elevation of the casted limb, and administration of analgesics are effective pain relief methods.
    • Avoid using a new cast as an initial pain relief measure.
    • Following a hip replacement, clients should avoid internal rotation and keep the leg from crossing the midline to prevent dislocation.

    Postoperative Complications

    • Hematoma is a primary concern in the immediate postoperative period following a leg amputation, alongside hemorrhage and infection.
    • Neuromas, chronic osteomyelitis, and causalgia are complications that may arise later.

    External and Internal Fixation

    • External fixation involves inserting metal pins from outside the skin to stabilize bones.
    • Internal fixation includes securing the bone with screws, plates, rods, or nails.

    Cast Care and Self-Care Activities

    • A splint supports and immobilizes a body part.
    • Covering a cast with plastic is contraindicated due to moisture buildup, which can compromise the cast and skin integrity.
    • Chlorhexidine is preferred for pin site care due to its effectiveness, while hydrogen peroxide and betadine may harm healthy tissue.

    Hip Replacement Rehabilitation

    • Clients should limit hip flexion to 90 degrees and avoid crossing legs to reduce dislocation risk.
    • Ambulation should begin the day after surgery, adhering to specific weight-bearing instructions based on the prosthesis type.

    Spica Cast Management

    • Keeping a spica cast clean and dry is critical, particularly around the perineal area.
    • The client should be positioned on the unaffected side regularly to prevent complications.

    Traction and Comfort Measures

    • Adjusting the client's position can relieve pressure from skeletal traction, enhancing comfort.
    • Analgesic medications might help with pain but will not alleviate pressure on bony areas.

    Meniscectomy Procedure

    • A meniscectomy involves excising damaged joint fibrocartilage, particularly in the knee.

    Fracture and Cast Immobilization

    • Immobility of joints above and below a fracture site is essential for healing.
    • Compartment syndrome symptoms include decreased sensory function, severe pain, and loss of motion; immediate assessment and intervention are vital.

    Ambulation Post-Hip Arthroplasty

    • Assisted ambulation with a walker should commence within 24 hours of total hip replacement surgery.

    Dislocation Indications

    • Leg internal rotation is a key indicator of potential dislocation following hip arthroplasty, necessitating immediate assessment.

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    Description

    Test your knowledge on the principles of traction as covered in PrepU Chapter 40 on Musculoskeletal Care. This quiz covers key concepts and definitions related to skeletal traction and patient alignment. Challenge yourself to identify inaccurate principles and reinforce your understanding of musculoskeletal care.

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