Interventions Musculoskeletal Trauma Part 1

Front 1

What does venous thromboembolism (VTE) include?

Back 1

deep vein thrombosis (DVT)pulmonary embolism (PE)

Front 2

DVTs often develop in people who are immobile because of?

Back 2

traumasurgerydisability

Front 3

DVTs are the most common complication of?

Back 3

lower extremity surgery or trauma

Front 4

DVTs are the most fatal complication of?

Back 4

musculoskeletal surgery

Front 5

Who may be at risk for DVTs?

Back 5

smokerobeseheart diseasetaking oral contraceptives or hormoneshistory of thromboembolitic complications

Front 6

The incidence of life-threatening embolic conditions is highest in older adults, particularly during the first ___ to ___ days after musculoskeletal surgery, usually hip repair

Back 6

two to three days

Front 7

DVT that leads to PE is more likely to develop in clients with fractures of the _____ _____ and _____.

Back 7

lower extremitiespelvis

Front 8

Local venous stasis secondary to trauma or surgical procedures (? give an example ?) increases the chance of VTE in clients with musculoskeletal trauma.

Back 8

use of tourniquets in lower extremity injuries

Front 9

Define blood clot embolism?

Back 9

obstruction of pulmonary artery by a blood clot or clots

Front 10

What is the origin of blood clot embolism?

Back 10

85% from deep vein thrombosis in the legs or pelvis; can occur anytime

Front 11

What is the assessment finding for blood clot embolism?

Back 11

NO PETECHIAEaltered mental status (earliest sign)increased respirations, pulse, temperaturechest paindyspneacracklesdecreased Sao2retinal hemorrhage (not common)mild thrombocytopenia(these are the same as for fat embolism, except no petechiae)

Front 12

Treatment for blood clot embolism?

Back 12

preventive measures (e.g., leg exercises, antiembolism stockings, SCDs)bedrestoxygenpossibly mechanical ventilationanticoagulantsthrombolyticspossible surgery; pulmonary embolectomy; vena cava umbrella

Front 13

___ ____ are the most common type of infection resulting from orthopedic trauma

Back 13

wound infection

Front 14

Wound infections range from _____ skin infections to ____ wound abscesses.

Back 14

superficialdeep

Front 15

Infection can also be caused by _____ _______ used to repair a fracture surgically, such as pins, plates, or rods.

Back 15

implanted hardware

Front 16

_____ infections can result in gas gangrene or tetanus and can prevent the bone from healing properly.

Back 16

Clostridial

Front 17

What is osteomyelitis?

Back 17

bone infection

Front 18

Osteomyelitis is most common with ____ ____ in which skin integrity is lost and after surgical repair of a fracture.For clients experiencing this type of trauma, the risk of _____-_____ _____ is increased.

Back 18

open fractureshospital-acquired (nosocomial) infections

Front 19

Define osteonecrosis, ischemic necrosis, aseptic necrosis, avascular necrosis?(all are the same condition)

Back 19

blood supply to bone is disrupted, which results in death of bone tissue...often a complication of hip fractures or any fracture in which there is displacement of bone...surgical repair of fractures also can lead to necrosis because the hardware can interfere with circulation

Front 20

____ ______ are associated most commonly with high-energy fractures and twisting injuries in the lower extremities.

Back 20

Fracture blisters

Front 21

With fracture blisters, extensive tissue edema allows fluid to move into the weakened space between _______ and ______. The increased 2______ _____pressure then pulls more fluid into the space. Fracture blisters can lead to 3_____ infection and delayed fracture treatment, which may then contribute to potential nonunion. Nursing measures that can assist in preventing or minimizing fracture blisters include maintaining proper ______ before definitive treatment and elevation to limit edema.

Back 21

1 epidermis and dermis2 colloidal osmotic3 wound4 immobilization

Front 22

_____ union describes a fracture that has not healed within 6 months of injury.

Back 22

Delayed

Front 23

Some fractures never achieve 1_____; that is, they never completely heal (2_____); others heal incorrectly (3_____). These problems are most common in clients with 4_____ fractures, fractures for which a number of different treatment techniques have been used (e.g., cast, traction), and pathologic fractures

Back 23

1 union2 nonunion3 malunion4 tibial

Front 24

Union may also be _____ or not achieved in the older client.

Back 24

delayed

Front 25

If bone does not heal, the client typically experiences ___ and ____ from deformity.

Back 25

painimmobility

Front 26

Besides fractures, a cast may be applied for correction of _______, such as _____, or for prevention of deformities (rheumatoid arthrtitis-related).

Back 26

deformitiesclubfoot

Front 27

A 1_______ is well-fitted and is placed under the cast. If it's too tight, it may impair 2______. If it's too loose, it may lead to development of 3___ ____ and skin breakdown.

Back 27

1 stockinette2 circulation3 pressure ulcers

Front 28

So the stockinette is next to the skin...1_____ is applied over the stockinette, followed by wet 2____ rolls wrapped around the extremity or other body part. The cast feels hot because an immediate 3_____ ____ occurs, but it soon becomes damp and cool. This type of cast takes 4____ to ___ hours to dry, depending on size and location of cast. A 5____ cast feels cold, smells musty, and is grayish. The cast is dry when it feels hard and firm, is odorless, and has a shiny white appearance. The outside material is plaster-of-Paris (anhydrous calcium sulfate)

Back 28

1 padding2 plaster3 chemical reaction4 24 to 72 hours5 wet

Front 29

The rough edges of a cast can cause _____ because of crumbling. ______ the cast will resolve this problem, if the underlying stockinette does not cover the edges of the cast. Small strips of ____ are placed over the rough edges to protect the skin.

Back 29

irritationPetalingtape

Front 30

If skin under cast is disrupted, the hcp cuts a 1____ into the cast so that the wound can be observed and cared for. It is also used for taking 2____, removing wound 3____, or relieving abdominal distention when the client is in a body or 4____ cast.

Back 30

1 window2 pulses3 drains4 spica

Front 31

What is bivalving a cast?

Back 31

cutting it lengthwise into two equal pieces...either half can be removed for inspection or care...the two halves are then reunited by an elastic bandage wrap

Front 32

If a cast is too tight, it can be cut or _____ if bone healing is almost complete.

Back 32

bivalved

Front 33

What are some synthetic materials for casts (2)?

Back 33

fiberglasspolyester-cotton knit(lightweight and minimal drying time; synthetic is used more often than plaster-of-Paris)

Front 34

Fiberglass casts dry in ___ to ____ minutes and can bear weight ____ minutes after application.

Back 34

10 to 1530

Front 35

Polyester-cotton knit casts take ___ minutes to dry and can withstand weight bearing in about ____ minutes.

Back 35

7 20

Front 36

Some health care providers use 1 ____ casts for upper extremities and 2____-___-___ casts for lower extremities because it can bear more weight for a longer time.

Back 36

1 synthetic2 plaster-of-Paris

Front 37

Casts can be generally divided into four main groups?

Back 37

arm castsleg castscast bracesbody castsspica casts

Front 38

When a client is in bed with ARM CAST, the arm is 1____ ___ the heart to reduce swelling. The hand should be 2____ than the elbow.Ice may be prescribed for the first 3____ to ____ hours.Use a sling for comfort. The sling should distribute the weight over a large area of the 4_____ and 5_____, not just the neck.

Back 38

1 elevated above2 higher3 24 to 484 shoulders5 trunk

Front 39

Some hcps advise against the use of a sling after a few days because?

Back 39

not using a sling after a few days encourages normal movement of the mobile joints and enhances bone healing (this is especially true of short-arm cast)

Front 40

A LEG CAST permits mobility and requires the client to use ____ _____, such as ____.

Back 40

ambulatory aidscrutches

Front 41

A cast shoe, sandal, or boot that attaches to the foot or a rubber walking pad attached to the sole of the cast assists in ambulation (if weight bearing is allowed) and helps prevent?

Back 41

damage to the cast

Front 42

With a leg cast, the affected leg is elevated on several pillows to reduce swelling, and ice is applied for the first ___ hours or as prescribed.

Back 42

24 hours

Front 43

A 1___ ____ enables the client to bend unaffected joints while the fracture is healing. The fracture 2___ show signs of healing and minimal tissue edema before application of this cast. Two 3_____ casts are made and connected by a hinge to allow joint movement. As healing occurs, the casts may be removed and replaced with a 4____ ____. Commercial immobilizers, which serve the same function as a cast brace, are available and may be used in some cases.

Back 43

1 cast brace2 MUST3 cylindrical4 soft brace

Front 44

A 1____ ____ encircles the trunk of the body; a 2____ cast encases a portion of the trunk and one or two extremities...special challenges for nursing care.

Back 44

1 body cast2 spica

Front 45

Potential complications related to severe impairment in mobility exist for use of a spica cast (body cast). These include (4)?

Back 45

skin breakdownrespiratory dysfunction, such as pneumonia and atelectasisconstipationjoint contractures

Front 46

What is an uncommon, but serious complication seen in orthopedic clients who have been placed in a hip spica or body cast?

Back 46

cast syndrome (superior mesenteric artery syndrome)

Front 47

In cast syndrome (superior mesenteric artery syndrome), there is partial or complete upper intestinal obstruction resulting in what classic symptoms (4)?

Back 47

abdominal distentionepigastric painnauseavomiting(the vomiting often occurs after meals, and clients may have normal bowel sounds)

Front 48

In cast syndrome (sup. mes. art. syn), partial obstruction occurs initially from compression of the third portion of the 1____ between the superior mesenteric artery and the 2____. This progresses to complete obstruction from duodenal edema caused by continued vomiting and distention. Placing a 3____ in the abdominal portion of the cast or 4____ the cast may be sufficient to relieve pressure on the duodenum. Management of intestinal obstruction is the same as for any client with this complication.

Back 48

1 duodenum2 aorta3 window4 bivalving

Front 49

With plaster casts, be sure to warn the patient that ___ will be felt after the wet cast is applied and that the new cast is not covered to facilitate ___-___

Back 49

heatair-drying

Front 50

When a client with a wet plaster cast is moved and turned, the cast is handled with the ____ of the hands to prevent indentations and resultant areas of pressure on the skin.

Back 50

palms

Front 51

The client is turned every ___ to ___ hours to allow air to circulate and dry all parts of the cast.

Back 51

1 to 2

Front 52

If the client is hospitalized, a sign is placed at the head of the bed as a reminder that?

Back 52

the cast is wet and requires special handling.

Front 53

If the hcp requests that the cast be elevated to reduce swelling, a 1___-___ pillow is used instead of one encased in plastic, which could cause the cast to retain heat and prevent drying.

Back 53

1 cloth-covered

Front 54

Elevation of the casted extremity reduces 1___ but may impair arterial circulation to the affected limb.

Back 54

1 edema

Front 55

Types of cast braces (or brace casts) (2)?

Back 55

patellar weight-bearing castextremity polycentric knee hinge cast

Front 56

Type of body casts? (3)

Back 56

hip spica Risser's casthalo cast

Front 57

Use and description of a short arm cast (SAC)?

Back 57

upper extremity...extends from below elbow to and including part of the hand...used for stable fractures of the wrist (metacarpals, carpals, or distal radius

Front 58

Use and description of a long-arm cast (LAC)?

Back 58

upper extremity cast...includes the upper arm to and including part of the hand...includes the upper arm to and including part of the hand

Front 59

Use and description of a hanging-arm?

Back 59

upper extremity cast...same as LAC but heavier, with added loop at the mid-forearm...fractures of the humerus that cannot be aligned by LAC (light traction is possible while the client is in bed or by an attached strap that extends around the neck

Front 60

Use and description of a thumb spica cast?

Back 60

upper extremity cast...similar to SAC with the thumb casted in abduction...fractures of the thumb

Front 61

Use and description of a shoulder spica cast?

Back 61

upper extremity casts...the shoulder is casted in abduction with the elbow flexed...unstable fractures of theh shoulder girdle or humerus; dislocations of the shoulder

Front 62

Use and description of a short-leg cast (SLC)?

Back 62

lower extremity cast...from below the knee to the base of the toes...fractures of the ankle, metatarsals, or foot

Front 63

Use and description of a long-leg cast (LLC)?

Back 63

lower extremity casts... from the mid-upper thigh to the base of the toes...unstable fractures of the tibia, fibula, ankle

Front 64

Use and description of a walking cast?

Back 64

lower extremity cast...a walking device on the bottom of SLC or LLC...same as for SLC or LLC

Front 65

Use and description of a leg cylinder?

Back 65

lower extremity cast...similar to SLC, but the ankle and foot ar not casted...stable fractures of the tibia, fibula, or knee

Front 66

Use and description of a long-leg cylinder?

Back 66

lower extremity casts...ankle andn foot are not casted...stable fractures of the distal femur, proximal tibia, or knee

Front 67

Use and description of a patellar weight-bearing cast?

Back 67

cast brace (brace cast)...similar to SLC or leg cylinder...midshaft or distal shaft fractures of the femur

Front 68

Use and description of an external polycentric knee hinge cast?

Back 68

cast brace (brace cast)...a hinge connects the lower and upper leg and allows 90 degrees of knee flexion...same as for patellar weight-bearing cast

Front 69

Use and description of a hip spica?

Back 69

body cast...extends from below the nipple line down the affected leg {single}, down the leg and half of the unaffected leg {1.5), or down both legs {double}...dislocation of the hip; pelvic or hip injuries

Front 70

Use and description of a Risser's cast?

Back 70

body casts...the body jacket extends from the shoulders to beyond theh iliac crests and hips, with a large opening over the anterior chest)...scoliosis; thoracic spinal fractures

Front 71

Use and description of a halo cast?

Back 71

body casts...the body jacket contains a halo brace...fractures of the cervical spine

Front 72

For preventing contamination by ___ or ____, the perineal area of a dry long leg or body cast is encased in a plastic protective covering.

Back 72

urine or feces

Front 73

_____ pans are preferred over traditional bedpans because they are smaller and more comfortable for the client. Care is taken to prevent spillage on client.

Back 73

Fracture

Front 74

Check to ensure the cast is not too tight and fequently monitor the client's neurovascular status, usually every hour for the first ____ hours after application....be able to insert a finger between the cast and the skin. ____ may be applied for the first ___ hours to reduce swelling and inflammation.

Back 74

24Ice24

Front 75

Once the plaster cast is dry, it is inspected at least once every ___ hours for drainage, cracking, crumbling, alignment, and fit.

Back 75

8

Front 76

Plaster casts act like ____ and absorb drainage, whereas synthetic casts act like a ____, pulling drainage away from the drainage site.

Back 76

spongeswick

Front 77

1____ can also absorb wound drainage...drainage on any cast should always be measured and documented in the client record; circling drainage on cast may cause 2____ and is controversial.

Back 77

1 Padding2 anxiety

Front 78

_____ report to the hcp any sudden increases in the amount of drainage or change in the integrity of the cast.

Back 78

IMMEDIATELY

Front 79

After ____ decreases, it is not uncommon for the cast to become too loose and need replacement.

Back 79

swelling

Front 80

What are some casting complications that should be monitored during hospitalization and then patient teaching on discharge?

Back 80

infectioncirculation impairmentperipheral nerve damage

Front 81

_____ most often results from the breakdown of skin under the cast (pressure necrosis)

Back 81

Infection

Front 82

If pressure necrosis occurs, the client typically complains of a very painful "____ ___" under the cast, and the cast may feel warmer in the affected area.

Back 82

"hot spot"

Front 83

Smell the area for _____ or an unpleasant odor that would indicate infected material. If the infection progresses, a ____ may develop.

Back 83

mustinessfever

Front 84

1_____ impairment and peripheral nerve damage can result from constriction of the cast.

Back 84

1 Circulation

Front 85

A client with a new cast may require _____ neurovascular assessments.

Back 85

hourly

Front 86

A client with a cast that is ___ or ___ days old usually requires assessments every ___ to ____ hours.

Back 86

3 or 4 days4 to 8 hours

Front 87

The client with a cast may be _____ for a prolonged period, depending on the extent of the fracture and type of cast.

Back 87

immobilized

Front 88

What are signs of immobility to assess for?

Back 88

skin breakdown pneumoniaatelectasisthromboembolismconstipation

Front 89

What may the client feel while the cast is being removed?

Back 89

warmth

Front 90

Because of prolonged immobilization, a joint may become ______, usually in a fixed state of flexion, or degenerative arthritis may develop from lack of weight bearing, which is necessary for _____ viability.

Back 90

contractedcartilage

Front 91

Besides degenerated cartilage, _____ atrophy can occur from lack of exercise during prolonged immobilization of the affected body part, usually an extremity

Back 91

muscle

Front 92

Define traction?

Back 92

application of a pulling force to a part of the body to provide reduction, alignment, and rest.

Front 93

What can traction decrease?

Back 93

muscle spasm...this relieves pain, as well as corrects deformity and tissue damage...requires longer hospitalization

Front 94

What are two types of mechanical traction?

Back 94

continuous, as in fracture treatmentintermittent, for relief of muscle spasm in other types of musculoskeletal/ neurologic trauma, such as cervical nerve root compression

Front 95

Traction may also be classified as? (2)

Back 95

running tractionbalanced suspension

Front 96

What is running traction?

Back 96

the pulling force is in one direction and the client's body acts as countertraction

Front 97

What can alter running traction force?

Back 97

moving the body or bed position

Front 98

Why is balanced suspension important in countertraction?

Back 98

so that the pulling force of the traction is not altered when the bed or client is moved....allows for increased client movement and facilitates care

Front 99

Traction is typically one of five types?

Back 99

skin tractionskeletal tractionplaster tractionbrace tractioncircumferential traction

Front 100

Skin traction involves the use of a _____ boot (Buck's traction), belt, or halter, which is secured around a body part.

Back 100

Velcro

Front 101

What is the primary purpose of skin traction?

Back 101

to decrease painful muscle spasms that accompany fractures

Front 102

About how many pounds are used as a pulling force so as not to prevent injury to the skin?

Back 102

5 to 10 pounds

Front 103

In skeletal traction, pins, wires, tongs, or screws are surgically inserted directly into ____?

Back 103

bone

Front 104

Skeletal traction uses 1____ traction time and 2____ weights, usually 15 to 30 pounds...aids in bone 3______

Back 104

1 longer2 heavier3 realignment

Front 105

_____ traction combines skeletal traction and a plaster cast.

Back 105

Plaster

Front 106

A brace traction device exerts a ____ for correction of alignment deformities.

Back 106

pull

Front 107

_______traction uses a belt around the body, such as pelvic traction for low back problems.

Back 107

Circumferential

Front 108

Once traction is applied, maintain the correct balance between traction _____ and countertraction _____.

Back 108

pullforce

Front 109

Weights are NOT USUALLY removed without an _____ and are not usually lifted _____ or allowed to set on the floor. Weights should be freely ______ at all times.

Back 109

ordermanuallyhanging

Front 110

When in traction, inspect the skin at least every ___ hours for signs of ____ or inflammation.

Back 110

8 hoursirritation

Front 111

When possible, remove the belt or boot that is used for skin traction every ___ ___ to inspect under the device.

Back 111

8 hours

Front 112

When skeletal traction is used, pay particular attention to the points of entry of ____, ____, and ____ for signs of inflammation or infection. A small amount of clear fluid drainage ("weeping") is _____. Most hcps prefer that pin care is performed every day.

Back 112

pinswiresscrewsexpected

Front 113

When in traction, observe pin sites at least every ____ hours for drainage, color, odor, and severe redness, which indicate inflammation and possible infection

Back 113

8 hours

Front 114

Cleaning the pins may disrupt skin's natural barrier to _____...may be advised against it.

Back 114

infection

Front 115

Infection of the pin _____ MAY result in osteomyelitis.

Back 115

tract

Front 116

The nurse is responsible for checking _____equipment to ensure its proper functioning.

Back 116

traction

Front 117

The nurse should check all ropes, knots, andn pulleys at least every ___ ___ for loosening, fraying, and positioning.

Back 117

8 hours

Front 118

Check the traction weight for consistency with ___ order...order can be changed without notification...contact person responsible to confirm change

Back 118

hcp

Front 119

Sometimes one of the weights is accidentally _____ by a staff member or visitor who bumps into it. Replace the weights if they are not correct, and notify the hcp or orthopedic technician.

Back 119

displaced

Front 120

If the client complains of severe ____ from muscle spasm, the weights may be too heavy or the client may need realignment. ____ pain to hcp if body realignment fails to reduce the discomfort.

Back 120

painReport

Front 121

Assess ______ status of the affected body part to detect circulatory compromise and subsequent tissue damage.

Back 121

neurovascular

Front 122

The circulation is usually monitored every ____ for the first ___ ___ after traction is applied and every __ ___ thereafter.

Back 122

hour24 hours4 hours

Front 123

For some types of fractures, surgical intervention is necessary.

Back 123

okay

Front 124

What is the PREOP care for fractures if surgery is indicated?

Back 124

possible traction (ex: fractured hip using Buck's traction)general or epidural anesthetic

Front 125

What is open reduction with internal fixation (ORIF)?

Back 125

a common method of reducing and immobilizing a fracture...used with elders as it permits early mobilization(if this isn't feasible, then, external fixation with closed reduction is used)

Front 126

What is open reduction?

Back 126

allows the surgeon direct visualization of the fracture site

Front 127

What is internal fixation?

Back 127

uses metal pins, screws, rods, plates, or prostheses to immobilize the fracture during healing

Front 128

With INTERNAL fixation, why does the surgeon make an incision?

Back 128

to gain access to the broken bone and then implants one or more devices

Front 129

With internal fixation, there is a new bioabsorbable plate, a device which is strong enough to fix the fracture but is resorbed by the body in about ___ ___.

Back 129

3 months

Front 130

What is EXTERNAL fixation?

Back 130

fracture is reduced ...physician makes small percutaneous incisions so that pins may be implanted into the bone..all pins are self-drilling...the pins are held in place by an external metal frame to prevent bone movement

Front 131

What are the advantages of EXTERNAL fixation over other immobilization techniques?

Back 131

blood loss minimal in comparison with internalfixation...ambulation earlier..exercise earlier..alignment maintained in closed fractures which may not be achieved with a castcomminuted fractures that require bone grafting are stabilizedaccess easier to wound with open fractures

Front 132

What are the disadvantages of EXTERNAL fixation?

Back 132

pin-tract infection which may lead to osteomyelitis...pin-care may have to be performed several times a day using skeletal traction pin care procedure...cleaning the pins is controversial

Front 133

With external pin care, inspect pin sites at least daily for severe?

Back 133

redness, swelling, and purulent drainage

Front 134

What are external fixators used for?

Back 134

an extremity or for fractures of the pelvis...after a fixator is removed, the client may be placed in a cast until healing is complete...disturbed body image possible

Front 135

Why might a client have a disturbed body image related to an external fixator?

Back 135

because the frame may be large and bulky, and the affected area may have massive tissue damage with dressings

Front 136

What are circular external fixators (Ilzarov) used for?

Back 136

treats new fractures closed comminuted open with bone lossmalunion nonunioncongenital bone deformities

Front 137

A circular external fixation stimulates?

Back 137

bone growth

Front 138

Unlike the traditional fixator, the Ilizarov external fixator promotes (6)?

Back 138

angulationlengtheningrotationshorteningsoft-tissue defect healingwidening of bone

Front 139

With an Ilizarov external fixator, the nursing care is the same as with other external fixator systems...the major exception is?

Back 139

if the device is being used for filling bone gaps, using bone transport or distraction, the client must be taught how to manually turn the four-sided nuts (clickers), usually 4 times per day, unless there is an automated device...1mm daily distraction rate is common...teach client carefully as he will have this apparatus for a prolonged time

Front 140

Post-op care for ORIF (open reduction with internal fixation) is same as with other surgeries. As with other musculoskeletal surgeries, complications such as ___ ___ and ___ ____ are possible.

Back 140

okayfat embolismvenous thromboembolism

Front 141

If there is NONUION, other options are available which include (3)?

Back 141

electrical bone stimulationbone grafting (new)ultrasound fracture treatment

Front 142

What is electrical bone stimulation?

Back 142

new technologytreats nonunion1 system:NON-INVASIVE...uses magnetic coils applied on the skin or over a cast to deliver a pulsed magnetic field...no known risks, just don't use on upper extremity if pacemaker present2 system:IMPLANTED direct-current stimulators are placed directly in the fracture site and have no external apparatusboth systems require about 6 months of treatment, and weight bearing is at the discretion of the hcp

Front 143

What is bone grafting?

Back 143

treats nonunionmay also replace diseased bone or increase bone tissue for joint replacement. in most cases, chips of bone are taken from the client's iliac crest or other site and are packed or wired between the bone ends to facilitate unionallografts from cadavers may also be used...these grafts are frozen or freeze-dried and stored under sterile conditions in a bone bank

Front 144

What is bone banking?

Back 144

living donors who undergo hip replacement can donate their femoral heads to a bank for later use as bone grafts for other clients...careful screening ensures that the bone is healthy and that the donor has no communicable disease...bone cannot be donated without client's written consent

Front 145

What is low-intensity pulsed ultrasound (exogen therapy)?

Back 145

treats nonunion...used for slow-healing fractures or for new fractures as an alternative to surgery, ultrasound treatment has yielded excellent results...the client applies the treatment for about 20 minutes each day

Front 146

Expected outcomes for acute pain?Client must take personal action against pain by?

Back 146

preventive measure usenonanalgesic relieve measure useanalgesic relief measure usereport changes in pain symptoms or sites to hcpreport uncontrollable pain symptoms to hcpreport that pain is controlled

Front 147

Musculoskeletal pain is prolonged and severe, so hcp commonly prescribes what kind of drugs (3)?

Back 147

anti-inflammatoryopioid analgesicsmuscle relaxants

Front 148

The patient is suffering from severe, chronic central and peripheral pain. How does the hcp treat this?

Back 148

gives opioid and nonopioid drugs alternately or given together

Front 149

The nurse and client discuss when is the best time to give the strongest pain relievers...these times include?

Back 149

before a complex dressingn change...physical therapy...bedtime

Front 150

While patient is on strong drugs for pain, the nurse needs to closely monitor (3)?

Back 150

effectiveness of medication..side effectsacute compartment syndrome (ACS) which is often the sudden inability of pain medication to relieve pain...patient might need PCA or epidural anesthesia

Front 151

The patient suffering from musculoskeletal pain cannot survive on pain medications alone...he must turn to?

Back 151

ice or heat, depending on the cause of painwarm, soothing bathback rubuse of therapeutic touchif these don't work, turn to?deep breathing

Front 152

What is appropriate alternative therapy for a patient with swelling at the affected area?

Back 152

ice and elevation of the affected body part

Front 153

What is appropriate alternative therapy for muscle spasms?

Back 153

heat and massage

Front 154

1 Planning: Expected Outcomes for Risk of Infection is?2 Client will have none of the following?

Back 154

1 The client with a fracture is expected to be free of a wound or bone infection2 foul-smelling discharge purulent drainage fever lethargy wound-site culture colonization (if wound present)white blood cell (WBC) elevation

Front 155

Strict aseptic technique is used for dressing changes and wound irrigations. If there are manifestations of 1 local inflammation and purulent drainage, what intervention should the nurse take?2 other infections, such as ____ and ___ may occur days after the fracture3 the client's vital signs are monitored every ___ to __ hours because increases in temperature and pulse often indicate systemic infection

Back 155

1 call hcp immediately2 pneumonia and UTIs3 4 to 8 hours

Front 156

What kind of drugs are prophylactically prescribed for patients with an open fracture, esp. those requiring surgical repair?

Back 156

broad-spectrum antibiotics

Front 157

1 The expected outcome for a client with a fracture is?2 Indicators include that the client will have none of the following?

Back 157

1 The client with a fracture is expected to be free of physiologic consequences of impaired mobility2 pressure ulcers constipation urinary retention contracted joints pneumonia venous thrombosis

Front 158

While using crutches...to prevent pressure on the axillary nerve, there should be 1__ to ___ finger breadths between the axilla and the tope of the crutch when the crutch tip is at least 2____ inches diagonally in front of the foot...the crutch is adjusted so that the elbow is flexed no more than 3___ degrees when the palm is on the handle

Back 158

1 2 to 32 6 inches3 30 degrees

Front 159

The most common type of walking with crutches is the ___-___ ___, which allows minimal weight bearing on the affected leg.

Back 159

three-point gait

Front 160

When using a cane, use it on the ____ side and should create no more than ___ degrees of flexion of the elbow. The top of the cane should be parallel to the ____ _____ of the ____

Back 160

unaffected30greater trochanter of the femur

Front 161

For promotion of bone and tissue healing, the client needs a 1____- ____, 2____-____ diet. Supplements of 3_____ _____ are required for tissue nutrition.

Back 161

1 high-protein2 high-calorie3 vitamins B and C

Front 162

Clients that are immobilized for extended periods are predisposed to?

Back 162

hypocalcemia, which results in loss of calcium from bone and in subsequent bone fragility.

Front 163

A negative nitrogen balance can develop ___ to ___ days after injury in an immobilized client because of an increase in catabolism without compensatory ____ intake.

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7 to 10protein

Front 164

What are some high-protein, high-calcium drinks for patients?

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frequent small feedings and supplements of:BoostCarnation Instant Breakfastmilk shakes

Front 165

Because of less weight bearing on long bones, the immobilized client with a fracture often becomes 1 ____. Blood loss from the injury or reparative surgery contributes to the 2____ state. Encourage intake of foods high in 3____ content. The hcp may prescribe a daily multivitamin with iron supplement.

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1 anemic2 anemic3 iron

Front 166

Nurse needs to assess barriers to mobility, such as ____, when patient is discharged from hospital.

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stairs

Front 167

Care of the extremity after cast is removed?Remove scaly, dead skin carefully by 1_____, do not scrub.Move the extremity carefully. Expect discomfort, weakness, and decreased 2____.Support the extremity with pillows or your 3____ device until strength and movement return.4_____ slowly as instructed by your physical therapist.Wear support stockings or elastic bandages to prevent 5____ (for lower extremity)

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1 soaking2 ROM3 orthotic4 Exercise5 swelling