Musculoskeletal Test For Irsc

Front 1

these cells in the bone build bone tissue

Back 1

osteoblasts

Front 2

these cells break bone down

Back 2

osteoclasts

Front 3

Ca+

Back 3

8.5-10.5
(9-11)

Front 4

What important consideration must the nurse be aware following a bone trauma?

Back 4

Fat Embolism

Front 5

What are the S/S of Fat embolism

Back 5

disorientation, dyspnea, cyanosis, petechiae is a late sign

Front 6

When you arrive in the pts room who suffered an oblique fracture of the femur and he is disoriented, dyspnec what should you do?

Back 6

Suspect he may have a fot embolism, get his vitals stat and call the physician with the data, stat! start o2 and steroids if perscribed

Front 7

What kind of problems would you watch for in the hypothyroid patient?

Back 7

osteoperosis

Front 8

Calcitonin

Back 8

hormone secreted by the thyroid and when in the presence of estrogen in women will secrete calcitonin to stimulate the osteoblasts (building)

Front 9

what is the appropriate treatment for a sprain?

Back 9

RICE- rest, ice, compress, elevate

Front 10

What kind of result would be indicative of a positive CPK but an MB fraction of 0?

Back 10

Skeletal muscle has been damaged. (Thes test is done if someone suffered a MI, a positive MB fraction would be indicative of cardiac muscle damage)

Front 11

What four muscle properties affect the older adult?

Back 11

Excitability- the ability to receive and respond to stimulus
Extensibility, the ability to extend
Elasticity- the ability to resume it's resting length
Contratcility Atrophy- decrease in muscle mass(happend when client is immobile) (hypertrophy is the opposite)

Front 12

What do you the nurse know about the older adult in relation to their muscular function?

Back 12

The older adult is more at risk for falls due to changes in their muscular excitability extensibility, elasticity, and atrophy

Front 13

The client presents with wrist pain and says she thinks it might be carpal tunnel, what two tests should you do to check for this?

Back 13

Phallen's sign(backs of the hands together-check for numbness)
Tinnel's sign (tap on median nerve at the wrist)

Front 14

when the patient is recieving gentamycin IV therapy at home what signs and symptoms should you instruct your patient on being aware of and notifying the practitioner of right away? What bone disease is this drug used for?

Back 14

S/S are visual, hearing, or urinary problems also you should assess your pt for dehydration before starting therapy. / This drug is used for osteomyelitis.

Front 15

What three positions does the knee take and elicit pain on, in the McMurray's test? What other manifestations may the patient report?

Back 15

Pain is elicited by flexion, internal rotation and then extension of the knee, the patient reports an unstable feeling in the knee and that the knee may click, pop, lock or give way.

Front 16

What three diagnostic tests may be performed with positive McMurray's test?

Back 16

Arthrogram (uses contrast medium, and local anesthesia), arthroscopy (uses camera anesthesia, large-bore needle for fluid or air), MRI (gadolinium, not in dialysis pts), however MRI has eliminated arthrogram as a diagnostic tool in many cases

Front 17

first test done to evaluate musculoskeletal problems
and to monitor effectiveness of treatment

Back 17

x-ray
(roentgenogram)

Front 18

Thomas Test tests for what? What would you hear if the test was positive?

Back 18

Tests for hip flexion contractures. You would hear cracking, clicking.

Front 19

What complications of positive Thomas test should you the nurse be aware of?

Back 19

this is indicative of hip flexion contracture, thus for limited ROM, risk for falls

Front 20

What are the goals of management for dislocation?

Back 20

First realign the joint, this may require anesthesia to relax the muscles, after reduction the extremity is usually braced to allow torn ligaments and capsular tissue time to heal.

Front 21

Increased fracture risk in which bone disorder?

Back 21

Osteoperosis

Front 22

Asian woman with hypothyroidism, low vit D and calcium in her diet. What factors are modifyable.? What should she do?

Back 22

Vit D and calcium are modifyable and should be increased in her intake, Tums is an inexpensive way to help with calcium and vit D.

Front 23

What patient teaching should be done on a 55 year old caucasian woman who smokes and drinks 3-4 glasses of wine a nite and has family history of osteoperosis. Also she had corticosteroid therapy for several years.

Back 23

ERT can be used (this is not advisable in the patient with increased risk of breast tumor or any woman for that matter, she should be told if she is going to use ERT she must not have ETOH and smoking) she should also be advised about weight bearing exercise like walking. Ther steroids also have contributed to her bone density defficiency.

Front 24

National Osteoperosis Five steps to Bone Health and Osteoperosis Prevention are:

Back 24

1) Get DRI's of Calcium and Vid D
2) ger regular weight bearing exercise
3) avoid smoking and excessive drinking ETOH
4)Talk to your health care provider about your bone health and Have a bone density test
5) Take medication if appropriate

Front 25

Name 4 anti-resorptive medications

Back 25

bisphosphonates
calcitonin
estrogens
raloxifene

Front 26

Labs: Alkaline Phosphatase

Back 26

30-120

Front 27

Labs: Calcium

Back 27

8.5-10.5 or 9-11

Front 28

Labs: Phosphorous

Back 28

2.5-4.5

Front 29

Labs: RF

Back 29

negative

Front 30

Labs: ESR

Back 30

<20

Front 31

Labs: Uric Acid

Back 31

2.5-6.5

Front 32

Labs: CRP

Back 32

negative

Front 33

Labs: CK

Back 33

10-105

Front 34

Teriparatide

Back 34

new form of parathyroid hormone- actually increases bone production

Front 35

Name three bisphosphonates and what patient deaching must be done for safe ingestion of this drug

Back 35

Fosomax, Boniva, Actonel
Must be taken on empty stomach first thing in the morning with eight ounce glass of WATER at leas 30-60 minutes before eating or drinking and pt must remain upright duting this 30-60 min period

Front 36

Patient teaching on side effects of sub q calcitonin

Back 36

allergic reaction, flushing of the face and hands, oliguria, neusea and skin rash

Front 37

Patient teaching on side effects of nasal calcitonin

Back 37

nasal irritation, back ache, bloody nose, headache

Front 38

The patient asks you why they cannot have an oral form of calcitonin and why they are perscribed it in the first place.

Back 38

This is a form of salmon calcitonin which is a protien that stimulates the osteoblasts which build bone by utilizing the calcium from the blood stream and taking it into the bone, since this is a protien it cannot be administeed through the digestive tract because it will be degisted and broken down before it reaches the blood stream.

Front 39

side effects/adverse effects of ERT/HT

Back 39

vaginal bleeding, breast terderness, increased resk of breast cancer, DVT, strokes, heart attacks, gall bladder disease

Front 40

FDA recomendations for women taking ERT/HT

Back 40

Consider other osterperosis medications, use the lowest possible dose for the shortest period of time.

Front 41

Patient teaching on their goals for managing their osteoarthritis.

Back 41

To maintain or improve joint function through a balance of rest and activity.

Front 42

Client presents with joint pain, crepetation, tenderness, swelling. What do you expect the diagnosis will be?

Back 42

Osteoarthritis.

Front 43

Paget's disease is defined as...?

Back 43

Inital increase in bone tissue breakdown followed by abnormal bone formation.

Front 44

Patient presents with unknown of sudden pain in feet especially the metatarsal area, what problem should you suspect?

Back 44

Possible Paget's disease, could be fractures in the feet.

Front 45

What is the course of treatment for the client with Paget's disease?

Back 45

Supplemental vit D, calcium and calcitonin (watch for s/s of calcitonin adverse effects)

Front 46

What must the nurse be observing for after the patient returnes to the floor from hip replacement surgery?

Back 46

Complications of infection in the bone, osteomylitis, watch for fever night sweats, pain, swelling, warmth and tenderness.

Front 47

Treatement for osteomyletis

Back 47

months of powerful IV antibiotics, surgically implanted antibiotic beads, irrigation of site with antibiotics, hyperbaric oxygen

Front 48

How does osteomylitis develop via indirect entry?

Back 48

Through the blood via a respiratory infection, UTI, esp with vascular insufficiency.

Front 49

Meater reading of ___ is indacitive of scholiosis. Or ___ of shoulder blades.

Back 49

10 degrees, asymmetry

Front 50

What is a hallux valgus?

Back 50

Bunion

Front 51

What is the best way to prevent a hallux valgus?

Back 51

Wear good shoes that are not squeezing the toes and allow the foot to be supported.

Front 52

34 yr old retail store manager who wears heels and stands for long periods presents with unatributable burning pain in her metatarsal, but only on her right foot, what could this be?

Back 52

Morton's neuroma

Front 53

Explain to your client what a Morton's Neuroma is.

Back 53

A mass or thickened formation within the neurovascular space of the metatarsal or metacarpals, it's not cancerous

Front 54

What diagnostic tests are used to diagnose bone tumors?

Back 54

H&P, x-ray, CT scans, MRI and needle biopsy

Front 55

Osteogenic sarcomas

Back 55

bone cancer in the long bones of adolescents

Front 56

Multiple myeloma

Back 56

bone cancer that causes infiltration and destruction of bone marrow

Front 57

S/S of patient with myltiple myeloma or osteogenic sarcoma

Back 57

infections, anorexia, fatigue, wt loss, back pain, anemia, thrombocytopenia and bleeding tendencies.
Hgb < 12, Hct <37

Front 58

Two main tests used for MD

Back 58

Muscular Dystrophy
CK (createnine kinase) 10-105
EMG Studies (ElectroMyogram)- unsertion of needles into muscles, can be very painful, avoid caffine and sedatives 24 hrs before procedure

Front 59

Patient is going for an EMG study, what should the patient do to prepare for this test?

Back 59

Do not have any caffine or sedatives 24 hrs before procedure

Front 60

closed/simple fracture

Back 60

skin intact

Front 61

open fracture

Back 61

break in skin

Front 62

#1 diagnosis for open fracture

Back 62

risk for infection

Front 63

complete fracture versus incomplete fracture

Back 63

complete means entire width of bone broken, incomplete is like green stick, only part of bone os fractured

Front 64

comminuted fracture

Back 64

compound fracture involving more than two fragments

Front 65

name the 6 phases of bone healing of a fracture

Back 65

hematoma- 72 hrs
granulation-day 3-14
callus formation
ossification- 3wks to 6 months
consolidation-bone fragments come together
remoleding- up to a year

Front 66

patient says i still have a bump on the bone where i broke it last summer, what is appropiate patient teaching?

Back 66

This is the normal process of remodeling which can take up to a year.

Front 67

What three functions must the nurse do for nursing care of client in traction.

Back 67

Maintain traction alingnment, pain management, and neurovascular checks.

Front 68

The nurse enters the room seeing the pt. trying to move the weights on their traction. What is the appropriate action?

Back 68

Explain to the patient that traction must be continuous at all times to have the desired therapeutic effect. Like dental braces.

Front 69

What nursing diagnosis should the you the nurse make for the patient recieving external fixation or skeletal traction?

Back 69

Increased risk for infection.

Front 70

What should the nurse assess for when performing pin care for the patient recieving skeletal traction?

Back 70

S/S of infection, erythemea, heat, swelling, pain, neurocheck(pallor, pulse, parasthesia, paralysis, pain)

Front 71

Name the 5 p's in a neuro check:

Back 71

Pulse
Pallor
Pain
Parasthesia
Paralysis

Front 72

What patient teaching can you do when the patient says he accidentally got his cast wet and his skin itches?

Back 72

Use a warm dryer to dry the cast, do not put anything down the cast, use a dryer on cool to relieve itching.

Front 73

How should you handle the drying cast for the patient when they have to be moved?

Back 73

Place palm under the cast so as not to cause indentions with your fingers and place a pillow under the limb.

Front 74

What are soma, flexeril and robaxin perscribed for?

Back 74

For pain due to fracture of bone.

Front 75

Patient has an external fixator, what major nursing assesments must you do and be watching for?

Back 75

Must watch for s/s of infection, pt is at major risk for bone infection, check for increase in pain, swelling, tenderness, fever.

Front 76

Patient with a fracture complains of numbness of tingling, and skin very white what could this be a sign of? What could this problem lead to if not treated immediately?

Back 76

Compartment syndrome- very serious
Can lead to amputation or loss of function.

Front 77

What leukocyte (WBC) count must the nurse be aware of for the fracture patient? What could an elevation be indacitive of?

Back 77

should be 4.3-10.8, increase means infection possible sepsis

Front 78

Nursing care of the client with FES (Fat Embolism Syndrome)

Back 78

Application of oxygen possible intubation, notify the physician, maintain fluid balance, administer steroids if ordered

Front 79

Triad symptoms of Fat embolism

Back 79

Confusion, dyspnea, petechiae

Front 80

Why would steroids be perscribed for the patient with FES?

Back 80

CorticoSteroids decrease inflammation and mucus production especially in the airways of the lungs.

Front 81

How should you position the patient post-op with hip fracture and hip replacement?

Back 81

Hip fracture (ORIF)- turn to affected side
Hip Replacement- turn to affected side and do not flex hip greater that 90 degrees (need an elevated toilet seat), do not go over midline abductor pillow, do not cross ankles or knees

Front 82

Post oerative care management of pt with mandible fracture?

Back 82

Airway, oral hygine, pain management, communication, adequate nutrition.

Front 83

Two major potential problems immediately after surgery from a jaw wired shut. What should the nurse be sure to have for the patient?

Back 83

airway obstruction and aspiration from vomiting. be sure wire cutters are taped to the head of the bed and go with client at all times.

Front 84

What medication is very important to give for the patient who has their jaw wired shut?

Back 84

Meds for N/V so they maintain patent airway.

Front 85

What kinds of things should the patient with a fractured clavicle be aware of for healing?

Back 85

Have to rest it and just let it heal, do not raise your arm above shoulder level.

Front 86

What patient teaching is important for the patient with fractured ribs?

Back 86

Turn, cough, deep breathe, use incentive spirometer
This may be painful but must be done to avoid respiratory compromise due to the fractures.

Front 87

Major complications of amputation?

Back 87

Hemmorage, infection, delayed healing(esp if diabetic)

Front 88

What type of positioning must you the nurse do for the patient with amputation?

Back 88

After the first 24 hrs clients should be encouraged to lie prone several times a day to avoid contractures. Unless contraindicated it COPD.