muscular skeletal test

Question 0

MRI (musculoskeletal magnetic resonance imaging)

Answer 0

assists in diagnosing abnormalities of the bones and joints and surrounding soft tissue structures, including cartilage, tendons, etc.
uses magnetism and radio waves to make images (more detailed pictures of fluid-filled soft tissue and blood vessels than any other test)
Pts required to lie still for 45-60 minutes while in the machine
Take vitals after test and allow pt to resume pretest activities; no adverse effects

Question 1

CT scan (computed tomography scan)

Answer 1

produces three-dimensional pictures
should not be used unnecessarily b/c of radiation exposure
Iodine contrast dye is sometimes used
Useful in locating injuries to the ligaments or tendons, tumors of the soft tissue, and fractures in areas difficult to define by other means
Important Prep:
keep pt on NPO status 3-4 hours before the test (if contrast dye is used)
have pt void before test
having pt void before test

Question 2

Nuclear medicine scan

Answer 2

uses scanners or camera detectors that record images on radiographic film. Uses low dosages of radioactive isotopes.
Nursing interventions:
obtaining written consent from the patient
Informing the patient that the radioactive isotopes will not affect family or visitors.
following the nuclear medicine department’s instructions for special preparations for specific scans.

Question 3

know what orif is

Answer 3

(Open reduction with internal fixation)- surgical procedure allowing fracture alignment under direct visualization while various internal fixation devices applied to the bone. (P.145)

Question 4

what the 7 Ps are (P.144)

Answer 4

Pain, Pallor, Paresthesia, Paralysis, Polar temperature, Puffiness, Pulselessness.

Question 5

know s/s of CTS- carpal tunnel syndrome (pg. 163-134)

Answer 5

painful disorder of the wrist and hands, caused by inflammation and edema of the synovial lining of the tendon sheaths in the carpal tunnel of the wrist
S/S (subjective):
burning pain; tingling in the hands relieved by shaking or exercising the hands
inability to grasp or hold small objects
edem; muscle atrophy or a depressed appearance of the soft tissue at the base of the thumb on the palmar surface
Diagnostic Test: electromyogram, MRI. handheld electro neurometer

Question 6

how and when to assess for cap refill and a blanching test

Answer 6

(p.170)- compress each fingernail or toenail of the affected extremity, release, and note how quickly the pink color returns to the nailbed. nailbed color return to normal within 2 or 3 seconds. if the color is slow to return, circulation is impaired and requires prompt attention.
these assessment are made on patients with musculoskeletal trauma or damage to nerves and blood vessels resulting from surgery, tight bandages, splints, or casts. impaired circulation resulting in alteration of nerve function can cause loss of the use of an extremity.

Question 7

what a fat embolism is? and what causes them? (pg. 150)

Answer 7

the embolization of tissue fat with platelets and circulating free fatty acids within the pulmonary capillaries
rare, but life threatening - cause brain hypoxia and tissue death
suspect fat embolism if the pt has multiple fractures, can occur within 48 hrs of injury
most serious complication of long bone fractures

Question 8

what bucks traction is?

Answer 8

(p.156) used as a temporary measure to provide support and comfort to a fractured extremity while waiting for more definitive treatment. is in a horizontal plane with affected extremity. frequently used to maintain the reduction of a hip fracture before surgery. can also be used to treat muscle spasms and minor fractures of the spine.

Question 9

what type of nursing int for rheumatoid arthritis. (pg. 123)

Answer 9

Nursing Diagnoses
Pain, r/t joint inflammation
-Administer salicylate or NSAIDS
-Assist pt w/exercise program
-Pt is to rest inflamed joints
-Maintain bed rest as ordered and proper body alignment
-Assist and teach pt to extend joints as possible and avoid external rotation of extremities; use sandbags or trochanter rolls
-Avoid using pillows under knees
-Immobilize and or support joints
Chronic low self-esteem, r/t negative self evaluation about self or capabilities

Question 10

know s/s of gout (p.127)

Answer 10

subjective= noticing complaint of pain occurring at night involving the great toe or other joints. dietary history with specific questions on consumption of alcohol and foods high in purines, such as organ meats (brains, kidney, liver, and heart), anchovies, yeast, herring, mackerel, and scallops.
objective: assessment of the joints (especially the great toe) for signs of edema, heat, discoloration, and limited movement. vital sign data may reveal an elevated temperature and hypertension, tachycardia, and tachypnea. Assess patient for urinary output as trophi can form in the kidneys and alter kidney function.

Question 11

know what gout is (pg. 128)

Answer 11

a metabolic disease resulting from an accumulation of uric acid in the blood.
an acute inflammatory condition associated with ineffective metabolism of purines
primary linked w/hereditary factors; secondary resulting from use of certain meds or complications of another disease; or idiopathic (of unknown source)
affects more men than woman, takes about 20 years for sufficient urates to accumulate in the body before causing signs and symptoms
Prognosis: s/s are recurrent; episodes become longer each year, the disorder is disabling and if untreated can progress to the development of tophi and destructive joint changes

Question 12

know scoliosis

Answer 12

(p.170)- lateral (or S) curvature of the spine.

Question 13

know lordosis(p.170)

Answer 13

an increase in the curve at the lumbar space region that throws the shoulders back, making the “lordly” or “kingly” appearance

Question 14

know kyphosis

Answer 14

(p.170)- rounding of the thoracic spine (humpback appearance).

Question 15

know s/s of osteoporosis, especially R/T to menopausal pt.

Answer 15

Subjective: complaints of pain that worsen with sitting, standing, coughing, sneezing, and straining

Question 16

if a pt had a comminuted fx and got a fat embolism, what should you do first?

Answer 16

maintain adequate oxygenation and ventilation.

Question 17

is there a cure for rheumatoid arthritis?

Answer 17

NO CURE

Question 18

Teach a pt how to walk with crutches.

Answer 18

Pg 158

Question 19

a pt going for a CT using contracts, what do you need to ask the pt? -if allergies to iodine or fish and if the pt had eaten (dye can cause nausea and vomiting)

Answer 19

.

Question 20

know what the procedure is for doing a CXR

Answer 20

.

Question 21

pt in skeletal leg traction they are not allowed to move side to side, what is the best way to provide good skin care? (pg. 157)

Answer 21

CircOlectric Bed: vertical turning bed that can be operated by one person and placed in a variety of positions, Side-to-side movement can be accomplished while maintaining proper positioning if traction is ordered

Question 22

if you have a pt that is going to get a cast on, what is the best way to prevent department syndrome

Answer 22

Elevation of the extremity

Question 23

medical term for surgical fusion of a joint

Answer 23

Arthrodesis

Question 24

know the following meds: mobic, prednisone, arava, naproxen, celebrex
(p.120-121)

Answer 24

.

Question 25

which meds work the best for rheumatoid arthritis

Answer 25

DMARDs?

Question 26

pick which meds are considered an analgesic, cox 2 inhibitor, anti inflammatory. -select all that apply. one med that has all

Answer 26

.

Question 27

what glucosamine supplements are?

Answer 27

(p.126) enables the body to manufacture collagen and proteoglycans and resupply lubricant found in the synovial joint necessary for restoring healthy cartilage. linked with reductions in articular pain, joint tenderness, and restricted joint movement in people suffering from arthritis.

Question 28

if someone has osteoporosis be familiar with their dietary needs for the pt. (pg. 130)

Answer 28

calcium is a mineral that can slow bone loss and may decrease fractures
a total of 1.500 mg of calcium daily in the diet or through supplements
food sources of calcium include milk products,many green vegetables, calcium-fortified orange juice, and soy milk
vitamin D helps calcium absorption and stimulates bone formation
a diet low in sodium, animal protein, and caffeine is recommended
foods that are high in calcium include whole and skim milk, yogurt, turnip greens, cottage cheese, ice cream, sardines, and spinach

Question 29

know the difference between a strain and a sprain

Answer 29

Sprain: can result from a wrenching or hyperextension of a joint, tearing the capsule and ligaments. can involve bleeding into a joint (hemarthrosis). common sites include the knee, ankle, and cervical spine(whiplash). sprains are often the result of a sudden twisting injury. medical management is similar to that for contusions. treatment usually consists of elevation, compression, ice, and rest of the affected area.
strains: strains are characterized by microscopic muscle tears as a result of overstretching muscles and tendons. an acute strain results when the muscles and tendons are overstretched in a forceful movement , such as unaccustomed vigorous exercise. (p.161)

Question 30

what fossa max is?

Answer 30

.

Question 31

if someone has osteoarthritis in the knee what exercises work well for them?

Answer 31

Bicycling and swimming are considered good exercises for people with osteoarthritis of the knee; walking should be done on level ground. (p.125)

Question 32

when someone has osteoarthritis, what are the nodes on their fingers are called? (pg. 125)

Answer 32

Heberden’s nodes: appear on the sides of the distal joints of fingers
Bouchard’s nodes: appear on the proximal joints of fingers; these nodes are hard,bony, and cartilaginous enlargements

Question 33

someone w/ fiberglass cast on their leg, when can they put weight on it?

Answer 33

after application (p.154)

Question 34

know what fibromyalgia is?

Answer 34

(p.131)- chronic syndrome of unknown etiology that causes pain in the muscles, bones, or joints. it is associated with soft tissue tenderness at multiple characteristic sites.

Question 35

someone with pelvic fx, what is the major cause of death?

Answer 35

hemorrhage

Question 36

know what compartment syndrome is? (pg. 148)

Answer 36

pathologic condition cause by the progressive development of arterial vessels compressed and reduced blood supply to an extremity

Question 37

the correct way to instruct a pt to use a cane

Answer 37

instruct patient to hold the cane in the opposite hand of the affected extremity and advance the cane at the same time the affected leg moves forward. (p.159)

Question 38

someone with above the knee amputation, how soon can they begin exercising the rest of the limb?

Answer 38

.

Question 39

someone that’s had an amputating, what is one of the major things you have to anticipate that they’ll have.

Answer 39

body image

Question 40

know s/s of fibromyalgia

Answer 40

subjective= question the patient about muscle pain, tension or migraine headaches; premenstrual tension; jaw pain; excessive fatigue;; anxiety; and depression. include questions about sensations of numbness, tingling, perception of insects crawling on or under the skin.
Objective= noting periodic limb movement, especially at night, or a persistent need to move the lower extremities day and night. ask about sleep deprivation and the patient’s ability to complete self-care activities.

Question 41

know the greatest risk for a pt with femoral fx

Answer 41

blood clots in the legs or lungs
bed sores
UTI
Pneumonia

Question 42

is someone is taking too much aspirin, what is s/s?

Answer 42

tinnitus

Question 43

should prednisone be taken w/ or w/o food?

Answer 43

taken with food

Question 44

pt admitted with gout, what type of bed works best for the pt? (pg. 127)

Answer 44

maintain bed rest and join immobilization while the pt is symptomatic, bed cradles prevent pressure from bed linens on the affected joints

Question 45

pt that is being admitted to have a prosthesis, which actions should you implement

Answer 45

pt teaching

Question 46

allopurinol used for gout, know what it is and how you take it?

Answer 46

used to treat gout and kidney stones due to increase uric acid
Take this medication by mouth, usually once daily or as directed by your doctor. Take this medication after a meal to reduce stomach upset. If your dose is more than 300 milligrams a day, you will need to take several smaller doses during the day to get this amount (ask your doctor for directions).

Question 47

what baclofed is and how it works?

Answer 47

it relaxes the muscles which reduces pain and comfort.

Question 48

Know what phantom pain is and how long it can last? (pg. 168)

Answer 48

pain felt in the missing extremity as if it were still present, occurs b/c the nerve tracks that register pain in the amputated area continue to send a message to the brain; this is normal
can last for months or decades on a consistent or intermittent basis

Question 49

explain the cause of gout, what blood test is to test it?

Answer 49

-uric acid (range: 3.5-7.2). -diet: no red meats,

Question 50

someone with compound fx, what is the shot that they get?

Answer 50

tetanus

Question 51

what is the most serious type of fx?

Answer 51

open

Question 52

whats the name of the fx when the bone is fragmented?

Answer 52

compo und fx

Question 53

which nerve is affected from CTS?

Answer 53

median nerve

Question 54

if pt has been of aspirin and prednisone for a long time, what is an indication that they need to stop?

Answer 54

tinnitus? potassium depletion? hypokalemia

Question 55

what flexeril is? and side effects.

Answer 55

Cyclobenzaprine is used short-term to treat muscle spasms. It is usually used along with rest and physical therapy. It works by helping to relax the muscles.
Side Effects: : rash,itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Question 56

if you have a pt taking methotrexate, what is the most important thing you should tell them? (pg. 121)

Answer 56

medication for RA

advise pt to avoid pregnancy while on drug and to not get vaccinations without physicians consent; keep well hydrated

Question 57

when assessing a pt with below the knee amputation what would be something you need to consider regarding safety?

Answer 57

.

Question 58

Pt that had an laminectomy what is the most important nursing intervention for the pt. (pg. 165)

Answer 58

monitor the patient for evidence of respiratory distress and paralytic ileus, complications that may occur in laminectomy patients.