Musculoskeletal System (Exam One) Flashcards
(236 cards)
1
Q
What will be affected if a patient has functional problems of the musculoskeletal system?
A
Activities of daily living (ADLs)
2
Q
Why are older adults at an increased risk for falls?
A
- Decreased strength
- Changes in balance
3
Q
Cushion deterioration will cause what in the older adult?
A
Loss of height
4
Q
What should the nurse do if a patient has continuous falls?
A
Further assessment
5
Q
For musculoskeletal injuries, will the nurse inspect the patients body unilaterally or bilaterally?
A
Bilaterally
6
Q
What is crepitation?
A
Grating or crunching sound upon joint movement
7
Q
Active range of motion is performed by the _______ for the _______?
A
By the patient for the patient
8
Q
Passive range of motion is performed by the ________ for the _______?
A
By the nurse for the patient
9
Q
Describe functional range of motion.
A
Patient can perform ADLs without having full range of motion
10
Q
What is imposed on the body if assistive devices do not fit properly?
A
Undue strain
11
Q
List the risk factors for developing a musculoskeletal disorder.
A
- Obesity
- Task repetition
- Trauma during childhood/adolescence
12
Q
If a patient has a muscle strength grade of 5/5, this person has ______ strength/ability to move.
A
Most
13
Q
If a patient has a muscle strength grade of 1/5, this person has ______ strength/ability to move.
A
Less
14
Q
If a patient has a muscle strength grade of 0/5, this person has ______ strength/ability to move.
A
Zero
15
Q
The grade 0/5 on the muscle strength scale indicates what?
A
Paralysis
16
Q
Before receiving an MRI, the nurse must check the patient for what?
A
Any source of metal
17
Q
What diagnostic procedure can not be performed on a patient who has a pacemaker?
A
Magnetic resonance imaging (MRI)
18
Q
Before performing a diagnostic test utilizing contrast, the nurse should assess the patient for what?
A
Shellfish allergies
19
Q
What color of fluid removed from a joint cavity should be concerning to the nurse?
A
- Cloudy
- Milky
20
Q
What should the nurse do before performing a diagnostic test on a patient?
A
Educate the patient
21
Q
What does a bone mineral density (BMD) measurement assess for?
A
Osteoporosis
22
Q
What does a bone scan assess for?
A
Avascular necrosis
23
Q
What laboratory tests are considered specialized and do not usually occur in the acute care setting?
A
- Antinuclear antibody (ANA)
- Anti-DNA antibody
24
Q
Rhabdomyolysis causes an increase in what laboratory value?
A
Creatinine kinase
25
Spinal cord injuries are usually caused by what?
Trauma
26
When will a secondary injury occur?
Occur after primary injury
27
Secondary injuries are usually __________.
Preventable
28
The nurse knows she should avoid moving a patient with a suspected spinal cord injury because it can cause what?
Secondary injury
29
List factors that can cause or result in a secondary injury.
- Swelling
- Inflammation
- Ischemia
- Movement of body fragments
30
What medication might the patient receive to aid in edema control?
Steroids
31
The extent of damage caused by a spinal cord injury and prognosis for recovery is most accurately determined during what time frame?
72 hours or more after injury
32
When does the most improvement occur following a spinal cord injury?
Three to six months
33
Permanent damage from a spinal cord injury may occur within how many hours following the injury? Why?
- 24 hours
| - Due to edema
34
How long does spinal shock last?
Less than 48 hours
35
What is occurring within the body during neurogenic shock?
Blood is rushing to the extremities and is not staying where it is supposed to
36
Where do spinal shock and neurogenic shock occur?
Below the level of injury
37
List the signs and symptoms of neurogenic shock.
- Sudden and drastic hypotension
- Bradycardia
- Warm, flushed skin
- Irregular circulation
38
Neurogenic shock may be mistaken for what other medical emergency? What must the nurse do?
- Bleeding out
| - Assess the situation
39
What type of shock is temporary?
Spinal shock
40
What type of shock is a medical emergency?
Neurogenic shock
41
List the signs and symptoms of spinal shock.
- Flaccid paralysis
- Decreased reflexes
- Loss of sensation
- Absent thermoregulation
- Bradycardia
42
What is flaccid paralysis?
Loose and floppy limbs
43
If a spinal injury occurs above C4 the patient will have a total loss of what function?
Respiratory function
44
What occurs at the skeletal level of injury?
Most damage to bones and ligaments
45
Spinal cord injuries are classified by what four criteria?
- Mechanism of injury
- Skeletal level of injury
- Neurological level of injury
- Degree of injury
46
If a patient has a cervical spinal cord injury, what is the nursing priority?
Frequent respiratory assessments
47
Patients with a thoracic spinal cord injury are at an increased risk for what? Why?
- Pneumonia
- Aspiration
- Atelectasis
-Due to ineffective coughing
48
Swelling will always travel in what direction with a spinal cord injury?
UP
49
Manifestations of a spinal cord injury are dependent upon what factor?
Level of injury
50
Describe a complete injury.
Total loss of sensory and motor function below the level of injury
51
Describe an incomplete (partial) injury.
Mixed loss of voluntary motor activity and sensation
52
Some tracts remain intact with what degree of injury?
Incomplete (partial)
53
What is the preferred and considered the first line diagnostic test?
CT Scan
54
Vertebral artery injury that affects blood flow will cause impaired blood flow to what other organ?
Brain
55
What diagnostic test is used to rule out vertebral artery injury?
CT angiogram
56
What causes veins to collapse?
Blood loss
57
Why is timely decompression vital with spinal cord injuries?
Maintain blood flow
58
What is the purpose of traction in a spinal cord injury?
- Realign
| - Decompress
59
The nurse knows the patient is at an increased risk of developing what condition if they have an immobilization device in place?
Infection
60
What is the priority nursing intervention for a patient with an immobilization device?
Cleaning the pin sites
61
List the different immobilization devices.
- Crutchfield
- Vinke
- Gardner
62
How does a halo vest differ from other immobilization devices?
Allows more mobility
63
An immobilized patient is at an increased risk for developing what conditions?
- Blood clots
- Pressure ulcers
- Atelectasis
- Pneumonia
64
What is the purpose of a TLSO jacket?
Prevents excessive twisting of body
65
Patients with spinal cord injuries involving the T6 nerve or higher are at an increased risk of developing what syndrome?
Autonomic dysreflexia
66
Describe autonomic dysreflexia.
Sympathetic reaction of the body to a certain type of stimulus
67
List the most common cause of autonomic dysreflexia.
Distended bladder or rectum
68
A patient with a spinal cord injury begins to complain of a headache, what is the nurses priority?
Take patients blood pressure
69
List the clinical manifestations of autonomic dysreflexia.
- Hypertension
- Throbbing headache
- Diaphoresis above injury level
- Bradycardia
70
What is the priority nursing intervention for a patient with autonomic dysreflexia?
Find the causative source and remove it
71
What type of injury should be reduced as soon as possible?
Dislocation
72
What is the most common sports injury?
ACL injury
73
List the signs and symptoms of strains and sprains.
- Pain
- Edema
- Decreased function
74
What is the primary treatment for strains and sprints?
- RICE
- Analgesics
- Elevation above heart
75
What is the priority concern with an open fracture?
Infection
76
What is an open fracture?
Open wound near site of broken bone
77
What is the priority treatment for an open fracture?
Immediate surgical fixation
78
What must be done to bones that have been displaced?
Must be reduced and put back into alignment
79
What is the overall goal of fracture treatment?
Restore body to previously injured state
80
Describe a closed reduction of a fracture.
Nonsurgical, manual realignment of bones
81
What must be applied following a closed reduction?
Immobilization device
82
The nurse knows if a patient has a fracture that is not aligned properly, the physician will have to do what?
Reduce and realign properly
83
Slings are commonly used to immobilize what part of the body?
Upper arm
84
What type of traction is used for severe breaks?
Skeletal traction
85
What type of traction is considered a temporary fix until surgery can be performed?
Buck's traction
86
What are the two most common types of traction?
- Skin traction (Bucks)
| - Skeletral traction
87
Describe an open reduction of a fracture.
Surgical incision using internal fixation
88
Open reduction will lead to what?
- Earlier range of motion of the joint
| - Earlier ambulation
89
If a bone has been crushed, what type of fixation will have to be done?
External fixation
90
If attempting to salvage an extremity, what type of fixation will have to be done?
External fixation
91
What type of education will the nurse provide to a patient with external fixation?
- How to clean pin sites
| - Signs and symptoms of infection
92
How do steroid medications affect healing?
Slow healing
93
List the 6 P's of a neurovascular assessment.
- Pain
- Pallor - color
- Paresthesia - sensation
- Paralysis - movement
- Pulselessness
- Pressure
94
A capillary refill that exceed's _____ seconds is of concern and the nurse should call the doctor.
5 seconds
95
What education should be provided to a patient on how to prevent musculoskeletal injuries/problems?
- Safety precautions
- Moderate exercise
- Hard soled shoes
- Safe environment
- Protective equipment
96
What vitamin supplements are recommended to prevent musculoskeletal injuries?
- Calcium
| - Vitamin D
97
If a patient is schedule for surgery, when should the nurse plan to educate the patient?
Before surgery, while still lucid
98
How often should neurovascular assessments be completed for a postoperative musculoskeletal injury patient?
Every 4 hours
99
The nurse begins to see capillary refill, color, and edema changes in the postoperative ACL patient, the nurse should plan to do what more often?
Neurovascular assessment
100
What is the first indication that a patient has lost too much blood?
Vital sign changes
101
Describe the vital sign changes associated with blood loss.
- Hypotension
| - Tachycardia
102
List nursing management for a postoperative musculoskeletal injury patient?
- Monitor vital signs
- Neurovascular assessments
- Pain control
- Proper alignment
- Monitor for bleeding
103
How is pain and discomfort minimized in a postoperative musculoskeletal injury patient?
Proper alignment
104
List the complications of immobility.
- Constipation
- Renal calculi
- Cardiopulmonary deconditioning
- DVT/Pulmonary embolism
105
What is a nursing intervention used to combat constipation and renal calculi in a patient who is immobile?
Increase fluids
106
Ice should be applied for what duration and location following surgery?
- First 24 hours
| - Directly over injured site
107
How long should the affected limb be elevated above the heart post-operation?
48 hours
108
Why should the nurse educate the patient to avoid bearing weight on the affected limb for 48 hours post-operation?
Avoid malformation or remolding the cast
109
If compartment syndrome is suspected, the nurse knows to avoid doing what with the limb?
Elevating the limb
110
The nurse knows to assess what prior to ambulating a post-operative musculoskeletal injury patient?
Weight bearing status orders
111
What is required in order for a patient too effectively and properly use assistive devices?
Upper arm strength
112
Death usually results in a fracture patient due to what?
Complications of fracture or immobility
113
Infection rates are higher in what type of injury?
- Open fractures
| - Soft tissue injury
114
Infection of a fracture or soft tissue injury can lead to what other complications?
- Chronic osteomyelitis
| - Sepsis
115
Where does compartment syndrome usually occur?
Lower leg
116
List the two types of compartment syndrome.
- Decreased compartment size
| - Increased compartment contents
117
What are the causes of decreased compartment size?
- Casts
- Restrictive clothing
- Splints
118
List the causes of increased compartment contents.
- Bleeding
- Edema
- Inflammation
119
Describe decreased compartment size.
Squeezing inward on limb
120
Describe increased compartment contents.
Bulging of inner limb contents
121
Nursing interventions can be applied to what type of compartment syndrome?
Compartment size
122
List the early signs and symptoms of compartment syndrome?
- Paresthesia
| - Pain unrelieved by medication
123
A patient with acute kidney injury will present with what type of urine?
Reddish brown urine
124
The nurse knows to monitor urine output and kidney function in a patient with compartment syndrome because of what?
Excess myoglobin is released and clogs up the kidneys
125
What should the nurse do once compartment syndrome is suspected?
- NO elevation above heart
- NO ice
- Surgical decompression/fasciotomy
126
When is fat embolism syndrome most likely to occur?
Fracture of long bones, ribs, tibia, and pelvis
127
Lipo suction, crush injury, and joint replacement may also cause what syndrome?
Fat embolism syndrome
128
When does fat embolism syndrome begin to show signs and symptoms?
24 to 48 hours after injury
129
Signs and symptoms of fat embolism syndrome will appear in what? Why?
- Triad
| - Due to poor oxygen exchange
130
List the triad of symptoms associated with fat embolism syndrome.
- Respiratory
- Neurological
- Petechiae
131
List the clinical manifestations of fat embolism syndrome.
- Rapid or acute
- Feeling of impending doom
- Skin color from pallor to cyanosis
- May become comatose
132
What is the most important factor in preventing fat embolism syndrome?
Careful immobilization and handling of fracture
133
What type of fracture imposes the highest risk for hemorrhage?
Pelvic fracture
134
Compartment syndrome is prominent in what type of fractures?
Tibial fracture
135
What type of fracture is prominent in older adults?
Hip fracture
136
The nurse knows a post-operative amputation patient should do what 24 hours after surgery?
Lay on stomach to stretch out muscles for prosthesis
137
What type of condition puts a patient most at risk for amputation?
Diabetes
138
What is the goal of amputation?
Leave as much length as possible while maintaining healthy tissue
139
The patient is encouraged to do what for the first 24 hours following amputation surgery?
Elevate the limb
140
The nurse knows that what type of limb amputation will be harder for a patient to cope with?
Upper extremity
141
A patient who has had a total hip arthroplasty (THA) is educated to avoid what type of movements? These put the patient at an increased risk for what?
- Cannot bend at waist
- Cannot cross legs
- Legs should bend at 90 degrees
- No low sitting chairs
-Dislocation
142
What is the normal range for Prothrombin Time (PT)?
11 - 12.5 seconds
143
What is the normal range for International Normalized Ratio (INR)?
0.8 - 1.1
144
List the type of patient care UAP are not allowed to perform.
- Assess
- Monitor
- Treat
145
List the complications of a total knee arthroplasty (TKA).
- Infection
| - DVT
146
The nurse must assure what before a patient has a total knee arthroplasty (TKA)?
There is no active infection
147
What is osteomyelitis?
Severe infection of bone, bone marrow, and surrounding soft tissue
148
What microorganism is the most common causative agent for developing osteomyelitis?
Staphylococcus aureus
149
What is the duration of acute osteomyelitis?
Less than 1 month
150
Why are spontaneous fractures prominent in patients with osteomyelitis?
Due to bone deterioration
151
What patients are at higher risk for developing osteomyelitis?
- Immunosuppressed
- Diabetics
- Those with foreign bodies (i.e. joint replacement)
152
What should be completed prior to prescribing antibiotics to a patient with osteomyelitis?
Diagnostic studies
153
X-rays will not show evidence of trauma until how many days following the injury?
2 to 4 days
154
What type of diagnostic study is the most accurate indicator of an issue or injury?
MRI
155
What antibiotic is detrimental to kidney function?
Vancomycin
156
What occurs if a vancomycin trough level is under 10?
Not therapeutic
157
What occurs if a vancomycin trough level is above 20?
Severe damage to kidneys
158
What is considered the first line treatment for acute osteomyelitis?
Aggressive, prolonged IV antibiotics
159
Prolonged administration of antibiotics can result in what other conditions?
- C-diff
| - Thrush
160
Describe how chronic osteomyelitis may present relating to duration.
Continuous and persistent or a process of exacerbations and remissions
161
What is the duration of chronic osteomyelitis?
Greater than 1 month
162
Are local or systemic signs and symptoms more common in chronic osteomyelitis?
Local
163
List examples of local manifestations with chronic osteomyelitis.
- Pain
- Swelling
- Warmth
164
Systemic manifestations are __________ in chronic osteomyelitis.
Reduced
165
What is the most common cause of bone cancers?
Metastasis from other cancers
166
What type of bone cancer is the most common?
Osteosarcoma
167
Patients with bone tumors or bone cancers may need higher doses of what?
Pain medication
168
What is muscular dystrophy?
Progressive wasting of skeletal muscles
169
Muscular dystrophy can lead to what?
Respiratory failure
170
What is the most common cause of lower back pain?
Musculoskeletal problems
171
What is radicular pain?
Pain that radiates down an entire nerve
172
Lower back pain is most common in the lumbar region due to what factors?
- Bears most of body weight
- Is most flexible
- Contains nerve roots
- Poor biomechanical structure
173
List the occupational risk factors for developing lower back pain.
- Repetitive lifting
- Vibration (i.e. jackhammer)
- Extended periods of sitting
- Health care personnel engaged in patient care
174
What is the duration of acute lower back pain?
4 weeks or less
175
What is the duration of chronic lower back pain?
Lasts longer than 3 months
176
What may happen if lower back pain is not caught in the acute phase?
Progress to chronic pain and become incapacitating
177
List the objective signs and symptoms associated with lower back pain.
- Guarded movement
- Tense, tight paravertebral muscles
- Lowered range of motion in spine
178
What is a priority nursing intervention for patients with chronic lower back pain?
Coping mechanisms
179
List the type of body movements that will increase pain.
- Bending
- Lifting
- Twisting
- Prolonged sitting
180
List the type of drug therapy used for lower back pain.
- Mild analgesics
- Antidepressants
- Gabapentin
181
What is the proper sleeping position for a patient who suffers from lower back pain?
Supine with knees bent or side-lying
182
What is the most common cause of lower back pain?
Spinal stenosis
183
What is spinal stenosis?
- Narrowing of spinal canal
| - Spinal disk puts pressure on spinal nerve
184
Intervertebral disks help absorb what?
Shock
185
What is radiculopathy?
Nerve cannot tell the muscle what to do
186
Describe degenerative disk disease.
- Disk becomes thinner as inner jelly dried out
- Shock load is shifted to outer hard layer
- Progressive destruction
- Pulposus seeps out
187
If the inner jelly of the vertebral disk seeps out, what is this known as?
Herniation
188
What is an osteophyte?
Bone spur
189
What diagnostic study shows the alignment of the spine?
X-rays
190
What is conservative therapy?
All therapeutic measures taken before surgery is necessary
191
When would surgery be indicated for intervertebral disk disease?
- Conservative treatment fails
- Radiculopathy worsens
- Loss of bowel of bladder control
- Constant pain
- Persistent neurological deficit
192
Describe a laminectomy.
Surgical removal of disk through excision
193
Describe a discectomy.
Surgical decompression of nerve root
194
What education should the nurse provide to a post-operative lumbar fusion patient?
- Pillows under thighs when supine
- Pillows between legs when side lying
- Log roll out of bed
195
What nursing management should be provided to a post-operative spinal surgery patient?
- Monitor for severe headache
| - Monitor for leakage of CSF
196
Describe cerebrospinal fluid.
- Clear or slightly yellow drainage
- Positive for glucose
- Frequent neurovascular assessments
- Assess circulation
- Monitor GI and bowel function/ability to void
197
The nurse knows they should contact the physician immediately if their postoperative spinal surgery patient if the patient presents with what?
Bowel or bladder incontinence
198
The nurse knows a post-operative spinal patient should void within what time frame following surgery?
4 to 6 hours
199
Post-operative spinal fusion patients may exhibit what problem if they have had surgery to the cervical spine?
Respiratory distress
200
Spinal cord edema may cause what?
- Airway issues
- Difficulty breathing
- Respiratory distress
201
What is osteomalacia?
Vitamin D deficiency causing bones to lose calcium and become soft
202
What type of medications are provided to a patient with osteomalacia?
- Vitamin D supplements
| - Calcium supplements
203
What type of foods are encouraged for a patient with osteomalacia?
- Eggs
- Meat
- Oily fish
204
What type of activity is encouraged for a patient with osteomalacia?
- Exposure to sun
| - Weight bearing exercises
205
What is osteoporosis?
Chronic, progressive deterioration of bone tissue
206
Patients with osteoporosis are prone to what type of fracture?
Hip
207
Is osteoporosis more common in males or females?
Females
208
Where does osteoporosis most commonly occur?
- Spine
- Hips
- Wrists
209
List the clinical manifestations of osteoporosis.
- Spontaneous fracture
- Back pain
- Gradual loss of height
- Kyphosis or Dowagers hump
210
At what age is an initial bone density test conducted in women? Men?
- 65 for women
| - No screening for men
211
What is the best method of preventing osteoporosis?
Regular weight bearing exercises
212
How is calcium best absorbed?
In small increments throughout the day
213
What is the golden standard for diagnosing osteoporosis?
Dual-energy x-ray absorptiometry (DXA)
214
What is the adequate daily calcium intake for women under the age of 51?
1000 mg per day
215
What is the adequate daily calcium intake for women over the age of 51?
1200 mg per day
216
What is considered an adequate amount of sunlight per day?
20 minutes of sunlight per day
217
What type of exercise is not recommended for patients with osteoporosis?
Swimming
218
List the drug class for Fosamax.
Bisphosphonates
219
List the proper administration of Fosamax.
- Take with full glass of water
- Take 30 minutes before food or other meals
- Remain upright for 30 minutes after taking
220
What do bisphosphonates do?
Inhibit bone resorption
221
How often is Fosamax taken?
Daily or weekly tablet
222
What does the drug Raloxifene do?
Reduces bone resorption
223
What does the drug Forteo do?
Stimulates new bone growth
224
The drug Forteo is a portion of what hormone?
Parathyroid hormone
225
What is osteoarthritis?
Slowly progressive non-inflammatory disorder of synovial joints
226
Is osteoarthritis a normal part of aging?
No
227
What risk factor for osteoarthritis is modifiable?
Obesity
228
What is the primary symptom of osteoarthritis?
Joint pain
229
Early morning joint stiffness related to osteoarthritis should resolve within what time frame?
30 minutes
230
Is osteoarthritis symmetrical or asymmetrical?
Asymmetrical
231
What might cause a temporary increase in joint swelling with osteoarthritis?
Overactivity
232
What type of nodes occur in osteoarthritis?
- Heberden's nodes
| - Bouchard's nodes
233
Where are Heberden's nodes located?
Distal joint of fingers (DIP joint)
234
Where are Bouchard's nodes located?
Proximal joint of fingers (PIP joint)
235
What is the most significant distinction between osteoarthritis and rheumatoid arthritis?
- Osteoarthritis is local
| - Rheumatoid arthritis is systemic
236
What type of exercise is recommended for osteoarthritis?
Swimming
