Muscular System Quiz Part 3: Injuries

The instructor would tell the students that it would be appropriate for the nurse to encourage the patient to avoid scratching and obtain an order for diphenhydramine (Benadryl) if severe itching persists. This is because scratching inside the cast can cause skin damage and increase the risk of infection. Providing an alternative object for scratching may still lead to skin damage. By encouraging the patient to avoid scratching and obtaining an order for diphenhydramine, the nurse can address the itching and minimize the risk of complications.

After a hip replacement surgery, it is important to keep the hips in abduction. This means keeping the legs apart and avoiding crossing them. This position helps prevent dislocation of the new hip joint and promotes proper healing. Keeping the hips flexed at 95 degrees or elevating the head of the bed to a high Fowler's position are not specific instructions for hip replacement patients. Seating the patient in a low chair may put strain on the hip joint and should be avoided.

If the patient's pain is unrelieved even after administering analgesics and elevating the limb, it may be a sign of compartment syndrome. Compartment syndrome occurs when there is increased pressure within a muscle compartment, leading to reduced blood flow and tissue damage. The pain is usually severe and out of proportion to the injury or condition. Prompt medical intervention is necessary to prevent further complications.

After receiving a right hip prosthesis, the nurse should maintain the leg in an abducted position. This position helps to prevent dislocation of the hip prosthesis by keeping the leg slightly apart from the midline of the body. Maintaining the leg in an abducted position also helps to reduce the risk of postoperative complications such as pressure ulcers and deep vein thrombosis. By keeping the leg in this position, the nurse ensures proper alignment of the prosthesis and promotes optimal healing and recovery for the patient.

The most appropriate nursing diagnosis for this patient would be "Risk of peripheral neurovascular dysfunction." This is because the patient has developed a hematoma at the knee replacement surgical site, which can potentially affect the blood flow and nerve function in the affected leg. The decreased pedal pulse indicates a compromised blood supply to the foot, which can lead to further complications if not addressed promptly. Therefore, the nursing diagnosis of "Risk of peripheral neurovascular dysfunction" accurately reflects the patient's current condition and the potential risk for complications related to impaired blood flow and nerve function.

The correct answer is B) Assess the surgical site and affected extremity. This is the most appropriate action for the nurse to take because the patient is experiencing severe pain in the surgical wound after ambulating. Assessing the surgical site and affected extremity will help the nurse determine the cause of the pain and whether there are any signs of infection or other complications. It is important to rule out any potential issues before assuming it is related to anxiety or increased activity. Monitoring the patient's temperature and vital signs may be necessary if there is a suspicion of infection, but this should be done after assessing the surgical site.

Buck's extension traction is the most appropriate type of traction to apply to a fractured proximal femur. This type of traction involves the use of a boot or traction tape applied to the lower leg, with weights attached to provide a pulling force. It is commonly used for fractures of the femur because it helps to immobilize and align the fractured bone, promoting healing and preventing further damage. Russell's traction is used for fractures of the femur in children, Dunlop's traction is used for fractures of the upper extremities, and a cervical head halter is used for cervical spine injuries.

The nurse should instruct the patient to keep their right leg elevated above heart level. Elevating the leg helps to reduce swelling and promote proper circulation, which can aid in the healing process. This position also helps to alleviate pain and discomfort.

The correct answer is D) The cast will only have full strength when dry. This answer is correct because a plaster leg cast needs to dry completely in order to harden and provide support to the injured limb. If the cast is not allowed to dry fully, it may become weak and less effective in immobilizing the limb. Therefore, it is important for the nurse to inform the patient that the cast will only have full strength when it is completely dry.

Volkmann's contracture is a condition characterized by the inability to straighten the fingers due to a lack of blood flow to the forearm and hand. This lack of blood flow is caused by obstruction of arterial blood flow. When the blood flow is obstructed, the muscles and tissues in the forearm and hand do not receive enough oxygen and nutrients, leading to muscle and tissue damage. This can result from various causes, such as trauma, compression, or compartment syndrome.

Numbness and burning of the foot are signs and symptoms that best represent peroneal nerve injury. The peroneal nerve supplies sensation to the lower leg, foot, and toes. Injury to this nerve can result in numbness and burning sensations in the affected area. Cyanotic toes and inadequate capillary refill are not specific to peroneal nerve injury and may indicate other vascular or circulatory problems. Numbness and burning of the hand would not be representative of a lower extremity fracture.

To prevent skin breakdown in a patient with skeletal traction, it is important to assess the pin insertion site every 8 hours. This is because regular assessment allows the nurse to identify any signs of infection, inflammation, or skin breakdown early on and take appropriate measures to prevent complications. By closely monitoring the pin insertion site, the nurse can ensure that it remains clean, dry, and free from any complications that could lead to skin breakdown. Regular assessment also allows for timely intervention if any issues are identified, promoting optimal healing and preventing further complications.

Proper traction use involves ensuring that knots in the rope are not resting against pulleys. This is important because if the knots were to rest against the pulleys, it could cause friction and potentially interfere with the effectiveness of the traction. Therefore, it is crucial to ensure that the knots are properly positioned away from the pulleys to maintain proper traction.

The most critical teaching point to emphasize in this teaching session is to report signs of impaired circulation. This is important because impaired circulation can lead to serious complications such as tissue damage or even amputation. It is crucial for the patient to be aware of the signs of impaired circulation, such as increased pain, numbness, tingling, or changes in skin color or temperature, and to report them to the physician immediately for prompt intervention.

The most important assessment for the nurse to make in this situation is for neurovascular compromise. A right hip fracture can potentially cause damage to the blood vessels and nerves in the area, leading to complications such as decreased circulation or nerve damage. Assessing for neurovascular compromise is crucial in order to identify any potential complications and provide appropriate interventions to prevent further damage or complications.

In order for a joint replacement surgery using cementless components to be successful, the patient must have the presence of healthy bone. Cementless components rely on the bone to grow and integrate with the implant, providing stability and long-term success of the joint replacement. If the patient has weak or compromised bone, the implant may not be able to properly integrate, leading to complications and potential failure of the surgery. Therefore, the presence of healthy bone is crucial for the success of the surgery.

When assessing for a DVT in a traction patient, the nurse would assess for signs and symptoms such as increased warmth of the calf. This could indicate inflammation and increased blood flow, which are common signs of a DVT. Other symptoms such as pain, swelling, and redness may also be present, but they are not listed as options in this question. Therefore, the correct answer is A) Increased warmth of the calf.

Mechanical prophylaxis for a DVT refers to the use of devices or methods that help prevent the formation of blood clots in the legs. Anti-embolism stockings, also known as compression stockings, are one such mechanical prophylaxis. These stockings apply pressure to the legs, helping to improve blood flow and prevent the pooling of blood, which can lead to the formation of clots. By wearing anti-embolism stockings, patients can reduce their risk of developing deep vein thrombosis (DVT) compared to those who do not use any mechanical prophylaxis.

The nurse would suspect a urinary infection because the patient's elevated temperature and elevated blood pressure and pulse could be signs of an infection. The patient's avoidance of using the urinal and bedpan may indicate discomfort or pain while urinating, which could be a symptom of a urinary infection. Additionally, the patient's age and the fact that they are in skeletal traction following a motor vehicle accident may increase their risk for developing a urinary infection.

The correct answer is B) Incentive spirometer. Incentive spirometry is a therapy that helps improve lung function and prevent respiratory complications by encouraging deep breathing and the expansion of the lungs. It helps to prevent atelectasis, a common postoperative complication, by promoting lung expansion and clearing secretions. Respiratory exercises may be beneficial, but they do not specifically target lung expansion. Chest percussion is a technique used to loosen and mobilize secretions, but it may not be appropriate for every patient. Broad-spectrum antibiotics are used to treat infections, not to prevent respiratory complications.

Once the skeletal traction is discontinued, a cast is applied to immobilize and support the healing bone. A cast provides stability and protection to the bone, allowing it to heal properly. It restricts movement and prevents any further injury or damage to the bone. A walking boot, crutches, or a cane may be used for mobility purposes, but they do not provide the same level of immobilization and support as a cast.

When setting up traction on a patient with Buck's traction, it is important to assess circulation to the affected leg regularly. The correct answer suggests that circulation should be assessed within 30 minutes of setting up the traction, and then every 1 to 2 hours thereafter. This is necessary to monitor for any signs of compromised blood flow, such as decreased pulses, coolness, or pallor in the affected leg. Regular assessment allows for early detection of any circulation issues and prompt intervention if needed.

Applying cold packs can help relieve pain in a patient with a muscle strain. Cold therapy can reduce inflammation, numb the area, and decrease muscle spasms, all of which can contribute to pain relief. Cold packs can also help to constrict blood vessels, which can reduce swelling and promote healing. Immobilizing the involved part may be necessary in some cases, but it may not directly relieve pain. Administering anti-inflammatories can also help with pain relief, but it is not specified in the question that the patient has been prescribed them.

When caring for a patient who underwent orthopedic surgery, the goals would include improving function. This means that the focus of the care is to help the patient regain their ability to perform daily activities and tasks, such as walking, dressing, and bathing, with as little difficulty or pain as possible. This may involve physical therapy, pain management, and providing support and guidance to the patient during their recovery process. The goal is to help the patient regain their independence and quality of life after the surgery.

The patient's statement that they will need assistance from their husband to get off the low toilet seat at home indicates that they may not have fully understood the instructions regarding post-operative mobility and independence. The nurse would need to provide further teaching to ensure that the patient is aware of the correct techniques and strategies to safely perform activities of daily living, including using the toilet.

During repositioning, the nurse should maintain the same degree of traction tension. This is important because changing the tension on the traction cords can lead to improper alignment and potential complications for the patient. By maintaining the same degree of traction tension, the nurse ensures that the fractured femur remains properly aligned and stable throughout the repositioning process.

To prevent dislocation of the new prosthesis after a total hip replacement, it is important to prevent internal rotation of the affected leg. Internal rotation can put stress on the hip joint and potentially cause the prosthesis to dislocate. Therefore, the nurse and other caregivers should ensure that the patient's leg is not rotated inward during routine turning or movement. This can be achieved by using proper positioning techniques and providing support to the leg to maintain it in a neutral or slightly externally rotated position.

To prevent bony fragments from moving against one another in a patient in skeletal traction, caution the patient against turning side to side. This movement can cause the bones to shift and potentially lead to further injury or complications. It is important for the patient to remain as still as possible to ensure proper healing and alignment of the bones. Removing the traction for bathing, repositioning with assistance, and coughing do not directly relate to preventing bony fragments from moving against one another.

The nurse would suspect that the patient has an infection at the surgical site that has spread from another site in the body. The presence of erythema and edema around the surgical scar indicates an inflammatory response, which is often seen in cases of infection. The fact that the patient had their hip replacement surgery 3 years ago suggests that the infection is not acute or delayed, but rather a chronic infection that has spread from another site in the body.

It is important to evaluate the patient's position frequently when caring for a patient in skeletal traction because if the patient slips down in bed, it can result in ineffective traction. Slipping down can cause the bones to shift and reduce the effectiveness of the traction. Checking the traction apparatus, ensuring that the weights hang freely, and securely tying the knots in the rope are also important, but evaluating the patient's position is the most crucial factor in maintaining effective traction.

The correct answer is D) Use of a pneumatic tourniquet. When the surgeon explains the technique of creating a "bloodless" field for the surgery to the patient, it means that they will be using a pneumatic tourniquet. This device is applied to the patient's limb and inflated to temporarily stop the blood flow to that area. By doing so, it reduces bleeding during the surgery, allowing for better visualization and control of the surgical site.

Plantar flexion is the movement of the foot that involves pointing the toes downward. This movement is primarily controlled by the tibial nerve, which innervates the muscles responsible for plantar flexion. The tibial nerve is a branch of the sciatic nerve and provides motor and sensory innervation to the posterior compartment of the leg and the sole of the foot. Therefore, the correct answer is B) Function of the tibial nerve.

Often balanced traction is used in skeletal traction. This means that the traction force is evenly distributed across the affected limb, helping to maintain alignment and prevent further injury. This type of traction is commonly used to treat fractures and dislocations. The other options are not accurate statements about skeletal traction.

To decrease the risk of deep vein thrombosis (DVT) in a patient in skeletal traction, it is important to promote blood circulation in the lower extremities. Doing foot and ankle exercises every 1 to 2 hours while awake helps to prevent blood clots by increasing blood flow and preventing stasis. This exercise stimulates the calf muscles, which helps to pump blood back to the heart and reduces the risk of DVT. Pretending to ride a bicycle while lying in bed may not provide enough movement to prevent DVT. Allowing the patient to assist with passive range-of-motion exercises or encouraging active ROM exercises on the affected leg may not provide adequate circulation to prevent DVT.

Patients in traction may experience urinary stasis, which refers to the inability to empty the bladder completely. Immobility can lead to decreased bladder tone and muscle weakness, making it difficult for the patient to fully empty their bladder. This can result in urinary retention, urinary tract infections, and other urinary complications. Anorexia, thromboemboli, diarrhea, and lactose intolerance are not directly related to immobility or traction.

Skeletal traction is a technique used to immobilize and align fractured bones. It involves the use of weights and pulleys attached to the affected limb. As the skeletal traction helps overcome the shortening spasms of affected muscles, the weight is gradually reduced to promote healing. This is done to prevent excessive tension on the muscles and to allow the bones to heal properly. Therefore, the correct answer is C) Weight is removed to promote healing.

To ensure that shearing forces are avoided, the student nurse can do the following:

B) Inspect and provide skin care q shift: By regularly inspecting the patient's skin and providing appropriate care, the student nurse can identify and address any areas of potential shearing or skin breakdown.

C) Palpate the area of the traction tapes daily: By palpating the area of the traction tapes daily, the student nurse can assess for any signs of shearing or pressure on the skin caused by the traction.

D) Provides back care at least q 2 hours: Regularly providing back care, such as repositioning the patient and ensuring proper alignment, can help prevent shearing forces on the skin.

These actions help in preventing shearing forces and maintaining the patient's skin integrity.

The nurse needs to assess the patient's respiratory status every 4 to 8 hours because being in skeletal traction for an extended period of time can increase the risk of respiratory complications such as pneumonia or atelectasis. Regular assessment of respiratory status allows the nurse to monitor for any signs of respiratory distress or decreased lung function, and take appropriate interventions if needed.

A brace is used to prevent additional injury by providing support and controlling movement. It helps to stabilize the body part and prevent further damage or strain. Additionally, a brace can also help in aligning the body part and preventing deformity by maintaining proper positioning and preventing any further misalignment.

Orthopedic surgery can be used to correct joint disease and tumors. Joint disease refers to conditions such as arthritis, where the joints become inflamed and damaged. Orthopedic surgery can help to repair or replace the affected joints, improving mobility and reducing pain. Tumors, on the other hand, can be benign or malignant growths that affect the bones or soft tissues. Orthopedic surgery can be used to remove these tumors and restore normal function. Stable fractures, inflamed tissue, and necrotic tissue are not specifically mentioned as conditions that can be corrected by orthopedic surgery.