# PrepU Chapter 37: Management of Patients with Musculoskeletal Trauma

Column A
HR- 92
RR- 20/min
pH- 7.32
CO2- 35 mm Hg
HCO2- 20 mEq/L
PaO2- 62 mm Hg

Column B
HR-116
RR- 32/min
pH- 7.50
CO2- 30 mm Hg
HCO2- 24 mEq/L
PaO2- 55 mm Hg

Column C
HR- 88
RR- 16/min
pH- 7.48
CO2- 43 mm Hg
HCO2- 20 mEq/L
PaO2- 85 mm Hg

Column D
HR- 102
RR- 26/min
pH- 7.45
CO2- 37 mm Hg
HCO2- 20 mEq/L
PaO2- 72 mm Hg

Which assessment findings would the nurse expect to find in the postoperative client experiencing fat embolism syndrome?

Column A

Column B

Column C

Column D
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Terms in this set (73)
Column A
HR- 92
RR- 20/min
pH- 7.32
CO2- 35 mm Hg
HCO2- 20 mEq/L
PaO2- 62 mm Hg

Column B
HR-116
RR- 32/min
pH- 7.50
CO2- 30 mm Hg
HCO2- 24 mEq/L
PaO2- 55 mm Hg

Column C
HR- 88
RR- 16/min
pH- 7.48
CO2- 43 mm Hg
HCO2- 20 mEq/L
PaO2- 85 mm Hg

Column D
HR- 102
RR- 26/min
pH- 7.45
CO2- 37 mm Hg
HCO2- 20 mEq/L
PaO2- 72 mm Hg

Which assessment findings would the nurse expect to find in the postoperative client experiencing fat embolism syndrome?

Column A

Column B

Column C

Column D
Correct response:
Column B

Explanation:
Fat embolism syndrome is characterized by fever, tachycardia, tachypnea, and hypoxia and other manifestations of respiratory failure. Arterial blood gas findings include a partial pressure of oxygen (PaO2) less than 60 mm Hg, with early respiratory alkalosis and later respiratory acidosis.
A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching?

"I'll need to keep several pillows between my legs at night."

"I need to remember not to cross my legs. It's such a habit."

"The occupational therapist is showing me how to use a sock puller to help me get dressed."

"I don't know if I'll be able to get off that low toilet seat at home by myself."
Correct response:
"I don't know if I'll be able to get off that low toilet seat at home by myself."

Explanation:
The client requires additional teaching if he is concerned about using a low toilet seat. To prevent hip dislocation after a total hip replacement, the client must avoid bending the hips beyond 90 degrees. The nurse should instruct the client to use assistive devices, such as a raised toilet seat, to prevent severe hip flexion. Using an abduction pillow or placing several pillows between the legs reduces the risk of hip dislocation by preventing adduction and internal rotation of the legs. Teaching the client to avoid crossing the legs also reduces the risk of hip dislocation. A sock puller helps a client get dressed without flexing the hips beyond 90 degrees.
Correct response:
Impacted

Explanation:

An impacted fracture is one in which a bone fragment is driven into another bone fragment. A comminuted fracture is one in which the bone has splintered into several fragments. A compression fracture is one in which bone has been compressed. A greenstick fracture is one in which one side of the bon is broken and the other side is bent.
Correct response:
Total arthroplasty

Explanation:
A total arthroplasty is a replacement of both articular surfaces within one joint. An arthrodesis is a fusion of a joint for stabilization and pain relief and is usually done on a wrist or knee. A hemiarthroplasty is the replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. An osteotomy is the cutting and removal of a wedge of bone to change the bone's alignment, thereby improving function and relieving pain.
Correct response:
Risk for ineffective therapeutic regimen management

Explanation:
The client without adequate support and resources is at risk for ineffective therapeutic regimen management. A total knee replacement may be used to treat avascular necrosis. While an orthopedic client is at risk for disturbed body image and situational low self-esteem, there is no evidence that these exist for this client.
Correct response:
Sharp and piercing

Explanation:
The nurse must carefully evaluate pain associated with the musculoskeletal condition, asking the client to indicate the exact site and to describe the character and intensity of the pain using a pain rating scale. Most pain can be relieved by elevating the involved part, applying ice or cold packs, and administering analgesic agents as prescribed.

Pain associated with the underlying condition (e.g., fracture, which is sharp and piercing) is frequently controlled by immobilization. Pain due to edema that is associated with trauma, surgery, or bleeding into the tissues can frequently be controlled by elevation and, if prescribed, intermittent application of ice or cold packs. Ice bags (one third to one half full) or cold application devices are placed on each side of the cast, if prescribed, making sure not to indent or wet the cast. Unrelieved or disproportionate pain may indicate complications.

Pain associated with compartment syndrome is relentless and is not controlled by modalities such as elevation, application of ice or cold, and usual dosages of analgesic agents. Severe burning pain over bony prominences, especially the heels, anterior ankles, and elbows, warns of an impending pressure ulcer. This may also occur from too-tight elastic wraps used to hold splints in place.
Correct response:
Difficulty lying on affected side

Explanation:
Clients with a rotator cuff tear experience pain with movement and limited mobility of the shoulder and arm. They especially have difficulty with activities that involve stretching their arm above their head. Many clients find that the pain is worse at night and that they are unable to sleep on the affected side.
A client's cast is removed. The client is worried because the skin appears mottled and is covered with a yellowish crust. What advice should the nurse give the client to address the skin problem?

Consult a skin specialist.
Scrub the area vigorously to remove the crust.
Apply lotions and take warm baths or soaks.
Avoid exposure to direct sunlight.
Correct response:
Apply lotions and take warm baths or soaks.

Explanation:
The client should be advised to apply lotions and take warm baths or soaks. This will help in softening the skin and removing debris. The client usually sheds this residue in a few days so the client need not consult a skin specialist. It is not advisable to scrub the area vigorously. The client need not avoid exposure to direct sunlight because the area is not photosensitive.