Bone scan post procedure client educationdrink plenty of fluids to excrete radioisotope in urine and feces.dual energy x-ray absorptiometry (DEXA)-scans estimate the density of bone mass, usually in hip or spine- and the presence of osteoporosis
-scans 2 beams of radiation
-computer analyses findings and radiologist interprets them
-client receives a score to their bone densitywhy would someone get a DEXA-Osteoporosis
-postmenopausal state
-baseline testing: females in their 40'sDEXA preprocedural client education-contraindicated for pregnant or lactating
-stay dressed but remove metallic objectsDEXA post procedure client educationfollow up with provider to discuss possible supplements and medication if bone loss is presentEMG and nerve conduction study determine what?presence and cause of muscle weaknessElectromyography (EMG)-done at bedside or EMG laboratory
-Tech places thin needles in the muscle under study.
-Electrodes attach to the needles to an oscilloscope, which records muscle contractionnerve conduction study-Tech attaches surgace or needle electrodes to skin
-low electrical currents go through producing a recording of muscles response to the stimulusEMG & nerve conduction study are performed why?-neuromuscular disorders
-motor neuron disease
-Peripheral nerve disorders (carpal tunnel)Contraindications for EMG-Anticoagulants
-infection in area of assessment
-ask if client takes muscle relaxers
-signed consent formEMG preprocedural client education-avoid using cream or lotion to the area on procedure day
-discomfort from needle injection/electrical stimulation
-might be asked to flex certain musclesEMG post procedure client education-Bruising can occur
-report any swelling or tenderness
-apply ice to prevent hematoma and to reduce swellingCT scan, resonance imaging, radiography, ultrasonographyProvide detailed images of the body structures, bone density and texture as well as surgical hardwareMRI, US, and CT provide visualization of whatsoft tissueswhy would someone need a CT scan, resonance imaging, radiography, or ultrasonography-tendon or ligament injury
-fracture of bony structures of the chest and pelvis
-skull and vertebral fracture
-herniated discCT scan nursing actions pre procedure-If contrast media is prescribed, assess for allergy, and ensure client has adequate fluid intakeMRI nursing actions preprocedure-determine if client has metal in the body (pacemaker) and remove jewelryA nurse is completing preoperative teaching for a client who is to undergo an arthroscopy to repair a shoulder injury. Which of the following statements should the nurse include ?
A) avoid damage or moisture to the cast on your arm.
B) Inspect your incision daily for indications of infection
C) Apply ice packs to the area for the first 24 hours.
D) keep your arm in a dependent position
E) Perform isometric exercisesB) Inspect your incision daily for indications of infection
C) Apply ice packs to the area for the first 24 hours.
E) Perform isometric exercisesA nurse is planning care for a client who is postoperative following an arthroscopy of the knee. Which of the following actions should the nurse take? (Select all that apply.)
A) Assess color and temp. of the extremity
B) Apply warm compresses to incision sites
C) Place pillows under the extremity
D) Administer analgesic medication
E) Assess pulse and sensation in the footA) Assess color and temp. of the extremity
C) Place pillows under the extremity
D) Administer analgesic medication
E) Assess pulse and sensation in the footA nurse is teaching a client who is going to have a bone scan. Which of the following statements should the nurse include?
A) You will receive an injection of a radioactive isotope when the scanning procedure begins.
B) You will be inside a tube-like structure during the procedure
C) You will need to take radioactive precautions with your urine for 24 hours after the procedure
D) You will have to urinate just before the procedureD) You will have to urinate just before the procedureA nurse is educating clients at a health fair about dual-energy x-ray absorptiometry (DXA) scans. Which of the following information should the nurse include? (SATA)
A) The test requires the use of contrast material
B) The hip and spine are the usual areas the device scans
C) The scan detects osteoarthritis
D) Bone pain can indicate a need for a scan
E) Females should have a baseline scan during their 40s.B) The hip and spine are the usual areas the device scans
D) Bone pain can indicate a need for a scan
E) Females should have a baseline scan during their 40s.A nurse is planning care for a client who will undergo electromyography (EMG). Which of the following actions should the nurse include? (SATA)\
A) Assess for bruising
B) Administer aspirin prior to the procedure
C) Determine whether the client takes a muscle relaxant
D) Instruct the client to flex muscles during needle insertion
E) Expect swelling, redness, and tenderness at insertion sitesA) Assess for bruising
C) Determine whether the client takes a muscle relaxant
D) Instruct the client to flex muscles during needle insertionarthroplastyrefers to the surgical removal of a diseased joint due to osteoarthritis, osteonecrosis, RA, trauma or congenital anomalies and replace with prosthetics or artificial components made of metal, steel titanium or plasticTotal Joint Arthroplasty/Replacementreplacement of all components of an articulating jointtotal knee arthroplasty (TKA)surgical reconstruction of knee joint with artificial knee joint; also called total knee replacement (TKR)Unicondylar knee replacementIs done when a client's joint is diseased in one compartment of the jointtotal hip arthroplasty (THA)The replacement of the acetabular cup, femoral head and femoral stemHemiarthroplastyreplacement of part of the jointwhat is the goal of both hip and knee arthroplasty?-eliminate pain
-restore joint motion
-improve clients functional status and quality of lifeArthroplasty contraindicationscurrent / recent infection,
-arterial insufficiency to affect extremity
-clients cant follow postsurgical regimenarthroplasty pre-op nursing actions-assess cbc, urinealysis, electrolytes, BUN, creatinine
-Chest xray to rule out tumor/infection
-ECG to gather baseline rhythmsarthroplasty pre-op client education-incentive spirometry
-transfusion
-surgical drains
-dressing
-pain control
-how to transfer
-exercises
-activity limitationsarthroplasty post op patient education-extensive PT required
-home care will be needed for 4-6 weeks
-monitor for infection
-care for incision
-monitor for DVTTendons connect ________ to ______.muscle to boneLigaments connect ______ to ______.bone to boneA nurse is reviewing the health record of a client who is to undergo total joint arthroplasty. The nurse should recognize which of the following findings as a contraindication to this procedure?
A) Age 78 years
B) History of cancer
C) Previous joint replacement
D) Bronchitis 2 weeks agoDA nurse is admitting a client to the orthopedic unit following a total knee arthroplasty. Which of the following actions by the nurse are appropriate? (SATA)
A) Check continuous passive motion device settings
B) Palpate dorsal pedal pulses
C) Place a pillow behind the knee
D) Elevate heels off bed
E) Apply heat therapy to incisionA) Check continuous passive motion device settings
B) Palpate dorsal pedal pulses
D) Elevate heels off bedA nurse is planning discharge teaching for a client who had a total hip arthroplasty. Which of the following should the nurse include in the teaching? (SATA)
A) Clean the incision daily with soap and water.
B) Turn the toes inward when sitting or lying
C) Sit in a straight-backed armchair
D) Bend at the waist when putting on socks
E) Use a raised toilet seatA) Clean the incision daily with soap and water.
C) Sit in a straight-backed armchair
E) Use a raised toilet seatA nurse is assessing a client who is scheduled to undergo a right knee arthroplasty. The nurse should expect which of the following findings? (SATA)
A) Skin reddened over the joint
B) Pain when bearing weight
C) Joint crepitus
D) Swelling of the affected joint
E) Limited joint motionB) Pain when bearing weight
C) Joint crepitus
D) Swelling of the affected joint
E) Limited joint motionA nurse is completing a preoperative teaching plan for a client who is scheduled to have a total hip arthroplasty. Which of the following should the nurse include in the teaching plan? (SATA)
B) Sit in a low reclining chair
C) Instruct the client to roll onto the operative hip
D)Use an abductor pillow when turning the client
E) Perform isometric exercisesA) Encourage complete autologous blood donation
D)Use an abductor pillow when turning the client
E) Perform isometric exercisesA nurse is presenting information to a group of clients at a health fair about measures to reduce the risk of amputation. Which of the follow information should the nurse provide? (SATA)
A) Encourage clients who smoke to consider smoking cessation programs
B) Encourage clients who have diabetes mellitus to maintain blood glucose within the expected reference range
C) Instruct clients to unplug electrical equipment when performing repairs
D) Encourage clients who have vascular disease to maintain good foot care
E) Advise clients to wait 2 hr after taking pain medication before drivingA) Encourage clients who smoke to consider smoking cessation programs
B) Encourage clients who have diabetes mellitus to maintain blood glucose within the expected reference range
C) Instruct clients to unplug electrical equipment when performing repairs
D) Encourage clients who have vascular disease to maintain good foot careA nurse is assessing a client who has arteriosclerosis and is scheduled for a possible right lower extremity amputation. Which of the following are expected findings in the affected extremity? (SATA)
A) Skin cool to touch from mid-calf to the toes
B) increased sensitivity to fine touch
C) palpable pouding pedal pulse
D) lack of hair on lower leg
E) Blackened areas over several toesA) Skin cool to touch from mid-calf to the toes
D) lack of hair on lower leg
E) Blackened areas over several toesA nurse is caring for a client following a Below-the-elbow amputation. Which of the following actions should the nurse take? (SATA)
A) Encourage dependent positioning of the residual limb.
B) Inspect for presence and amount of drainage
C) Implement shrinkage intervention of the residual limb
D) Wrap the residual limb in a circular manner using gauze
E) Assess for feelings of body image changesA) Encourage dependent positioning of the residual limb.
B) Inspect for presence and amount of drainage
C) Implement shrinkage intervention of the residual limb
E) Assess for feelings of body image changesA nurse is caring for a client who had an above-the-knee amputation. The client reports a sharp, stabbing type of phantom pain. Which of the following actions should the nurse take?
A) Remove the initial pressure dressing
B) Encourage use of cold therapy
C) Question whether the pain is real
D) Administer an anti-epileptic medicationD) Administer an anti-epileptic medicationOsteoporosis occurs whenbone breakdown exceeds bone formation resulting in fragile bone tissueOsteopeniaThe precursor to osteoporosis. indicated by reduced bone mass.bone mineral density peaks between18 to 30Osteoporosis: health promotion and disease prevention-consume adequate amounts of calcium and Vit D, esp during childhood
-Spend time outdoors
-engage in weight bearing exercises (walking, weight lifting)Osteoporosis Risk Factors-Family history
-Loss of estrogen
-Aging
-Calcium, vitamin D
-Cigarette smoking
-Excessive alcohol
-Sedentary lifestyleOsteoporosis expected findings-reduced height (2-3 in)
-acute back pain after lifting or bending
-restriction in movement
-history of fractures
-thoracic(kyphosis) of the spineA nurse is admitting an adult client who has suspected osteoporosis. Which of following findings are risk factors for osteoporosis?
A) History of consuming one glass of wine daily
B) Loss in height of 2 in (5.1 cm)
C) Body mass index (BMI) of 18
D) Kyphotic curve at upper thoracic spine
E) History of lactose intoleranceB) Loss in height of 2 in (5.1 cm) (loss of 2 inches is suggestive of osteoporosis)
C) Body mass index (BMI) of 18 (at risk due to low body weight and thin build)
D) Kyphotic curve at upper thoracic spine (kyphosis curve is highly suggestive of osteoporosis)
E) History of lactose intolerance (due to lack of calcium intake)A nurse is providing care for a client who had a vertebroplasty of the thoracic spine. Which of the following actions should the nurse take?
A) Apply heat to the puncture site
B) Place the client in a supine position
C) turn the client every 1 hr
D) Ambulate the client within the first hour post procedureB) Place the client in a supine position (this allows cement to harden after procedure)A nurse is providing dietary teaching about calcium-rich foods to a client who has osteoporosis. Which of the following foods should the nurse include in the instructions?
A) White bread
B) Kale
C) Apples
D) Brown riceB) Kale (green leafy vegs are good sources of calcium)A nurse is performing health screenings at a health fair. Which of the following clients have a risk factor for osteoporosis? (SATA)
A) A 40-year-old client who has been taking prednisone for 4 months.
B) A 30-year-old client who jogs 3 miles daily
C) A 45-year old client who takes phenytoin for seizures
D) A 65-year-old client who has a sedentary lifestyle
E) A 70-year-old client who has smoked for 50 yearsA) A 40-year-old client who has been taking prednisone for 4 months.(prednisone affects absorption and metabolism of calcium)
C) A 45-year old client who takes phenytoin for seizures(phenytoin affects absorption and metabolism of calcium)
D) A 65-year-old client who has a sedentary lifestyle( bones need the stress of weight bearing activity for bone rebuilding and maintenance)
E) A 70-year-old client who has smoked for 50 years (smoking increases the risk for ostoporosis)A nurse is teaching a client how to manage an external fixation device upon discharge. Which of the following statements by the client indicates an understanding of the teaching? (Select all that apply)
A. "I will clean the pins twice a day"
B. "I will use a separate cotton swab for each pin"
C. "I will report loosening of the pins to my doctor"
D. "I will move my leg by lifting the device in the middle
E. "I will report increased redness at the pin sitesA. "I will clean the pins twice a day" (clean more than prescribed if drainage increases)
B. "I will use a separate cotton swab for each pin" (decreases risk of cross contamination)
C. "I will report loosening of the pins to my doctor"
(this can indicate infection and should report)A nurse is assessing a client who has a casted compound fracture of the femur. Which of the following findings is a manifestation of a fat emboli?
A. Altered mental status
B. Reduced bowel sounds
C. Swelling of the toes distal to the injury
D. Pain with passive movement of the foot distal to the injuryA. Altered mental status (early manifestation of fat emboli)A nurse is assessing a client who had an external fixation device applied 2h ago for a fracture of the left tibia and fibula. Which of the following findings is a manifestation of compartment syndrome? (Select all that apply)
A. Intense pain when the client's left foot is passively moved
B. Capillary refill of 3 sec on the client's left leg
C. Hard, swollen muscle in the client's left leg
D. Burning and tingling of the client's left foot
E. Client report of minimal pain relief following the second dose of opioid medicationA. Intense pain when the client's left foot is passively moved (can indicate edema)
C. Hard, swollen muscle in the client's left leg (can indicate edema)
D. Burning and tingling of the client's left foot (can indicate edema)
E. Client report of minimal pain relief following the second dose of opioid medication (can indicate edema)A nurse is completing discharge teaching for a client who had a wound debridement for osteomyelitis. Which of the following information should the nurse include in the teaching?
A. Antibiotic therapy should continue for 3 months
B. Relief of pain indicates the infection is eradicated
C. Airborne precautions are used during wound care
D. Expect paresthesia distal to the woundA. Antibiotic therapy should continue for 3 months (treatment of osteomyelitis includes antibiotic therapy for 3 months)A nurse in the emergency department is planning care for a client who has a right hip fracture. Which of the following immobilization devices should the nurse anticipate in the plan of care?A. Skeletal traction
B. Buck's traction
C. Halo traction
D. Bryant's tractionB. Buck's traction
(a temporary immobilization device applied to a client who has a femur or hip fx to diminish muscle spasms and immobilize the affected extremity until surgery)
