Orthopaedic Nursing ONC
Orthopaedic Nursing Review ONC
Which of the following recreational activities is most appropriate for the orthopaedic nurse to suggest to a patient with rheumatoid arthritis?
B. Square dancing
C. Power walking
Answer: B. Square dancing
For the patient with rheumatoid arthritis (RA), suggest activities that have low joint impact, which can be performed with the body in a normal anatomical and functional position. Of the options listed, recreational square dancing most closely meets these criteria. Bowling requires hand strength and movement in exaggerated positions. Power walking impacts the heel and knee joints. Billiards is played largely with the hands and requires leaning over the table in an unnatural position. Maintaining activities of daily living, and participating in pursuits that are enjoyable, help RA patients maintain a positive self-image and promotes a sense of self-worth. However, caution patients to minimize stress and avoid becoming overtired, which can exacerbate RA.
Which of the following is the most serious long-term complication of hip dislocation?
A. Avascular necrosis
B. Traumatic arthritis
D. Heterotopic ossification
Answer: A. Avascular necrosis
The femoral head has an extremely limited blood supply. Therefore, prolonged traumatic dislocation—which interrupts blood flow—can produce ischemic injury to the bone. This condition is known as avascular necrosis. Once the femoral head dies, removal and artificial replacement become necessary. Another complication of hip dislocation is sciatic nerve stretching. Because the common peroneal nerve branches from the sciatic nerve, patients can develop foot drop. Traumatic arthritis is also a complication of hip dislocation, but it is less debilitating than avascular necrosis. Once a traumatically dislocated hip is relocated, it is unlikely to dislocate again because hip dislocation requires considerable force. Heterotopic ossification typically occurs only when an amputation or fracture is involved.
A soccer player who was hit on the head by a fast-moving ball complains of numbness and tingling that radiates down the entire left arm. The orthopaedic nurse suspects
A. pinched nerve syndrome.
B. shoulder dislocation.
C. acromioclavicular separation.
D. brachial nerve contusion.
Answer: A. pinched nerve syndrome.
The orthopaedic nurse understands that radiculopathic pain (pain that radiates along a spinal nerve root's distribution), indicates a spinal nerve root injury. In this case, a cervical spinal nerve root has been stretched, or pinched. Swelling around the nerve root and the surrounding soft tissues can be expected. Ice to the cervical spine, for twenty minutes out of an hour and administration of a non-steroidal antiinflammatory drug would be appropriate interventions. A muscle relaxant could be taken if the athlete experiences significant muscle spasms. Shoulder dislocation, acromioclavicular (AC) separation, and brachial nerve contusion are unrelated to a blow to the head.
An infant is diagnosed with osteogenesis imperfecta. An ATYPICAL finding in this patient would be
A. blue-tinged sclera.
B. normal bone mineral stores.
C. bilateral conductive hearing loss.
D. dense skeletal bone.
Answer: D. dense skeletal bone.
Osteogenesis imperfecta (OI) is an inherited disease that results in thin, fragile bones and generalized osteopenia. OI patients have normal amounts of bone and cartilage minerals, but collagen synthesis is decreased and its quality is poor. OI occurs in varying degrees of severity, with life expectancy ranging from neonatal death to a normal life span. Typical findings in the OI patient are thin, translucent skin, blue sclera, hearing loss, and a "shepherd crook" deformity, in which the femurs bow outward resembling a shepherd's staff. Unfortunately, there is currently no treatment for the underlying collagen defect, so the focus of care is on fracture prevention. Pamidronate sodium (Aredia®) is a calcium regulator that may be given to inhibit osteoclastic activity without affecting osteoblast activity and bone mineralization.
A patient with a rare musculoskeletal disease is now having difficulty swallowing. The orthopaedic nurse knows that this finding is a common complication of
A. psoriatic arthritis.
B. polymyalgia rheumatica.
D. systemic sclerosis.
Answer: D. systemic sclerosis.
All of the conditions listed have a number of findings in common. Each is an inflammatory disorder with diffuse and often non-specific symptoms affecting not only the musculoskeletal system, but many other structures as well. Systemic sclerosis (a.k.a. scleroderma) is a widespread connective tissue disease that involves changes in the skin, blood vessels, muscles, and internal organs due to collagen accumulation. Findings are diffuse, but bone and muscle symptoms include: joint pain; pain and paresthesia of the feet; and pain, stiffness, and swelling of fingers and wrists. As connective tissue loses flexibility it becomes difficult to breathe and swallow. Polymyalgia rheumatica (PMR) is an inflammatory disorder involving pain and stiffness in the shoulders and hips.
Orthopaedic Nursing Review ONC
Orthopaedic Nursing Review ONC®
Pocket Study Guide Volume 1
Mary R. Evans MS RN-BC ONC OCNS-C
Laura M. Criddle PhD RN-BC ONC ACNS-BC FAEN