Chapter 46 Nursing Care of Patients with Musculoskeletal and Connective Tissue Disorders

Answers CHAPTER 46 NURSING CARE OF PATIENTS WITH MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS AUDIO CASE STUDY Alex and Osteomyelitis 1. Osteomyelitis. 2. Hand hygiene and use of sterile technique for dressing changes. 3. Analgesics. VOCABULARY 1. Arthritis 2. Arthroplasty 3. Synovitis 4. Arthrocentesis 5. Hyperuricemia 6. Vasculitis 7. Avascular necrosis 8. Replantation 9. Hemipelvectomy 10. Fasciotomy 11. Osteosarcoma 12. Osteomyelitis FRACTURES 1. (10) 2. (1) 3. (9) 4. (8) 5. (7) 6. (6) 7. (5) 8. (4) 9. (3) 10. (2) PROSTHESIS CARE EDUCATION 1. False. New shoes should be the same height as well as type. 2. False. Clean with mild soap and water. 3. True 4. True 5. False. Grease the parts as ordered by the prosthetist. HEALTH PROMOTION FOR PATIENTS WITH GOUT 1. purine, sardines 2. Avoid 3. fluids 4. aspirin, aspirin 5. Avoid 6. stress 7. cherry 1 2 Chapter 46 Answers CRITICAL THINKING NURSING DIAGNOSIS Impaired Physical Mobility related to hip precautions and surgical pain Interventions • Reinforce transfer and ambulation techniques. • Monitor the patient for and take measures to prevent complications of immobility. • Turn patient every 2 hours to the side ordered and check skin. • Keep heels off bed. • Teach patient to deep breathe and cough every 2 hours while awake. • Teach use of incentive spirometer every hour while awake. • Apply thigh-high elastic stockings as ordered. • Give anticoagulants as ordered. • Encourage the patient to practice leg exercises. • Mobilize the patient as soon as possible as prescribed. Rationale • Activity is restricted due to hip precautions and weight-bearing limitations. • Immobility complications can occur in multiple body systems if preventive measures are not used. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (2, 5) is correct. It should be wrapped in a cool, moist cloth (sterile, if available) and sealed in a plastic bag. (1) is incorrect. It should be cool and moist. (3) is incorrect. It is not placed on dry ice, which is also not readily available. (4) is incorrect. It is not readily available or moist. (6) is incorrect. It is not placed in ice to avoid extreme temperature. 2. (3) is correct. An elevated serum uric acid level, which is a waste product resulting from the breakdown of proteins, occurs with gout. Urate crystals, formed because of excessive uric acid buildup, are deposited in joints and other connective tissues, causing severe inflammation. (1, 2, 4) are incorrect. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 3. (2) is correct. Buck traction is skin traction. (1, 3, 4) are examples of skeletal traction. 4. (2) is correct. Palming the cast to move it prevents indentations being made in the wet cast with fingertips. (1, 3, 4) are incorrect. Evaluation • Does the patient transfer and ambulate as instructed by physical therapy? • Is the patient free from complications of immobility? 5. (3, 5) are correct. Giving a test dose of gold is important to observe for an allergic reaction, and the patient is monitored after the test dose for an allergic reaction. (1, 2, 4, 6) are incorrect. 6. (4) is correct. The morphine should be prepared so it is ready to give promptly when it can be given after 3 hours; 10 mg should be given because the pain level is at the maximum and is occurring before the minimum ordered time interval. (1) is incorrect. Applying ice to the cast may be helpful. However, because the pain is at the maximum, it will not provide enough relief. (2) is incorrect. There are no abnormalities to report to the health care provider at this time. (3) is incorrect. Removing the pillow may increase pain if swelling increases. 7. (4) is correct. This is a sign of hip dislocation. (1, 2, 3) are incorrect. 8. (1, 2, 3, 6) are correct. They are not high-purine foods and can be eaten. (4, 5) are high in purines and should be avoided. 9. (1, 5, 6) are correct. They contain aspirin, which can cause an attack of gout. (2, 3, 4) are incorrect. 10. (3) is correct. The erythrocyte sedimentation rate is a general screening test for systemic inflammation. (1, 2, 4) are incorrect. Chapter 46 11. (2, 4, 5) are correct. Pathological fractures result from disease. (1, 3, 6) are not diseases. 12. (2) is correct. Stiff, sore joints are one of the early symptoms of rheumatoid arthritis. (1, 4) are not early symptoms. (3) is not a related symptom. 13. (1, 2, 4, 6) are correct. Weight-bearing exercise and weight training, intake of foods high in calcium, and supplements help prevent osteoporosis. (3) is incorrect. Dark green leafy vegetables are high in calcium and should be included in the diet. (5) is incorrect. Maintaining normal weight is important to reduce stress on joints to prevent osteoarthritis, not osteoporosis. 14. (1, 3, 4, 6) are correct. (2) is incorrect. Give in morning upon arising. (5) is incorrect. Wait 30 minutes before giving other medication. 15. (2, 3, 5, 6) are correct. Further teaching is needed as they all promote flexion of the hip, which would promote contracture development and prevent the use of a prosthesis. (1, 4) prevent contracture development and should be used. Answers 16. The most common location for pain and inflammation associated with gout are the great toes. 3