Chapter 62: Musculoskeletal Trauma and Orthopedic Surgery

What should the nurse include when teaching older adults at a community recreation center

about ways to prevent fractures?

• Tack down scatter rugs on the floor in the home.

• Expect most falls to happen outside the home in the yard.

• Buy shoes that provide good support and are comfortable to wear.

• Get instruction in range-of-motion exercises from a physical therapist.

Answer explanation

Comfortable shoes with good support will help decrease the risk for falls. Scatter rugs should

be eliminated, not just tacked down. Activities of daily living provide range-of-motion

exercise; these do not need to be taught by a physical therapist. Falls inside the home are

responsible for many injuries.

A factory line worker has repetitive strain syndrome in the left elbow. What topic should the

nurse plan to include in patient teaching?

• Surgical options

• Elbow injections

• Wearing a left wrist splint

• Modifying arm movements

Answer explanation

Treatment for repetitive strain syndrome includes changing the ergonomics of the activity.

Elbow injections and surgery are not initial options for this type of injury. A wrist splint might

be used for hand or wrist pain.

What should the occupational health nurse advise a patient whose job involves many hours of

typing?

• Obtain a keyboard pad to support the wrist.

• Do stretching exercises before starting work.

• Wrap the wrists with compression bandages every morning.

• Avoid using nonsteroidal antiinflammatory drugs (NSAIDS).

Answer explanation

Repetitive strain injuries caused by prolonged work at a keyboard can be prevented by using a

pad to keep the wrists in a straight position. Stretching exercises during the day may be

helpful, but these would not be needed before starting work. Use of a compression bandage is

not needed, although a splint may be used for carpal tunnel syndrome. NSAIDs are

appropriate to decrease swelling.

Which discharge instruction should the emergency department nurse include for a patient with

a sprained ankle?

• Keep the ankle loosely wrapped with gauze.

• Apply a heating pad to reduce muscle spasms.

• Use pillows to elevate the ankle above the heart.

• Gently move the ankle through the range of motion.

Answer explanation

Elevation of the leg will reduce swelling and pain. Compression bandages are used to

decrease swelling. For the first 24 to 48 hours, cold packs are used to reduce swelling. The

ankle should be rested and kept immobile to prevent further swelling or injury.

A tennis player has an arthroscopic repair of a rotator cuff injury performed in same-day

surgery. Which information will the nurse include in postoperative teaching?

• “You will not be able to serve a tennis ball again.”

• “You will begin work with a physical therapist tomorrow.”

• “Keep the shoulder immobilizer on for the first 4 days to minimize pain.”

• “The surgeon will use the drop arm test to determine the success of surgery.”

Answer explanation

Physical therapy after a rotator cuff repair begins on the first postoperative day to prevent

“frozen shoulder.” A shoulder immobilizer is used immediately after the surgery, but leaving

the arm immobilized for several days would lead to loss of range of motion. The drop arm test

is used to test for rotator cuff injury but not after surgery. The patient may be able to return to

tennis after rehabilitation.

The nurse is caring for a patient who has a pelvic fracture and an external fixation device.

How should the nurse perform assessment of pressure areas and provide skin care to the

patient’s back and sacrum?

• Ask the patient to turn to the side independently.

• Defer back assessment until the patient is ambulatory.

• Have the patient lift the back and buttocks using a trapeze.

• Roll the patient over to the side by pushing on the patient’s hips.

Answer explanation

The patient can lift the back slightly off the bed by using a trapeze. The patient may find it

very difficult to turn to the side without assistance while in a fixator device. Delaying

assessment and skin care may put the patient at risk for an undetected pressure injury. Pushing

on the patient’s hips may cause additional injury.

The nurse should instruct a patient with a nondisplaced fractured left radius that the cast will

need to remain in place for what amount of time?

• Two weeks

• At least six weeks

• Until swelling of the wrist has resolved

• Until x-rays show complete bony union

Answer explanation

Bone healing starts immediately after the injury, but because ossification does not begin until

3 weeks after injury, the cast will need to be worn for at least 3 weeks. Complete union may

take up to 1 year. Resolution of swelling does not indicate bone healing.

Which patient statement indicates understanding of the nurse’s teaching about a new

short-arm synthetic cast?

• “I can remove the cast in 4 weeks using industrial scissors.”

• “I should avoid moving my fingers until the cast is removed.”

• “I will apply an ice pack to the cast over the fracture site off and on for 24 hours.”

• “I can use a cotton-tipped applicator to rub lotion on any dry areas under the cast.”

Answer explanation

Ice application for the first 24 hours after a fracture will help reduce swelling and can be

placed over the cast. The cast is typically removed in the outpatient setting. The patient should

be encouraged to move the joints above and below the cast. Patients should not insert objects

inside the cast.

A patient who is to have no weight bearing on the left leg is learning to use crutches. Which

observation by the nurse indicates the patient can safely ambulate independently?

• The patient moves the right crutch with the right leg and then the left crutch with

  the left leg.

• The patient advances the left leg and both crutches together and then advances the

  right leg.

• The patient uses the bedside chair to assist in balance as needed when ambulating

  in the room.

• The patient keeps the padded area of the crutch firmly in the axillary area when

  ambulating.

Answer explanation

Patients are usually taught to move the crutches and the injured leg forward at the same time

and then to move the unaffected leg. If the 2- or 4-point gait is to be used, the crutch and leg

on opposite sides move forward, not the crutch and same-side leg.

Patients are discouraged from using furniture to assist with ambulation. The patient is taught

to place weight on the hands, not in the axilla, to avoid brachial plexus damage.

A patient who had open reduction and internal fixation (ORIF) of left lower leg fractures

continues to report severe pain in the leg 15 minutes after receiving the prescribed IV

morphine. The nurse determines pulses are faintly palpable and the foot is cool to the touch.

Which action should the nurse take next?

• Notify the health care provider.

• Assess the incision for redness.

• Reposition the left leg on pillows.

• Check the patient’s blood pressure.

Answer explanation

The patient’s clinical manifestations suggest compartment syndrome and delay in diagnosis

and treatment may lead to severe functional impairment. The data do not suggest problems

with blood pressure or infection. Elevation of the leg will decrease arterial flow and further

reduce perfusion.