Mobility (ATI med-surg) exam| 101 questions and answers.

Arthroscopy - visualization of internal joint structures through endoscope (knee & shoulder) - can repair torn ligament or meniscus or perform synovial biopsies - requires informed consent Contradictions to arthroscopy joint infection and lack of joint mobility Arthroscopy considerations - assess NV status & dressing every hour - ice for first 24hr, elevate for 12-24hr, monitor temp, color, pain & sensation Bone scan - inject radioactive isotope 2-3hr before scan - detect hairline bone fracture, tumors, fractures, bone disease (osteomyelitis, osteoporosis, vertebral compression) Bone scan indications degenerative bone disease and progression, osteomyelitis, stress or vertebral compression fractures, osteoporosis, primary or metastatic bone cancer, bone pain, aseptic necrosis Bone scan considerations instruct client to remain still & empty bladder prior, drink fluids after to promote excretion of radioactive substances Dual-energy x-ray absorptiometry - estimates bone mass density (usually in hip or spine) and presence of osteoporosis - usually postmenapausal or baseline in 40s Dual-energy x-ray absorptiometry contraindications prenant or lactating, remove all metal objects Electromyography & nerve conduction - use thin needles placed in muscle attached to electrolytes and oscilloscope that records activity - dx neuromuscular disorders, motor neuron disease, & peripheral nerve disorders EMG contraindications anticoagulant use, skin infections, muscle relaxants EMG considerations require signed consent form, avoid applying lotion/cremes day before, apply ice to prevent hematoma CT scan, MRI, & Ultrasound - give detailed images of body structures, bone density/texture, and surgical hardware, and visualization of soft tissues - dx injuries to tendons or ligaments, body structure fractures (chest & pelvis), skull/vertebral fracture, or herniated disc MRI considerations client removes metal jewelry, assess for metal in body (pacemakers) A 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? (SATA) - "inspect your incision daily for indications of infection" - "apply ice packs to area for the first 24 hours" - "perform isometric exercises" A 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? - "assess color and temp of extremity" - "place pillows under extremity" - "administer analgesic meds" - "assess pulse and sensation in the foot" A nurse is teaching a client who is going to have a bone scan. Which of the following statements should the nurse include? "you have to urinate just before the procedure" A 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? - the hip and spine are the usual areas the device scans - bone pain can indicate a need for a scan - females should have a baseline scan in their 40s A nurse is planning care for a client who will undergo an electromyography (EMG). Which of the following actions should the nurse include? - assess for bruising - determine if client takes muscle relaxant - instruct client to flex muscles during needle insertion Arthroplasty surgical removal of diseased joint due to OA, osteonecrosis, RA, trauma, or congenital anomaly and replacement with prosthetics Arthroplasty contraindications infection, arterial impairment, comorbid condition (uncontrolled DM or HTN, advanced osteoporosis, progressive inflam, unstable cardiac or resp condition Arthroplasty education - post op care: incentive spirometry, transfusion, surgical drains, dressing, pain control, transfer, exercises, activity limits - antiseptic soap night before and morning of - take medications with sip of water morning of surgery Knee arthroplasty assessment NV status (movement, sensation, color, pulse, capillary refill) q2-4hr Knee arthroplasty education avoid kneeling and deep knee bends Hip arthroplasty education use elevated seating, straight chairs with arms, pillow between legs, externally rotate toes, avoid flexion >90degrees, do not cross legs, avoid turning to operative side, use anticoagulant medications Pulmonary embolism s/s acute dyspnea, tachycardia, & pleuritic chest pain VTE prophylaxis - pharm management, antiembolic stockings, sequential compression devices, foot pumps - encourage plantar flexion, dorsiflexion, & circumduction - early ambulation A nurse is reviewing the health record for a client who is to undergo total joint arthroplasty. The nurse should recognize which of the following findings as a contradiction to this procedure? bronchitis 2 weeks ago A nurse is admitting a client to the orthopedic unit following a total knee arthroplasty. Which of the following actions by the nurse are appropriate? check continuous passive motion device setting, palpate dorsal pedal pulses, elevate heels off bed A 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? clean incision daily with soap and water, sit in straight-backed armchair, use raised toilet seat A nurse is assisting a client who is scheduled to undergo a right knee arthroplasty. The nurse should expect which of the following findings? pain when bearing weight, joint crepitus, swelling of affected joint, limited joint motion A nurse is complimenting 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? encourage complete autologous blood donation, use abductor pillow when turning client, perform isometric exercises Amputation findings altered peripheral pulses, different temp in extremities, altered color, infection or open wounds, lack of sensation Amputation nursing actions - monitor capillary refill, observe for edema, necrosis & lack of hair - assess for complications (hypovolemia, pain, infection) - assess for bleeding Amputation Dx procedures - doppler laser & ultrasound (measure speed of blood flow) - transcutaneous oxygen pressure (TcPO2) indicates blood flow to extremity Phantom limb pain - calcitonin in 1st week - beta blockers (propranolol) for continual, dull burning sensation - antiepileptics (gabapentin or pregabalin) for sharp, stabbing and burning pain - teach to push limb down onto pillow Flexion contracture prevention ROM exercises, don't elevate limb on pillow, lie prone 20-30mins several times a day, discourage prolonged sitting A nurse is presenting information to a group of clients at a health fair about measures to reduce risk of amputation. Which of the following info should the nurse include? encourage smoking cessation, encourage diabetics to maintain glucose control, instruct clients to unplug electrical equipment when performing repairs, encourage clients who have vascular disease to maintain good foot care A 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? skin cool to touch from mid-calf to toes, lack of hair on lower leg, blackened areas on several toes A nurse is caring for a client following a below the elbow amputation. Which of the following actions should the nurse take? encourage dependent positioning of residual limb, inspect for presence and amount of drainage, implement shrinkage intervention of residual limb, assess for body image feeling changes A nurse is preparing a plan of care to prevent a client from developing flexion contractions following a below the knee amputation 24hr ago. Which of the following actions should the nurse include? position client prone several times a day Osteoporosis - chronic metabolic bone disorder resulting in low bone density due to resorption rate exceeding formation rate - common in wrists, hips, and spine Osteopenia - precursor to osteoporosis - low bone mineral density relative to clients age and sex Osteoporosis health promotion calcium (milk, green leafy, fortified, beans, figs), vitamin D (sunlight, fortified, egg yolks), weight bearing exercises Osteoporosis risk factors family history, thin lean body, females, limited protein diet, tobacco, high alcohol intake, excess caffeine, hx of malabsorption disorders, prolonged immobility, high phosphorus intake (carbonated beverages), medications (loop diuretics, corticosteroids, thyroid meds, anticonvulsants)