ONC Certification study Cards Exam 165 Questions with Verified Answers
What age does bone density peak for most people? - CORRECT ANSWER age 30
A 14
... [Show More] year old fell during a baseball game suffering first degree ankle sprain, physician rec standard conservative tx for 24 hours then contrast baths, which correctly describes contrast baths - CORRECT ANSWER soak foot in cold water for 15 min followed by warm for 15 min QID
during the acute stage of rheumatoid arthritis affecting the ankles, what primary precaution should the patient use to protect the ankle joints - CORRECT ANSWER use of ankle splints
which of the following is the definitive diagnostic test for juvenile idiopathic/rheumatoid arthritis - CORRECT ANSWER there is no definitive test for this
which of the following is a method to relive pressure on the back for people whose work requires prolonged standing? - CORRECT ANSWER place one foot on a small stool or box
what is the greatest risk in the immediate postoperative period for patients who suffer orthopedic traume requiring reconstructive surgery of the lower extremeties? - CORRECT ANSWER pulmonary embolism
which of the following statements by the parent of a child with systemic juvenile idiopathic/rheumatoid arthritis (still's diesease) indicates a need for further education about the diesease - CORRECT ANSWER my child no longer has symptoms so i dont think she needs the medications
which of the following patients is the best candidate for surgical repair of a ruptured achilles tendon? - CORRECT ANSWER 40 year old male in good general health
using the symptom based diagnostic criteria of the american college of rheumatology for diagnosis of fibromyalgia, which of the minimal scores is consistent with the diagnosis - CORRECT ANSWER widespread pain index score of > or equal to 7 and symptom severity score of > or equal to 5
which of the follow heat producing therapies is most indicated for pain and stiffness of large joints such as shoulder or hip? - CORRECT ANSWER short wave diathermy
what soft tissue penetrance does superficial heat such as paraffin baths or moist heat packs provide? - CORRECT ANSWER 1-2cm
when using cryotherapy for an athletes foot, what is the max length of time the foot should be immersed in an ice bath at each treatment? - CORRECT ANSWER 20 minutes
when using vapocoolant spray to facilitate stretching of the muscle after a hamstring injury, how far away from the skin should the spray container be held when spraying the skin? - CORRECT ANSWER 12 incehs
which of the following tx is contraindicated for patients with a pacemaker? - CORRECT ANSWER TENS treatment
A football player is to use a whirlpool bath to relieve muscle pain and stiffness what temperature should the water be maintained at? - CORRECT ANSWER 95-104 degrees fahrenheit
women of childbearing age taking oral methotrexate for tx of rheumatoid arthritis should utilize birth control for what period - CORRECT ANSWER during tx and through one ovulatory cycle after tx
which of the following is correct advice for patient during periods of exacerbation of rheumatoid arthritis affecting the knees? - CORRECT ANSWER avoid positions of flexion
at what stage of rheumatoid arthritis is a patient if there is bone thinning with slight damage to the bone and slight cartilage damage wtih atrophy of adjacent muscles and limitations in join mobility? - CORRECT ANSWER stage 2
a patient with rheumatoid arthritis has been advised to do isometric exercises prior to beginning a program of dynamic and weight bearing exercises, what percentage of max contraction should be used for isometric exercises? - CORRECT ANSWER 70%
a patient has a splint on the wrist and forearm but has developed "window" edema between the securing straps. In addition to elevating the extremity, which of the following is the best initial solution - CORRECT ANSWER replace straps with bias cut wrapping, from distal end to proximal
a 60 year old woman has osteoarthritis of both knees. which of the following most suggests the need for intervention? - CORRECT ANSWER patient is 5'6" and weights 250 pounds
a child is having serial plaster casts for treatment of talipes equinovarus (clubfoot) what should the parents be advised to do before bringing the child in for a cast change? - CORRECT ANSWER soak the cast off
which of the following imaging techniques is most effective for diagnosing osteomyelitis from and infected injury? - CORRECT ANSWER MRI
a 12 year old child with seropositive polyarticular juvenile idiopathic/rheumatoid arthritis has severe morning pain and stiffness and is reluctant to get out of bed. what intervention would be most helpful? - CORRECT ANSWER set an electric blanket to turn on 10 min before the child arises
a 16 year old girl playing soccer fell, resulting in a lateral patellar dislocation with hemarthosis. The knee was relocaed and hemarthrosis aspirated how long should the extension brace be worn? - CORRECT ANSWER 3-4 weeks
what is the most common cause of acute compartment syndrome? - CORRECT ANSWER tibial diaphysis or distal radius fracture
what is the most common indication of advanced osteoporosis - CORRECT ANSWER kyphosis
when assessing a patient gait, the ortho nurse notes that the patient appears unsteady and uncoordinated with a wide base measurement and lifts feet higher than normal while stepping with feet flat onto floor. how is gait characterized? - CORRECT ANSWER atAxia
children with duchennes muscular dystrophy should be assessed for bone density beginning at about what age? - CORRECT ANSWER 3 years
a patient with psoriasis develops marked edema of the fingers and toes (dactylitis) what does this probably indicate? - CORRECT ANSWER psoriatic arthritis
a patient must wear a wrist immobilization splint, but the splint tends to migrate as the patient moves the fingers and elbow, which of the initial measures indicated to reduce friction and migration? - CORRECT ANSWER cover skin with stockinet or elastic tubular bandage like tubigrip
for which of the following common complications should an infant with achondroplasia be monitored? - CORRECT ANSWER hydrocephalus and otitis media
a patient complains of bouts of recurring pain, erythema and swelling at the base of the right big toe with sudden onset and symptoms persisting 3-10 days what are the symptoms consistent with? - CORRECT ANSWER acute gout
during the physical examination of a patient, the orthopedic tech notes nodules on the dorsolateral aspects of teh distal interphalangeal joints (herberden's nodules) what does this finding indicate - CORRECT ANSWER osteoarthritsi
a patient who has rheumatoid arthritis and whose functional status is class 3, should be able to perform which of the following? - CORRECT ANSWER can carry out usual activities involving self care but limited in work and other activities
a 16 year old adolecent playing basketball sprains his ankle (grade II inversion injury) what tx is most likely? - CORRECT ANSWER RICE
for tx of osteoporosis, which of the following agents stimuates the formation of bone? - CORRECT ANSWER teriparatide (forteo)
according to the 3 step world health organization analgesic ladder "a patient complaining of moderate to severe pain unresponsive to NSAIDS may require which of the following medications? - CORRECT ANSWER CODEINE
How should a child with juvenile idiopathic/rheumatoid arthritis be positioned in bed? - CORRECT ANSWER no support under knees and no or ver low pillow under head (to maintain extension)
a bed bound patient has a 1.5 inch foam overlay over her mattress, the nurse places her hand under teh overlay and finds that it has compressed to 0.75 inches, what does this indicate? - CORRECT ANSWER bottoming out
With the times up and go test to assess ambulation and mobility, which time shows an increase risk for falls? - CORRECT ANSWER 14 seconds
a patient has had an open reduction of a potts fracture and has a still damp short leg cast, a small spot of blood appears on the cast what action should the nurse take? - CORRECT ANSWER time date and circle the spot
a patient with systemic lupus has developed swollen tender joints, increased fatigue and weakness, low grade fever, mild depression, and loss of appetite. She has a rash present on her face. lab finding show increased ESR which of following is likely tx? - CORRECT ANSWER nsaids and corticosteroids
a 70 year old patient with fracture of the proximal femur develops sudden onset of hypoxia, tachypnea, high fever, buccal and conjuctival petichaiae and tachycardia 24 hours after injury, initial blood gasses indicate respiratory alkalosis, which complication is most likely the cause. - CORRECT ANSWER fat embolism syndrome.
a patient with bone mets from prostate cancer is to be treated with zoledronic acid (reclast, Zometa) whcih lab test must be done prior to initiated treatment? - CORRECT ANSWER creatinine/Creatinine clearance
a woman who is jogging trips on an uneven path and experiences a moderately severe ankle sprain. Splint is applied to support the anlkle in a neutral position. how long does she have to wear the splint? - CORRECT ANSWER 5 days
56 YO female has pain and swelling of the small joints of the hands and wrist. Which test confirms rheumatoid arthritis? - CORRECT ANSWER rheumatoid factor and anti citrullinated protein antibody ACPA
a patient who is post amputation of a lower limb and insists he needs no physical therpay or rehab is probably experiencing what? - CORRECT ANSWER denial
which of the following is a cause of secondary osteoporosis in adolescenets - CORRECT ANSWER juvenile idiopathic/rheumatoid arthritis
8 year old child is relearning to walk after serious injury. which response to "i cant do this" shows reflective listening? - CORRECT ANSWER New exercises can be scary because you don't know whats going to happen
a 42 YO client who experience a traumatic BE amputation has been fitted for a prosthesis what is the first task to be completed? - CORRECT ANSWER education on prosthetic use, including overuse and nerve entrapment
a patient using crutches for two point ambulation without weight bearing must be able to ascend and descend the stairs to his front door before discharge. what is teh correct procedure - CORRECT ANSWER place the well foot first on the higher step then crutches then injured foot
56 YO arthritic woman is chari bound with total score on the braden of 16 sensory prec 4 moisture 3 activity 2 mobility 3 nutrition 2 and friction and sheer 2 what is accurate descritption of this patients risk? - CORRECT ANSWER breakpoint for risk (moderate)
36 year old female has bee training to run a marathon but develops increasing pain while running and point tenderness in shine. x ray is negative for fx what further test is indicated? - CORRECT ANSWER bone scan
36 year old male falls on elbow, extremely painful and flexed at 60 degree angle. spasms are occuring but circulation is good. what do you do? - CORRECT ANSWER attempt to securely splint arm without attempting to change flexion
patient with end stage bone cancer has elected hospice and palliative care. having extreme sever bone pain from tumor, physican order radiotherapy to reduce tumor size and reduce pain. is this acceptable under hospice? - CORRECT ANSWER yes if purpose is to relive pain, it is essentially palliative
patient is to begin zometa for bone metastasis, what lab test is indicated prior to each dose? - CORRECT ANSWER creatinine/clearance
which infection control precautions should be used when caring for a patient with osteomyelitis and a fistula infected with staph aureus? - CORRECT ANSWER standard and contact
what is the most common complication of pagets diesease? - CORRECT ANSWER fracture
a patient with a hip spica cast complains of feeling severely claustrophobic which intervention is most effective - CORRECT ANSWER cut a windown above patient abdomen
patient is receiving high doses of vitamin d to treat oseomalacia what dietary intervention is also indicated - CORRECT ANSWER diet high in vitamin c and phosphorus
a patient is screen for oseoporosis by a bone mineral density test which of the following score indidcates osteopenia? - CORRECT ANSWER -1.5
when assessing a patient gait and posture how far apart should a patient s heels be as they pass while walking? - CORRECT ANSWER 2-4 inches
what is the primary concern for the orthopedica nurse when monitoring a patient with a new cast on a an upper extremity - CORRECT ANSWER neurvascular status
which of the following neurovascular injuries is associated with distal radius fracture - CORRECT ANSWER median nerve injury
a patient experienced a traumatic posterior acetabular (hip) dislocation in an auto accident. which complication is most often associated with this type of dislocation. - CORRECT ANSWER Sciatic nerve injury
the ortho nurse is assessing a patients elbow ROM which actions are within the elbows normal ROM? - CORRECT ANSWER flexion, extension, pronation, supination
which of the following results in indicative of developmental /congenital hip dysplasia in a 6 month old child. - CORRECT ANSWER positive allis sign
a newborn was diagnosed with Osteogenesis imperfecta type 1 at birth based on rib fracture blue sclera and short limbs. what critical info should the parents receive before going home? - CORRECT ANSWER correct methods of handling, bathing, and placing child in the crib
two year old chilld dis place in bryant traction because of femur fx which position is correct? - CORRECT ANSWER buttocks slightly elevated off of the bed
an adolescent female has been fitted with a milwaukee brace for kyphoscoliosis but she has developed skin irritation with areas of denuded skin and tenderness over pelvic bones from wearing the brace what caused this? - CORRECT ANSWER pelvic piece is too loose
a foot drop splint used for peroneal nervne palsy would be classified as which type of orthotic? - CORRECT ANSWER functional
a patient with an injured leg imagines how it feel sto extend and flex the limb in normal range of motion and imagines walking and using the limb, what is this technique? - CORRECT ANSWER visualization
which of the follwing is the correct postoperative positioning of a patient who has undergone a posterior cervical fusion with wiring after cervical fracture - CORRECT ANSWER flat of head elevated with neck in neutral position
which of teh following is most indicative that chronic carpal tunnell syndrome is progressing? - CORRECT ANSWER atrophy (flattening) of teh thenar muscle of the thumb
a patient with degenerative arthritis and a herniated intervertabral disc has undergone an ACDF to relive sever pain. postop the patient exhibitys hoarseness and cannot cough effectively.. what could the complication be? - CORRECT ANSWER injury to recurrent laryngeal nerve
56 year old female with osteopenia tell the ortho nurse that she plans to start an exercise program to prevent more bone loss. what exercise would be best? - CORRECT ANSWER bicycling
which of the following is an advantage to applying a cast for a wrist fracture rather than a splint? - CORRECT ANSWER better immobilization
the nurse is evaluating a patient for VTE following a total hip replacement. which indicates positive homans sign? - CORRECT ANSWER pain in calf when foot is dorsiflexed
a patient with osteoarthritis in both feet form old injuries states she can barely walk because of pain and stiffness when she first gets up in the AM. what would be most helpful? - CORRECT ANSWER advice pt to do ROM exercises for both feet before arising
pt involved in an auto accident has unstable pelvic fx, what intervention does teh nurse expect patient will most likely requirei - CORRECT ANSWER transfusions
foot ball player fell on knee during scrimmage resulting in non displaced fracture of knee. extension brace has been applied but the knee is becoming increasingly painful and "tight" what is most likely the cause of the pain? - CORRECT ANSWER hemarthosis
pt who suffered a traumatic fx has developed signs of acute compartment syndrome. compartment pressure is 32 mm hg and bp is 110/60 what is patients delta pressure? - CORRECT ANSWER 28 mm hg (diastolic-CP = DP)
patient involved in a skiiing accident incurred a rupture of the ACL what inital tx is usually indicated? - CORRECT ANSWER knee brace
a trauma victim has been admitted to the unit with fractures of the upper two ribs on the right side resulting from an auto accident. patient should be assess for what secondary injury or injuries? - CORRECT ANSWER tracheal/bronchial/great vessel trauma
an infant has congenital metatarsus adductus with curvature of less than 13 degrees what should the ortho nurse expect to teach parents.... - CORRECT ANSWER stretching exercises
when checking nerve function in the hand the "ok" sign and abductor pollicis brevis test are used for which nerve? - CORRECT ANSWER median
32 year old woman with autoimmunde myesthenia gravis has fluctuation but increasing muscle weakness and has begun to sleep in her chair because she sleeps better sitting upright. she yawns and sighs frequently which intervention is most appropriate with these symptoms? - CORRECT ANSWER respiratory assessment with pulmonary function tests.
35 year old female involved in a side impact automobile collision suffered pronouced cervical rotation and complains of severe right sided neck pain and severe unremitting right side headache and exhibits ecchymosis and swelling of right neck and right opthalmic ptosis with contraction of the pupil what is most likely reason for symptoms. - CORRECT ANSWER carotid dissection
the use of which of the following medications puts patient at risk for defective vitamin D metabolism and osteomalacia? - CORRECT ANSWER phenytoin
what triad of s/s is associated with familial x linked hypophostphatemia (XLH) - CORRECT ANSWER stunted growth, deformities of the lower extremeties, and hypophosphatemia
which of the following is the best dietary source of vitamin d - CORRECT ANSWER fortified dairy products
which of the following disorders can result in renal osteodystrophy - CORRECT ANSWER chronic kidney diesease
patient receiving antimalarials for rheumatoid arthritis should be monitored for which opthalmic disorder - CORRECT ANSWER macular degeneration
which site of pain is usually present at the onset of ankylosing spondylosis - CORRECT ANSWER sacroilliac pain
a patient with RA plans to do aquatic exercises at a local pool what water temp is optimal? - CORRECT ANSWER 85-94 degrees fahrenheit
boutonniere deformity is characteristic of which disorder? - CORRECT ANSWER RA!
amyloidosis (protein in the organs) secondary to RA is associated with which of the following? - CORRECT ANSWER kidney failure
patient scheduled for hyaluronic acid (Orthovisc) injection to teh knee for tx of osteoarthritis. what allergy should nurse question for prior to tx? - CORRECT ANSWER chicken
patient has injury to the right knee, what is the correct instruction for the patient use of cane? - CORRECT ANSWER cane in left hand and move cane and right leg forward together
when examining a patient, the nurse notes that passive exercise results in cogwheeling (jerky incremental movements) cogwheeling is characteristic of which of the following dieseases? - CORRECT ANSWER parkinsons diesease
which of teh following is a primary use of electrical muscle stimualtion? - CORRECT ANSWER relieve muscle spasms and increase muscle size
an athlete wtih a hip flexor injury in returning to sports activities but must wear a hip spica wrap. how should the athlete stand when the wrap is applied? - CORRECT ANSWER foot on the affected side turned slightly inward
what is the initial symptom for most patients eventually diagnosed with sclerodoma? - CORRECT ANSWER raynaud phenomenon
what is the first line treatment for macrophage activation syndrome associated with systemic juvenile/rheumatoid arthritis (still diesease) - CORRECT ANSWER cycosporin A
what surgical option is most commonly used to treat severe kyphosis associated with anklosing spondylosis - CORRECT ANSWER osteotomy (lumbar)
which of the following is the most common primary malignant tumor of teh bone - CORRECT ANSWER osteosarcoma
what is the tender point test used for? - CORRECT ANSWER to differentiate fibromyalgia from other disorders
what is the first line drug for polyarticular juvenile idiopathic/RA? - CORRECT ANSWER NSAIDS
what structure is damaged when a strain occurs? - CORRECT ANSWER muscle
a tennis player has developed bursitis of the left elbow with marked pain, swelling and stiffness. what tx is most critical - CORRECT ANSWER rest and temporary immobilization
which type of dislocation poses the most risk for development of avasular necrosis - CORRECT ANSWER hip
what grade is assigned to an open (compound) fracture in which the wound is 2cm in length and extensive soft tissue damage is evident? - CORRECT ANSWER grade II (greater than 1cm and tissue damage is evident)
which of the following ismost indicative of a closed fracture in lower extremity? - CORRECT ANSWER inability to walk immediately and in the ER
when assessing sensation of the radial nerve for a pt with a fracture of the humerus where should the nurse prick the skin? - CORRECT ANSWER midway between thumb and index finger
screen for osteoporosis should begin routinely for all women at what age - CORRECT ANSWER 65
which of the following in addition to rest is teh most important intervention of fat pad contusion? (policemans heel) - CORRECT ANSWER shock absorbing insoles or heel pads
which joint is the most commonly injured in sports - CORRECT ANSWER ankle
a female golfer has developed a mortons neuroma of the right foot and has been advised to wear a wide toed shoe,, what other footwear modification is needed? - CORRECT ANSWER metatarsal rasie
a child with polyartivular JI/RA is non responsive to other drugs and is going to receive a TNF blocking agent (Infliximab) remicade what test must be completed prior to admin of med - CORRECT ANSWER TB test
which of the following injuries is common to ballet dancers because of postions the foot in placed in? - CORRECT ANSWER sinus tarsi syndrome
a 30 year old expert in martial arts developed turf toe from excess flexion of great toe. once injury has healed what precautions should the patient use to prevent reinjury - CORRECT ANSWER wear a brace to support the toe or hard soled shoes
in the adult which type of bone produces the greatest number of red blood cells? - CORRECT ANSWER flat bones
following closed reduction of a should dislocation what exercises are indicated after initial resting period - CORRECT ANSWER gentle rang of motion
a construction worker fell feet first form an eight foot ladder onto a concrete floor. which type of spinal fracture should be suspected? - CORRECT ANSWER axial burst
which type of skull fracture results in widening of the sutures in children under age 3? - CORRECT ANSWER diastatic
a womn experience sever hyperextension of the head and neck when he hair was caught in mechanical equipment at her place of employment what type of injury is common with this type of hyperextension? - CORRECT ANSWER primary brainstem lesion
a conscious and responsive pt is brought to hospital by friends following fall off a roof resulting in severe back pain. what is initial intervention - CORRECT ANSWER immobilize pt
when grading reflexes in lower extremeties, how is normal reflex activity graded - CORRECT ANSWER 2
when assessing a patient right lower ext for sensation the patient reports that the pinprick feels like pressure only and does not feel the sharp compared to the normal response felt on the left side, how is this response graded? - CORRECT ANSWER absent
the risk for fat embolism is highest with which of the following fractures? - CORRECT ANSWER comminuted fracture of the tibia
patient who has a thigh wound or amputation of teh lower extremity and is incontinent of stool is most at risk for what type of infection? - CORRECT ANSWER gas gangrene (clostridium perfrigens)
children with oligoarticular JI/RA ar particularly at risk for which of the following - CORRECT ANSWER anterior uveitis (inflammation of middle layer of eye) and chronic iridocyclitis (inflammation of the iris)
a patient with acute lower backpain spent one day on bedrest and is now able to move about but still has marked lower back pain. what are the time limits for sitting in a chair for a pt with acute lower back pain? - CORRECT ANSWER 20-50 min at a time
which of the following is an indication that a patient with chronic low back pain is experiencing dependecy issues? - CORRECT ANSWER patient wife lays out clothes and assists him to dress.
early signs of muscular dystrophy - CORRECT ANSWER significant incoordination, clumsiness, balance difficulties, muscle weakness, difficulty with stairs, and problems getting into standing position
tx and self care of cerebral palsy - CORRECT ANSWER no known cure, physical and occupational therapy as well as speech very early, use of braces walkers, and wheelchairs, pain medications and muscle relaxers for spasms and pain. goal is maximize independent functioning as much as possible.
pavlik harness teaching - CORRECT ANSWER used in first few months of life in developmental hip dysplasia in infants, maintains hips and knees at 90 degrees and fully abducted hips. show parents that position is necessary in maintaining the let in the hip socket. natural comfortable position for the newborn and parents should not be alarmed by it or worry about hurting child. teach correct technique of bathing dressing, applying harness and skin care of infant
tx options of developmental hip dysplasia by age - CORRECT ANSWER newborns-closed reduction maneuvers or pavlik harnessfor a few months.
later diagnosis tx may be closed reduction with anesthesia followed by placement of cast.
DDH that persists or after 2 years of age requires surgical reduction followed by body spica cast
Define Pes cavus in child - CORRECT ANSWER abnormaly arched feet, or clawfoot. if seen in children under 6 neuromuscular problem is suspect and must be ruled out first as it is rare in children. Elimitate muscle spasm or weakness and spinal etiology as cause. as child grows finding shoes difficult and frequent ankle sprains. pain is only complain later in life and orthotics and arch supports are primary tx in childhood
congenital muscular torticollis - CORRECT ANSWER constant unilateral contraction or tightness in the steronucleomastoid muscle in teh neck. parents note lack of head movement to one side or a knot that is felt along the proximal attachment side of the tightened muscle on the sternum.
tx is primarily PT , massage bracing and postioning.
Signicant proportion of children with this will also have hip dysplasia
describe pigeon toeing - CORRECT ANSWER not described as a disorder under age of 2
secondary to a slightly rotated tibial bone. usualy does not require tx. in child over the age of 3 may signify twisting of femur. bracing and PT have not proven effective. surgery is only indicated if condition causes pain, disability or significant assymetry.
describe clubfoot - CORRECT ANSWER tallipes equinovarus can be unilateral or bilateral. foot postioned abnomally in 3 different directions. 1. heel points medially and is inverted. 2. ankle points in the inferior direction. third. entire foot appears supinated (plantar surface up)
tx is manual manipulation with splinting and casting with frequent follow up and gradual anatomic positioning. prognosis good with early tx
bowlegs and knock knees "Genu Varum" - CORRECT ANSWER anomaly in which tibia and fibula are angled medially in relation to femur.
most noted in children under 2
usually resolve themselves
if not bracing is successful into the third decade. Surgery is only indicated if affecting growth or is assymetrical.
reassurance of parents is priority that thsehse conditions are most often outgrown
primary concern in child born without limb - CORRECT ANSWER assure health and stabilization of newborn
then, parents needs counseling, reassurance, education, and support.
medical specialty evaluation is necessary for to further reassure parents and alleviate anxiety
Leg-Calve-Perthes diesease LCP - CORRECT ANSWER head of femur deteriorates due to temporary lack of bood supply. more males than females ages 3-9. other risk factors are short stature, low birth weight, second hand smoke exposure, and first borns. more often unilateral.
TX. self limiting,but with bracing, pain management and physical therapy prognosis is good. Education on healing time and diesease progression are essential.
Complications of noncompliance: decreased ROM, early onset osteoarthritis
three Tx options for limb length discrepancies - CORRECT ANSWER TX only a consideration greater than 1 inch descrepancy or if gait disturbance and pain
1. shoe lift are initial tx of choice
2. leg shortening surgical procedure primary for skelatally immature. however, results not immediate and complication of miscalculation is high
3. leg lengthening tx for skeletally mature reliable and compliant pt. lengthy process and frequent follow up. infection risk high due to external fixator use
spina bifida - CORRECT ANSWER congenital disorder in which development of brain or spinal cord and covering is abnormal.
four types: occulta, closed neural tube defect, meningocele and myelomeningocele
ortho considerations of myelomeningocele - CORRECT ANSWER most severe form of spina bifida.
requires multi medical team approach to tx as well as patient and caregiver education. deformities will most likely develop in lower extremeties such as tallipes equinovarus (clubfoot) calcaneus (veritcally oriented calcaneus) and cavus (fixed plantar flexion of foot), Muscle atrophy and bone density loss common. Hip dysplasia is common as well as contractures and spinal curvatures.
osteogenesis imperfecta define, tx, self care - CORRECT ANSWER "brittle bone Diesease" hereditary child born with possible fracutre and sustain fractures frequently with activities that normally would not cause bone to break.
TX: focuses on prevention, developing and maintaining bone mass, and working on muscle strength and minimizing complications. Appropriate reduction and immobilization.
Self Care: Acute: Cast care, Pain Management can include ice heat, TENS, medications, and nerve blocks.
Chronic: appropriate low impact exercise, PT and nutrition counseling
Salter Harris Classification system - CORRECT ANSWER decribes fracture in children and involvement in growth plate. 5 types (stages)
type 1: fracture through plate itself increasing width of plate not disrupting epiphysis or metaphysis.
type II: fracture through physis and metaphysis, not involving epipysis.
type III: involves a fracture through the phsysis and epiphysis
type IV: fracture pass vertically through all 3
Type V: fractures completely compress of crush the physis with no fx of other 2
difference in child amputees vs adult - CORRECT ANSWER heal faster, earlier prosthetic fitting, smaller learning curve
scoliosis mgmt - CORRECT ANSWER observation is less than 20 degree curvature
back brace with up to 40 degree curvature and complaint of pain or gait impairment
greater than 40 degrees surgical candidate
Rheumatoid Arthritis - CORRECT ANSWER genetic autoimmune diesease. Immune system attacks body. patient complaints of persistent joint pain. Body attack synovium of joint causing swelling and thickening of the area. Damage extends to surrounding joint structure including bone. Can be progressive or be exacerbated and remissed. hands, wrists, shoulders, knees, and feet are most often affected bilaterally
swan neck deformity, boutonniere deformity - CORRECT ANSWER swan neck: fingers- DIP and MCP joints in flexion while PIP joint is hyperextended. TX is splints, anti rheumatic drugs or surgical option such as tendon release (RA deformity)
Boutonniere-fingers-Hyperextension of DIP jointand Flexion of PIP joint. TX is NSAIDS, Diesease modifying anti rheumatics, splinting and OT. Surgery is last resort. Seen in RA and "Jamming a Finger"
Pharmacologic TX for RA - CORRECT ANSWER Cornerstone tx: Diesease modifying anti rheumatic drugs. Slow progression and joint deformities. encourage remission. Acute exacerbations: NSAIDS, COX-2 inhibitors, and corticosteroids. Plaquenil is shown to help modify course of RA
New class of medications called Biologics, injectable and IV only.
All used in cominations for best disease control.
Nursing MGMT of RA - CORRECT ANSWER Controlling pain and maintaining function are most important. patient education especially on pain management and compromised immune system management are very important. ADLS including self care and hobbies
Juvenile Rheumatoid Arthritis-3 types - CORRECT ANSWER similar to adult RA but patients under 16 and most children grow out of diesease.
Polyarticular-most common- involves greater than 5 joints, sudden onset, most likely to have permanant joint damage.
pauciarticular- 4 or less joints more often in lower extrememties. has major complication before age 6 of chronic eye problems
systemic JRA- recurring spiking fevers and truncal rash in addition to joint pain. can get pericarditis
Challenges and considerations Nursing MGMT of JRA - CORRECT ANSWER younger the child the harder to describe symptoms they are feeling. therapy and splinting are essential. maintaining self esteem and school participation must be done. everyone in contact should be educated
Ortho exam findings and considerations in pt with systemic lupus erythematosus - CORRECT ANSWER butterfly rash on cheeks, erythemous plaques on body,
Differences of RA and SLE - CORRECT ANSWER both autoimmune disorders. musculoskelatal system is primary target in RA SLE affects more distal joints while RA does distal as well as all other joints. SLE onset is earlier in life than RA
during the acute stage of rheumatoid arthritis affecting the ankles, what primary precaution should the patient use to protect the ankle joints - CORRECT ANSWER
during the acute stage of rheumatoid arthritis affecting the ankles, what primary precaution should the patient use to protect the ankle joints - CORRECT ANSWER
during the acute stage of rheumatoid arthritis affecting the ankles, what primary precaution should the patient use to protect the ankle joints - CORRECT ANSWER
during the acute stage of rheumatoid arthritis affecting the ankles, what primary precaution should the patient use to protect the ankle joints - CORRECT ANSWER [Show Less]