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NSG 554 Exam 4 Study Guide

HEAL100 Health Care — exam and revision material · Other

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Health Care exam material, 50 pages. Originally published on StudyMerit.

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50
Academic year
2025/2026
Language
English

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NSG 554 Exam 4 Study Guide Module 9: Musculoskeletal Disorders: 26 questions ● Sprains/Strains: basic difference, overall assessments and treatments 2 ○ Overall assessments and treatments ○ Sprains: injury to ligaments ■ Often caused when stretched beyond their normal ROM ■ Basic difference ● Sprains: complete or partial ligamentous injuries either within the body of the ligament or at the site of attachment to bone ○ Grade 1: stretch injury without ligamentous laxity ○ Grade 2: partial sear with increased ligamentous laxity but firm end point on exam ○ Grade 3: complete tear with increased ligamentous s laxity and no firm end point on exam ○ Strains: injury to muscles or tendons ■ Often caused by overstretching or overexertion ■ Basic difference ● Strain: partial or complete disruptions of the muscle, muscle tendon junction or tendon ● First degree: minimal damage to muscle, tendon or musculotendinous unit ● Second degree: partial tear to muscle, tendon or musculotendinous unit ● Third degree: complete disruption of the muscle, tendon or musculotendinous unit. ○ Overall assessments and treatments ■ History ● Obtain a thorough description of mechanism of activity, trauma, baseline conditioning, and prior injuries ■ Physical examination ● Swelling, asymmetry, ecchymosis, and gait disturbances ● Neurovascular ● Palpate tenderness ● ROM of joint and joint stability ■ Sprains ● Grade 1: tenderness without laxity; minimal pain; swelling; little ecchymosis; can weigh bear ● Grade 2: tenderness with increased laxity of exam but firm endpoint; more pain, swelling; often ecchymosis; some difficulty weight bearing ● Grade 3: tenderness with increased laxity; no firm end point; severe pain, swelling; obvious ecchymosis, difficulty weight bearing Downloaded by Studymerit Dotcom (samuelkaruiki40@gmail.com) lOMoARcPSD|6879242

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■ Diagnostics ● Ankle: ○ Anterior drawer test; integrity of anterior talofibular ligament ○ Talar tilt; integrity of calcaneofibular ligament ○ Squeeze test; syndesmotic injury ○ Palpate lateral and medial malleoli ● Knee ○ Lachman and anterior drawer tests; integrity of ACL. Posterior drawer test integrity of PCL ○ Valgus/varus test: integrity of medial and lateral collateral ligaments ● Shoulder ○ Load and shift test: sulcus sign; apprehension, relocation and surprise test; stability of glenohumeral joint ● Radiographs ○ Bilateral ● Ottawa ankle rules: xr required if pain in malleolar zone and ○ Bone tenderness in posterior aspect distal 6 cm of tibia or fibula or ○ Unable to bear weight immediately or in emergency department ■ Follow-up ● Repeat Xr in 1-2 wks ● CT scan ● MRI ● US ■ Treatment ● Acute: protection, rest, ice, compression, elevation, medications, modalities ● Ankle sprains: functional support and NSAIDS ● Grades 1 and 2: functional treatment with brace, orthosis, taping, elastic bandage ● Grade 3: short period of immobilization. Short walking boot or crutches ■ Medications ■ First line ● Acetaminophen don’t exceed 3 g a day ● NSAIDS ○ Ibuprofen 200-800 mg TID ○ Naproxen 250-500 mg BID ○ Diclofenac 50-75 mg BID ● NSAIDS better than narcotics ● Second line ○ Platelet rich plasma injections Downloaded by Studymerit Dotcom (samuelkaruiki40@gmail.com) lOMoARcPSD|6879242

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○ Opioids; rarely use ● Referral ○ ACL sprain in athletes ○ Salter-Harris physeal fractures ○ Joint instability; esp if chronic ○ Tendon disruption ○ Lack of improvement ● Additional ○ Physical therapy ○ Surgery ● Fractures: Risk factors, assessment, general initial evaluation and general treatment, goals of care, referral 4 ○ A fracture is a break in a bone, which can range from small to a complete break. Fractures are usually caused by trauma, such as falls, car accidents, or sports injuries, but can also result from overuse (stress fractures) or underlying conditions that weaken bones, such as osteoporosis. Symptoms of a fracture include severe pain, swelling, bruising, deformity, and inability to use the affected limb. Diagnosis is confirmed through imaging studies, such as X-rays. Treatment may involve immobilization with casts or splints, traction, or surgical intervention to realign and stabilize the bone. ○ Patients may present to primary care with complaints of pain. An injury is usually in the history, though stress fractures may occur. Older adults and those with osteoporosis are at increase risk for fractures from a fall or may have spontaneous fractures. NPs will perform the initial assessment, order x-rays, and initiate treatment. Referral to orthopedics is required. ○ Here is a list of common sites for fractures seen in primary care. ○ Clavicle: ■ Common Causes: Falls onto an outstretched arm, direct blows to the shoulder ■ Symptoms: Pain at the site, swelling, bruising, difficulty moving the shoulder ○ Radius and Ulna: ■ Common Causes: Falls onto an outstretched hand, direct trauma ■ Symptoms: Pain, swelling, deformity, difficulty moving the wrist or elbow ○ Wrist (Distal Radius): ■ Common Causes: Falls onto an outstretched hand ■ Symptoms: Pain, swelling, tenderness, bruising, difficulty moving the wrist ○ Humerus: ■ Common Causes: Falls, direct blows ■ Symptoms: Severe pain, swelling, bruising, inability to move the shoulder ○ Ankle: Downloaded by Studymerit Dotcom (samuelkaruiki40@gmail.com) lOMoARcPSD|6879242

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