ch. 21 - musculoskeletal Flashcards
1
Q
- Bone mineral density decreases
- ROM of joints decreases
- Muscle cells are lost and not replaced
- Lean body mass decreases while adipose tissue increases
- Progressive loss of cartilage occurs
A
musculoskeletal changes in older adults
2
Q
- porous bone and is characterized by a low bone mass causing your bones to become brittle and frail, placing the patient more at risk for fractures.
- It is considered a silent disorder because a patient may never know they have this condition until they experience a fracture.
- loss of bone mineral density accelerates after menopause
men can have this condition too, but women are most likely at risk
A
osteoporosis
3
Q
- Back pain that occurs after lifting, bending, or stooping
- Back pain that increases with palpation
- Pelvic or hip pain with weight bearing activities
- Problems with balance
- Decline in height from vertebral compression
- Kyphosis of the dorsal spine, also called a “Dowager’s hump”
A
assessment findings of osteoporosis
4
Q
- condition where bone mineral density is lost but it is not as severe as in osteoporosis
- most likely at risk for developing osteoporosis
A
osteopenia
5
Q
- softening of the bones.
- A lack of vitamin D is the most significant risk factor.
- Encourage the patient to get sunlight exposure, increase food sources of vitamin D (dairy and fish).
- This patient can have pain in the pelvis region, lower back, and legs. We are worried about their ability to ambulate and preventing fractures
A
osteomalacia
6
Q
- low calcium and vitamin D intake
- Long term use of steroid medications and anticonvulsants
- inactive lifestyle (leads to weaker bones)
- excessive alcohol intake (increases risk for bone loss and fractures)
- smoking (affects the bones, heart, and lungs), it decreases the body’s absorption of calcium
- hormone levels (low testosterone in men, low estrogen in women)
- underweight (anorexia)
A
modifiable risk factors of osteoporosis
7
Q
- Thin (small framed) females
- Older adults (post-menopausal women)
- Caucasian, Asian, African American, Hispanic ethnicity
- Family history
A
non-modifiable risk factors of osteoporosis
8
Q
- Diagnosis is based on a DEXA scan & comprehensive assessment
- BMD tests can:
Detect low bone density before a fracture occurs.
Confirm a diagnosis of osteoporosis if you already have one or more fractures.
Predict your chances of fracturing in the future.
Determine your rate of bone loss, and monitor the effects of treatment if the test is conducted at intervals of a year or more.
A
diagnosis of osteoporosis
9
Q
dorsal spine, a.k.a. “Dowager’s hump”
A
kyphosis
10
Q
- Perform weight bearing activity such as brisk walking with light weights
performing weight bearing exercises helps to maintain bone mass by applying mechanical force to the spine and long bones (walking, hiking, jogging, climbing stairs, playing tennis, dancing, using weight machines) - Increase intake of calcium and vitamin D
- Smoking cessation
- Avoid heavy drinking of alcohol
- Avoid excessive caffeine
- Fall prevention! (We are most concerned about preventing fractures!!!)
- Perform a home safety inspection
A
education for osteoporosis
11
Q
- increase intake of calcium rich foods
- calcium and vitamin D supplements
- get exposure to sunlight for vitamin D
- Bisphosphonate meds
A
treatment for osteoporosis
12
Q
- Use a cane or walker for added stability if needed.
- Wear rubber-soled shoes for traction.
- Walk on grass when sidewalks are slippery.
- In winter, carry salt or kitty litter to sprinkle on slippery sidewalks.
A
home safety outdoors
13
Q
- rooms MUST be free of clutter, ESPECIALLY on floors.
- floor surfaces = smooth BUT not slippery
- supportive, low-heeled shoes must be worn even when at home.
- socks, stockings, or slippers must be avoided when walking (the 3 Ss)
- carpets and area rugs = skid-proof backing or tacked to the floor.
- stairwells should be well lit and stairs have handrails on both sides
- grab bars = installed on bathroom walls near the tub, shower, and toilet
- rubber bathmat must be used in the shower or tub.
- flashlight with fresh batteries must be kept beside your bed.
- If using a step stool for hard-to-reach areas, use a sturdy one with a handrail and wide steps.
- ceiling fixtures must be added to rooms lit by lamps.
- cordless phone is considered for purchase so that there wouldn’t be no rush answering the phone when it rings, or if you fall, you can call for help
- highly polished floors = be very cautious and careful b/c they can become slick and dangerous when wet.
A
home safety indoors
14
Q
- pt should hold cane on the stronger side of the body
- place it forward 6-10 inches and move his weaker leg forward to the cane
distributing his weight between the cane and the stronger leg - then he should move the stronger leg forward beyond the cane and distribute his weight
between the cane and weaker leg
A
canes
15
Q
- The nurse should stand adjacent to the client on the AFFECTED (weak) side
- Instruct the client to put all 4 points of the walker FLAT on the floor BEFORE putting weight on the hand pieces
- Instruct the client to move the walker forward, followed by the affected or weaker foot and then the unaffected foot
A
walker
16
Q
- Place the belt on the client prior to ambulation
- Encircle the client’s waist with the belt
- Hold on to the side or back of the belt so that the client does not lean to one side
- Return the client back to bed if they get dizzy or become unsteady
- When finished ambulating, remove belt from patient
A
gait belt use
17
Q
a group of drugs that work by slowing bone loss; they reduce the risk of hip and spine fractures
- Take on empty stomach with full glass of water
- Sit upright for at least 30 minutes after taking
- Not appropriate for someone with memory loss
A
bisphosphonates
18
Q
- This term applies to more than 100 musculoskeletal conditions
- Osteoarthritis
- Rheumatoid arthritis
- Gout
A
arthritis
19
Q
- Degenerative joint disease that develops slowly
- caused by damage or breakdown of joint cartilage between bones
- Most common site affected is the knees –> hands, hip, and feet
- Pain, stiffness, & swelling occurs leads to loss of ROM
- Stiffness with inactivity that is relieved by performing activity
- Stiffness is greatest in the AM but should resolve after about 30 minutes of moving
- Crepitus is present
A
osteoarthritis (OA)
20
Q
No cure, so doctors usually treat symptoms with a combination of therapies, which may include the following:
- Increasing physical activity
- Physical therapy with muscle strengthening exercises
- Weight loss
- Medications, including over-the-counter pain relievers and prescription drugs
- Supportive devices such as crutches or canes
- Surgery (if other treatment options have not been effective)
A
treatment for OA
21
Q
- Maintain weight within normal range to decrease stress on joints
- Instruct client to balance activity with rest and to participate in an exercise program that limits stressing the affected joints
- Exercises should be active rather than passive and to stop exercise if pain occurs
- Limit exercise when joint inflammation is severe
- If all other measures do not control symptoms pt can have a total joint replacement (arthroplasty) where the total joint is replaced (hips and knees are most commonly replaced)
large pillows must be avoided placing under head or knees
A
patient education for OA
22
Q
crunching or popping sound you hear within the joint that indicates the joint is deteriorating
A
crepitus
23
Q
Joint injury or overuse: Injury or overuse, such as knee bending and repetitive stress on a joint, can damage a joint and increase the risk of OA in that joint.
Age: The risk of developing OA increases with age. Gender—Women are more likely to develop OA than men, especially after age 50.
Obesity: Extra weight puts more stress on joints, particularly weight-bearing joints like the hips and knees. This stress increases the risk of OA in that joint. Obesity may also have metabolic effects that increase the risk of OA.
Genetic: People who have family members with OA are more likely to develop OA. People who have hand OA are more likely to develop knee OA.
A
risk factors of OA
24
Q
Hard nodules or enlargements
of the distal interphalangeal
joints of the fingers
A
Herberden’s nodes
25
nodes on middle of finger joint
Bouchard's nodes
26
- A chronic, systemic inflammatory joint disorder
- Autoimmune
- Pain & swelling in symmetrical joints
- Affects small joints in wrists, hand, and ankle
- Pain/stiffness with RA lasts longer than 30 minutes when first waking up
- Joints are tender and warm
- Weight loss, fever, fluctuating good and bad days, generalized fatigue and malaise
- Elevated ESR (this is a lab that indicates inflammation) and positive rheumatoid factor (this is a blood test used to assist in diagnosing RA
Malaise- you just feel bad , general discomfort
Erythrocyte Sedimentation Rate (ESR): To detect the presence of inflammation caused by one or more conditions such as infections, tumors or autoimmune diseases; to help diagnose and monitor specific conditions such as temporal arteritis, systemic vasculitis, polymyalgia rheumatica, or rheumatoid arthritis
Rheumatoid arthritis (RA)
27
Pain management and preserving function is important tasks
Medications used for treatment include NSAIDS (watch for signs of bleeding in the older adult with chronic use, NSAIDS also increase risk of stroke), DMARDS (watch for immunosuppression), glucocorticoids (diabetic patients will need to assess their glucose levels more frequently because steroids can cause hyperglycemia)
pain management of RA
28
patient will need to see a rheumatologist routinely
- Preserve joint function
- Provide ROM activities to maintain joint motion and muscle strengthening
- Balance activity with rest (don’t try to cluster all nursing care in at the same time, you will exhaust the patient)
- Apply heat or cold therapy to joints as prescribed
- Use joint protecting devices like braces as needed
- Avoid weight bearing on inflamed joints
- Work with an OT to help perform ADLs as needed
Instruct client to sit in a chair with a high, straight back, and use only a small pillow when lying down
treatment for RA
29
- Inflammatory arthritis
- Results from the accumulation of uric acid crystals in the joint
- Uric acid is produced when purines found in food are broken down
- Patient will experience an acute attack
gout
30
- Swelling and inflammation of the joints, leading to excruciating pain
- Tophi (hard, irregularly shaped nodules in the skin containing chalky deposits of sodium urate)
- Low grade fever, malaise, headache
- Pruritus from urate crystals in the skin
- Presence of renal stones from elevated uric acid levels
assessment findings of gout
31
- Provide a low purine diet
- Encourage high fluid intake 2000ml/day to prevent stone formation
- Encourage weight reduction if required
Avoid alcohol and starvation diets (these can precipitate an attack)
- Provide bed rest during acute attacks with the affected extremity elevated
- Monitor ROM in the affected joint
- Position the affected joint in mild flexion during acute attacks
- Protect the affect joint from excessive movement or direct contact with sheets or blankets
- Provide heat or cold for local treatments to affected joint
- Administer medications such as analgesics (for pain)
treatment for gout
32
- asparagus
- gravy
- sardines
- scallops
- any alcohol
- red meat
- organ meets
foods high in purines
33
- dairy (yogurt, cheese, milk)
- orange juice
- beans
- green leafy vegetables
- sardines
- salmon
- tofu
- figs
- bread
foods rich in calcium
