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NURS3313 Adult Health > Chapter 36 Management of Patients w/ Musculoskeletal Disorders > Flashcards

Chapter 36 Management of Patients w/ Musculoskeletal Disorders Flashcards

1
Q

Osteoporosis

A

A bone disorder primarily affecting older people in which the bones become porous, brittle, and more prone to fracture

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2
Q

Osteoporosis Risk Factors

A

Small-framed women ( less bones)

Postmenopausal women (drop in estrogen)

History of bone fractures during adulthood

History of impaired glucose tolerance and diabetes

Asian, Caucasian, and African American women

Poor calcium intake due to lactose intolerance

Use of aromatase inhibitors in women with breast cancer (blocks estrogen)

Bariatric surgery (bypasses duodenum where Ca+2 is absorbed)

GI disease that cause malabsorption (e.g., celiac disease, alcoholism)

Autoimmune disease (e.g., rheumatoid disease)

Men >60 years of age

Corticosteroid therapy >3 months

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3
Q

What disease is the precursor to osteoporosis?

A

Osteopenia

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4
Q

Osteopenia

A

Thinner than average bone density

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5
Q

Primary Osteoporosis

A

Mainly occurs in post-menopausal women due to low vitamin D levels & failure to develop optimal peak bone mass

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6
Q

Secondary Osteoporosis

A

Result of medications or diseases that affect bone metabolism, such as celiac disease & hypogonadism

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7
Q

Meds That Can Lead to Secondary Osteoporosis

A

Anticonvulsants (phenytoin, [Dilantin])

Thyroid replacement agents (levothyroxine [Synthroid])

Antiestrogens (medroxyprogesterone [Depo-Provera])

Androgen Inhibitors (leuprolide [Lupron])

Proton Pump Inhibitors (esomeprazole [Nexium])

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8
Q

Osteomalacia

A

Abnormal softening of bones in adults

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9
Q

What vitamin deficiency s present in pts w/osteomalacia?

A

Activated Vitamin D

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10
Q

Clinical Manifestations of Osteomalacia

A

Soften, weakened bones

Skeletal deformities (spinal kyphosis and bowed legs)

Waddling gait

Pain and tenderness to touch

Pathologic fractures

Fall risk

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11
Q

Diagnostic Studies for Osteomalacia

A

X-ray and lab studies: serum calcium, phosphorus, and ALP

Urine test

Bone biopsy

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12
Q

Nursing Interventions to Decrease Risk for Fractures & Associated Disability

A

Early identification for at-risk teens and young adults

Increased calcium and vitamin D intake

Regular weight-bearing exercise

Lifestyle modifications

  • Reduced use of caffeine, tobacco products, carbonated drinks, and alcohol
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13
Q

Diagnostic Studies for Osteomalacia

A

X-ray and lab studies: serum calcium, phosphorus, and ALP

Urine test

Bone biopsy

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14
Q

Nursing Interventions for Osteomalacia

A

Reduce discomfort and pain

Calcium and/or vitamin D supplement for malabsorption

Exposure to sunlight

Diet rich in calcium and vitamin D

Braces or surgery for persistent orthopedic deformities

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15
Q

Paget’s Disease

A

A disease of unknown origin that is characterized by extensive breakdown of bone tissue followed by abnormal bone formation.

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16
Q

In the initial phase of Paget’s disease…

A

…excessive bone reabsorption occurs

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17
Q

The second phase of Paget’s disease involves…

A

…excessive abnormal bone formation

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18
Q

Clinical Manifestations of Paget’s Disease

A

Severe, persistent pain that worsens w/weight-baring

Impaired mvmt

Cranial enlargement (frontal & occipital areas)

Headaches w/skull involvement

Impaired hearing

Visual acuity

Kyphosis

Barrel chest

Asymmetrical bowing of the tibia & femur

Waddling gait

Forward bent spine and is rigid

Chin rests on the chest

Arms are bent outward and forward, appearing long in relation to the shortened trunk

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19
Q

Associated Assessment & Diagnostic Findings of Paget’s Disease

A

Elevated serum ALP concentration and urinary hydroxyproline excretion

-Higher values suggest more active disease

Patients w/ Paget disease have normal blood calcium levels

X-rays: Local areas of demineralization and bone overgrowth in the characteristic mosaic patterns

Bone scans demonstrate extent of disease

Bone biopsy may provide differential diagnosis w/ other bone diseases

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20
Q

Medical Management of Paget’s Disease

A

NSAIDS, Bisphosphonates, and Plicamycin

Walking aids, shoe lifts, and PT

Weight control

Diets adequate in calcium and vitamin D and periodic monitoring

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21
Q

Gerontological Considerations

A

Educate patients, families, and caregivers on how to compensate for altered musculoskeletal functioning with an emphasis on the risk of falls

Assess the home environment for safety to prevent falls and reduce the risk of fracture

Develop strategies for coping with a chronic health problem and its effect on quality of life

Provide alternative communication devices (e.g., text telephone, telecommunication device for the deaf) and home safety alarms if need

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22
Q

Osteomyelitis

A

Infection of the bone that results in inflammation, necrosis, and formation of new bone

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23
Q

High-Risk Patients for Osteomyelitis

A

Older adults

Poorly nourished or obese

Impaired immune systems

Chronic illnesses (diabetes, RA)

Receiving long-term corticosteroid therapy or immunosuppressive agents

IV drug users

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24
Q

Risk Factors of Osteomyelitis

A

Older age
 Diabetes
 Long-term corticosteroid therapy
 History of previous injury, infection, or
orthopedic surgery

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25
Q

Clinical Manifestations of Osteomyelitis

A

Bloodborne infections:

-Clinical and lab s/s of sepsis (e.g., chills, high fever, rapid pulse, general malaise)

-Systemic symptoms may shadow local s/s at first

  • Infected area becomes painful, swollen and extremely tender as the infection extends

-Patient reports constant, pulsating pain that intensifies with movement

No systemic s/s when spread of adjacent infection or from direct contamination

Non-healing ulcer with intermittent and spontaneous pustulous drainage with chronic osteomyelitis

Diabetic osteomyelitis can occur without external wound:
- Non-healing fracture
- Foot ulcer > 2 cm in diameter

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26
Q

Physical Exam of Osteomyelitis

A

Signs & Symptoms of localized pain

Warm, inflammed, edematous area, tender to touch

Erythema

Fever

Recurrent purulent drainage of an infected sinus

Altered gait

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27
Q

Associated Assessment & Diagnostic Findings for Osteomyelitis (Acute vs. Chronic): Wound & Blood Cultures

A

Acute: only positive in 50% of cases; antibiotic treatment initiated without results

Chronic: frequently unreliable for isolating organism, therefore, open bone biopsy is indicated

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28
Q

Associated Assessment & Diagnostic Findings for Osteomyelitis (Acute vs. Chronic): X-Rays

A

Acute: soft tissue edema in early findings; periosteal elevation and bone necrosis evident after 2-3weeks

Chronic: large, irregular cavities, raised periosteum, sequestra, or dense bone formations

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29
Q

Associated Assessment & Diagnostic Findings for Osteomyelitis (Acute vs. Chronic): Radioisotope Bone Scans

A

Acute: (isotope-labeled WBC scan) and MRI help with early definitive diagnosis

Chronic: identify areas of infection

30
Q

Associated Assessment & Diagnostic Findings for Osteomyelitis (Acute vs. Chronic): Blood Studies

A

Acute: leukocytosis and elevated ESR

Chronic: ESR and WBC count usually normal; anemia may be evident

31
Q

Medical Care of Osteomyelitis

A

Goal is prevention

Elective orthopedic surgery postponed if infection present

Urinary catheters and drains removed asap Pharmacological Therapy - Antibiotics

-Prophylactic treatment at time of surgery and for 24hrs post op

-Longer therapy than other infections; typically continues for 3-6 weeks; oral antibiotics when infection is controlled

Surgical management: Debridement indicated if infection is chronic and not responsive to antibiotic therapy

  • All dead, infected bone and cartilage must be removed before healing can occur

-Closed suction irrigation system may be used to remove debris

-May be staged over time to ensure healing

-Weakens bone, so internal fixations or external supportive devices may be needed to prevent pathologic fractures

32
Q

Nursing Interventions for Osteomyelitis

A

Relieve pain

Improve physical mobility

Control the infectious process

Educate patient about self-care
 Adherence to therapeutic regimen of antibiotics
 Maintenance of IV access and administration
equipment at home
 Medication name, dosage, frequency, admin rate, safe storage and handling, adverse reactions, and necessary laboratory monitoring

Home health nurse if support questionable or if patient lives alone to assist with IV antibiotic therapy

Stress importance of follow-up care appointments

33
Q

Hematogenous Osteomyelitis

A

Caused by bloodborne spread of infection

34
Q

Low Back Pain Causes

A

Acute lumbosacral strain
Unstable lumbosacral ligaments & weak muscles
Intervertebral disc problems
Unequal leg length

35
Q

Gerontological Considerations for Low Back Pain

A

Older adults may experience back pain associated w/ osteoporotic vertebral fractures, osteoarthritis of the spine, & spinal stenosis

36
Q

Diagnostic Studies for Low Back Pain: Spinal X-Rays

A

May demonstrate a fracture, dislocation, infection, osteoarthritis or scoliosis

37
Q

Diagnostic Studies for Low Back Pain: Bone Scan & Blood Studies

A

May disclose infections, tumors, & bone marrow abnormalities

38
Q

Diagnostic Studies for Low Back Pain: CT Scan

A

Useful in identifying underlying problems, such as obscure soft tissue lesions adjacent to the vertebral column & problems of the vertebral discs

39
Q

Diagnostic Studies for Low Back Pain: MRI Scan

A

Permits visualization of the nature & location of the spinal pathology

40
Q

Diagnostic Studies for Low Back Pain: Electromyogram (EMG) & Nerve Conduction Studies

A

Used to evaluate spinal nerve root disorders (radiculopathies)

41
Q

Diagnostic Studies for Low Back Pain: Myelogram

A

Permits visualization of segments of the spinal cord that may have herniated or may be compressed

Indications: When an MRI cannot be performed

42
Q

Diagnostic Studies for Low Back Pain: Ultrasound

A

Useful in detecting tears in ligaments, muscles, tendons, & soft tissues in the back

43
Q

Prevention Strategies for Acute Low Back Pain

A

Weight reduction as needed
Stress reduction
Avoid high heels
Walk daily & gradually increase the distance & pace of walking
Avoid jumping & jarring activities
Stretch to enhance flexibility
- Do strengthening exercises

44
Q

Body Mechanics for Acute Low Back Pain

A

Practice good posture

Avoid twisting, lifting above waist level, & reaching up for any length of time

Push objects rather than pull them

Keep load close to the body when lifting

Lift w/ large leg muscles & not back muscles

Squat while keeping back straight when it is necessary to pick something up off the floor

Bend your knees & tighten your abdominal muscles when lifting

Avoid overreaching or a forward flex position

Use a wide base of support

45
Q

Work Modification for Acute Low Back Pain

A

Adjust the height of chair using a footstool to position knees higher than the hips

Adjust height of work area to avoid stress on the back

Avoid bending, twisting, & lifting heavy objects

Avoid prolonged standing & repetitive tasks

Avoid work involving continuous vibrations

Use lumbar support in straight back chair w/ arm rests

When standing for any length of time, rest one foot on small stool/box to relieve lumbar lordosis

46
Q

Bursitis

A

Inflammation of a fluid-filled sac in a joint

47
Q

Bursae

A

Fluid-filled sacs that prevent friction between joint structures during joint activity & are painful when inflamed

48
Q

Tendonitis

A

Inflammation of muscle tendons

49
Q

Conservative Treatment of Bursitis & Tendonitis

A

Rest of the extremity
Intermittent ice & heat to the joint
NSAIDs for pain control

50
Q

(T/F) True or False: Tendon & bursae inflammatory conditions go away w/ or w/out treatment

A

True

Treatment is primarily aimed at symptom relief, not cure

51
Q

Impingement Syndrome

A

Generalized term that describes impaired movement of the rotator cuff of the shoulder

52
Q

Radiculopathy

A

Pain radiating from a diseased spinal nerve root (down the leg)

53
Q

Sciatica

A

Pain radiating from an inflamed sciatic nerve

54
Q

Carpal Tunnel Syndrome

A

An entrapment neuropathy that occurs when the median nerve at the wrist is compressed by a thickened flexor tendon sheath, skeletal encroachment, edema, or a soft tissue mass

55
Q

Risk Factors for Carpal Tunnel Syndrome

A

Women between the ages of 30-60

Women going through menopause or are taking estrogen & birth control pills (HIGHEST RISK!!)

People employed in occupations that frequently require repetitive hand movements or flexing of the wrist
- Hairdressers
- Assembly-line workers

Those exposed to vibrations when doing such tasks
- Construction workers
- Machinists

56
Q

Carpal Tunnel Syndrome Causes

A

It is caused by repetitive hand & wrist movements

Associated w/ RA, diabetes, acromegaly, hyperthyroidism, or trauma

57
Q

Clinical Manifestations of Carpal Tunnel Syndrome

A

Pain, numbness, paresthesia &/or weakness along median nerve distribution
- Thumb, index, & middle fingers

Night pain &/or fist clenching upon waking

Positive Tinel Signs: Elicited by percussing lightly over the median nerve near the inner aspect of the wrist
- Reports tingling, numbness, or pain

58
Q

Contusion

A

Soft tissue injury produced by blunt force

59
Q

Signs & Symptoms of Contusions

A

Pain, swelling, and ecchymosis

60
Q

Ecchymosis

A

Bruising/discoloration

61
Q

Strain

A

Pulled muscle injury to the musculotendinous unit

62
Q

Signs & Symptoms of Strains

A

Pain, edema, muscle spasm, ecchymosis, and loss of function are on a continuum graded 1st, 2nd, and 3rd degree

63
Q

Sprain

A

Injury to ligaments & supporting muscle fiber around a joint

64
Q

Signs & Symptoms of Sprains

A

Pain (may increase with motion), edema, tenderness; severity graded according to ligament damage and joint stability

65
Q

Dislocation

A

Articular surfaces of the joint are not in contact

66
Q

Signs & Symptoms of Dislocations

A

A traumatic dislocation is an emergency with pain change in contour, axis, and length of the limb & loss of mobility

67
Q

Subluxation

A

Partial or incomplete dislocation (Does not cause as much deformity as a complete dislocation)

68
Q

Management of Soft Tissue Injuries

A

Rest
Ice
Compression
Elevation

69
Q

What should the nurse assess to evaluate the effectiveness of alendronate (Fosamax) therapy for a patient with Paget’s disease?

A) Oral intake
B) Daily Weight
C) Grip strength
D) Pain intensity

A

D) Pain intensity

70
Q

Which information should the nurse include in the discharge teaching for a patient after 1 week of IV antibiotic therapy for acute osteomyelitis?

A) How to apply warm packs to the leg to reduce pain
B) How to monitor for & care for a long-term IV catheter
C) The need for daily aerobic exercise to help maintain muscle strength
D) The reason for taking oral antibiotics for 7-10 days after discharge

A

B) How to monitor for & care for a long-term IV catheter

NURS3313 Adult Health (27 decks)

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