Disorders of the Musculoskeletal System

Question 1

Musculoskeletal Assessment

Answer 1

Inspection
Palpation
Motion: Passive and Active ROM

Strength: during contraction; 0-5 scale

Use of assistive devices: walker, cain, wheelchair

Question 2

Osteomalacia

Answer 2

Demineralized Bone - lack of Vitamin D

easily confused w/ osteoporosis b/c of fracture risk

looser’s zone

Question 3

Osteomalacia Dx

Answer 3

serum calcium
phosphate
alkaline phosphatase
X-rays

Question 4

Osteomalacia interventions

Answer 4

increase dietary Vit. D - 600 to 800 per day

calcium/phosphorus
increase exposure to sun
increase exercise

Question 5

Paget’s Disease

Answer 5

Osteitis deformans - excessive bone resorption followed by replacement of normal marrow by vascular fibrous connective tissue

skull, femur, tibia, pelvic bones – enlarged thickened skulls

ID’d on X-ray
Cannot be fixed, only slowed down

Question 6

Paget’s Disease manifestations

Answer 6

Waddling gait, spine bent
chin rests on chest

slow changes to bone appearances

Question 7

Paget’s Disease Tx

Answer 7

calcitonin
biphosphonate drugs: boniva, phosinex – prevent further bone breakdown

NSAIDS
weight control
reduce stress on weak bones - reduces fracture risks

Question 8

Soft Tissue Injuries: Sprain

Answer 8

injury to tendenoligament surrounding a joint

ankle or wrist

Question 9

Soft Tissue Injuries: Strain

Answer 9

excessive stretching of muscle and fascial sheath

usually back

Question 10

Acute Intervention for Soft Tissue Injuries

Answer 10

RICE - decreases inflammation and pain
cold causes vasoconstriction and decreased nerve pain impulses
compression decreases swelling

48 hours: warm moist heat, NSAIDS, tylenol for swelling

Question 11

RICE

Answer 11

rest, ice, compression, elevation

Question 12

Carpal Tunnel Syndrome

Answer 12

compression of the median nerve in the wrist

caused by increased pressure in the carpel tunnel from trauma or edema

may be hormone related: increased incidence during menstrual cycle, pregnancy, menopause

Increased incidence in DM and hypothyroidism

associated with hobbies, occupations requiring repetitive wrist movements

Question 13

Carpal Tunnel Syndrome manifestations

Answer 13

Weakness (particularly of thumb)
Burning pain
numbness, impaired sensation
difficulty performing fine hand movements

Phalen’s Test
Tinel’s Test

Atrophy of thenar muscles (late stages); recurrent pain and dysfunction of hand

Question 14

Phalen’s Test

Answer 14

put back of hands together

Question 15

Tinel’s Test

Answer 15

tap the nerve to elicit numbness, tingling of hands

Question 16

Carpal Tunnel Syndrome collaborative care

Answer 16

prevention - exercises, good body mechanics, braces
cease aggravating movement
wrist splints
avoid temp extremes - cannot feel hot -> risk for burns
Lifestyle/occupational changes

surgical tx: neurovascular checks post-op; rehab up to 7 wks

Question 17

Amputation

Answer 17

Hazardous occupation, circulation impairment, thermal injury, trauma

indicated when there is an extremity with:

• loss of sensation
• inadequate circulation
• pallor/necrosis
• local infection
• vascular studies indicate the client is not a candidate for revascularization

Question 18

Levels of Amputation

Answer 18

Above or below the knee, above or below the elbow

Question 19

Closed or “flap” amputation

Answer 19

stump is covered with a flap of skin sutured over the end of it

performed when there is no infection present

Question 20

Open or “guillotine”

Answer 20

infection present and requires second surgery when infection is gone

Question 21

Amputation nursing management

Answer 21

assess for signs of bleeding/oozing
surgical tourniquet
elevate stump for first 24hrs then flat on bed (depending on Dr preference) - can get contractures
Assess incision for signs of healing
encourage ROM
prepare client for phantom limb sensation (can occur up to 2-3months after amputation) - nerve based pain b/c the nerves are still there even though limb is gone

Question 22

Tourniquet

Answer 22

for excessive bleeding; hemorrhage – always note the time applied

Question 23

amputation nursing management

Answer 23

compression bandage to reduce edema, increase healing, decrease pain, promote shrinkage

measure for prosthesis in OR
limit hip flexion: position on abdomen 3-4X/day for extension; limit time sitting in chair

rehab

Question 24

Low back pain

Answer 24

2nd most common client complaint

risk factors: more muscle tone, obesity, poor posture, smoking, stress, heavy lifting, prolonged sitting (occupational risks)

Etiology: lumbosacral strain, instability of lumbosacral bony mechanism, osteoarthritis of lumboscral vertebrae, degenerative disk disease, herniation of intervertebral disk

Question 25

Acute low back pain

Answer 25

pain lasting 4 wks or less

Question 26

Acute low back pain dx studies

Answer 26

hx and PE

MRI and CT if trauma or systemic disease suspected

Question 27

Acute low back pain collaborative care

Answer 27

anaglesics (NSAIDS, opioids if severe)
muscle relaxants
massage
alternating warm and cold compresses
rest
avoid lifting, bending, twisting, prolonged sitting

Question 28

Chronic Low Back Pain

Answer 28

pain lasting more than 3 months or repeating episodes (pain is usually every day)

Spinal Stenosis: pain in back radiated to buttock and leg

Intervertebral lumbar disk damage: radicular pain, straight leg raising test

Question 29

chronic low back pain: 3 s/s to report to dr immediately

Answer 29

depressed or absent reflexes
parasthesia and weakness to lower extremities
bowel/bladder incontinence, impotence (cauda equina)

Question 30

Cauda Equina

Answer 30

bowel/bladder incontinence, impotence

Question 31

Classic sign of low back pain

Answer 31

Pain in the back that radiates to buttock and legs

Question 32

chronic low back pain dx studies

Answer 32

X-rays
mylegram
MRI/CT
EMG

Question 33

Chronic low back pain conservative therapy

Answer 33

physical therapy
epidural corticosteroids injections

opioids
muscle relaxants
alternating warm and cold compress
rest
avoid lifting, bending, twisting, prolonged sitting

Question 34

Chronic low back pain surgical therapy

Answer 34

laminectomy with or without spinal fusion
diskectomy - remove disc
artificial disc replacement
spinal fusion - using pt’s bone to make a graft to fuse spine together

Question 35

chronic low back pain post op nursing care

Answer 35

bed rest/logrolling (depends on procedure and surgeon's preference)
analgesia
report leakage of CSF or severe headache
Assess extremity movement and sensation
assess peripheral pulses
adequate bladder emptying

Report bladder/bowel incontinence or difficulty evacuating to surgeon -> cauda equina

no twisting/bending: reverse trandelenburg when eating

Question 36

spinal fusion post op nursing care

Answer 36

may require immobilization for extended period

rigid orthosis

must assess bone graft donor site (where they took bone from) - often more painful than infused site

Question 37

chronic low back pain teaching

Answer 37

teach proper body mechanics
all twisting motions contraindicated
firm mattress