Exam 3 Study Guide - Musculoskeletal Problems

Question 1

Osteoporosis Etiology

Question 2

Osteroporsis - Risk Factors

Answer 2

• Older age in both genders & all races
• Parental hx of osteoporosis, esp mother
• Hx of low-trauma fracture after 50yrs
• Low body weight
• Chronic low calcium and/or vit D intake
• estrogen or androgen deficiency
• current smoking
• high alcohol intake
• lack of physical exercise or prolonged immobility

Question 3

Osteoporosis - Assessment

physical
lab
imaging

Answer 3

• Physical
  > kyphosis
  > reports of “getting older”
  > pain
  > assess for fracture (pain, swelling, misalignment)
• Lab
  > no definitive lab test confirms diagnosis of primary osteoporosis
  > serum calcium & vit D3 lvls annually for all women & men older than 50 who are at high risk for disease
• Imaging
  > dua x-ray absorptiometry (DXA or DEXA): measures bone mineral density, best tool available for a definitive diagnosis

Question 4

Osteoporosis - Interventions

nutrition
exercise
lifestyle

Answer 4

• Nutrition Therapy
  > fruits & veggies
  > low-fat diary & protein sources
  > incrd fiber
  > moderation of alcohol & caffeine
  > dcr carbonation
• Exercise
  > walking 30mins 3-5/wk is most effective
• Lifestyle Changes
  > avoid tobacco
  > hazard-free envr’t to dcr risk for falls

Question 5

Osteoporosis - Drug Therapy Intervention

Answer 5

• Calcium & Vit D supplements
• Bisphosphonates
  > slows bone resorp by binding w/ crystal elements in bone
  > EX: Alendronate (Fosamax), Risedronate (Actonel), Ibandronate (Boniva)
  > take early in AM, 8oz water, sit upright for 30-60mins
• Estrogen agonist/antagonists
  > EX: Reloxifene (Evista)
  > inhibits bone resorp (breakdown of bones)
  > stimulates osteoblast activity & inhibits PTH (parathyroif hormone)
• Calcitonin
  > inhibits bone resorp (breakdown of bones)

Question 6

Osteoarthritis Causes

Answer 6

• Combination of many factors: aging, genetic, obesity, joint injury, occupation
• More females affected 2:1

Question 7

Osteoarthritis - Assessment

pattern
px assess

Answer 7

• Hx
• Disease Pattern:
  > unilateral, single joint
  > affects weight-bearing joints & hands, spine
  > non-systemic
• Physical Assessment/Key Features:
  > chronic joint pain & stiffness
  > Herbeden’s Nodes

Question 8

Osteoarthritis - Assessment

psychosocial
imaging
lab

Answer 8

• Psychosocial Assessment
  > constant, chronic pain
  > inability to care for oneself
  > depression & anxiety
  > altered body image
  > dcrd self-esteem
• Imaging
  > x-ray
  > MRI
  > CT
• Lab Findings
  > normal or slightly elevated ESR
  > slightly elevated C-reactive protein (CRP)

Question 9

Osteoarthritis - Drug Therapy

Answer 9

• Tylenol (drug of choice):
  > not a primary inflamm disorder
• Topical Drug: Lidocaine 5% patch (Lidoderm)
  > may apple for 12hrs/day
• NSAIDs
  > CBC, kidney, liver func tests are obtained for baseline
  > EX: celecoxib (Celebrex), ibuprofen
• Cortisone Injections
• Muscle Relaxants

Question 10

Osteoarthritis - Treatment/Interventions

nonpharm
surgery
contras

Answer 10

• Nonpharmacologic
  > restm balanced w/ exercise
  > joint positioning
  > heat or cold applications
  > weight control (to dcr stress on joints)
• Surgery
  > most common procedure is Total Joint Arthroplasty
  > hip & knee joints are most commonly replaced
• Contraindications to Surgery
  > active infection
  > advanced osteoarthritis
  > rapidly progressive inflamm

Question 11

Total Joint Arthoroplasty - Dislocation + Interventions

Answer 11

• Position correctly
  > hip: keep leg slightly abducted & prevent hip flexion beyond 90degrees
  > assess for pain, rotation, & extremity shortening

Question 12

Totaly Joint Arthroplasty - Infection + Intervention

Answer 12

• Use aseptic technique for wound care & emptying of drains
• Culture drainage fluid, if needed
• Monitor temp
• Report excessive inflamm or drainage

Question 13

Total Joint Arthroplasty - Venous Thromboembolism + Intervention

Answer 13

• Use of sequential compression devices and/or compression hose
• Teach leg exercises
• Encourage fluid intake
• Observe for signs of thrombosis (redness, swelling, pain)
• Admin anticoag as prescribed
• Do not massage legs

Question 14

Total Joint Arthroplasty - Bleeding & Hypotension + Intervention

Answer 14

• VS at least q4
• Observe pt for bleeding
• Assist w/ slow position changes

Question 15

Total Joint Arthroplasty - Neurovascular Compromise + Intervention

Answer 15

• Check & document color, temp, distal pulses, capillary refill, movement, & sensation
• Compare the operative leg w/ nonoperative leg

Question 16

Total Joint Arthroplasty - Scar Tissue Formation (total knee) + Intervention

Answer 16

• Continuous passive motion (CPM) machine
• Keeps knee in motion
• Formation of scar tissue can dcr knee mobility & incr postop pain

Question 17

Osteomalacia Etiology

Answer 17

• Loss of bone r/t vitamin D deficiency
• Bones soften secondary to inadequate amnts of calcium & phosphorus in bone matrix

Question 18

Osteomalacia - Interventions

Answer 18

• Incr vit D intake through diet
  > milk, eggs, swordfish, chicken, liver, enriched cereals & bread products
• Daily sun exposure
  > 5 mins/day
• Vit D supplements
  > ergocalciferol

Question 19

Paget’s Disease - Diagnostic Assessment

Answer 19

• Incr in serum alkaline phosphate (ALP)
  > caused by overactive osteoblasts
• Incr in urinary hydroxyproline lvls
  > indicates degree of disease severity
  > reflects bone collagen turnover
• Elevated uric acid
• x-rays
• bone scan

Question 20

Paget’s Disease - Interventions

Answer 20

• Oral bisphosphonates when ALP lvls are at 2x the normal lvl
  > EX: aldreonate (Fosamax), risedronate (Actonel)
• Monoclonal Antibody
  > EX: denosumab (Prolia)
  > binds to a protein tht is essential for formation, function, & survival of osteoclasts
• Calcitonin
  > hormone tht reduces bone resorp & relieves pain
  > given SQ
  > used in pts tht don’t tolerate bisphosphonates
• Aspirin or NSAIDs for mild-mod pain
• Heat & gentle massage
• Exercise
• Diet rich in calcium & vit D

Question 21

Osteomyelitis Etiology

Answer 21

• Infectious organisms enter from outside of body
  > infection in bone: bacteria, virus, fungi
• Organisms are carried by bloodstream from other areas of infection in body

Question 22

Osteomyelitis - Assessment

physical
lab
diagnostic

Answer 22

• Phsycial Assessment
  > assess for CMs: fever, swelling, erythema, tenderness, bone pain tht is constant, localized, & pulsating & intesifies w/ movement
• Lab Findings
  > elevated WBC
  > elevated erythrocyte sedimentation rate (ESR): normal early in course of disease
  > positive blood cultures: occurs when bacteremia is present
• Diagnostic
  > radionuclide scanning
  > MRI
  > bone changes can’t be detected early w/ x-ray, changes in blood flow to bone can be seen by radionuclide scan & MRI

Question 23

Acute Osteomyelitis - Interventions

Answer 23

• IV antibiotic therapy long-term
  > may possibly beed multiple antibiotics
• Contact precautions
  > if presence of copious wound drainage
• Wound care
• Drug therapy for pain control

Question 24

Chronic Osteomyelitis - Interventions

Answer 24

• IV antibiotic therapy
  > optimal time not well established
• Hyperbaric oxygen chamber (HBO) therapy
  > sued to incr tissue perfusion by exposure to high lvls of oxygen
• Surgery

Question 25

Bone Cancer Etiology

Answer 25

- Unknown - Genetic & envr't factors are likely causes

Question 26

Bone Cancer - Assessment

Answer 26

- **Determine pt's general health** - **Ask pt if they have had previous radiation therapy** - **CMs depend on type of lesion** > pain > local swelling > tender, palpable mass if possible - **Labs** > abn values may occur depending on type of primary tumor - **Diagnostic** > x-rays > CT > MRI > needle bone biopsy

Question 27

Bone Cancer - Interventions

Answer 27

- For primary tumors, treatment is aimed at reducing size of or removing tumor - Palliative therapies are to treat metastatic bone tumors - Nonsurgical > drug therapy (includes chemo) > radiation therapy > interventional radiology - Surgical