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NUR3220 ADULT HEALTH I > Exam 3 Study Guide - Musculoskeletal Problems > Flashcards

Exam 3 Study Guide - Musculoskeletal Problems Flashcards

1
Q

Osteoporosis Etiology

A
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2
Q

Osteroporsis - Risk Factors

A
  • 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
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3
Q

Osteoporosis - Assessment

physical
lab
imaging

A
  • 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
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4
Q

Osteoporosis - Interventions

nutrition
exercise
lifestyle

A
  • 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
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5
Q

Osteoporosis - Drug Therapy Intervention

A
  • 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)
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6
Q

Osteoarthritis Causes

A
  • Combination of many factors: aging, genetic, obesity, joint injury, occupation
  • More females affected 2:1
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7
Q

Osteoarthritis - Assessment

pattern
px assess

A
  • 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
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8
Q

Osteoarthritis - Assessment

psychosocial
imaging
lab

A
  • 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)
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9
Q

Osteoarthritis - Drug Therapy

A
  • 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
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10
Q

Osteoarthritis - Treatment/Interventions

nonpharm
surgery
contras

A
  • 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
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11
Q

Total Joint Arthoroplasty - Dislocation + Interventions

A
  • Position correctly
    > hip: keep leg slightly abducted & prevent hip flexion beyond 90degrees
    > assess for pain, rotation, & extremity shortening
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12
Q

Totaly Joint Arthroplasty - Infection + Intervention

A
  • Use aseptic technique for wound care & emptying of drains
  • Culture drainage fluid, if needed
  • Monitor temp
  • Report excessive inflamm or drainage
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13
Q

Total Joint Arthroplasty - Venous Thromboembolism + Intervention

A
  • 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
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14
Q

Total Joint Arthroplasty - Bleeding & Hypotension + Intervention

A
  • VS at least q4
  • Observe pt for bleeding
  • Assist w/ slow position changes
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15
Q

Total Joint Arthroplasty - Neurovascular Compromise + Intervention

A
  • Check & document color, temp, distal pulses, capillary refill, movement, & sensation
  • Compare the operative leg w/ nonoperative leg
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16
Q

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

A
  • Continuous passive motion (CPM) machine
  • Keeps knee in motion
  • Formation of scar tissue can dcr knee mobility & incr postop pain
17
Q

Osteomalacia Etiology

A
  • Loss of bone r/t vitamin D deficiency
  • Bones soften secondary to inadequate amnts of calcium & phosphorus in bone matrix
18
Q

Osteomalacia - Interventions

A
  • 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
19
Q

Paget’s Disease - Diagnostic Assessment

A
  • 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
20
Q

Paget’s Disease - Interventions

A
  • 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
21
Q

Osteomyelitis Etiology

A
  • 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
22
Q

Osteomyelitis - Assessment

physical
lab
diagnostic

A
  • 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
23
Q

Acute Osteomyelitis - Interventions

A
  • 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
24
Q

Chronic Osteomyelitis - Interventions

A
  • 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
25
Q

Bone Cancer Etiology

A
  • Unknown
  • Genetic & envr’t factors are likely causes
26
Q

Bone Cancer - Assessment

A
  • 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
27
Q

Bone Cancer - Interventions

A
  • 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

NUR3220 ADULT HEALTH I (13 decks)

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