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NRSG 102: Med Surg 1 > Exam 4: Chapter 41 - Management of Patients with Musculoskeletal Disorders > Flashcards

Exam 4: Chapter 41 - Management of Patients with Musculoskeletal Disorders Flashcards

1
Q

Osteoporosis is the most prevalent

A

bone disease in the world; more than 1.5 million osteoporotic fractures occur each year

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2
Q

What is Osteopenia?

A

Low bone mineral density (BMD)

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3
Q

Osteoporosis: Normal homeostatic bone turnover altered, causing

A

the rate of resorption is greater than the rate of bone formation, resulting in loss of total bone mass.

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4
Q

What happens to bone is Osteoporosis?

A

Bone becomes porous, brittle, and fragile and breaks easily under stress.

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5
Q

Osteoporosis: Frequency results in

A

compression fractures of the spine, fractures of the neck or intertrochanteric region of the femur, and Colles’ fractures of the wrist

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6
Q

Primary Osteoporosis occurs in

A

women after menopause and in men later in life

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7
Q

Failure to develop what leads to the development of osteopenia without associated bone loss?

A

Failure to develop optimal peak bone mass and low vitamin D levels

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8
Q

Inverventions to decrease the risk of fractures?

A

Early Identification of At-Risk Teenagers

Increased Calcium and Vitamin D intake

Regular Exercise

Modification in Lifestyle

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9
Q

Secondary osteoporosis is the result of

A

medications or diseases that affect bone metabolism

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10
Q

What medications can cause an increased risk for Osteoporosis?

A

Anticonvulsants (Phenytonin)

Thyroid Replacement Agents (Levothyroxine)

Antiestrogens (Medroxyprogesterone)

Androgen Inhibitors (Leuprolide)

PPI (Esomeprazole)

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11
Q

Prevelance of Osteoporosis in women older than 80 years old is

A

50%

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12
Q

Osteoporosis looks like ?

A

Swiss cheese. There is a lot of holes in the bone.

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13
Q

Doral Kyphosis is when they

A

hunch over

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14
Q

Cervical Lordosis is when

A

the back twists like the letter “s”

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15
Q

How often should someone try to get sunshine every week?

A

5-30 Minutes

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16
Q

Where is Vitamin D stored? And why don’t we need it everyday?

A

It is stored in fat, and stores a large amount

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17
Q

Vitamin D helps with the absorption of ?

A

Calcium

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18
Q

Osteoporosis is characterized by

A

Reduced bone mass, deterioration of boen matrix, and diminished boen architercutural strength

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19
Q

Bone turnover in Osteoporosis?

A

The rate of bone resorption by osteoclasts is greater than rate of bone formation by osteoblasts

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20
Q

Osteoporosis occurs most commonly as

A

compression fractures of the thoracic and lumbar spine, hip fractures, and Colles fracture of the wrist

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21
Q

What does Calcitonin do?

A

Inhibits bone resorption and promotes bone formation

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22
Q

What decreases with aging?

A

Calcitonin and Estrogen, which inhibits bone breakdown

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23
Q

What increases with aging?

A

Parathyroid Hormone increases with aging, thus increasing bone turnover and resorption. Consequence is net loss of bone mass over tim e

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24
Q

What surgery leaves people at an increased risk for Osteoporosis?

A

Bariatric surgery, because the duodenum is bypassed which is the primary site for absorption of calcium

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25
Q

What is most beneficial for developing and maintaining bone mass?

A

Resistance and impact exercises

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26
Q

Acronym to remember risk factors for Osteoporosis

A

“ACCESS”

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27
Q

Risk Factors: (A)CCESS

A

Alcohol Use

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28
Q

Risk Factors: A(C)CESS

A

Corticosteroid Use: Leach the calcium out of bone

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29
Q

Risk Factors: AC(C)ESS

A

Calcium Low/Low Vitamin D

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30
Q

Risk Factors: ACC(E)SS

A

Estrogen Low

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31
Q

Risk Factors: ACCE(S)S

A

Smoking

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32
Q

Risk Factors: ACCES(S)

A

Sedentary Lifestyle

If they are not walking to break down to rebuild the bone, they are at risk for osteoporosis

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33
Q

Nutrition Risk Factors for osteoporosis?

A

Low Calcium Intake

Low Vitamin D intake

High Phosphate Intake (Carbonated Beverages)

Inadequate Calories

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34
Q

osteoporosis diagnosed by

A

Dual Energy X-Ray Absorptiometry (DEXA), provides information about BMD at the Spine and Hip

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35
Q

DEXA scan data are analyzed and reported as

A

T-Scores (Number of SD’s above or below the average BMD value for a 30 year old healthy woman)

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36
Q

Baseline DEXA testing recommended for

A

all women older than 65 years old

Women who are postmenopausal older than 50 years

All people who have had a fracture occur bc of osteoporosis

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37
Q

BMD studies are also useful in assesing

A

response to therapy and are recommended 3 months post any osteoporotic fracture

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38
Q

Laboratory studies to test for osteoporosis

A

Serum Calcium/Phosphate/Alkaline Phosphate

Urine Calcium Excretion

Urinary Hydroxproline Excretion

hematrocrit

Erythrocyte Sedimentation Rate

X Ray STudies

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39
Q

Diet Education for osteoporosis

A

Increase Calcium and Decrease CAffeine

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40
Q

Education for osteoporosis

A

Exercise

Fall Prevention

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41
Q

Foods high in Calcium?

A

Cheese and Other Dairy Products

Steamed Broccoli

Canned Salmon with Bones

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42
Q

Recommended adequate intake level of Calcium for men 50-70 years in ____ and for men 71 and older is _____

A

1000 mg daily

1200 mg daily

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43
Q

Recommended Vitamin D Intake For Those Under 70?

For Those Over 70?

A

600 IU Daily

800 IU Daily

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44
Q

Exercise recommendation to prevent osteoporosis?

A

Regular Weight-Bearing Exercise

Need 20-30 Minutes of Aerobic, Bone-Stressing Exercise Daily

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45
Q

What Pharmacologic Method may be given to ensure adequate calcium intake?

A

A calcium supplement with Vitamin D may be prescribed and taken with meals or with a beverage high in Vitamin C to promote absorption

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46
Q

Common side effects of Calcium supplements?

A

Abdominal Distention and Constipation

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47
Q

What drugs could be given as a supplement to Vitamin D and Calcium to treat osteoporosis?

A

Bisphosphonates

Estogen Agonist/Antagonists

Receptor Activator of Nuclear Factor Kappa-B Ligand (RANKL ) Inhibitors

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48
Q

Osteoporotic compression fractures of the vertebrae are managed

A

conservatively

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49
Q

Osteoporosis: Health History focuses on

A

Family History, Previous Fractures, Dietary Consumption of Calcium, Exercise Patterns, Onset of Menopause, and Use of Certain Medications

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50
Q

Osteoporosis: What are some nursing diagnoses that may be assigned?

A

Deficient Knowledge about osteoporotic process and treatment regimen

Acute pain RT fracture and muscle spasm

Risk for Constipation RT immobility

Risk of injury

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51
Q

Relief of back pain resulting from compression fracture may be accomplished by

A

short periods of resting in bed in a supine or side-lying position

52
Q

What measure could be performed to increase comort?

A

Knee flexion increases comfort by relaxing back muscles

53
Q

What promotes muscle relaxation?

A

Intermittent local heat and backrubs

54
Q

Nurse instructs the patient to move the trunk as a

A

unit and to avoid twisting

55
Q

Constipationis a problem RT

A

immobility and medications

56
Q

What can be done early to relieve constipation?

A

Early institution of a high-fiber diet, increased fluids, and the use of prescribed stool softeners help prevent or minimize constipation

57
Q

If the vertebral collapse involves the T10-L2 vertebrae, the patietn may develop

A

paralytic ileus

58
Q

Osteomalacia is

A

a metabolic bone disease characterized by inadequate mineralization of bone

59
Q

Result of osteomalacia?

A

Skeleton softens and weakens, causing pain, tenderness to touch, bowing of the bones, and pathologic fractures

60
Q

Major defect is osteomalacia is a

A

deficiency of activated Vitamin D, which promotes clacium absorption from the gastrointestinal tract and facilitates minerization of bone

61
Q

Osteomalacia may result from

A

failced calcium absorption or from excessive loss of calcium from the body (kidney failure)

62
Q

GI Disorders that cause Osteomalacia?

A

Caliac Disease, Chronic Biliary Tract Obstruction, Chronic Pancreatitis, Small Bowel REsection

63
Q

Severe renal insufficiency results in

A

acidosis

64
Q

To combat acidosis, what does the body do?

A

Body uses available calcium and PTHstimulates release of skeletal calcium in an attempt to reestablish a physiologic pH. Skeletal calcium is drained.

65
Q

Osteomyelitis is

A

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

66
Q

Osteomyelitis can be classified as

A

Hematogenous Osteomyelitis

Contiguous-Focus Osteomyelitis

Osteomyelitis with Vascular Insufficiency

67
Q

What is Hemaogenous Osteomyelitis

A

Due to bloodborne spread of infection

68
Q

What is Contiguous-Focus Osteomyelitis

A

From contamination from boen surgery, open fracture, or traumatic injury (gunshot wound)

69
Q

What is Osteomyelitis with Vascular Insufficiency

A

Seen most commonly in patients with diabetes and peripheral vascular disease, most commonly affecting feet

70
Q

Patients who are at high risk for Osteomyelitis

A

Older Adults who are Poorly Nourished or Obese

Those with Impaired Immune System

Those with Chronic Illnesses

Those receiving long-term corticosteroid therapy or immunosuppressive agents

71
Q

Postoperative surgical wound infections typically occur within

A

30 days after surgery

72
Q

Postoperative Surgical Wound Infections classified as

A

incisional (superifical, located above the deep fascia layer) or deep (involving tissue beneath the deep fascia)

73
Q

If an implant has been used, infections for Osteomyelitis may occur within

A

a year

74
Q

Osteomyelitis occurs when

A

bacteria grows in the bone

75
Q

Treatment for Osteomyelitis

A

Antibiotics.

76
Q

How do you test to see what Antibiotic will work for Osteomyelitis?

A

Surgery. A portion of the boen is removed and tested. Different antibiotics are tested to see what will kill it.

77
Q

More than 50% of boen infections are caused by

A

Staphyloccus Aureus (S. Aureus) and incresingly Methicillin-Resistant S. Aureus (MRSA)

78
Q

Surgical Site Ink Markers have been linked to

A

infections by cross contamination between preoperative patients who use their mrkers

79
Q

Other pathogens that cause bone infections?

A

Gram-Positive Organisms Streptococci and Enterococci

Gram NegativePseudomonas

80
Q

Initial response to infection is

A

inflammation, increased vasculatirty, and edema

81
Q

2-3 days after bone infection..

A

thrombosis of the local blood vesels occurs resulting in ischemia with bone necrosis

82
Q

2-3 days after bone infection, it extends into

A

the medullary cavity and under the periosteum and may spread into adjacent soft tisseus and joints

83
Q

IF the bone infection is not treated promptly, what occurs?

A

Bone abscess forms

84
Q

The abscess cavity contains

A

sequestrum (dead bone tissue) which does not easily liquefy and drain. This means the cavity cannot collapse and heal.

85
Q

What surrounds the sequestrum?

A

New bone growth, the involucrum forms and surrounds it

86
Q

Why is Involucrum problematic?

A

Athough healing appears to take place, a chronically infected sequestrum remains and produces recurring abscesses through the patients life. This is referred to as chronic Osteomyelitis

87
Q

When the infection is bloodborne, the onset is usually

A

sudden, often occuring with the clinical and laboratory manifestations of sepsis (chills, high fever, rapid pulse, general malaise)

88
Q

The sysemic symptoms at may may overshadow the

A

local signs

89
Q

AS the infection extendss through the cortext of the bone, it involves

A

the periosteum and the soft tisseus

90
Q

The infected area becomes

A

painful, swollen and extremely tender

91
Q

With a bone infection, the patient may describe

A

a constant, pulsating pain that intensifies with movement as a result of the presure of the collecting purulent material

92
Q

When Osteomyelitis occurs from spread of adjacent infection or from direct contamination, there are no

A

manifestations of sepsis

93
Q

The surface area that lies over the infected bone is

A

wollen, warm, painful, and tender to touch

94
Q

The patient with chronic osteomyelitis presents with a

A

nonhealing ulcer that overlies the infected bone with a connecting sinus that will intermittently and spontaneously drain pus

95
Q

Diabetic osteomyelitis can occur without

A

any external wounds

96
Q

With those who are diabetic, micro and macrovascular pathophysiologic changes can

A

exacerbate the spread of infection from other sources

97
Q

In acute Osteomyelitis, early X-ray findings demonstrate

A

soft tissue edema

98
Q

2-3 Weeks after bone infection, what is evident?

A

Areas of Periosteal Elevation and Bone Necrosis

99
Q

What helps with early definitive diagnosis?

A

Radioisotope Bone Scans and MRI and Bone Scan

100
Q

Blood Studies for Bone Infection reveal

A

leukocytosis and an elevated ESR

101
Q

With chronic osteomyelitis, what is seen on a X-Ray

A

Large, Irregular CAvities, Raised Periosteum, Sequestra, or DEnse Bone Formation

102
Q

In Chronic Osteomyelitis, ESR and WBC are?

A

normal. Anemia may be present however.

103
Q

Osteomyelitis Prevention: Surgery should be postponed if

A

The patient has a current infection (UTI, Sore Throat)

104
Q

What Antibiotic is gen to achieve adequate tissue levels?

A

Prophylactic Antibiotics. Given to achieve adequate tissuee levels at the time of surgery and for 24 hours after surgery

105
Q

The initial goal of therapy is to

A

control and halt the infective process. Hydration, Diet high in Vitamins and PRotein, and Correction of Anemia are instituted.

106
Q

Area affected with osteomyelitis is immobilized to

A

decrease discomfort and to prevent pathologic fracture of the weakened bone

107
Q

Signs and Symptoms of Bone Infection include

A

localized pain, edema, erythema, fever, drainage

108
Q

With chronic Osteomyelitis, fever may be

A

low grade and occur in the afternoon or evening

109
Q

If the infection is chronic and does not respond to antibiotic therapy, what is recommended?

A

Surgical debridement is indicated

110
Q

What occurs during surgery for someone with Bone Infection?

A

Infected Bone Exposed

Purulent and Necrotic Material Removed

Area Irrigated With Sterile Saline

This is a Sequestrectomy

111
Q

What is a Sequestrectomy?

A

Removal of enough involucrum to enable the surgeon to remove the sequestrum

112
Q

Debrided cavity may be packed with

A

cancellous bone graft to stimulate healing

113
Q

In Osteomyelitis, patient resports an acute onset of

A

localized pain, edema, erythema, fever, or recurrent drainage of an infected sinus with associated pain, edema, and low-grade fever

114
Q

Risk factors for someone with Osteomyelitis

A

Older Age
Diabetes
Long-Term Corticosteroid Therapy
History of previous injury, infection, or orthopedic surgery

115
Q

Physical Examination in Osteomyelitis reveals

A

an inflamed, markedly edematous warm area that is tender. Purulent drainage may be noted. With Elevated Temperature

116
Q

Temperature with someone with chronic Osteomyelitis

A

temperature elevation may be minimal, occuring in the afternoon or evening

117
Q

Nursing Diagnosis for Osteomyelitis

A

Acute Pain RT Inflammation and Edema

Impaired Physical Mobility RT Pain

Risk for Infection: Bone Abscess Formation

Deficient Knowledge RT Treatmetn REgimen

118
Q

Patients goals for Osteomyelitis

A

Relief of Pain, Improved Physical Mobility Within Therapeutic Limitations, Control and Eradication of Infection, Knowledge of treatment knowledge

119
Q

Relieving Pain Osteomyelitis: Affected Part may be

A

immobilzied with a splint to decrease pain and muscle spasm. Nurse monitors skin and neurovascular status.

120
Q

RElieving Pain Osteomyelitis: Elevation reduces

A

swelling and associated discocmfort. Pain is controlled with prescribed analgesic agents and other pain-reducing techniques

121
Q

Improving Physical Mobility: Osteomyelitis - Treatment regimens restrict

A

weight-bearing activity. Bone is weakened by the infective process and must be protected by avoidance of stress on the bone.

122
Q

Improving Physical Mobility in Osteomyelitis: Jones above and below affected part should be

A

gently momved through their range of motion.

123
Q

Controlling the infectious Process in Osteomyelitis: Nurse monitors the

A

paitents response to antibiotic therapy and observes the IV access site for evidence of phlebitis, infection, or infilitration

124
Q

Controlling the infectious Process in Osteomyelitis: With long-term intestive antibiotic therapy, nurse monitors the patient for signs of

A

superinfection (oral or vaginal candidiasis, loose or foul smeeling stools). And monitors for development of additional sites that are painful or suddent increases in body temperature

125
Q

If surgery is necessary, nurse takes measures to ensure

A

adequate circulation to the affected area (wound suction to prevent fuluid accumulation, elevation of the area to promote venous drainage, avoidance of pressure on the grafted area,) to maintain needed immobility and to ensure patietns adherence to weight-bearing exercies

NRSG 102: Med Surg 1 (52 decks)

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