lewis ch 63 - musculoskeletal problems

Question 1

severe infection of bone, bone marrow, and surrounding soft tissue

Answer 1

osteomyelitis

Question 2

most common organism causing osteomyelitis

Answer 2

s aureus

Question 3

risk factors osteomyelitis (5)

Answer 3

• old age
• debilitation
• hemodialysis
• sickle cell disease
• IV drug use

Question 4

most common infection site of osteomyelitis in adults

Answer 4

vertebrae

Question 5

name for dead bone

Answer 5

sequestrum

Question 6

S+S osteomyelitis (5)

Answer 6

• constant pain
• swelling
• tenderness
• warmth
• restricted movement

Question 7

systemic manifestations acute osteomyelitis (7)

Answer 7

• fever
• night sweats
• chills
• restlessness
• nausea
• malaise
• drainage (late)

Question 8

chronic osteomyelitis S+S (4)

Answer 8

• infection lasting longer than 1 month or not responding to antibiotics
• continuous exacerbations and remission
• pain and swelling
• more scar tissue

Question 9

complications osteomyelitis (4)

Answer 9

• septicemia
• septic arthritis
• pathologic fractures
• amyloidosis

Question 10

important nursing considerations when giving gentamicin antibiotic to osteomyelitis pt (4)

Answer 10

• assess for dehydration before
• ensure renal function testing has been done
• monitor peak and trough levels
• teach pt to report vision, hearing, or urinary problems

Question 11

treatment options besides antibiotics for osteomyelitis (4)

Answer 11

• hyperbaric O2
• negative pressure wound therapy
• prosthetic device removed
• possible amputation

Question 12

what kind of benign bone tumor is most common

Answer 12

osteochrondroma

Question 13

malignant tumor in bone, muscle, fat, nerve,

or cartilage

Answer 13

sarcoma

Question 14

• Aggressive primary bone cancer
• Rapidly spreads
• Mostly in kids and young adults
• Gradual onset of pain and swelling in affected bone
• Chemo is done to decrease size, followed by surgery and more chemo

Answer 14

osteosarcoma

Question 15

most common type of muscular dystrophy

Answer 15

duchenne muscular dystrophy

Question 16

most definitive diagnosis for osteomyelitis

Answer 16

bone/soft tissue biopsy

Question 17

complications muscular dystrophy (2)

Answer 17

• cardiomyopathy

- decreased respiratory function

Question 18

risk factors low back pain (5)

Answer 18

• excess body weight
• stress
• smoking
• pregnancy
• trauma

Question 19

how long does acute low back pain last

Answer 19

4 weeks or less

Question 20

how long does chronic low back pain last

Answer 20

3 months or more

Question 21

metabolic bone disease:

-bone loses calcium and becomes soft

Answer 21

osteomalacia

Question 22

treatment osteomyelitis

Answer 22

long term IV antibiotics

Question 23

risk factors osteomalacia (6)

Answer 23

• limited sun exposure
• GI malabsorption
• diarrhea
• pregnancy
• chronic liver, kidney, small intestine disease
• long term antiseizure drugs and phosphate-binding antacids

Question 24

when do you take a blood culture when giving antibiotics

Answer 24

before

Question 25

S+S osteomalacia (4)

Answer 25

- bone pain: worse at night - muscle weakness - waddling gait - fractures

Question 26

metabolic bone disease: | -chronic, marked by low bone mass and deterioration of bone tissue that leads to fragility

Answer 26

osteoporosis

Question 27

who is more common to develop osteoporosis

Answer 27

-women (white and asian)

Question 28

risk factors osteoporosis in women (3)

Answer 28

- lower calcium intake - bone reabsorption begins earlier and becomes rapid in menopause - pregnancy and breastfeeding

Question 29

high risk factors osteoporosis (4)

Answer 29

- low body weight - smoker - prior fractures - long term use corticosteroids

Question 30

what meds should osteoporosis pts take (3)

Answer 30

fluoride calcium vit d

Question 31

what age is peak bone mass achieved

Answer 31

20 yo

Question 32

S+S osteoporosis (4)

Answer 32

- pain common in spine, hips, wrists - spontaneous fractures - gradual loss of height - kyphosis

Question 33

what t score in bone mineral density test indicates normal bone density

Answer 33

between +1 and -1

Question 34

what t score in bone mineral density test indicates osteopenia

Answer 34

between -1 and -2.5

Question 35

what t score in bone mineral density test indicates osteoporosis

Answer 35

-2.5 and lower

Question 36

drug therapy for osteoporosis

Answer 36

- bisphosphonates - SERMs (selective estrogen receptive modifiers) - calcitonin - teriparatide

Question 37

4 examples bisphosphonates

Answer 37

- alendronate - ibandronate - risedronate - zoledronic acid

Question 38

adverse effects bisphosphonates (4)

Answer 38

- headache - GI upset - joint pain - esophageal burns

Question 39

what should you teach the pt taking bisphosphonates (3)

Answer 39

- take with full glass water - take 30 mins before food - remain upright for 30 mins after taking

Question 40

contraindications for bisphosphonates (3)

Answer 40

- hypocalcemia - esophageal dysfunction - inability to sit/stand upright for 30 mins

Question 41

2 examples SERMs

Answer 41

raloxifene | tamoxifen

Question 42

adverse effects SERMs (3)

Answer 42

- hot flashes - leg cramps - increased risk VTE

Question 43

contraindications SERMs (3)

Answer 43

- pregnancy - venous thromboembolic disorder - retinal vein thromboiss

Question 44

effect of calcitonin

Answer 44

inhibits osteoclastic bone resorption

Question 45

only drug that stimulates bone formation

Answer 45

teriparatide

Question 46

(3) nursing recommendations for osteoporosis

Answer 46

- weight bearing exercises - quit smoking - reduce alcohol intake

Question 47

what meds increase risk of osteoporosis

Answer 47

corticosteroids