MED SURGE MSK TEST 2 Flashcards
What is osteomyelitis?
What are the signs and symptoms?
Bone infection (commonly from staph aureus), inflammation leads to ischemia, necrotic bone tissue>bone abscesses. S/S include acute fever and inflammation (redness, swelling, PAIN) and chronic ulceration and drainage and localized pain.
What are diagnostics of osteomyelitis?
What is nursing care for osteomyelitis?
•Leukocytosis, high ESR, infection biopsy, +/- blood culture, MRI/XRAY/scan
•Sterile dressing, long term IV antibiotics, prevent osteomyelitis, sterile dressing change, hand hygiene
True or False: amputation can occur in osteomyelitis
True
Vancomycin leaked into a PTs blood stream. This can cause:
- Hemorrhage
- Infiltration
- Infarction
2.
A PT with osteoporosis may experience:
1. Morning stiffness and fever
2. High uric acid levels and inflamed joints
3. Decrease in height and spinal deformity
3.
Who is at risk of developing osteoporosis ?
Females, white and Asian population, small/petite people, low estrogen and testosterone PTs, Pt with family history of osteoporosis, PTs with fracture history, PTs with poor eating habits, PTs who are sedentary, smoker PTs
What kinds of treatment and teaching would an osteoporosis PT receive?
*Tx would include diet change, antiresorptive(bisphosphonates)/anaerobic meds, bone loss supplements
*teach PT risk factors, pain relief, med teaching
Elevated ALP may indicate severe bone loss in what PT?
- CHF PT
- Osteomyelitis PT
- Osteoporosis PT
3.
Paget’s Disease is defined as ________ with ___ being a major symptom
Increased breakdown & formation of bone resulting in abnormal, weak bones that cause deformities, fractures, OA..PAIN is a major symptom
Is there a cure for Paget’s disease?
No but biophosphonates reducing bone resorption, calcitonin, joint replacement, exercise,support system, pain relief may help
A PT is admitted for their 3rd fracture in four months. They complain of severe pain in the chest and a lab panel returns with elevated ALP and ESR. An MRI returns showing multiple areas in the breast bones and ribs. PT also has swelling and palpable areas on the left breast. What concerns the nurse the most?
PT may have metastatic bone disease based on the MRI, angina prior fractures, and painful, palpable mass. Nursing care to provide is adjusting to possible diagnosis and chemotherapy.
Define Gout and its signs and symptoms
Caused by possible inherited purine metabolism issues or a secondary medical condition, gout is purine breakdown resulting in crystals that cause inflammation in joints and connective tissue. S/S Acute gout attacks/acute severe pain/ acute redness, swelling, warmth, and pain in one (big toe) or many joints. chronic symptoms may not be present but renal stones can occur.
What would a PTs diagnostic tests for gout include?
- Elevated uric acid and joint fluid analysis for high crystal Lvls
- Elevated ALP and scan for bone loss
- Elevated uric acid and MRI
1.
A PT with gout may need further teaching if they say the following:
- “I will avoid any organ meats and alcohol to avoid gout attacks”
- “I can continue to smoke and eat shellfish on Thursdays and Saturdays”
- “Indocin and drinking water can help with my gout attacks”
- Smoking and shellfish should be avoided
What PTs should the nurse be concerned are at risk of osteoarthritis?
- Pt who weighs 5’3 and is 300 lbs
- Pt with asthma
- Pt who is celebrating their 98th birthday
- Pt who suffers from halitosis
- Pt who presents nodes on their fingers
- 78 Y.O. PT who fractured his shoulder three times as a former factory worker
- PT who experiences pain with activities and no pain with rest
- PT who just had a child and suffers from PPD
- Because obesity
- Because of age
- Because bone nodes are a S/S
- Because of age and history of repetitive joint trauma
7. - Because those are S/S of OA
With no current cure for OA, the main goal of ______ & _______ can be achieved with NSAIDs, rest & exercise, diet, heat/cold therapy, and surgeries
Optimum independence and pain management
Osteoarthritis can result in localized _____, _____, & ______
Pain, swelling, & stiffness
Rheumatoid arthritis is:
- Chronic, progressive, systemic inflammatory disease
- Bone infection resulting in possible antibiotic resistance from treatment
- Concerning disease in which metastatized sites in bone appear
1.
Pannus, which erodes and destroys joint bone and joint cartilage, Is associated with:
Rheumatoid arthritis
True or false: osteoarthritis can affect connective tissues and organs
False. That’s rheumatoid arthritis
A PT reports early morning stiffness and bilateral, symmetrical joint inflammation. The nurse suspects the PT is exhibiting:
Early symptoms of rheumatoid arthritis
A PT that’s been diagnosed with RA asks a nurse what they can do to alleviate their symptoms. The nurse would suggest which of the following:
- Antibiotics
- Corticosteroids
- Antihypertensives
- Bronchodilators
- Antioxidants
- Elevating extremities
- Heat therapy
- 7.
TJR is commonly performed when ______ and the ____ & ____ are the most common replacements
All other conservative option have been ineffective ; knee, hip
Treat phantom pain as
Real pain…not be confused with phantom sensations
Preoperative care for THR
Teaching/screening, meet with PT/OT,imaging and testing
Postoperative for THR
OOB same day as surgery, prevent flexion/adduction of hip, early ambulation WT bearing per Dr.’s orders, observe wound dressing/drainage, watch for hypovolemia
What should be found in the room of a PT post THR?
A frame pillow to keep
A pt four days post-op THR bends at a 130 degree angle to sit in a chair. The PT hears a “pop” and immediately screams in pain for help. What has occurred and why?
- The PT has fractured their knee due to hyper extension
- The PT had dislocated their hip due to hyperflexion
- The pt has dislocated their knee replacement due to adduction
2.
A PT with a recent post-op THR should avoid:
- Gardening
- Swimming
- Walking
- Shuffleboarding
- Using light weights
- May cause hyper flexión
- May cause internal rotation and adduction past midline
PT may indicate further teaching if they say:
- “To get off the bed, I put my arms on my knees and push up.”
- “I should report bleeding to my nurse immediately”
- “It’s important to stay hydrated and use barrier cream after surgery”
- “I should avoid a dislocation by not sitting cross legged”
- Because this would cause hyperextension
The diet for a post op THR PT should include:
Fluid balance, protein intake, vitamin C, calcium, vitamin D, prenatals
Why would a PT use a CPM machine post op?
- To prevent scar tissue formation and stiffness
- To promote skin integrity
- To promote bone resorption
1.
The goal of THR post op is to promote hyper— of the knee.
- Extension
- Flexion
1
Surgical vs traumatic amputation
Surgical: ischemia >PVD, DM, bone tumors, thermal injuries, congenital problems …pt has time to adjust to amputee status
Traumatic: accidents —machinery, vehicles, lawn mower, chainsaw …pt doesn’t have time to process, monito for mental health status
Prevention of hemorrhage/infection post OP is a priority for:
Amputations
Amputation skin flap should be:
Flesh tone and warm, adequate profusion to stump’s skin flap
Laying a pt ______ may prevent hip contractures post-amputation
- Supine
- Dorsal
- Prone
3.
Prolonged elevation can lead to
Contractures
Because its a salicylate, an RA PT on aspirin may experience:
Select all that apply
Muscle soreness
1.Tinnitus
2.Sore throat
3.Headache
4.Bleeding gums
5.Tarry, black stools
6.Tachycardia
1,4,5,6
An amputee one week post-amputation would probably have which meds prescribed:
- Allopurinol and Febuoxtat
- Cozaar and Albuterol
- Neurotin and Elaviln
- Aka gabapentin and amiriplyine; Lyrica (pregabalin), Inderal (propranolol) may also be prescribed
Should a metastatic bone disease PT pursue surgery?
No. But radiation may be appropriate.
A ______ should be in an amputee’s room
Tourniquet
Bisphosphonates inhibit bone resportion in not only Pagets Disease PTs but also:
Osteoporosis PTs
A gout PT is prescribed Allopurinol. What would the nurse include in their teaching?
- It is used to maintain acute gout attacks
- Bone pain is a side effect of the medicine
- There’s a rash risk when using Allopurinol with Ampicillin
- Vomiting and nausea are highly concerning
- It is used for maintaining/preventing gout attacks
- 5.
