MS Questions Flashcards
A nurse is performing a musculoskeletal assessment on an older adult living independently in a senior housing apartment. What normal physiological changes does the nurse expect? (Select all that apply)
A. Increased bony prominence
B. Slowed movement
C. Decreased range of motion
D. Narrowed gait
E. Cartilage regeneration
Answer: A, B, C
Widened gait
Cartilage breaks down over time - often need surgery
Increased risk for falls
Increased risk for fractures when fall and may need go to long-term care facility as a result
Increased risk for skin breakdown - prevent pressure ulcer
Allow more time for activity - ADLs
May need more assistance - including at home
What does that mean to our nursing care?
Cartilage degeneration
Decreased bone density
Kyphotic posture: hunchback - rounded back - leads to widened gait; prevent: exercise and good posture
Widened gait
What other normal physiologic changes should be expected in the older adult?
Electromyography (EMG)
Which diagnostic test is used to assess for muscle weakness?
Ultrasound
Which diagnostic test uses sound waves to produce an image of the tissue?
Arthroscopy
Which diagnostic test uses a fiberoptic scope inserted into the joint for direct visualization?
Radiography (X-ray, myelogram (contrast media into subarachnoid space to look at issues in vertebral column), arthrogram (x-ray of joints with contrast), CT)
Nuclear scans
MRI (Magnetic Resonance Imaging)
Electromyography (EMG)
Arthroscopy
Diagnostic tests
Good diagnostic tool for joints, soft tissue and bony tumors
MRI (Magnetic Resonance Imaging)
Used to evaluate diffuse or localized muscle weakness
Usually accompanied by nerve conduction studies for determining the electrical potential
May cause temporary discomfort - inserting needles
Mild sedation may be prescribed for selected patients
Skeletal muscle relaxants may be held several days prior to procedure: check func of nerves and muscles and want see baselin
Electromyography (EMG)
Diagnostic test or surgical procedure - direct visualization
Fiberoptic tube inserted into a joint for direct visualization or surgical repair
Nursing care after procedure:
Arthroscopy
Assess neurovascular status of the affected limb (pulses, temperature, color, cap refill, pain, movement, sensation) - done sev times
Pain control: Mild analgesic or opioid short amt times, ice for 24 hours, elevation of extremity for 12 to 24 hours
Observe for complications which may include swelling, increased joint pain, thrombophlebitis (blood clots big so go home on anticoag), infection
Nursing care after procedure: - Arthroscopy
Older age
Maternal history of osteoporosis
History of low trauma fracture after age of 50
Low body weight
Chronic low calcium or vitamin D intake
Estrogen or androgen deficiency
Smoking
High alcohol intake
Lack of physical activity or prolonged immobility
Carbonated drinks - high phosphate work inversely with Ca
Caffeine - Ca loss in urine
Postmenopausal, female
What are risk factors for osteoporosis?
Kyphosis
Reports of “getting shorter” - breakdown vertebrae
Pain
Assess for fractures (pain, swelling, misalignment) - easier
Other than fractures, what other signs and symptoms might the nurse expect when caring for this patient?
DEXA scan
Measures bone density - monitors progression; see if increased/not and how help
What diagnostic test is used to diagnose and monitor progression of osteoporosis?
Which statement by the patient regarding lifestyle changes indicates a need for further teaching?
A. “I will get rid of my scatter rugs”
B. “ I will cut back to 3 martinis a day”
C. “I will increase my calcium and vitamin D intake”
D. “I am going to walk every day”
Answer: B
A - Hazard free environment decreases risk of falling; scatter rugs increases risk for falls
B - 3 is too many; Heavy alcohol use increases risk of osteoporosis
C - Good to increase food intake even when on supplement
D - Walking is the most effective exercise at least 3-5 x a week; weight-bearing exercise
Nutrition therapy
Avoid tobacco
Drug therapy
What are other interventions for osteoporosis?
Vit D and calcium
Fruits and vegetables, increased fiber
Low-fat dairy and protein sources
Decrease carbonated beverages
Moderate intake of caffeine
Decrease alcohol intake
Nutrition therapy - What are other interventions for osteoporosis?
Calcium and vitamin D supplements
Bisphosphonates
Estrogen agonist/antagonists
Calcitonin
Drug therapy - What are other interventions for osteoporosis?
Slows bone resorption by binding with crystal elements in bone
Ex. Alendronate (Fosamax); risedronate (Actonel); ibandronate (Boniva)
-dronate
Take early in the morning, 8 oz. of water, sit upright for 30-60 min: can cause GERD
Bisphosphonates - Drug therapy - What are other interventions for osteoporosis?
Ex. raloxifene (Evista)
Inhibits bone resorption (breakdown of bones)
Stimulates osteoblast activity and inhibits PTH (parathyroid hormone - stim release of Ca)
Estrogen agonist/antagonists - Drug therapy - What are other interventions for osteoporosis?
Inhibits bone resorption (breakdown of bones) - keep Ca in bone
Calcitonin - Drug therapy - What are other interventions for osteoporosis?
Progressive deterioration and loss of cartilage in one or more joints
Not systemic - not every single joint
Usually unilaterally; weightbearing joints/hands
Symptoms: pain; decrease mobility esp side having deterioration or loss cartilage; enlarged joints that swell
Osteoarthritis
Which patients are at risk for developing OA? (Select all that apply)
A. Obese, older woman living alone
B. Slender, non smoking middle aged man
C. Middle aged man with 25 years working in construction
D. Young woman with a family history of cancer
E. Middle aged adult with multiple knee surgeries from high school soccer
Answer: A, C, E
Cancer not put you at risk
Age - older; natural wear and tear
Genetics
Obesity - more wear and tear
Joint injury - if had lots injuries as younger
Occupation - phys one higher risk
What are the risk factors for osteoarthritis
X-ray - diagnostic
MRI - diagnostic
CT scan - further look, diagnostic
May be slight increase in CRP (C reactive protein): inflammation
What diagnostic tests are used to diagnose osteoarthritis?
Might need joint surgery if bad enough; just trying get them through
Medications
Rest - with exercise mixed in
Heat/Cold
Weight control - big
What are some non-surgical options?
Acetaminophen
NSAIDS
Topical lidocaine patches
Steroid injections - prior to replacement to tide over - joint not last forever so hold on as long as can
Muscle relaxants
Medications - What are some non-surgical options?
Postoperative care of a total knee replacement may include which of the following? (Select all that apply)
A. Hot compress to incisional area
B. Continuous passive movement (CPM) used immediately or several days post op
C. Ice packs to incisional area
D. Check CMS (circulation, movement, sensation)
E. Maintaining abduction
Answer: B, C, D
Do ice postop
Do abduction for hips
The nurse is preparing an educational session for nursing students on the orthopedic unit. Which three signs of hip dislocation would be included? (Select all that apply)
A. Increased pain
B. Hip flexing at 45 degrees
C. Shortening of affected leg
D. Leg rotation
E. Skin breakdown near the incision
Answer: A, C, D
Keep leg abducted - fixation device
Prevent hip flexion beyond 90 degrees - want move around tho
What interventions do we put in place to prevent this complication?
Infection
Clot/DVT - not moving as much
Bleeding from surgery
Neurovascular compromise
Scar tissue formation - continuous passive motion machine - keep in motion
What are other complications in addition to hip dislocation?
Position correctly
Hip: keep leg slightly abducted and prevent hip flexion beyond 90 degrees
Assess for pain, rotation, and extremity shortening
Dislocation: - Joint replacement (arthroscopy) complications
Use aseptic technique for wound care and emptying of drains
Culture drainage fluid, if needed
Monitor temperature
Report excessive inflammation or drainage
Infection: - Joint replacement (arthroscopy) complications
Use of sequential compression devices and/or compression hose
Teach leg exercises,
Encourage fluid intake,
Observe for signs of thrombosis (redness, swelling, or pain);
Administer anticoagulant as prescribed,
Do not massage legs if have clot - mobilize
Venous thromboembolism: - Joint replacement (arthroscopy) complications
VS at least every 4 hours
Observe patient for bleeding
Assist with slow position changes
Bleeding and hypotension: - Joint replacement (arthroscopy) complications
Check and document color, temperature, distal pulses, capillary refill, movement, and sensation
Compare the operative leg with the non-operative leg
Neurovascular compromise: - Joint replacement (arthroscopy) complications
Continuous passive motion (CPM) machine
Keeps the knee in motion
Formation of scar tissue can decrease knee mobility and increase postoperative pain - need involve PT
Scar tissue formation (total knee arthroplasty): - Joint replacement (arthroscopy) complications
Which interventions does the nurse encourage with a patient diagnosed with osteomalacia? (Select all that apply)
A. Increase intake of milk and enriched cereal
B. Drink 8 cups of coffee a day
C. Use of calcium supplement
D. Increase time outside
E. Use of vitamin B12 supplement
Answer: A, D
Rationale: loss of bone Caused by a vitamin D deficiency and causes the bones to soften
Milk, eggs, swordfish, chicken, liver, enriched cereals and bread products
Increase vitamin D intake through diet - What interventions should be included?
5 minutes each day
Daily sun exposure - What interventions should be included?
Ergocalciferol
May need blood monitored
Vitamin D supplements - What interventions should be included?
The nurse admits a patient diagnosed with Paget’s disease. The nurse anticipates that the patient will have which condition?
A. Progressive muscle weakness
B. Low body weight, thin build
C. Enlarged, thick skull
D. Bone infection
Answer: C
Rationale: Paget’s disease is a metabolic disease characterized by bones excessively breaking down and then being reformed. Bones are disorganized and weak. An Enlarged skull is a common sign.
When reformed are weaker because not same norm restructure
More at risk for fractures
Bone and joint pain
Pathological fractures
Bowing of long bones
Enlarged, thick skull
There is an increased risk of bone cancer and fractures
Bones are overall weak
Goals of treatment: reduce pain, increase mobility and slow down bone resorption - help with Paget’s disease
What musculoskeletal changes does the nurse expect to find when assessing a patient with a history of Paget’s disease?
NSAIDS, biphosphates, calcitonin
Heat, massage, exercise
Goals of treatment: reduce pain, increase mobility and slow down bone resorption - help with Paget’s disease
Fever
Swelling
Erythema
Tenderness
Bone pain (constant, localized, pulsating and worse with movement)
Infection of bone and trying to avoid it
A patient is being admitted with possible osteomyelitis. What are the expected signs and symptoms?
WBC - increase?
ESR (erythroctye sedimentation rate): inflamation
Blood cultures: +/not and see if gone into bone; couple days grow out to see bacteria
What labs should be ordered?
IV antibiotics - long-period use
Wound care - source of infection: from wound and eventually into bone
Pain control - sig pain
Hyperbaric oxygen therapy (HBO) - helps with tissue perfusion; not work if lot of necrosis
What interventions should be included?
Surgery - get rid necrotic tissue; debride
Used to increase tissue perfusion by exposing to high concentrations of oxygen
What is more common, primary or secondary bone cancers?
Secondary is more common (metastasis from another site)
Osteosarcoma is most common
Ewings sarcoma is most malignant
Age of onset is commonly 10-30 - younger
50% occur in the distal femur
Primary bone cancers
Pain
Local swelling
Tender palpable mass is possible
What signs and symptoms do you expect when caring for a patient with bone cancer?
Radiation
Chemotherapy
Possible Surgery
What are expected interventions?
