MSK Disorders

Question 1

What is the infection of bone caused by ,most common organism, Staphylococcus aureus.

Answer 1

Osteomyelitis

Question 2

Inflammation occurs, followed by ischemia, bone tissue becomes necrotic - often resulting in bone abscess.

Answer 2

Etiology of Osteomyelitis

Question 3

S/S of Osteomyelitis are…?

Answer 3

ACUTE- less than 4 weeks, Fever, Inflammation (redness, heat, swelling & pain)

CHRONIC- more than 4 weeks, Ulceration, Drainage, Localized Pain

Question 4

What are the Diagnostic Testing for Osteomyelitis?

Answer 4

• Blood test for Leukocytosis (increased WBC’s)
• Elevated ESR ( Inflammation marker)
• Bone Biopsy for infection
• Blood Culture
• MRI, X-ray, CT scan

Question 5

What is the Nursing Care for Osteomyelitis?

Answer 5

• Long term antibiotics
• Sterile Dressing Changes
• Hand Hygiene
• Pain Management
• Pain Control (bone pain)
• May result in amputation

… infection in one part of the body may migrate into another bone in the body

Question 6

Metabolic bone disorder with bone density loss, resulting in fragile bones which are more likely to fracture.

Answer 6

OSTEOPOROSIS

Question 7

What is the Etiology of Osteoporosis?

Answer 7

• Peak bone density is reached @ 30-35yrs old. After peak yrs, bone breakdown exceeds the rate of bone build up, resulting in irreversible bone loss that increase with age.

Question 8

What common cause results in bone loss in women?

Answer 8

In postmenopausal women, the absence of estrogen appears to slow down the absorption of calcium, resulting in bone loss

Question 9

• Is the most common & is not associated with another disease

Answer 9

PRIMARY

Question 10

• Results from an associated medical condition or procedure

Answer 10

SECONDARY

Question 11

Risk factors for Osteoporosis have both non-modifiable & modifiable risk factors……what are the non-modifiable risk factors??

Answer 11

• Gender ( female) • Aging. • Caucasian/Asian
• Petite (small/ short) body build
• Postmenopausal status. • Low testosterone
• History of/ Family History of Osteoporosis or Fractures.

Question 12

Risk factors for Osteoporosis have both non-modifiable & modifiable risk factors……what are the modifiable risk factors???

Answer 12

• Smoking. • Excessive Alcohol use.
  
  • Anorexia nervosa • Nutrition. • Low Ca+ and Vit D.
  • Excessive Caffeine, protein or sodium consumption
• Sedentary lifestyle (not exercising enough/ constantly sitting)

Question 13

How to prevent Osteoporosis?

Answer 13

Adequate Ca+ & vit D, weight bearing exercises, muscle- strengthening exercises, advoid alcohol and smocking.

Question 14

S/S of Osteoporosis?

Answer 14

• Often undetected until a fracture occurs. • pain
• decrease in hight • Spinal Deformities.
• ADL’s may become limited. •

Question 15

What Diagnosis Testing are use to detect Osteoporosis?

Answer 15

• DEXA (bone density test). • X-ray
  
  • Calcium & Vit D may be decreased.
• Increased🔺 Phosphorus
• APL may be elevated w/ severe bone loss.

Question 16

What treatments are used with Osteoporosis?

Answer 16

Control risk factors to prevent bone loss

Supplements

Antiresorptive medications

Anabolic meds

Diet change

Exercise

Fall prevention

Question 17

What nursing care INTERVENTIONS are pit in place for OSTEOPOROSIS?

Answer 17

Education on risk factors, pain reliefs & medication teaching. Increase fluids with meds.fall prevention (free of clutter on the floor ex: throw rugs, use non skid socks or shoes, using assistant devices.

Question 18

Metabolic bone disease, increased breakdown and formation of bone, results in abnormally formed- weak bones causing deformities (punched out areas of bones),pain fractures and osteoarthritis.

Answer 18

PAGAT’S DISEASE

Question 19

Etiology of pagat’s disease ?

Answer 19

• Mainly effects men
• X-rays shows punched out areas, bone scan shows how widespread it is , increased ALP due to Osteoblasts activity
• PAIN IS THE MAJOR SYMPTOM, #1 ISSUE SEVERE PAIN

Question 20

Treatments for pagat’s disease?

Answer 20

NO CURE, but NSAID’s , bisphosphonates reduce bone resorption, calcitonin decrease bone loss

Encourage exercise as tolerated, joint replacement may be recommend.

Question 21

Nursing care for pagat’s disease?

Answer 21

Provide pain relief, supportive system care, and education and teaching.

Question 22

Systemic connective tissue disorder from the build-up of uric acid, more common in males. Uric acid is the waste product resulting from the breakdown of proteins (PURINES).

Answer 22

GOUT

Question 23

Etiology of gout?

Answer 23

Urate crystals are formed and deposited in the joints causing severe inflammation.(mainly BIG TOE).
Urate deposits can develop in the urinary system causing renal calculi (kidney stones) and under the skin cause tophi.

Question 24

What are the acute and chronic S/S of Gout?

Answer 24

Acute gout- one or more severely inflamed joints, attack usually being in the great toe, joint is edematois, red, hot, and extremely painfully.

Chronic gout- may not be obvious symptoms, renal stones may develop.

Question 25

What’s the Diagnostic Testing for Gout?

Answer 25

Elevated uric acid and joint fluid analysis to identify uric acid crystals.

Question 26

What are the theraputic interventions for Gout?

Answer 26

Acute attack medications-

° NSAIDs

° steroids

° colchicine > gout with diarrhea

° Indocin _ NSAIDs for treatment of acute and chronic gout.

° DAILY MEDS: febuxostate and allopurinol (zyloprine) to decrease acid production

° HERBAL REMEDY: Cherry Juice

Question 27

What nursing interventions/ teaching for Gout?

Answer 27

Analgesics meds NSAID’S (ASA)

Diuretics

Avoid alcohol consumption

Increase fluids to prevent renal calculi

**ADVOID HIGH PURINES (PROTEINS) FOODS, ex: ORGAN MEAT, SHELLFISH, ANCHOVIES, SARDINES, HARRIN (FISH)

Question 28

Occurs when the articular cartilage and bone ends of joints deteriorate due to the wear of aging. Joint space narrows, bone spurs develop, joint may become inflamed.

Answer 28

OSTEOARTHRITIS

Question 29

What are the risk factors of OA?

Answer 29

Severe risk factors include:

• Age
• Obesity
• Activities that create mechanical stress on synovial joints.

Question 30

S/S of OA?

Answer 30

• Joint pain or stiffness
• Problems with ADL’s
• Bony nodes on the joints of their fingers (HEBERDEN’S AND BOUCHARDS)
• PAIN WITH ACTIVITY

Question 31

DX testing for OA?

Answer 31

• X-ray • CT. • MRI. • Analysis of synovial fluid

Question 32

Theraputic measures for OA?

Answer 32

• No Cure, goal is to maintain optimum independence and pain management
• Synvisc injection treats osteoarthritic knees,the medication acts like healthy synovial fluid,helps with pain and mobility
• NSAID’s • Topical Creams.
• Rest and exercise (balanced). • Diet. • Surgery
• Heat and Cold Therapy. • Alternative therapies

Question 33

Chronic, progressive, systemic inflammatory disease, Destroys synovial joints and other connective tissues including amor organs

Answer 33

RHEUMATOID ARTHRITIS (RA)

Question 33

Chronic, progressive, systemic inflammatory disease, Destroys synovial joints and other connective tissues including amor organs

Answer 33

RHEUMATOID ARTHRITIS (RA)

Question 34

What’s the Etiology of RA?

Answer 34

Inflammatory cells and chemicals cause synovitis occurs 🔻

Synovium thickens and fluid accumulates (as inflammation progresses) 🔻

Destructive pannus erodes joint cartilage, destroying joint bone 🔻

Pannus is covered into bony tissue resulting in loss of mobility 🔻

Any connective tissue can be affected by RA

PAIN INCREASES WITH REST AND DECREASE WITH ACTIVITY

Question 35

S/S of RA?

Answer 35

EARLY: -bilateral, symmetrical joint inflammation

• Red,.warm, swollen, stiff, painful joints
• stiffness after resting
• activity 🔻 pain & stiffness
• low grade fever, weakness, fatigue, Anorexia, systemic s/s

LATE:- joint deformity. - Secondary Osteoporosis

**Pain 🔻 with activity

Question 36

DX testing for RA ?

Answer 36

Increased WBC’S and platelets by blood test

Other findings include….
Rheumatoid factor (RF) - is present with RA
-decreased RBC’s
-Decreased C4 component
- increased ESR (inflammation marker)
- Positive + for Antinuclear antibody (ANA) & C-Reactive protein ( CRP)
- X-RAY, MRI, BONE SCAN
- ARTHROCENTESIS* (removal of fluid from joint)