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Clients with Health Challenges - N3600 > MSK disorders - part 2 > Flashcards

MSK disorders - part 2 Flashcards

1
Q

Guidelines for neurovascular checks:

  • Observe capillary refill by _______ the ______ bed of the finger or toe, release and count the seconds until the nail turns pink
  • Observe the ______ of the casted tissues and compare with like tissues on the opposite side of the body
  • Feel the ________ of both extremities or like tissues of both sides of the body. The casted tissue will be slightly _____
  • Observe for presence and amount of _____. The affected tissues may be slightly to moderately _______, but the skin should not be tight
A

compressing, nail
colour
temperature, cooler
edema, edematous

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2
Q

How is edema ranked?

A

Scored as 1+ if edema is 1mm
3+ for 3mm
anything above 4 is considered gross edema

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3
Q

Guidelines for neurovascular checks (continued):

  • Ask patient to describe _______
  • Ask the patient to _____ the fingers or toes neighbouring the casted tissues
  • ask the patient about the amount of ______ and changes in ______ if experienced
  • ______ the casted side with the opposite side, report and record any differences
A

sensation
move
pain, function
compare

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4
Q

Describe the nursing interventions for prevention of the following MSK complications:

  • Muscle atrophy
  • Contractures
  • Foot drop
  • Pain
  • Muscle spasms
A

Muscle atrophy - isometric exercises

Contractures - good alignment, regular position changes and ROM exercises

Foot drop - foot support (support foot in dorsiflexion

Pain - corrective action, loosen device, etc.

Muscle spasms - apply heat (can also use anti-spasm medications but less often used), do not massage

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5
Q

What is foot drop?

A

a contracture in which the person’s foot is locked in plantar flexion essentially

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6
Q

What is the number one fracture that occurs in the elderly?

What is the most common cause?

A

Hip fracture

Falls

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7
Q

Hip fracture:

  • 70% of hip fractures are related to _________
  • gender impact?
  • Requires one of the ______ hospital stays
  • 25% of hip fracture clients die from complications within __ year(s)
  • 40% will require ____
  • Approximately 75% of the elderly do not return to their prior level of _______
A 
osteoporosis
women > men
longest
1 year
LTC
functioning
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8
Q

What are the risk factors for individuals over 65 for hip fractures?

A 
Poor muscle tone
polypharmacy
decreased vision and hearing
Slower reflexes
Orthostatic hypotension
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9
Q

What is orthostatic hypotension?

A

Drop in BP when changing position - 10-20 torr drop in systolic

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10
Q

What are the three main reasons that a senior will go to a nursing home?

A

Mobility issues, confusion and memory impairment, incontinence

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11
Q

Describe functioning after a hip fracture (stat)/

A

Approximately 75% of seniors do not return to their prior level of functioning following a hip fracture

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12
Q

What are the clinical manifestations of a hip fracture?

A

External rotation of the affected leg
Muscle spasm
Shortening of the affected leg
Severe pain and tenderness in the region of the fracture site

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13
Q

What are the nursing interventions to keep a client’s hip in alignment?

A

Place large billow between client’s legs when turning
keep leg abductor splints (if ordered) on, except when bathing
turn only on the side approved by the surgeon
Avoid positions/activities that predispose the client to dislocation

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14
Q

What activities/positions predispose a client to hip dislocation?

A

Hip flexion > 90°
Adduction
internal rotation

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15
Q

After a hip fracture, we have to remind patients to not do this for the first 6 weeks.

A

Cross their legs

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16
Q

What is a trochanter roll?

A

Take a towel, stick one end under the affected area and then roll it towards the client - immobilizes limb

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17
Q

What are some nursing diagnoses for a client with a hip fracture?

A

At risk for ineffective respiratory function related to decreased mobility

Acute pain related to hip surgery

Risk of impaired skin integrity..
Impaired physical mobility, etc.

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18
Q

Legal responsibility:

- All _______ injuries such as fractures resulting from abuse or neglect are a reportable event.

A

intentional

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19
Q

Scoliosis:

  • a lateral curvature of the spine measuring ___° or more on an x-ray
  • 80-85% of the cases are due to?
  • More common in _______
  • 3-5 out of 1000 kids develop spinal curvature that are considered large enough to require _______
  • should not be confused with poor ______
A 
10
idiopathic scoliosis
females
treatment
posture
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20
Q

Screening for scoliosis:

  • Difference in _____ height
  • _____ is not centered with the rest of the body
  • Difference in ____ height or position
  • Difference in ________ ______ height or position
  • When standing straight, difference in the way the ____ hang beside the body
  • When bending forward, the sides of the back appear different in ______
A 
shoulder
head
hip
shoulder blade
arms
height
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21
Q

Reduction of bone density and a change in bone structure which leads to increased risk of fragility fractures.

A

Osteoporosis

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22
Q

Responsible for 80% of the fractures over age 60.

A

Osteoporosis

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23
Q

Why are women over 50 more at risk for osteoporosis?

A

Menopause and subsequent drop in estrogen

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24
Q

Osteoporosis risk factors:

  • Over ____ years old
  • ________ compression fracture
  • ________ deficiency or early _______ (before age 45); ______ deficiency in men
  • Family ______
  • primary __________
  • ________ visible on x-ray
  • tendency to ______
  • Medical conditions that affect ______ absorption
  • > __ months continuous _______ use
A 
65
vertebral
estrogen, menopause, testosterone
history
Hyperparathyroidism
osteopenia
fall
nutrient
>6 months on continuous corticosteroids
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25
Q

Decreased bone density but not to the extent of osteoporosis. This decreased bone density leads to bone fragility and an increased change of breaking a bone

A

osteopenia

26
Q

Occurs when one or more of the four parathyroid glands grows into a tumour and behaves inappropriately by constantly making excess parathyroid hromone.

A

Hyperparathyroidism

27
Q

What is the result of hyperparathyroidism?

A

Excess PTH –> goes two bones and removes calcium from bones –> can clog arteries and kidneys and cause osteoporosis

28
Q

Specifically, Celia’s or Chron’s disease can decrease the absorption of these nutrients.

A

vitamin D, calcium

29
Q

Osteoporosis risk factors (continued):

  • ethnic origin?
  • ____ body mass index (
A 
white and asian women
low BMI; less than 57 kg in women
physical inactivity
low vitamin D and calcium intake
>1000mL of coffee/day
>2 drinks/day
30
Q

What is the acronym for osteoporosis treatment, what does each letter stand for?

A 
CDEFG S
C - calcium
D - vitamin D
E - exercise
F - prevent Falls
G - gain weight
S - stop smoking
31
Q

Treatment recommendations are often based on an estimate of your risk of breaking a bone in the next ___ years using information such as the ___ ____ test.
If the risk is not high, treatment might not include ______, but instead focus on modifying lifestyle factors.

For both men and women at increased risk of fracture, the most widely prescribed osteoporosis medications are _________.

A

10
bone density
medications
biphosphates

32
Q

We encourage people to take how much calcium (esp. women) daily?

A

1500mg +

33
Q

Most common form of joint disease; slow, progressive non-inflammatory disorder of synovial joints, previously known as wear and tear arthritis

A

Osteoarthritis

34
Q

Osteoarthritis:
- ______ common form of joint disease
- slow, progressive ____-________ disorder of synovial joints
- risk increases after _______,
- Results from cartilage damage and erosion of the _______ surface
gender influence?

A 
most
non-inflammatory
menopause
articular
affects men and women equally
35
Q

OA is also known as what?

A

Wear and tear arthritis or degenerative arthritis

36
Q

Although OA is not an inflammatory disease, there is inflammation. Why?

A

As a result of bone grinding

37
Q

Which joints are more often affected by OA?

What are the classical nodes seen in OA but not RA?

A

Weight bearing joints

Heberden’s and Bouchard’s nodes

38
Q

What are some common signs that indicate that it is OA, rather than RA?

A

Bow-legged (one leg becomes shorter)

Assymetrical nodes at weight bearing joints

39
Q

Nodes at the distal interphalageal joints.

A

Heberden’s nodes

40
Q

Proximal interphalangeal joint nodes

A

Bouchard’s nodes

41
Q

Describe the evolution of osteoarthritis/

A

(articulating) Cartilage breaks down, then the smooth synovial membrane is compromised, leading to bone on bone grinding and pain

42
Q

Adults should not exceed __g of Tylenol per day.

These medications are effective in treating OA.

A

4g

Tylenol and Aspirin

43
Q

Why is Tylenol and Aspirin use limited for treatment of OA?

A

aspirin can cause gastric bleeding

Tylenol is tough on the liver

44
Q

OA treatment:

  • ______ reduction
  • Rest and joint protection
  • avoid forceful, _______ movements
  • maintain good _____
  • ________ devices
  • therapeutic exercise (such as?)
  • heat and cold
  • Topical agents
  • Acetominophen, NSAIDs
  • Intra-articular _______ ______ injections
  • ________ surgery
A 
weight
repetitive
posture
assistive
taichi/yoga
hyaluronic acid
reconstructive
45
Q

To get around the gastric bleeding issue when taking aspirin, what type should be taken?

A

enteric coated

46
Q

RA:

  • chronic, _______, _________ disease
  • gender impact?
  • _________ of CT in the diarthodial (synovial) joints
  • Cause ______, ______ predisposition
  • _____ stages - they are?
A 
systemic, autoimmune
2-3x more common in women
inflammation
unknown, genetic
four stages - early, moderate, severe, terminal
47
Q

What causes RA flare ups?

A

stress - good or bad stress

48
Q

How are RA nodes different from OA nodes?

A

RA nodes can happen anywhere and present symmetrically

49
Q

Describe RA nodes/

A

calcified accumulations that are pea sized

50
Q

extra articular manifestation of RA - Dry eyes, mouth, mucus membranes

A

Sjogren syndrom

51
Q

Extra-articular manifestation of RA - Inflammatory eye disorders, splenomegaly, lymphadenopathy, pulmonary disease and blood dysacrias (anemia, thrombocytopenia, granulocytopenia)

A

Felty syndrome

52
Q

How is RA diagnosed?

A

Blood test
look for RF (rheumatoid factor) which occurs in 80% of patients
To confirm, do a sedimentation rate test - ESR - if elevated (off the chart) - diagnose RA

53
Q

What does ESR test for?

A

Inflammation in the body

54
Q

More reliable test than RF.

A

Erythrocyte sedimentation rate

55
Q

Describe the following for RA:

  • CRP
  • Synovial fluid WBCs
A

C reative protein is not normally found in serum unless there is necrosis or acute inflammatory conditions

in RA, there will be a higher WBC count in the synovial fluid

56
Q

What scan can be done to help determine an RA diagnosis?

A

X-ray

57
Q

The amount of joint movement is measured by a _______, this device measures the angle of the joint in degrees.

A

Goniometer

58
Q

What does DMARD stand for?

A

disease modifying anti-rheumatic drugs

59
Q

Humira and other monoclonal antibody treatments for RA are very effective, but what limits their use?

A

very expensive (1500$ per injection)

60
Q

How is humira administered?

A

By injection, twice a month

61
Q

What kind of drug is humira (adalimumab)

A

TNF blocker (monoclonal antibody)

Clients with Health Challenges - N3600 (22 decks)

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