Musculoskeletal Flashcards
Intervertebral Disc Disease
A common condition characterized by the breakdown (degeneration) of one or more of the discs that separate the bones of the spine (vertebrae), causing pain in the back or neck and frequently in the legs and arms.
Osteomalacia
a disorder of “bone softening” in adults that is usually due to prolonged deficiency of vitamin D.
Osteoporosis Pathophysiology
Fragile, porous bones
Big holes inside bones, loss of bone mass results in low bone density and very brittle bones
Body is making too little bone, calcium leaves the bone and goes into the bloodstream
Osteoporosis Causes and risk factors
Female Gender
Old age
Postmenopausal
Caucasian and asian
Osteoporosis Bad Habits
Excess caffeine intake
Smoking or alcohol abuse
Osteoporosis Diseases
Hyperparathyroidism
Increases in PTH
Puts the calcium high in the blood
Cushing Syndrome - High steroids in the body which decreases the bone density
Diabetes Miletus
Which off the following medications can increase their risk for development of osteoporosis?
Prednisone
Which disease has an increase chance of occurrence in a 60 year old postmenopausal patient?
Osteoporosis
What are the risk factors for osteoporosis
Steroid use
High intake of caffeine
Being white or asian women
Postmenopausal sate
Anticonvulsant therapy for seizure disorders
Osteoporosis Signs and Symptoms
Frequent fractures
Reduced heigh
Kyphosis (round back, curving of upper back)
Osteoporosis Treatment and Education
Vitamin D and Calcium supplements (vitamin D helps calcium to absorb)
Go outside in the sun
Activity: Weight bearing exercises
Frequent ambulation
Fall precautions: provide rubber mats in showers
Well lit halls
Not throw rugs*
Stop Bad habits
Stop smoking
Decrease Caffeine intake
A nurse is providing education for a client who is at risk for osteoporosis. Which of the following instructions should the nurse include?
Walk for 30 minutes, 4 times a week
Which interventions should the nurse implement while providing care for an elderly female patient with osteoporosis?
Encourage frequent ambulation
Provide rubber mats in the shower
Encourage weight bearing exercises
Encourage the patient to stop smoking
Rheumatoid Arthritis
Autoimmune disorder where body attacks itself
Mainly attacks joints causing inflammation usually seen in the joints of the hands
Can involve the skin, eyes and lungs
What is the difference between rheumatoid arthritis and osteoarthritis?
Rheumatoid arthritis is a systemic disease and osteoarthritis is not
Rheumatoid arthritis Diagnosis
Can be very difficult to diagnosis since early signs and symptoms mimic those of many other diseases
Xrays and MRI
Synovial fluid aspiration
Arthoscopy
Blood test
RF - rheumatoid factor
ESR - erythrocyte sedimentation rate
CRP - C-reactvie protein
Rheumatoid arthritis Signs and Symptoms
Early signs: Fatigue, anorexia (weight loss) and morning pain and stiffness
Symmetrical pain and swelling in the small joints of the hands
Fingers: Swan-neck and a boutonniere deformity
Contractors of joints = High priority
Joint pain:
Pain relief with activity
More pain at rest
Suspected rheumatoid arthritis. The nurse would expect to note which early signs and symptoms
Fatigue
Morning stiffness
Rheumatoid arthritis Education
Pain control - Assess pain levels
Do NOT elevate the knees with pillows at night
Exercise (low impact)
Swimming
heat and cold to affected joints
Warm shower or bath before bed
A nurse is assessing a client who has a diagnosis of rheumatoid arthritis. Which of the following non-pharamacological interventions could the nurse suggest to help reduce pain
Alternate applying heat and cold to the affected joints
Which nursing intervention is most appropriate for a client diagnosed with rheumatoid arthritis and reporting generalized pain?
Assist the client with heat application and range of motion exercises
Rheumatoid arthritis Pharmacology
NSAIDS
Prednisone
Both decrease swelling
Methotrexate given to help the body to stop attacking itself
Methotrexate
Mainly given for rheumatoid arthritis and psoriasis swell as certain types of cancer
Stops folic acid metabolism which stops cellular reproduction
MethNOOOtrexate
No pregnant clients
No client crowds or live vaccines to avoid infection
No razors or brushing teeth hard - huge bleed risk with those low platelets
Methotrexate, what does it suppress
B and T lymphocytes
Suppresses white blood cells
Assessment on a client with rheumatoid arthritis (RA). The nurse checks for which assessment finding that is associated with RA?
Systemic symptoms such as fatigue, anorexia and weight loss
Lyme Disease
A thick transmitted bacterial infection that causes local inflammation and infection, left untreated can cause the immune system to react abnormally and can spread to organs and can cause systemic complications
Lyme Disease Symptoms
fever
headache
fatigue
characteristic skin rash called erythema
If left untreated, infection can spread to joints, the heart, and the nervous system.
Lyme disease is diagnosed based on symptoms, physical findings (e.g., rash), and the possibility of exposure to infected ticks.
Lyme disease Treatment
most cases of Lyme disease can be cured with a 2 to 4 week course of oral antibiotics, patients can sometimes have symptoms of pain, fatigue, or difficulty thinking that lasts for more than 6 months after they finish treatment.
Gout
It’s a type of arthritis due to the accumulation of uric acid in the blood.
pain, inflammation, redness, and limited mobility.
It tends to most commonly occur in the BIG TOE, but can affect the fingers, elbow, knee, small toes, wrist.
What is uric acid?
It is a waste product created from the purine breakdown during digestion. It enters the blood stream and is filtered through the kidneys and excreted out in the urine.
The kidneys play a role in keeping the uric acid levels within normal range….therefore, if the kidneys are damaged there is a high risk of uric acid levels increasing.
What can cause Gout?
High consumption of:
purine rich foods
fruit juice and soda drinks
alcohol…
Alcohol and uric acid compete within the kidneys, and the kidneys choose to excrete alcohol rather than uric acid, which leads to the buildup of uric acid.
Signs and Symptoms of Gout - Acute gout attacks:
Happen randomly…may only happen a few times or once in a person’s lifetime and lasts 1-2 weeks.
Tends to start out in the big toe…may also affect the fingers, elbows, writs, knees, heel, toes.Patient may have flu-like like symptoms…body aches.
As the day progresses, the pain intensifies (4-24 hours), and the patient may have joint stiffness. The affected area is VERY sensitive and the slightest pressure on the joint causes intense pain.
Nursing Interventions for Gout
Assess patient joints, especially toes, fingers, elbows for warmth, redness, or pain
Cold and warm compresses, if tolerated by the patient (alternate between cold and warm)
Systematic Lupus Erythematosus
Systemic lupus erythematosus is an autoimmune condition that causes inflammation in the joints, organs, and tissues of the body. This inflammation can damage affected structures permanently.
Systemic lupus erythematosus can affect almost any part of the body, but the most common areas include the following:
Joints
Lungs
Skin (disoid rash, butterfly “malar” rash)
Heart
Brain
Kidneys
Blood System
Polymyositis
an uncommon inflammatory disease that causes muscle weakness affecting both sides of your body. Having this condition can make it difficult to climb stairs, rise from a seated position, lift objects or reach overhead
Dermatomyositis
Dermatomyositis is a rare disease that causes muscle weakness and skin rash. Symptoms include a red or purple rash on sun exposed skin and eyelids, calcium deposits under the skin, muscle weakness, and trouble talking or swallowing. There is no cure, but treatment is done to reduce the symptoms.
Fibromyalgia
Fibromyalgia is a chronic (long-lasting) disorder that causes pain and tenderness throughout the body, as well as fatigue and trouble sleeping.
do not fully understand what causes it, but people with the disorder have a heightened sensitivity to pain.
A client with rheumatoid arthritis has been taking large doses of aspirin to relieve joint pain. Which finding is likely?
tinnitus
Client is admitted to the trauma center with a spinal cord transection at T4. Which of the physical limitations does the nurse anticipate when planning care? Select all that apply.
The client will be unable to independently ambulate.
The client will have no control of the bladder.
The nurse is planning care with an older adult who is at risk for falling because of postural hypotension. Which intervention will be most effective in preventing falls in this client?
Instruct the client to sit, obtain balance, dangle their legs, and rise slowly.
A client is recovering from an attack of gout. Client teaching should include the need to lose weight because
weight loss will reduce uric acid levels and reduce stress on joints.
Which nursing intervention is essential in caring for a client with compartment syndrome?
removing all external sources of pressure, such as clothing and jewelry
A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan?
elevating the stump for the first 24 hours
A client being discharged after treatment for a compound fracture asks why antibiotics are needed for a broken bone. Which response by the nurse is most appropriate?
This prophylactic antibiotic therapy is required because your bone broke through your skin.”
What are important nursing priorities on the first postoperative day for a client who has had an open reduction and internal fixation (ORIF) after a right hip fracture?
assessing the neurovascular status in the right leg, providing pain control, encouraging position changes, and early ambulation
A client undergoes an arthroscopy at the outpatient clinic. After the procedure, the nurse provides discharge teaching. Which response by the client indicates the need for further teaching?
“I should use my heating pad this evening to reduce some of the pain in my knee.”
The client shouldn’t use heat at the procedure site during the first 24 hours because doing so may increase localized swelling. Ice is indicated during this time. Elevating the extremity helps reduce swelling.
The nurse is caring for an adult with a grade III compound fracture of the right femur; the client has been placed in skeletal traction. What is the intended outcome of the traction?
Reduce and immobilize the fracture.
A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be?
administering ordered analgesics and monitoring their effects
A client is diagnosed with gout. Which foods should the nurse instruct the client to avoid? Select all that apply.
liver
cod
sardines
A client was undergoing conservative treatment for a herniated nucleus pulposus, at L5 – S1, which was diagnosed by magnetic resonance imaging. Because of increasing neurological symptoms, the client undergoes lumbar laminectomy. The nurse should take which step during the immediate postoperative period?
Logroll the client from side to side.
Osteoarthritis
More pain with more activity
The nurse is teaching a client with osteoporosis about taking alendronate. What information should the nurse give the client about how to take the medication:?
The medication should be taken:The nurse is teaching a client with osteoporosis about taking alendronate. What information should the nurse give the client about how to take the medication:?
The medication should be taken:
with a full glass of water and remain upright for 30 minutes.
The nurse is teaching a client with osteoporosis about optimal dietary choices to reduce the severity of the condition. What instruction should the nurse provide?
“Eat more dairy products such as cheese and yogurt.”
A client seeks medical attention for a ganglion. Which statement about this musculoskeletal mass is true?
Dorsiflexion exacerbates signs and symptoms of a ganglion.
The nurse is caring for a client with a fractured fibula who has skeletal traction and skeletal pins. What would the nurse instruct the unlicensed assistive personnel (UAP) to report immediately?
The traction weights are resting on the floor.
The nurse is caring for a child with osteomyelitis who will be receiving high-dose intravenous antibiotic therapy for 3 to 4 weeks. What should the nurse plan to monitor?
urine specific gravity
hich findings best correlate with a diagnosis of osteoarthritis?
joint stiffness that decreases with activity
The client sustained an open fracture of the femur from an automobile accident. The nurse should assess the client for which type of shock?
hypovolemic
A male client underwent a lumbar spinal fusion yesterday. Which nursing assessment should alert the nurse to the development of a possible complication?
clear yellowish fluid on the dressing
hemiparesis
weakness or the inability to move on one side of the body
diplopia
Double vision
A client undergoes hip-pinning surgery to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan?
keeping a pillow between the client’s legs at all times
After a person experiences a closure of the epiphyses, which statement is true?
No further increase in bone length occurs.
A nurse is teaching a client with osteomalacia how to take ordered vitamin D supplements. Which adverse effects should the nurse instruct the client to report?
GI upset and metallic taste
Two days after being placed in a cast for a fractured femur, the client suddenly has chest pain and dyspnea. The client is confused and has an elevated temperature. The nurse should assess the client for which health problem?
fat embolism syndrome
A client who has just been diagnosed with mixed muscular dystrophy asks the nurse about the usual course of this disease. How should the nurse respond?
“You may experience progressive deterioration in all voluntary muscles.”
A client reports an onset of pain in the ankle. The ankle is swollen, red, and extremely sensitive to pressure. The health care provider diagnoses secondary gout and the client asks for more information. What disease state(s) could the nurse discuss with the client that are associated with secondary gout? Select all that apply.
chronic alcohol ingestion
diabetes mellitus
hypercholesterolemia
hypothyroidism
A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching?
“I don’t know if I’ll be able to get off that low toilet seat at home by myself.”
The nurse should instruct the client to use assistive devices, such as a raised toilet seat, to prevent severe hip flexion.
A nurse is teaching a female client about preventing osteoporosis. Which teaching point is correct?
The recommended daily allowance of calcium may be found in a wide variety of foods.
The nurse is caring for a client who has been diagnosed with a strained ankle. The client asks the nurse what the difference is between a sprain and a strain. How should the nurse respond?
Sprains involve injury to the ligaments and strains to tendons or muscles.”
In preparation for total knee surgery, a 200-lb (90.7-kg) client with osteoarthritis must lose weight. Which exercise should the nurse recommend as best if the client has no contraindications?
aquatic exercise
A client has an intracapsular hip fracture. The nurse should conduct a focused assessment to detect which change near the fracture?
shortening of the affected leg
A client is admitted to the hospital with a diagnosis of a right hip fracture. The client has right hip pain and cannot move the right leg. The nurse should further assess the right leg to determine if the leg is in which position?
shorter than the leg on the unaffected side
A client who has had an above-the-knee amputation develops a dime-sized bright red spot on the dressing after 45 minutes in the postanesthesia recovery unit. What should the nurse do first?
Draw a mark around the site.
The nurse is admitting a client with a fractured tibia. Which area should the nurse assess first?
area distal to the fracture
When a nerve or blood vessel is severed or obstructed at the actual fracture site, innervation to the nerve or blood flow to the vessel is disrupted below the site;
A nurse is assigned a client with an acute exacerbation of rheumatoid arthritis (RA). Which medical facts about RA are essential in developing a plan of care? Select all that apply.
The client experiences stiff, swollen joints bilaterally.
Erythrocyte sedimentation rate (ESR) is elevated, and x-rays show erosions and decalcification of involved joints.
Inflamed cartilage triggers complement activation, which stimulates the release of additional inflammatory mediators.
The nurse is setting goals with a client with rheumatoid arthritis. Which is a priority goal for the client?
Demonstrate the use of adaptive equipment.
The emergency room nurse is caring for a client who fell, breaking the tibia. The nurse determines that the client understands the risk of compartment syndrome when knowing to report which early symptom following treatment?
paresthesia
A client with an open femoral fracture was discharged to home and reports having a fever, night sweats, chills, restlessness, and restrictive movement of the fractured leg. The nurse should interpret these findings as the client may be experiencing which complication?
osteomyelitis
The nurse is assessing a client with a fracture of the right femur for signs of complications. Which finding indicates the client may be developing a fat embolus?
acute respiratory distress syndrome
A nurse is caring for a client who has been immobilized in Buck’s traction for 3 weeks. Which actions by the nurse is most important in preventing a metabolic complication related to the immobilization?
Increase fluid intake and monitor urine output.
A client who has skeletal traction to stabilize a fractured femur has not had a bowel movement for 2 days. The nurse should:
increase the client’s fluid intake to 3,000 mL/day.
The nurse is advising a client who underwent femoral head prosthesis placement on the type of chair to sit in during the first 6 to 8 weeks after surgery. Which chair would be the correct type to recommend?
a high-backed chair with armrests
The nurse is preparing a client who underwent a knee replacement with a metal joint to go home. What should the nurse instruct the client to do? Select all that apply.
Notify the health care provider (HCP) about the joint before undergoing invasive procedures.
Inform the HCP before having magnetic resonance imaging (MRI) scans.
Notify airport security that the joint may set off alarms on metal detectors.
The client sustained a tibia fracture and a cast was applied. The client is reporting increasing pain when flexing toes. Which symptoms does the nurse assess as associated with compartment syndrome? Select all that apply.
Paresthesia
pain
pulselessness
A client who has had a total hip replacement has a dislocated hip prosthesis. What should the nurse do first?
Notify the orthopedic surgeon.
The client has a cast applied for a comminuted fracture of the left radius. The client returns to the emergency department (ED) with reports of pain described as “unrelenting.” Which objective findings indicate that the client is experiencing acute compartment syndrome? Select all that apply.
coolness in the extremity distal to the fracture
compartment pressure of 22mm Hg
poor skin color and delayed capillary refill
After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?
with the leg on the affected side abducted
The nurse must keep the leg on the affected side abducted at all times after hip surgery to prevent accidental dislodgment of the affected hip joint. Placing a pillow or an A-frame between the legs helps maintain abduction and reminds the client not to cross the legs.
The nurse is caring for an older adult who has hip pain related to rheumatoid arthritis. The client is practicing appropriate self-care activities when the client chooses to sit in which type of chair?
straight-back chair with elevated seat
A child diagnosed with osteomyelitis will be discharged on IV nafcillin. After teaching the parents about adverse effects that are important to report, which effects as stated by the parents indicate that they understand the teaching? Select all that apply.
sore mouth
stomach upset
fever
The nurse is teaching a client about using crutches. On which part of the body should the nurse instruct the client to support the body weight?
hands
A client is hospitalized for open reduction of a fractured femur. During the postoperative assessment, the nurse notes that the client is restless and observes petechiae on the client’s chest. Which nursing action is indicated first?
Administer oxygen.
On the evening of surgery for a total knee replacement, a client wants to get out of bed. What should the nurse do to safely assist the client?
Apply a knee immobilizer.
The nurse is assessing a client who is reporting pain in the lower part of the leg. To differentiate bone pain from pain from trauma, the nurse should ask the client if the pain is described as what? Select all that apply.
Bone pain is usually described as a throbbing sensation. Sharp pain occurs with bone trauma, such as fractures or bone infections. Dull pain is associated with a bone tumor. Muscle pain is usually described as an aching sensation that increases with movement.
Ambulating with a Cane
Going up stairs: Strong leg, cane, weak leg
Going downstairs: Cane, weak leg, strong leg
*Can always move before the weak leg
