Musculoskeletal

Question 1

osteoporosis patho

Answer 1

• chronic metabolic disease in which bone loss causes decreased density and possible fracture
• occurs when osteoclastic activity is greater than osteoblastic activity

Question 2

osteoporosis risk factors (6)

Answer 2

• older age
• low body weight, thin build
• low calcium/vitamin D intake
• estrogen/androgen deficiency - ex. menopause
• alcohol intake
• lack of physical exercise, prolonged immobility

Question 3

daily calcium and vitamin D intake

Answer 3

calcium: 1200 mg/day

vit D: 800 mg/day

Question 4

osteoporosis physical/psychosocial assessment (4)

Answer 4

• Dowager’s hump
• loss of height
• back pain
• fallophobia

Question 5

labs for osteoporosis

Answer 5

• serum calcium, vitamin D, phosphorus - rule out secondary causes/other bone diseases

Question 6

how do you diagnose osteoporosis?

Answer 6

• dual x-ray absorptiometry - measures bone mineral density

T score:
• -1 to -2.5 = osteopenia
• < -2.5 = osteoporosis

Question 7

nutritional therapy for osteoporosis

Answer 7

• calcium and vitamin D intake/supplementation - milk, leafy greens, legumes
• protein, magnesium, vitamin K and other minerals also important

Question 8

teaching for calcium/vit D supplementation

Answer 8

can cause GI side effects, constipation - take with lots of water

Question 9

lifestyle changes for osteoporosis

Answer 9

• muscle strengthening and weight bearing exercises - walk 30 mins 3-5 times/week
• smoking cessation

Question 10

drug therapy for osteoporosis (3)

Answer 10

• calcium/vitamin D - Os-Cal, Citracal
• selective estrogen receptor modulator (SERM) - Raloxifine
• biphosphonates - alendronate (Fosamax)

Question 11

teaching for biphosphonates

Answer 11

• side effect: esophagitis

- take on empty stomach first thing in the morning w/ full glass of water, remain upright for 30 mins

Question 12

osteoarthritis patho

Answer 12

• joint pain and loss of function characterized by progressive deterioration and loss of cartilage in the joints
• “wear and tear” of joints

Question 13

osteoarthritis physical assessment (6)

Answer 13

• chronic joint pain/stiffness
• tenderness with palpation/ROM
• enlarged joints - Heberden’s and Bouchard’s nodes
• joint effusion
• atrophy
• loss of function

Question 14

goal of osteoarthritis treatment

Answer 14

relieve pain and minimize functional disability

Question 15

medications for osteoarthritis (6)

Answer 15

• acetaminophen = drug of choice
• NSAIDs
• lidoderm patch
• cortisone injections
• hyalunorate injections (Synvisc)
• muscle relaxants

Question 16

non-pharmacological treatments for osteoarthritis (4)

Answer 16

• rest and positioning
• hot/cold application
• weight control
• complementary/ alternative therapies

Question 17

surgery for osteoarthritis

Answer 17

total joint arthroplasty

Question 18

total hip replacement precautions (4)

Answer 18

• don’t stand or sit for long periods of time
• don’t flex hip more than 90 degrees
• keep abducted - pillow between legs
• avoid internal rotation

Question 19

post-op care for joint replacement (7)

Answer 19

• prevent dislocation
• monitor for infection
• prevent thromboembolic complications
• assess for bleeding
• assess neurovascular status (6 P’s)
• pain management
• encourage ambulation ASAP

Question 20

what do you do for a hip fracture before surgery?

Answer 20

immobilize immediately to prevent further damage - ex. Buck’s traction

Question 21

surgery of choice for hip fracture

Answer 21

open reduction internal fixation (ORIF)

Question 22

complications after hip fracture repair (7)

Answer 22

• dislocation
• necrosis of femoral beck
• infection of incision or hardware - beware of sepsis!
• delayed healing
• DVT, PE
• compartment syndrome
• skin alterations