Musculoskeletal

Question 1

What are the risk factors for osteoporosis?

Answer 1

Genetics, thin white and asian women. Age, postmenopausal women as they lose estrogen. Nutrition. Physical exercise. Lifestyle choices. Meds, esp steroids. Comorbidity.

Question 2

What test is used to diagnose osteoporosis?

Answer 2

Dual x-ray absorptiometry (DEXA) scan

Question 3

S/s of osteoporosis?

Answer 3

Bone pain or tenderness, fractures with little or no trauma, loss of height over time, neck or lower back pain due to fractures, stooped posture

Question 4

s/s of osteomyelitis?

Answer 4

Fever, chills, tachycardia, malaise, pain, edema, erythema, ulceration, drainage

Question 5

Diagnosis of osteomyelitis?

Answer 5

Radiologic confirmation, bone scans, leukocytosis, elevated erythrocyte sedimentation rate (ESR), wound/blood cultures\

Question 6

Management of osteomyelitis?

Answer 6

Prevention, pain control, antibiotics, supportive measures, hyperbaric treatment, surgical debridement, wound care, glycemic control

Question 7

A fracture that occursthrought an area of disease bone; can occur without trauma or fall.
A fracture that results from repeated loading of bone and muscle

Answer 7

Pathologic fracture

Stress fracture

Question 8

s/s of osteomyelitis? Diagnosis?

Answer 8

Pain, loss of function, deformity, shortening, crepitus, localized edema and ecchymosis.
Diagnosis has no special lab tests, but confirmation via radiology.

Question 9

5 P’s of a neurovascular check? Same as 5 P’s of what?

Answer 9

Pain, pallor, pulselessness, paresthesia, paralysis

Same as the 5 P’s of acute compression syndrome

Question 10

What are the advantages of an external fixator?

Answer 10

Facilitate the alignment of fracture fragments, permits early mobilization, permits wound care, permits ROM to unaffected joints.
Open ones allow for direct visualization of the fracture

Question 11

Disadvantages of an external fixator?

Answer 11

Potential for infection at pin site is high. Increases incidence of osteomyelitis. Altered body image.

Question 12

What are factors that inhibit fracture healing?

Answer 12

Infection, malignancy, bone disease, age, corticosteroids, NSAID’s, smoking, diabetes

Question 13

Complications of amputations?

Answer 13

Phantom limb pain, hemorrhage, infection, flexion contractures, skin breakdown

Question 14

s/s of FES, fat embolism syndrome?

Answer 14

Hypoexmia, usually seen first. Neurologic compromise, usually develops after respiratory s/s. Petechial rash, develops after respiratory and neurologic s/s. Fever, fat in the urine.

Question 15

Nursing care for FES?

Answer 15

Steroids, methylprednisone. Position every 2 hours. Pain management. Monitor respiratory, cardio, and neuro. Fracture immobilization. Care manipulation. Strict I and O, pt may need . Frequent vitals.

Question 16

Autoimmune, connective tissue disease that is characterized by periods of remissions and exacerbations. Pathophysiology?

Answer 16

Rheumatoid arthritis. Autoimmune reaction begins in synovial tissue. Results in breakdown of collagen. Edema, proliferation of synovial membrane, panes formation (destroys cartilage, erodes bone), loss of articular surface and motion, muscle weakness.

Question 17

Medical management of ACS?

Answer 17

Contact the surgeon immediately, it’s a surgical emergency. Open the splint. Bivalve the cast. Prepare for surgery. Keep the extremity at heart level, not above. Fasciotomy.

Question 18

S/s of RA, rheumatoid arthritis?

Answer 18

Symmetric join pain, early morning stiffness, joint swelling/warmth, erythema, loss of function, spongy joints, ulnar deviation (swan-neck), rheumatoid nodules, fever, weight loss, fatigue, anemia, enlarged lymph nodes

Question 19

Diagnosis of RA?

Answer 19

History and physical exam. Labs, increased ESR and C-reactive protein. Mild leukocytosis (rheumatoid factor, anti-nuclear antibody, ANA). X-rays. Aspiration of joint.

Question 20

Non-inflammatory, degenerative disorder of the joints. Primary and secondary?

Answer 20

Osteoarthritis, degeneratie joint disease. Primary is related to advanced age, while secondary more about damage to cartilage including trauma or long-term mechanical stressors.

Question 21

Risk factors for osteoarthritis?

Answer 21

Age, female, obesity, athletes, previous injury, muscle weakness, genetics

Question 22

s/s of OA?

Answer 22

Pain, joint stiffness, decreased function, enlarged joint, decreased ROM, edema, muscle atrophy, crepitus

Question 23

Treatment for OA?

Answer 23

Salicylates, NSAIDs, acetaminophen, intra-articular injections, opined analgesics, glucosamine and chondroitin, rest, weight loss, ambulatory devices, braces, splints, physical therapy
Surgical is total knee replacement (TNR), total hip replacement (THR)

Question 24

Nursing care of TNR after surgery?

Answer 24

Compression bandage, wound suction device, no hyper-flexion of the knee, physical therapy, ROM exercises, patient-controlled analgesia, Ice, SCDs/TED hose, neurovascular check, continuous passive motion

Question 25

How to avoid hip dislocation after a THR surgery?

Answer 25

Prevent hip adduction, avoid flexing the hip more than 90 degrees, don’t turn the affected leg inward, elevated toilet seat, no crossing of legs

Question 26

s/s of hip dislocation?

Answer 26

Increased pain at the surgical site, swelling, immobilization, acute groin pain at the affected hip, report of hearing a popping sensation, internal/external rotation affected, shortening of the affected extremity, restricted ability to move

Question 27

What are the types of hearing loss?

Answer 27

Sensorineural hearing loss

Conductive hearing loss, something physically blocking transmission of sound waves

Question 28

What is the safest way to remove ear wax?

Answer 28

Through gentle irrigation of the ear with warm water. Avoid inserting objects into the ear canal.

Question 29

Occurs due to defect in the cochlea, the eighth cranial nerve or brain. Often permanent hearing loss.

Answer 29

Sensorineural hearing loss, often permanent. From constant exposure to loud noises. Ringing in the ears. Ototoxic meds, meniere’s disease, diabetes mellitus

Question 30

Accumulation of med within inner ear that leads to cellular damage, impairs hearing, and impairs balance.

Answer 30

Ototoxicity. If pt is on an ototoxic med and they report tinnitus, hold the drug. Notify HCP.

Question 31

Risk of ototoxicity is high in?

Answer 31

High trough levels of the drug, impaired renal function, the elderly, prolonged use of the meds

Question 32

Ototoxic meds?

Answer 32

Antibiotics, diuretics, NSAIDs, antineoplastic meds

Question 33

Disorder of the vestibular system that can lead to a disturbed sense of balance. Clinical manifestations?

Answer 33

Vertigo. Nausea, vomiting, feeling of falling, hearing loss, tinnitus.

Question 34

Treatment of vertigo?

Answer 34

Avoid sudden head movement, hydration, uncluttered environment, assistive devices to ambulate prn, avoid driving during episodes

Question 35

Vertigo meds?

Answer 35

Dimenhydinate (dramamine)
diazepam (valium)
meclizine (antivert)

Question 36

Etiology of tinnitus?

Answer 36

Presbycusis (aging), otosclerosis, meniere’s disease, drugs, exposure to loud noise, inner ear problems

Question 37

Treatment of tinnitus?

Answer 37

Identify and eliminate the cause. If no cause can be found mask the sounds. Referral to support groups.

Question 38

Progressive and debilitating, periods of remission and exacerbations. Cause is unknown.

Answer 38

Meniere’s disease.

Associated with infections, allergic reactions, fluid imbalances, stress, ages 20-50, affects white men more

Question 39

Clinical manifestations of meniere’s disease?

Answer 39

Severe, intense, debilitating vertigo. Tinnitus. Fluctuating sensorineural hearing loss.

Question 40

How does meniere’s disease work?

Answer 40

Backed-up fluid leads to swelling and pressure in the endolymphatic scale. Distorts balance and sound information in the canals. Distorted information travels to the brain.

Question 41

Treatment for meniere’s disease?

Answer 41

Goal is to preserve hearing. Low sodium diet, spreads food out during the day, avoid caffeine and alcohol, no MSG. Move head slowly. Quitting smoking.

Question 42

Medication for meniere’s disease?

Surgical treatment?

Answer 42

Diuretics, antihistamines, antiemetic, diazepam

Endolymphatic decompression with drainage and shunt.

Question 43

Care of a patient after ear surgery?

Answer 43

Safety, avoid increasing pressure in the ear. Keep the ear dry. Avoid moving head too rapidly, report excessive draining, may experience some changes in hearing related to packing and swelling