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Adult Health Test 4 > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

Assessment: Physical Exam (7)

A 
Posture
Gait
Bone Integrity
Joint function
Muscle strength and size
Skin
Neurovascular status
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2
Q

Neurovascular assessment (2)

A

CSM

DTRs

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3
Q

Assessment: Health history

A

Common MS complaints

  • pain or tenderness
  • altered sensations (paresthesia: burning, tingling, numbness)
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4
Q

Muscle Strength Testing (0-5)

A

0: no detection of muscular contraction
1: barely detectable flicker or trace of contraction with observation or palpation
2: active movement of body part with elimination of gravity
3: Active movement against gravity only and not against resistance
4: active movement against gravity and some resistance
5: Active movement against full resistance without evident fatigue (normal muscle strength)

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5
Q

Dx Labs

A

Ca, alk, phos, thyroid, calcitonin, Vit D, CK-MB, urine Ca

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6
Q

Nursing diagnoses

A 
Acute pain
Impaired physical mobility
Risk for situational self-esteem
Imbalanced nutrition
Risk of injury
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7
Q 
Acute low back pain
Potential causes (9)
A 
Unstable ligaments
Weak muscles
OA of spine
Spinal stenosis
Intervertebral disc problems
Unequal leg length
Obesity
Stress
Depression
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8
Q

Low back pain: patient edu

A
  • Sleep in side lying position with knees and hips bent (pillow between knees)
  • Sleep on back with lift under knees and legs
  • Prevent lower back from straining forward by placing foot on a step or stool during prolonged standing
  • Back strengthening
  • avoid long periods in one position
  • bend knees, tighten abs during lifting
  • carry items close to body
  • avoid twisting, jerking during lifting
  • use local heat/cold application
  • use lumbar roll of pillow for sitting
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9
Q

Low back pain: Patient edu: DONTs

A

Do NOT

  • lean forward without bending knees
  • lift anything above level of elbows
  • stand in one position for long
  • sleep on abdomen or back with legs straight
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10
Q

Common conditions of the upper extremities (6)

A 
Bursitis
Tendonitis
Impingement syndrome
Carpal tunnel syndrome
Ganglion
Dupuytren’s contracture
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11
Q

Test for Carpel’s tunnel syndrome

How?

A

Tinel’s sign

Tap carpal tunnel at wrist (index finger to elbow)
Positive: tingling felt in thumb, index, lateral half of middle)

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12
Q

Important consideration for foot sx!

A

Explore the need for home assistance and the structural characteristics of the home

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13
Q

Foot surgery nursing dx

A

Risk for ineffective peripheral tissue perfusion***
Acute pain
Impaired physical mobility
Risk for infection

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14
Q

Osteoporosis: Patho

A

Normal homeostatic bone turnover is altered, rate of bone resorption is greater than the rate of bone formation  loss of total bone mass  Bone becomes porous brittle and fragile, break easily

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15
Q

Osteoporosis: Common injuries

A

Compression fx of spine
Fx of neck
Intertrochanteric region of femur fx
Colles’ fx of wrist

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16
Q

Risk factors osteoporosis (6)

A 
Genetics
Age
Nutrition
Physical exercise
Lifestyle choices
Medications
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17
Q

Dx osteoporosis

A

BMD

Dual energy x-ray absorptiometry (DEXA) testing

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18
Q

Genetic risks osteoporosis

A

Caucasian or Asian
Female
Family history
Small frame

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19
Q

Age risk osteoporosis

A 
Postmenopausal
Advanced age
Loss of testosterone in men
Decreased calcitonin
Kidneys absorb less Ca and excrete Ca easily
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20
Q

Hormones that inhibit bone loss osteoporosis

A

Estrogen
Calcitonin
Testosterone

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21
Q

Nutrition risks osteoporosis

A

Low calcium intake
Low vitamin D intake
High phosphate intake (carb beverages)
Inadequate calories

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22
Q

Physical exercise risk osteoporosis

A

Sedentary
Lack of weight bearing
Low weight and body mass index

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23
Q

Lifestyle risks osteoporosis

Why?

A

Caffeine
Alcohol
Smoking
Lack of sunlight

Reduces osteogenesis in bone remodeling

24
Q

Medication risks osteoporosis

A

Corticosteroids
Antiseizure meds
Heparin
Thyroid hormone

25
Q

Comorbidity risks osteoporosis

A

Anorexia nervosa
Hyperthyroidism
Malabsorption syndrome
Kidney failure

26
Q

Progressive osteoporosis: prevention

A

Balanced diet high in calcium and vitamin D
Use calcium supplements to ensure adequate calcium intake
Regular weight-bearing exercises: walking
Weight training  stimulates bone mineral density

27
Q

Progressive osteoporosis: pharm (6)

A
  • Calcium and vitamin D
  • Bisphosphonates
  • Calcitonin
  • Selective estrogen modulators (SERMs)
  • Teriparatide
  • RANK ligand inhibitor
28
Q

Bisphosphonate examples (4)

A

Alendronate
Risedronate
Ibandronate
Zoledronic acid

29
Q

Bisphophonate edu

A
  • 1st thing in the morning
  • empty stomach
  • 8 oz water (no other beverages)
  • sit or stand for 30 minutes after taking (prevent N/V)
30
Q

SERMs example

A

Evista

31
Q

Nursing Assessment: Osteoporosis or fracture with suspected osteo (have a few risk factors) (8)

A
  • occurrence of osteopenia and osteoporosis
  • family hx
  • previous fx
  • dietary consumption of Ca
  • exercise
  • onset of menopause
  • use of corticosteroids
  • use of alcohol, smoking, and caffeine intake
32
Q

Osteopenia

A

Weaking of bones – precursor to osteoporosis

33
Q

Nursing dx: osteoporosis

A

Deficient knowledge
Acute pain
Risk for constipation
Risk for injury

34
Q

Osteoporosis: goals and priorities

A

Education – tx
Relief of pain
Improved bowel elimination
Absence of additional fxs

35
Q

Osteomalacia: Patho

A

Softening and weakening of the long bones causes pain, tenderness, and deforimites caused by the bowing of bones and pathologic fxs

36
Q

Osteomalacia: Causes

A

GI disorders
Severe renal insufficiency
Hyperparathyroidism
Dietary deficiency

37
Q

Osteomalacia: Tx

A

Correct underlying cause
Increased doses of vitamin D, calcium
Handle patient gently
Address pain and discomfort

38
Q

Paget’s Disease alternate name

A

Osteitis deformans

39
Q

Paget’s disease Patho

A

Excessive bone resorption by osteoclasts  increased osteoblastic activity  bone structure disorganized, weak and highly vascular

40
Q

Manifestations of advanced Paget’s

A

Fractures
Arthritis
Hearing loss – compression of nerve in bony meatus
Kyphosis
Increased cardiac output due to great bone vascularity
Enlarged head, headache
Bowing of femurs or long bones
Increased warmth and tenderness over bones
Increased limb volume
Mild to moderate aching pain

41
Q

Paget’s: pharm (4)

A

NSAIDs
Caclitonin
Bisphosphonates (etidronate)
Plicamycin

42
Q

What is Plicamycin

What is it commonly used to treat

A

A cytotoxic antibiotic may be sued for severe disease resistant to therapy

Paget’s

43
Q

Infectious arthritis: Most common area of appearance

A

Knees

Hips

44
Q

Infectious arthritis: dx

A

Culture of synovial fluid

45
Q

Osteomyelitis: Causes (4)

A

Extension of soft tissue infection
Direct bone contamination
Bloodborne spread from another site of infection

46
Q

Osteomyelitis: causative organisms (4)

A

MRSA
Proteus spp.
Pseudomonas spp.
E. coli

47
Q

Assessment: Osteomyelitis

A

Risk factors
s/s of infection
s/s of adverse reactions and complications of abx
ability to adhere to prescribed therapy

48
Q

s/s consideration for chronic osteomyeltits

A

Fever may be low grade and occur in the afternoon or evening

49
Q

Osteomyelitis nursing interventions

A

Relieve pain

  • joint immobilization
  • elevation
  • handle with care
  • pain meds

Improving physical mobility

  • activity restricted
  • ROM to joints above and below affected

Participation in ADLs within limitations

50
Q

Osteomyelitis: medical interventions (4)

A

Prophylactic abx
Hydration
Vitamins
Protein

51
Q

Which type of bone tumor is more common?

A

Metastatic

52
Q

Metastatic bone tumors

-most common type/most often fatal

A

Osteogenic sarcoma

53
Q

Bone tumor sx: post op assessment

A 
VS
LOC
Neurovascular status
Pain
s/s complications
Labs (WBC and serum Ca)
s/s hypercalcemia
54
Q

When post op does elevated WBC become concerning

A

3-4 days

55
Q

Bone tumor: potential complications

A

Delayed wound healing
Nutritional deficiency
Infection
hypercalcemia

56
Q

Orthopedic surgery general nursing interventions

A 
Promoting proper nutrition
-antiemetics as prescribed
-relaxation techniques
-oral care
-nutritional supplements
Provide adequate hydration
Use strict aseptic technique
57
Q

Why does renal disease cause bone problems

A

Causes acidosis, calcium is used to neutralize pH, more PTH is produced to pull calcium from bones for this same purpose

Adult Health Test 4 (1 decks)

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