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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
Comorbidity risks osteoporosis
Anorexia nervosa Hyperthyroidism Malabsorption syndrome Kidney failure
26
Progressive osteoporosis: prevention
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
Progressive osteoporosis: pharm (6)
* Calcium and vitamin D * Bisphosphonates * Calcitonin * Selective estrogen modulators (SERMs) * Teriparatide * RANK ligand inhibitor
28
Bisphosphonate examples (4)
Alendronate Risedronate Ibandronate Zoledronic acid
29
Bisphophonate edu
- 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
SERMs example
Evista
31
Nursing Assessment: Osteoporosis or fracture with suspected osteo (have a few risk factors) (8)
- 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
Osteopenia
Weaking of bones – precursor to osteoporosis
33
Nursing dx: osteoporosis
Deficient knowledge Acute pain Risk for constipation Risk for injury
34
Osteoporosis: goals and priorities
Education – tx Relief of pain Improved bowel elimination Absence of additional fxs
35
Osteomalacia: Patho
Softening and weakening of the long bones causes pain, tenderness, and deforimites caused by the bowing of bones and pathologic fxs
36
Osteomalacia: Causes
GI disorders Severe renal insufficiency Hyperparathyroidism Dietary deficiency
37
Osteomalacia: Tx
Correct underlying cause Increased doses of vitamin D, calcium Handle patient gently Address pain and discomfort
38
Paget’s Disease alternate name
Osteitis deformans
39
Paget’s disease Patho
Excessive bone resorption by osteoclasts  increased osteoblastic activity  bone structure disorganized, weak and highly vascular
40
Manifestations of advanced Paget’s
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
Paget’s: pharm (4)
NSAIDs Caclitonin Bisphosphonates (etidronate) Plicamycin
42
What is Plicamycin What is it commonly used to treat
A cytotoxic antibiotic may be sued for severe disease resistant to therapy Paget's
43
Infectious arthritis: Most common area of appearance
Knees | Hips
44
Infectious arthritis: dx
Culture of synovial fluid
45
Osteomyelitis: Causes (4)
Extension of soft tissue infection Direct bone contamination Bloodborne spread from another site of infection
46
Osteomyelitis: causative organisms (4)
MRSA Proteus spp. Pseudomonas spp. E. coli
47
Assessment: Osteomyelitis
Risk factors s/s of infection s/s of adverse reactions and complications of abx ability to adhere to prescribed therapy
48
s/s consideration for chronic osteomyeltits
Fever may be low grade and occur in the afternoon or evening
49
Osteomyelitis nursing interventions
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
Osteomyelitis: medical interventions (4)
Prophylactic abx Hydration Vitamins Protein
51
Which type of bone tumor is more common?
Metastatic
52
Metastatic bone tumors | -most common type/most often fatal
Osteogenic sarcoma
53
Bone tumor sx: post op assessment
``` VS LOC Neurovascular status Pain s/s complications Labs (WBC and serum Ca) s/s hypercalcemia ```
54
When post op does elevated WBC become concerning
3-4 days
55
Bone tumor: potential complications
Delayed wound healing Nutritional deficiency Infection hypercalcemia
56
Orthopedic surgery general nursing interventions
``` Promoting proper nutrition -antiemetics as prescribed -relaxation techniques -oral care -nutritional supplements Provide adequate hydration Use strict aseptic technique ```
57
Why does renal disease cause bone problems
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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