musculoskeletal disorders Flashcards
what are some causes of low back pain
- “akward movement”
- trauma/fall
- OA of spine
- osteoporosis of vertebrae
- scoliosis
how will the client with low back pain present
- acute or chronic
- radiculopathy
- sciatica (shoot sharp pain from back to thigh)
- most common: sacral and lumbar
what are some diagnostic tests for low back pain
- xray
- CT/CRI
what meds can help for chronic low back pain
- TCAs (amitriptyline)
- SSRIs (duloxetine)
- atypical anticonvulsants (gabapentin)
whats a complication of low back pain
loss of bowel or bladder function => something more severe is going on -> get CT/MRI
how can nurses help with low back pain
- education
- self limiting with rest
- avoid strain
- take prescrubed meds for acute (short tem opioids, muscle relaxants and possible steroids)
- daily pains = NSAIDs
- hot/cold
- chiropractic care
- orthopedica shoes/lumbar support
- limit sitting
- condition exercises
- good body posture and mechanics
what NSAIDS may be used for low back pain
- ibuprofen/motrin/naproxen/ASA/aleve
- ketorlac or tramadol (stronger)
what muscle relaxants can be used for low back pain
cyclobenzaprine
what TCAs/atypical anticonvulsants may be used for low back pain
- amitriptyline
- duloxetine
- gabapentin
what opioids may be used for low back pain
- hydrocodone/acetaminophen (vicoden or norco)
- oxycodone/acetaminophen (percosnack)
used for acute not chronic pain
describe the relationship between calcium and vitamin D
calcium and vitamin D work together to protect bones
calcium helps build and maintain bones
vitamin D helps the body absorb calcium
so even if you have enough calcium you can do shit with it if you dont have vitamin D
what are some causes of osteoporosis
- smaller fram
- postmenopausal
- malnutrition
- bariatric surgery
- GI malabsorption disorders
- immobilization
- corticosteroids
- meds
- tobacco/alcohol use
- sedentary lifestyle
- reduced calcitonin, estrogen
- increased PTH
whats happening with osteoporosis
- Reduced bone mass
- Deterioration of bone matrix
- Diminished architectural strength
- Fracture easily under stress
how will a client with osteoporosis
- early = no symptoms
- back pain (collapsed vertebra)
- loss of height
- stooped posture
- bones fracturing easily
what are some labs and disgnostic tests for osteoporosis
- DEXA Scan, FRAX, X-Ray
- Serum P & Ca, ALP, Urine Ca Excretion, Hematocrit, ESR
what are some foods that can help with osteoporosis
- Foods high in Ca
- Cheese, Dairy products, Broccoli, Canned Salmon
- Dark green leafy veggies
- Soy products
- Ca fortified cereals & OJ
whats a complication of osteoporosis
fracture management
how can nurses help with osteoporosis
- educate
- Diet rich in Ca and Vitamin D
- Peak bone mass “bank it!”
- Weight bearing exercises
- Supplements (Caltrate, Vitamin D)
- Medication therapy
- Reduce use of caffeine, tobacco, alcohol & carbonated soft drinks
- Educate on secondary osteoporosis
what meds can be used for osteoporosis
Biphosphates
Alendronate (weekly pill)
Risedronate (weekly / monthly pill)
Ibandronate (monthly pill or quarterly IV infusion)
Zoledronic acid (annual infusion)
Antineoplastic
denosumab
Estrogens
raloxifene
whats happening with osteomalacia
- soft and weak skeletal bones
- lower back, pelvis, hips, legs, and ribs
what are some causes of osteomalacia
- Lack of Vitamin D (sunlight & dietary)
- Renal failure
- GI disorders (Celiac)
- Hyperparathyroidism
- Medications
- Malnutrition
how will a client with osteomalacia present
- Pain & Tenderness to bones (Worse when ambulating)
- Bowing of bones (kyphosis / legs)
- Possible pathologic fxs
- Waddling gait
- Possible Steatorrhea
- Pain not relieved by rest (as progresses)
where does the proccess of activation of vitamin D occur?
liver then the kidney
what happens to the bones without vitamin D
they become thin, brittle, or misshaphen
what are some labs and diagnostics for osteomalacia
X-Ray (demineralization)
Serum Ca / P levels & ALP
Urine Ca & Creatinine
what foods can help with osteomalacia
- same as osteoporosis
- may need supplements
whats a complication of osteomalacia
fractures
how can nurses help with osteomalacia
- educate
- Discuss dietary changes (foods w/ D & Ca)
- Supplements for liver / kidney issues
- Sunlight therapy!
- Braces may help with pain / deformity
- S&S of fracture
- Safety to prevent fractures
whats heppening with osteomyletis
bone infection
what are some causes of osteomyelitis
- Bloodstream (often staph)
- Nearby tissue infection
- Open fractures / ORIF
- Complicated DM
- Immunocompromised / Poor Circulation
how will a client with osteomyelitis present
- May be asymptomatic
- VS changes (fever, tachycardia)
- Swelling, warmth & redness over area
- Pain to affected area
- Fatigue
what are some labs and diagnostics for osteomyelitis
- CBC and blood cultures
- CT/MRI
- ESR
what meds amy help with osteomyelitis
- strong IV antibiotics, then move on to oral
- long term (3-6wks) for both
what are some acute interventions for osteomyelitis
- surgery (remove areas of dead bone)
- ORIF reversal ot treatment
- strong IV antibiotics
what are some complications of osteomyelitis
- avascular necrosis
- amputation
- sepsis -> dead
how can nurses help with osteomyelitis
- educate
- Smoking cessation
- Safety
- Monitor for worsening infection (discuss S&S)
- Prolong elective orthopedic surgery’s if needed
- Remove urinary catheters ASAP
- Aseptic postop wound care
- Prompt management of soft tissue infections
- At home wound care
- Clients with DM – inspect feet daily
