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Adult Health 2 Test 4 > Musculoskeletal management > Flashcards

Musculoskeletal management Flashcards

1
Q

What is osteomyelitis?

A

Invasion of microorganism in bone tissue, bone marrow and surrounding soft tissue
Most common infecting agent is STAPH

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2
Q

What are the ways that you can get osteomyelitis?

A

Direct - infection enters from outside of body - Open wound
Indirect - infection carried by blood stream to THE BONE - most common males for example from external fixator from compound fracture

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3
Q

In osteomyelitis what is the possible problem caused by staphylococcus aureus?

A

Pressure ulcer, penetrating wound, open fracture, orthopedic surgery, vascular insufficiency disorder

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4
Q

In osteomyelitis what is the possible problem caused by staphylococcus epidermidis?

A

Indwelling prosthetic device

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5
Q

In osteomyelitis what is the possible problem caused by streptococcus viridans?

A

abscessed tooth, gingival disease

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6
Q

In osteomyelitis what is the possible problem caused by escherichia coli?

A

urinary tract infection

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7
Q

In osteomyelitis what is the possible problem caused by mycobacterium tuberculosis?

A

tuberculosis

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8
Q

In osteomyelitis what is the possible problem caused by neisseria gonorrhoeae?

A

gonorrhea

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9
Q

In osteomyelitis what is the possible problem caused by pseudomonas sp.?

A

puncture wounds, intravenous drugs

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10
Q

In osteomyelitis what is the possible problem caused by salmonella sp.?

A

sickle cell disease

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11
Q

In osteomyelitis what is the possible problem caused by fungi, mycobacteria?

A

immunocompromised host

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12
Q

What is acute osteomyelitis and what are the signs and symptoms?

A 
Initial infection <1 month
Signs and Symptoms 
  Local and Systemic 
    Pain (unrelieved with rest, increases w/ activity)
    Fever
    Edema around area 
    Erythema and heat 
    Increased WBC count
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13
Q

What is chronic osteomyelitis and what are the signs and symptoms?

A

Present longer than one month/fails to respond to initial course of antibiotics

Local signs of infection more common
Ulcerations
Constant pain
Drainage/warmth at site

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14
Q

What diagnostic studies are done to diagnose osteomyelitis?

A 
bone biopsy
blood cultures, wound cultures 
radionuclide bone scans 
MRI 
x-rays (may not reveal osteomyelitis 10days to weeks after clinical symptoms)
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15
Q

How do you non-surgically manage chronic osteomyelitis?

A 
Vigorous/ prolonged 
  IV antibiotic 4-6 weeks 
  Followed by oral antibiotics 2-3 months 
    Penicillin, Nafcillin, Vancomycin, Gentamicin 
  Hyperbaric Oxygen Therapy 
  Wound VAC 
  Immobilization 
  Pain Management
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16
Q

How do you surgically manage osteomyelitis?

A 
Debridement 
Bone grafts 
Muscle flaps 
Amputation 
Pain management
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17
Q

What nursing management is done for osteomyelitis?

A 
Educate "at risk" populations 
Pain relief: splint, careful movement, meds 
Sterile dressing changes 
Bedrest/avoid contracture
Affects of long term antibiotic therapy 
Physical and Psychological support
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18
Q

What health information so you need to collect regarding osteomyelitis?

A 
Past health history 
bone trauma
open fracture
open or puncture wounds
other infections 
medications 
surgery or other treatments
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19
Q

What subjective data must you collect when performing an assessment for osteomyelitis?

A

IV drug use, malaise, anorexia, weight loss, chills, weakness, paralysis, muscle spasms, local tenderness over affected area, increase in pain in affected area

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20
Q

What objective data must you collect when obtaining an assessment for osteomyelitis?

A

General: restlessness, high spiking temperature, night sweats
Integumentary: diaphoresis, erythema, warmth, edema at infected bone
Musculoskeletal: restricted movement, wound drainage, spontaneous fractures

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21
Q

What are some nursing diagnosis for osteomyelitis?

A

acute pain
ineffective self-health management
impaired physical mobility

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22
Q

What are the overall goals for someone with osteomyelitis?

A

have satisfactory pain and fever control
do not experience any complications associated with osteomyelitis
cooperate with treatment plan
maintain a positive outlook on outcome of disease

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23
Q

What health promotions would you want for someone with osteomyelitis?

A 
control infections already in body 
susceptible adults 
immunocompromised 
wear orthopedic prosthetic devices 
have vascular insufficiencies 
instruct susceptible adults and their families on local and systemic manifestations
24
Q

What are some acute interventions for osteomyelitis?

A

Some immobilization of affected limb will ↓ pain, Limb should be handled carefully to avoid excessive manipulation and ↑ pain, Assess and manage patient’s pain level, Apply dressings to absorb exudate from draining wounds, Patient is frequently on bed rest in early stages of acute infection, Good body alignment and frequent position changes prevent complications associated with immobility and promote comfort, Flexion contracture is a common sequela of osteomyelitis, Patient frequently positions affected extremity in a flexed position to promote comfort, Contracture may then progress to deformity.
Footdrop can develop quickly in lower extremity if foot is not supported in a neutral position by a splint, or if there is excessive pressure from a splint, Instruct patient to avoid activities that ↑ circulation and swelling and serve as stimuli to spread infection, Exercise, heat application, Teach patient potential adverse and toxic reactions with prolonged and high-dose antibiotic therapy, Lengthy antibiotic therapy can result in overgrowth of Candida albicans, Patient and family are often frightened and discouraged, Continued psychologic and emotional support is an integral part of nursing management.

IV antibiotics can be administered to patient in a skilled nursing facility or home setting. If at home, Patient and family must be instructed on proper care and management of venous access device. Must also be taught how to administer antibiotics. Importance of continuing antibiotics after symptoms have subsided should be stressed. Periodic nursing visits provide support and decrease anxiety. Frequent dressing changes for open wounds. May require supplies and instruction in technique.

25
Q

What is muscular dystrophy?

A 
genetically transmitted diseases 
progressive wasting of skeletal muscles 
no neurological involvements 
loss of strength increase in disability 
types of dystrophies differ in groups of muscles affected age of onset, rate of progression and mode of genetic inheritance
26
Q

What forms of muscular dystrophy are only seen in males?

A

Duchenne

Becker

27
Q

What diagnostic studies are performed to diagnose muscular dystrophy?

A

muscle serum enzymes (CK)
EMG
muscle fiber biopsy

28
Q

What are the goals of treatment for those with muscular dystrophy?

A 
muscle biopsy confirms diagnosis 
no definitive therapy available to stop progressive wasting 
preserve mobility 
PT, orthopedic appliances 
ROM exercises 
emotional care for patient and family 
assist them to be independent
29
Q

How do you help with management of muscular dystrophy?

A 
Corticosteroid therapy
Preserve mobility and independence through 
  exercise 
  physical mobility 
  physical therapy 
  orthopedic appliances 
Teach family 
  communication 
  ROM 
  nutrition 
  signs and symptoms of disease progression 
When an acute infection occurs, you may need to help with ADLS
need more protein in diet
30
Q

What are bone tumors?

A

cancerous cells travel from primary tumor site: breast, prostate, lungs, kidneys, thyroid
lesions typically found: vertebrae, pelvis, femur, humerus, ribs
can occur at any time
any bone pain and history of cancer should be evaluated for bone mets
primary tumors are rare in adults
usually metastatic from another area
the name of the cancer is based on the area of the bone and surrounding area
primary bone cancer is called sarcoma

31
Q

What are the types of bone cancer?

A

osteosarcoma, chrondrosarcoma, ewings, sarcoma and chordma

32
Q

What is osteochondroma?

A

primary benign tumor. grows near cartilage and bone near the end of the bone or growth plate
clinical manifestation: painless, hard, immobile mass, lower than normal height for age, soreness of muscles near the mass
diagnostic: x-ray, CT, MRI, biopsy

33
Q

What is osteosarcoma?

A

aggressive and rapidly metastasizes
usually long bones
affects children and young adults
clinical manifestations: gradual onset of pain and swelling
diagnostic: tissue biopsy, elevation of serum alkaline phosphatase and calcium levels
treatment: chemo, radiation and surgery

34
Q

What is the nursing management for bone cancer?

A 
nursing assessment 
nursing diagnosis 
planning 
nursing implementation 
  health promotion
  acute intervention
evaluation
35
Q

Why is is back pain common in the lumbar region?

A

bears most of body weight
is most flexible region of the spinal column
contains nerve roots that are susceptible to injury
poor biomedical structure

36
Q

What are risk factors for back pain?

A 
lack of muscle tone 
excess body weight 
poor posture 
stress 
repetitive lifting 
degenerative disc disease
37
Q

What causes lower back pain?

A 
acute lumbosacral strain
instability of lumbosacral bony mechanism 
osteoarthritis of lumbosacral vertebrae 
degenerative disk disease 
herniation of 
  intervertebral disease
38
Q

how long does acute low back pain last and how do you treat it?

A 
last 4 weeks or less-caused by undue stress to back
Treatment 
  rest
  analgesics-NSAIDS, narcotics 
  muscle relaxants: flexaril 
  massage 
  heat/cold
39
Q

What is chronic low back pain and what causes it?

A 
lasts more than 3 months 
repeated incapacitating episode 
causes
  degenerative disc disease 
  lack of exercise 
  obesity 
  previous injury 
  structural/postural 
  abnormalities
40
Q

Whar are goals for patient with lower back pain

A

pain relief
avoid constipation
learn back sparing practices
return to prior level of function

41
Q

What is spinal stenosis?

A

narrowing of vertebra canal/nerve root canals
congenital
traumatic
degenerative
pain in back radiates to buttock and leg, increases with walking/standing A condition that primarily afflicts elderly patients,spinal stenosisis caused by degenerative changes that result in enlargement of the facet joints. The enlarged joints then place pressure on the nerves, and this pressure may be effectively relieved with the laminectomy.

42
Q

What is degenerative disc disease?

A

intervertebral disc lose: elasticity, flexibility, and shock absorbing capabilities
compression of nerve root and cord may occur
normal part of aging process
thinning of disc
most people have some thinning by age 60
DDD contributes to osteoarthritis and formation of bone spurs

43
Q

What is a herniated intervertebral disc?

A

slipped disc
result of natural degeneration with age or repeated stress or trauma to spine
the nucleus pulpous can bulge and the herniate, putting pressure on nearby nerves

44
Q

What are the clinical manifestation of lumbar disc damage?

A 
low back pain
radicular pain 
positive straight leg test
diagnostic testing 
  x-rays 
  myelogram
  CT or MRI
45
Q

What is a myelogram?

A 
specialized x-ray 
lumbar puncture below L3 and injection of contrast agent into subarachnoid space 
can show
  bony overgrowth 
  spinal cord tumors 
  spinal abscesses 
  HNP or pinched nerve
46
Q

How do you manage disc damage?

A 
Conservative treatment first 
  limitation of mobility 
  heat or ice
  rest
  ultrasound or massage 
  traction 
  TENS 
  NSAIDS/muscle relaxants/narcotics
47
Q

When do you surgically manage disc disease?

A

when patients do not respond to conservative treatment
persistant pain
neurologic deficits
laminectomy is most common procedure
diskectomy or spinal fusion may also be performed
get them walking as soon as you can
make sure they are being turned in bed to keep them comfortable

48
Q

How do manage care for someone after spinal surgery?

A 
maintain alignment 
pain control
hydration
assess peripheral nerve function
assess bowel and bladder function 
assess donor site if patient had spinal fusion
49
Q

In the nursing care for a patient with spinal surgery whow do you manage their activity and pain

A 
respiratory status 
proper alignment of back at all times 
know specific activity orders 
logroll 
activity is usually less
TED's/ sequential stockings 
narcotics-assess respiratory status 
muscle relaxants 
constipation
50
Q

What nursing care do you provide for a patient who had spinal surgery?

A

Assess area for redness/drainage infection
did patient have a bone graft - know where donor site is
watch the spinal canal entrance which could lead to spinal fluid leak
neurological signs such as weakness, paresthesias
bladder or bowel issues

51
Q

What is osteoporosis?

A 
metabolic disease 
 low bone mass
 deterioration of bone tissue 
 leads to bones being much more fragile 
 referred to as the "silent thief"
52
Q

What are risk factors for osteoporosis?

A 
alcohol use 
corticosteroid use 
calcium low 
estrogen low 
smoking 
sedentary lifestyle
53
Q

What is the etiology/genetic risk for osteoporosis?

A 
age >65 
post menopausal 
female 
body build-thin, lean, white, asian 
exercise-too much, not enough
diet low in calcium/vitamin D deficiency 
ETOH/smoking
54
Q

What does the assessment entail for osteoporosis?

A 
inspect vertebral column 
dowager's hump-kyphosis
back pain 
compression fractures 
normal x-rays: osteoporosis is no noted until more than 25-40% of calcium in bone is lost 
Bone mineral density (DEXA)
55
Q

What nursing interventions do you apply to osteoporosis?

A

nutrition - calcium and vitamin D supplements
exercise - moderation
safety - prevention of falls
patient and family education
drug treatment
assess for DME needs
Medication
Hormone replacement-estrogen prevention strategy
parathyroid hormone-calcitonin in synthetic forms
bisphosphonates-inhibit bone resorption-increase total bone mass - Fosamax, Boniva

Adult Health 2 Test 4 (5 decks)

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