Musculoskeletal management

Question 1

What is osteomyelitis?

Answer 1

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

Question 2

What are the ways that you can get osteomyelitis?

Answer 2

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

Question 3

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

Answer 3

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

Question 4

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

Answer 4

Indwelling prosthetic device

Question 5

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

Answer 5

abscessed tooth, gingival disease

Question 6

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

Answer 6

urinary tract infection

Question 7

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

Answer 7

tuberculosis

Question 8

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

Answer 8

gonorrhea

Question 9

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

Answer 9

puncture wounds, intravenous drugs

Question 10

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

Answer 10

sickle cell disease

Question 11

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

Answer 11

immunocompromised host

Question 12

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

Answer 12

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

Question 13

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

Answer 13

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

Question 14

What diagnostic studies are done to diagnose osteomyelitis?

Answer 14

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

Question 15

How do you non-surgically manage chronic osteomyelitis?

Answer 15

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

Question 16

How do you surgically manage osteomyelitis?

Answer 16

Debridement 
Bone grafts 
Muscle flaps 
Amputation 
Pain management

Question 17

What nursing management is done for osteomyelitis?

Answer 17

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

Question 18

What health information so you need to collect regarding osteomyelitis?

Answer 18

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

Question 19

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

Answer 19

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

Question 20

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

Answer 20

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

Question 21

What are some nursing diagnosis for osteomyelitis?

Answer 21

acute pain
ineffective self-health management
impaired physical mobility

Question 22

What are the overall goals for someone with osteomyelitis?

Answer 22

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

Question 23

What health promotions would you want for someone with osteomyelitis?

Answer 23

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

Question 24

What are some acute interventions for osteomyelitis?

Answer 24

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.

Question 25

What is muscular dystrophy?

Answer 25

``` 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 ```

Question 26

What forms of muscular dystrophy are only seen in males?

Answer 26

Duchenne | Becker

Question 27

What diagnostic studies are performed to diagnose muscular dystrophy?

Answer 27

muscle serum enzymes (CK) EMG muscle fiber biopsy

Question 28

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

Answer 28

``` 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 ```

Question 29

How do you help with management of muscular dystrophy?

Answer 29

``` 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 ```

Question 30

What are bone tumors?

Answer 30

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

Question 31

What are the types of bone cancer?

Answer 31

osteosarcoma, chrondrosarcoma, ewings, sarcoma and chordma

Question 32

What is osteochondroma?

Answer 32

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

Question 33

What is osteosarcoma?

Answer 33

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

Question 34

What is the nursing management for bone cancer?

Answer 34

``` nursing assessment nursing diagnosis planning nursing implementation health promotion acute intervention evaluation ```

Question 35

Why is is back pain common in the lumbar region?

Answer 35

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

Question 36

What are risk factors for back pain?

Answer 36

``` lack of muscle tone excess body weight poor posture stress repetitive lifting degenerative disc disease ```

Question 37

What causes lower back pain?

Answer 37

``` acute lumbosacral strain instability of lumbosacral bony mechanism osteoarthritis of lumbosacral vertebrae degenerative disk disease herniation of intervertebral disease ```

Question 38

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

Answer 38

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

Question 39

What is chronic low back pain and what causes it?

Answer 39

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

Question 40

Whar are goals for patient with lower back pain

Answer 40

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

Question 41

What is spinal stenosis?

Answer 41

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 stenosis is 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.

Question 42

What is degenerative disc disease?

Answer 42

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

Question 43

What is a herniated intervertebral disc?

Answer 43

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

Question 44

What are the clinical manifestation of lumbar disc damage?

Answer 44

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

Question 45

What is a myelogram?

Answer 45

``` 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 ```

Question 46

How do you manage disc damage?

Answer 46

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

Question 47

When do you surgically manage disc disease?

Answer 47

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

Question 48

How do manage care for someone after spinal surgery?

Answer 48

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

Question 49

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

Answer 49

``` 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 ```

Question 50

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

Answer 50

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

Question 51

What is osteoporosis?

Answer 51

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

Question 52

What are risk factors for osteoporosis?

Answer 52

``` alcohol use corticosteroid use calcium low estrogen low smoking sedentary lifestyle ```

Question 53

What is the etiology/genetic risk for osteoporosis?

Answer 53

``` 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 ```

Question 54

What does the assessment entail for osteoporosis?

Answer 54

``` 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) ```

Question 55

What nursing interventions do you apply to osteoporosis?

Answer 55

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