musculoskeletal MS disorders

Question 1

osteoporosis

Answer 1

Characterized by reduced bone mass- > decreased bone strength.
Consequence: bone fracture

Question 2

osteoporosis prevention

Answer 2

1. Primary osteoporosis
2. Low Vit. D level
3. To prevent: consume adequate calcium (1,000 – 1,300 mg/day) and Vitamin D
4. Engage in weight-bearing exercises
5. Lifestyle modification: avoid smoking, alcohol, caffeine, carbonated beverages
6. Secondary Osteoporosis- due to medications or diseases that affect bone metabolism.

Question 3

primary osteoporosis

Answer 3

occurs among women after menopause and men later in life.
Women- decrease in estrogen
Men- decrease in testosterone

Question 4

secondary osteoporosis

Answer 4

due to medications or diseases that affect bone metabolism

• Use of corticosteroids, excessive alcohol intake
• Specific disease: celiac disease; hypogonadism
• Certain medications: anticonvulsants, thyroid replacements, anti-estrogen, androgen inhibitors, PPI.

Question 5

osteoporosis management

Answer 5

Diet rich in calcium and Vit D
Regular weight-bearing exercises (20-30 min)
Hormone replacement therapy after menopause

Question 6

management of osteoporosis pharm

Answer 6

Calcium supplement with Vit. D tablet- take with Vit C/high vit. C drink

Osteoporosis Medications: (page 1207, Table 53.5) look in book for administration/special considerations

Question 7

vitamin k2

Answer 7

new supplement –> absorption of calcium into bone (from blood to bone)

Question 8

fracture management

Answer 8

fracture of hip- managed by joint replacement ; or close or open reduction with internal fixation
Compression fracture- treat conservatively

Question 9

dx for osteoporosis

Answer 9

1. Xray- can reveal low bone density and fracture
2. DXA (dual x-ray absorptiometry)
3. QCT (quantitative computed tomography)
4. Peripheral Quantitative Ultrasound

Question 10

DXA

Answer 10

Usually done in the hips or spine; used to screen early changes in bone density
health teaching: lie flat or stay x-ray table while the scan is going on, pt have to lie still/ follow instruction (ex: not good for people with dementia)

Question 11

Peripheral Quantitative Ultrasound

Answer 11

This is inexpensive, portable and low-risk method to determine osteoporosis

Question 12

gerontologic consideration

Answer 12

• Women older than 80- prevalence is 50%
• Men have higher mortality than women after sustaining hip fracture b/c - incidence of living alone in men is higher, men have less compliance
• Older adults absorb dietary calcium less efficiently and excrete more readily via kidneys.

Question 13

osteoarthritis/ degenerative joint disease

Answer 13

OA is a noninflammatory degenerative disorder of the joints.

• Usually on weight-bearing joints- hips/knees
• Can also be seen in PIP (proximal interphalangeal) joints, DIP joints

Question 14

osteoarthritis patho

Answer 14

The articular cartilage breaks down- > progressive damage to the underlying bone- > formation of osteophytes (“bone spurs”)(protrude into the joint space)- > joint space is narrowed- > decreased joint movement.

The joint can progressively degenerate!

Question 15

osteoarthritis risk factors of disease and progression

Answer 15

older age; female gender; obesity; certain occupations; engaging in sports activity; history of previous injuries; genetic predisposition.

Question 16

s/s of osteoarthritis

Answer 16

S/S: main: pain; morning stiffness; functional impairment (the onset is insidious and progressing over multiple years!), aggravated by movement and relieved by rest
- joints may be enlarged, decrease ROM

Question 17

tx for morning stiffness

Answer 17

warm bath

Question 18

management goal

Answer 18

Goal: decrease pain and stiffness; improve joint mobility

Question 19

how to manage osteoarthritis

Answer 19

Exercise- cardio, aerobic, lower extremity strength training
Weight loss
Complementary, alternative and integrative health therapies
pharmacologic therapy
surgical management: osteotomy, arthroplasty

Question 20

pharm management osteoarthritis

Answer 20

• Initial: acetaminophen (2 tabs Q 6 hrs – extra strength 500 mg)
• NSAIDs (alieve, ibuprofen, naproxen) - take w/ food
• COX-2 (cyclooxygenase- 2) enzyme blockers (use cautiously!) Celecoxib (Celebrex) common SE is stroke or heart attack so max for 5 days
• Opioid
• Intra-articular corticosteroids (steroid injection)
• Topical analgesics- like capcaisin
• Topical diclofenac sodium gel (Voltaren)- FDA-approved

Question 21

osteomyelitis

Answer 21

Infection of the bone.

Question 22

osteomyelitis classification

Answer 22

1. Hematogenous osteomyelitis- blood borne
2. Contiguous- focus osteomyelitis- contamination from bone surgery, open fracture etc.
3. Osteomyelitis with vascular insufficiency– commonly seen among patients with diabetes and PVDs.

Question 23

most common cause of osteomyelitis

Answer 23

Staphylococcus aureus (can be MRSA!)
Surgical ink markers used in surgery have been linked (cross-contamination)!

Question 24

s/s of osteomyelitis

Answer 24

1. Systemic s/s
2. Local: infected area: painful, swollen and tender
3. Pain description: constant, pulsating that intensifies with movement.
4. For chronic osteomyelitis: non-healing ulcer that overlies the infected wound - > intermittently drains pus

Question 25

dx osteomyelitis

Answer 25

x-ray - bone necrosis
radioisotope bone scan- determine area of infection
MRI
wound and blood culture- not a sensitive indicator

Question 26

management of osteomyelitis

Answer 26

drugs, surgical, supportive

Question 27

drugs osteomyelitis management

Answer 27

Note: bone is mostly avascular - > infection is harder to eradicate (no veins)
Antibiotic therapy is longer than for usual infections- 3-6 weeks (mostly IV)

Question 28

surgical management osteomyelitis

Answer 28

Intended for chronic and those that do not respond to antibiotics

Infected bone-> surgically exposed- > necrotic and purulent materials removed- > irrigated with sterile saline solution

Question 29

supportive measures for osteomyelitis

Answer 29

diet high in protein (healing), vitamins, correction of anemia, etc.

Question 30

prevention osteomyelitis

Answer 30

• elective orthopedic surgery - must be postponed if pt has current infection (simple as UTI)
• prompt tx of soft tissue infection (do not wait too long for tx)
• surgical ink (one per pt)
• tattoo sterilitiy