Musculoskeletal System

Question 1

156 - Osteoporosis:
+ What is it?
+ Risk factors, S/S, Diagnosis, Medications, Patient teaching

Answer 1

MUSCULOSKELETAL SYSTEM

OSTEOPOROSIS: Rate of bone resorption exceeds rate of bone formation, resulting in low bone density and fragile bones. Osteopenia is a precursor to osteoporosis.

RISK FACTORS: Female gender, thin/lean body, menopause, insufficient calcium or vitamin D intake, smoking, alcohol abuse, excess caffeine intake, lack of physical activity, hyperparathyroidism, long-term steroid use, long-term anticonvulsant medications use.

S/S: Back pain, fractures, kyphosis, reduced height.

DIAGNOSIS: Dual x-ray absorptiometry (DXA),

MEDS: Calcitonin, estrogen (increased risk of breast cancer and CVT), raloxifene, alendronate (remain upright for 30 minutes after taking).

TEACHING: Get sufficient calcium and vitamin D, moderate sun exposure using sunscreen, WEIGHT BEARING EXERCISES, home safety measures to prevent falls.

Question 2

163 - Immobilization devices: Pin site care

Fracture complications: Compartment syndrome, what is it, symptoms, treatment

Answer 2

PIN SITE CARE, COMPARTMENT SYNDROME

PIN SITE CARE:
+ Monitor for signs of infection; increased drainage, erythema, LOOSENING OF PINS, SKIN TENTING AT PIN SITE.
+ Clean pins using a NEW cotton tip swab for each pin
+ Do not remove crusting at pin site!

COMPARTMENT SYNDROME: Increased pressure within muscle compartment of an extremity that impairs circulation.
+ SYMPTOMS: Intense pain w/passive movement, paresthesia (early sign!), paralysis (late sign!), pallor, pulselessness (late sign!), hard/swollen muscles.
+ TREATMENT: Fasciotomy

Question 3

164 - Fracture Complications
+ Fat embolism: what is it, symptoms
+ Osteomyelitis: what is it, symptoms, treatment

Answer 3

FRACTURE COMPLICATIONS

FAT EMBOLISM: Fat globule from bone marrow travels to lungs, impairing respirations. Long bone and hip fractures are most common.
+ SYMPTOMS: Dyspnea, confusion (early sign), tachypnea, tachycardia, petechiae on upper body (late sign!)

OSTEOMYELITIS: Bone infection
+ SYMPTOMS: bone pain, erythema, edema, fever, elevated WBC
+ TREATMENT: Long-term antibiotic therapy, surgical debridement of bone, hyperbaric oxygen therapy

Question 4

165 - Osteoarthritis:
+ What is it?
+ Risk factors, Symptoms, Patient care/teaching

Answer 4

OSTEOARTHRITIS

OSTEOARTHRITIS: progressive degeneration of articular cartilage in joints.

RISK FACTORS: Older age, women, obesity, smoking, repetitive stress on joints.

SYMPTOMS: Joint pain/stiffness, crepitus, enlarged joints, Herberden’s nodes (distal interphalangeal joints), Bouchard’s noes (proximal interphalangeal joints).

PATIENT CARE/TEACHING:
+ Apply ice (acute inflammation) or heat.
+ Splinting and/or use of assistive devices.
+ Physical Therapy.
+ TENS (transcutaneous electrical nerve stimulation).

Question 5

166 - Osteoarthritis:

+ Medications, Surgery

Answer 5

OSTEOARTHRITIS

MEDS:
+ Oral analgesics (acetaminophen, NSAIDs)
+ Topical analgesics (capsaicin): Wear gloves when applying, do not apply on areas with broken skin, burning sensation is normal.
+ Glucosamine: increases synovial fluid production and helps rebuild cartilage.
+ Injections: glucocorticoids, hyaluronic acid

SURGERY: Total joint arthroplasty

Question 6

167 - Osteoarthritis vs. Rheumatoid Arthritis: Key differences

Answer 6

OSTEOARTHRITIS VS. RHEUMATOID ARTHRITIS

OSTEOARTHRITIS:
+ Degenerative disease process
+ Pain with activity, gets better with rest
+ Affects specific joints, not symmetrical
+ Herberden’s and Bouchard’s nodes
+ Negative rheumatoid factor

RHEUMATOID ARTHRITIS:
\+ Inflammatory disease process
\+ Pain after rest/immobility, gets better with movement
\+ Affects ALL joints, symmetrical
\+ San neck and boutonniere deformities
\+ Positive rheumatoid factor