musculoskeletal system + BONE DISEASES

Question 1

What are the pertinent hormones of the musculoskeletal system

Answer 1

+ Growth hormone
+ parathyroid hormone
+ androgens
+ estrogens
+ glucocorticoids
+ calcitonin
+ thyroxine
+ insulin

Question 2

What are the pertinent minerals of the musculoskeletal system

Answer 2

+ Calcium
+ vitamin D
+ phosphorus

Question 3

Cells that destroy bone

Answer 3

Osteoclasts

Question 4

Cells that build bone

Answer 4

Osteoblasts

Question 5

How many bones are in the human body

Answer 5

206

Question 6

Physiological changes of aging in the bones

Answer 6

+ Gradual progressive loss of bone mass
+ vertebral collapse
+ Fragility
+ fractures / prone to fractures
+ loss of height
+ kyphosis
+ lots of flexibility
+ pain
+ osteoporosis

Question 7

Physiological changes of aging in the muscles

Answer 7

+ Fibrosis from increased collagen
+ muscle atrophy and wasting
+ tendons lose elasticity 
+ Loss of strength and flexibility
+ Weakness, fatigue, stumbling, falls
+ Diminished agility

Question 8

Physiological changes of aging in the joints

Answer 8

+ Cartilage deterioration – progressive
+ thinning intravertebral discs
+ diminished range of motion
+ pain due to nerve compression

Question 9

Three types of joints

Answer 9

1– diarthrosis: freely moving - wrists, hips
2– synarthrosis: fibrous immovable joints – skull
3– amphiarthrosis: cartilaginous, limited movement – vertebral joints and symphysis pubis

Question 10

Musculoskeletal assessment for older people

Answer 10

+ Patient history: nutrition health family
+ Skeletal system – physical assessment including assessing for issues related to osteoporosis
+ muscular system: range of motion, atrophy, symmetry, and all the other regular stuff
+ psychosocial: body image affected by pain, deformity, stress
+ current health assessment of common symptoms: pain, body alignment, inflammatory diseases, altered sensation – paresthesias (burning tingling numbness)
+ FRAX - fracture risk assessment tool, joint function (arthritic joints)
+ Assessing To see if assistive devices for movement & stability are needed

Question 11

What is Osteomyelitis 

Answer 11

Infection of the bone

Question 12

Who is at risk for osteomyelitis

Answer 12

“BACTERIA + OPPORTUNITY”
+ Older adults
+ IV drug users, dialysis patients, long-term indwelling catheter patients
+ malnourished
+ obesity
+ impaired immune system
+ chronic illness
+ stage four PI: wounds to the bone
+ long-term corticosteroid for immuno suppressant use
+30 days post surgery, 1 year post implant

Question 13

Diagnostic tests for osteomyelitis

Answer 13

+ WBC
+ ESR
+ CBC
+ C-reactive protein
+ bone culture
+ bone biopsy
+ x/MRI

Question 14

What bacteria usually causes osteomyelitis

Answer 14

+ Staphylococcus aureus / MRSA
+ Also caused by enterococci, streptococci, pseudomonas

Question 15

What is the medical treatment for osteomyelitis

Answer 15

+ Heavy antibiotics for long periods of time
+ remove catheters as soon as possible
+ aseptic wound care
+ project management of soft tissue infections
+ bone debridement

Question 16

What is osteoporosis, Who is at risk

Answer 16

+ Rate of bone resorption by osteoclasts is greater than rate of bone formation by osteoblasts - resulting in diminished bone mass - mainly in older people

+ Small Caucasian women are highest at risk
+ men over 60
+ smoking/drinking
+ poor diet – lacking vitamin D and calcium
+ post menopause
+ low BMI
+ Sedentary lifestyle, and activity

Question 17

What areas of the body are affected by osteoporosis

Answer 17

+ spine
+ hips
+ wrists

Question 18

Nursing interventions for someone at risk for osteoporosis

Answer 18

+ Encourage walking three times per week, weight-bearing exercises
+ good body mechanics and posture
+ lots of sunshine

Question 19

What medication is taken for osteoporosis? What is core drug knowledge for the drug?

Answer 19

+ Fosamax / alendronate
+ Bone resorption inhibitor, biphosphonate
+ Treatment and prevention of postmenopausal osteoporosis, treatment of osteoporosis in men
+ Adverse reactions:
- MAJOR GI AFFECTS, a fib, erythema, blurred vision, abdominal distention/pain, constipation and diarrhea, dyspepsia, esophagitis, gastritis, nausea/vomiting
- Musculoskeletal pain, headache, asthma exacerbation


Question 20

What tests are performed to diagnose osteoporosis

Answer 20

+ DEXA– Dual energy x-ray absorptiometry
+ BMD – bone mineral density test
+ FRAX - fracture risk assessment tool
+ X-rays

Question 21

What is most important to teach patience about Fosamax medication

Answer 21

+ Can burn a hole in esophagus
+ must be taken with full glass of water and no food
+ patient must NOT lie down for 30 minutes after taking!!!!

Question 22

What is osteomalacia

Answer 22

Inadequate mineralization of bone due to deficiency of vitamin D
+ RICKETS (children) - bowed legs

Question 23

What is important to assess when diagnosing osteomalacia

Answer 23

+ Family history
+ vitamin D and calcium deficiency

Question 24

Risk factors for osteomalacia

Answer 24

+ Decreased vitamin D from poor nutrition and lack of sun exposure
+ decreased calcium from lactose intolerance and malnutrition
+ renal insufficiency
+ skeletal calcium drained from bone cyst and fibrosis
+ hyperthyroidism

Question 25

What part of the body is mainly affected by osteomalacia

Answer 25

Leg bones, weight bearing bones

Question 26

How do you diagnose osteomalacia

Answer 26

+ X-ray
+ serum calcium, phosphate, elevated ALP, creatinine, excretion of calcium
+ bone biopsy

Question 27

Signs and symptoms of osteomalacia

Answer 27

+ Bone pain
+ muscle weakness
+ bowed legs
+ skewed gait

Question 28

How do you treat Osteomalacia

Answer 28

+ Find causative issue: kidney disease, supplementation, exposure to light, dietary
+ braces, surgery

Question 29

Who is at risk for osteomalacia

Answer 29

+ Elderly
+ homebound
+ poor
+ malnourished