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Nursing 2 Exam 4 > Unit 17 Musculoskeletal Abnormalities > Flashcards

Unit 17 Musculoskeletal Abnormalities Flashcards

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1
Q

What are factors contributing to Carpal Tunnel Syndrome?

A
  • Entrapment movement
  • Repetitive movement
  • Exposure to extreme cold
  • Arthritis
  • Hypothyroidism
  • Pregnancy
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2
Q

What are the defining characteristics of CTS?

A 
Burning
Tingling
Pain
Numbness 
Weakness along median nerve
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3
Q

How is CTS Dx?

A

-Tinel’s sign

tapping on the wrist; the tingling pins feeling is a positive sign

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4
Q

What are the treatments/Interventions for CTS?

A
  • Focused on cause
  • Wrist splints
  • Ergonomic changes (How you use your body to do things)
  • Avoidance of repetitive motions
  • NSAIDs (for anti-inflammation and pain)
  • Cortisone injection (for severe pain and inflammation)
  • Yoga
  • Acupuncture
  • Surgery
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5
Q

What can we teach the PT regarding CTS?

A
  • Hand splint but never for 24hrs a day
  • Limit hand movement
  • ADL assistance
  • Recovery could take weeks to months
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6
Q

What is Osteoporosis?

A

A medical condition in which the bones become brittle and fragile typically as a result of hormonal changes, or deficiency of calcium or vitamin D.

Osteoblasts (new bone formation) decreases
Osteoclasts (old bone dissolved and reabsorbed) increases

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7
Q

What are risk factors for osteoporosis?

A
  • Postmenopause
  • Low testosterone in men
  • Low calcium & vitamin D intake
  • Small frame body
  • Lack of exercise
  • Caffeine, alcohol, smoking
  • Lack of sunlight exposure
  • Excess corticosteroids or other comorbidities
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8
Q

What are the Diagnostics for Osteoporosis and what is the Gold Standard with values?

A 
>DEXA Scan (Dual energy X-Ray Absorpitiometery)
*Gold standard for Dx*
-1 and above = Bone density normal
Between -1 and -2.5 = Osteopenia 
-2.5 and below = Osteoporosis

> Bone mineral density studies (BMD)
Labs (Ca, Phos, etc.)
X-Ray
QUS scan (Quantitate Ultrasound)

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9
Q

What are the classes of pharmacological interventions for Osteoporosis?

A

Bisphosphonates

SERMS (Selective Estrogen Receptor Modulator)

Calcitonin: Nasal

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10
Q

Name and describe Bisphosphonates.

A
  • alendronate
  • risedronate
  • ibandronate

Work to decrease osteoclast activity

Top choice

SE: GI ulcers, jaw necrosis, GERD

Taken on an empty stomach first thing in the morning
Sit up 90 degrees for at least 30-60 minutes, NO Laying down

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11
Q

What is the goal of Osteoporosis pharmacological intervention?

A

Stop the progression and prevent complications

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12
Q

Name and describe SERMS.

A

-raloxifene

Increases osteoblasts, Decreases osteoclasts

SE: increased risk of thromboembolism, allergic reactions, chest tightness

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13
Q

Describe Nasal Calcitonin.

A

Decrease osteoclasts, increase osteoblasts

SE: Nasal irritation, flushing, GI, urinary frequency

  • alternate nares
  • taken once a day
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14
Q

What are non-pharmacological interventions for Osteoporosis?

A
  • Increase dietary calcium food intake
  • Vitamin D-enriched milk, orange juice, streamed broccoli, canned salmon,

-Vitamin D supplementation (cholecalciferol)
800-1000 IU daily

-calcium supplementation
*take with meals and orange juice
*split the dose
PT’s with renal calculi-decrease dose, drink lots of fluids
SE: abdominal distention, bloating, renal calculi

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15
Q

Name foods high in calcium.

A
  • Milk
  • Yogurt
  • Green leafy vegetables
  • Sardines
  • Almonds
  • Tofu
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16
Q

What are PT teaching points for Osteoporosis?

A
  • Weight bearing exercise (walking, hiking, jogging, climbing stairs) *3-5 days 30 min
  • Sunshine
  • Antacids
  • Prevention of constipation (increase fiber diet)
  • Prevent falls/Home safety
  • Decrease modifiable risk factors: smoking, decrease carbonated sodas
17
Q

What is a Total Hip Replacement and when is it usually done?

A

Surgical replacement of the hip joint with artificial prosthesis

Done usually for joint disease, deformity, fracture, OA

18
Q

What is the pre-op care for THR?

A
  • Preoperative care prioritizes PT education about positioning and assessment for infection
  • Donation of autologous blood
  • Neurovascular assessment of affected limb
  • Post-op education: adduction
19
Q

What is the post-op care for THR?

A
  • Positioning to prevent dislocation and [promote abduction]
  • EARLY ambulation: PT assistive device
  • Monitoring for complications (hemorrhage)
  • Monitoring wound drainage
  • DVT and infection prophylaxis
  • Orthopat/cell saver infusion
  • Maintain HOB below 60 degrees
  • Raised toilet seat and chairs
  • Assessment for dislocation
  • Pain management
  • 3-6months
20
Q

What PT’s usually are candidates for Total Knee Replacement?

A

PT’s with severe pain and functional disabilities related to destruction of joint surfaces

Chronic bone disease, hemophilia, injury

Prosthesis

21
Q

What is the post-op care for a total knee replacement?

A
  • Compression bandage
  • Wound drain
  • Continuous passive motion device
  • Early ambulation within 24 hrs
  • Pain management
  • Knee immobilizer when OOB
  • Weight bearing limitations
  • DVT/VTE prophylaxis
22
Q

Describe acute back pain.

A
  • Caused by a variety of musculoskeletal problems

- May be a result of involvement by muscles and/or intervertebral disks

23
Q

What are the defining characteristics of acute back pain?

A

-Acute: lasting < 3 months
-Focused H and P
-Sciatic pain or radiculopathy
-What can be affected:
Gait
Reflexes
Leg length
Leg motor strength
Sensory perception
-Paravertebral muscle spasms

24
Q

What is the goal of treatment for back pain?

A

Pain relief, return of mobility

25
Q

What are interventions for acute back pain?

A 
Rest, relaxation, and stress reduction 
Pain management
Heat or ice therapy
Physical therapy 
TENS (electrical stimulation)
26
Q

Name and define the Surgical intervention for back pain.

A

Laminectomy: excision of the lamina and spinous process of a vertebra

fusion of fixation

27
Q

What do you want to do preoperatively for a PT before a Laminectomy Surgical intervention?

A
  • Evaluation of extremity movement, strength, and pain BEFORE Sx to compare with after Sx.
  • Assessment of bowel and bladder
  • Teaching - log rolling post-op
28
Q

What is the goal of treatment for a Laminectomy?

A

relieve pain, slow disease progression, and increase the patient’s functional ability

29
Q

What are Laminectomy interventions?

A

Manage pain and spasms
Log roll
Pillows under head and knees
OOB in 1 smooth motion

Assessment:
CSF leak, Urinary retention, Hemorrhage,
Strength and sensatio

30
Q

What is Osteomyelitis?

A

*Infection of the bone

Extension of soft tissue infection

Direct bone contamination

Hematogenous spread

May become chronic

31
Q

What are risk factors for Osteomyelitis?

A
  • Poor nutrition
  • Elderly
  • Obesity
  • Diabetics**
  • Impaired immune system
  • Chronic illness
  • Long term steroid use
32
Q

What are the defining characteristics of Osteomyelitis?

A
  • Sudden
  • Signs and symptoms of SEPSIS
  • Localized pain
  • Swelling around bone
  • Erythema
  • Fever, night sweats, chills
  • Purulent drainage
  • Labs: Leukocytosis, elevated ESR, anemia
  • Pain- constant, pulsating, and increases with movement
33
Q

What are diagnostics for Osteomyelitis?

A 
X-ray findings
Radioisotope bone scans
MRI
Wound culture
Blood culture
34
Q

What is the goal of Osteomyelitis intervention?

A

Stop the infectious process, prevent complications

35
Q

What are the Osteomyelitis interventions?

A
  • IV antibiotic therapy (proper PICC care for PT going home)
  • Avoid excessive manipulation
  • Sterile dressing changes
  • Good body alignment
  • Activity limitations
  • Pain management
  • ROM exercises to prevent contractures
36
Q

What are PT teaching points for Osteomyelitis?

A 
Antibiotic therapy
Report signs and symptoms of worsening infection
Fall prevention
Aseptic wound care
Physical mobility 
Pain management
Use of ambulatory aids
37
Q

In what percentage range of demineralization will osteoporosis show up on an X-ray?

A

25-40%

Nursing 2 Exam 4 (5 decks)

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