Week 7 Musculoskeletal System

Question 1

Musculoskeletal

Answer 1

disorders are considered a major cause of chronic pain and disability and, according to Calleja, Theobald and Harvey (2020), are the second most common reason for a person to seek healthcare in Australia, making these disorders one of the highest economic burdens of disease in our country.

Question 2

Components of the musculoskeletal (MSK) system includes

Answer 2

bones, muscles, cartilage, tendons, ligaments and joints.

Primarily, the function of the MSK system is to provide shape and support whilst facilitating motion, allowing a person to maintain and change positions in response to internal and external stimuli.

Additional functions include protection of internal organs, production of blood cells, and storage of minerals. For instance, bones facilitate mineral homeostasis, the lever function of joints enable speed and strength while muscles drive movement but also serve to maintain body temperature.

Question 3

Disorders of the MSK system

Answer 3

can result from an injury or condition that impacts the function of any MSK structure or a person’s ability to move.
MSK disorders may be acute, chronic, or acute on chronic where a patient with an underlying chronic disorder can experience an acute exacerbation.
MSK impairment may also be acquired, congenital or traumatic.

Question 4

___ of our population >50 years have a musculoskeletal disorder.

Answer 4

66% of our population >50 years have a musculoskeletal disorder

Question 5

There are over 100 different types of musculoskeletal disorders with the most common being

Answer 5

arthritis, osteoporosis, spinal disorders and trauma such as fractures.

Question 6

Passive motion

Answer 6

When someone else manually moves a person’s joint, while the person is in a relaxed state; meaning, the person does not use their muscles to manually move.

Question 7

Active motion

Answer 7

used to assess how much a person can move their own joint, without assistance

Question 8

Flexion

Answer 8

Bending the joint with muscle contraction so that the articulating bones on either side of the joint move closer together

Question 9

Extension

Answer 9

Straightening a joint so that the articulating bones on either side of the joint move further apart

Question 10

Adduction

Answer 10

Moving a part medially and towards the midline of the body

Question 11

Abduction

Answer 11

Moving a part laterally and away from the midline of the body

Question 12

Supination

Answer 12

Rotating the forearm laterally at the elbow so the palm of the hand turns laterally to face upwards

Question 13

Pronation

Answer 13

Rotating the forearm medially at the elbow so the palm of the hand turns medially to face downwards

Question 14

Oppostition

Answer 14

Moving the thumb to touch the 5th finger of the same hand

Question 15

Eversion

Answer 15

Tilting the foot (outwards) so that the sole of the foot faces outwards away from the midline of the body

Question 16

Inversion

Answer 16

Tilting the foot (inwards) so that the sole of the foot faces inwards towards the midline of the body

Question 17

Dorsiflexion

Answer 17

Flexing the ankle so that the toes are lifted towards the body

Question 18

Plantar flexion

Answer 18

Flexing the ankle so that the toes move away from the body

Question 19

Antalgic Gait

Answer 19

Limping. Shortened stride with as little weight-bearing as possible on affected side

Question 20

Ataxic Gait

Answer 20

Uncoordinated, straggering gait often with a sway

Question 21

Soft Tissue Injuries

Answer 21

Soft tissue injuries (STI) are injuries to muscles, tendons, and ligaments but not bone. They can include sprains, strains, dislocations, and subluxations and are most commonly caused by trauma. The two most common STI are sprains and strains.

Question 22

Sprain

Answer 22

Overstretching or tearing of a ligament surrounding a joint.
→ A ligament is the fibrous band that holds bones together, providing stability to the body’s joints.

Mechanism of Injury (MOI)
→ An acute injury usually caused by sudden trauma such as a fall, wrenching or twisting motion
→ inversion or eversion injury

Can become a chronic disorder with repeated overuse; when the area has not had a chance to heal between occurences, as what can occur with sports injuries.

Areas most vulnerable to sprains are knees, ankles, and wrists.

Classified by severity
Grade 1 = mild, slight stretching with some damage to the fibres of the ligament
Grade 2 = moderate, partial tearing of the ligament with abnormal laxity in the joint
Grade 3 = severe, complete tear of the ligament which results in significant joint instability.

Question 23

Strain

Answer 23

A general term used to describe local muscle or tendon damage
→ Tendons are the fibrous bands that hold muscles to bones.
→ Occurs when a muscle, it’s facial sheath and/or it’s tendon is stretched beyond its usual capacity resulting in the muscle rupturing or the tendon tearing.

An acute disorder but can become chronic when the muscle is repeatedly stretched beyond capacity

Mechanism of injury
→ Traumatic injury resulting in sudden, forced motion causing the muscle to excessively stretch or stress.

Most common in large muscles groups, including lower back, calf, and hamstrings.

Question 24

Dislocation

Answer 24

Usually caused by trauma
Temporary displacement of one or more bones in a joint
Opposing bone surfaces lose contact entirely

Question 25

Subluxation

Answer 25

Partial loss of bone surface contact Usually caused by trauma

Question 26

Dislocation & Subluxation

Answer 26

Usually caused by trauma More common in younger people as bones are stronger and have higher resistance to fractures but the force of the MOI disrupts the joint Can also occur due to congenital or acquired disorders such as muscular imbalances, arthritis, or joint instability Most common joints that are susceptible to dislocation / subluxation are shoulder, elbow, wrist, phalanges, patella

Question 27

Common Clinical Manifestations Associated with Soft Tissue Injuries

Answer 27

Pain → Soft tissue injuries are quite painful. This pain is caused by the presence of inflammatory mediators, ligament / tendon cramping from changes in contour and muscle contractions. → Can be acute or chronic, mild, moderate or severe and worse with range of motion (ROM), weight-bearing activities, or when the injury is dependent. → Pain associated with soft tissue injuries is usually localised to the injury site. → Pain can be described as sharp, spasmodic, cramping, a deep ache, throbbing or tenderness. → Usually increases significantly when the injury is directly palpated Contusions → Also referred to as ecchymosis, a bruise, or a haematoma → Occurs when the injury crushes underlying muscle fibres and connective tissue, causing localised blood vessels to rupture. The blood pools in the extravascular space (usually subcutaneous), lysing quickly, resulting in discolouration of the skin. Discolouration can range from black, blue, purple, green and yellow. → Discolouration will usually be evident within 24-48 hours and can take approximately 2 weeks to dissipate. Localised swelling and inflammation → When MSK soft tissue is ruptured or torn, inflammatory mediators are released and fluid will accumulate locally, between the torn edges. This fluid is derived from the blood and contains inflammatory chemicals. → When healing begins, macrophages remove the damaged tissue, fibroblasts make new collagen and capillary buds grow new blood vessels. These processes grow inwards from the surrounding tissue. → Swelling is usually worse 2-4 days post injury and resolves within 1-2 weeks. Severe or chronic injuries may exhibit swelling for months when the acute inflammation transitions to chronic inflammation. Impaired range of motion (ROM) → Reduction in the normal range of motion of a joint, i.e. how far the joint can bend, rotate, or twist and the direction in which the joint performs these actions. → Can be caused by pain, swelling of the tissue surrounding the joint or muscle stiffness. Impaired weight bearing with loss of strength and function

Question 28

Fractures

Answer 28

A fracture is a traumatic injury interrupting bone continuity and usually occurs when the stress placed on a bone exceeds the bone’s ability to absorb it. Most fractures are caused by trauma, some will result from disease processes. The latter are referred to as pathological fractures. You will see fractures abbreviated to a hash (#) on medical records.

Question 29

Fractures can be described and classified in relation to:

Answer 29

Type Open or closed → in relation to the external environment Location of the bone involved → proximal, distal, mid-, inter- Degree of stability → stable, unstable, displaced, non-displaced

Question 30

Fracture TYPES

Answer 30

Closed simple, uncomplicated fractures Open compound, complicated fractures Incomplete fractures Complete fractures Comminuted fractures Greenstick fractures Spiral (torsion) fractures Transverse fractures Oblique fractures

Question 31

Closed simple, uncomplicated fractures

Answer 31

→do not cause a break in the skin.

Question 32

Open compound, complicated fractures

Answer 32

→ involve trauma to surrounding tissue and break in the skin

Question 33

Incomplete fractures

Answer 33

→ are partial cross-sectional breaks with incomplete bone disruption.

Question 34

Complete fractures

Answer 34

→ are complete cross-sectional breaks severing the periosteum.

Question 35

Comminuted fractures

Answer 35

→ produce several breaks of the bone, producing splinters and fragments.

Question 36

Greenstick fractures

Answer 36

→ break one side of a bone and bend the other.

Question 37

Spiral (torsion) fractures

Answer 37

→ involve a fracture twisting around the shaft of the bone.

Question 38

Transverse fractures

Answer 38

→ occur straight across the bone.

Question 39

Oblique fractures

Answer 39

→ occur at an angle across the bone (less than a transverse)

Question 40

Fracture Risk Factors

Answer 40

From crushing force or direct blow Sudden twisting motion → risk increases with osteoporosis Extreme muscle contractions Pathological fractures → a weakness in bone tissue → which may be caused by disease processes such as neoplasm or a malignant growth, liver disease Advancing age History of age-related fractures in a first-degree relative Excessive alcohol consumption Weight extremes Medications → steroid therapy, chemotherapy, proton pump inhibitors Smoking Being a female → increased risk of osteoporosis, different bone structures, decreased bone density with advancing age

Question 41

Stages of normal fracture healing include:

Answer 41

Inflammation Cellular proliferation Callus formation Callus ossification Mature one remodelling

Question 42

Clinical Manifestations The clinical manifestations associated with a fracture will occur immediately at the time of the injury.

Answer 42

Pain → increased pressure on nerves with involuntary reflex action of surrounding muscles → will be localised to site of fracture → when assessing a fracture, the site of maximum pain coincides with the location of the fracture Oedema → penetration of bone through soft tissue bleeding into tissues Tenderness Guarding → an individual will guard, or self-splint their injured body part to protect from further injury, movement, and pain Abnormal movement and crepitus → grating or crunching of bony fragments Loss of function Inability to weight bear or use the affected part → either grasping an object or tolerating body weight with steps Ecchymoses → extravasation of blood into subcutaneous tissue Deformity → common with displaced / unstable fractures → not obvious with stable, non-displaced fractures Paraesthesias and other sensory abnormalities Muscle spasms → irritation of surrounding tissues and protective response → can further displace fractures

Question 43

Diagnosis Radiographs and other imaging studies can be used to identify the site and type of fracture, plus any complications inluding soft tissue concomitant injuries.

Answer 43

Tools have been developed to guide radiography decisions. For example: Ottawa Ankle Rules Ottawa Knee Rules Imaging Options: X-ray → standard diagnosing tool for bone structure and continuity assessment CT scan → computed tomography → if a fracture is suspected but not obvious on an x-ray then a CT scan may be ordered to rule out or confirm a fracture MRI → magnetic resonance imaging → shows hydrogen density of tissues to construct images of soft tissue and bone

Question 44

Ottawa Ankle Rules

Answer 44

Whilst diagnosing a fractured ankle is outside of your scope of practice, you can apply the Ottawa Ankle Rules to guide ankle injury radiography and subsequent nursing care considerations. This is especially relevant for rural and remote nursing care where a senior nurse with accreditation can initiate simple x-rays. If working in an acute setting, Ottawa ankle rules can be used to initiate earlier intervention after discussion with the treating doctor.

Question 45

Ottawa Knee Rules

Answer 45

As per the Ottawa Ankle Rules, the Ottawa Knee Rules can be applied to determine if your patient requires medical imaging. Remember, you cannot order imaging, but you can utilise the Ottawa Knee Rules to initiate care through discussion with the treating team.

Question 46

Medical Management Fracture

Answer 46

The principles of fracture treatment include anatomical realignment of bone fragments through reduction, immobilisation to maintain realignment and regaining of normal function and strength through rehabilitation. Reduction Immobilisation Function → Maintained and restored by controlling swelling with elevation of the injured extremity and applying ice as prescribed. Symptom management → Restlessness, anxiety, and discomfort are controlled using a variety of approaches → reassurance, position changes, analgesics, and anti-inflammatories Rehabilitation → Isometric and muscle-setting exercises are done to minimise disuse atrophy and to promote circulation. → With internal fixation, the surgeon determines the amount of movement and weight-bearing stress the extremity can withstand and prescribed the level of activity.

Question 47

Reduction

Answer 47

A displaced fracture can be reduced using a non-surgical, closed method of manipulation and manual traction with counter-traction. This method is distressing and very painful so the patient will require a form of anaesthesia → procedural sedation, Bier block, local anaesthetic, general anaesthesia. Some fractures will require an open method of reduction which involves surgical placement of internal fixation devices like pins, wires, screws, plates and nails. This is abbreviated to an ORIF (open reduction and internal fixation). Both methods of reduction are designed to restore the fracture fragments to anatomic alignment and rotation. The specific method depends on the nature of the fracture. Traction is the application of a pulling force to an injured extremity to realign a fractured bone or dislocation. Some fractures are managed with skin traction, others require skeletal traction with the surgical insertion of internal nailing with an external splinting frame.

Question 48

Immobilisation

Answer 48

After the fracture has been reduced, immobilisation holds the bone in correct position and alignment until union occurs. Immobilisation is accomplished by external or internal fixation → casting, pins, plates Casting → a temporary immobilisation device → can be a back slab or circumferential casting → casting often needs to incorporate joints above and below the fracture with the extremity aligned in a neutral position → materials include Plaster of Paris (POP), synthetic material or fibreglass → each have their own pros and cons which are important to note when educating your patient

Question 49

Nursing Management of Acute Musculoskeletal Injuries

Answer 49

Nursing care of acute MSK injuries varies depending on location, severity, type, concomitent injuries and patient lifestyle/demographics. The aim is to reduce symptoms such as pain, muscle spasms, muscle atrophy, contracture, footdrop, and loss of function. Assessments of the musculoskeletal system commence with a comprehensive patient history to obtain subjective data and is followed by a focused physical assessment to collect objective data.

Question 50

Nursing Management of Acute Musculoskeletal Injuries Considerations

Answer 50

Linked body systems How other body systems influence the musculoskeletal system Assessment tools can be used to assist with assessing the MSK system, e.g., falls risk assessment, pressure injury risk, pain assessment

Question 51

There is a systemic approach to a musculoskeletal assessment which involves:

Answer 51

Inspection → look → asymmetry of joints, swelling, deformity, erythema, lesions, rashes, open wounds, ecchymosis, cyanosis Palpation → feel → soft tissue swelling, bony nodules, tenderness, crepitus, joint warmth, pain, fracture → temper your palpation according to the degree of pain being experienced → severe pain = only light palpation required Movement → active then passive movement of the limb / joint → always perform painful movements last → consider gait, ability to weight-bear, movement of arms, transferring Strength → asymmetrical, loss, normal Measurements → swelling, oedema

Question 52

Neurovascular compromise can occur with a MSK injury, including swelling, and oedema, and with interventions such as bandaging, casting, anaesthesia, poor positioning, or dressings → all can result in nerve or vascular impairment distal to the injury → can then lead to permanent damage, loss of function, infection, avascular necrosis or amputation

Answer 52

Neurovascular status can be determined by assessing the 6 Ps during your neurovascular assessment Pain → should be localised to site of injury → increased, diffuse pain is an indication of compartment syndrome Pallor → is the skin colour paler than usual, is there cyanosis → pale skin distal to the injury may indicate compartment syndrome. Cyanosis distal to an injury may indicate poor venous return Pulse (pulselessness) → compare affected and unaffected side for rate and quality → an absent pulse may indicate vascular dysfunction and insufficiency Paraesthesia → often described as 'pins & needles' and may include numbness or tingling → documented as altered sensation → usually first sign of neurovascular compromise from nerve damage or inadequate circulation typically associated with compartment syndrome Polar (poikilothermia) → is the skin cooler to touch when compared to the unaffected side or baseline → indication of impaired circulation → often associated with compartment syndrome Paralysis → can the affected area be moved or is it without movement / weaker than usual → partial or complete loss of sensation or function is a late stage of neurovascular damage

Question 53

Acute Interventions

Answer 53

When an acute injury occurs, nurses can implement immediate interventions with the aim of reducing pain and swelling, minimising movement, ensuring the safety of the individual and limiting further injury. Some options include: R.I.C.E → rest, ice, compression, elevation Immobilisation Compression Ice (cryotherapy) Heat Elevation Pharmacological options

Question 54

Acute Interventions R.I.C.E

Answer 54

→ rest, ice, compression, elevation → a traditional intervention designed to reduce swelling, reduce pain, prevent further injury

Question 55

Acute Interventions Immobilisation

Answer 55

→ splinting with bandaging, slings, casting material, prefabricated splint boards, braces → remember to include the immediate proximal and distal joints

Question 56

Acute Interventions Compression

Answer 56

→ elastic bandages can be applied over and around the injury → reduces inflammation and oedema by encouraging fluid return which in turn decreases pain → start distally to the injury and progress proximally ensuring that the bandage is firm but not tight which could compromise circulation and increase pain and/or numbness

Question 57

Acute Interventions Ice (cryotherapy)

Answer 57

→ acute injuries should have ice applied immediately for intermittent periods of 20-30 minutes → never heat → produces localised hypothermia → physiological changes in the soft tissue including vasoconstriction (reduces inflammation, oedema, and bruising), reduction of nerve pain transmission and impulses (reduces pain) and reduction of muscle spasms

Question 58

Acute Interventions Heat

Answer 58

→ 48 hours after the injury → the acute phase has passed → you can apply heat for intermittent periods of 20-30 minutes

Question 59

Acute Interventions Elevation

Answer 59

→ elevate an injured part above the level of the heart → reduces oedema by mobilising excess fluid away from the injury → examples include a broad arm sling, using pillows to elevate an injured ankle

Question 60

Acute Interventions Pharmacological options

Answer 60

→ combined paracetamol and ibuprofen (NSAID) is often more efficacious than opioids in reducing pain and inflammation associated with MSK injuries → both can be nurse initiated (check organisation policy first)

Question 61

Fracture Specific Nursing Care Considerations

Answer 61

An important component of nursing care for a person experiencing a fracture is comprehensive assessment and management. Bone malalignment, and compartment syndrome can place pressure on nerves and blood vessels causing temporary or permanent damage to the distal part of the limb. Initial primary assessment → DRSABCDE → treat life-threatening injuries first → control external bleeding with pressure bandaging and elevation Prevent infection → Cover any breaks in the skin with clean or sterile dressing. Provide care during client transfer. → Immobilise a fractured extremity with splint in the position of the deformity before moving the client; avoid strengthening the injured body part if a joint is involved. Immobilising a fracture is an important intervention that decreases the risk of further damage to the bones and surrounding soft tissues along with reducing risk of complication. → Support the affected body part above and below fracture site when moving the client. Provide client and family teaching. → Explain prescribed activity restrictions and necessary lifestyle modification because of impaired mobility. → Educate correct use of assistive devices, such as crutches Administer prescribed medications, which may include opioid or nonopioid analgesics and prophylactic antibiotics for an open fracture. Prevent and manage potential complications. → Observe for symptoms of life-threatening fat embolus, which may include personality change, restlessness, dyspnoea, crackles, white sputum, and petechiae over the chest and buccal membranes. Assist with respiratory support, which must be instituted early. → Observe for symptoms of compartment syndrome, which include deep, unrelenting pain; hard oedematous muscle; and decreased tissue perfusion with impaired neurovascular assessment findings. → Monitor closely for signs and symptoms of other complications. Patient education regarding different factors that affect fracture healing → Cast Care → Factors that enhance fracture healing → Factors that inhibit fracture healing

Question 62

Patient education regarding different factors that affect fracture healing

Answer 62

Cast Care → It takes 48 hours for Plaster of Paris to set → do not weight-bear during this time → Do not get wet → skin will break down under cast → Do not put foreign bodies under cast to stratch skin → skin can open → Do not remove inner padding → Adhere to medical advice → Observe for altered sensation, changes to skin colour, increased pain within first 48 hours → seek medical review if occurs → Any concerns → seek medical advice Factors that enhance fracture healing → Immobilization of fracture fragments → Maximum bone fragment contact → Sufficient blood supply → Proper nutrition → Exercise: weight bearing for long bones → Hormones: growth hormone, thyroid, calcitonin, vitamin D, anabolic steroids Factors that inhibit fracture healing → Extensive local trauma → Bone loss → Inadequate immobilization → Space or tissue between bone fragments → Infection → Local malignancy → Metabolic bone disease (Paget’s disease) → Irradiated bone (radiation necrosis) → Avascular necrosis → Intra-articular fracture (synovial fluid contains fibrolysins, which lyse the initial clot and retard clot formation) → Age (elderly persons heal more slowly) → Corticosteroids (inhibit the repair rate)

Question 63

Complications

Answer 63

Soft tissue injuries are often associated with concurrent injuries, such as a fractures, due to the stress applied to the bone, bruising, and nerve impairment. Avulsion injury Suspected dislocations / subluxations Nerve damage Chronic loss of function and weakness secondary to decreased strength and reduced range of motion Arthritis

Question 64

Avulsion injury

Answer 64

A fracture that occurs as a complication of a soft tissue injury → when a bony fragment attached to a ligament or tendon gets pulled away from main part of the bone → often treated as a severe sprain

Question 65

Suspected dislocations / subluxations Complications

Answer 65

→ should have radiological investigations prior to reduction of the joint → reducing a dislocation without an x-ray ruling out a fracture could result in further fracture complications

Question 66

Delayed complications may occur after initial treatment or in response to treatment.

Answer 66

Non-union Compartment syndrome Fat Emboli Arterial damage during treatment Infection and possibly sepsis Hemorrhage, possibly leading to shock

Question 67

Non-union

Answer 67

Some open fractures may have difficulty healing because of damage to the blood supply around the bone at the time of injury. If the bone does not heal, further surgery, including bone grafting to the fracture site and repeat internal fixation, may be necessary.

Question 68

Compartment syndrome

Answer 68

Acute compartment syndrome occurs when there is increased pressure with nerve and vessel compression within a closed osteofascial compartment, resulting in impaired local circulation → time critical → immediate treatment required to prevent ischemia, necrosis and loss of limb → escalate to nurse in charge / medical team → do not raise limb above heart level, avoid ice, administer analgesics, reassure patient 6 cardinal signs of compartment syndrome Pain that is not relieved by narcotic analgesics Pulselessness or diminshed peripheral pulses Pallor and cool to touch Paraesthesia Paralysis, weakness, loss of function Pressure → skin tightness, firm / tight to touch, shiny skin

Question 69

Fat Emboli

Answer 69

This is a life-threatening syndrome caused by fat golubles being released into the circulation most commonly following orthopedic trauma causing systemic embolisation. The most common systemic manifestations are: respiratory distress, altered LOC and peticchial rash → most commonly develops within 24 to 72 hours after fracture.

Question 70

What Are Chronic Musculoskeletal Disorders?

Answer 70

These disorders can include back pain, inflammatory joint disorders like rheumatoid arthritis, osteoporosis, gout and osteoarthritis. Some chronic MSK disorders can have acute exacerbations secondary to infection such as septic arthritis, osteomyelitis or even gout. As MSK disorders are typically characterised by loss of function, chronic pain, mobility impairment and loss of dexterity, chronic MSK disorders are a major contributor to disability, loss of income, poor mental health and wellbeing and illness.

Question 71

Non-inflammatory: Osteoarthritis

Answer 71

Osteoarthritis (OA) is the most common form of arthritis in Australia. OA is a slowly progressive non-inflammatory disorder which essentially wears out a joint. It affects the synovial joints, or weight-bearing joints, and involves the formation of new joint tissue in response to cartilage destruction. OA is characterised by localised loss and damage of articular cartilage, new bone formation of joint margins, subchondral bone changes, synovitis and thickening of the joint capsule. → Mostly occurs >40 years, but can occur earlier from repeated joint stress Cartilage destruction can begin in later adolescent years → Leading cause of pain and disability in older adults → onset due to bone on bone contact from a deteriorated joint and complete loss of articular cartilage → Not considered normal process of ageing → Affects women more than men → Most often caused by a known event or condition that directly damages cartilage or tissue resulting in joint instability → Inflammation is not a characteristic of OA, but secondary inflammation can occur when phagocytic cells attempt to repair the joint damage → early disease pain and stiffness

Question 72

Joints Most Commonly Affected by Osteoarthritis

Answer 72

Peripheral joints → hands, wrists, fingers (distal interphalangeal [DIP] & proximal interphalangeal [PIP] joints), knees, feet, toes Central joints → shoulders, hips, lower cervical spine, lumbosacral spine

Question 73

Osteoarthritis Risk factors

Answer 73

Reduction oestrogen → menopause Obesity → hip and knee OA Mechanical stress → sporting injuries → quick stops and pivoting → netball, football, and soccer. Occupations which require frequent kneeling and stooping → carpeting, plumbing, mechanics Trauma → fractures Inflammation Medications → corticosteroids, colchicine, indomethacin

Question 74

Osteoarthritis Causes

Answer 74

→ interaction of all factors that result in destruction of cartilage → body can't keep up with repairing the destruction → fissures and erosion on a normally smooth surface, osteophytes, joint surface incongruity → uneven distribution of stress → reduction of mobility and increasing pain Genetic links Metabolic factors Local factors

Question 75

Osteoarthritis Clinical Manifestations

Answer 75

Onset of clinical manifestations is gradual with most people affected not experiencing symptoms until >50 years of age → symptoms will be specific to the joint involved Symptoms more commonly unilateral Systemic clinical manifestations do not occur Pain → aching, sometimes difficult to localise, aggravated by weight-bearing → relieved by resting the joint Referred pain to buttocks, sciatic, groin, medial thigh, or knee Joint stiffness → early morning stiffness is very common usually resolved within 30 minutes Decreased ROM → difficulty sitting and moving from sitting to standing Bone spurs (osteophytes) Heberden's nodes Muscle atrophy Overactivity will lead to joint effusion Joint deformity → bowlegs, one leg shorter than the other Joint crepitus Night pain not relieved by rest is very common later in disease progression → occasionally associated with altered sensation → leads to sleep deprivation Antalgic gait

Question 76

Osteoarthritis Diagnosis

Answer 76

x-rays → used for confirming disease and for staging CT scan MRI Bone scan

Question 77

Osteoarthritis Treatment

Answer 77

Conservative → rest, ROM exercises, mobility aides, simple analgesics (paracetamol) and anti-inflammatories (NSAIDs), weight loss Surgery → used to improve joint ROM, correct deformities and reduce pain → joint replacement, arthroscopies

Question 78

Osteoarthritis Interprofessional Care

Answer 78

OA has no cure. Therefore, nursing referrals for interprofessional support can be very effective in ensuring person-centered care. The focus is on symptom management, preventing disability, and maintaining and improving joint function.

Question 79

Inflammatory arthritis (IA) is

Answer 79

a group of disorders that result in varying degrees of joint pain, swelling, warmth and tenderness with morning stiffness lasting >1 hour and mobility dysfunction. Most IA are systemic with inflammatory clinical manifestations occurring in multiple areas of the body including the skin, lungs, kidneys, heart, and eyes. What makes IA different to non-inflammatory forms of arthritis are the associated inflammatory symptoms → pain, erythema, warmth, swelling and loss of function. All forms of IA can result in infectious processes. If left untreated, IA will result in joint damage and deformities.

Question 80

Rheumatoid arthritis (RA)

Answer 80

A chronic disease of the MSK system with an autoimmune aetiology characterised by inflammation of connective tissue in the synovial joints. The inflammation eventually spreads to articular cartilage and surrounding soft tissues including ligaments and tendons. Localised vasculature can also be affected when swelling results in the compression of veins. This, in turn, results in poor circulation, metabolic acidosis, localised tissue hypoxia and potential tissue necrosis.

Question 81

Rheumatoid arthritis RA is characterised by periods of remission and exacerbation and is often associated with extra-articular symptoms.

Answer 81

Considered a systemic autoimmune disease → immune system mistakenly attacks joints → chronic pain and inflammation → also affects surrounding joint soft tissue Exact cause is unknown → thought to be a combination of environmental and genetic factors. More common in women → 70% prevalence with 55% >55 years Onset usually between 35 - 50 years but can occur at any age, including young children Can affect any joint → more common in hands and feet Commonly affects internal organs including the heart, lungs, kidneys, skin and nervous system → pericarditis, valvular deformities, splenomegaly, acute glaucoma, diffuse pleuritis, pulmonary fibrosis, thrombosis, myocardial infarcts from tissue necrosis Seasonal variations → clinical manifestations worse in colder climates and during winter If left untreated → joint erosion and permanent damage Chronic inflammation can result in granulated tissues, haemorrhages, and coagulation changes.

Question 82

Joints Involved in Rheumatoid arthritis

Answer 82

Multiple joints will be affected by rheumatoid arthritis → bilateral, or symmetrical presentation → due to being an autoimmune disease Peripheral joints → hands, wrists, elbows, feet, ankles → the first joints involved will be metacarpophalangeal [MCP] joint, PIP joint of the 3rd phalanges and wrists Central joints → shoulders, hips, spine

Question 83

Rheumatoid arthritis Risk Factors

Answer 83

Modifiable factors → smoking, obesity, air pollution exposure First Nations peoples → prevalence doubles Female → prevalence triples → hormonal involvement → symptoms decrease during pregnancy but increase during postpartum period Advancing age → rates increase after the age of 30 years Genetics → increases risk by 50% Vitamin D deficiency

Question 84

Rheumatoid arthritis Clinical Manifestations

Answer 84

Insidious onset Begins with general systemic symptoms → fever, malaise, rash, fatigue, lymphadenopathy, enlarged spleen, Raynaud's phenomenon, anorexia, weight loss Localised symptoms gradually occur over a period of months → Chronic joint pain, tenderness, and stiffness → occurs initially from pressure within the joints → Joint stiffness on waking → lasting for >1 hour → caused by synovitis → Heat and swelling to joints → symmetrical → caused by increased inflammatory exudate → Skin over joints appear cyanosed and ruddy with thin and shiny skin → Loss of joint function with decreased ROM and loss of strength → Joint deformity → ulnar deviation, boutonniere, swan-neck deformities of the fingers, hallux valgus, flexion contractures of knees and hips → Muscular atrophy Joint instability → Rheumatoid nodules → on skin, in the heart, spleen and lungs

Question 85

Rheumatoid arthritis Diagnosis

Answer 85

The key to managing rheumatoid arthritis is early diagnosis and early interventions. If an individual has had symptoms for >6 weeks, the following diagnostic criteria will be used with an individual requiring at least 4 of the following, to be diagnosed: Early morning stiffness >1 hour Arthritis >3 joints Arthritis of the hand Symmetrical symptoms Rheumatoid nodules Serum rheumatoid factor X-ray changes

Question 86

Rheumatoid arthritis Investigations include:

Answer 86

Serology testing → CRP, rheumatoid factor, circulating immune complexes, routine FBC and UEC X-ray

Question 87

Rheumatoid arthritis Treatment

Answer 87

As with osteoarthritis, treatment approach can be conservative or surgical. Education on symptoms and disease management Resting for several hours per day with flare ups Hot / cold pack application

Question 88

Gout

Answer 88

A syndrome of impaired uric acid metabolism and hyperuricaemia. Excess urate forms needle-like crystals that are deposited in connective, articular and subcutaneous tissue and synovial fluid, resulting in sudden and severe joint pain, inflammation and erythema of the joints. Uric acid is the end product of purine metabolism → renally excreted All primary processes can lead to elevated plasma urate levels → hyperuricaemia → insoluble crystals form → deposited in joints → exact process of deposition is unknown → initial deposits most commonly affects joints of the great toe (metatarsophalangeal joint) → 50% → inflammation of the great toe is called podagra Decreasing temperature → decreased solubility of urate → peripheral regions of the body have lower temperatures Uric acid crystal deposits progressively worsen over years and are deposited systemically Crystals buildup in subcutaneous tissue → tophi, or white nodules develop → most common site is the helix Crystals can also be deposited in the kidneys → urate kidney stones → renal failure Can be treated with some Rheumatologists claiming gout can be cured

Question 89

Considered a complex form of recurring arthritis → most common type of inflammatory arthritis → slowly progressive disability

Answer 89

Gout

Question 90

Gout is precipitated by primary processes which can occur singularly or in combination:

Answer 90

Increased uric acid production Underexcretion of uric acid → impaired renal function = impaired excretion → primary gout → most common cause → 90% of cases Exposure to a trigger → trauma, systemic illness, medications, high alcohol consumption, diet high in purine (shellfish, lentils, asparagus, spinach, beef, chicken) → metabolised to uric acid

Question 91

Gout Risk Factors

Answer 91

More common in affluent countries with the rate of occurrence in Australia as 10% of all types of arthritis → New Zealand has the highest rate of gout in the world Modifiable factors → Obesity → HTN → High alcohol consumption → increased keto acids → Hyperlipidaemia → Prolonged fasting → increased keto acids Male > 50 years of age → peak onset 40-60 years Medications → Diuretics → Chemotherapy agents → Aspirin Cancers

Question 92

Gout Joints Involved

Answer 92

Initial attack → usually one joint affected → metatarsophalangeal joint (MTP) Peripheral joints → hands, wrists, elbows (olecranon), feet, ankles, heal, mid-tarsal Central joints → spine

Question 93

Gout Clinical Manifestations

Answer 93

Onset typically at night → Mild attack → symptoms last 1-2 days → Severe attack → symptoms can last weeks Severe, excruciating pain Swelling to joints Hot, erythematous joints Lymphangitis Systemic signs of inflammation → fever, malaise, leucocytosis, nausea Progressive joint stiffness Persistent aching

Question 94

Gout Complications

Answer 94

Septic arthritis Carpal tunnel syndrome Kidney stones → renal failure

Question 95

Gout Diagnosis

Answer 95

80% of cases → diagnosis can be made on clinical history and assessment Blood test → serum uric acid levels → not used in isolation due to the number of other disorders that can result in hyperuricaemia 24 hour urine collection → test urine uric acid levels Joint aspiration → performed under sterile precautions → synovial fluid aspirate tested for crystal deposits → used to rule out septic arthritis → also acts to decompress pressure in a swollen affected join

Question 96

Gout Treatment

Answer 96

Medications → primary therapy → Inflammation and pain experienced during acute attack are treated as soon as possible → NSAIDs (indomethacin), colchicine, allopurinol → Once resolved, aim is to prevent further attacks and decrease risk of complications → corticosteroid injection, probenecid Infection needs to be ruled out Reversing modifiable causes Ice Rest Low-purine diet Weight reduction High water intake to increase urinary output

Question 97

Gout is characterised by the following 4 stages:

Answer 97

Asymptomatic gout Acute gouty arthritis Intercritical gout Chronic tophaceous gout

Question 98

Asymptomatic gout

Answer 98

= also known as asymptomatic hyperuricaemia → serum urate levels abnormally high with an absence of arthritic symptoms → a person can have hyperuricaemia all their life and never progress to symptomatic gout → diagnosed with a blood test → no treatment recommended

Question 99

Acute gouty arthritis

Answer 99

= characterised by acute 'attacks' with hyperuricaemia → can be triggered by trauma, surgery, medications, systemic infection or high alcohol and purine food intake → attacks usually occur at night and are sudden and excruciating → can affect one or more joints → peaks within 12-24 hours after initial onset of symptoms → can begin to resolve without treatment → full resolution can take 7-14 days with return to being asymptomatic → 75% of people will experience a 2nd or 3rd attack with 12 months

Question 100

Intercritical gout

Answer 100

= asymptomatic period between attacks → remission → buildup of urate crystals still occurring while a person feels well → potential for joint damage remains

Question 101

Chronic tophaceous gout

Answer 101

= chronic gout → multiple joint involvement associated with visible crystal deposits in the subcutaneous tissue → tophi → common locations include olecranon, helix, vertebrae, and tendons → occurs many years after initial onset of acute attack

Question 102

Gout Nursing Management

Answer 102

Education → symptom awareness, rest, when to apply ice, elevation, importance of following medical advice, taking medication as directed and prompt review with onset of symptoms → Comprehensive program → Balance of rest and activity → Joint protection → Heat and cold applications → Exercise → Patient and caregiver teaching → Ambulatory and home care → Modify tasks for less stress on joints → Energy conservation Support Bed rest with foot cradle if lower limb affected Joint immobilisation → decrease possible ROM → avoid using / palpating affected joint Cryotherapy Nursing referrals → dietician, pharmacist, exercise physiologist, occupational therapist

Question 103

Osteomyelitis

Answer 103

A severe infection of the bone, bone marrow and surrounding tissue Occurs when a pathogen, such as a bacterium or a fungi infect the bone → Haematogenous spread → indirect entry → from the bloodstream usually affects long bones in paediatrics and vertebrae in adults → common infections include ear infections, skin sores, urinary tract infections, respiratory infections → Contagious spread → from nearby tissue → common in trauma, surgery, diabetic foot ulcers, or foreign body → Direct Inoculation → direct entry through, for example, a compound fracture or surgical procedure, penetrating wound, ulcers Infection → inflammation → formation of pus → increased pressure in bone → compromised circulation → ischaemia → bone destruction → necrosis of the bone tissue May lead to chronic infection if not treated properly

Question 104

Septic Arthritis

Answer 104

Infection of a joint Usually caused by a bacterium → can also be caused by fungi or viruses Considered a medical emergency → requires prompt diagnosis and treatment to prevent joint destruction and serious complications Occurs when a pathogen enters the joint space → inflammation, destruction of cartilage and bone → suseptible to the same types of spread as per osteomyelitis

Question 105

Osteomyelitis & Septic arthritis Risk Factors

Answer 105

Co-morbidities → diabetes, peripheral vascular disease, rheumatoid arthritis Immunosuppression → immunosuppressive therapy Recent trauma Surgery → joint replacement surgery, prosthetic joints

Question 106

Osteomyelitis & Septic arthritis Causes

Answer 106

Bacteria → Staphylococcus aureus, Escherichia coli, Pseudomonas, Salmonella Fungal → less common but can occur in immunocompromised patients Trauma or surgery → open fractures or surgical procedures can introduce pathogens

Question 107

Clinical Manifestations Acute Osteomyelitis → initial infection or an infection of <1 month

Answer 107

Rapid onset of local and systemic symptoms Severe and constant bone pain → unrelieved by rest → worsens with activity Swelling, tenderness, erythema, hot to touch over site of infection Restricted ROM and decreased strength Systemic symptoms → fever, malaise, lethargy, night sweats, chills, restlessness, nausea

Question 108

Clinical Manifestations Chronic Osteomyelitis → bone infection that persists > 1 month or an infection that has not responded to treatment

Answer 108

Continuous or chronic problem → characterised by periods of remissions and exacerbations → symptoms usually not as severe as an acute episode Chronic, constant bone pain Drainage / pus from abscess or sinus tracts Swelling, tenderness, erythema, hot to touch over site of infection Restricted ROM and decreased strength Systemic symptoms → fever, malaise, lethargy, night sweats, chills, restlessness, nausea Granulated tissue → scar tissue → site for ongoing microorganisms growth

Question 109

Clinical Manifestations Septic Arthritis

Answer 109

Rapid onset of symptoms Severe joint pain, swelling, erythema, warmth to joint Restricted ROM, decreased strength, decrease weight bearing Systemic symptoms → fever, malaise, lethargy, night sweats, chills, restlessness, nausea

Question 110

Osteomyelitis & Septic arthritis Diagnosis

Answer 110

Prompt diagnosis and treatment are required to prevent serious complications and to restore function: Clinical assessment Imaging → x-ray, CT scan, MRI → to visualise the infection Blood test → inflammatory markers, UEC, FBC, blood cultures MCS of fluid aspirated from either the bone tissue or joint

Question 111

Osteomyelitis & Septic arthritis Treatment

Answer 111

Hospitalisation Antimicrobials → dependent on type of pathogen→ antibiotics if bacteria is the causative agent → usually intravenously administered then transitioned to oral route of administration Surgery → to wash out an infected joint, drain abscesses, remove infected tissue, remove necrotic bone, stabilise affected area Supportive care → symptom management and physiotherapy to restore function

Question 112

Osteomyelitis & Septic arthritis Complications

Answer 112

Chronic pain Bone abscess or sinus tract Bone necrosis → osteonecrosis Inflammation and/or infection of soft tissue → cellulitis Leg length discrepancies Pathological fractures Amputation Sepsis Multisystem failure Death

Question 113

Osteomyelitis & Septic arthritis Nursing Management Hospital nursing care

Answer 113

Subjective assessment → targeted health history questions Objective assessment → primary survey, secondary assessment → Monitoring vital signs, neurovascular assessment, fluid balance, pain assessment → Observing and assessing for deterioration Limb elevation and immobilisation DVT prevention Wound care if necessary Education Supportive care Medication administration → analgesia, NSAIDs, antibiotics Coordination of care → collaborate with interprofessional team, nursing referrals Health promotion Discharge planning

Question 114

Osteoporosis is

Answer 114

a chronic, progressive metabolic bone disease characterised by decreased bone mass and density, leading to fragile bones that are prone to fractures. It is often referred to as a “silent disease” because it progresses without symptoms until a fracture occurs. Osteoporosis → porous bone or fragile bone disease Osteoporosis occurs when the creation of new bone doesn’t keep up with the removal of old bone → imbalance → decreased bone density → impaired structural integrity of the bone → porous, brittle bones that cannot withstand normal mechanical stress

Question 115

The process in osteoporosis involves:

Answer 115

Bone remodelling → normally, bone is continuously broken down (resorption) and rebuilt (formation). In osteoporosis, resorption outpaces formation. Hormonal influence → decreased levels of oestrogen in women and testosterone in men → bone loss. Other hormones like parathyroid hormone and calcitonin also influence bone remodelling

Question 116

Primary Osteoporosis

Answer 116

→ often related to aging and decreased sex hormones.

Question 117

Secondary Osteoporosis

Answer 117

→ results from co-morbidities or medications such as glucocorticoids or anticonvulsants

Question 118

Osteoporosis Risk Factors

Answer 118

→ Non-Modifiable Advancing age → > 60 years → 9% of people > 50 years have osteoporosis More common in women → 75% prevalence → women have lower calcium intake, less bone mass, pregnancy, and breast feeding deplete skeletal reserves of calcium, bone resorption begins earlier with menopause Family history Ethnicity → higher in Caucasians and Asians Small statue, thin build Early menopause Late menarche Nulliparity (no children) Cushing's syndrome Hypoparathyroidism Rheumatoid arthritis Renal insufficiency → Modifiable Low calcium and vitamin D intake Excessive sodium intake Sedentary lifestyle Smoking Excessive alcohol comsumption Low body weight Obesity Malabsorption Anorexia

Question 119

Osteoporosis Clinical Manifestations

Answer 119

Clinical manifestations depend on the bones that are involved. Onset is insidious and awareness usually occurs once the disease is at an advance state, and this usually coincides with the first fracture resulting from low-height. By this stage, bone deterioration is unable to be reversed: Bone pain → especially in the back Bone deformity Fractures → commonly occur in the hip, spine, ribs, long bones, and wrist. Neck of femur (NOF) fractures are also very common and occur most commonly with very elderly woman Loss of height → due to vertebral compression fractures Kyphosis → hunched posture from spinal fractures

Question 120

Osteoporosis Complications

Answer 120

Pathological fractures → risk of fractures increases 42% once over the age of 50 years → occurs because spongy bone becomes too thin and compact bone becomes too porous Fat emboli → from fractures Pulmonary embolism → from fractures Pneumonia Haemorrhage Hypovolaemic shock

Question 121

Osteoporosis Diagnosis

Answer 121

Health prevention → Bone screening from age 60 years for women and 75 years for men Bone Mineral Density (BMD) Test → the gold standard for diagnosing osteoporosis → a DEXA scan measures bone density at the hip and spine → measured in grams of mineral per volume → Osteoporosis is defined as BMD ≤-2.5 → Osteopenia → bone loss > normal → T score -1 to - 2.5 Bone biopsy Pathology testing → calcium, vitamin D, thyroid function test (LFT) X-rays cannot detect osteoporosis until >40% calcium in the bone is lost

Question 122

Osteoporosis Treatment

Answer 122

Medications: Bisphosphonates → inhibit bone resorption. Calcitonin → helps regulate calcium levels and bone metabolism. Parathyroid Hormone Analogues → stimulate bone formation. Calcium and Vitamin D Supplements → essential for bone health. *Lifestyle Modifications

Question 123

Osteoporosis Nursing Considerations

Answer 123

Patient Education → educate patients about the importance of medication adherence, diet, exercise, medical reviews and falls prevention Monitoring → regularly assess pain levels, mobility, psychosocial wellbeing, nutrition Support → provide emotional support and resources for patients coping with chronic illness. Understanding osteoporosis is crucial as it involves comprehensive care, from prevention and early detection to treatment and patient education. Effective management can significantly improve patient outcomes and quality of life.

Question 124

Joint replacement surgery, also known as arthroplasty, involves

Answer 124

replacing a damaged joint with a prosthesis. The most common joints replaced are the hip and knee, but other joints like the shoulder, elbow, and ankle can also be replaced. Arthroplasty is the most common orthopaedic surgical procedure performed on older adults. Aimed at relieving pain, improving joint motion, correcting deformity and malalignment, and removing intraarticular causes of erosion

Question 125

Nursing Care Considerations: Pre-operative Phase Joint replacement surgery

Answer 125

Patient Education → educate the patient about the procedure, expected outcomes, and postoperative care and expectations. This includes discussing PACU, ward care, pain management, mobility expectations, and potential complications. Assessment → conduct a thorough preoperative assessment, including medical history, current medications, and any allergies. Evaluate the patient’s physical and psychological readiness for surgery. Discharge planning → starts on admission. Consider nursing referrals and your patient's needs once discharged. Home Care Instructions → ensure the patient and their caregivers understand how to care for the surgical site, manage pain, and perform prescribed exercises at home. Follow-Up Care → schedule follow-up appointments with the surgeon and physical therapist. Provide information on when to seek medical attention for any concerning symptoms

Question 126

Nursing care Considerations: Post-operative Care

Answer 126

Pain Management → administer prescribed pain medications and monitor their effectiveness. Some patients may return to the ward with a PCA running. Use non-pharmacological methods like ice packs and positioning to help manage pain. Wound Care → monitor the surgical site for signs of haemorrhaging. After 48 hours, monitor for infection, such as redness, swelling, or discharge. Keep the wound clean and dry and follow the surgeon’s instructions for dressing changes. The patient may also return to the ward with a surgical drain insitu. Follow medical advice on expected date for removal and document output on the FBC. Mobility and Rehabilitation → encourage early mobilization to prevent complications like deep vein thrombosis (DVT), prevent dislocation of the new prosthesis and promote recovery. Ensure correct positioning of the limb as per post-operative instructions. This can include: Total hip replacement → position the patient in a semi-fowler position whilst using a Charnley pillow with legs abducted for hip immobility. Total knee replacement → avoid the use of a pillow under the knee and use a Richard splint for joint immobility. Assist the patient with physical therapy exercises and ensure they understand the importance of adhering to their rehabilitation plan. Monitoring for Complications → watch for signs of complications such as DVT, pulmonary embolism (PE), volume deficit, or prosthesis dislocation. Assess vital signs as per postoperative care guidelines and regularly perform neurovascular assessments of the affected limb. Patient Education → provide instructions on postoperative care, including activity restrictions, wound care, and signs of potential complications. Educate the patient on the importance of follow-up appointments and adherence to their rehabilitation program.

Question 127

Post-operative Complications

Answer 127

Cardiovascular Hypotension Hypertension Arrhythmias Venous thromboembolism (VTE) Syncope Fluid and Electrolyte Fluid overload Fluid deficit Electrolyte imbalances Acid-base imbalances Respiratory Airway obstruction Hypoxaemia Atelectasis Aspiration Bronchospasm Hypoventilation Orthopaedic Specific Bleeding at wound site Joint dislocation (hip) Fixed flexion deformity (knee) SSI – surgical site infection DVT

Question 128

Nursing Management Pre and Post Hip Replacement

Answer 128

Early surgical intervention is the preferred method of managing hip fractures as this allows early mobilisation and decreases the risk of complications. Traction may be used in the early management of these fractures to help relieve muscle spasms and immobilisation of the affected extremity assists in reduction of pain. Nursing care focuses on pre and post operative care, minimising pain, managing discomfort and preventing deterioration through early recognition. Here are some resources that you can review to help develop your understanding: Hip fracture Clinical Care Standard from the Australian Commission on Safety and Quality in Health Care Orthogeriatric Hip Fracture Care by the NSW Agency for Clinical Innovation

Question 129

Nursing Management Pre and Post Hip Replacement Pain Management

Answer 129

Assessment → regularly assess pain levels, vital signs, neurovascular status, fluid balance Medication → administer prescribed analgesics as charted and monitor for adverse effects Non-Pharmacological Methods → splinting, encourage the use of ice packs, positioning, and relaxation techniques.

Question 130

Nursing Management Pre and Post Hip Replacement Mobility and Physical Therapy

Answer 130

Early Mobilisation → encourage patients to start moving as soon as possible post-operatively to prevent complications like deep vein thrombosis (DVT) → refer to physiotherapist for guidance Mobility Devices → educate patients how to use walkers, crutches, or canes safely → refer to physiotherapist for guidance

Question 131

Nursing Management Pre and Post Hip Replacement Post-operative Wound Care

Answer 131

Assessment → monitor the surgical site for signs of infection (will not show within first 48 hours), such as erythema, swelling, or discharge. Dressing changes → perform dressing changes as per protocol using an ANTT approach Patient education educate patient on how to care for their wound at home and how to recognise signs and symptoms of a wound infection

Question 132

Nursing Management Pre and Post Hip Replacement Prevention of Complications

Answer 132

DVT prevention → administer anticoagulants as prescribed and encourage leg exercises as guides by physio Respiratory care → encourage deep breathing exercises and the use of incentive spirometry to prevent pneumonia Pressure injury prevention reposition patients regularly and use pressure-relieving devices

Question 133

Nursing Management Pre and Post Hip Replacement Nutrition and Hydration

Answer 133

Balanced diet → encourage a diet rich in protein, vitamins, and minerals to promote healing Hydration → ensure adequate fluid intake to prevent dehydration and constipation

Question 134

Nursing Management Pre and Post Hip Replacement Patient Education and Discharge Planning

Answer 134

Activity restrictions → educate patients on activity restrictions and safe movements to avoid dislocation Home environment → discuss modifications to the home environment to ensure safety, such as removing tripping hazards and installing grab bars → refer to occupational therpaist Follow-up → ensure your patient knows when follow-up reviews are scheduled, provide information on when to seek medical advice

Question 135

Nursing Management Pre and Post Hip Replacement Emotional Support

Answer 135

Psychosocial assessment → assess the patient’s emotional state and provide support as needed Encouragement → offer encouragement and reassurance to boost the patient’s confidence in their recovery process

Question 136

Damage to the external intercostal muscles would interfere with what important process? Standing upright Gait Respirations Digestion

Answer 136

Respirations

Question 137

Which of the following would be the most appropriate for long term treatment of rheumatoid arthritis? Methotrexate Ibuprofen Paracetamol Codeine

Answer 137

Methotrexate

Question 138

If someone hit you in your rectus abdominis muscle, how would your body position change? You would lean to the right You would double over You would bend backwards you would twist to the left

Answer 138

You would double over

Question 139

Which of the following would be the most appropriate treatment for the early stages of both osteoarthritis and gout? Methotrexate Ibuprofen Dexamethasone Certolizumab

Answer 139

Ibuprofen

Question 140

Which muscle would be the prime mover for dorsiflexion at the ankle? Gastrocnemius Tibialis posterior Soleus Tibialis anterior

Answer 140

Tibialis anterior

Question 141

In fracture repair, which of the following does NOT occur during soft callus formation? Fibroblasts form collagen strands which links bone ends Chondrocytes form a cartilage matrix between fracture ends Angiogenesis continues to supply the wound site with nutrients Osteoblasts form a spongy bone network in the site of the fracture

Answer 141

Osteoblasts form a spongy bone network in the site of the fracture

Question 142

Which of the following best describes the role of Vitamin D in the regulation of calcium balance in the body? It is a precursor for parathyroid hormone which stimulates osteoclast activity It is a precursor for calcitriol which stimulates intestinal absorption of calcium It increases calcium deposition in bone by stimulating osteocyte contract It is a precursor for calcitonin and stimulates osteoblast activity

Answer 142

It is a precursor for calcitriol which stimulates intestinal absorption of calcium

Question 143

What is the primary goal of nursing care for a patient with a fracture? Prevent infection Increase physical activity Restore function Reduce dietary calcium

Answer 143

Restore function

Question 144

What is the recommended position for a patient with a hip fracture to prevent complications? High-fowler position Supine with legs extended Prone position Semi-fowler with legs abducted

Answer 144

Semi-fowler with legs abducted

Question 145

Which of the following is a key nursing assessment for a patient with osteoporosis? Monitoring blood glucose levels Checking skin turgor and skin integrity Evaluating neurological status Assessing for signs of bone pain and fractures

Answer 145

Assessing for signs of bone pain and fractures