Care of Patients with Musculoskeletal Problems

Question 1

Chronic metabolic disease in which bone loss causes decreased density and possible fracture - lack Ca in bone
Spine, hip, and wrist are most often at risk
Can be classified as generalized or regional
Generalized
Regional

Answer 1

Osteoporosis

Question 2

decreased bone mass - bone weak

Answer 2

Chronic metabolic disease in which bone loss causes decreased density and possible fracture - lack Ca in bone - Osteoporosis

Question 3

Postmenopausal women: decreased estrogen levels - estrogen helps move Ca in
Men in their seventh or eighth decade of life: decreasing levels of testosterone which builds bone

Answer 3

Generalized: Primary - Osteoporosis

Question 4

Results from other medical conditions - lack ability get Ca into bone

Answer 4

Generalized: Secondary - Osteoporosis

Question 5

Occurs when a limb is immobilized related to a fracture, injury, or paralysis - not moving Ca in bone
Immobility for longer than 8-12 weeks can result in this type of osteoporosis

Answer 5

Regional - Osteoporosis

Question 6

Older age in both genders and all races
Parental history of osteoporosis, especially mother
History of low-trauma fracture after age 50
Low body weight - not much weight bearing on bones
Chronic low calcium and/or vitamin D intake
Estrogen or androgen (male) deficiency
Current smoking
High alcohol intake
Carbonation beverages or high phosphate levels
Lack of physical exercise or prolonged immobility

Answer 6

Osteoporosis risk factors

Question 7

Excessive caffeine in the diet can cause calcium loss in the urine and carbonated beverages - high phosphate in them
A diet lacking enough calcium and vitamin D stimulates the parathyroid gland to produce parathyroid hormone which triggers the release of calcium from the bony matrix - not enough Ca tells release PTH which tells bone release Ca from bones
Activated vitamin D is needed for calcium uptake in the body - need sunlight activate vit D
Malabsorption of nutrients in GI tract contributes to low serum calcium levels
People not exposed to sunlight may be at higher risk because they do not receive adequate vitamin D for the metabolism of calcium
Calcium loss occurs at a more rapid rate when phosphorus intake is high
People drinking large amounts of carbonated beverages each day (over 40 ounces) are at high risk for calcium loss
Protein deficiency may reduce bone density, but excessive protein intake may increase calcium loss in the urine

Answer 7

Osteoporosis etiology

Question 8

Build strong bones as a young person - activities
Decrease modifiable risk factors

Answer 8

Osteoporosis: teaching prevention

Question 9

Build strong bones as a young person - activities
Decrease modifiable risk factors

Answer 9

Osteoporosis: teaching prevention

Question 10

Especially young women - automatically bone loss starts after age 30

Answer 10

Build strong bones as a young person - activities - Osteoporosis: teaching prevention

Question 11

Include dietary calcium: Dairy products and dark green, leafy vegetables
Importance of sun exposure - activated vit D
Adequate vitamin D in the diet or a supplement
Limit amount of carbonated beverages per day and caffeine in diet
Low alcohol
Exercise - huge: Weight bearing exercises (ex. Walking - gold standard) - good

Answer 11

Decrease modifiable risk factors - Osteoporosis: teaching prevention

Question 12

Physical assessment
Lab
Imaging

Answer 12

Osteoporosis: assessment

Question 13

Kyphosis
Reports of “getting shorter” - breakdown bony matrix in vertebra and will lose height
Pain
Assess for fractures (pain, swelling, misalignment) - high risk; unexplained fractures investigate

Answer 13

Physical assessment

Question 14

No definitive lab test confirms the diagnosis of primary osteoporosis
Serum calcium and vitamin D3 levels annually for all women and men older than 50 who are at high risk for the disease

Answer 14

Lab

Question 15

Dual x-ray absorptiometry (DXA or DEXA)
Xray Measures bone mineral density
Best tool available for a definitive diagnosis

Answer 15

Imaging

Question 16

Nutrition therapy - HUGE
Exercise
Lifestyle changes
Drug therapy

Answer 16

Osteoporosis: interventions

Question 17

Fruits and vegetables
Low-fat dairy and protein sources - increase Ca and sunlight
Increased fiber
Moderation of alcohol and caffeine
Decrease carbonation

Answer 17

Nutrition therapy - HUGE

Question 18

Walking 30 minutes 3 to 5 times a week is the most effective - weight bearing exercise

Answer 18

Exercise

Question 19

Avoid tobacco
Hazard-free environment to decrease risk for falls - safety precaution because high risk for fracture

Answer 19

Lifestyle changes

Question 20

Calcium and vitamin D supplements
Stim osteoblasts
Bisphosphonates
Estrogen agonist/antagonists
Calcitonin

Answer 20

Drug therapy

Question 21

Slows bone resorption by binding with crystal elements in bone and causes Ca stay in bone
Commonly taken
Ex. Alendronate (Fosamax); risedronate (Actonel); ibandronate (Boniva)
Severe esophagitis
Take early in the morning, 8 oz. of water, sit upright for 30-60 min - can cause reflux irritation

Answer 21

Bisphosphonates

Question 22

Ex. raloxifene (Evista)
Inhibits bone resorption (breakdown of bones)
Stimulates osteoblast activity and inhibits PTH (parathyroid hormone)
Keeps Ca in bones

Answer 22

Estrogen agonist/antagonists

Question 23

Inhibits bone resorption (breakdown of bones) - keeps Ca in bone

Answer 23

Calcitonin

Question 24

Most common arthritis
Major cause of disability among adults older than 60
Also called osteoarthrosis or degenerative joint disease (DJD)
Progressive deterioration and loss of cartilage in one or more joints - looking at joints not bones
Causes:

Answer 24

Osteoarthritis

Question 25

Combination of many factors: aging, genetic, obesity (more wear and tear on joints), joint injury, occupation More females affected 2:1

Answer 25

Causes: - Osteoarthritis

Question 26

History Disease pattern: Physical assessment/Key Features:

Answer 26

Osteoarthritis: assessment

Question 27

Typ Unilateral, single joint Affects weight-bearing joints and hands (frequent use), spine Non-systemic - indiv joints

Answer 27

Disease pattern:

Question 28

Chronic joint pain and stiffness Herbeden’s Nodes (in joints of hand)

Answer 28

Physical assessment/Key Features:

Question 29

Psychosocial assessment: - hard be in pain Imaging: - BIG; diagnosis Lab findings:

Answer 29

Osteoarthritis: assessment

Question 30

Cannot do things independent or do ADLs Constant, chronic pain Inability to care for oneself Depression and anxiety Altered body image Decreased self-esteem

Answer 30

Psychosocial assessment: - hard be in pain

Question 31

X-rays MRI CT

Answer 31

Imaging: - BIG; diagnosis

Question 32

Normal or slightly elevated ESR Slightly elevated C-reactive protein (CRP) Inflammatory markers

Answer 32

Lab findings:

Question 33

Chronic pain related to cartilage deterioration Decreased mobility related to joint pain and muscle atrophy

Answer 33

Osteoarthritis: planning/nursing diagnosis: Priority problems:

Question 34

Pain control that is acceptable to the patient Moves and functions in his or her own environment independently with or without assistive devices - as mobile and functional as possible

Answer 34

Osteoarthritis: planning/nursing diagnosis: Expected outcomes:

Question 35

Tylenol drug of choice Topical drug applications lidocaine 5% patch (Lidoderm) NSAIDs Cortisone injections - stop-gap things; not control pain with PO meds; tiding to get joint replacement as late in life as possible Muscle relaxants

Answer 35

Osteoarthritis: treatments/interventions: Drug therapy:

Question 36

Not a primary inflammatory disorder

Answer 36

Tylenol drug of choice

Question 37

May apply for 12 hours each day Relieve pain and right on area where pain is

Answer 37

Topical drug applications lidocaine 5% patch (Lidoderm)

Question 38

CBC, kidney, liver function tests are obtained for baseline From tylenol to here If inflammation gets worse Ex. celecoxib (Celebrex); ibuprofen

Answer 38

NSAIDs

Question 39

Rest, balanced with exercise - active as can be but rest joints Joint positioning Heat or cold applications - good thing Weight control (to decrease stress on joints) - first things do

Answer 39

Osteoarthritis: treatment/interventions: Nonpharmacologic:

Question 40

Most common procedure is total joint arthroplasty Hip and knee joints are most commonly replaced

Answer 40

Osteoarthritis: treatment/interventions: Surgery:

Question 41

Active infection Advanced osteoarthritis Rapidly progressive inflammation; age

Answer 41

Osteoarthritis: treatment/interventions: Contraindications to surgery:

Question 42

Dislocation: Infection: Venous thromboembolism: Bleeding and hypotension: Neurovascular compromise: Scar tissue formation (total knee arthroplasty):

Answer 42

Total joint arthroplasty: complications and nursing interventions

Question 43

Position correctly Hip: keep leg slightly abducted and prevent hip flexion beyond 90 degrees - lot precautions taken - keep hips in joint Assess for pain, rotation, and extremity shortening - out of joint

Answer 43

Dislocation:

Question 44

Use aseptic technique for wound care and emptying of drains Take out joint if infection Culture drainage fluid, if needed Monitor temperature Report excessive inflammation or drainage

Answer 44

Infection:

Question 45

Highest risk for DVT Use of sequential compression devices and/or compression hose Teach leg exercises, Encourage fluid intake, Observe for signs of thrombosis (redness, swelling, or pain); Administer anticoagulant as prescribed, Do not massage legs if already have DVT

Answer 45

Venous thromboembolism:

Question 46

VS at least every 4 hours Observe patient for bleeding Fluid volume lost in OR so always keep an eye of vitals Assist with slow position changes

Answer 46

Bleeding and hypotension:

Question 47

Check and document color, temperature, distal pulses, capillary refill, movement, and sensation Compare the operative leg with the nonoperative leg

Answer 47

Neurovascular compromise:

Question 48

Continuous passive motion (CPM) machine Keeps the knee in motion Formation of scar tissue can decrease knee mobility and increase postoperative pain - passive movement Slowly increase angle and mobility as pat improves

Answer 48

Scar tissue formation (total knee arthroplasty):