Care of Patients with Musculoskeletal Problems II

Question 1

Loss of bone related to a vitamin D deficiency
Interventions:
Child form: rickets

Answer 1

Osteomalacia

Question 2

Bones soften secondary to inadequate amounts of calcium and phosphorus in the bone matrix - not calcify properly without D

Answer 2

Loss of bone related to a vitamin D deficiency - Osteomalacia

Question 3

Increase vitamin D intake through diet
Daily sun exposure
Vitamin D supplements

Answer 3

Interventions: - Osteomalacia

Question 4

Milk, eggs, swordfish, chicken, liver, enriched cereals and bread products
Read labels that things high in D

Answer 4

Increase vitamin D intake through diet

Question 5

5 minutes each day
UV radiation to activate D

Answer 5

Daily sun exposure

Question 6

Ergocalciferol

Answer 6

Vitamin D supplements

Question 7

Also called osteitis deformans
Second most common bone disease after osteoporosis
Pathophysiology
May occur in one bone or multiple sites - bone and joint pain; reforming not in proper way
Two types
Clinical manifestations
Increased risk for bone cancer
Diagnostic assessment
Interventions
Aspirin or NSAIDS for mild to moderate pain
Heat and gentle massage - help with pain
Exercise - good idea; weight bearing helps rebuild bone
Diet rich in calcium and Vitamin D - risk for hypocalcemia with bisphosphonates

Answer 7

Paget’s disease

Question 8

Chronic metabolic disorder
Bone is excessively broken down and then reformed - increased osteoblasts and clasts
Bone is structurally disorganized
Bones are weak and at increased risk for fractures - not as strong
Risk for bowing

Answer 8

Pathophysiology - Paget’s disease

Question 9

Familial and sporadic

Answer 9

Two types - Paget’s disease

Question 10

Asymptomatic OR
Bone and joint pain
Pathological fractures
Bowing of long bones
Enlarged, thick skull

Answer 10

Clinical manifestations - Paget’s disease

Question 11

Increase in serum alkaline phosphatase (ALP)
Increase in urinary hydroxyproline levels
Elevated uric acid
X-rays - enlarged bones; indicate make have paget’s
Bone scan - definitive; inject radioactive dye

Answer 11

Diagnostic assessment - Paget’s disease

Question 12

Caused by overactive osteoblasts

Answer 12

Increase in serum alkaline phosphatase (ALP)

Question 13

Indicates the degree of disease severity
Reflects bone collagen turnover/breaking down

Answer 13

Increase in urinary hydroxyproline levels

Question 14

Oral bisphosphonates when ALP levels are at least twice the normal level - prevent breakdown bones
Monoclonal antibody
Calcitonin

Answer 14

Interventions - Paget’s disease

Question 15

Ex. aldreonate (Fosamax); risedronate (Actonel)

Answer 15

Oral bisphosphonates when ALP levels are at least twice the normal level - prevent breakdown bones

Question 16

Ex. denosumab (Prolia)
Binds to a protein that is essential for the formation, function, and survival of osteoclasts
Inhibits osteoclasts life

Answer 16

Monoclonal antibody

Question 17

Hormone that reduces bone resorption and relieves pain
Given SQ
Used in patients that do not tolerate bisphosphonates
Prevent breaking down bone and resorption

Answer 17

Calcitonin

Question 18

Infection in a/of bone
Etiology
May be acute or chronic
Can be severe and difficult to treat
Clinical manifestations of acute infection

Answer 18

Osteomyelitis

Question 19

Bacteria, virus or fungi
Diff treat

Answer 19

Infection in a/of bone - Osteomyelitis

Question 20

Infectious organisms enter from outside of the body to bone
Organisms are carried by the bloodstream from other areas of infection in the body
Once enters bone tissue inflamed, vessels leak causing edema compromising blood flow to bone causing necrosis, tissues around bone inflamed

Answer 20

Etiology - Osteomyelitis

Question 21

Fever - VERY HIGH
Swelling - infected around
Erythema - infected around
Tenderness
Bone pain that is constant, localized, and pulsating and intensifies with movement - adequately address

Answer 21

Clinical manifestations of acute infection - Osteomyelitis

Question 22

Physical assessment
Lab
Diagnostic

Answer 22

Osteomyelitis: assessment

Question 23

Assess for clinical manifestations

Answer 23

Physical assessment

Question 24

Elevated WBC - infection
Elevated erythrocyte sedimentation rate (ESR)
Positive blood cultures

Answer 24

Lab

Question 25

Radionuclide scanning MRI *While bone changes can not be detected early with x-ray, changes in blood flow to the bone can be seen by radionuclide scan and MRI

Answer 25

Diagnostic

Question 26

normal early in the course of the disease - inflammation; stay elevated for long-period time

Answer 26

Elevated erythrocyte sedimentation rate (ESR)

Question 27

Occurs when bacteremia is present - infection in bloodstream can get into bone

Answer 27

Positive blood cultures

Question 28

IV antibiotic therapy long-term Contact precautions Wound care - take care external wounds Drug therapy for pain control

Answer 28

Osteomyelitis: interventions: Acute

Question 29

May possibly need multiple antibiotics

Answer 29

IV antibiotic therapy long-term

Question 30

If the presence of copious wound drainage MRSA/S aureus Antibiotic resistant organisms sometimes

Answer 30

Contact precautions

Question 31

IV antibiotic therapy Hyperbaric oxygen chamber (HBO) therapy Surgery

Answer 31

Osteomyelitis: interventions: Chronic

Question 32

Optimal time not well established

Answer 32

IV antibiotic therapy

Question 33

Used to increase tissue perfusion by exposure to high levels of oxygen High doses O2; increase O2 treatment

Answer 33

Hyperbaric oxygen chamber (HBO) therapy

Question 34

Debride or get rid necrotic so treatments can be effective Check for neurovascular compromises

Answer 34

Surgery

Question 35

Most often occurs in people between 10 and 30 - peds most often Small percentage of cancers Osteosarcoma most common type Ewing’s sarcoma Chondrosarcoma - cartilage tissue Fibrosarcomas - fibrous tissue Metastasis to lungs often

Answer 35

Bone cancer: Primary

Question 36

More than 50% occur in the distal femur - LE long-bones Seen in Paget’s disease pats

Answer 36

Osteosarcoma most common type

Question 37

Most malignant but not as often

Answer 37

Ewing’s sarcoma

Question 38

Originate in other tissues and metastasize to the bone Pathological fractures often

Answer 38

Secondary: Bone cancer

Question 39

Unknown exposed to prior radiation, Paget’s disease Genetic and environmental factors are likely causes

Answer 39

Etiology: Bone cancer

Question 40

Determine the patient’s general health Ask the patient if they have had previous radiation therapy Clinical manifestations depend on the type of lesion Diagnostic

Answer 40

Bone cancer: assessment

Question 41

Pain Local swelling Tender, palpable mass is possible

Answer 41

Clinical manifestations depend on the type of lesion - Bone cancer: assessment

Question 42

X-rays - pathological fractures, tumor, mass CT - pathological fractures, tumor, mass MRI - pathological fractures, tumor, mass Needle bone biopsy - definitive

Answer 42

Diagnostic - Bone cancer: assessment

Question 43

For primary tumors, treatment is aimed at reducing the size of or removing the tumor Palliative therapies are to treat metastatic bone tumors Nonsurgical Surgical - depends on location tumor, type it is, what caused it

Answer 43

Bone cancer: interventions

Question 44

Drug therapy (includes chemotherapy) Radiation therapy - good for bone therapy for palliative to reduce tumor and help with pain Interventional Radiology

Answer 44

Nonsurgical - Bone cancer: interventions