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NURS3313 Adult Health > Chapter 36 Management of Patients w/ Musculoskeletal Disorders > Flashcards

Chapter 36 Management of Patients w/ Musculoskeletal Disorders Flashcards

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1
Q

Osteoporosis

A

A bone disorder primarily affecting older people in which the bones become porous, brittle, and more prone to fracture

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2
Q

Osteoporosis Risk Factors

A

Small-framed women ( less bones)

Postmenopausal women (drop in estrogen)

History of bone fractures during adulthood

History of impaired glucose tolerance and diabetes

Asian, Caucasian, and African American women

Poor calcium intake due to lactose intolerance

Use of aromatase inhibitors in women with breast cancer (blocks estrogen)

Bariatric surgery (bypasses duodenum where Ca+2 is absorbed)

GI disease that cause malabsorption (e.g., celiac disease, alcoholism)

Autoimmune disease (e.g., rheumatoid disease)

Men >60 years of age

Corticosteroid therapy >3 months

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3
Q

What disease is the precursor to osteoporosis?

A

Osteopenia

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4
Q

Osteopenia

A

Thinner than average bone density

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5
Q

Primary Osteoporosis

A

Mainly occurs in post-menopausal women due to low vitamin D levels & failure to develop optimal peak bone mass

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6
Q

Secondary Osteoporosis

A

Result of medications or diseases that affect bone metabolism, such as celiac disease & hypogonadism

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7
Q

Meds That Can Lead to Secondary Osteoporosis

A

Anticonvulsants (phenytoin, [Dilantin])

Thyroid replacement agents (levothyroxine [Synthroid])

Antiestrogens (medroxyprogesterone [Depo-Provera])

Androgen Inhibitors (leuprolide [Lupron])

Proton Pump Inhibitors (esomeprazole [Nexium])

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8
Q

Osteomalacia

A

Abnormal softening of bones in adults

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9
Q

What vitamin deficiency s present in pts w/osteomalacia?

A

Activated Vitamin D

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10
Q

Clinical Manifestations of Osteomalacia

A

Soften, weakened bones

Skeletal deformities (spinal kyphosis and bowed legs)

Waddling gait

Pain and tenderness to touch

Pathologic fractures

Fall risk

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11
Q

Diagnostic Studies for Osteomalacia

A

X-ray and lab studies: serum calcium, phosphorus, and ALP

Urine test

Bone biopsy

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12
Q

Nursing Interventions to Decrease Risk for Fractures & Associated Disability

A

Early identification for at-risk teens and young adults

Increased calcium and vitamin D intake

Regular weight-bearing exercise

Lifestyle modifications

  • Reduced use of caffeine, tobacco products, carbonated drinks, and alcohol
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13
Q

Diagnostic Studies for Osteomalacia

A

X-ray and lab studies: serum calcium, phosphorus, and ALP

Urine test

Bone biopsy

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14
Q

Nursing Interventions for Osteomalacia

A

Reduce discomfort and pain

Calcium and/or vitamin D supplement for malabsorption

Exposure to sunlight

Diet rich in calcium and vitamin D

Braces or surgery for persistent orthopedic deformities

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15
Q

Paget’s Disease

A

A disease of unknown origin that is characterized by extensive breakdown of bone tissue followed by abnormal bone formation.

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16
Q

In the initial phase of Paget’s disease…

A

…excessive bone reabsorption occurs

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17
Q

The second phase of Paget’s disease involves…

A

…excessive abnormal bone formation

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18
Q

Clinical Manifestations of Paget’s Disease

A

Severe, persistent pain that worsens w/weight-baring

Impaired mvmt

Cranial enlargement (frontal & occipital areas)

Headaches w/skull involvement

Impaired hearing

Visual acuity

Kyphosis

Barrel chest

Asymmetrical bowing of the tibia & femur

Waddling gait

Forward bent spine and is rigid

Chin rests on the chest

Arms are bent outward and forward, appearing long in relation to the shortened trunk

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19
Q

Associated Assessment & Diagnostic Findings of Paget’s Disease

A

Elevated serum ALP concentration and urinary hydroxyproline excretion

-Higher values suggest more active disease

Patients w/ Paget disease have normal blood calcium levels

X-rays: Local areas of demineralization and bone overgrowth in the characteristic mosaic patterns

Bone scans demonstrate extent of disease

Bone biopsy may provide differential diagnosis w/ other bone diseases

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20
Q

Medical Management of Paget’s Disease

A

NSAIDS, Bisphosphonates, and Plicamycin

Walking aids, shoe lifts, and PT

Weight control

Diets adequate in calcium and vitamin D and periodic monitoring

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21
Q

Gerontological Considerations

A

Educate patients, families, and caregivers on how to compensate for altered musculoskeletal functioning with an emphasis on the risk of falls

Assess the home environment for safety to prevent falls and reduce the risk of fracture

Develop strategies for coping with a chronic health problem and its effect on quality of life

Provide alternative communication devices (e.g., text telephone, telecommunication device for the deaf) and home safety alarms if need

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22
Q

Osteomyelitis

A

Infection of the bone that results in inflammation, necrosis, and formation of new bone

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23
Q

High-Risk Patients for Osteomyelitis

A

Older adults

Poorly nourished or obese

Impaired immune systems

Chronic illnesses (diabetes, RA)

Receiving long-term corticosteroid therapy or immunosuppressive agents

IV drug users

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24
Q

Risk Factors of Osteomyelitis

A

Older age
 Diabetes
 Long-term corticosteroid therapy
 History of previous injury, infection, or
orthopedic surgery

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25
Clinical Manifestations of Osteomyelitis
Bloodborne infections: -Clinical and lab s/s of sepsis (e.g., chills, high fever, rapid pulse, general malaise) -Systemic symptoms may shadow local s/s at first - Infected area becomes painful, swollen and extremely tender as the infection extends -Patient reports constant, pulsating pain that intensifies with movement No systemic s/s when spread of adjacent infection or from direct contamination Non-healing ulcer with intermittent and spontaneous pustulous drainage with chronic osteomyelitis Diabetic osteomyelitis can occur without external wound: - Non-healing fracture - Foot ulcer > 2 cm in diameter
26
Physical Exam of Osteomyelitis
Signs & Symptoms of localized pain Warm, inflammed, edematous area, tender to touch Erythema Fever Recurrent purulent drainage of an infected sinus Altered gait
27
Associated Assessment & Diagnostic Findings for Osteomyelitis (Acute vs. Chronic): Wound & Blood Cultures
Acute: only positive in 50% of cases; antibiotic treatment initiated without results Chronic: frequently unreliable for isolating organism, therefore, open bone biopsy is indicated
28
Associated Assessment & Diagnostic Findings for Osteomyelitis (Acute vs. Chronic): X-Rays
Acute: soft tissue edema in early findings; periosteal elevation and bone necrosis evident after 2-3weeks Chronic: large, irregular cavities, raised periosteum, sequestra, or dense bone formations
29
Associated Assessment & Diagnostic Findings for Osteomyelitis (Acute vs. Chronic): Radioisotope Bone Scans
Acute: (isotope-labeled WBC scan) and MRI help with early definitive diagnosis Chronic: identify areas of infection
30
Associated Assessment & Diagnostic Findings for Osteomyelitis (Acute vs. Chronic): Blood Studies
Acute: leukocytosis and elevated ESR Chronic: ESR and WBC count usually normal; anemia may be evident
31
Medical Care of Osteomyelitis
Goal is prevention Elective orthopedic surgery postponed if infection present Urinary catheters and drains removed asap Pharmacological Therapy - Antibiotics -Prophylactic treatment at time of surgery and for 24hrs post op -Longer therapy than other infections; typically continues for 3-6 weeks; oral antibiotics when infection is controlled Surgical management: Debridement indicated if infection is chronic and not responsive to antibiotic therapy - All dead, infected bone and cartilage must be removed before healing can occur -Closed suction irrigation system may be used to remove debris -May be staged over time to ensure healing -Weakens bone, so internal fixations or external supportive devices may be needed to prevent pathologic fractures
32
Nursing Interventions for Osteomyelitis
Relieve pain Improve physical mobility Control the infectious process Educate patient about self-care  Adherence to therapeutic regimen of antibiotics  Maintenance of IV access and administration equipment at home  Medication name, dosage, frequency, admin rate, safe storage and handling, adverse reactions, and necessary laboratory monitoring Home health nurse if support questionable or if patient lives alone to assist with IV antibiotic therapy Stress importance of follow-up care appointments
33
Hematogenous Osteomyelitis
Caused by bloodborne spread of infection
34
Low Back Pain Causes
Acute lumbosacral strain Unstable lumbosacral ligaments & weak muscles Intervertebral disc problems Unequal leg length
35
Gerontological Considerations for Low Back Pain
Older adults may experience back pain associated w/ osteoporotic vertebral fractures, osteoarthritis of the spine, & spinal stenosis
36
Diagnostic Studies for Low Back Pain: Spinal X-Rays
May demonstrate a fracture, dislocation, infection, osteoarthritis or scoliosis
37
Diagnostic Studies for Low Back Pain: Bone Scan & Blood Studies
May disclose infections, tumors, & bone marrow abnormalities
38
Diagnostic Studies for Low Back Pain: CT Scan
Useful in identifying underlying problems, such as obscure soft tissue lesions adjacent to the vertebral column & problems of the vertebral discs
39
Diagnostic Studies for Low Back Pain: MRI Scan
Permits visualization of the nature & location of the spinal pathology
40
Diagnostic Studies for Low Back Pain: Electromyogram (EMG) & Nerve Conduction Studies
Used to evaluate spinal nerve root disorders (radiculopathies)
41
Diagnostic Studies for Low Back Pain: Myelogram
Permits visualization of segments of the spinal cord that may have herniated or may be compressed Indications: When an MRI cannot be performed
42
Diagnostic Studies for Low Back Pain: Ultrasound
Useful in detecting tears in ligaments, muscles, tendons, & soft tissues in the back
43
Prevention Strategies for Acute Low Back Pain
Weight reduction as needed Stress reduction Avoid high heels Walk daily & gradually increase the distance & pace of walking Avoid jumping & jarring activities Stretch to enhance flexibility - Do strengthening exercises
44
Body Mechanics for Acute Low Back Pain
Practice good posture Avoid twisting, lifting above waist level, & reaching up for any length of time Push objects rather than pull them Keep load close to the body when lifting Lift w/ large leg muscles & not back muscles Squat while keeping back straight when it is necessary to pick something up off the floor Bend your knees & tighten your abdominal muscles when lifting Avoid overreaching or a forward flex position Use a wide base of support
45
Work Modification for Acute Low Back Pain
Adjust the height of chair using a footstool to position knees higher than the hips Adjust height of work area to avoid stress on the back Avoid bending, twisting, & lifting heavy objects Avoid prolonged standing & repetitive tasks Avoid work involving continuous vibrations Use lumbar support in straight back chair w/ arm rests When standing for any length of time, rest one foot on small stool/box to relieve lumbar lordosis
46
Bursitis
Inflammation of a fluid-filled sac in a joint
47
Bursae
Fluid-filled sacs that prevent friction between joint structures during joint activity & are painful when inflamed
48
Tendonitis
Inflammation of muscle tendons
49
Conservative Treatment of Bursitis & Tendonitis
Rest of the extremity Intermittent ice & heat to the joint NSAIDs for pain control
50
(T/F) True or False: Tendon & bursae inflammatory conditions go away w/ or w/out treatment
True Treatment is primarily aimed at symptom relief, not cure
51
Impingement Syndrome
Generalized term that describes impaired movement of the rotator cuff of the shoulder
52
Radiculopathy
Pain radiating from a diseased spinal nerve root (down the leg)
53
Sciatica
Pain radiating from an inflamed sciatic nerve
54
Carpal Tunnel Syndrome
An entrapment neuropathy that occurs when the median nerve at the wrist is compressed by a thickened flexor tendon sheath, skeletal encroachment, edema, or a soft tissue mass
55
Risk Factors for Carpal Tunnel Syndrome
Women between the ages of 30-60 Women going through menopause or are taking estrogen & birth control pills (HIGHEST RISK!!) People employed in occupations that frequently require repetitive hand movements or flexing of the wrist - Hairdressers - Assembly-line workers Those exposed to vibrations when doing such tasks - Construction workers - Machinists
56
Carpal Tunnel Syndrome Causes
It is caused by repetitive hand & wrist movements Associated w/ RA, diabetes, acromegaly, hyperthyroidism, or trauma
57
Clinical Manifestations of Carpal Tunnel Syndrome
Pain, numbness, paresthesia &/or weakness along median nerve distribution - Thumb, index, & middle fingers Night pain &/or fist clenching upon waking Positive Tinel Signs: Elicited by percussing lightly over the median nerve near the inner aspect of the wrist - Reports tingling, numbness, or pain
58
Contusion
Soft tissue injury produced by blunt force
59
Signs & Symptoms of Contusions
Pain, swelling, and ecchymosis
60
Ecchymosis
Bruising/discoloration
61
Strain
Pulled muscle injury to the musculotendinous unit
62
Signs & Symptoms of Strains
Pain, edema, muscle spasm, ecchymosis, and loss of function are on a continuum graded 1st, 2nd, and 3rd degree
63
Sprain
Injury to ligaments & supporting muscle fiber around a joint
64
Signs & Symptoms of Sprains
Pain (may increase with motion), edema, tenderness; severity graded according to ligament damage and joint stability
65
Dislocation
Articular surfaces of the joint are not in contact
66
Signs & Symptoms of Dislocations
A traumatic dislocation is an emergency with pain change in contour, axis, and length of the limb & loss of mobility
67
Subluxation
Partial or incomplete dislocation (Does not cause as much deformity as a complete dislocation)
68
Management of Soft Tissue Injuries
Rest Ice Compression Elevation
69
What should the nurse assess to evaluate the effectiveness of alendronate (Fosamax) therapy for a patient with Paget's disease? A) Oral intake B) Daily Weight C) Grip strength D) Pain intensity
D) Pain intensity
70
Which information should the nurse include in the discharge teaching for a patient after 1 week of IV antibiotic therapy for acute osteomyelitis? A) How to apply warm packs to the leg to reduce pain B) How to monitor for & care for a long-term IV catheter C) The need for daily aerobic exercise to help maintain muscle strength D) The reason for taking oral antibiotics for 7-10 days after discharge
B) How to monitor for & care for a long-term IV catheter

NURS3313 Adult Health (27 decks)

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