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NUR 340 > Chapter 36: Management of Patients with Musculoskeletal Disorders > Flashcards

Chapter 36: Management of Patients with Musculoskeletal Disorders Flashcards

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1
Q

frequent comorbidities of low back pain

A

depression, smoking, alcohol abuse, obesity, stress, kidney disorders, pelvic problems, retroperitoneal tumors, abdominal aortic aneurysms `

poor posture and body

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2
Q

low back pain diagnostic test

A

MRI

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3
Q

candidates for spinal surgery

A

back and leg pain that limits normal activity or impairs quality of life
development of neurological deficits (leg weakness or numbness)
loss of normal bowel function
difficultly standing or walking
medication and PT are ineffective
reasonably good health

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4
Q

nursing intervention for back pain

A

pain management
exercise (get up early)
body mechanics
work modifications
stress reduction
health promotion (weight management)
dietary plan

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5
Q

proper body mechanics

A

bend at the knees, good posture

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6
Q

postop back surgery priorities

A

pain management
monitor surgical site for excess bleeding, drainage, and infection
vitals signs- O2, BP (low= bleeding, sepsis, reaction to meds), respiratory depression, tachycardia (hypovolemic, pain)

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7
Q

postop back surgery nursing diagnosis

A

acute pain
impaired mobility
anxiety
risk for infection
urine retention

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8
Q

affect of anesthesia on urine and bowel function

A

can produce constipation and urine retention

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9
Q

Bursitis and Tendonitis

A

inflammatory conditions
common occur in the shoulder

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10
Q

loose bodies (joint mice)

A

occur in a joint space as a result of articular cartilage wear and bone erosion
these fragments can interfere with joint movement (locking the joint)

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11
Q

impingement syndrome

A

impaired movement of the rotator cuff of the shoulder

occur from repetitive overhead movement of the arm or from acute trauma resulting in irritation and inflammation of the rotator cuff tendons or the subacromial bursa as they grate against the coracoacromial arch

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12
Q

carpal tunnel syndrome

A

is 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

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13
Q

ganglion

A

collection of neurological gelatinous material near the tendon sheaths and joints - appears as a round, firm, cystic swelling (usually on the dorsal of the wrist)

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14
Q

dupuytren contracture

A

inherited autosomal dominant trait
progressive contracture (an abnormal shortening) of the palmar fascia that causes flexion of the fourth, fifth and sometimes middle finger rendering them useless

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15
Q
A
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16
Q

important assessment during the first 24 hours after hand or wrist surgery

A

neurovascular assessment (capillary refill, numbness and tingling, pulses, skin warm to touch)

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17
Q

pain control after surgery

A

ice first then heat
elevation to decrease swelling
pain medication

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18
Q

bursae

A

fluid filled sacs that prevent friction between the joint structures during joint activity

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19
Q

bursitis

A

bursae sacs that become inflamed

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20
Q

tendonitis

A

muscle tendon sheaths become inflamed with repetitive stretching

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21
Q

treatments of bursitis and tendonitis

A

both are inflammatory conditions that are self limiting (go away on their own with or without therapy). treatments are focused on pain relief, not a cure.

rest of the extremity
intermittent ice and heat
NSAIDS (control inflammation and pain)

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22
Q

loose bodies treatment

A

arthroscopic surgery to remove loose bodies

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23
Q

impingement syndrome signs and symptoms

A

edema from hemorrhage of these structures
pain
shoulder tenderness
limited movement
muscle spasm
eventual dies atrophy

may progress to partial or complete rotator cuff

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24
Q

patient education for impingement syndrome

A
  • rest the joint
  • support the affected arm on pillows while sleeping to keep from turning on to that shoulder
  • gradually resume motion and use of the joint
  • avoid working and lifting above shoulder level or pushing an object against a locked shoulder
  • perform ROM and strengthen exercises
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25
treatment of impingement syndrome
NSAIDS intra-articular injections of corticosteroids heat or cold application therapeutic exercise program is required to improve outcomes and function
26
those at high risk for carpal tunnel syndrome
women between 30 and 60 years of age women going through menopause or on birth control
27
common causes of carpal tunnel syndrome
caused by repetitive hand and wrist movements occupations that require frequent repetitive hand movements or flexing of the wrist (Construction workers, hair dressers, assembly lines workers, machinists)
28
signs and symptoms of carpal tunnel syndrome
pain, numbness, paresthesia, weakness along the median nerve distribution (thumb, index, and middle finger), night pain, fist clenching
29
three tests for carpal tunnel
tinels sign (lightly tapping over the nerve to see if it generates a tingling sensation) Phalen's test (pushing the dorsal surface of hands together and holding 30-60 secs) carpal compression test (pressure on median nerve within the carpal tunnel, located just distal to the wrist crease, positive if the responds with numbness and tingling within 30 secs)
30
plantar fasciitis
31
plantar fasciitis treatment
32
corn
33
corn treatment
34
callus
35
ingrown toenail
36
hammer toe
37
Hallux valgus (bunion)
38
flat foot (Pes Planus)
39
postoperative foot surgery education
Describe methods to prevent wound infection (e.g., keeping dressing clean and dry during activities of daily living). *Demonstrate how to assess neurovascular status. *Demonstrate control of edema by elevating extremity and applying ice intermittently if prescribed. *Observe prescribed weight-bearing, activity and exercise limits. *Demonstrate safe use of assistive devices, if appropriate. *Consume a healthy diet to promote healing.
40
after foot surgery, before discharge make sure to have (if needed)
home assistance assess structural characteristics of home, presence of stairs? rugs? clutter? - want to prevent future injuries
41
nursing interventions for foot surgery
neurovascular assessment relieve pain related to inflammation and edema improve mobility prevent infection patient education
42
osteoarthritis
noninflammatory degenerative disorder of the joints most common form of joint disease origin: primary (idiopathic) or secondary
43
what type of cartilage breaks down leading to osteoarthritis
articular cartilage
44
in osteoarthritis, what forms after the articular cartilage breaks down
osteophytes (bone spurs) that protrude into the joint space
45
osteoarthritis pain is worse in the ___
morning
46
in osteoarthritis, joint space is ____ leading to ____ joint movement
narrowed decreased
47
risk factors for osteoarthritis
older women obesity occupations (requiring laborious tasks) sports history of frequent injuries to the same area
48
signs and symptoms of OA
pain, stiffness, functional impairment joint pain aggravated by movement and relieved by rest morning stiffness, goes away 30 mins progressive onset enlarged joint decreased ROM most often in weight bearing joints (hips, knees, cervical and lumbar spine)
49
labs for osteoporosis
check Ca, Vitamin D, and phosphorous
50
osteoporosis
metabolic bone disorder the rate of bone resorption (osteoclasts) accelerates while the rate of bone formation (osteoblasts) slows down, causing a loss of bone mass
51
osteoclasts
think Consume break down calcium in bone so that most calcium is released
52
osteoblasts
excess calcium moves into bone which helps build bones
53
people with osteoporosis are at high risk for
fractures
54
Risk factors for Osteoporosis
think CALCIUM Calcium- low intake Age- hormonal changes Lifestyle - smoking, sedentary Caucasian or asian Inherited Underweight (low calcium levels already) Medications- steroids interfere with osteoblasts
55
signs and symptoms of osteoporosis
think FRAIL Fractures- hip, spine, wrist Rounding of upper back (kyphosis) Asymptomatic Inches off height Low back, hip, and neck pain
56
testing for osteoporosis
bone density scan (dexa scan) no calcium supplements for 24 hours before scans (no tums, rolaids, or vitamins)
57
medications for osteoporosis
Ca and Vitamin D supplements bisphosphonates (fosamax and bonava)
58
bisphosphonates
Up right for 30 minutes after admin** Alendronate (Fosamax) Ibandromate (Bonava) Can cause GI upset – give with full glass of water on empty stomach**
59
osteomalacia
softening and weakening of the long bones usually due to a deficiency in vitamin D
60
signs and symptoms of osteomalacia
pain, tenderness, and deformities bowing of bones
61
causes of osteomalacia
gastrointestinal disorders, severe renal insufficiency, hyperparathyroidism, and dietary deficiency
62
osteomalacia treatment
adding vitamin D to diet surgery- break bones and reset them
63
paget's disease
disorder of localized bone turnover (new bone grows over old bone) new bone is bnormally shaped, weak, and brittle. bones thin out - more risk for fractures
64
septic (infectious) arthritis
infection in the joint (synovial) fluid and joint tissues mostly common in knee and hip joints
65
People at risk for septic arthritis
those with diabetes, rheumatoid arthritis, or a skin infection
66
signs and symptoms of septic arthritis
warm, painful joints with decreased range of motion patient may have a fever
67
how to diagnose septic arthritis
culture of synovial fluid
68
treatment for septic arthritis
immobilization of the joint (wrist of knee brace), pain relief, and antibiotics
69
osteomyelitis
inflammation of bone or bone marrow, usually due to infection
70
osteomyelitis occurs because
extension of soft tissue infection direct bone contamination bloodborne spread from another site of infection
71
causative organisms of osteomyelitis
Methicillin-resistant Staphylococcus aureus Proteus and Pseudomonas spp., Escherichia coli
72
treatment for osteomyelitis
antibiotics for 4-6 weeks
73
signs and symptoms of osteomyelitis
leukocytosis, elevated sed rat, positive culture, fever, swelling, redness, warmth on affected area, localized pain, edema erythema, drainage
74
osteomyelitis interventions
relieving pain - immobilization - elevation -

NUR 340 (3 decks)

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