[Exam 1] Chapter 41: Management of Patients with Musculoskeletal Disorders

Question 1

Benign Bone Tumors: What are these?

Answer 1

Slow growing, well circumscribed, and encapsulated. Present few symptoms.

Question 2

Benign Bone Tumors: This includes which types?

Answer 2

Osteochondroma, enchondroma, bone cysts, osteoid osteoma, rhadbaomyoma and fibroma

Question 3

Benign Bone Tumors: What is the most common type?

Answer 3

Osteochondroma, which shows as large projection of bone at end of long bones (knees or shoulders) during growth. Then becomes a static bony mass.

Question 4

Benign Bone Tumors: Whatr are bone cysts?

Answer 4

Are expanding lesions within the bone.

Question 5

Benign Bone Tumors: What is seen in young adults for bone cysts?

Answer 5

Aneurysmal (Widening), and present with a painful, palpable mass of long bones, vertebrae or flat bone

Question 6

Benign Bone Tumors: When do unicameral bone cysts occur?

Answer 6

Most often within first two decades of life and cause mild discomfort and possible pathjologic fracture of humerus.

Question 7

Benign Bone Tumors: What is a osteoid osteomam?

Answer 7

Painful tumor that occurs in children and young adults. Surrounded by reactive bone formation that can be seen on xray.

Question 8

Benign Bone Tumors: Wat is a enchondroma?

Answer 8

Common tumor of the hyaline cartilage that develops in hand, femur, or humerus.

Question 9

Malignant Bone Tumors: Usually arise from what?

Answer 9

Connective and supportive tissue cells (sarcomas) or bone marrow elements

Question 10

Malignant Bone Tumors: Types of this include?

Answer 10

osteosarcoma, chondrosarcoma, ewing sarcoma and firosarcoma.

Question 11

Malignant Bone Tumors: Osteosarcoma is the most common what

Answer 11

fatal primary malignant bone tumor. Diagnsosis depends if it has metastasized to the lungs.

Question 12

Malignant Bone Tumors: Osteosarcoma presents msot often with who

Answer 12

children, adolescents, young adults and older adults with paget disease.

Question 13

Malignant Bone Tumors: Osteosarcoma CMs?

Answer 13

localized bone pain, that can be accompanied by tender, palpable soft tissue mass.

Question 14

Malignant Bone Tumors: Malignant tumors of the hyaline cartilage are called what

Answer 14

chondrosarcomas , where they grow and metastasize slowly or very fast depending on characteristics of tumor cells involved.

Question 15

Metastatic Bone Disease: Is this more comon than primary bone tumors?

Answer 15

No

Question 16

Metastatic Bone Disease: What is this?

Answer 16

Tumors that arise from tissues elsewhere in the body that may invade the bone and produce localized bone destruction or bone overgrowth.

Question 17

Metastatic Bone Disease: Most primary sites of tumors that metastasize to boen include?

Answer 17

Kidney, prostate, lung, breast, ovary.

Question 18

Bone Tumors. CMs: What signs may they show?

Answer 18

Symptom free, or may show weight loss, malaise, and fever.

Question 19

Bone Tumors. CMs: What may occur with spinal metastasis?

Answer 19

Spinal cord compression.

Question 20

Bone Tumors. CMs: What neurologic deficits may occur?

Answer 20

Progressive pain, weakness, gait abnormality, paresthesia, paraplegia, urinary retention , and los of bowel

Question 21

Bone Tumors. Assess/Diagnostic: Diagnostic studies may include what

Answer 21

CT, bone scans, myelography, arteriography, MRI, biopsy, biochemical assays of blood and urine.

Question 22

Bone Tumors. Assess/Diagnostic: Why are Chest X-Rays performed?

Answer 22

To determine the presence of lung metastasis.

Question 23

Bone Tumors. Assess/Diagnostic: How are serum ALP levels here?

Answer 23

Frequently elevated with osteogenic sarcoma or bone metastasis.

Question 24

Bone Tumors. Assess/Diagnostic: What electrolyte dysfunction may be present?

Answer 24

Hypercalcemia from breast, lung, or kidney cancer.

Question 25

Bone Tumors. Assess/Diagnostic: Symptoms of hypercalcemia?

Answer 25

Muscle weakness, fatigue, anorexia, N/V, polyuria, cardiac dysrhythmias, seizures

Question 26

Bone Tumors. Medical Mx of Primary Bone Tumors: Goal here?

Answer 26

Destroy or remove the tumor rapidly. May be accomplished by surgical excisioon, radiation therapy and chemotherapy.

Question 27

Bone Tumors. Medical Mx of Primary Bone Tumors: Major gains are being made with what procedures?

Answer 27

Wide bloc excision with restorative frafting technique

Question 28

Bone Tumors. Medical Mx of Primary Bone Tumors: If possible, what procedures are used?

Answer 28

Limb-sparing (salvage)

Question 29

Bone Tumors. Medical Mx of Primary Bone Tumors: What can replace teh resected tissue?

Answer 29

Customized prosthesis, total joint arthroplasty, or bone tissue from patient (Autograft) or from donro (allograft)

Question 30

Bone Tumors. Medical Mx of Primary Bone Tumors: Complications from grafting?

Answer 30

infection, lossening or dislocation of prosthesis, allograft nonunion, fracture, and devitalization of the skin

Question 31

Bone Tumors. Medical Mx of Primary Bone Tumors: What is usually doen before and after surgery?

Answer 31

Chemotherapy due to danger of metastasis .

Question 32

Bone Tumors. Medical Mx of Secondary Bone Tumors: Treatment of advanced metastic bone cancer?

Answer 32

Palliative. Goal is to relieve the patients pain and discomfort.

Question 33

Bone Tumors. Medical Mx of Secondary Bone Tumors: What to do if bone weakened?

Answer 33

Structural support and stabilization are needed to prevent fracture.

Question 34

Bone Tumors. Medical Mx of Secondary Bone Tumors: How are bones strengthened?

Answer 34

By prophylactic internal fixtion, arthroplasty or PMMA reconstruction.

Question 35

Bone Tumors. Medical Mx of Secondary Bone Tumors: Are at higher risk than other patients for what problems postop

Answer 35

pulmonary congestion, hypoxemia, VTE and hemorrhage

Question 36

Bone Tumors. Medical Mx of Secondary Bone Tumors: What is frequently disrupted by tumor invasion?

Answer 36

Hematopoiesis, but blood compoennt therapy can help resture this.

Question 37

Bone Tumors. Nursing Mx: What does the nurse usually ask the patient?

Answer 37

About the onset and course of symtpoms.

Question 38

Bone Tumors. Nursing Mx: During interview, what does te patient assess?

Answer 38

Nurse assesses the patietns understanding of disease, how patient has been coping, and how they've managed pain.

Question 39

Bone Tumors. Delayed Wound Healing: Why may this occur?

Answer 39

Because of tissue trauma from surgery, previous radiation therapy, inadequate nutrition,, or infection.

Question 40

Bone Tumors. Delayed Wound Healing: How does nurse help here?

Answer 40

Minimizes pressure on wound site ot promote circulation ot tissues. Aseptic wound dressing promtoes healing.

Question 41

Bone Tumors. Delayed Wound Healing: How to reduce skin breakdown?

Answer 41

Respositioning the patient at frequent intervals

Question 42

Bone Tumors. Inadequate Nutrition: What can be given to help with this?

Answer 42

Antiemetic agents and relaxation techniques reduce teh adverse GI effects of chemotherapy.

Question 43

Bone Tumors. Inadequate Nutrition: How is stomatitis controlled?

Answer 43

With anesthetic or antifungal mouthwash.

Question 44

Bone Tumors. Osteomyelitis and Wound Infections: What is done to diminsih this?

Answer 44

Prophylactic antibiotics and strict aseptic dressing techniques.

Question 45

Bone Tumors. Osteomyelitis and Wound Infections: Why must other infections need to be prevented?

Answer 45

So that healing efforts are not divided between the cancer and the new acute process.

Question 46

Bone Tumors. Hypercalcemia: Symptoms of this>

Answer 46

Muscular weakness, incoordination, anorexia, N/V, oconstipaion, ECG changes and AMS.

Question 47

Bone Tumors. Hypercalcemia: Treatment includes?

Answer 47

Hydration with IV administration of normal saline, siuresis, mobilization, and meds like IV biphosphonates.

Question 48

Bone Tumors. Hypercalcemia: What can the nurse help assist with?

Answer 48

Increasing the activity and ambulation to decrease calcium in blood.

Question 49

Bone Tumors. Hypercalcemia: What is given if not responsive to IV biphosphonates?

Answer 49

DEnosumab

Question 50

Bone Tumors. Educating About Self-Care: Patient education includes what?

Answer 50

Med, dressing changes, treatment regimens, and important of phusical and Ot programs