[M4] Musculoskeletal Disorders Flashcards
(85 cards)
1
Q
What is osteoarthritis (OA)?
A
slowly, progressive, noninflammatory disorder of the synovial joints involving the gradual loss of articular cartilage with formation of bony outgrowths at joint margins
2
Q
What are the risk factors for developing OA?
A
- age
- decreased estrogen at menopause
- obesity
- ACL injury
- frequent kneeling or stooping
3
Q
What can decrease risk of developing OA?
A
regular, moderate exercise, avoid smoking, healthy diet
4
Q
How does OA manifest in the joints?
A
- asymmetric (unlike RA)
- mild discomfort to significant disability
joints appear red, swollen, and tender - stiffness occurs after periods of rest or unchanged position
5
Q
What distinguishes OA from rheumatoid arthritis?
A
OA morning stiffness usually resolves within 30 minutes
RA morning stiffness lasts from 60 mins. to several hours and is accompanied by fever, fatigue, and additional organ involvement
6
Q
What is crepitation?
A
grating sensation of joints caused by loose cartilage particles in the joint cavity, causing stiffness
7
Q
What is the best way to diagnose OA? Why?
A
x-rays
x-rays detect joint space narrowing, increased bone density, and osteophytes
8
Q
What are some additional diagnostic tests for OA? Any labs?
A
- bone scan, CT, and MRI - show early joint changes
- synovial fluid analysis - helps distinguish OA from other types of inflammatory arthritis
9
Q
What is involved in the treatment plan for OA?
A
pain management, prevent further disability, and maintain/improve joint function
10
Q
What are some common medications for treating OA?
A
- NSAIDs
- DMOADs
- topical agents
- COX-2 inhibitors (Celebrex)
- intraarticular corticosteroid injections
11
Q
Why are DMOADs beneficial for OA treatment?
A
theorized to slow the progression and support joint healing
12
Q
Why are intraarticular corticosteroid injections useful for OA?
A
systemic corticosteroids may hasten the disease process
13
Q
What should be taught to a patient with OA?
A
- balance rest and activity
- rest affected joint(s) during periods of acute inflammation
- adjust home management/routine to cushion joints (rugs, supportive shoes, etc.)
- avoid standing, kneeling, or squatting for long periods of time
14
Q
What non-drug therapies are used for OA? Why do they work?
A
- ice - helps reduce swelling during acute inflammation
- heat - useful for stiffness by improving blood flow to the area and increases flexibility
15
Q
What kind of exercise should an OA patient do?
A
aerobic conditioning, gentle ROM, and strength building
16
Q
What is osteoporosis (OP)?
A
chronic, progressive metabolic bone disease marked by low bone mass and deterioration of bone tissue which leads to bone fragility
17
Q
What are the risk factors for developing OP?
A
- age (> 65)
- female and estrogen deficiency
- low body weight
- smoking/excessive alcohol intake
- family history
- long term corticosteroid, THY replacement, or antiseizure drug use
18
Q
What are the early manifestations of OP?
A
back pain and spontaneous fractures
19
Q
How does OP manifest as it progresses?
A
most commonly affects spine, hips, and wrists with gradual loss of height; causes kyphosis or “dowager’s hum”
20
Q
What is the most important factor for diagnosing OP?
A
history and physical
21
Q
What are some additional tests for OP? Why/Why not are these the best options?
A
- bone mineral density - detects bone deterioration
- x-ray/lab studies - not applicable until 25 - 40% bone loss
22
Q
What should be priority in OP care planning?
A
- proper nutrition
- calcium and vitamin D supplementation
- exercise
- prevention of falls and fractures
- cease smoking and decrease alcohol intake
23
Q
What type of exercise should a patient with OP be doing? Provide example(s).
A
weight bearing
walking 30 mins a day, 3x a week, hiking, tennis, dancing
24
Q
Why are weight bearing exercises beneficial to a patient with OP?
A
these build and maintain bone mass, and increases strength, coordination, and balance
25
What foods are good sources of calcium?
- milk and yogurt
- turnip greens/spinach
- cottage cheese
- sardines
26
What do **Bisphosphonates** do for OP? Provide example(s) of.
inhibits bone resorption and slow remodeling
Alendronate (*Fosamax*)
27
Your patient was prescribed Bisphosphonates for osteoporosis. What should you teach them?
- take with a FULL glass of water 30 minutes before food or other meds
- remain upright for at least 30 minutes after taking
- be aware of signs of osteonecrosis (rare)
28
What is **osteomyelitis** (OM)?
a severe infection of the bone, bone marrow, and surrounding soft tissue
29
What is the most common cause of OM?
*Staphylococcus aureus*
30
Explain the etiology/pathophysiology of OM.
caused by indirect or direct entry (direct most common at 80%)
microorganism enters the blood, spreads through the bone, cortex, and marrow, obstructing blood flow; harder for WBCs and Anti–Bs to reach the infection
31
What are the **local** manifestations of OM?
- constant pain that worsens with activity, unrelieved by rest
- swelling, tenderness, and warmth at site
- restricted movement of affected part
32
What are **systemic** manifestations of OM?
- fever
- night sweats/chills
- restlessness
- nausea
- malaise
- drainage (late)
33
How is OM diagnosed? Any labs?
- bone or soft tissue biopsy
- blood/wound cultures
- WBC count
- radionuclide WBC scan
- ESR/C-reactive protein
- MRI/CT/bone scans
34
What test is the best way to diagnose OM? Why?
MRI/CT scans
shows the infection and detects bone marrow edema
35
What labs would be increased in a patient with OM? Why?
WBC, ESR, and CRP
only with acute infection; detects inflammation
36
What should be considered/taught when prescribing antibiotic treatment for OM?
- get cultures or bone biopsy prior to start
- lengthy antibiotic therapy can cause an overgrowth of *Candida albicans* and *C. diff*
37
How long is a patient with OP on Bisphosphonates?
5 years
38
How long does IV antibiotic therapy last for a patient with OM?
4 - 6 weeks (some need 3 - 6 months)
39
What are the additional support methods for OM treatment/management?
| think of necrotizing fasciitis in Grey's/ER
- casts or braces
- negative-pressure wound therapy
- hyperbaric oxygen therapy
- removal of prosthetic devices
- muscle flaps, skin/bone grafts
- amputation (only in extreme cases)
40
What is the preferred treatment of choice for **acute** OM?
prolonged antibiotic therapy
41
What is a **sprain**?
injury to the ligaments around a joint
42
What complications can arise from a sprain?
dislocation or subluxation due to joint instability
43
What is a **strain**?
excessive stretching of a muscle and fascia (can involve a tendon)
44
What is a **dislocation**?
complete displacement or separation of the articular surfaces of the joint
45
What complications can arise from a dislocation?
risk of vascular injury or necrosis of bone tissue due to lack of oxygen (considered an "orthopedic emergency")
46
What is the difference between an **open reduction** and a **closed reduction**?
open - joint stabilization/resetting through surgery
closed - done under local/general anesthesia to realign and rest the joint without incision
47
What is a **contracture**?
stiffening of tendons and ligaments
48
What factors influence soft tissue healing?
- blood supply
- immobilization
- internal fixation devices
- risk of infection
- poor nutrition
- age
- smoking
49
What is the main treatment for sprains and strains?
RICE (rest, ice, compression, elevation)
50
What is involved with nursing management for fractures?
- NV/circulation checks
- realignment
- casting/immobilizing
51
What is an **open** fracture?
skin is broken and bone is exposed, causing soft tissue injury
52
What are **tendons**? What do they do?
dense, fibrous tissue that attaches **muscle** to **bone**
aids in movement when muscles contract or shorten
53
What are **ligaments**? What do they do?
dense, fibrous tissue that connects **bone** to **bone**
provides joint stability and strength
54
What is a **complete** fracture? Provide example(s).
the break went through the entire bone (snap)
transverse, oblique, spiral, comminuted
55
What is an **incomplete** fracture? Provide example(s).
the break went partially across the shaft, but the bone is still intact
greenstick, stress
56
What is a **closed** fracture?
skin remains intact after break
57
What is a **nondisplaced** fracture?
fracture occurred but bone fragments remain in alignment
58
What is a **displaced** fracture?
fracture occurred and 2 ends of the broken bone are separated from each other
59
Name the fracture types from LEFT to RIGHT.
transverse, stress, oblique (displaced), greenstick, comminuted
60
What is **traction**?
pulling force applied to an injured or diseased body part or extremity
61
What qualifies as a **hip fracture**?
fracture to the proximal third of the femur
62
Hip fractures are most common among who?
older adults, women
63
Why is traction used in fractures?
to prevent pain, immobilize, reduce dislocated fracture, prevent soft tissue damage and promote ROM
64
What is included in nursing management for sustained traction in a fracture?
| (weighted traction)
- neurovascular checks
- maintain proper body alignment
- monitor for infection with skeletal/open traction
- assess for complications from pressure and devices
- WEIGHTS SHOULD NEVER TOUCH THE FLOOF
65
What is the **5 Ps Assessment**?
- pain
- paresthesia
- paralysis
- pulse
- pallor
66
What is the **CMS Assessment**?
- circulation - color/temp, cap refill/pulses
- motion - movement below injury site
- sensation
67
What are important nursing considerations following a patient's TOTAL hip replacement?
- use elevated toilet
- keep hip in neutral condition
- use seat or shower chair
- DO NOT ROTATE OR MOVE HIP!!
68
What is **external fixation**?
metal pins and wires are attached to external rods at the injury site to apply traction, compress fragments, and immobilize reduced fragments
69
When is external fixation used?
for complex fractures with extensive soft tissue damage, congenital bone defects, limb lengthening, or an attempt to save an extremity that may have required amputation
70
What should be used for pin-site care following external fixation?
chlorhexidine
71
What is **Halo Traction**?
most rigid cervical and spinal traction and immobilization
72
What are the time parameters for being weight bearing following an open or internal hip reduction?
6 - 12 weeks
73
What should be assessed long term following external fixation?
5 Ps along with pin loosening and infection
74
What are some important considerations regarding care for a patient with Halo Traction?
- tape an emergency wrench at the HOB for emergency intervention
- NEVER use the halo vest to lift or reposition a patient
- turn the patient every 2 hours
- assess the skin every 2 hours in the acute phase, then every 4 hours
- change the sheepskin liner weekly
75
What is included in nursing management for patients with a cast?
- 5 Ps and CMS assessments
- elevate limb to decrease pain and edema
- educate patient not to get the cast wet
- instruct patient to use a hair dryer on the "cool" setting to alleviate itching; don't place items in the cast
76
What is **compartment syndrome**?
when swelling causes increased pressure within a limited space, cutting off blood supply
77
What are the important considerations regarding treating compartment syndrome?
- do not elevate the extremity above the heart
- do not apply cold
78
What are the treatment options for compartment syndrome? Explain what they are.
- fasciotomy - linear incision along the fascia to alleviate pressure and allow for expansion of fluid and tissues
- bivalve cast - cast split on both side to relieve pressure
79
What are **early** signs of compartment syndrome?
- pain unmanaged by drugs and out of proportion from injury
- paresthesia
80
What can happen if compartment syndrome isn't treated?
necrosis/necessary amputation
81
What is *phantom limb pain**?
perceived pain in missing part of limb
82
What are the treatment options for phantom limb pain? Why might this work?
- mirror therapy
- VR treatment
visual information replaces sensory feedback in the brain
83
What is a **fat embolism**?
systemic fat globules from fracture that are distributed to tissues and organs (especially lungs and brain)
84
When are fat emboli most common?
following fracture of long bones, ribs, tibia, and pelvis
85
What are the signs of a fat embolism?
- vision changes
- trouble breathing
- tachycardia
- changes in mental state and vision
- fever
- jaundice
- petechial rash
