MED SURGE MSK TEST 2

Question 1

What is osteomyelitis?
What are the signs and symptoms?

Answer 1

Bone infection (commonly from staph aureus), inflammation leads to ischemia, necrotic bone tissue>bone abscesses. S/S include acute fever and inflammation (redness, swelling, PAIN) and chronic ulceration and drainage and localized pain.

Question 2

What are diagnostics of osteomyelitis?

What is nursing care for osteomyelitis?

Answer 2

•Leukocytosis, high ESR, infection biopsy, +/- blood culture, MRI/XRAY/scan

•Sterile dressing, long term IV antibiotics, prevent osteomyelitis, sterile dressing change, hand hygiene

Question 3

True or False: amputation can occur in osteomyelitis

Answer 3

True

Question 4

Vancomycin leaked into a PTs blood stream. This can cause:

1. Hemorrhage
2. Infiltration
3. Infarction

Answer 4

2.

Question 5

A PT with osteoporosis may experience:
1. Morning stiffness and fever
2. High uric acid levels and inflamed joints
3. Decrease in height and spinal deformity

Answer 5

3.

Question 6

Who is at risk of developing osteoporosis ?

Answer 6

Females, white and Asian population, small/petite people, low estrogen and testosterone PTs, Pt with family history of osteoporosis, PTs with fracture history, PTs with poor eating habits, PTs who are sedentary, smoker PTs

Question 7

What kinds of treatment and teaching would an osteoporosis PT receive?

Answer 7

*Tx would include diet change, antiresorptive(bisphosphonates)/anaerobic meds, bone loss supplements
*teach PT risk factors, pain relief, med teaching

Question 8

Elevated ALP may indicate severe bone loss in what PT?

1. CHF PT
2. Osteomyelitis PT
3. Osteoporosis PT

Answer 8

3.

Question 9

Paget’s Disease is defined as ________ with ___ being a major symptom

Answer 9

Increased breakdown & formation of bone resulting in abnormal, weak bones that cause deformities, fractures, OA..PAIN is a major symptom

Question 10

Is there a cure for Paget’s disease?

Answer 10

No but biophosphonates reducing bone resorption, calcitonin, joint replacement, exercise,support system, pain relief may help

Question 11

A PT is admitted for their 3rd fracture in four months. They complain of severe pain in the chest and a lab panel returns with elevated ALP and ESR. An MRI returns showing multiple areas in the breast bones and ribs. PT also has swelling and palpable areas on the left breast. What concerns the nurse the most?

Answer 11

PT may have metastatic bone disease based on the MRI, angina prior fractures, and painful, palpable mass. Nursing care to provide is adjusting to possible diagnosis and chemotherapy.

Question 12

Define Gout and its signs and symptoms

Answer 12

Caused by possible inherited purine metabolism issues or a secondary medical condition, gout is purine breakdown resulting in crystals that cause inflammation in joints and connective tissue. S/S Acute gout attacks/acute severe pain/ acute redness, swelling, warmth, and pain in one (big toe) or many joints. chronic symptoms may not be present but renal stones can occur.

Question 13

What would a PTs diagnostic tests for gout include?

1. Elevated uric acid and joint fluid analysis for high crystal Lvls
2. Elevated ALP and scan for bone loss
3. Elevated uric acid and MRI

Answer 13

1.

Question 14

A PT with gout may need further teaching if they say the following:

1. “I will avoid any organ meats and alcohol to avoid gout attacks”
2. “I can continue to smoke and eat shellfish on Thursdays and Saturdays”
3. “Indocin and drinking water can help with my gout attacks”

Answer 14

2. Smoking and shellfish should be avoided

Question 15

What PTs should the nurse be concerned are at risk of osteoarthritis?

1. Pt who weighs 5’3 and is 300 lbs
2. Pt with asthma
3. Pt who is celebrating their 98th birthday
4. Pt who suffers from halitosis
5. Pt who presents nodes on their fingers
6. 78 Y.O. PT who fractured his shoulder three times as a former factory worker
7. PT who experiences pain with activities and no pain with rest
8. PT who just had a child and suffers from PPD

Answer 15

1. Because obesity
2. Because of age
3. Because bone nodes are a S/S
4. Because of age and history of repetitive joint trauma
   7.
5. Because those are S/S of OA

Question 16

With no current cure for OA, the main goal of ______ & _______ can be achieved with NSAIDs, rest & exercise, diet, heat/cold therapy, and surgeries

Answer 16

Optimum independence and pain management

Question 17

Osteoarthritis can result in localized _____, _____, & ______

Answer 17

Pain, swelling, & stiffness

Question 18

Rheumatoid arthritis is:

1. Chronic, progressive, systemic inflammatory disease
2. Bone infection resulting in possible antibiotic resistance from treatment
3. Concerning disease in which metastatized sites in bone appear

Answer 18

1.

Question 19

Pannus, which erodes and destroys joint bone and joint cartilage, Is associated with:

Answer 19

Rheumatoid arthritis

Question 20

True or false: osteoarthritis can affect connective tissues and organs

Answer 20

False. That’s rheumatoid arthritis

Question 21

A PT reports early morning stiffness and bilateral, symmetrical joint inflammation. The nurse suspects the PT is exhibiting:

Answer 21

Early symptoms of rheumatoid arthritis

Question 22

A PT that’s been diagnosed with RA asks a nurse what they can do to alleviate their symptoms. The nurse would suggest which of the following:

1. Antibiotics
2. Corticosteroids
3. Antihypertensives
4. Bronchodilators
5. Antioxidants
6. Elevating extremities
7. Heat therapy

Answer 22

1. 2. 5. 7.

Question 23

TJR is commonly performed when ______ and the ____ & ____ are the most common replacements

Answer 23

All other conservative option have been ineffective ; knee, hip

Question 24

Treat phantom pain as

Answer 24

Real pain…not be confused with phantom sensations

Question 25

Preoperative care for THR

Answer 25

Teaching/screening, meet with PT/OT,imaging and testing

Question 26

Postoperative for THR

Answer 26

OOB same day as surgery, prevent flexion/adduction of hip, early ambulation WT bearing per Dr.’s orders, observe wound dressing/drainage, watch for hypovolemia

Question 27

What should be found in the room of a PT post THR?

Answer 27

A frame pillow to keep

Question 28

A pt four days post-op THR bends at a 130 degree angle to sit in a chair. The PT hears a “pop” and immediately screams in pain for help. What has occurred and why?

1. The PT has fractured their knee due to hyper extension
2. The PT had dislocated their hip due to hyperflexion
3. The pt has dislocated their knee replacement due to adduction

Answer 28

2.

Question 29

A PT with a recent post-op THR should avoid:

1. Gardening
2. Swimming
3. Walking
4. Shuffleboarding
5. Using light weights

Answer 29

1. May cause hyper flexión
2. May cause internal rotation and adduction past midline

Question 30

PT may indicate further teaching if they say:

1. “To get off the bed, I put my arms on my knees and push up.”
2. “I should report bleeding to my nurse immediately”
3. “It’s important to stay hydrated and use barrier cream after surgery”
4. “I should avoid a dislocation by not sitting cross legged”

Answer 30

1. Because this would cause hyperextension

Question 31

The diet for a post op THR PT should include:

Answer 31

Fluid balance, protein intake, vitamin C, calcium, vitamin D, prenatals

Question 32

Why would a PT use a CPM machine post op?

1. To prevent scar tissue formation and stiffness
2. To promote skin integrity
3. To promote bone resorption

Answer 32

1.

Question 33

The goal of THR post op is to promote hyper— of the knee.

1. Extension
2. Flexion

Answer 33

1

Question 34

Surgical vs traumatic amputation

Answer 34

Surgical: ischemia >PVD, DM, bone tumors, thermal injuries, congenital problems …pt has time to adjust to amputee status
Traumatic: accidents —machinery, vehicles, lawn mower, chainsaw …pt doesn’t have time to process, monito for mental health status

Question 35

Prevention of hemorrhage/infection post OP is a priority for:

Answer 35

Amputations

Question 36

Amputation skin flap should be:

Answer 36

Flesh tone and warm, adequate profusion to stump’s skin flap

Question 37

Laying a pt ______ may prevent hip contractures post-amputation

1. Supine
2. Dorsal
3. Prone

Answer 37

3.

Question 38

Prolonged elevation can lead to

Answer 38

Contractures

Question 39

Because its a salicylate, an RA PT on aspirin may experience:
Select all that apply

Muscle soreness
1.Tinnitus
2.Sore throat
3.Headache
4.Bleeding gums
5.Tarry, black stools
6.Tachycardia

Answer 39

1,4,5,6

Question 40

An amputee one week post-amputation would probably have which meds prescribed:

1. Allopurinol and Febuoxtat
2. Cozaar and Albuterol
3. Neurotin and Elaviln

Answer 40

3. Aka gabapentin and amiriplyine; Lyrica (pregabalin), Inderal (propranolol) may also be prescribed

Question 41

Should a metastatic bone disease PT pursue surgery?

Answer 41

No. But radiation may be appropriate.

Question 42

A ______ should be in an amputee’s room

Answer 42

Tourniquet

Question 43

Bisphosphonates inhibit bone resportion in not only Pagets Disease PTs but also:

Answer 43

Osteoporosis PTs

Question 44

A gout PT is prescribed Allopurinol. What would the nurse include in their teaching?

1. It is used to maintain acute gout attacks
2. Bone pain is a side effect of the medicine
3. There’s a rash risk when using Allopurinol with Ampicillin
4. Vomiting and nausea are highly concerning
5. It is used for maintaining/preventing gout attacks

Answer 44

1. 3. 5.