Musculoskeletal 1 Flashcards
(77 cards)
1
Q
What are causes/risk factors for Low Back Pain?
A
- Muscle strain
- Unstable ligaments
- Intervertebral disc problems
- Unequal leg lengths
- Vertebral fractures
- Cauda equina syndrome
- Kidney problems (nonmusculoskeletal)
- Retroperitoneal tumors (nonmusculoskeletal)
- Abdominal aortic aneurysms (nonmusculoskeletal)
- Muscle disuse
- Obesity
- Poor posture
- Age
2
Q
What is Cauda Equina Syndrome?
A
Medical emergency
Compression of the cauda equina (bundle of nerves that arise from the lower portion of the spinal cord)
3
Q
What are clinical manifestations of Cauda Equina Syndrome?
A
- Lower back pain
- Bowel and bladder dysfunction
- Saddle anesthesia (paresthesia in perineal, inner thighs, buttocks)
4
Q
What is the treatment for Cauda Equina Syndrome?
A
- Surgical removal of vertebral fragments
- Decompression of a mass
5
Q
What are risk factors for spinal fractures?
A
- Advanced age
- Osteoporosis
- Prolonged corticosteroid use
- Potential elder abuse
6
Q
What are the diagnostic procedures for Low Back Pain?
A
X-Ray: may demonstrate a fracture, dislocation, infection, osteoarthritis, or scoliosis
Bone scan and blood studies: May disclose infections, tumors, and bone marrow abnormalities
CT: Useful in identifying underlying problems - soft tissue lesions, problems with vertebral discs
MRI: permits visualization of the nature and location of spinal pathology
Myelogram: visualizes spinal cord herniations, compressions (infrequently performed, only when MRI is contraindicated)
Ultrasound: useful in detecting tears in ligaments, muscles, tendons, soft tissues
7
Q
What is the medical management for Low Back Pain?
A
Usually resolves with analgesics, rest, avoidance of strain in 4-6 weeks
Acute cases:
- NSAIDs
- Muscle relaxants
- Severe pain: opioids
Chronic cases:
- May benefit from antidepressants
- Gabapentin
- SNRIs (Duloxetine)
- Treatment goal is 30% reduction from baseline
Nonpharmacologic:
- Heat/cold therapy
- Spinal manipulation
- Cognitive-behavioral therapy
- Physical therapy
- Acupuncture
- Massage
- Yoga
- limit prolonged sitting
- Walking and low stress aerobic exercised
8
Q
What is Bursitis and Tendonitis?
A
- Inflammation of the bursae or muscle tendon sheaths
- Caused by irritation of repetitive movement
- Typically in the shoulder
- Inflammation can lead to restricted joint movement
9
Q
What is the typical treatment for Bursitis and/or Tendonitis?
A
- Rest
- Ice/heat therapy
- NSAIDs
- Corticosteroid injections for short term relief
Treatment is aimed at pain relief, not cure
10
Q
What is Carpal Tunnel Syndrome?
A
- Compression of the median nerve at the wrist
- Due to repetitive movements, hormonal changes, or conditions like RA, diabetes, acromegaly, or hyperthyroidism
11
Q
Who is most likely at risk of experiencing Carpal Tunnel Syndrome?
A
- Women age 30-60
- Women going through menopause, using estrogen, or birth control
- Hairdressers
- Assembly line workers
- Construction workers
- Machinists
12
Q
What are clinical manifestations of Carpal Tunnel Syndrome?
A
- Pain
- Numbness
- Tingling
- Weakness in the thumb, index, and middle fingers
- Often worsening at night
13
Q
What is a positive Tinel Sign?
A
- Used to diagnose carpal tunnel syndrome
- Tingling when the median nerve is palpated
- Helps identify patients needing interventions
14
Q
What is the treatment for Carpal Tunnel Syndrome?
A
- Corticosteroids
- NSAIDs
- Acupuncture
- Wrist splints
Surgical options: (indicated when conservative treatments have failed)
- Open nerve release
- Endoscopic laser surgery (faster recovery and less scarring)
- Recovery can take weeks to months with splinting and limited hand use post-surgery
15
Q
What is Dupuytren Disease?
A
Slow, progressive contracture of the palmar fascia causing flexion of the 4th, 5th, and sometimes middle finger
16
Q
Who is most likely to develop Dupuytren Disease?
A
- Men over 50 of Scandinavian or Celtic descent with an autosomal dominant link
- Associated conditions: diabetes, arthritis, gout, smoking, and alcoholism
17
Q
What are clinical manifestations of Dupuytren Disease?
A
- nodules
- discomfort
- stiffness
- numbness
- often begins in one hand and later affects both
- contracture of 4th, 5th, and sometimes middle finger
18
Q
What is the treatment for Dupuytren Disease?
A
- Finger stretching exercises
- Corticosteroid or collagenase injections
- Advanced: surgical fasciotomy to restore function
19
Q
What is the definition of Osteoarthritis (OA)?
A
A non-inflammatory degenerative disorder of the joints, limited to the affected joint - not systemic
Classified as either primary (idiopathic), or secondary (resulting from previous joint injury or inflammatory disease, such as RA)
OA is the most common form of joint disease
20
Q
What are the risk factors for Osteoarthritis?
A
- Older age
- Female
- Obesity - most prominent modifiable risk factor
- laborious occupations
- Sports
- History of previous injuries or muscle weakness
- Genetic predisposition
- Certain diseases
21
Q
How is Osteoarthritis medically managed?
A
Goal: reduce pain/stiffness and maintain/improve joint mobility
- exercise, strength training
- weight loss
- physical and occupational therapy
- Devices: orthotics, braces, insoles, canes
Pharmacologic Therapy:
- Acetaminophen - (first line)
- Opioids (for severe pain) (Tramadol)
- Intra-articular corticosteroid injections
- Topicals: capsaicin, methylsalicylate, diclofenac sodium gel
- Methotrexate and colchicine - (considered last)
22
Q
What is a Joint Arthroplasty?
A
Surgical removal of an unhealthy joint and replacement of joint surfaces with metal or synthetic material
Total: all surfaces of the joint are replaced
Partial: only some surfaces are replaced
Common joints replaced: Hip, knee, finger joints
23
Q
What are common indications for Joint Arthroplasty?
A
- Osteoarthritis
- Severe joint pain or loss of function
- Rheumatoid Arthritis
- Trauma
- Congenital deformity
- Fractures
24
Q
What is Osteoporosis?
A
- Reduced bone mass and deterioration of bone matrix
- Normal turnover of bone is altered, rate of bone resorption is greater than bone formation
- Bone becomes brittle, porous, fragile, breaks easily under stress
Most prevalent bone disease in the world
25
What are common fractures seen with **Osteoporosis**?
* Spine
* Neck
* intertrochanteric region of the femur
* Colles’ fractures of the wrist *(commonly from falling with an outstretched hand)*
26
What is the typical loss of height with Osteoporosis and aging?
**Development of kyphosis with the collapse of vertebra**
* 1.5" loss within 15 years of menopause
* 3.5" loss within 25 years of menopause
27
What are the risk factors for **Osteoporosis**?
* Small framed women
* Asian and caucasion *(women)*
* Men older than 60
* Women who are post-menopausal
* Alcohol intake of 3 or more drinks/day
* Corticosteroid long term use
* Family history
* Inadequate calcium and Vit. D intake
* Low body mass index
* Malabsorption disorders *(e.g. eating disorders, celiac, bariatric surgery)*
28
How is **Osteoporosis** medically managed?
* Calcium and Vit D. diet/supplement
* Weight bearing/resistance exercises *(20-30 min/day)*
* Avoid excessive alcohol, quit tobacco
**Pharmacologic:**
* **Bisphosphonates:** inhibit osteoclasts *(Ex: Alendrondate)*
* **Estrogen Agonist/Antagonist:** Promotes estrogenic effect on bones, preserves BMD *(Ex: Raloxifene)*
* **RANKL inhibitor:** Monoclonal antibody - inhibits effect of TNF on osteoclasts, inhibiting their activity *(Ex: Denosumab)*
* **PTH Analogue:** synthetic PTH, increases bone strength and density *(Ex: Teriparatide)*
28
What are key sources of Calcium and Vitamin D rich foods?
* Dairy
* Broccoli
* Canned Salmon
* Calcium fortified OJ
29
What is **Osteomalacia**?
* A metabolic bone disease characterized by inadequate bone mineralization
* Softening and weakening of long bones
* Deficiency of activated Vitamin D, low extracellular calcium and low phosphate
30
What are risk factors for **Osteomalacia**?
* GI Disorders
* severe renal insufficiency
* hyperparathyroidism
* dietary deficiency
## Footnote
***Treatment involves correcting the underlying cause***
31
What are some clinical manifestations of **Osteomalacia**?
* Bone Pain
* Tenderness
* Deformities - bowing of the bones
* High risk of falls
* pathologic fractures
32
What is **Paget Disease**?
* Disorder of localized **rapid bone turnover**
* Occurs in the skull, femur, tibia, pelvic bones, and vertebrae
* Developing bone is disorganized, weak, highly vascular, prone to fractures
33
What are risk factors of **Paget Disease**?
* Men
* Older than age 50
* familial predisposition
* Cause is unknown
34
What are some clinical manifestations of **Paget Disease**?
* **Develops gradually without clear or obvious symptoms**
* May experience skeletal deformities
* Thickened skull/enlarged cranium
* Face appears small
* Femurs and tibiae may bow - causing waddling gait
* Spine bent forward and rigid
* Tenderness and warmth over bones
* Mild to moderate, deep and aching pain
35
What are some diagnostic procedures for **Paget's Disease**?
* Lab studies: Elevated serum alkaline phosphate concentration
* Urinalysis: elevated hydroxyproline excretion
* X-Ray: confirms diagnosis and reveals local areas of demineralization/bone overgrowth
36
How is **Paget's Disease** medically managed?
* NSAIDs
* Walking aids
* Shoe Lifts
* Physical Therapy
* Diets adequate in calcium and Vitamin D
37
What are some complications of **Paget's Disease**?
* Fractures
* Arthritis
* Hearing Loss
38
What is **Osteomyelitis**?
An **infection** of the bone causing inflammation, necrosis, and new bone formation
39
What are common causative organisms of **Osteomyelitis**?
* Staphylococcus aureus
* MRSA
* Proteus and Pseudomonas spp.
* E. coli
40
What is the cause of **Hematogenous Osteomyelitis**?
Bacteria travels through the bloodstream and infects bone
41
What is the cause of **Contiguous-focus Osteomyelitis**?
Bacteria enters the bone through direct contamination from surgery, open fracture, or traumatic injury
42
What is the cause of **Osteomyelitis with vascular insufficiency**?
Seen in patients with diabetes or peripheral vascular disease
43
What are the clinical manifestations of **Osteomyelitis**?
* Area becomes painful, swollen, and extremely tender
* Constant, pulsating pain, intensifies with movement
* Chronic osteomyelitis presents with a nonhealing ulcer overlying the affected bone
**Hematogenous Osteomyelitis:**
* Sudden onset
* Signs of sepsis: chills, high fever, rapid pulse, general malaise
**Diabetic Osteomyelitis:**
* Nonhealing fracture
* Any foot ulcer bigger than 2 cm is highly suspicious for osteomyelitis
44
How is **Osteomyelitis** medically managed?
***Goals: Control infection, provide supportive care, immobilize affected bone***
* **Antibiotics:** long term therapy *(6-12 weeks)*, starts as IV, may switch to oral once infection is under control
* **Surgery:** required for chronic and unresponsive infections
* **Wound care:** includes irrigation, packing, closure or grafting *(bone grafts or muscle flaps may be used to promote healing)*
* **Stabilization:** weakened bone may need internal fixation or external devices
45
What are some common **Benign Bone Tumors**?
* **Osteochondroma**: *most common*, occurs at end of long bones, rarely becomes malignant
* **Bone cysts**
* **Osteoid Osteoma**: Painful, seen in children/young adults
* **Enchondroma**: hyaliine cartilage-based, mild ache, may cause fractures
* **Giant Cell Tumors**: locally aggressive, may eventually become malignant and metastasize
## Footnote
***More common than malignant bone tumors, typically grow slower, are well-defined, and not life-threatening***
46
What are some common **Malignant Primary Bone Tumors**?
* **Osteosarcoma**: *most common and most fatal*
* **Chondrosarcoma** *second most common*
* **Ewing Sarcoma**
* **fibrosarcoma**
Sarcomas: Arise from connective tissues
Multiple Myeloma: arises from bone marrow
## Footnote
***More rare than benign tumors***
47
Who does **Osteosarcoma** affect most often?
* Children
* Young adults
* Older adults with Paget's disease
* Older adults with prior radiation exposure
48
What are the clinical manifestations of **Osteosarcoma**?
* Localized bone pain
* Soft tissue mass
*Common in rapidly growing bones: distal femur, proximal tibia, proximal humerus*
## Footnote
**Lung metastasis is common**
49
Who does **Chondrosarcoma** typically affect?
* Middle-aged adult
* Older adult
50
Which bones are typically affected by **Chondrosarcoma**?
* Pelvis
* Femur
* Humerus
* Spine
* Scapula
* Tibia
*Grows at varying rates depending on grade*
## Footnote
***Less than half metastasize to lungs***
51
Which primary cancer sites commonly metastasize to the bone?
* Kidney
* Prostate
* Lung
* Breast
* Ovary
* Thyroid
52
Where are metastatic bone tumors most frequently found?
* skull
* spine
* pelvis
* femur
* humerus
## Footnote
***These are called Secondary Malignant Bone Tumors***
53
How are **Bone Tumors** medically managed?
**Benign:** observation, medication, surgery
**Primary Malignant:** surgical excision, radiation therapy, chemotherapy
**Secondary Malignant:** Palliative care
54
What are **Nursing Interventions** for **Lower Back Pain**?
**Assess:**
* Emotional well being
* Neurovascular
* Ability to do ADLs
* Posture, gait, how they are changing positions
**Encourage:**
* Exercise
* Stress reduction
* Avoid long periods of sitting
* Weight reduction
**Educate:**
* Good shoe support
* Proper body mechanics and posture
* Shift weight frequently when standing for long periods of time
**Collaborative:**
* Pain management
* Anti-depressants
* OT/PT
* Referral for counseling
* Referral to speciality chronic pain clinic
* Dietary plan
55
How is **Lower Back Pain** prevented?
* Weight reduction
* Stress reduction
* Avoid wearing heels
* Walk daily, avoid jumping or jarring activities
* Stretch to enhance flexibility
* Proper body mechanics
* Work modifications
56
What are some **Body Mechanics** interventions to prevent **Lower Back Pain**?
* Good posture
* Avoid twisting
* Avoid lifting above waist level
* Avoid reaching up for any length of time
* **Push objects** rather than pull them
* Keep load **close to your body** when lifting
* Lift with the **large leg muscles**, not the back
* Squat while keeping back straight when picking something up off the floor
* **Bend your knees and tighten ab muscles** when lifting
* Avoid overreaching or a forward flexion position
* Use a **wide base of support**
57
What are some **Work Modification** interventions to prevent **Lower Back Pain**?
* Adjust height of chair, use a footstool to keep knees higher than hips
* Adjust height of work area to avoid stress on back
* Avoid bending, twisting, and lifting heavy objects
* Avoid prolonged standing and repetitive tasks
* Avoid work involving continuous vibrations
* Use lumbar support in a chair with a straight back
* When standing for a long period of time, rest one foot on a small stool or box to relieve lumbar lordosis
58
**The nurse can recognize that a patient with bursitis is experiencing...**
**a.** inflammation of a fluid filled sac in the joint
**b.** new bone growth around a sequestrum
**c.** Disease of a nerve root
**d.** Inflammation of muscle tendons
**a. inflammation of a fluid filled sac in the joint**
59
What interventions help promote **Shoulder Healing**?
* Rest joint in a position that minimizes stress
* Support affected arm on pillow while sleeping
* Gradually resume motion and use of the joint
* Patient may require assistance with dressing and other ADLs
* Avoid lifting above shoulder level
* Perform range-of-motion and strengthening exercises
60
What are the nursing interventions for **Hand/Wrist Surgery**?
* **Neurovascular assessment** - Q1H for the 1st 24hr
* **Pain control**: Medication, elevation, intermittent ice
* **Prevention of infection**: keep dressing clean and dry, wound care, signs and symptoms of infection
* Assistance with ADLs and measures to promote independence
* **Patient education**
61
What are the nursing interventions for **Osteoarthritis**?
* Weight loss
* Exercise - walking
* Demonstrate how to properly use a cane or walker
* PT/OT referral
62
Which nursing interventions help prevent **bleeding loss** before and during a **joint arthroplasty** surgery?
* Pre-op treatment with epoetin alfa or iron supplements
* Application of pneumatic tourniquets during TKA
* Employment of intraoperative red blood cell salvage systems
* Intraoperative administration of the antifibrinolytic agent tranexamic acid
63
Which nursing interventions help **manage pain** before a **joint arthroplasty** surgery?
Preoperative telephone support and education has shown to improve quality of life and pain postoperatively *(lowers anxiety and sets expectations)*
64
Which nursing interventions help prevent **venous thromboembolism** before and during a **joint arthroplasty** surgery?
* Discontinue medications that increase risk of clotting, such as certain hormones and NSAIDs before surgery
* LMWH may be prescribed before surgery
65
Which nursing interventions help **prevent infection** before and during a **joint arthroplasty** surgery?
* Any infection presenting 2-4 weeks before planned surgery may result in postponement of surgery
* Instruct patient to shower with antiseptic soap the evening before and the morning of surgery
* Prophylactic broad-spectrum antibiotics given 60 minutes prior to skin incision and discontinued within 24 hours postoperatively are effective in preventing surgical site infections
66
Which nursing interventions help prevent **dislocation of the hip** after a **joint arthroplasty** surgery?
* Use **abduction** splints or pillows between legs
* **Avoid hip flexion beyond 90°**
* Use **cradle boots** to prevent leg rotation and heel pressure injuries
* During transfers, maintain limited hip flexion and use assistive devices (e.g. abduction splints/pillows)
* Sit only in high-seat chairs or raised toilets, **hips should always be higher than knees when sitting.**
* **Never** allow the patient to **cross their legs or bend past 90°** at the waist
* Consult occupational therapists
* **Monitor for signs and symptoms of dislocation:** increased pain, shortening of affected extremity, abnormal rotation, inability to move leg, reported popping sensation in hip
67
What are **Long Term Complications** of a **Total Hip Arthroplasty**?
* **Heterotropic Ossification**: Formation of bone in the periprosthetic space
* **Avascular Necrosis**
* **Loosening of the prosthesis**
68
What are nursing interventions for a **Total Knee Arthroplasty**?
* Use compression bandage and cold packs to reduce swelling and bleeding
* Neurovascular checks every 2-4 hours
* Patients are encouraged to flex the foot hourly while awake
* Monitor for: VTE, Peroneal nerve palsy, infection, bleeding, limited ROM
69
When do patients begin ambulating after a Total Knee Arthroplasty?
**Post Op Day 1**
Knee immobilizer brace used, leg elevated when sitting
70
**The nurse understands that a patient taking bisphosponates will need to stay standing, or sitting, upright after administration for...**
**a.** 10 minutes
**b.** 20 minutes
**c.** 30 minutes
**d.** 120 minutes
**c. 30 minutes**
**Rationale:**
Sitting upright reduces stomach upset and heartburn
Also take first thing in the morning, with a full glass of water, and on an empty stomach
71
**A patient with a known history of breast cancer presents with new onset back pain and imaging reveals multiple lesions in the spine, skull, and femur. Which of the following treatment approaches is MOST appropriate for this patient?**
**a.** Aggressive surgical excision of all lesions
**b.** Chemotherapy targeting the primary breast cancer
**c.** Palliative care focused on pain relief and quality of life
**d.** Radiation therapy to the spine only
**c. Palliative care focused on pain relief and quality of life**
72
Why should you not palpate a bone tumor mass?
Palpating the mass may increase the potential for the bone tumor to seed *(spread)*
73
What is important to know about bone pain?
* It can be difficult to control
* External Beam Radiation Therapy may be used to relieve pain and improve quality of life
74
What are nursing interventions to **prevent delayed wound healing** in a patient with **Bone Tumors**?
* Minimize pressure on the wound
* Perform dressing changes using aseptic technique
* Frequent repositioning
* Use specialty mattress
* Monitor nutrition and hydration status
* Use antiemetics and relaxation techniques to reduce GI effects of chemo
75
What are nursing interventions to **prevent Osteomyelitis and wound infection** in a patient with **Bone Tumors**?
* Prophylactic antibiotics and strict aseptic dressing techniques
* Preventing other infections is crucial
* Patient to avoid contact with people who have a cold/other infections
* Monitor WBC count
76
What are nursing interventions to **prevent hypercalcemia** in a patient with **Bone Tumors**?
* Monitor for s/s of hypercalcemia: muscle weakness, N/V, AMS, ECG changes
* Treatment includes: IV hydration with NS, diuresis, mobilization, IV bisphosponates
