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musculoskeletal Prob
Chapter 64 Lewis Musculoskeletal Problems
| Question | Answer |
|---|---|
| What is osteomyelitis? | Severe infection of bone, marrow, and surrounding tissue |
| Which organism is usually to blame for osteomyelitis? | Staph. aureus |
| Which kids and which adults are most likely to get osteomyelitis? | boys less than 12, adults with vascular insufficiency (diabetes mellitus), genitourinary disorders, and respiratory infections. |
| What vascular rich sites are favorite sites for osteomyelitis in adults? | pelvis, tibia, vertebrae |
| What sites are most commonly infected by osteomyelitis in boys? | distal femur, proximal tibia, humerus, and radius |
| What kind of bone tumors are rarer in adults and what kind are more common? | primary tumors both malignant and benign are rarer in adults. Metatastic bone cancer – cancer that started somewhere else and settled in the bones- is more common |
| Name 3 types of benign tumors that are usually cured by surgery. | osteochondroma, Ostelclastoma, and endochroma |
| What is the most common type of benign tumor and where does it like to settle down? | Osteochondroma likes the metaphyseal region of the leg, pelvis, or scapula bones of 10-25 year olds. |
| What kind of primary, benign bone tumor starts in the cancellous ends of the arm and leg bones? | Osteoclastoma |
| 10% of osteoclastomas are especially bad. Why? | they are locally aggressive and spread to the lungs and have a high rate of recurrence after surgery |
| What kind of primary benign tumor grows in the medulla of single hand or foot bone in persons age 10-20? | endochroma |
| What do we call primary cancers of the bone, cartilage, muscle fibers, fatty tissue, and nerve tissue? | sarcomas |
| Name the most common types of bone cancer (4 of them). | Osteogenic sarcoma, Chondrosarcoma, Ewing’s sarcoma, and chordoma. |
| What kind of bone cancer occurs most often in the arm, leg, or pelvis bones of males between ages 10-25 years of age? | osteogenic sarcoma |
| What kind of bone cancer most commonly occurs in cartilage cells of the arm, leg, or pelvis bones of people between 50-70 years old? | chondrosarcoma |
| What kind of bone cancer sometimes develops form benign osteochondroma? | chondrosarcoma |
| How is chondrosarcoma usually treated and why? | surgery because it does not respond well to radiation and chemotherapy |
| What kind of bone cancer is associated with Paget’s disease and occurs in adults over 60? | secondary osteosarcoma |
| What is the most common bone cancer in affecting children and adults and what is the age group with the highest incidence? | Ostogenic Sarcoma – 10-25 year old males |
| What are the clinical manifestations of osteogenic sarcoma? | gradual onset of pain and swelling especially around the knee. |
| What serum levels would be elevated if a person has osteogenic sarcoma? | alkaline phosphatase and calcium |
| What tests confirm the diagnosis of osteogenic sarcoma? | biopsy, elevation of serum alkaline phosphatase and calcium, x ray, CT, PET, and MRI |
| What is present in 10-20% of diagnosed osteogenic sarcomas and where is it usually? | metastasis, especially to the lungs |
| What are these? Methotrexate,doxorubicin, cisplatin, cyclophosphamide, bleomycin, dactinomycin ifosfamide | Chemotherapeutic agents used in the treatment of osteogenic sarcoma |
| Where do bone cancers secondary to a primary cancer from the lungs, kidneys, GI, ovary, thyroid, breast or prostrate usually settle? | in the vertebrae, pelvis, femur, humerus, or ribs (bones above the knees and elbows and below the head) |
| What causes serum calcium levels to be high in bone cancer? | Calcium is released from damaged bone |
| What would a smart physician do next if a metastic bone lesion was discovered in a patient who had recovered from breast cancer several years ago? | a radionuclide bone scan to detect metatastic lesions before they are visible on x-Ray. |
| What should we suspect in a patient who comes in with local bone pain and recovered from stomach cancer? | metastatic bone cancer can occur at any time after the diagnosis and treatment of cancer |
| What are 3 nursing assessments we will make for our patient with bone cancer? | How bad do they hurt and how well can they get around? - location and severity of pain, weakness related to anemia and immobility, and swelling /joint function at the site |
| Give 5 concerns to address in the planning phase of nursing care for a patient with bone cancer? | pain relief; quality of life; body image acceptance; protection from injury; and understand disease process and prognosis |
| What should nurses teach about bone cancer in regards to health promotion? | regular screenings and health exams; recognition of the signs of bone cancer: swelling, bone pain of unexplained origin, limited joint function, changes in skin temperature |
| In regards to acute interventions on behalf of our patients with bone cancer, what are some special considerations? | They are especially fragile. We need to protect them from added injury due to immobility, falls, and pathologic fractures- careful handling of affected extremity and log rolling. Regular rest periods to avoid fatigue from therapeutic activities. |
| What are the survival rates for chondrosarcoma related to? | the stage, size, and grade of the tumor |
| What kind of bone cancer settles in the medullary cavity of long bones (femur, tibia, humerus, and pelvis) most often occurring in whites, children, and teenagers? | Ewing’s sarcoma |
| What is the treatment for Ewing’s sarcoma? | Wide surgical resection, radiation, and chemotherapy |
| What is the current 5 year survival rate for Ewing’s sarcoma? | 60% |
| What bone cancer is rare but occurs in the base of the skull of adults age 50-70? | Chordoma |
| What is the problem with surgery and radiation to fix chordoma? | proximity/involvement of the spinal cord and nerves. |
| How long after treatment is recurrence a possibility with chordoma? | 10 years or more |
| What primary benign tumor is characterized by an overgrowth of cartilage and bone near the end of the bone at the growth plate? | osteochondroma |
| Where is osteochondroma usually located? | leg, pelvis, or scalpula |
| What is distinctive about the hereditary version of osteochondroma? | multiple tumors before age 10 |
| What are the clinical manifestations of osteochondroma? | painless, hard, immobile mass; short for age; muscle soreness in proximity to tumor; one limb longer than the other; pressure/irritation with exercise |
| What types of muscular dystrophy are x linked mutations of the dystrophin gene? | Duchenne (psuedohypertrophic) and Becker (benign pseudohypertrophic) |
| What are the clinical manifestations of Duchenne? | Onset before 5; progressive weakness of pelvic and shoulder muscles; unable to walk after age 12; cordiomyopathy; respiratory failure in teens or 20s; mental impairment; very few live into adulthood |
| What are the clinical manifestations of Becker’s? | onset between 5 and 15; slower course of pelvic and should muscle wasting than Duchenne; cardiomyopathy; respiratory failure; may survive into 30s or 40s. |
| Which sex is usually the only one who get Duchenne or Becker MD? | Males |
| What are the diagnostic studies for diagnosing MD? | muscle serum enzymes – creatine kinase, electromyogram, muscle fiber biopsy, electrocardiogram abnormalaities, genetic pedigree |
| What are the signs of MD in a muscle fiber biopsy? | fat and connective tissue deposits, muscle degeneration and necrosis, deficiency of dystrophin. |
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