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Adulth Health
Muscular Skeletal
| Question | Answer |
|---|---|
| What are the characteristics of Osteoarthritis? | >60 yr & female 2:1 |
| What are the risk factors for Osteoarthritis | Aging, Genetics, Obesity, Trauma, Occupation |
| T/F The disease process of osteoarthritis is inflammatory | False - the disease process is degenerative |
| What is the disease pattern of osteoarthritis | Unilateral, single joint, weight-bearing joints and hands, spine, metacarpophalangeal joints spared, nonsystemic |
| Types of drugs for osteoarthritis | NSAIDs, Acetaminophen, other analgesics |
| T/F with OA later in the disease, pain diminishes after rest and intensifies after activity. | False - these are early signs, later in the disease pain occures with slight motion or even when the client is at rest |
| OA - pain is due to | joint and soft-tissue involvement and spasms surrounding muscles. Cartilage has no nerve supply |
| a continuous grating sensation caused by irregular cartilage, may be felt or heard as the joint is put through passive range of motion. One or more joints are affected. | Crepitus |
| The presence of inflammation in clients with OA usually indicates | secondary synovitis |
| Approximately 50% of clients with OA hand involvement display what two characteristics bilaterally? | Heberden's nodes (at the distal interphalangeal joints) and Bouchard's nodes (at the proximal interphalangeal joints). |
| contractures, muscle atrophy, further pain and loss of function is due to | discouraging the movement of painful joints |
| Osteoarthritis (OA) can often affect the spine, especially the lumbar region at the ____ level or the cervical region at____ level. | L3-4 & C4-6 |
| 5 pain relief measures for patients with OA other than drug therapy. | Rest, Positioning, Thermal Modalities, Weight Control and Transcutaneous Electrical Nerve Stimulation (TENS) |
| If acetaminophen or topical agents are not successful in relieving pain, the analgesic drug class of choice is usually | nonsteroidal anti-inflammatory drugs (NSAIDs) |
| What is the MOA of the NSAIDs; celecoxib (Celebrex), meloxicam (Mobic), and valdecoxib (Bextra) in the tx of OA? | inhibiting both forms of the enzyme cyclooxygenase, COX-1 and COX-2. COX-1 produces prostaglandins that help regulate normal cell activity, including protecting the lining of the gastrointestinal (GI) tract. |
| What are primary contraindications for total joint replacement? | infection anywhere in the body, advanced osteoporosis, and severe inflammation. |
| After a total hip replacement, do not bend hips more than ____ degrees | 90 degrees |
| After a total hip replacement, do not cross your legs beyond the ___ of your body | midline of your body |
| After a total hip replacement do not sit or ____ for prolonged periods | stand |
| After a total hp replacment call your physician immediately if you notice ____, ____, or ____ of the incision | redness, heat or drainage |
| T/F Cleanse your hip incision with a mild soap and water every day | True |
| T/F perform daily leg exercises after a total hip replacement | True |
| What are the major complications of total joint replacement | Dislocation, Infection, Venous thromboembolism, and Hypotension, bleeding or infection |
| To prevent dislocation after a total hip replacement, keep legs slightly (flexed, abducted, or rotated | Abducted |
| T/F After a total joint replacement the client should massage legs with elastic stockings. | False - elastic stockings are encouraged, massage is not |
| To prevent hypotention, bleeding or infection after a total joint replacment, the client should be monitored every ___ hrs. | 4 |
| Disorders of bone are often reflected in an alteration of ____ or ____ levels. | Calcium or phosphorus levels |
| An elevation in alkaline phosphatase might indicate ____ disease, or ____, or ____ bone cancer. | paget's disease or osteomalacia or metastic bone cancer |
| What contrast allergy should the nurse or radiology tech ask the client before having a CT scan? | Iodine-based contrat allergy |
| How long does a typical CT scan take? | 20 minutes |
| Why would selected clients be prescribed a mild sedation before an electromyography? | Discomfort from episodes of electrical current. |
| Why is there a temporary discontinuation of skeletal muscle relaxants several days before an electromyography? | to prevent medication from having effects on the test results. |
| ____is a minimally invasive surgical procedure in which an examination and sometimes treatment of damage of the interior of a joint is performed? | Arthoscopy |
| After what procedure would you monitor distal pulses, hypothermia, swelling, color, capillary refill, pain, movement, infection, thrombophleblitis, and sensation of the affected extremity. | Arthoscopy |
| What is the nuclear medicine physician or technician administers as an isotope 1 to 2 days before scanning? | gallium - used in the Gallium scan |
| The radioactive material gallium isotope poses no threat because it readily ____ in the body. | deteriorates - excreted through the intestinal tract |
| MRI stands for | Magnetic Resonance Imaging |
| T/F It is okay for a pregnant client to have an MRI | False |
| During an MRI, the client must be able to liestill in the supine position for ___ min. | 40-60 minutes |
| What type of implants does a client need to disclose before an MRI? | ferromagnetic fragments or implants, pacemaker or electronic implant |
| Before initiating joint exercising for an osteoporosis patient the nurse should offer. | Pain control measures |
| A nursing intervention: Collaborate with ____ in developing and executing an exercise program. | Physical Therapy |
| osteoporosis pt receiving 3rd of daily dose at bedtime due to | Calcium is most readily utilized by the body when the client is fasting and immobile |
| osteoporosis pt receiving Ca need to push fluids to prevent___. | The formation of calcium-based urinary stones. |
| osteoporosis pt on Ca supplements should be monitored for ___. | Hypercalcemia. |
| S/S of Hypercalcemia | urinary stones, cardiac dysrhythmias, increase or decrease in skeletal muscle tone. |
| osteoporosis pt on estrogen or estrogen/progesteron should be monitored for what 2 cancers? | Endometrial and breast |
| ____ (CV condition) and ___ (vascular condition) may result from combined estrogen-progesterone therapy | Hypertension and DVT |
| Results from Hypertension and DVT while taking estrogen-progesterone therapy | elevated cholesterol level |
| Which drug for osteoporosis is taken early in AM with 8 oz water and don't lie down until after breakfast? | Alendronate (Fosamax), Ibandronate (Boniva) and Risedronate (Actonel) |
| This drug taken for osteoporosis can cause CNS effects that may not be tolerated | Risedronate (Actonel) |
| Calcitronin is given SQ, IM, or IV | IM |
| Common side effects of Calcitronin | flushing, HA, N/V |
| Parasthesia, tetany, Trousseau and Chvostek signs, hyperactive reflexes, arrhythmias, prolonged QT & ST interval are SS of | hypocalcaemia |
| When taking calcitronin, monitor ____ function, calcium and vitamin___. | renal function - vitamin D |
| T/F Osteomalacia is defined as decreased bone mass. | False - Osteoprosis is decreased bone mass |
| ____________ is demineralized bone | Osteomalacia |
| Osteoporosis is lack of calcium where Osteomalacia is ___ calcium level | Low or normal |
| Osteomalacia has (lack of, normal value or high) vitamin D | lack of vitamin D |
| X-ray findings of osteopenia can be found in ___ | Osteoporosis |
| Phosphate levels are normal in ___ and low or normal in ___ | normal osteoporosis and low or normal osteomalacia |
| Parathyroid hormone is ____ or normal in osteomalacia | High or normal |
| Alkaline phosphatase is normal in ____ and high in ____ | normal in osteoporosis and high in osteomalacia |
| Diagnositc factor between osteoporosis and osteomalacia | Vitamin D |
| ____, or osteitis deformans, is a metabolic disorder of bone remodeling, or turnover, in which increased resorption or loss results in bone deposits that are weak, enlarged, and disorganized. | Paget's disease |
| Musculoskeletal manfestations of Paget's disease | pain in bone or low back, bowing, loss spine curvature, thick skull, osteogenic sarcoma and pathologic fractures |
| Skin manifestations of Paget's disease | Flushed, warm skin |
| fatigue, hyperparathyroidism, gout, urinary or renal stones, and heart failure from fluid overload are additional manifestations of ___ disease | Paget's |
| What are the 3 primary lab findings indicating the probability of Paget’s disease? | Increased serum alkaline, phosphates and urinary hydroxyproline |
| Asprin or NSAIDs, calcitronin, Etidronate, Fosamax or mithramycin are drug therapy interventions for ____ disease. | Paget's |
| Non drug therapy for Paget's disease include | gental massage, non impact exercise, relaxation teniues and diet therapy |
| Surgery including tibial astronomy or partial or total joint replacement and surgical decompression of the spine may also be used for ____. | Paget's disease. |
| decreased blood flow to the bone causes | bone necrosis / bone abscess |
| A bone abscess provides for ___ invasion, which results in tissue ____ and increased ____ formation. | pathogen invasion, tissue inflammation, edema formation |
| Osteomyelitis drug therapy includes IV ___, can be for 3+ months | Antibiotics |
| Osteomyelitis infection control includes cover ___ and use ____ technique | cover open wound, and aseptic technique |
| Tissue perfusion using ____ O2 therapy is used for pt with ____. | Hyperbaric O2 therapy for pt with osteomyelitis |
| a piece of dead bone that has become separated during the process of necrosis | sequestrum |
| Osteomyelitis procedure - debrides the infected bone and allows for revascularization of tissue | sequestrectomy |
| Osteomyelitis procedure - bone segment transfer and bone grafts use ____ part of bone | cancellous (spongy) usually from iliac crest. |
| Osteomyelitis procedure - Used if bone defect is small. Provides wound coverage and enhances blood flow | Muscle Flaps |
| Osteomyelitis procedure - last resort if other surgery is unsuccessful | Amputation |
| osteomyelitis intervention post-op, neurovascular (NV) assessments must be done ____ because the client experiences ____. | frequently - swelling |
| ___ Assessment of: pain, movement, sensation, warmth, temp, distal pulses and capillary refill are used post ___ surgery | Neurovascular assessment for postoperative Osteomyelitis procedures |
| Common nursing diagnoses for bone tumors or metastatic bone disease | acute and chronic pain, anticipatory grieving and disturbed body image |
| Wide or radical resection procedures are commonly performed for clients with bone ___. | sarcomas |
| Because the pain is often due to direct tumor invasion, treatment is aimed at ____. | reducing the size of or removing the tumor. |
| As an alternative to total replacement, an ____ may be implanted with internal fixation for those clients who do not have metastases. | allograft |
| For clients with metastatic disease, intractable pain is surgically treated with ____ (cutting of the spinal nerve roots). | percutaneous cordotomy |
| ____may reduce bone pain and tumor size | Cryosurgery (cold application) |
| T/F It is the doctor's responsibility to help the client and others to cope with the loss and resolve the grief | False - it is the nurses most important role. |
| What is the most common repetitive strain injury? | Carple Tunnel Syndrome (CTS) |
| Carple Tunnel Syndrome (CTS) include ____ hand activities involving pinch or grasp during wrist flexion. | repetitive |
| How often do you check the neurovascular status of the digits during the postoperative period of CTS? | Every hour |
| The surgeon may require that the client's hand and arm be ____ for several days to reduce swelling from surgery. | elevated above heart level |
| 8 potentially life-threatening complications related to fractures | acute compartment syndrome, shock, fat embolism syndrome, venous thromboembolism, infection, ischemic necrosis, fracture blisters, delayed union, nonunion, and malunion |
| What does a comartment hold in acute compattment syndrome? | muscle, blood vessles and nerves |
| a serious condition in which increased pressure within one or more compartments causes massive compromise of circulation to the area. | Acute compartment syndrome (ACS) |
| What is the most common sites for ACS in clients experiencing musculoskeletal trauma? | the compartments in the lower leg and the dorsal and volar compartments of the forearm |
| examples of external pressure in acute compartment syndrome | Tight, bulky dressings and casts |
| common source of internal pressure with acute compartment syndrome | Blood or fluid accumulation |
| ____ is a serious complication, usually resulting from a fracture, in which fat globules are released from the yellow bone marrow into the bloodstream | Fat embolism syndrome (FES) |
| FES may also occur, although less often, with what 5 conditions? | pancreatitis, diabetic coma, osteomyelitis, blunt trauma, or sickle cell anemia. |
| The release of fat emboli is most likely with what type of fractures? | fractures of long bones or multiple fractures, although a break in any bone with sufficient bone marrow content can cause the complication |
| Who is at the greatest risk for FES? | young men between ages 20 and 40 years and older adults between ages 70 and 80 years |
| The earliest manifestation of FES is ____, which is caused by a low arterial oxygen level. | altered mental status |
| Petechiae are characteristic of ____. | fat emboli |
| Fat embolism usually occurs within ____ hours of the fracture and can result in ____ or death, often from pulmonary edema. | 48 hours, respiratory failure |
| The incidence of life-threatening embolic conditions is highest in ____, particularly during the first 2 to 3 days after ____ surgery | older adults, musculoskeletal |
| DVT that leads to PE is more likely to develop in clients with fractures of the ____ and pelvis | lower extremities |
| Wound infections are the most common type of infection resulting from ____ trauma | orthopedic |
| Infection can also be caused by ____ used to repair a fracture surgically, such as pins, plates, or rods. | implanted hardware |
| Clostridial infections can result in gas gangrene or tetanus and can prevent the ____ from healing properly. | bone |
| Another word for bone infection | osteomyelitis |
| For clients experiencing osteomyelitis, the risk of ____ infections is increased. | hospital-acquired (nosocomial) |
| Ischemic necrosis is sometimes referred to as aseptic or avascular necrosis or ___. | osteonecrosis. |
| Ischemic necrosis or osteonecrosis is most often a complication of hip fractures or any fracture in which there is____ of bone. | displacement |
| Surgical repair of fractures also can lead to necrosis because the hardware can interfere with ____. | circulation |
| ____ are associated most commonly with high-energy fractures and twisting injuries in the lower extremities | Fracture blisters |
| Fracture blisters can lead to wound infection and delayed fracture ____. | Treatment |
| Nursing measures that can assist in preventing or minimizing fracture blisters include maintaining proper ____ before definitive treatment and elevation to limit ____ | proper immobilization, limit edema |
| Delayed union describes a fracture that has not healed within ____ months of injury. | six |
| Some fractures never achieve ____; that is, they never completely heal | union |
| fractures that heal incorrectly, are most common with ____ fractures | malunion. tibial fractures |
| . If bone does not heal, the client typically experiences pain and immobility from ____. | deformity |
| When a client with a wet plaster cast is moved and turned, the cast is handled with the ____ of the hands to prevent indentations and resultant areas of pressure on the skin | palms |
| The client is turned every ___ to ___ hours to allow air to circulate and dry all parts of the cast | 1 to 2 hours |
| a pillow encased in plastic could cause the ____ to retain heat and prevent drying. | cast |
| Uniform support is needed while the cast is drying to prevent development of ____ points | pressure |
| ____ pans are preferred over traditional bedpans because they are smaller and more comfortable for the client in a cast. | Fracture |
| You should be able to insert a ____ between the cast and the skin | finger |
| Once the ____ cast is dry, it is inspected at least once every 8 hours for drainage, cracking, crumbling, alignment, and fit | plaster |
| Plaster casts act like ____ and absorb drainage, whereas synthetic casts act like a ____, pulling drainage away from the drainage site. | sponges, wick |
| T/F Drainage on any cast should always be measured | True |
| ____ involves the use of a Velcro boot (Buck's traction) (Figure 55-5), belt, or halter, which is secured around a body part | Skin traction |
| ____ such as pins, wires, tongs (e.g., Crutchfield), or screws are surgically inserted directly into bone. | skeletal traction |
| Skeletal traction aids in bone ____. | realignment |
| The primary purpose of skin traction is to decrease painful ____ that accompany fractures | muscle spasms |
| limit of weight with skin traction is ____ and skeletal traction is ____ | 5 to 10 lbs, 15 - 30 lbs |
| With skin traction inspect the skin at least every ____ hours for signs of irritation or inflammation | 8 |
| The circulation is usually monitored every hour for the first 24 hours after ____ is applied and every 4 hours thereafter. | traction |
| What is the primary cause of hip fracture in older adults | osteoporosis |
| ____ is rapidly becoming the most common surgical procedure for people older than 85 years of age | repair of hip fracture |
| Studies suggest that older, thin, white women are at the greatest risk for ____ | hip fracture |
| Hemorrhage, Infection, Phantom Limb pain, Problems with Immobility, Neuronal, and Flexion contractures are major complications following | amputation |
| Feels pain in an area where lib used to be | phantom limb pain |
| a sensitive tumor of nerve cells found at severed nerve endings | neuronal |
| What nursing interventions can help prevent flexion contractures | teach ROM exercises, use firm mattress, stretching |
| What special body positioning is needed postoperatively for the older adult who has had an open reduction and internal fixation of the hip | balanced suspension skeletal traction |
| ____ is when pins inserted in bone and weights applied to grow and bone reformation | balanced skeletal traction |
| pin care of balanced skeletal traction includes | soap and water |
| velcro boot used in fractured hip muscles to contract and make bone shorter | Buck's traction |
| Buck's traction is used how long | short term 24-48 hours |
| Which cast is more expensive and come in colors, light weight and can get wet for short periods | synthetic cast |
| Assessment of neurovascular status includes | skin color, skin temp, movement, sensation, pulses, cap refill, pain |
| Acute compartment syndrome can also be a result from | burn scaring |
| When broken bones are sever and tear vessles ____ can occure | shock |
| Most common repetive strain injury | carpal tunnel syndrome |
| Post op care of caral tunnel syndrome | elevate arm higher than heart and apply ice |
| softening of the bones, malnourished | Ricketts |
| Pt with osteomalacia can use ____ chamber to treat wounds because it can increase tissue perfusion | hyperberic |
| Causes decrease in heigth | osteoporosis |
| Most common connected tissue disease. | osteoarthritis |
| Pt with osteoarthritis have pain in ____ joints first | weightbearing |
| T/F osteoarthritis includes swelling | False |
Created by:
cgwayland
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