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Musculoskeletal 64

Nursing management of musculoskeletal problems

QuestionAnswer
What is Osteomyelitis? It is a severe infection of the bone, bone marrow, and surrounding soft tissue.
Most common infecting microorganism of Osetomyelitis is? Staphylococcus aureus
What type of organisms cause Osteomyelitis? Aerobic gram-negative and/or mixed with gram-positive organisms.
What helps reduce mortality rate and complications associated with Osteomyelitis? Use of anitbiotics in conjunction with surgical treatment.
What are the two ways a infecting microorganisms can invade? Indirect and direct
What are the common sites for infection through indirect entry in children? Distal femur, proximal tibia, humerus, and radius
What adults are at higher risk for a primary infection through indirect entry to spread via the blood to the bone? Adults with vascular insufficiency disorders (diabetes mellitus)and genitourinary and respiratory infection
What are the common sites of osteomyelitis infections in adults? Pelvis, tibia, and vertebrae
How does direct entry of osteomyelitis occur? At any age when there is an open wound where the microorganisms gain entry to the body. Also in the presence of a foreign body such as implant or orthopedic prosethetic device.
What are predisposing problems of Staphylococcus aureus in osteomyelitis? Pressure ulcer, penetrating wound, open fracture, orthopedic surgery, vascular insufficiency disorders (diabetes, atherosclerosis)
Predisposing problems of Staphylococcus epidermis in osteomyelitis? Indwelling prosthetic devices (joint replacements, fracture fixation devices)
Predisposing problems of Streptococcus viridans in osteomyelitis? Abscessed tooth, gingival disease
Predisposing problem of Escherichia coli in osteomyelitis? Urinary tract infection
Predisposing problem of Mycobacterium tuberculosis in osetomyelitis? Tuberculosis
Predisposing problem of Neisseria gonorrhoeae in osteomyelitis? Gonorrhea
Predisposing problems of Pseudomonas in osteomyelitis? Puncture wounds, IV drug use
Predisposing problem of Salmonella in osteomyelitis? Sickle cell disease
Predisposing problem of Fungi, mycobacteria in osteomyelitis? Immunocompromised host
What is acute osteomyelitis? Initial infection or infection of less than 1 month in duration.
What are systemic manifestations of acute osteomyelitis? Fever, night sweats,chills, restlessness, nausea, and malaise
What are local manifestations of acute osteomyelitis? constant bone pain the is not relieved by rest and worsens with activity, swelling, tenderness, and warmth at the infection site, and restricted movement of affected part.
What are the later signs of acute osetomyelitis? Drainage from sinus tracts to the skin and/or the fracture site.
What is chronic osteomyelitis? A bone infection that persists for longer than 1 month or infection that has failed to respond to initial course of antibiotic therapy.
What are systemic signs of chronic osteomyelitis? May be diminished.
What are the local signs of chronic osteomylitis? Constant bone pain and swelling, tenderness and warmth at infection site. Local signs most common.
What is the best way to determine the causative microorganism in osteomyelitis? Bone or soft tissue biopsy
What diagnostic studies are used with osteomyelitis? CBC, radiologic signs, radionuclide bone scans, MRI and CT scans.
What is the treatment of choice for acute osteomyelitis? Vigorous and prolonged IV antibiotic therapy as long as bone ischemia has not yet occurred.
What is preferred to be done before treatment initiated? Cultures or a bone biopsy.
If antiobiotic therapy is delayed what can be done? Surgical debridement and decompression
Where is antibiotic therapy given? central venous catheter or peripherally inserted centeral catheter
What is important about gentamicin (Garamycin)? Instruct patient to notify health care provider if any visual, hearing, or urinary problems develop. Assess patient for dehydration before starting therapy.
What are treatments of chronic osteomyelitis? Surgical removal, extended use of antibiotics, antibiotic-impregnated polymethylmethacrylate bead chains, irrigation with antibiotics, casts or braces, and wound VAC.
When can hyperbaric oxygen be given in chronic osteomyelitis? As an adjunct therapy in refractory cases of chronic osteomyelitis.
What is done is orthopedic prosthetic device is source of chronic infection? Must be removed
What are long-term and mostly rare complications of osteomyelitis? Septicemia, septic arthritis, pathologic fractures, and amyloidosis.
What are the overall goals for patient with osteomyelitis? 1.Have satisfactory pain and fever control 2.Not experience any complications 3.Cooperate with the treatment plan 4.Maintain a positive outlook on the outcome of the disease
What type of meds are prescribed to provide patient comfort in patients with osteomyelitis? NSAIDs, opioid analgesics, and muscle relaxants
What type of dressings are used on patient with osteomyelitis? Dry, sterile dressings; dressings saturated in saline or antibiotic solution; and wet-to-dry dressings
What is Flexion contracture? Is a common sequel of osteomyelitis of the lower extremity because the patient frequently positions the affected extremity in a flexed position to promote comfort. Most commonly in hip and knee.
What can develop because of flexion contracture? Deformities (footdrop)
What activities should patient avoid with osteomyelitis? Exercise and heat application stimulate spread of infection.
What are adverse effects of aminoglycosides (tobramycin, neomycin) in treatment of osteomyelitis? Hearing deficit, fluid retention, and neurotoxicity
What are adverse effects of extended use of cephalosporins (cefazolin) in treatment of osteomyelitis? Jaudice, colitis, and photosensitivity
What is adverse effect of fluoroquinolones (ciprofloxacin [Cipro], levofloxacin [Levaquin]) in the treatment of osteomyelitis? Tendon rupture (especially Achilles tendon)
Lengthy antibiotic therapy can result in overgrowth of what? Candida albicans and Clostridium difficile in genitourinary and oral cavities (especially immunosuppressed and older patients).
Patients on lengthy antibiotic treatments for osteomyelitis should report what to health care provider? Whitish, yellow, curdlike lesions.
What is Osteomalacia? It is a uncommon disease of adult bone associated with vitamin D deficiency resulting in decalcification and softening of bone.
What are the etiologic factors in the development of osteomalacia? Lack of exposure to ultraviolet rays, GI malabsorption, extensive burns, chronic diarrhea, pregnancy, kidney disease, and drugs such as phenytoin (Dilantin).
What are the most common clinical features of osteomalacia? Localized bone pain, difficulty rising from chair, and difficulty walking.
What are other clinical manifestations of osteomalacia? low back pain and bone pain, progressive muscular weakness (pelvic gridle), weight loss, and progressive deformities of the spine (kyphosis) or extremities.
What is a sign of delayed bone healing in osteomalacia? Fractures (common)
What are common lab findings in patients with osteomalacia? Decreased serum calcium or phosphorus levels, decreased serum 25-hydroxyvitamin D, and elevated serum alkaline phosphatase.
What can be found in x-rays of patients with osteomalacia? Looser's transformation zones (ribbons of decalcification in bone found on x-rays)are diagnostic of osteomalacia.
What is prescribed in the treatment of vitamin D deficiency associated with osteomalacia? Vitamin D3 (cholecalciferol) and vitamin D2 (ergocalciferol), calcium salts and phosphorus supplements.
What dietary intake is encouraged for treatment of osteomalacia? Eggs, meat, oily fish, and milk, and breakfast cereals fortified with calcium and vitamin D.
What are other things that can help with treatment of osteomalacia? Exposure to sunlight (and ultraviolet rays) along with weight-bearing exercise.
What is osteoporosis (fragile bone)? Is a chronic, progressive metabolic bone disease characterized by low bone mass and structural deterioration of bone tissue, leading to increased bone fragility.
What is osteoporosis known as and why? "Silent thief" because it slowly and insidiously over many years robs the skeleton of its banked resources.
Why is osteoporosis more common in women than men? 1.Women tend to have lower calcium intake 2.Women have less bone mass 3.Bone resorption begins at an earlier age 4.Pregnancy and breastfeeding deplete reserves 5.Longevity increases likelihood
What helps to decrease the risk of osteoporosis? Regular weight-bearing exercise, fluoride, calcium, and vitamin D ingestion.
What happens to the remodeling process during osteoporosis? Bone resorption exceeds bone deposition.
Where does osteoporosis most commonly occur? Bones of spine, hips, and wrists.
Wedging and fractures of vertebrae produce in osteoporosis? Gradual loss of height and a humped back known as "dowager's hump" or kyphosis.
What is the first signs of osteoporosis? Back pain or spontaneous fractures
What diseases are associated with osteoporosis? Inflammatory bowel disease, intestinal malabsorption, kidney disease, RA, hyperthyroidism, and diabetes mellitus
What drugs affect osteoporosis? Corticosteroids, antiseizure drugs (divalproex sodium [Depakote], phenytoin [Dilantin]), aluminum-containing antacids, heparin, certain cancer treatments, and excessive thyroid hormones
What does corticosteriods do in patients with osteoporosis? Causes a loss of bone and inhibition of new bone formation.
What are clinical manifestations of osteoporosis? Sudden strain, bump, or fall causes a hip, vertebral or wrist fracture. Collapsed vertebrae may initially be manifested as back pain, loss of height, or spinal deformities (kyphosis).
What is quantitative ultrasound (QUS)? Measures bone density with sound waves in the heel, kneecap, or shin.
What is dual-energy x-ray absorptiometry (DEXA)? Measures bone density in the spine, hips, and forearms also to assess the effectiveness of treatment. Reported as T-scores.
Osteoporosis is a BMD of? Osteoporosis is defined as a BMD of <_-2.5 below the mean BMD of young adults.
What is used to differentiate the diagnosis of osteoporosis and osteomalacia? Bone biopsy
The National Osteoporosis Foundation recommends treatment for osteoporosis... For postmenopausal women who have(1)a T-score of<_-2.5(2)T-score btw-1and-2.5 w/risk factors(3)prior history of hip or vertebral fracture.
What is FRAX? Fracture Risk Assessment tool takes into account bone mineral density and additional clinical factors when assessing fracture risk.
What is adequate Calcium intake? 1000mg/day in premenopausal women and postmenopausal women taking estrogen 1500mg/day in postmenopausal women who are not receiving supplemental estrogen
What are food high in calcium content? Whole and skim milk, yogurt, turnip greens, cottage cheese, ice cream, sardines, and spinach.
How much is supplemental vitamin D and who is it prescribed for? vit D 800 to 1000IU recommended for postmenopausal women, older adults, homebound ppl, and ppl who get minimal sun exposure.
What is weight-bearing exercises? Its a exercise that forces a individual to work against gravity. Such as walking,hiking,weight training,stair climbing,tennis,and dancing.
What should the patient cut down on to decrease the likelihood of losing bone mass? Smoking and alcohol intake
What regimen should the patient with osteoporosis follow? Calicum and vitamin D supplementation, exercise, and medications (alendronate [Fosamax], raloxifene [Evista]).
What is Vertebroplasty? Bone cement is injected into the collapsed vertebra to stabilize it, but it does not correct the deformity in osteoporosis.
What is Kyphoplasty? An air bladder is inserted into the collapsed vertebra and inflated to regain vertebral body height and then bone cement is injected.
Why is estrogen replacement therapy no longer given as primary treatment to prevent osteoporosis after menopause? Increased risk of heart disease and breast and uterine cancer.
What does estrogen do in treatment of osteoporosis? Inhibits ostoclast activity, leading to decreased bone resorption and preventing both corical and trabecular bone loss.
Salmon calcitonin (Calcimar) is used in treatment of osteoporosis in what forms can it be used? IM,subQ,and intranasal forms
Bisphosphonates are used in treatments of osteoporosis what is the names of these drugs? etidronate (Didronel),alendronate (Fosamax), pamidronate (Aredia),risedronate (Actonel), clondronate (Bonefos), tilufronate (Skelid), and ibandronate (Boniva)
What are common side effects of bisphosphonates in the treatment of osteoporosis? Anorexia, weight loss, and gastritis
What rare serious side effect is associated with bisphosphonates in treatment of osteoporosis? Jaw osteonecrosis (occurs most frequently in patients with advanced cancer)
What instruction should be given to patients taking bisphophonates in the treatment of osteoporosis? Take with full glass of water,take 30 minutes before food or other medications, and to remain upright for at least 30 minutes after medications.
Selective estrogen receptor modulator(raloxifene[Evista]) are also used in treatment of osteoporosis. What do they do? Reduces bone resorption without stimulating the tissues of breast or uterus.
What are side effects of raloxifene (Evista)? Leg cramps, hot flashes, and blood clots
How does teriparatide (Forteo) help in treatment of osteoporosis? Increases the action of osteoblasts. First drug approved that stimulates new bone formation.
What are side effects of teriparatide (Forteo) in treatment of osteoporosis? Leg cramps and dizziness
What is denosumab (Prolia) used for? Postmenopausal women with osteoporosis who are high risk for fractures. It inhibits osteoclast formation and function.
What is Paget's disease? (Osteitis deformans) is a chronic skeletal bone disorder where there is excessive bone resorption followed by replacement of normal marrow by vascular, fibrous connective tissue.
What parts of the body are usually affected by Paget's disease? Pelvis, long bones, spine, ribs, sternum, and cranium
What are the initial clinical manifestations of Paget's disease? Insidious bone pain, complaints of fatigue, and progressive development of waddling gait.
What do patients with Paget's disease complain of? Fatigue, becoming shorter and heads becoming larger
What can happen to patients with enlarged, thickened skulls associated with Paget's disease? Headaches, dementia, visual deficits, and loss of hearing
What is the most common complication of Paget's disease? Pathologic fracture and may be first indication of disease.
What element is increased with advanced Paget's disease? Serum alkaline phosphatase
Administeration of human calcitonin (Cibacalcin) does what in Paget's disease? Bone resorption, relief of acute symptoms, and lowering the serum alkaline phosphatase levels. It inhibits osteoclastic activity.
What drugs are used in the treatment of Paget's disease? Human calcitonin (Cibacalcin),salmon calcitonin (Calcimar), bisphosphonate drugs, zoledronic acid (Reclast),calcium and vitamin D.
Calcium and vitamin D are given to reduce what common side effect of drugs used to treat Paget's disease? Hypocalcemia
What other treatments should be given to promote comfort of Paget's disease? Firm mattress and corset or light brace
Created by: Rachel'sNotes