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Gero Nursing Ch.27

Musculoskeletal System in older adults

What percentage of older adults are given a diagnosis of arthritis? 40%
What are 5 main age related changes occur in the musculoskeletal system Gradual decreased muscle mass and strength, decreased elasticity of ligiments tendons and cartilage, decreased bone mass, intervertebral disks lose water, and changes occur in posture and gait.
What fracture is the most debilitating to the older adult? Hip fracture (24% die within 1 year of injury)
Why is risk for infection a possible nursing diagnosis for an older person with a fracture? Impaired wound healing, compromised nutrition, and effects of immobility.
This type of fracture occurs at the distal radius, usually as a result of one reaching out to break fall with an open hand? Colles' Fracture
What should the nurse instruct the patient to do to improve venous return and reduce edema after a colles fracture? Move thumb and fingers.
Name some signs of a clavicular fracture. point tenderness, local edema, crepitus, shoulder dropping downward, forward, and/or inward.
What are some appropriate nursing measures after a client has had a clavicular fracture? Monitor for neurovascular complications, elevate extremity, and instruct client to move fingers and hands.
A client that has suffered a fracture has been fitted with a cast. What should the nurse do? Assess for areas of skin irritation/breakdown, perform neurovascular assessment, control pain with meds, prepare client for self-care and prevention of complications.
noninflammatory disease of joints characterized by progressive articular cartilage deterioration and formation of new bone in joint space. Osteoarthritis
Bony enlargments that may be seen on interphalangeals. Heberden’s nodes
What should be assessed in someone with Osteoarthritis? history of problem, Inspect affected joints for pain, tenderness, swelling, redness, crepitation, and range of motion
What are some expected outcomes for someone with osteoarthritis? Client will report impoved level of comfort with activities, The client will be able to successfully use various adaptive devices in maintaining independence in ADLs and ambulation
What are some indications that surgical intervention may be necessary in someone with osteoarthritis? severe pain and increasing disability
What are postoperative goals of nursing care for someone with osteoarthritis? prevent complications, relieve surgical pain, and assist client in achieving higher level of function and activity
How quickly does rehab begin on a post-op OA patient, and what does it include? 24 to 48 hours of the surgical procedure and includes muscle strengthening and range-of-motion exercises
Bony overgrowth of facet joints of vertebrae, which leads to narrowing of spinal canal and possible compression of nerve roots. Spinal stenosis (Leads to progressive back pain and possible weakness of lower extremities)
What may be noticed during assessment of someone with spainal stenosis? Symptoms are generally relieved with flexion of the spine.
Why is Risk for injury a possible nursing diagnosis in someone with spinal stenosis? Difficulty with ambulation.
What may accompany a Musculoskeletal disorder that could amplify pain symptoms and why? Depression, because of possible loss of self-esteem, and perception of decreased quality of life.
Chronic, systemic, inflammatory disease that causes joint destruction and deformity and results in disability, Cause is not known. Rheumatoid arthritis,Most widely accepted theory that it is autoimmune disease
During assessment in someone with RA, what questions should be asked? Questions about family history and constitutional symptoms, including fever, anorexia, weight loss, fatigue, and duration of the joint stiffness
What are some nursing Expected outcomes in a client with RA? The client will maintain normal joint motion in affected joints, with minimum deformities, The client’s pain related to inflammation will be well controlled, The client will be able to maintain optimal functional status.
What are some nursing interventions for a client with RA? Clients and families will require extensive education on chronic nature of the disease, Need to discuss pain management, drug therapies, self-care activities, safe mobility, methods of joint protection and precautions, and management of overall health.
Disease in which acute attacks of arthritis pain occur as result of elevated levels of serum uric acid Gouty arthritis
Deposits of uric acid crystals are called? tophi
What are some appropriate nursing implementations for a client with gouty arthritis? focus on pain relief measures and prevention of recurrent attacks of gout, Information about role of dietary habits should be provided
What is the most common metabolic bone disorder? Osteoporosis
What are some modifiable risk factors for osteoporosis? calcium intake, exercise, cigarette smoking, and consumption of alcoholic beverages
What are some NON-mdifiable risk factors for osteoporosis? age, race, gender, and body frame.
How much bone mass must be lost for osteoporosis to be apparent on a standard X-ray? 30%
A bone densitometry is commonly done with what? A dual-energy x-ray absorptiometry (DEXA)
What lab studies can be done to differentiate between osteoporosis and other diseases that cause bone loss? CBC, serum calcium, serum phosphorus, alkaline phosphatase, and urinary calcium.
What should be assessed in someone with Osteoporosis? Family Hx, Risk Factors, level of exercise, ETOH & Caffeine intake, smoking, Age of onset of menopause, use of ERT, and Hx of fractures.
What are some expected outcomes for someone with osteoporosis? Client will demonstrate taking precautions to prevent falls, will consume nutritional supplements, food, and meds prescribed for dietary needs AEB diet log.
What are some nursing interventions for someone with osteoporosis? Focus on client education about disease process, strategies to prevent further injury or deformity, Exercises that place some stress on bones.
This disease causes deformities and enlarged bones. It is caused by a rapid production of osteoclasts and osteoblasts. Paget’s disease
Which bones are most commonly affected by Paget's disease? pelvis, femur, skull, tibia, and spine
What is the first symptom of Paget's disease? Bone pain not relieved by rest or movement.
What should be assessed in someone with Paget's disease? Family history, assess for warmth, deformity, pain, and erythema over long bones; assess range of motion in joints.
Infection of the bone that can be either acute or chronic. Osteomyelitis
What are symptoms of osteomyelitis? Changes in mental status, low grade fever, and increased purulent wound drainage (symptoms may go unnoticed until sepsis occurs).
What are some nursing interventions to prevent osteomyelitis? Nurse should use sterile technique during dressing changes, teach client importance of completing antibiotics, methods of preventing infection, and techniques of wound management.
What are the most common causes of amputation? PVD, infections, neoplasms, and traumatic injury (PVD is most common cause in older adults).
What are symptoms of polymyalgia rheumatica? Muscle stiffness present in morning and lasts more than 1 hour; other symptoms include fever, malaise, anorexia, and weight loss.
T/F: Foot problems are often overlooked in assessment and care of older adults. True
Thickened and hardened, dead or hyperkeratotic tissue that develops over bony protuberances. Corns
Dead tissue found on plantar surfaces of the feet. Calluses
Bony protuberances on side of big toe. Bunions
What is the first treatment for bunions? Soft leather shoes that are flat and wide and lace up.
Deformity of the 2nd toe caused by improperly fitted shoes, muscle weakness, and arthritis. Hammertoe
What are some treatments for hammertoe? Metatarsal arch support, orthotics, splints, and passive manual stretching of proximal interphalangeal joint.
Created by: Joshdole04