Musculoskeletal #1

Neurovascular Assessment

-6 P's: Pain, Pallor, Pulses, Paralysis, Pressure, Paresthesia -Compartment Syndrome -CMS: Circulation - pulses, pallor, temp, cap refill Mobility - ROM Sensation - paresthesia

Nursing Diagnoses for Osteoarthritis

-Acute/chronic pain r/t degenerative changes secondary to OA -Impaired physical mobility -Imbalanced nutrition: more than body requirements -Depression r/t chronic pain secondary to OA -Self-care deficit Body image changes

Non-pharmacologic treatment for OA

-Balance activity & rest -Hot (chronic) or cold (acute) application -Exercise to maintain joint flexibility -Nutrition: omega 3, Ca+, vit. D, C, K. Avoid sugar, saturated fats, high cholesterol, refined carbs

Osteoporosis pharmacologic interventions

-Calcium supplements (tums) -Vit. D supplements -HRT

Osteoporosis non-pharmacologic interventions

-Fall prevention -Diet - adequate protein, Ca+, vit. D & K consumption -Exercise & weight loss - weight bearing exercise for 30 mins 3x a week

Gout - Etiology

-Family hx -Age - middle-aged men, post-menopausal women -Obesity -Excessive alcohol -High purine diet (alcohol, fish, meat) -HTN -DM -Hyperlipidemia -Thiazide diuretic

Osteoporosis non-modifiable risk factors

-Female -Caucasian/Asian -DM, RA Family hx

Paget's Disease non-pharmacologic interventions

-Firm mattress -Brace -Pt to increase muscle strength -Good body mechanics -Balanced nutrition -Prevent falls

Physical Assessment - Inspection

-Gait, posture, ROM, transfer ability, & balance -Use of assistive devices -Edema -Symmetry of joints, muscles

Gout pharmacologic interventions: acute & intercritical phase

-NSAIDs (except aspirin) -Colchicine: anti-inflammatory -Glucocorticoids

Osteoarthritis - Clinical Manifestations

-Pain with activity -Stiffness after periods of inactivity -Progressive loss of function -Crepitation -Deformity -Heberden's (distal) and Bouchard's (proximal) nodes in fingers

What are some chief complaints a pt might have regarding musculoskeletal system?

-Pain/changes in sensation -Swelling -Limited ROM r/t stiffness & crepitus -Deformity

Pt history to gather during musculoskeletal assessment?

-Past & current medical diagnoses -Meds: Corticosteroids, HRT, Glucosamine, Bromelain, -Capsaicin -Surgery or other treatments

Osteoporosis Clinical Manifestations

-Pathological fractures (hip, spine, wrist) -Vertebral degeneration - Kyphosis, compression fractures

Osteoporosis modifiable risk factors

-Smoking -High caffeine or alcohol intake -Low dietary calcium intake -Use of corticosteroids -Sedentary lifestyle

Physical Assessment - Palpation

-Temperature of structures -Tenderness -Crepitation -Muscle strength

A nurse is preparing a presentation at a senior center about age-related musculoskeletal changes. Which of the following changes should the nurse plan to include? A. Decreased muscle mass B. Thickened vertebral disks C. Reduced chest width D. Increased force of isometric contraction

A A decrease in muscle mass and strength occurs with aging.

A nurse is caring for a client who is scheduled for an arthroscopy. The nurse asks the client to state if he understands the procedure that is being performed. Which of the following statements by the client indicates an understanding of the procedure? A. "This procedure determines the extent of joint damage." B. "This procedure will fuse my point to reduce my pain." C. "This procedure will prevent further joint damage." D. "This procedure will replace my joint to improve function."

A Arthroscopy is used to diagnose and treat joint problems.

Osteoarthritis

A degenerative joint disease characterized by softening cartilage, increased synovial fluid, and development of osteophytes (bone spurs).

Osteomalacia

A vitamin D-deficiency disease in adults, in which bones become weak and prone to fractures

A nurse in a medical clinic is providing teaching to an older adult client who has osteoarthritis that is affecting her knees. Which of the following client statements indicates an understanding of the teaching? A. "I can use either heat or ice to help relieve the discomfort." B. "Ibuprofen is the first step in medication therapy for osteoarthritis." C. "I should limit physical activity to prevent further injury." D. "I will elevate my legs by placing two pillows under my knees when I go to bed."

A. The nurse should reinforce that different treatment modalities, such as heat or cold therapy, can be tried to determine which one is more effective for the client. Heat application can help with muscle relaxation in the area around the affected joint. The application of cold numbs nerve endings and decreases joint inflammation.

Pharmacologic treatment for OA

Acetaminophen to relieve mild to moderate pain -avoid alcohol, 4g max daily (3g for elderly) NSAIDs (ibuprofen, Motrin, Aleve) to relieve moderate to severe pain

Gout pharmacologic interventions: chronic phase

Allopurinol: s/e rash, decreased CBC Febuxostat: s/e rash, nausea, decreased liver function

Electromyography

Assess health of motor neurons and muscle

Postoperative Management

Assess: pain, CMS, neuro, bowels, ABC, VS, dressing Interventions: No bending >90 degrees, do not cross legs, no foot rotation, SCDs, pain meds, PT, posterior hip precautions, hip abductor pillow

A nurse is teaching a client who has a new prescription of allopurinol for the treatment of gout. Which of the following instructions should the nurse include? A. "Take the medication on an empty stomach." B. "Drink 2 liters of fluid each day while taking the medication." C. "Take a 650 milligram dose of aspirin for joint pain." D. "Do not crush the medication before taking it."

B An adverse effect of allopurinol is renal damage. The client should drink 2 L of fluids a day to decrease the risk of renal damage.

A nurse is teaching a client who is scheduled for an indium bone scan of his knee. Which of the following instructions should the nurse include? A. "You will need to decrease your fluid intake after the test." B. "You will need to drink 2500-3000 mL of fluid after the test " C. "The provider will inject the isotope 30 minutes before the test." D. "You will need to discard your urine in a lead container following the test."

B The client should increase fluid intake following the test to promote urinary excretion of the indium.

A nurse is teaching an older adult client who has osteoporosis about beginning a program of regular physical activity. Which of the following recommendations should the nurse make? A. High-impact aerobics B. Walking briskly C. Riding a bicycle D. Stretching exercises

B Weight-bearing exercises are essential for maintaining bone mass. Walking is an appropriate activity for an older client to promote weight bearing and to maintain bone mass.

Paget's Disease pharmacologic interventions

Bisphosphonate, calcium, vit. D, NSAIDs

Bisphosphonates for Osteoporosis Alendronate Ibandronate

Block bone resorption by inhibiting osteoclast activity, increase bone density May cause esophageal irritation, take with a full glass of water on an empty stomach, remain upright for 30 mins

Paget's Disease Clinical Manifestations

Bone pain, visual disturbances, loss of hearing Mostly effects skull & long bones

A nurse is reviewing the cause of gout with a group of nurses. Which of the following statements should the nurse make? A. "Uric acid levels drop and calcium forms precipitate." B. "Tophi form in the kidneys and they impair the excretion of uric acid." C. "The intra-articular deposition of urate crystals causes inflammation." D. "Articular cartilage thins, leading to splitting and fragmentation."

C Gout, or gouty arthritis, develops when urate crystals deposit in joints and tissues and cause inflammation and pain.

A nurse is teaching a client about risk factors for osteoarthritis. Which of the following factors should the nurse include in the teaching? (Select all that apply.) A. Bacteria B. Diuretics C. Aging D. Obesity E. Smoking

C, D, E Aging is correct. Aging is a risk factor for osteoarthritis, as the joints bear the load of the body's weight over time. Obesity is correct. Obesity is a risk factor for osteoarthritis, as it increases the load of the body's weight over time. Smoking is correct. Smoking is a risk factor for osteoarthritis, as smoking predisposes people to the loss of cartilage in the knees.

A nurse is teaching a client about preventing osteoporosis. Which of the following statements by the client indicates a need for further teaching? A. "I will reduce my intake of sodium." B. "I will decrease my intake of caffeine." C. "I will limit my intake of soft drinks." D. "I will reduce my intake of vitamin K-rich foods."

D

A nurse is caring for a client who is postoperative following knee arthroplasty and has a continuous passive motion (CPM) machine. Which of the following actions should the nurse take? A. Store the CPM machine on the floor when not in use. B. Use a special pillow to rotate the affected knee internally. C. Set the CPM to fully flex the knee joint. D. Apply ice to the operative knee.

D The nurse should apply ice to the client's operative knee to reduce edema postoperatively, which will decrease pain and bruising

A nurse is planning care for a client who is postoperative following a total hip arthroplasty. Which of the following interventions should the nurse include in the plan of care? A. Instruct the client to avoid movement of the affected leg. B. Prevent hip flexion of the affected extremity C. Position the lower extremities so that they are touching. D. Ensure that the client's heels are touching the bed.

D The nurse should elevate the client's heels off of the bed to help prevent skin breakdown.

A nurse is providing discharge teaching to a client who had a total hip arthroplasty. Which of the following information should the nurse include in the teaching? A. Use a twisting motion when turning to pick an object up. B. Cleanse the incision with hydrogen peroxide. C. Bend at the waist to put shoes on when sitting. D. Sit with legs apart at the ankles.

D The nurse should instruct the client to not cross legs beyond the midline of the body; therefore, the client should sit with legs apart.

Arthroscopy

Endoscopy procedure used to diagnose & treat joint problems. Teach the pt to monitor for infection

Preoperative Management

H&P: diabetes, hx of DVTs, MRSA, COVID, obesity, smoking Meds: anticoagulants, steroids ECG & Labs: CBC, electrolytes, BUN & creat, BG, UA, PT/INR, WBC

Total Hip Arthroplasty

Hip replacement to relieve pain & improve joint function

Osteoarthritis - Etiology

Idiopathic/Primary Osteoarthritis -Age -Women -Obesity -Smoking Secondary Osteoarthritis -Mechanical stress -Prior injury or congenital anomalies -Legg-Calve-Perthes Disease (affects hip)

C-Reactive Protein & Erythrocyte Sedimentation Rate

Indicator of acute inflammation (non-specific)

Prolia

Inhibits bone resorption Treats postmenopausal women with osteoporosis who are at high risk for fractures or cannot use other osteoporosis meds

Probenecid

Inhibits reabsorption of uric acid in proximal convoluted tubule. Teach 2000-3000mL fluid daily s/e rash, stomach pain, kidney stones Monitor CBC & serum uric acid levels

Pharmacologic treatment for OA Corticosteroids

Local: short term relief, max 3 injections w/ 3 months in-between due to joint destruction Systemic: watch for fluid retention, increased BG, increased risk for infection

Pharmacologic treatment for OA COX2 Inhibitors: Celecoxib (Celebrax), Meloxicam, Rofecoxib

NSAID, reduces pain & inflammation with fewer GI effects. Monitor for GI, renal, & cardiac effects (MI, stroke, renal failure)

Paget's Disease

Osteitis Deformans -Excessive bone resorption, replaced with connective tissue

Knee Arthroplasty

Osteotomy: reshaping of tibia/femur Knee Arthoplasty: total or partial

Osteoporosis

Progressive loss of bone mass After age 30 bone resorption>bone formation

Calcitonin

Selective Estrogen Receptor Modulator Inhibits osteoclast activity

Raloxifene

Selective Estrogen Receptor Modulator Mimica estrogen on bone Does not increase cancer risk

Teriparatide

Selective Estrogen Receptor Modulator Parathyroid hormone

Arthrocentesis

Surgical puncture to remove synovial fluid from a joint

Gout

Uric acid crystals in joint

Indium Sacn

Use of radioactive isotopes to diagnose deformities or infection. Teach pt to drink 2500-3000mL of fluid after procedure to excrete radiation.

What is a CPM device used for?

Used to prevent loss of motion in a joint

Arthrogram

X-ray with dye injected into the joint. Helps to determine accurate diagnosis of joint pain/swelling.

Diagnostics for Osteoporosis

X-ray, Bone Density Scan