NACP Test 4: Musculoskeletal

thermal; tumors; osteomyelitis; younger; peripheral vascular disease; diabetes; history; length; function; everything; reason; residual limb; skin flap; image; tissue integrity; pain; mobility

Amputation (Card 1) Can Occur Due To: - _____________ injuries - _____________ - _________________ - Congenial limb disorders - In _______________ people we see a higher number of amputations in trauma cases, motor vehicle crashes, farm related injuries. - You also have people who have _____________ _____________ _____________ (esp in older pts with _____________) that can sometimes have amputations of those limbs. - Thorough assessment of patient and their ____________ is important before amputation. ---> Make sure you understand everything that's going on with he patient. - Goal of any amputation surgery is to reserve the greatest extremity _________ and the ____________ while removing __________________ that is infected or dead (necrosis or any tissue that is no longer viable). - The type of amputation depends on the ____________ for the surgery. - Closed amputation creates a weight-bearing ___________ _____________ or a stump. --> Use a ________ ________ which helps to pad the bony part of the residual limb. Nursing Diagnoses - Disturbed body __________ - Impaired ____________ ____________ - Chronic __________ - Impaired visible ______________

residual limb; stop using; wash; DO NOT; daily; ROM; elevate; prone; extension

Amputation (Card 2) Lower Extremity Amputation: Patient/Caregiver Teaching 1) Inspect ____________ _______ daily for signs of skin irritation. Especially redness, abrasion, and odor. 2) _______ _________ the prosthesis if irritation develops. 3) __________ the residual limb thoroughly each night with warm water and bacteriostatic soap. Rinse gently. Then expose limb to air for 20 minutes. 4) _____ _________ use lotions, alcohol, powders, or oil on residual limb unless prescribed by HCP. 5) Change residual limb sock ___________. 6) Perform ________ to joints daily. 7) DO NOT ____________ residual limb with pillow. 8) Lay ________ with hip in _________________ for 30 min 3-4 times a day daily.

inflammation; women; joints; tendons; ligaments; rheumatism; degenerative; crystal induced; diffuse connective-tissue

Arthritis - Arthritis involves _____________ of a joint or joints. - Most forms of arthritis affect _______________ more than men in every age group. - Primarily affects _________, ____________, and _____________, but also has some effect on bones and muscles. - _________________: Disorders with inflammation, degeneration, or derangement of the connective tissues including the joints. Categories - _______________ joints disease. - ___________ ____________ arthritis. - _____________ ___________-___________ disorders.

pneumonia; DVT; PE; hypertension; nutritional; muscle; constipation; urinary; atrophy

Complications of Immobility - Pain - _________________ - ________/_____ - Postural _______________ - _________________ deficit. - ______________ wasting. - __________________ - ________________ problems. - Contractions and _____________.

uric acid; uric acid crystals; remissions; exacerbations; african americans; purine; excrete; too much; hyperuricemia

Crystal-Induced Arthritis Gout (Card 1) Overview/Etiology - Gout is a type of arthritis characterized by elevation of _______ ________ and the deposit of ________ ________ _____________ in one or more joints. - Unlike other types of arthritis, gout is marked by painful flares lasting days to weeks followed by long periods without symptoms. ---> ______________ and _______________. - ____________ ____________ have a higher incidence than other ethnicities. - Uric acid is the major end-product of _____________ catabolism. - Gout occurs when either the kidneys cannot ______________ enough uric acid or there is _______ ________ for the kidneys to handle efficiently. - Gout can also be called ________________. --> Primary caused by genetics. --> Secondary caused by conditions that increase uric acid production or decrease uric acid excretion. Can also be caused by drugs.

great toe; dusky; cyanotic; tender; trauma; alcohol; night; sensitive; fever; tophi; stone

Crystal-Induced Arthritis Gout (Card 2) Clinical Manifestations - Inflammation of the _________ ______ is the most common initial problem. - Other joints affected may include wrists, knees, ankles, and the midfoot. - Affected joints may appear __________ or ________________ and are extremely ______________. - Acute gout arthritis usually triggered by _________, surgery, _____________ use, or systemic infection. - Symptom onset typically occurs at __________ with sudden swelling and severe pain peaking within several hours. - The painful area is very ____________ to light touch. - A low grade-____________ is also common. - Chronic gout is characterized by multiple joint involvement and visible deposits of sodium urate crystals called ___________ (Hard white nodules. Generally occur years after onset of disease). - Excessive uric acid excretion may lead to ________ formation in the kidneys or urinary tract.

synovial fluid aspiration; colchicine; NSAIDS; corticosteroids; allopurinol; uric acid; alcohol; purines; reduction

Crystal-Induced Arthritis Gout (Card 3) Diagnosis - Gold Standard: _____________ _________ ____________ (only done in some patients because diagnosis can usually be made based on clinical manifestations.) Collaborative Management Drugs - Acute gout is usually treated with oral ________________ (Colcrys, Mitigare) and ____________. - __________________ can also be helpful in treating an acute attack. - Future attacks of gout are prevented by xanthine oxidase inhibitor which decrease the production of uric acid (________________) Other - Serum _______ ________ must be checked regularly. - Teaching patient to limit ___________ and foods that contain ______________. - Teach obese patients the need for weight _______________.

careless handling; bed rest; footboard; limitations; pain; anchovies; liver; alcohol

Crystal-Induced Arthritis Gout (Card 4) Nursing Management - Avoid causing pain to joints by _____________ ____________ of inflamed joint. - ______ _________ may be appropriate to immobilize affected joints as needed. - Use a cradle or ______________ to protect painful lower extremity from the weight of bed linens. - Assess motion ______________ and degree of ________. **Foods High in Purines that Should be Avoided: ______________, __________, and ________________.

slowly progressive noninflammatory; synovial; increase; articular cartilage; bony outgrowths; aging; event; condition; genetic; more likely; estrogen; obesity; anterior cruciate ligament

Degenerative Joint Disease Osteoarthritis (Card 1) Overview/Etiology - Osteoarthritis (OA) is a _________ _______________ _______________________ disorder of the _____________ joints. - Currently osteoarthritis affects 30 million Americans. This number is expected to greatly ______________ as the population ages. - Osteoarthritis involves the gradual loss of _____________ ____________ with formation of ________ ________________ (spurs or osteophytes) at the joint margins. Causes/Risk Factors - ___________ ---> OA is not a normal process of aging! - May be caused by a known _______ or ______________ that directly damages cartilage or causes joint instability. - Various ____________ traits may contribute to cartilage defects. - People with hand OA are _______ __________ to develop knee OA. - Decreased ______________ at menopause may contribute to incidence of OA in aging women. - ______________ is a modifiable risk factor of OA. It increases mechanical stress on the joint. - _____________ ____________ _______________ injury are linked to increased risk for OA.

drugs; hematologic; endocrine; inflammation; instability; mechanical stress; neurologic; deformities; trauma

Degenerative Joint Disease Osteoarthritis (Card 2) Other Causes - __________: Can stimulate collagen-digesting enzymes in joint synovium. - ______________ or ______________ disorders: Contributes to cartilage deterioration. - _________________: Release of enzymes can affect cartilage health. - Joint ________________: Places uneven stress on joint cartilage. - ______________ ________: Repetitive physical activities cause cartilage deterioration. - ________________ disorders: Such as diabetic neuropathy. Cause abnormal movements that contribute to cartilage deterioration. - Skeletal ________________: Congenital or acquired conditions contribute to cartilage deterioration. - __________: Dislocations or fractures may lead to avascular necrosis or uneven stress on cartilage.

discomfort; disability; joint; use; disability; function; pain; sleeping; stiffness; early morning; crepitation; one; fever

Degenerative Joint Disease Osteoarthritis (Card 3) Clinical Manifestations - Manifestations range from mild ______________ to significant ______________. - ________ pain is the main symptom and the typical reason the patient seeks medical attention. - Pain generally gets worse with joint ________. - As OA progresses, increasing pain can contribute greatly to ____________ and loss of ______________. - In early stages, OA pain is usually relieved by rest. However, the patient with advanced disease may have ________ at rest or have trouble ______________ due to increased joint pain. - Unlike pain, which typically worsens with physical activity, joint _________________ occurs after periods of rest or an unchanged position. _________ _____________ stiffness is common (important for differentiation from other types of arthritis). - _______________ (popping, cracking) is common in pts with knee OA. - OA typically only affects ______ side of the body rather than in pairs. - Fatigue, ____________, and organ involvement are usually NOT present with OA. This is an important distinction between OA and inflammatory joint disorders such as rheumatoid arthritis.

bone scan; CT scan; MRI; x-rays; cure; nondrug; rest; activity; rest; immobility; long; assistive devices; heat; cold; reduction

Degenerative Joint Disease Osteoarthritis (Card 4) Diagnosis - A _______ _________, _______ ________, or _________ may be used to diagnose OA. - _____-______ can help to confirm disease and stage joint damage. Interprofessional Care - OA has NO _______. - ____________ interventions are the basis of OA management. They should be maintained throughout the patient's treatment. - Teach the patient with OA to balance _________ and _____________. ---> Encourage _______ of affected joint during periods of acute inflammation. - Teach the patient to avoid ______________ for more than 1 week to prevent joint stiffness and to not stand, kneel, or squat for _________ periods of time. ---> Use of ____________ _____________ can help decrease joint stress. - Apply _______ and _________ to reduce pain and stiffness. --> Ice for Inflammation --> Heat for stiffness. - If the patient is overweight, encourage weight _______________. ---> Help them change their diet.

acetaminophen; capsaicin; NSAIDS; arthroscopy; osteotomy; arthroplasty

Degenerative Joint Disease Osteoarthritis (Card 5) Drug Therapy - The patient with mild to moderate joint pain may get relief from ___________________. - Topical agents, like _____________ cream may be helpful. - If patient does not get adequate pain relief from acetaminophen, ____________ in low-doses may be given. Surgical Therapy - _______________: Removes loose bodies from the joint. - _______________: Removing a wedge or slice of bone to restore alignment and to shift weight-bearing. - _______________: Reconstruction or replacement of a joint.

outpatient; drugs; physical therapist; pain; assistive devices

Degenerative Joint Disease Osteoarthritis (Card 6) Nursing Management Acute Care - Patients with OA are usually treated as ______________. - _________ are given for the treatment of pain and inflammation. - Once an acute flare has subsided, a ___________ ______________ can give valuable assistance in planning an exercise program for the patient. - Patient teaching: Provide information about the disease, ______ management, body mechanics, correct use of ____________ ____________, joint protection, and energy conservation.

risk factors; procedure; breathing; turning; practice; rapidly; discharge; neurovascular; medications; complications; ROM; ambulation; 3; infection; venous thrombus embolism

Degenerative Joint Disease Osteoarthritis (Card 7) Nursing Care for Joint Replacements Preoperative - Identify _____ ___________ for postoperative complications. - Patient teaching about ______________, and teach deep _____________, ____________, and use of a bedpan and bedside commode. - Provide opportunities to ____________ with assistive devices. - Patients should realize that recovery does not occur ______________. - ____________ planning occurs immediately. Postoperative - Regularly perform _______________ assessment. - Give ordered _________________. - Monitor for postoperative ______________________. - Assess _______ at regular intervals. ---> In general, the affected joint is exercised and _______________ is encouraged as early as possible to prevent complications of immobility. - Hospital stay is usually about ______ days. - Teach patient the signs of infection. Complications of Joint Surgery - ______________ is a serious complication of joint surgery, especially joint replacement therapy. ---> Administer antibiotics. - ____________ _____________ ____________ is another potentially serious complication after joint surgeries, especially those involving the lower extremities. ---> Anticoagulant drugs, compression devices, and early ambulation.

chronic; autoimmune; inflammation; remissions; exacerbations; extraarticular; disabling; vary; women

Diffuse Connective Tissue Disorder Rheumatoid Arthritis (Card 1) Overview/Etiology - Rheumatoid Arthritis (RA) is a ___________, systemic, _________________ disease characterized by __________________ of connective tissues in synovial joints. - Typically marked by periods of _________________ and ___________________. - Often has ________________ manifestations. - RA has long been considered one of the most _______________ forms of arthritis. - Symptoms and outcomes can _________ greatly. - More common in _______________.

subtle; anorexia; loss; stiffness; pain; stiffness; limited; heat; swelling; hands; inactivity; spindle; increases; painful; warm; swan neck

Diffuse Connective Tissue Disorder Rheumatoid Arthritis (Card 2) Clinical Manifestations - The onset of RA is usually ___________. Nonspecific manifestations such as fatigue, _____________, weight ________, and generalized _________________ may precede the onset of joint symptoms. - Specific joint involvement is marked by ________, ______________, ______________ motion, and signs of inflammation (_______, ____________, tenderness). - Joints symptoms occur symmetrically and usually affect the small joints of the ___________. ---> Other Joints that May be Involved: Wrists, Elbows, Shoulders, Knees, Hips, Ankles, Jaw. - The patient typically has joint stiffness after periods of _______________. Morning stiffness may last from 60 minutes to several hours or more. - In early disease, the fingers may become ___________ shaped from synovial hypertrophy and thickening of the joint capsule. - Joint pain _______________ with motion. - Joints are tender, _____________, and _________ to the touch. - Ulnar drift, ______ _________ deformity, and boutonniere deformities are commonly seen in the hands.

history; findings; laboratory; bone scans; disease-modifying antirheumatic; surgery

Diffuse Connective Tissue Disorder Rheumatoid Arthritis (Card 3) Diagnosis - Diagnosis is often made based on patient ____________ and physical ____________. - _____________ tests are used to confirm diagnosis and monitor disease progression. ---> Will show positive RF factor. - ________ __________ can also be used to detect early joint changes and confirm diagnosis so that RA treatment can be started. Treatment **Drugs are the primary treatment for this disorder. - ___________-_____________ ___________________ drugs are the cornerstone of RA treatment (Plaquenil) ---> These drugs may slow the progression of the disease and decrease risk for joint erosion and deformity. - ____________ may be needed to relieve severe pain and improve the function of severely deformed joints. ---> Synovectomy, Arthroplasty

medications; quality; function; rehabilitation; rest; activity; protective; passive ROM; self-care; physical therapist; occupational therapist; social worker

Diffuse Connective Tissue Disorder Rheumatoid Arthritis (Card 4) Nursing Management - Give ordered ______________ and teach patient/caregiver about these. - Assess disease impact on ____________ of life and joint ______________. - Develop program for _________________ and education with Interprofessional team. - Teach patient about need for balance of ________ and ____________ and the use of joint _______________ strategies. - Aid patient with __________ ______ of affected joints. - Help patient with _______-________ needs. Consults - _______________ _____________: Assess patient's current mobility and need for assistance. Develops exercise plan. Teaches to use assistive devices. - _______________ ______________: Helps patient perform ADLs. - _____________ ___________: Can help coordinate discharge and future planning with patient. **Body-image and self esteem are very important in nursing management as this disease impacts both.

break; blow; crushing force; twisting; pathologic; direct; indirect; compression; torsion; weaken

Fractures (Card 1) - A ________ in the continuity of the bone. Causes - Direct _______ - ____________ _________ - Sudden ____________ motion - _______________ fracture - There can be ____________ or ______________ force. - A crushing force will usually create a ________________ fracture. - A sudden twisting motion will usually create a ___________ fracture. - Pathological fractures occur when there is a disease in the bone that causes the bone to __________________.

closed; open; complete; incomplete; stable; unstable; vascular; blood flow

Fractures (Card 2) Classification - ___________ Fractures: Simple fracture. Skin is no opened. - __________ Fractures: Compound fracture. More serious. Increased risk of complications such as infection. - A _____________ fracture goes through the entire length of the bone (bone broken all the way through). - An ________________ fracture does not extend through the whole width of the bone (fracture stopes midline or somewhere else, bone not completely broken through). - A ____________ fracture is a fracture that is nondisplaced. Bones will be in a normal anatomical alignment. - A ____________ fracture occurs when the bones are displaces. Bones move out of aligment ---> Needs immediate intervention because we are worried about the ______________ system (swelling, causing damage to other organs around the bone). ---> Can lead to decreased __________ __________ to area around the fracture and below the fracture.

transverse; linear; oblique; spiral; greenstick; comminuted; pelvic; hip

Fractures (Card 3) Classification By Direction - ______________: Occur when bone is broken perpendicular to its length. - _____________: Break parallel to the bone's long axis. Most skull fractures. - _______________: The fracture is a straight line that's angled across the width of your bone, angled/slanted line. --> Can be displaced in which bone fully breaks apart, or nondisplaced where bone stays together with an angled break. - ____________: Creates a line that wraps around your bone and looks like a corkscrew. ---> Usually caused by a twisting force. May also be referred to as a complete fracture. - _______________: When a bone bends and cracks instead of breaking completely into separate pieces. - __________________: When the bone is broken into more than two pieces. - The most serious fracture is a ____________ fracture because there is a huge amount of blood loss. - The most common fracture is a _______ fracture.

position; swelling; edema; spasms; pressure; movement; grating; numbness; nerve entrapment; guarding; hypovolemic shock; contract; ecchymosis

Fractures (Card 4) Clinical Manifestations - Deformities in the ___________ of the bones. - _____________, __________ from bleeding and other serous fluids. - Pain that can be caused by muscle _______ or nerve ____________ or actual ______________ of fractured bone. Bone ____________ together can also cause pain. - ________________ from nerve damage or __________ ______________ where bone is pushing up against nerve. - ______________ of the area - ______________ ___________ if there is a lot of internal bleeding. - Muscles will ___________ near the fracture. - ________________ is also common where there is blood in the subcutaneous tissue around the area of injury.

pins; infection; reduction; fixation; place; drain; neurovascular; capillary refill; pulses

Fractures (Card 5) Surgery External Fixation - Frame connected to _______ above and below the fracture line. - Anytime you have anything external risk for _____________ is a lot higher. Internal Fixation - ORIF: Open _____________, internal _____________: Nails, screws, plates, or pins, to hold the bone in __________. - A lot of times they will have some type of ________ after surgery to remove fluid that builds up in the area. ***Important to do _________________ checks with any type of fracture and with surgery. ---> Make sure leg and arm have good ___________ _________, and ___________ are present above and below level of surgery.

fluid; pressure; hemorrhage; edema; tight; circulation; necrosis; fasciotomy; fat bodies; blood vessels; bone marrow; blood flow; inflammation; mental status; petechia; blood loss; sepsis; stasis; open; external; staphylococcus aureus; pseudomonas; healing; longer; arm; leg

Fractures (Card 6) Fracture Complications - Compartment Syndrome: Caused by a buildup of _________ within a closed space. Causes excessive _____________ to structures within the compartment. Usually caused by _____________, ___________, or a cast that's too ___________. Causes inadequate ______________ to the area which can lead to tissue ____________. May need a _______________ where they cut into the area and release the pressure. - Fat Embolus: Characterized by ______ ___________ that enter the circulatory system from fractures. They can collect in areas with abundant _________ _______________ (lungs, brain) . --> Most commonly associated with fractures of the long bones, ribs, tibia, and pelvis. --> Can also occur after joint replacement, spinal fusions, crush injuries or bone marrow transplants. --> It is thought that the mechanism behind this is that it is released from the _______ _____________ of the broken bones. Then enters the systemic circulation and travels to other organs and it can get stuck in small blood vessels where we see a lack of _______ __________ to those areas and we can see __________________ to those areas as well. --> Changes in __________ _____________ due to hypoxia common with this. --> _______________ on the neck, anterior chest wall, arm pits, buccal membrane, and sometimes the conjunctivae of the eye (warns you this is associated with a fat embolism versus another problem). - Shock: From _________ _________ or ____________. - DVT: Venous __________ from the immobility. - Infection: Especially in _________ fractures and ones that have ______________ fixators (screws coming through the skin), ____________________ ____________, __________________ common infecting organisms. - Delayed Union: Prolonged _____________. A bone that takes _____________ than normal to heal. - Reflex Sympathetic Dystrophy: Chronic ______ or ______ pain that develops after injury. May involve abnormal inflammation and nerve dysfunction.

pain; elevate; swelling; usage; position; alternative; physician

Fractures (Card 7) Nursing Care - Administer ________ meds. - ________________ involved extremity. - Monitor ________________. - Encourage muscle ______________. - Change ________________. - Use _________________ pain relieving strategies. - Notify _________________ if you observe any complications.

long-term; debilitating; activities; head of the trochanter; 50; surgery; vital signs; pain; gently; exercises; buck's traction

Hip Fractures (Card 1) Overview - 15-25% of patients that have hip fractures remain in ______-_______ care. Highly _________________ fracture. - Only 50% of people will return to pre-fracture ______________. - Most will involve the __________ ________ ________ ___________, or the femur head/neck. - There's over 240,000 a year and they are more common in people > ______ yo. - Expect ____________ in first 24 hours Nursing Care - Monitor _________ ________ - Make sure patient's _________ is under control. - Turn patients ____________. - Do ________________ with them and orientation. - _________ ______________ can be used with hip fractures, then surgery with pins, screws, nails or plates.

realignment; pain; 90; neutral straight; deformity; popping back out

Hip Fractures (Card 2) Surgical Repair of Hip - Buck's Traction: A skin traction that is used widely for lower limb fractures and hip fractures. ---> We use this for patients before they have surgery to get them in a position of ___________________ and help with _________ control. Post-op Nursing Care - Be really careful not to flex the hip greater than ______ degrees. --> Can happen when sitting in low chairs or toilet seats. - Keep hip in a _____________ __________ position when sitting, walking, or lying. - It is an emergency (notify HCP at once) if you see a ______________ in the hip. --> Severe pain deformity, loss of function from hip ______________ _________ ________ of place.

elevated; shower; tub; seated; pillow; deformity; pain; function; 90; adduct; internally rotate; cross; adaptive; arms

Hip Fractures (Card 3) Patient/Caregiver Teaching Do - Use ____________ toilet seat. - Place chair inside ____________ and ________ and remain _____________ while washing. - Use _____________ between legs for 6 wks after surgery when lying on nonoperative side or supine. - Notify HCP at once if ___________, severe ________, or loss of ______________ occurs. Don't - Flex hip greater than ______ degrees (sitting in low chairs/toilet seats) - ____________ hip (bring legs together at knee) - ______________ _____________ hip. - _________ legs at knees or ankles. - Put on own shoes or stockings without _________________ device. - Sit on chairs without _________.

localized; diffuse; common; weight; health care

Lower Back Pain (Card 1) Overview - Lower back pain is most often due to musculoskeletal problem. - In _____________ pain, patients feel discomfort or soreness when a specific area of the lower back is palpated or pressed. - ____________ pain occurs over a larger area and comes from deep tissue. - Very _____________ ---> Affects about 80% of adults in the US at least once in their life. - Low back pain is common because the lumbar region bears most of the ____________ of the body. - ________ _________ personnel who provide direct patient care are at risk for lower back pain. Other Risk Factors: Lack of muscle tone, excess body weight, stress, poor posture, smoking, pregnancy, prior compression fracture of the spine, spinal problems, and a family history of lower back pain.

4 weeks; trauma; stress; ache; pain; limited; upright; cause; prevent; exercise; NSAIDS; relaxants; corticosteroids; opioid; rest

Lower Back Pain (Card 2) Acute Lower Back Pain - Lasts _____ _________ or less. - Mostly caused by ________ or an activity that produces undue ________ (often hyperflexion) on the lower back. - Symptoms may range from muscle ________ to shooting, stabbing _________, ______________ flexibility or ROM, or inability to stand ____________. - Symptoms of acute low back pain usually improve within 2 weeks without treatment. - Teach the patient about the __________ of the pain and ways to _______________ further episodes. --> Refrain from lifting, bending, twisting, and prolonged sitting. - Patient needs an ____________ program to strengthen muscles (physical therapist may assist in developing this). Treatment - If acute muscle spasms and accompanying pain are not severe and unbearable, the patient is treated as an outpatient with ____________ and muscle _______________. - Severe pain may require a brief course of _________________ or __________ analgesics. - Massage and back manipulation, acupuncture, and the application of heat and cold compresses may also help some patients. - Some people may need a brief period (1-2 days) of _______ but should avoid prolonged bedrest.

three months; progressive; degenerative; osteoporosis; weakness; strain; spine; spinal stenosis; NSAIDS; antidepressants; anti-seizure; back school; surgical

Lower Back Pain (Card 3) Chronic Lower Back Pain - Chronic lower back pain lasts more than _________ __________ or involves repeated incapacitating episode. - It is often ______________ and the cause can be hard to determine. - Causes Include: (1) ______________ conditions (2) ______________ or other metabolic bone diseases. (3) ______________ from the scar tissue of prior injury. (4) Chronic _________ on lower back muscles. (5) Congenital _________ problems. - ____________ ___________ is a narrowing of the spinal canal which holds the spinal cord and is a common cause of chronic lower back pain. --> Numbness, weakness, tingling, and heaviness are common S/S of this. Treatment - Manage the patient's pain and stiffness with mild analgesics, such as ____________, for daily comfort. - __________________ may be used to help with pain management and sleep problems. - _______-_______________ Drugs (Neurontin): May improve walking or leg symptoms. - Weight reduction, rest periods, heat/cold application, and activity throughout the day can help keep the muscles and joints mobilized. - "______ __________" can significantly reduce pain and improve body posture. - _____________ intervention may be indicated in patients with severe chronic lower back pain that does not respond to usual therapy options.

force; blunt; penetrating; extent; blunt; penetrating

Musculoskeletal Trauma Can be Caused by: - Excessive external _________ that is either _________ or __________________. Overview - The amount of impact at the site determines ___________ of injury. - Some bones can take more force than others. - A ________ force does not break the skin while a ______________ force goes through the skin interrupting skin integrity.

rare; metastatic; x-rays; ct scan; mri; needle; alkaline phosphate; red blood cells; calcium

Neoplasms: Bone Tumors - Primary: Somewhat ________ in adults. --> Only 3% of cases; - Secondary: Spread from another site. Also referred to as _______________ tumors. --> thyroid, lungs, kidneys, or breasts is where cancer o Diagnosis: _____-______, _____ ________, _________, ____________ biopsy, serum ____________ ______________. - Malignant tumors can cause an elevation in _______ _________ __________. - Elevated serum ____________ level because of bone breakdown.

vitamin D deficiency; calcium; soft; rickets; soft; sun; GI malabsorption; diarrhea; pregnancy; long-term

Osteomalacia (Card 1) Overview/Etiology - Osteomalacia is caused by a ___________ ____ ______________ that causes bone to lose _____________ and become ________. - The disease is uncommon in the US. - It is the same disorder as ______________ in children, except the epiphyseal plates are closed in adults. **Vitamin D is required for the absorption of calcium from the intestine. Insufficient vitamin D intake can interfere with normal bone mineralization. With little or no calcification, bones become ________. Causes - Limited _______ exposure. - ______ _________________: Post weight loss surgery, celiac disease. - Chronic _____________ - _________________ **Residents of _______-_________ care facilities at increased risk because of limited exposure to sun thus poor synthesis of vitamin D.

long-term; obese; anti-seizure; bone pain; muscle weakness; night; walking; waddling; fractures; x-ray; looser's transformation zones

Osteomalacia (Card 2) People at Risk - People living in a ________-________ care facility (inadequate sun exposure). - _________ people due to inactivity. - People who use ______-___________ drugs and phosphate-binding antacids long-term (may decrease calcium and vitamin D absorption). Clinical Manifestations - _______ ________ and ___________ _____________ are common. - The pain is often worse at ___________ and affects the lower back, pelvis, hips, legs, and ribs. - Muscle weakness and progressive deformity of weight-bearing bones can lead to problems with _____________ and a _______________ gait. - _______________ are common and indicate delayed bone healing. Diagnosis - _____-_______: May show effects of generalized bone demineralization, especially loss of calcium in the bones of the pelvis and associated bone deformity. ---> _____________ _________________ __________ (ribbons of decalcification in bone found on x-ray) are diagnostic of osteomalacia. ---> Significant osteomalacia may exist without x-ray changes.

vitamin d deficiency; calcium; phosphate; eggs; meat; fish; milk; cereals; sunlight; weight-bearing; weight loss surgery; corrected

Osteomalacia (Card 3) Interprofessional Care - Directed towards correcting ____________ _____ _____________. - ____________ or _____________ supplements may be prescribed. - Encourage dietary intake of ________, __________, and oily ________. - _______ and breakfast ___________ fortified with calcium and vitamin D should be part of the diet. - Exposure to ______________ and _________-___________ exercises are valuable as well. - Assess patients who had _________ _________ ___________ to treat obesity for osteomalacia. - Any vitamin D deficiencies should be ________________.

infection; staphylococcus aureus; one; 20; 17; age; sickle cell; IV drug; vertebrae; adults; open wound; foreign body; implant; diabetes; vascular; more than

Osteomyelitis (Card 1) Overview/Etiology - Osteomyelitis is a severe ______________ of the bone. - Although ______________ _________ is the most common cause of infection, a variety of pathogens can cause osteomyelitis. Microorganisms can Invade in 2 Different Ways: - Indirect Entry (hematogenous): ---> Usually associated with infection with ______ microorganism. ---> Accounts for about ____% of all cases. ---> Most often affects children < ______ yo. ---> Risk Factors: Increased _______, debilitation, hemodialysis, _________ ______ disease, and ______ _________ use. ---> The ____________ are the most common site of infection in adults. - Direct Entry: ---> Most often affects ___________. ---> It can occur when an ________ __________ allows microorganisms to enter the body. ---> May also be related to a _________ ______ or ___________ (plate, total joint prothesis). ---> It may occur in the feet of patients with _____________ or ____________ disease (related ulcers or in the hips or sacrum near a pressure injury). ---> _______ _______ one microorganism usually involved.

grow; pressure; ischemia; blood flow; necrosis; death; separates; reservoir; sinus tract

Osteomyelitis (Card 2) Overview/Etiology (cont.) - After entering the blood, microorganisms ______ and ____________ increases because of the nonexpanding nature of most bones. - This increasing pressure eventually leads to ______________ and vascular compromise of the periosteum. - The infection spreads through the bone cortex and marrow cavity, obstructing _________ __________ and causing ______________. - Bone __________ occurs because of ischemia. The area of dead bone usually _______________ from the surrounding living bone, forming sequestra. - Antibiotics or white blood cells have difficulty reaching the sequestrum through the blood, thus the sequestrum may become a _____________ for microorganisms that spread to other sites, including the lungs and the brain. - If the sequestrum does not resolve or is not debrided, a __________ _______ may develop. Chronic, purulent cutaneous drainage from the tract results.

initial; one; constant bone; worsens; unrelieved; swelling; warmth; restricted; fever; night sweats; one; respond; persistent; exacerbations; remissions; lessened; more common; bone; swelling; warmth; scar

Osteomyelitis (Card 3) Clinical Manifestations - Acute osteomyelitis refers to the __________ infection of an infection of less than ______ month in duration. ---> Local manifestations of acute osteomyelitis include ___________ _______ pain that ____________ with activity and is _______________ by rest; _____________ and tenderness; _________ at the infection site; and ______________ movement of the affected part. ---> Systemic Manifestations: ___________, chills, ________ _________, restlessness, nausea, and malaise. - Chronic osteomyelitis refers to a bone infection that lasts longer than _______ month or an infection that did not ____________ to initial antibiotic treatment. ---> May be a continuous, _____________ problem (a result of inadequate acute treatment), or a process of _________________ and ________________. ---> Systemic manifestations are _____________ with chronic osteomyelitis. ---> However, local signs of infection are _________ _______________ including constant ______ pain and _____________ and ________ at the infection site. ---> Over time granulation tissue turns into __________ tissue.

septicemia; arthritis; fractures; biopsy; blood; wound; WBC; C-reactive; 2; 4; CT scan; MRI

Osteomyelitis (Card 4) Complications - _______________, septic ______________, pathologic ______________, and amyloidosis. Diagnosis - Bone or soft tissue __________ is the definitive way to identify the causative agent. - The patient's _________ and _________ cultures are usually positive. - Increased _______ count and erythrocyte sedimentation rate (ESR) may occur. - High _____-___________ protein may occur with acute infection. - X-Ray: Signs of osteomyelitis usually DO NOT appear until ____-____ weeks after the initial clinical symptoms. ---> By this time, the disease will have progressed. - ______ _________ may be more helpful than x-rays in assessing the extent of infection. In the acute phase, _______ may be more sensitive than the CT in detecting bone marrow edema, which is an early sign of osteomyelitis.

IV antibiotic; hospital; 4; 6; months; central venous access; surgical removal; antibiotics; amputation

Osteomyelitis (Card 5) Treatment - Aggressive, prolonged _______ ______________ therapy is the treatment of choice (gold standard) for acute osteomyelitis if bone ischemia has not yet occurred. ---> Cultures or bone biopsy should be done, if possible, before starting drug therapy. - IV antibiotic therapy starts in the ____________ then continues at home for _____-______ weeks. ---> A few persons may need therapy for 3-6 ____________ (if infection is hard to treat). ---> Patients may be discharged to home care or a skilled nursing facility so the antibiotics can be given through a _____________ ______________ ______________ device. - Treatment for chronic osteomyelitis includes (1) ______________ ___________ of the poorly perfused tissue and dead bone. (2) Extended use of _______________. ---> _______________ of the extremity may be needed if bone destruction is extensive. Should improve quality of life or could even save patient's life if systemic complications are developing. ***If infection is due to implants (discs, screws, hip replacement) it has to be removed, infection is treated, then must be replaced or redone. ***

infections; immunocompromised; diabetes; implants; signs; immobility; NSAIDS; opioids; dressings; bed rest; side effects; emotional

Osteomyelitis (Card 6) Nursing Interventions Health Promotion - Control of other current ___________ (urinary, respiratory, pressure ulcers) is important in preventing osteomyelitis. - Persons at risk for osteomyelitis are those who are ___________________, have _____________, or have prosthetic orthopedic ______________, and those with vascular insufficiency. - Teach patient the ________ of acute osteomyelitis. Acute Care - Some ______________ of the affected limb is usually needed to prevent pain and reduce risk for further injury. - ___________ and __________ may be given to control pain. - ______________ are used to absorb drainage from wounds and debride dead tissue from the wound bed. - The patient is often placed on _______ ________ in the early stages of the acute infection. ---> Risk for foot drop. ---> Perform frequent position changes. - Teach the patient possible _______ ___________ of prolonged high-dose antibiotics therapy (hearing deficit, impaired renal function, neurotoxicity). - Continued psychologic and _____________ support is needed because patients and caregivers tend to be discouraged due to the serious nature of osteomyelitis.

chronic; progressive; metabolic; low; deterioration; fragility; silent thief; normal mechanical stress; calcium; bone mass; reabsorption; pregnancy; longevity; bone density test

Osteoporosis (Card 1) Overview/Etiology - Osteoporosis is a __________, _____________, ______________ bone disease marked by _______ bone mass and _______________ of bone tissue, leading to increased bone ______________. - More than 54 million people in the US have decreased bone density or osteoporosis. - Osteoporosis is known as the "____________ ________" because it slowly robs the skeleton of its banked resources. Bone eventually become so fragile that they cannot withstand ____________ ___________ __________. - Osteoporosis is more common in women because: (1) Women tend to have lower _____________ intake than men. (2) Women have less ______ _________ because of their generally smaller frames. (3) Bone _________________ begins at an earlier age in women and becomes more rapid at menopause. (4) _____________ and breastfeeding deplete a women's skeletal reserve unless calcium intake is adequate. (5) _____________ increases the risk for osteoporosis. - Current guidelines recommend an initial ________ ______________ ______ in all women over the age of 65. ---> Testing should start earlier and be done more often if the person is at risk for fractures.

age; female; weight; white; asian; smoking; inactive; estrogen; history; calcium; D; alcohol; testosterone; corticosteroids; spine; hips; wrists; back; spontaneous fractures; kyphosis

Osteoporosis (Card 2) Risk Factors - Advancing ________ - _____________ gender - Low body _________ - ___________ or ________ ethnicity - _____________ - ______________ lifestyle - _______________ deficiency in women. - Family ____________ of osteoporosis. - Diet low in ____________ or vitamin _____ deficiency. - Excess intake of ____________ - Low _________________ in men. - Long-term use of _________________. Clinical Manifestations - Osteoporosis occurs most often in bones of the _________, _________, and __________. - Typical early manifestations are _______ pain and _____________ ______________. - ____________ or "dowager's hump" due to vertebral fractures and wedging causing gradual loss of height and humped thoracic spine.

detected; severe; bone mineral density; DEXA

Osteoporosis (Card 3) Diagnosis - Osteoporosis often goes unnoticed because it cannot be ______________ by conventional x-ray until 25-40% of calcium in the bone is lost. ---> When it is caught on x-ray disease has already progressed to ___________ level. - ________ ____________ ___________ Measurements: Determined by peak bone mass and amount of bone loss. May be measured by quantitative ultrasound and dual-energy x-ray absorptiometry (DEXA). - _________ is considered the gold standard of BMD studies by the WHO. Measures the bone density in the spine, hips, and forearms (the locations most commonly affected by osteoporosis).

calcium; D; exercise; falls; fractures; drugs; 1000; 1200; dairy; orange; seafood; 20; physical activity; weight-bearing; 30; ambulatory

Osteoporosis (Card 4) Interprofessional Care Focuses On: - Proper Nutrition (____________ and vitamin ______ supplementation). - ______________ - Preventing _______ and _____________. - Prescription of _________. Calcium - Recommended daily intake of calcium ranges from ___________-___________ mg/day depending on age. - Foods High In Calcium: __________ products (icecream, milk, cheese, yogurt), ____________ juice, _________________. Teaching - Vitamin D is important in calcium absorption and function and may have a role in bone formation. Encourage patients to be in the sun for at least ______ minutes a day and eat foods high in vitamin D. ---> Can get vitamin D supplement if pts are not getting enough from sun or diet. - Regular __________ __________ is important to build and maintain bone mass. ---> Best are _________-____________ exercises ---> Encourage patients to walk for _____ minutes 3 times a week. - Encourage patients with osteoporosis to remain _______________ to prevent further loss of bone density due to immobility.

bisphosphonates; osteoclast; remodeling; 5; full glass; 30; upright

Osteoporosis (Card 5) Drug Therapy - The recommended drug therapies for the prevention and treatment of osteoporosis are the ______________________ alendronate, risedronate, zoledronic acid, or denosumad. - These drugs inhibit _______________-mediated bone reabsorption and slow the cycle of bone ________________. - Treatment should continue for ______ years. Drug Alert: Bisphosphonates - Take with _______ _________ of water. - Take _____ minutes before food or other medication. - Remain _____________ for at least 30 minutes after taking.

osteoclastic; chronic; reabsorption; connective; larger; weaker; pelvis; long; spine; 5; men; viral; genetic

Paget's Disease (Card 1) Overview/Etiology - Defined by excessive _________________ activity. - Paget's disease is a _____________ skeletal bone disorder in which excessive bone __________________ is followed by replacement of the normal marrow by vascular, fibrous __________________ tissue. ---> The new bone is _______________, disorganized, and ____________. - Areas commonly affected include the ___________, ________ bones, ________, ribs, and sternum. - Also called osteitis deformans. - Up to _____% of adults in the US are affected by Paget's disease. ---> _______ are affected twice as often as women. ---> Uncommon in people under the age of 40. - We do not know what exactly causes Paget's disease. ---> May be __________ or ____________ (40% of all patients with the disease have at least 1 relative with the disease).

severe; fatigue; waddling; shorter; larger; fractures; serum alkaline phosphatase; curvature; bone scans

Paget's Disease (Card 2) Clinical Manifestations - In the milder forms of Paget's patients will not have any symptoms. - Bone pain may develop gradually and progress to ______________ intractable pain. - Other early manifestations include ______________ and progressive development of a __________________ gait. - Patients report becoming _______________ or their heads becoming _______________. ---> Headaches, dementia, vision deficits, and loss of hearing can result from an enlarged, thickened skull. - Pathologic ______________ is the most common complication and may be the first sign of Paget's disease. Diagnosis - __________ __________ ______________ is markedly increased in advanced disease, showing high bone turnover. - X-rays may show _____________ of an affected bone. - ________ _________ using a radiolabeled bisphosphonate show increased uptake in the affected skeletal areas.

supportive; correction; bisphosphonate; calcitonin; NSAIDS; surgery; firm; lifting; vitamin D; calcium; protein; assistive devices; throw rugs

Paget's Disease (Card 3) Interprofessional Care - Interprofessional care is usually limited to symptomatic and ________________ care with ________________ of secondary deformities by surgical interventions or braces. - _______________ drugs are used to slow bone reabsorption. ---> _____________ is an option for patients who cannot tolerate this drug which inhibits osteoclast activity. - Pain is usually managed with ____________. - Orthopedic ____________ for fractures, hip and knee replacement, and knee realignment may be needed. - A _______ mattress can provide back support and relieve pain. ---> The patient may need to wear a corset or light brace to relieve back pain and for support when upright. - Discourage _____________ and twisting. Good body mechanics are essential. - A diet that includes ______________ ______, ____________, and ______________ should be encouraged. - To decrease risks of falls and fractures, teach patient to use ____________ _____________ and make environmental changes (NO ________ _________).

carpal tunnel; bursitis; typing; twisting; turning; pronation; supination; kneeling; raising; numbness; tingling; hand; rest; immobility; splints; surgery; bursitis; heat; NSAIDS; surgery

Repetitive Use Injury - Commonly seen as _____________ ___________, _________________, and epicondylitis. Causes - Results from technology in the workplace. ---> _____________ over and over again. - Repetitive __________ or _____________ of the wrist. - ______________ and _____________ the forearm. - ______________ - ______________ arms over head. - Show with _____________ and _____________ on the thumb and sometimes the index finger, as well as other surfaces of the _________. - Treated with _______, ______________, ____________, and in really bad cases they may need ________________. - _______________: Inflammation of the bursa. Cause is constant friction. ---> Commonly happens in the shoulder, hip, elbow. Conservative management - Rest - Immobilization - _________ therapy - _____________ - _____________ if needed

young; middle; normal; underweight; inflammatory; remissions; exacerbations; small; symmetrically; 4; 5; overweight; degenerative; progressive; weight bearing; asymmetrically

Rheumatoid VS Osteoarthritis Rheumatoid Arthritis - Age: ________-___________ - Weight: ____________ or ______________. - _______________ disease - _______________ and _________________ - Affects __________ joints. - Affects joints ________________. Osteoarthritis - ______-_____th decade. - Weight: __________________ - ________________ disease - Variable, __________________ - __________ __________ joints commonly affected. - Affects joints __________________.

realign; heal; higher amounts; freely; replace; pulley tracks; infection; sites

Skeletal Traction - Pins, pulleys, and weights attached to nail or screw that's an external device (goes into the bone and come out where we hook it to the skeletal traction). Used to _______________ and help _________ a fracture or broken bone. - Used when ___________ ________ of force are needed. Nursing Care - Keep weights hanging _________. ---> Don't lay them on the bed or the floor, it won't work. - _____________ frayed ropes. - Keep ropes in _____________ _________. - Really high _______________ risk!!! --> Because there is things coming out of the bone and skin. --> Keep close eye on ________ where device comes out of the skin.

work; back strain; contusion; sprain; strain; dislocations; protect; rest; ice; compression; elevate; vital signs; immobility

Soft Tissue Trauma - 50% of ________-related injuries. --> _______ ________ is the most commonly reported work injury. - _____________ (bleeding into the soft tissue due to a blunt force, small blood vessels rupture and a hematoma or bruise forms) ---> Pts will have tenderness and edema in that area. Leads to joint instability with the pain and the swelling. - _________: Injury to a ligament that results from a twisting motion. Usually when the ligament has overstretched or torn. - __________: Microscopic strains in the muscle that results in bleeding in the tissues. --> Overexertion, Also called a pulled muscle. --> Muscle is pulled past its point of elasticity. --> Sometimes lifting heavy objects or motor vehicle crashes can cause this. --> Sharp or dull pain while moving and contraction of the muscles. - ________________: Separation of the bones in the joint. --> Causes pain (especially when they change the shape of the joint). --> Hip and shoulder are most common. Nursing Care - P: _______________ - R: __________ - I: ________ - C: _____________ (ACE bandages) - E: ______________ - ___________ __________ need to be taken. - _______________ may be needed.