NUR 221 - Ch 41 WB - patients with musculoskeletal disorders

Ischemia and Bone necrosis develops.

Bone abscess forms unless the in effective process is promptly treated.

When lifting objects, the use of this muscle should be maximized

Quadriceps

Infection causes inflammation, increased vascularity, and edema.

Thrombosis of the blood vessels occurs.

Learning objectives

describe the rehabilitation and health education needs of the patient with low back pain

Post menopause

hormones inhibit bone loss

The majority of bone infections - 70 to 80% - are caused by

staphylococcus aureus

Age-related bone loss begins at about age

40

The gradual collapse of a vertebra, also known as a dowager's hump.

Kyphosis

This common foot problem involves swelling of the third branch of the median plantar nerve

Morton's neuroma

Explain how nutritional factors contribute to the development of osteoporosis.

Nutritional factors contribute to the development of osteoporosis. A diet that includes adequate calories and nutrients needed to maintain bone, calcium, and vitamin D must be consumed. Vitamin D is necessary for calcium absorption and for normal bone mineralization. Dietary calcium and vitamin D must be adequate to maintain bone remodeling and body functions.

An infection of the bone.

Osteomyelitis

The most common and most often fatal primary malignant bone tumor.

Osteosarcoma

Name of pain felt from the low back to behind the thigh and radiating down below the knee.

Sciatica

Explain the basic concept of the pathophysiology of osteoporosis.

The normal homeostatic bone turnover is altered, the rate of bone absorption, the lysis or breakdown of bone, is greater than the rate of bone formation, resulting in a reduced total bone mass.

Explain how a person with low back pain should be advised to sleep.

The patient should sleep on his or her side with knees and hips flexed, or supine with knees supported in a flexed position. Sleeping prone should be avoided.

Corticosteroids

effects calcium absorption and metabolism

Using proper body mechanics to lift objects is essential to prevent exacerbations of low back pain. Which of the following is the most important teaching point?

lift with the large leg muscles, quadriceps, not the back muscles rationale all teaching points are in important but the most important involves limiting back strain by maximizing the use of the quadriceps muscle

An osseous enlargement of the medial side of the first metatarsal head.

Exostosis

A collection of gelatinous material near the tendon sheaths and joints.

Ganglion

Elevated levels of this mineral are found in the serum of patients with bone metastases from the breast, lungs, or kidneys.

Hypercalcemia

Small body frame

predisposes to low bone mass

Decreased exposure to sunlight

reduces osteogenesis in bone remodeling

Which of the following is the most important nursing diagnosis for an elderly patient diagnosed with osteoporosis?

risk for injury related to fractures due to osteoporosis. Ration out the most important concern for an elderly patient with osteoporosis is prevention of Falls and fractures. Pain and constipation can be managed, and knowledge can be reinforced, but fractures can cause significant morbidity and mortality.

A provider asks the nurse to teach a patient with low back pain how to sit in order to minimize pressure on the spine. Which of the following teaching points would the nurse include? Select all that apply.

sit in a straight back chair with armrests, avoid hip extension, Place feet flat on the floor, sit with the buttocks tucked under. Rationale all choices are correct except that a soft pillow is recommended to eradicate the hollow of the back. Refer to box 41-2 in the text.

Health education for a woman over age 50 includes providing information about the importance of adequate amounts of calcium and vitamin D to prevent osteoporosis. Select the daily dosage of calcium and vitamin D that the nurse should recommend.

1200 mg, 1000 international units rationale the daily recommended dosage is 1200 mg of calcium and 1000 international units of vitamin D.

A 65 year old woman's x-rays reveal a diagnosis of osteoporosis. The nurse advises the woman that the radio lucencies seen in the bones indicates a minimum level of demineralization of about

25% rationale demineralization seen on x-rays occurs when bone loss of 25 to 40% occurs.

Osteoporosis is a significant bone disorder estimated to affect _____ % of women and _____ % of men.

50%, 20%

A term for a deformity in which the great toe deviates laterally.

Bunion

Explain the cause of Dupuytren's disease.

Dupuytren's disease results in a slowly Progressive contracture of the Palmar fascia, called Dupuytren's contracture, which causes flexion of the fourth and fifth fingers, and frequently the middle finger. It is caused by an inherited autosomal dominant trait. It starts as a nodule of the Palmer faccia. The nodule may not change, or it may progressed so that the fibrous thickening extends to involve the skin in the distal palm and produces a contracture of the fingers.

Primary osteoporosis is not merely a consequence of aging. Describe other factors that influence its development.

Failure to develop optimal Peak bone mass during childhood, adolescence, and young adulthood contributes to the development of osteoporosis without resultant bone loss. Early identification of at-risk teenagers and young adults, increased calcium intake, participation in regular weight-bearing exercises, and modification of Lifestyle, EG reduce use of caffeine, cigarettes, carbonated soft drinks, and alcohol, are interventions that decrease the risk of osteoporosis, fractures, and associated disability later in life.

A provider prescribes a subcutaneous anabolic agent for an elderly patient to prevent fractures associated with osteoporosis. Which of the following is the most likely prescribed drug?

Forteo. rationale: teriparatide, forteo, is a subcutaneously administered anabolic agent that is taken once daily. The Other Drug choices are oral preparations.

Common foot disorders - identify the nerves innervating the foot

Hallux valgus a.k.a. bunion; neuro fibroma a.k.a. Morton's neuroma: Tibial nerve, medial plantar nerve, lateral plantar nerve, site of neurofibroma {Morton's}

Case study: Sally is a 69 year old, 5 foot 2, 120 lb Caucasian who has recently been diagnosed with osteoporosis postmenopausal. She lost one inch off her height in the last 9 years.

Her dual-energy, x-ray absorptiometry DEXA of the hip yielded a t-score of -2.5. BMD is 2.5 standard deviations below the mean peak bone mass.

A patient visits an orthopedic specialist because of pain that he feels beginning in his low back and radiating behind his right thigh and down his right knee. The doctor suspects a diagnosis of sciatica. The nurse knows that the origin of the pain is between these intervertebral discs:

L4, L5, and S1 rationale the lower lumbar discs, L4 and L5 and L5 to S1, are subject to the greatest mechanical stress and the greatest degenerative changes. Disk protrusion, herniated nucleus pulposus, or facet joint changes can cause pressure on nerve Roots as they leave the spinal canal, which results in pain that radiates along the nerve.

Describe the etiology and symptoms of impingement syndrome.

Overuse, micro trauma, May produce and impingement syndrome in the shoulder. The Supra spin at us and biceps tendons become irritated and edematous and press against the a chromium process, limiting shoulder motion. The patient experiences pain, shoulder tenderness, limited movement, muscle spasm, and atrophy.

A disorder of localized rapid bone turnover, most commonly affecting the skull and femur.

Paget's disease

Caffeine and alcohol

Reduces osteogenesis in bone remodeling

Describe the value of physical activity as a means of preventing injury in a patient with a diagnosis of osteoporosis.

Regular weight bearing exercise promotes bone formation. From 20 to 30 minutes of aerobic exercise, such as walking, three days or more a week, is recommended. Weight training stimulates and increase in bmd. In addition, exercise improves balance, reducing the incidence of Falls and fractures. Isometric exercises can strengthen trunk muscles.

An inflammatory condition of muscle tendon sheaths.

Tendonitis

Describe management of the patient with Paget's disease.

Use the nursing process as a framework for care of the patient with osteomyelitis.

Identify four of six causes of low back pain

acute lumbosacral strain, unstable lumbosacral ligaments and weak muscles, osteoarthritis of the spine, spinal stenosis, intervertebral disk problems, and unequal leg length

A patient is evaluated for a diagnosis of Paget's disease. Which of the following is a diagnostic finding for this disease?

alkaline phosphate of 165 international units per liter rationale all elevated serum alkaline phosphate concentration reflects increased osteoblastic activity

The World Health Organization defines osteoporosis as being present when the t score on the DEXA scan is _____; osteopenia is diagnosed when the BMD T-score is _____.

at least 2.5 SD below the young adult mean on the BMD scan; 1 and 2.5 SD below

Low body fat

bones need stress for bone maintenance

Calcium metabolism in osteoporosis. Label the figure identifying factors involved in calcium metabolism in osteoporosis.

calcium; normal absorption of calcium by intestines; lining of intestine; calcium stored in bone; normal bone; osteoporotic bone; increased calcium resorption from bone; ineffective absorption of calcium by intestines

A nurse practitioner was asked to explain to a patient the age-related process of bone loss that results in osteoporosis. Which of the following is the best statement the nurse should use?

decreased estrogen inhibits bone breakdown rationale osteoporosis is characterized by decreased estrogen, calcitonin, and vitamin D use, the parathyroid hormone increases with age, causing increased bone turnover and resorption.

Thyroid hormone

effects calcium absorption and metabolism

Describe common conditions and nursing care of the upper and lower extremities

explain the pathophysiology, pathogenesis, prevention, and management of osteoporosis.

The provider asks a nurse to test a patient for Tinel's sign how to diagnose carpal tunnel syndrome. The nurse asked the patient to

hold his palm up while the nurse percusses over the median nerve rationale if tingling, numbness, or pain is felt when the median nerve is percussed then Tinel's sign is considered positive. Refer to figure 41 - 3 in the text.

The most common primary sites of tumors that metastasize to the bone are the

kidney, prostate, lung, breast, ovary, and thyroid

The most common benign bone tumor is

osterochondroma

Low calcium intake

reduces nutrients needed for bone remodeling

The nurse is aware that the specific treatment for chronic osteomyelitis is

surgical removal of the sequestrum. Rationale in chronic osteomyelitis, antibiotics are adjective therapy to surgical debridement. A sequester me, removal of enough involucrum to enable the surgeon to remove the sequestrum is performed. In many cases, sufficient bone is removed to convert a deep cavity into a shallow saucer, saucerization. All Dead Infected bone and cartilage must be removed before permanent healing can occur.

Sequence of the pathophysiology of osteomyelitis

Bone infection usually caused by staphylococcus aureus occurs.

The drug of choice for Paget's disease is

Calcitonin

What pharmacologic therapy would be prescribed to treat osteoporosis?

Hormone therapy with estrogen and progesterone had been the Mainstay of therapy to retard bone loss and prevent occurrence of fractures. Estrogen replacement decreases bone resorption and increases bone mass, reducing the incidence of Osteo parodic fractures. Selective estrogen receptor modulators, SERMs, reduce the risk of osteoporosis by preserving bmd without estrogen it affects on the uterus. They are indicated for both prevention and treatment of osteoporosis. Medications commonly prescribed to treat osteoporosis include by phosphonates and calcitonin. Bisphosphonates reduce spine and hip fractures associated with osteoporosis through inhibiting osteoclast activity, and reducing bone resorption and turnover. Adequate calcium and vitamin D intake are needed.

Which of the following is the first-line medication that would be used to treat and prevent osteoporosis?

bisphosphonates rationale bisphosphonates, along with calcium and Vitamin D supplements, are the first-line medications given to prevent or treat osteoporosis. The other medications are prescribed after these drugs are used.

To confirm a diagnosis of low back pain, which of the following diagnostic procedures would be ordered to rule out the presence of a tumor?

bone scan rationale a bone scan is the preferred diagnostic procedure to disclose tumors in a patient with low back pain

Hypercalcemia is a dangerous complication of bone cancer. Therefore, nursing assessment includes evaluation of symptoms that require immediate treatment. Which of the following are signs / symptoms that are indicators of an elevated serum calcium? Select all that apply.

muscle weakness, and anorexia and constipation, shortened QT interval, lack of muscle coordination rationale hypercalcemia is a dangerous complication of bone cancer. The symptoms must be recognized and treatment initiated promptly. Symptoms include muscular weakness, in coordination, anorexia, nausea and vomiting, constipation, electrocardiographic changes, shortened QT interval and st-segment, bradycardia, heart blocks, and altered mental status, EG, confusion, lethargy, psychotic behavior.

The nurse advises a patient that the best position to ease low back pain is

supine, with the knees slightly flexed and the head of the bed elevated 30 degrees. Rationale lumbar flexion is increased by elevating the head and thorax 30° using pillows or a foam wedge and slightly flexing the knees supported on a pillow. Alternatively, the patient can assume a lateral position with knees and hips flexed, curled position, with a pillow between the knees and legs and a pillow supporting the head a prone position should be avoided because it accentuates lordosis, inward curvature of the spine.