Module 14: Nursing Care of Patients with Disorders of the Musculoskeletal System
Fractures may be the first clinical manifestation of ____________.
Osteoporosis
Pain management and optimal functional ability are major goals of nursing intervention. False True
True Pain management and optimal functional ability are major goals of nursing intervention.
Recognition of risks and problems associated with osteoporosis form the basis for nursing assessment. Physical examination may disclose which of the following? Select all that apply. shortened stature kyphosis of the cervical spine localized pain problems in mobility and breathing kyphosis of the thoracic spine
localized pain kyphosis of the thoracic spine shortened stature Problems in mobility and breathing
Case Study Jane Smith is a 54-year-old elementary school teacher who has recently had a bone density screening test indicating low bone mass. She has a history of COPD and has required treatment with corticosteroids on a number of occasions over the past 10 years. She continues to smoke one pack per day. She is postmenopausal and is not taking hormone replacement therapy. The nurse is providing education to Ms. Smith on osteoporosis prevention. 1. Ms. Smith states that she knows she needs adequate amounts of calcium to prevent osteoporosis, so she takes a multivitamin each day. How should the nurse respond? 2. Discuss Ms. Smith's risk factors for osteoporosis. In addition to calcium supplementation, what measures could she take to reduce her risk? 3. Ms. Smith states that she has seen television commercials for ibandronate and asks if this medication would be of benefit to her. How should the nurse respond?
Answer 1. The nurse should explain that to prevent osteoporosis, Ms. Smith needs more calcium than is contained in a typical multivitamin supplement. She should take at least 1000 to 1500 mg per day but should not exceed 2500 mg daily. She can obtain this in the form of calcium carbonate (Tums) or calcium citrate supplements. The nurse should explain that adequate amounts of vitamin D are also necessary for her body to absorb calcium. If Ms. Smith does not ingest adequate amounts of vitamin D in her diet, she can obtain it from supplements. Many calcium supplements also contain vitamin D. She should ensure that she does not exceed 400 international units of vitamin D daily. 2. Ms. Smith is at risk for osteoporosis due to her age, is at postmenopausal, has decreased bone density, and she takes corticosteroids for her COPD. In addition to obtaining adequate amounts of calcium and vitamin D, she can lower her risk of developing osteoporosis by maintaining a program of regular weight-bearing exercise. Smoking cessation would also decrease her risk. Hormone replacement therapy could also decrease her risk for developing osteoporosis. The nurse should encourage her to discuss this with her physician, as there are also significant risk factors associated with hormone replacement therapy, particularly in women who smoke. Treatment with a bisphosphonate drug may also be indicated if she is to continue with regular periods of corticosteroid therapy. 3. Ibandronate is a bisphosphonate drug that may be indicated for Ms. Smith, since these drugs prevent resorption of bone. The U.S. Food and Drug Administration has approved several of the bisphosphonate drugs for osteoporosis prevention, and the nurse should encourage Ms. Smith to discuss this with her physician. If she is given a prescription for a bisphosphonate, the nurse should ensure that Ms. Smith knows how to take the drug correctly. Since bisphosphonates are poorly absorbed from the intestinal tract, Ms. Smith would need to take the medication on an empty stomach, with water, at least 30 minutes before any other fluid, food, or medication.
The most common sites of fracture in patients with osteoporosis are which of the following? Colles fractures Cervical spine Hip fractures Lumbar spine Thoracic spine
Colles fractures Hip fractures Lumbar spine Thoracic spine This occurs most commonly as compression fractures (see Fig. 41-7) of the thoracic and lumbar spine, hip fractures, and Colles fractures of the wrist. These fractures may be the first clinical manifestation of osteoporosis
Osteoporotic compression fractures of the vertebrae are managed by which of the following? Back bracing Conservatively Surgical repair Medications
Conservatively Osteoporotic compression fractures of the vertebrae are managed conservatively.
Osteoporosis is diagnosed by _________ scan which provides information about BMD at the spine and hip (enter acronym only).
DEXA
Osteoporosis is diagnosed by which of the following? dual-energy x-ray absorptiometry (DEXA) fracture Risk Assessment Tool (FRAX) erythrocyte sedimentation rate (ESR) routine x-rays
DEXA Osteoporosis is diagnosed by dual-energy x-ray absorptiometry (DEXA), which provides information about BMD at the spine and hip.
Which of the following is not a drug class used to treat gout? Dopamine agonists Uricosuric agents Corticosteroids NSAIDS
Dopamine agonists The treatment of gout involves the administration of NSAIDs and corticosteroids to reduce inflammation as well as uricosuric agents to increase the elimination of uric acid.
A diet rich in calcium and vitamin C throughout life protects against skeletal demineralization. False True
False A diet rich in calcium and vitamin D throughout life, with an increased calcium intake during adolescence and the middle years, protects against skeletal demineralization.
A single injection of calcitonin decreases serum calcium levels in approximately 8 hours, and its effects last approximately 12 to 16 hours. False True
False A single injection of calcitonin decreases serum calcium levels in approximately 2 hours, and its effects last approximately 6 to 8 hours
A single injection of calcitonin increases serum calcium levels in approximately 2 hours, and its effects last approximately 6 to 8 hours. False True
False A single injection of calcitonin decreases serum calcium levels in approximately 2 hours, and its effects last approximately 6 to 8 hours.
Osteoporosis is diagnosed by Fracture Risk Assessment Tool (FRAX), which provides information about BMD at the spine and hip. False True
False Osteoporosis is diagnosed by dual-energy x-ray absorptiometry (DEXA), which provides information about BMD at the spine and hip
Pharmacologic management of OA is directed toward stopping the disease progression. True False
False Pharmacologic management of OA is directed toward symptom management and pain control.
Vitamin A increases calcium and phosphorus absorption from the GI tract. It also promotes movement of calcium and phosphorus from the bones to maintain normal serum calcium levels. True False
False Vitamin D increases calcium and phosphorus absorption from the GI tract. It also promotes movement of calcium and phosphorus from the bones to maintain normal serum calcium levels.
Vitamin E increases calcium and phosphorus absorption from the GI tract. It also promotes movement of calcium and phosphorus from the bones to maintain normal serum calcium levels. False True
False Vitamin D increases calcium and phosphorus absorption from the GI tract. It also promotes movement of calcium and phosphorus from the bones to maintain normal serum calcium levels.
Which of the following may be the first clinical manifestation of osteoporosis? Fractures Dowager hump Postural changes Painful joints
Fractures
Gout is caused by which of the following? hypercalcemia hyperglycemia hyperuricemia antidiuretic hormones
Gout is caused by hyperuricemia (increased serum uric acid).
Which of the following occurs most often in weight-bearing joints? Select all that apply. Gout Rheumatoid arthritis (RA) Ankylosing Spondylitis Osteoarthritis (OA)
Osteoarthritis (OA) Although OA occurs most often in weight-bearing joints (hips, knees, cervical and lumbar spine), the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints are also often involved causing bony enlargements of the DIP (Heberden's nodes) and PIP (Bouchard's nodes) joints
Uric acid is a by-product of which metabolism? chlorine methine triglycerine purine
Purine Uric acid is a by-product of purine metabolism; purines are basic chemical compounds found in high concentrations in meat products. Urate levels are affected by diet, medications, overproduction in the body, and inadequate excretion by the kidneys.
Medications used in the treatment of osteoarthritis include all of the following except? Sulfonylureas NSAIDS Aspirin Acetaminophen
Sulfonylureas
In patients with osteoporosis the bones become what? Select all that apply. brittle progressively porous fragile painful fracture easily under stress
The bones become progressively porous, brittle, and fragile.
Which of the following are drug interactions with calcium preparations? Select all that apply. Thiazide diuretics Phosphates Prednisone NSAIDs
Thiazide diuretics Phosphates Prednisone
A single injection of calcitonin decreases serum calcium levels in approximately 2 hours, and its effects last approximately 6 to 8 hours. False True
True
Vitamin D increases calcium and phosphorus absorption from the GI tract. It also promotes movement of calcium and phosphorus from the bones to maintain normal serum calcium levels. False True
True
Recognition of risks and problems associated with osteoporosis form the basis for nursing assessment. False True
True Recognition of risks and problems associated with osteoporosis form the basis for nursing assessment
Uric acid crystals are seen within the polymorphonuclear leukocytes in the fluid. True False
True Uric acid crystals are seen within the polymorphonuclear leukocytes in the fluid.
___________ acid crystals are seen within the polymorphonuclear leukocytes in the fluid.
Uric
_________________ acid is a by-product of purine metabolism; purines are basic chemical compounds found in high concentrations in meat products.
Uric
Manifestations of the gout syndrome include which of the following? Select all that apply. acute gouty arthritis kidney failure uric acid urinary calculi tophi gouty nephropathy
acute gouty arthritis (recurrent attacks of severe articular and periarticular inflammation) tophi (crystalline deposits accumulating in articular tissue, osseous tissue, soft tissue, and cartilage) gouty nephropathy (renal impairment) uric acid urinary calculi
Four stages of gout can be identified as which of the following? Select all that apply. chronic tophaceous gout asymptomatic hyperuricemia common gout intercritical gout acute gouty arthritis
asymptomatic hyperuricemia acute gouty arthritis intercritical gout chronic tophaceous gout
Recognition of risks and problems associated with osteoporosis form the basis for nursing assessment. The health history focuses on which of the following? Select all that apply. on family history dietary consumption of potassium and sodium onset of menopause use of corticosteroids previous fractures
family history onset of menopause previous fractures use of corticosteroids Remainder not on list: dietary consumption of calcium exercise patterns use of certain medications (e.g., corticosteroids) use of alcohol, smoking, and caffeine intake
The development of __________________ is directly related to the duration and magnitude of the hyperuricemia.
gout
The procedures most commonly used are which of the following? pain relieving injections and arthroplasty osteotomy and amputation amputation and arthroplasty osteotomy and arthroplasty
osteotomy and arthroplasty The procedures most commonly used are osteotomy (to alter the distribution of weight within the joint) and arthroplasty. In arthroplasty, diseased joint components are replaced.
A definitive diagnosis of gouty arthritis is established by polarized light microscopy of the _____________ fluid of the involved joint.
synovial