Ch 38 Degenerative Musculoskeletal Disorders

Question 4 of 5 A child is recently diagnosed with rickets. Which of the following characteristics would you expect to observe? Select all that apply. Bow-shaped femurs Increased height Increased bone density Flattened skull Delayed tooth development

Bow-shaped femurs Delayed tooth development

Question 4 of 5 While caring for a patient with abnormal narrowing of the spinal cord, the nurse determines that the disease has become severe. Which symptom supports the nurse's conclusion? Back pain Foot drop Skeletal muscle weakness Impaired bladder function Tingling sensation down leg

Impaired bladder function

Question 2 of 5 _______________causes the wearing down of joint cartilage. Osteoporosis Rickets Osteomalacia Osteoarthritis Osteopenia

Osteoarthritis

Question 3 of 6 Gerald, 62 years of age, has suffered from pain and neuropathy from degenerative disc disease in the lumbar/sacral area for the past 8 years. He has treated his condition with over-the-counter anti-inflammatories, stretching, and occasional chiropractic appointments. His history shows worsening symptoms over the years. Gerald had been considering surgery to see if that may relieve his pain. Today, however, his wife has called the clinic very upset as Gerald has lost bladder and bowel function, and sensation in his leg. Hearing this, you know Gerald's condition is now a medical emergency. What condition is consistent with Gerald's signs and symptoms? Make the connection. For each clinical scenario, drag and drop the disorder that matches the patient data. cauda equina syndrome degenerative disk disease osteoarthritis osteomalacia osteoporosis rickets

cauda equina syndrome CORRECT. The cauda equine (horse's tail) is located at the base of the spinal cord. The nerve fibers innervate the sphincters for urination and defecation. They also innervate the perineum and are involved in sexual function. Stenosis and degeneration of this area of the spine may impinge upon these nerves to such an extent that bladder and bowel function are lost. When this occurs, it is a medical emergency.

Question 5 of 5 Disc degeneration most commonly occurs in the _____________ areas. Select all that apply. thoracic cervical coccygeal sacral lumbar

cervical lumbar

Question 5 of 6 Kevin, age 56 years, presents with severe back pain that worsens whenever he has to stoop or bend over. He states he even had to have his wife tie his shoes for him the other day. He reports the sensation of "pins and needles" along his left leg. On one occasion, he was particularly concerned as his lower leg and foot went numb. What disorder does Kevin have? Make the connection. For each clinical scenario, drag and drop the disorder that matches the patient data. cauda equina syndrome degenerative disk disease osteoarthritis osteomalacia osteoporosis rickets

degenerative disk disease CORRECT. Back pain accompanied by numbness and alterations in sensation may indicate disruption of spinal nerve conduction. As intervertebral discs become worn down with age and trauma, degenerative disc disease manifests. As these discs degenerate, the spine may become misaligned, and impingement of spinal nerves may occur, causing sensory and motor function problems.

Question 2 of 6 Debbie works as an administrative assistant. Debbie is overweight and leads a sedentary lifestyle. She recently turned 50 and presents with a primary complaint of joint pain, especially in the morning, and her joints "snap" and "pop." She states the pain makes her not want to get out of bed. At work, her hands often hurt while typing. Examination of her hands reveals the presence of Heberden's nodes. What disorder does Debbie have? Make the connection. For each clinical scenario, drag and drop the disorder that matches the patient data. cauda equina syndrome degenerative disk disease osteoarthritis osteomalacia osteoporosis rickets

osteoarthritis CORRECT. Osteoarthritis is degeneration of the joints resulting in pain and stiffness, especially in the morning. Previous trauma of the joint is frequently a precipitating factor. Crepitus, or joint "clicking," is also a very common sign. Heberden's nodes develop in the distal interphalangeal joint in osteoarthritis of the fingers.

Question 4 of 6 Bill, age 66 years, lives in northern Minnesota. Because he has had two basal cell carcinomas, Bill is now a self-described "sunscreen addict." He avoids being out in the sun at all costs. He states that he does not take any vitamin or mineral supplements. His diet consists primarily of "snacking" as he lives alone and does not like to cook. He avoids dairy products as they upset his stomach. Bill complains that he has been feeling tired and weak lately and his back hurts whenever he does anything. What disorder does Bill have? Make the connection. For each clinical scenario, drag and drop the disorder that matches the patient data. cauda equina syndrome degenerative disk disease osteoarthritis osteomalacia osteoporosis rickets

osteomalacia CORRECT. Living in a northern climate and robust use of sunscreen may put an individual at risk for low vitamin D levels, as vitamin D is formed by ultraviolet light striking the skin. In this case, lack of vitamin D intake may also be present, because no vitamin or mineral supplement usage is reported, and dairy products are avoided. Lack of vitamin D and calcium in adulthood can cause the disease of osteomalacia.

Question 6 of 6 Violet is a 62-year-old Caucasian woman of petite stature. She recently fell while stepping off a curb on an icy morning. She suffered a transverse fracture of her right, distal radius. Height and weight measurements show that Violet has lost a half an inch in height over recent years. Her posture shows slight kyphosis. Violet informs you that, prior to her fall, she had volunteered at the community health fair and received a complimentary bone mineral density test. She was confused about her score, which was a T score of -2.8. She said they recommended she make an appointment with her physician. What disorder does Violet have? Make the connection. For each clinical scenario, drag and drop the disorder that matches the patient data. cauda equina syndrome degenerative disk disease osteoarthritis osteomalacia osteoporosis rickets

osteoporosis CORRECT. A bone mineral density T score of -2.8 indicates osteoporosis. T scores are based on standard deviations from a normalized reference population. A distal radius fracture in an elderly individual may indicate weakened bones. A loss of height in an individual accompanied by developing kyphosis may indicate compression fractures of the vertebrae, common in osteoporosis.

Question 1 of 6 Unusual X-rays of a 14-month old infant reveal bowed femurs and tibias. Costochondral swelling and asymmetry of the thoracic cage are also noted. Blood laboratory reports reveal hypocalcemia, elevated PTH, and decreased vitamin D. What condition do you suspect? Make the connection. For each clinical scenario, drag and drop the disorder that matches the patient data. cauda equina syndrome degenerative disk disease osteoarthritis osteomalacia osteoporosis rickets

rickets CORRECT. Rickets is a condition of weakened bones due to lack of vitamin D and/or calcium. Rickets appears in children, especially young children. A pronounced bow-legged appearance is a hallmark of the disease, as well as a deformed thoracic cage.

Question 2 of 5 Which question helps assess for signs and symptoms of lumbar degenerative disc disorder? "Do you have pain in the lower back that radiates down the back of the leg?" "Do you have problems breathing?" "Do you have chronic neck pain that can radiate to the shoulders and down the arm?" "Do you experience numbness or tingling in the arm or hand?" "Do you have muscle weakness of the arm or hand?"

"Do you have pain in the lower back that radiates down the back of the leg?"

Question 5 of 5 What are the risk factors for osteoporosis? Select all that apply. Age Hypothyroidism Hyperparathyroidism Long-term use of corticosteroids Gender

Age Hyperparathyroidism Long-term use of corticosteroids Gender

Question 1 of 5 The nursing instructor is explaining osteoarthritis to a group of student nurses. During the practicum, the instructor asks a student nurse to assess a client for symptoms of osteoarthritis. Which action by the student nurse indicates effective learning? Select all that apply. Asking the client if he or she is experiencing muscle pain Asking the client if he or she has experienced an increase in body temperature Asking the client if he or she feels tired without much physical work Asking the client if he or she is experiencing joint pain Asking the client if he or she has a family history of autoimmune disease

Asking the client if he or she is experiencing joint pain

Question 3 of 5 Lack of vitamin ______ may result in decreased bone mineralization. A B D K E

D

Question 3 of 5 Which result does the nurse observe in the blood report of a patient diagnosed with softening of bones caused by vitamin D deficiency? Select all that apply. Low serum phosphate levels Low parathyroid hormone levels Low alkaline phosphatase levels Elevated levels of 25-hydroxyvitamin D Low calcium levels

Low calcium levels

Question 1 of 5 Which of the following groups may be at risk for osteoporosis? Postmenopausal women Teenage males Teenage females Women of reproductive age Infants

Postmenopausal women

Degenerative musculoskeletal disorders fall within several categories: those specific to bones, known as osteoporosis; those specific to joints, known as osteoarthritis; those with a metabolic component, including rickets and osteomalacia; and those that affect joints and surrounding tissues, including degenerative disc disease and spinal stenosis. Osteoporosis is a condition of low bone density and structural deterioration of the bone. Often this is caused by an imbalance in the two normal processes of bone breakdown by osteoclasts and bone formation by osteoblasts. While osteoclasts take weeks to reabsorb bone, osteoblasts require months to produce new bone, resulting in a net bone loss over time after age 30. Postmenopausal women and elderly men are at particular risk for osteoporosis because they experience accelerated bone loss. They lack estrogen, which normally inhibits osteoclasts. Osteoarthritis is a condition of degeneration in the joints, most frequently in the weight-bearing joints. Excessive stress on the joint, due to physical activity or excess body weight, causes joint inflammation and the wearing down of cartilage. Osteoarthritis gets worse over time. Some degenerative diseases of the bone are associated with a lack of nutrients, including calcium, phosphorus, and vitamin D. Vitamin D, which is formed in the body when ultra violet light strikes the skin, aids in calcium absorption by the small intestine. Inadequate vitamin D and/or calcium results in a reduced bone mineralization. Lack of vitamin D, calcium, or phosphorus in malnourished growing children causes the disease known as rickets. Typically, the child's femurs develop a bow shape, and the thoracic cage develops asymmetrically. Tooth development is delayed due to a weakened bone matrix. Osteomalacia is similar to rickets, but occurs in adults. Lack of calcium absorption due to reduced vitamin D levels results in bone breakdown, weakness, and pain. Other causes for osteomalacia include cancer, liver and malabsorption disorders, and medications. In degenerative disc disease, the joint and surrounding structures of the intervertebral discs degenerate. The discs flatten and collapse, and then become thinner as they dehydrate and change from a supple state to a rigid state that restricts movement. As the discs deteriorate, herniation and spinal misalignment occur. Misalignment may impinge the spinal nerves, causing pain, neuropathy, and weakness. Degenerative disc disease most commonly affects the cervical and lumbar areas. Degenerative disc disease can cause narrowing of the spinal column, called spinal stenosis. Osteophytes are bony overgrowths that develop on bone adjacent to lost cartilage; they are caused by osteoarthritis or a result of aging. Spinal stenosis can also arise from congenital abnormalities. If severe spinal stenosis occurs in the lumbar or sacral area, impingement on the cauda equina nerves of the spinal cord may result in bladder and bowel dysfunction. This is a medical emergency known as cauda equina syndrome.

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