Chapter 41: Management of Patients With Musculoskeletal Disorders

A patient diagnosed with carpal tunnel syndrome (CTS) asks the nurse about numbness in the fingers and pain in the wrist. In responding to the patient, how would the nurse best describe CTS?

"CTS is a neuropathy that is characterized by compression of the median nerve at the wrist."

The nurse is educating a patient with low back pain about techniques to relieve the discomfort and prevent further complications. What statement by the patient shows an understanding of the education the nurse provided?

"I will avoid prolonged sitting or walking"

Explain the difference between bursitis and tendonitis.

- Are both common conditions that involve swelling around the muscles and the bones. They occur most often in the shoulder, elbow, wrist, knee, or ankle. Bursitis is the inflammation of the fluid filled sac, and tendonitis is the inflammation of a tendon.

osteomyelitis with vascular insufficiency, which most commonly affects the feet is seen most often among patients with ______________ and _______________.

- Diabetes - peripheral vascular disease

The intervertebral discs that are subject to the greatest mechanical stress and greatest degenerative changes are _______________, _______________, and _________________.

- L4 - L5 - S1

A patient is diagnosed with osteomyelitis of the right leg. What signs and symptoms does the nurse recognize that are associated with this diagnosis?

- Pain in the right leg - Erythema of the right leg - fever

Identify at least 5 musculoskeletal problems that can cause acute lower back pain:

- acute lumbosacral strain - unstable lumbosacral ligaments - weak lumbosacral muscles - osteoarthritis of the spine - spinal stenosis

How much calcium should the nurse advise Emily to take daily?

1000 to 1500mg

The layman's term for onychocryptosis, a common foot condition, is _________________.

Ingrown toenail

Most common benign bone tumor is:

Osteochondroma

The nurse is educating the patient with low back pain about the proper way to lift objects. What muscle should the nurse encourage the patient to maximize?

Quadriceps

A patient stepped on an acorn while walking barefoot in the backyard and developed an infection progressing to osteomyelitis. What microorganism does the nurse understand is most often the cause of the development of osteomyelitis?

Staphylococcus aureus

A patient reports experiencing low back pain. What position can the nurse suggest to relieve this discomfort?

Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees.

Describe the clinical manifestations associated with septic arthritis:

The patient with ___________________presents with a warm, painful, swollen joint with decreased ROM. Systemic chills, fever, and leukocytosis are sometimes presented. Although any joint may be infected, 50% of cases involve a knee.

Describe the assessment technique used for the tinel sign:

Tinel sign may be elicited in patients with carpal tunnel syndrome by percussing lightly over the median nerve, located on the inner aspect of the wrist. If the patient reports tingling , numbness, and pain, the test for tinel sign is considered positive.

Electromyogram (EMG)

Used to evaluate the spinal nerve root disorders (radiocilopathies)

Computed tomography scan (CT)

Useful in identifying underlying problems, such as obscure soft tissue lesions adjacent to the vertebral columns and problems of vertebral discs.

A patient is diagnosed with osteogenic sarcoma. What lab studies should the nurse monitor for the presence of elevation?

alkaline phosphatase

The major consequence of osteoporosis is:

bone fracture

A patient has been diagnosed with osteomalacia. What common symptoms does the nurse recognize correlate with the diagnosis?

bone pain and tenderness

The nurse is assessing the feet of a patient and observes an overgrowth of the horny layer of the epidermis, What condition will the nurse educate the patient about?

corn

A patient comes to the clinic reporting low back pain radiating down the left leg. After diagnostic studies rule out any pathology, the physician prescribes a serotonin-norepinephrine reuptake inhibitor (SNRI). Which medication does the nurse anticipate educating the patient about?

duloxetine

What is the impingement syndrome and what measures are necessary to promote shoulder healing?

is a general term that describes impaired movement of the rotator cuff of the shoulder. Impingement usually occurs from repetitive overhead movement of the arm from acute trauma resulting in irritation and eventual inflammation of the rotator cuff tendons or the subacromial bursa as they grate against the coacromial arch.

Name the risk factors (modifiable and non modifiable) associated with osteoporosis:

refer to 47-1 in text

The nurse advises Emily that the development of osteoporosis is significantly dependent on what factors?

refer to text

The hospice nurse is assigned to care for a patient with metastatic bone cancer who wants to remain at home. What is the therapeutic goal in the care of this patient?

relieve pain and discomfort while promoting quality of life

What two reasons could the nurse share to explain why women develop osteoporosis more frequently than men?

women have lower peak bone mass than men, and estrogen loss affects the development of the disorder.

Bone Scan

May disclose infections, tumors, and bone marrow abnormalities.

Three medications used to treat paget disease are _______________, _________________, and _________________.

- calcitonin - biophosphonates - plicamycin

Bone formation is enhanced by _________________, __________________, and _____________________.

- calcium intake - muscular activity - weight bearing exercise

The patient shows the nurse a round, firm nodule on the wrist. The pain is described as aching, with some weakness of the fingers. What treatment does the nurse anticipate assisting with?

- corticosteriod injections - surgical excision - aspiration of cyst

The recommended adequate intake (RAI level) of calcium for all the individuals is___________ to ___________ mg daily.

1000 to 1500

A patient comes back to the clinic wth continued reports of back pain. What time frame does the nurse understand constitutes "chronic pain".

3 months

Primary osteoporosis in women usually begins between the ages of ____________ and ______________.

45, and 55, after menopause

The primary deficit i osteomalacia is ________________ which promotes calcium absorption from the gastrointestinal tract.

A deficiency in activated vitamin d (calcitriol)

Magnetic Resonance imaging scan (MRI)

Permits visualization of the nature and location of spinal pathology

The nurse is caring for a patient with bone metastasis from a primary breast cancer. The patient reports muscle weakness and nausea and is voiding large amounts frequently. Cardiac dysrhythmias are observed on the telementary monitor. What should the nurse suspect based on these clinical manifestations?

Hypercalcemia

What would the nurse tell Emily about why she is losing bone mass?

Patient education focuses on factors influencing the development of osteoporosis, interventions to arrest or slow process, and measures to relieve symptoms. The nurse emphasizes that people of any age need sufficient calcium, vitamin D, and weight bearing exercise to slow the progression of osteoporosis. Patient education related to medication therapy as described previously is important. Patients must understand that having one fracture increases the probability of sustaining another.

A patient had hand surgery to correct a Dupuytren's contracture. What nursing intervention is a priority postoperatively?

Performing hourly neurovascular assessments for the first 24 hours

Myelogram

Permits visualization of segments of the spinal cord that may have been herniated or may be compressed (infrequently performed; indicated when MRI scan is contraindicated)

Ultrasound

Useful in detecting tears in ligaments, muscles, tendons, and soft tissues in the back.