Adult health Musculoskeletal Disorders

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Questions and Answers

Which of the following is NOT a recommended position for someone with ankylosing spondylitis?

Back straight with a small pillow under the head

Pillows under knees (correct)

Avoiding hip and knee flexion

Trochanter roll to prevent external rotation

What is the primary characteristic of ankylosing spondylitis?

Causes abrupt joint pain without long-term impact

Is a chronic progressive rheumatic disorder primarily affecting the spine (correct)

Only involves the sacroiliac joints

Affects primarily the upper limbs

What is the typical initial symptom of osteoporosis?

Dowager’s hump

Increased lordosis

Fracture of vertebrae (correct)

Backache in lumbar region

Which symptom is associated with ankylosing spondylitis aside from back pain?

Changes in finger and toe nails Signup and view all the answers

Which medication is commonly used for treating acute gout attacks?

Colchicine Signup and view all the answers

What does the term 'ankylosis' refer to in ankylosing spondylitis?

Fusion of the spine into an abnormal position Signup and view all the answers

Which of the following is an important management strategy for ankylosing spondylitis?

Planned activity with rest periods Signup and view all the answers

What demographic is most likely to be affected by osteoporosis?

Women between ages 55-65 Signup and view all the answers

What dietary consideration is important for patients with gout?

Avoid foods high in purines Signup and view all the answers

What is a common physical change associated with osteoporosis?

Loss of bone density Signup and view all the answers

What laboratory test is essential for diagnosing osteoporosis?

Bone density test (DXA scan) Signup and view all the answers

Which of the following factors is NOT a contributing factor to osteoporosis?

Regular physical activity Signup and view all the answers

What type of joint is most affected during a gout attack?

Joint of the great toe Signup and view all the answers

What is one diagnostic test that shows inflammation in joints?

Elevated HLA-B27 Signup and view all the answers

Which treatment is NOT typically used for osteoarthritis?

Corticosteroids Signup and view all the answers

A common nursing intervention for a patient with back issues would include which of the following?

Firm mattress with no pillow Signup and view all the answers

Which surgical intervention involves the replacement of the head of the femur and acetabulum?

Arthroplasty Signup and view all the answers

Which of the following is a symptom indicative of gouty arthritis?

Excruciating pain Signup and view all the answers

Which condition is primarily characterized as a degenerative joint disease?

Osteoarthritis Signup and view all the answers

Which of the following is an assessment finding for osteoarthritis?

Stiffness that resolves with activity Signup and view all the answers

Which of the following is NOT a complication associated with surgical interventions for osteoarthritis?

Joint fusion Signup and view all the answers

What is one of the primary functions of the musculoskeletal system?

Protection of internal organs Signup and view all the answers

Which diagnostic test is used to assess for autoimmune diseases like rheumatoid arthritis?

Rheumatoid factor (RF) Signup and view all the answers

What is a common symptom of rheumatoid arthritis upon waking?

Joint stiffness Signup and view all the answers

Which of the following objective assessments assesses neurovascular integrity?

Skin temperature comparison Signup and view all the answers

In the treatment of rheumatoid arthritis, what role does methotrexate play?

Offers rapid anti-inflammatory effects Signup and view all the answers

How often should neurovascular assessments be done after surgery or cast application?

Every 30 minutes Signup and view all the answers

What measurement indicates normal phosphorus levels?

2.5-4.5 mg/dL Signup and view all the answers

What symptom might indicate complications from limited mobility?

Unrelieved pain Signup and view all the answers

What is the significance of a high erythrocyte sedimentation rate (ESR) value?

Suggests an autoimmune disease Signup and view all the answers

Which of the following exercises is considered isometric?

Quad setting Signup and view all the answers

What is the primary purpose of using weight-bearing exercises in osteoporosis management?

To prevent fractures through improved bone density Signup and view all the answers

What is a common side effect of Parathyroid hormone treatment for osteoporosis?

Nausea Signup and view all the answers

Which of the following describes the technique of vertebroplasty?

Injecting cement into vertebral spaces Signup and view all the answers

What is typically avoided after a hip replacement surgery for a period of 2-3 months?

Using the affected leg for weight-bearing Signup and view all the answers

What is the main concern with compartment syndrome following a fracture?

Edema leading to ischemia Signup and view all the answers

In patients with fibromyalgia, which symptom is commonly associated with the condition?

Involuntary limb movement at night Signup and view all the answers

What dietary recommendation is suggested for patients with osteoporosis?

Consume more dairy products Signup and view all the answers

Which of the following types of fractures is characterized by the bone being splintered into multiple pieces?

Comminuted fracture Signup and view all the answers

What is a key consideration in the initial treatment of a fracture?

Assessment for possible concurrent injuries Signup and view all the answers

What is the primary indicator of a hip fracture?

Inability to move the leg Signup and view all the answers

Which class of drugs is typically used as a first-line treatment for osteoporosis?

Bone resorption inhibitors Signup and view all the answers

In knee replacement care, which intervention focuses on preventing infection?

Using aseptic techniques during dressing changes Signup and view all the answers

What is essential for proper body alignment after hip replacement surgery?

Using an abduction splint Signup and view all the answers

What is a critical nursing intervention for a patient with an open fracture to prevent complications of shock?

Administer IV fluids to restore blood volume Signup and view all the answers

Which of the following is a symptom of gas gangrene that requires immediate attention?

Gas production under the skin Signup and view all the answers

What are common signs of thromboembolism in a patient?

Cold and cyanotic affected extremities Signup and view all the answers

When providing care for a patient in a wet plaster cast, which of the following actions is appropriate?

Elevate cast on pillows and handle with palms Signup and view all the answers

What is a recommended action after a cast is removed?

Wash the limb gently and apply oils Signup and view all the answers

Which type of traction is used primarily for temporary immobilization of the lower extremities?

Buck's traction Signup and view all the answers

What precaution should be taken when caring for a spica cast?

Monitor for signs of cast syndrome Signup and view all the answers

What is NOT an appropriate nursing intervention for a patient in a skeletal pin fixation?

Allow unrestricted movement at the fracture site Signup and view all the answers

During cast care, what should be done if foul odors are detected?

Inspect skin at cast edges immediately Signup and view all the answers

What consistency should be expected from the discharge from a casted limb?

Thin and foul smelling Signup and view all the answers

Study Notes

Musculoskeletal Disorders Review

Musculoskeletal system provides structural framework, protects internal organs, allows movement, stores minerals (calcium, phosphorus, magnesium), and produces blood cells.

Assessment-Subjective

Assessment of joints, muscles, and bones.
Evaluation of functional assessment and self-care behaviors.
Reporting of numbness.

Assessment-Objective

Assessment of body alignment and symmetry.
Evaluation of edema, pulses, and skin color.
Evaluation of ability to perform activities of daily living (ADLs).
Assessment of range of motion (ROM).
Assessment of muscle strength (5 P's).

Diagnostic Tests

ESR:
- Men: 0-15 mm/hr
- Women: 0-20 mm/hr
CBC:
- RBC
- WBC
- HCT
- Hgb
- Platelets
RF: 40-60 units/mL (normal). High levels indicate autoimmune diseases (e.g., rheumatoid arthritis).
Calcium: 9-10.5 mg/dL
Phosphorus: 2.5-4.5 mg/dL
ANA
Uric Acid:
- Males: 2.1-8.5 mg/dL
- Females: 2.0-6.6 mg/dL
X-rays
Arthroscopy
Arthrocentesis
Arthrogram
MRI
CT
EMG
Bone Scan
DXA Scan
Myelogram

Patient Positioning

Positioning necessary to prevent complications related to limited mobility.
Active and passive range of motion (AROM/PROM) exercises.
Isometric exercises (muscle tightening/relaxation without movement).
Turning regularly.

Neurovascular Integrity

Assessment of sensation, color, pain, pulses, and capillary refill is crucial to detect any impairment in blood flow to a limb.
Assess every 30 minutes after surgery or cast application.
Include assessment of signs of arterial or venous impairment (edema, coolness, pallor/cyanosis,pain/numbness/tingling).
Assess trauma, tight bandages, splints, or casts.

Pain Assessment

Fractures cause acute, deep pain.
Fractured hip pain often is severe due to muscle spasms.
Pain recurrence after reduction indicates a potential underlying issue.
Spinal column disorders can yield chronic pain that may alternate with sharp pain and extend to both extremities.

Rheumatoid Arthritis

The most serious form of autoimmune disorder affecting joints and synovial membranes.
Most prevalent ages 30-60.
More common in women than men.
Can begin with acute or insidious(gradual) onset.
Affected mostly fingers, hands, feet, and wrists.
Can experience remissions and exacerbations.

Rheumatoid Arthritis (Assessment)

Symptoms include unexplained weight loss, muscle aches, fever, malaise, and swollen/tender joints.
Another key symptom is morning stiffness that lingers.
Deformities of the affected joints may manifest in later stages.

Rheumatoid Arthritis (Diagnostic Tests)

Elevated RF titer and ESR
Anti-CCP antibody tests.
Anti-nuclear antibody tests.
C-reactive protein tests.
RBC count
Synovial fluid aspiration and biopsy.
X-rays to detect joint damage.

RA Treatment

Anti-inflammatory medications, Disease Modifying Anti-Rheumatic Drugs (DMARDs).
Pain relief using these drugs.
Reduce symptoms and slow the progression of joint damage.
Promote daily living activities and exercise to support health.

Nursing Interventions (RA)

Positioning interventions (straight extension without under-knee pillows, trochanter rolls, head pillows)
Proper drug administration (with food to decrease stomach upset, monitor for side effects)
Functional needs assessment and assistance, planned activity with rest periods.
Exercise to prevent joint stiffness and muscle weakness.
Encourage patients to do as much as they comfortably can.

Ankylosing Spondylitis

Chronic, progressive rheumatic disorder, primarily affecting the spine.
Often part of the broader rheumatic disease category.
Sacroiliac and hip joints may be affected if the disease progresses beyond the spine.

Ankylosing Spondylitis (Clinical Manifestations)

Spine fusing and becoming immobile.
Kyphosis (humped posture) might develop.
Difficulty expanding rib cage may arise.
Issues with the digestive system (IBS) might manifest.
Potential eye problems (blindness).
Heart abnormalities and pericarditis (inflammation of the sac around the heart).

Ankylosing Spondylitis (Diagnostic Tests)

Decreased hemoglobin and hematocrit (H&H) levels.
Elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels.
Elevated serum alkaline phosphatase levels.
Elevated levels of HLA-B27.
X-rays to show inflammation, bone erosion, and joint space fusion of spine and sacroiliac joints

Ankylosing Spondylitis (Treatment)

Oral analgesics and NSAIDs.
Corticosteroids.
TNF inhibitors.
Exercises.
Surgery (for severe cases).

Nursing Interventions (Ankylosing Spondylitis)

Maintaining a posture that supports spinal alignment and promoting spinal mobility.
Encouraging and monitoring activity levels to promote physical fitness and strength.
Educating patients about their condition, treatment, and potential complications.

Osteoarthritis

Degenerative joint disease.
Non-inflammatory disorder; most common type of arthritis.
Often a result of aging or factors like joint injury or overuse.
Commonly affects hands, cervical/lumbar vertebrae, hips, and knees.

Osteoarthritis (Assessment)

Symptoms include pain with movement and stiffness, especially in the morning.
Characterized by Heberden's nodes (on distal interphalangeal joints) and Bouchard’s nodes (on proximal interphalangeal joints).

Osteoarthritis (Treatment)

Weight reduction and exercise programs.
Analgesics (painkillers).
Intra-articular injection with hydrocortisone.
Treatments to relieve symptoms and enhance joint motion.

Surgical Intervention (OA)

Arthrodesis (fusion of the joint).
Arthroplasty (increasing joint mobility through surgery).
Arthroscopy (visual examination).
Total hip replacement (THR) or hip hemiarthroplasty (replacement of a part of the hip joint).
Complications can include bleeding, infections and poor circulation to the affected limb.
Osteotomy (surgical reshaping of bone).

Gouty Arthritis

Inflammatory arthritis caused by excess uric acid in blood.
Primary/Hereditary or secondary (due to medications or other conditions).
Idiopathic means unknown cause.

Gouty Arthritis (Assessment)

Excruciating pain, swelling and redness in affected joints, especially the big toe.
Heat, discoloration.
Uric acid deposits (tophi) in joints/kidneys.

Gouty Arthritis (Treatment)

Colchicine or Indocin for acute attacks.
Zyloprim and Febuoxstat for maintenance or chronic gout.
Anti-inflammatory medicines and rest.
Reduce intake purine-rich foods.
Ensure enough fluids.

Osteoporosis

Bone density loss.
Primarily affects women between ages 55-65; likely related to estrogen loss.
Factors include lifestyle, genetics, and certain conditions/medications.

Osteoporosis (Signs & Symptoms)

First signs may be a bone fracture, a stooped posture/loss of height, and back pain.
Low back pain usually worsens during and immediately after activity.

Osteoporosis (Diagnosis)

Complete blood count (CBC).
Calcium and phosphorus levels.
Blood urea nitrogen (BUN) and creatinine testing for kidney function.
24-hour urine collection tests.
Thyroid function testing.
Bone density tests (DXA scans).

Osteoporosis (Medical Management)

Daily calcium intake of 1200mg.
800 IU of Vitamin D.
Weight-bearing exercises.
Medications to inhibit bone breakdown (i.e., bisphosphonates such as alendronate/Fosamax or risedronate/Actonel).
Selective estrogen receptor modulators (SERMs).
Parathyroid hormone (PTH) treatment.

Osteoporosis (Nursing Interventions)

Fall prevention strategies
Use of assistive devices (i.e., canes, walkers)
Diet and exercise encouragement
Calcium and vitamin D supplementation.

Osteomyelitis

Bone inflammation usually caused by pathogenic bacteria, sometimes following injury/trauma.

Osteomyelitis (Assessment)

Signs of infection include severe pain, swelling warmth, and redness.
Increased body temperature, tachycardia.

Fibromyalgia

Chronic syndrome with unknown cause.
Pain in muscles, bones, and joints with pronounced tenderness.

Fibromyalgia (Assessment)

Poor sleep, headaches, confusion, depression, muscle aches, and other cognitive changes.
Typically affects women between ages 20-50.

Fibromyalgia (Treatment)

No cure, but treatment aims to relieve symptoms
Tricyclic antidepressants.
Anticonvulsants.
Pain relievers (analgesics).
Non-impact exercise.
Regular sleep patterns.

Knee Replacement (Partial/Total)

Assess the surgical site.
Aseptic dressing changes.
Pain and comfort measures (analgesics).
Monitor for complications.
Box 44.4

Hip Fractures (Signs and Symptoms)

Pain localized at the fracture site.
Shortening of the affected limb.
External rotation of the affected leg.
Inability to move the affected leg.

Hip Fractures (Complications)

Pulmonary complications (pneumonia, atelectasis).
Deep vein thrombosis (DVT) or pulmonary embolism.
Skin breakdown (decubitus ulcers).
Urinary retention.
Constipation.
Depression.

Hip Fractures (Treatment)

Temporary immobilization using traction (e.g., Buck's traction).
Internal fixation (e.g., surgical nailing or pinning).
Total hip replacement.
Follow-up treatment plan.

Nursing Interventions (Hip Fracture)

Neurovascular assessment regularly.
Monitor for pain.
Assess surgical wounds or site of fracture.
Maintain proper body alignment and positioning.
Monitor for complications, including constipation.

Complications of Fractures (Fat Embolism)

Fat globules from bone marrow/fat tissues enter bloodstream.
Occurs within 48 hours following injury.

Complications of Fractures (Compartment Syndrome)

Edema/pressure increase to nerves and blood vessels inside a closed space.
Can cause irreversible damage to nerves/tissues.

Complications of Fractures (Shock)

Blood loss causing severe hypotension, tachycardia, and shock.
Assess and treat the related symptoms.

Complications of Fractures (Gas Gangrene)

Clostridium bacteria infection in skeletal muscle causing severe tissue damage, pain, and gas under skin.

Complications of Fractures (Thromboembolism)

Clot forms and travels to a vessel.
Causes vessel obstruction.
Occurs in lungs or other areas of the body causing pain, shortness of breath, and possible danger.

Cast Care

Handling of casts, especially wet ones, should be done carefully.
Provide care to prevent further injury.

Hip Spica/Body Casts

Cautious handling/lifting to avoid causing further injury to the patient.
Smaller/more frequent meals.
Breathing exercises prevent atelectasis (lung collapse).
Monitor for cast syndrome (NV, abdominal pain, obstruction).

Cast Removal

Tools and care needed for cast removal.
Promoting healing after injury.

Traction

Pulling force with weights or similar mechanisms.

Traction (Types)

Skin traction (skin attached to a material to apply pulling force).
Skeletal traction (inserting pins in bone to apply pulling force),overhead, and other types.

Nursing Care (Traction)

Maintain proper alignment.
Secure and safe positioning.
Promote general well-being.
Monitor/prevent complications.

Other Orthopedic Devices

Splints (support/immobilize).
Walking casts (enhanced mobility).
Air casts (inflatable supports).
Neck collars (support neck).
Milwaukee brace (encompassing thoracic cavity and for spinal deformity correction).

Traumatic Injuries (Contusions, Sprains, Strains)

Contusions (bruises), involve soft tissue trauma.
Sprains (ligaments/tendons) require rest, elevation, ice.
Strains (muscle tissue) may require rest, elevation, and potentially bracing/casting
RICE (rest, ice, compression, elevation).
Care needed for recovery from these injuries.

Whiplash

Common neck injury involving severe flexion and extension movements.
Symptoms may not be immediate but can appear days later.
Treatment includes pain relief measures.

Traumatic Injuries (Dislocations)

Dislocations imply bone displacement from their normal joint alignment.
Resulting pain can be severe.
Need to be manipulated/realigned.

Carpal Tunnel Syndrome

Painful condition in the wrist associated with repetitive movement activities and other factors.
Symptoms include numbness, tingling, and pain.
Treatment usually involves rest, pain management, and splinting.

Bone Tumors

Can be primary (originating in bone) or secondary (metastasizing from another site).
Benign tumors can put pressure on nerves/tissues but usually do not spread.

Bone Tumors (Treatment)

Malignant tumors need wide excision, curettage, or amputation.
Radiation/chemotherapy also used to treat malignant tumors.

Nursing Interventions (Post-op Bone Tumor Surgery)

Monitoring neurovascular status (5 P's).
Managing pain.
Providing cast/dressing care.
Assisting with physical therapy and occupational therapy.
Educating patients about tumor recurrence.

Amputations

Pre-operative interventions involve assessing the patient for any conditions needing addressing.
Post-operative care can include promoting healing, positioning, and monitoring for pain and complications.

Amputations (Complications)

Phantom limb pain is a common complication of amputation, and can require treatment.

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Test your knowledge on ankylosing spondylitis, osteoporosis, and gout. This quiz covers symptoms, management strategies, and key characteristics of these conditions. Challenge yourself to see how well you understand these important health issues.