Care of Musculoskeletal Disorders

Questions and Answers

What is the purpose of heat and cold application in joint care?

To help with pain (correct)

To assist with mobility

To promote weight loss

To strengthen muscles

Total Knee Arthroplasty (TKA) is a conservative management method.

False

What is the purpose of Continuous Passive Motion (CPM) Machine in TKA?

To promote mobility and ambulation

Match the following joint replacement surgeries with their corresponding descriptions:

Total Knee Arthroplasty (TKA) = Replacement of knee joint Total Hip Arthroplasty (THA) = Replacement of hip joint Signup and view all the answers

What is a common risk associated with immobility after TKA surgery?

DVT Signup and view all the answers

Glucosamine and chondroitin are prescription medications used to treat joint pain.

False Signup and view all the answers

What is osteoporosis primarily characterized by?

Decreased bone mass Signup and view all the answers

Osteomalacia is a condition associated with decreased calcification in bones.

True Signup and view all the answers

At what age is peak bone mass typically achieved?

30 Signup and view all the answers

Post-menopausal women are at higher risk for osteoporosis due to a decrease in _____ levels.

estrogen Signup and view all the answers

Match each term to its correct definition:

Osteopenia = Less than normal density in the bone Osteoporosis = Severe reduction in bone density Osteoblasts = Cells that build bone Osteoclasts = Cells that consume bone Signup and view all the answers

Which of the following is NOT a risk factor for osteoporosis?

High calcium intake Signup and view all the answers

Bone pain is often a symptom of osteoporosis in its early stages.

False Signup and view all the answers

Name one type of osteoporosis.

Primary osteoporosis Signup and view all the answers

The imaging test commonly used to assess bone density is called _____ scan.

DEXA Signup and view all the answers

What is a common lifestyle change recommended to prevent osteoporosis?

Weight-bearing exercises Signup and view all the answers

What is the primary treatment for Rheumatoid Arthritis (RA)?

NSAIDS Signup and view all the answers

Rheumatoid factor is detected by CP.

True Signup and view all the answers

What is the purpose of monitoring liver enzymes and creatinine in patients taking methotrexate?

To detect potential adverse effects on the liver and kidneys Signup and view all the answers

Arthrocentesis checks for _______________________ in RA patients.

WBCs, inflammatory cells, RA factor Signup and view all the answers

Match the following medications with their actions in RA treatment:

Methotrexate = Suppresses immune system Etanercept = Modifies disease progression Steroids = Reduces joint pain during flare-ups NSAIDS = Decreases inflammation Signup and view all the answers

What is a potential adverse response to methotrexate?

All of the above Signup and view all the answers

Etanercept is a type of NSAID.

False Signup and view all the answers

Why is it important to discuss contraception with patients taking methotrexate?

Because methotrexate is teratogenic Signup and view all the answers

What is a common adverse effect of estrogen therapy?

Stroke Signup and view all the answers

Osteomyelitis is typically seen in non-diabetic patients.

False Signup and view all the answers

What is the primary usage of estrogen therapy in postmenopausal women?

Preventing osteoporosis and maintaining bone density. Signup and view all the answers

Osteomyelitis is an infection of the _______________________ tissue caused by bacteria, virus, parasites, or fungi.

bone Signup and view all the answers

Hyperbaric oxygen therapy is used to treat osteomyelitis.

True Signup and view all the answers

Match the following types of fractures:

Pathologic fracture = Occurs after minimal trauma due to underlying disease Stress fracture = Results from excessive stress or strain on the bone Signup and view all the answers

What is crepitus in the context of fractures?

A grinding, crunching, or grating sound that happens from moving a joint, often accompanied by subcutaneous air. Signup and view all the answers

Acute Compartment Syndrome (ACS) is a _______________________ emergency.

medical Signup and view all the answers

What is a symptom of Acute Compartment Syndrome (ACS)?

All of the above Signup and view all the answers

Which of the following is a key action to prevent dislocation after a Total Hip Replacement (THA)?

Use an abduction pillow Signup and view all the answers

It is acceptable for patients after THA to kneel in order to perform daily activities.

False Signup and view all the answers

What device is commonly used to promote mobility in patients after surgery to prevent deep vein thrombosis (DVT)?

Sequential Compression Devices (SCDs) Signup and view all the answers

Patients after THA should perform deep __________ and use an incentive spirometer.

breaths Signup and view all the answers

Match the signs and symptoms of hip dislocation after THA with their descriptions:

Increased pain at surgical site = A sign of dislocation or complication Internal/external rotation of affected extremity = Abnormal limb positioning Swelling = A response to inflammation Acute groin pain = Severe discomfort near the hip area Signup and view all the answers

Which of the following statements is true regarding postoperative care for THA?

Neurovascular checks are necessary. Signup and view all the answers

Physical therapy is optional after Total Hip Replacement.

False Signup and view all the answers

What is the primary goal of using an incentive spirometer after surgery?

To promote lung expansion and prevent pneumonia. Signup and view all the answers

To avoid complications, it is important for patients after THA not to __________ the knee past the belly button.

move Signup and view all the answers

What should patients do if they experience acute chest pain or shortness of breath after surgery?

Call 911. Signup and view all the answers

What is the maximum rate at which potassium can be infused intravenously?

10 mEq/100 mL Signup and view all the answers

Potassium tablets should be crushed or chewed for faster absorption.

False Signup and view all the answers

What is the recommended potassium level at which a patient's potassium should be checked 4 hours after the last dose?

3.5 Signup and view all the answers

Potassium is absorbed better and more comfortably when administered ______.

orally Signup and view all the answers

Match the following potassium levels with their corresponding actions:

3.9 = Monitor the potassium level more frequently. Critically low = Check the potassium level more frequently. 3.5 = Check the potassium level 4 hours after the last dose. Signup and view all the answers

If a patient's creatinine level is greater than 2 with normal body weight, potassium should be administered.

False Signup and view all the answers

Which of the following is NOT a factor that can lead to hypokalemia?

Excessive intake of potassium Signup and view all the answers

Potassium is primarily an extracellular cation.

False Signup and view all the answers

What is the primary role of the kidneys in potassium balance?

The kidneys are responsible for regulating the excretion and reabsorption of potassium in the body. Signup and view all the answers

Low potassium levels can lead to a condition called ______, which can cause muscle weakness and paralysis.

hypokalemia Signup and view all the answers

Match the following signs and symptoms with their corresponding potassium imbalance:

Cardiac dysrhythmias = Hypokalemia Irritability and anxiety = Hyperkalemia Muscle weakness and paralysis = Hypokalemia Bradycardia = Hyperkalemia Increased bowel sounds = Hyperkalemia Shallow respirations = Hypokalemia Paralytic ileus = Hypokalemia Signup and view all the answers

Which of the following is a common treatment for hyperkalemia?

Sodium polystyrene sulfonate (Kayexalate) Signup and view all the answers

Hypokalemia can be caused by excessive intake of potassium.

False Signup and view all the answers

What is a common dietary intervention for patients with renal disease who need to restrict potassium intake?

Restricting high-potassium foods such as bananas, avocados, and processed foods. Signup and view all the answers

The medication ______ can cause a decrease in serum potassium levels.

insulin Signup and view all the answers

Magnesium is not affected by fluid volume changes, similar to potassium.

False Signup and view all the answers

Which medication is used for pushing potassium into cells?

Insulin Signup and view all the answers

Kayexalate binds with potassium in the bowels, allowing its excretion.

True Signup and view all the answers

What is the maximum rate for administering intravenous potassium?

10 mEq/hr Signup and view all the answers

Always monitor the patient's __________ status when administering potassium.

cardiac Signup and view all the answers

Match the potassium treatment options with their descriptions.

Diuretics = Promote potassium excretion through urine Kayexalate = Binds potassium in the bowels for elimination Insulin = Shifts potassium into cells Glucose = Prevents hypoglycemia during potassium administration Signup and view all the answers

What is a notable contraindication for using potassium protocols?

If the patient is NPO Signup and view all the answers

It is acceptable to give intravenous potassium as a rapid IV push.

False Signup and view all the answers

What tool should always be used when administering intravenous potassium?

IV pump Signup and view all the answers

What should be done if a patient's creatinine level is more than 2 with normal body weight?

Do not use potassium Signup and view all the answers

Potassium tablets can be crushed or chewed to increase absorption.

False Signup and view all the answers

What is the maximum infusion rate for potassium in mEq/100 mL?

10 Signup and view all the answers

If the potassium level is 3.5, it should be checked _____ hours after the last potassium dose.

4 Signup and view all the answers

When should a physician's instructions be followed in addition to given medical instructions?

Always after completing the given medical instructions Signup and view all the answers

What is the maximum recommended rate for administering intravenous potassium?

10 mEq/hr Signup and view all the answers

Kayexalate is an intravenous medication that directly reduces potassium levels in the blood.

False Signup and view all the answers

What should be monitored closely when administering potassium intravenously?

Cardiac rhythm Signup and view all the answers

Insulin works quickly to push potassium into ______.

cells Signup and view all the answers

Match the following potassium treatment options with their functions:

Diuretics = Removes excess potassium via urine Insulin = Pushes potassium into cells Kayexalate = Binds potassium in the bowels Intravenous potassium = Supplemental potassium for deficiency Signup and view all the answers

Which of the following is a contraindication to using potassium protocols?

Patient is NPO Signup and view all the answers

It is acceptable to give IV push potassium if a patient is experiencing severe hypokalemia.

False Signup and view all the answers

Protocols for administering potassium must always be checked because they are subject to ______.

change Signup and view all the answers

What is the primary function of potassium in the body?

Muscle contraction and nerve impulses Signup and view all the answers

Hypokalemia can result from excessive intake of potassium.

False Signup and view all the answers

What condition is characterized by elevated potassium levels in the blood?

Hyperkalemia Signup and view all the answers

Potassium is primarily absorbed in the body when magnesium levels are ______.

normal Signup and view all the answers

Match the following potassium levels with their corresponding conditions:

Hypokalemia = Less than 3.5 mEq/L Normal potassium = 3.5-5.0 mEq/L Hyperkalemia = More than 5.0 mEq/L Signup and view all the answers

Which of the following is a common treatment for hypokalemia?

Potassium replacement therapy Signup and view all the answers

Diuretics can lead to hyperkalemia.

False Signup and view all the answers

Name one symptom of hypokalemia.

Muscle weakness Signup and view all the answers

______ is a condition that can result in muscle twitching and paralysis due to high potassium levels.

Hyperkalemia Signup and view all the answers

What can cause potassium levels to drop quickly during an illness?

Vomiting Signup and view all the answers

Study Notes

Objectives of Musculoskeletal Disorders Care

Identify pathophysiology and clinical manifestations of musculoskeletal disorders.
Recognize diagnostic tests and develop/evaluate a plan of care.
Discuss pharmacological interventions and identify complications.

Musculoskeletal System Overview

Comprises the skeletal (bones and joints) and muscular systems.
Bones store calcium and phosphorus, and protect vital organs.
Red marrow in bones generates blood cells.
Muscle issues often follow bone-related problems.

Osteopenia & Osteoporosis

Osteopenia: reduced bone density.
Osteoporosis: severe osteopenia leading to significant bone deterioration.
Falls in older patients commonly result in major health declines.

Osteoporosis Terminology

Osteomalacia: softening of bones due to calcification issues.
Osteoporosis is characterized by decreased bone mass.
Bone remodeling involves osteoblasts (build bone) and osteoclasts (consume bone).
Peak bone mass is typically reached by age 30, influenced by estrogen levels.

Types of Osteoporosis

Generalized (Primary: due to aging, hormonal changes; Secondary: due to medications like glucocorticoids).
Regional (localized, often after fractures or seen in astronauts).

Risk Factors for Osteoporosis

Family history, age (increased risk after age 50), and inadequate nutrition (calcium and Vitamin D deficiency).
Lack of weight-bearing exercise increases risk.
Smoking, alcohol use, hormone deficiencies, low body weight, and certain medications (diuretics, steroids) contribute to risk.

Signs and Symptoms of Osteoporosis

Often asymptomatic until fractures occur.
Symptoms include bone pain, height loss, neck/lower back pain, and stooped posture.

Diagnostic Testing for Osteoporosis

Lab tests: Calcium and Vitamin D levels.
Imaging: Dual-energy X-ray absorptiometry (DXA) for assessing bone mineral density.

Prevention and Treatment of Osteoporosis

Adequate vitamin D from sunlight; limited dietary sources.
Engage in weight-bearing exercises (30 min, 3-4 times/week).
Estrogen therapy can help but carries risks of thrombosis.

Osteomyelitis

Infection of bone caused by bacteria, viruses, or fungi.
Can be exogenous (external source), endogenous (from bloodstream), or contiguous (originating from nearby tissue).
Common in diabetes patients and IV drug users.

Clinical Manifestations of Osteomyelitis

Acute: fever, chills, swelling, tenderness, erythema, localized pain.
Chronic: may exhibit foot ulcers, drainage, pain depending on blood circulation.

Risk Factors for Osteomyelitis

Immunosuppression, malnourishment, chronic illnesses, certain medications, and presence of wounds or artificial joints.

Diagnosis of Osteomyelitis

Laboratory tests indicating leukocytosis.
Cultures from blood or infected area.
Imaging via X-ray, MRI, and bone biopsy for definitive diagnosis.

Treatment of Osteomyelitis

Nonsurgical: Antibiotic therapy (often IV), pain control, hyperbaric oxygen therapy.
Surgical: Debridement, excision of infected bone, possible amputation.

Fractures Overview

Classifications: Complete (all the way through) and incomplete; closed (skin intact) and open (skin broken).
Pathologic fractures occur from minimal trauma due to underlying conditions like osteoporosis.

Clinical Manifestations of Fractures

Pain, loss of function, deformity, crepitus (crunching sound), ecchymosis, and edema noted.

Complications of Fractures

Acute: Increased risk of venous thromboembolism, infection, acute compartment syndrome, and fat embolism syndrome.
Chronic: Delayed healing and chronic pain.

Acute Compartment Syndrome (ACS)

A medical emergency; occurs when swelling compromises artery and nerve function in limbs.
Early signs include severe pain, paresthesia, weak pulses, pallor, increased pressure, and potential paralysis.

Medications for Rheumatoid Arthritis (RA)

NSAIDs for inflammation, steroids for flare-ups, and disease-modifying anti-rheumatic drugs (DMARDs) including methotrexate and etanercept.
Monitor liver enzymes and patient education on teratogenic effects and infection risks.### Joint Management
Joint positioning and body posture are crucial, requiring active movement.
Heat and cold applications can alleviate pain.
Platelet-rich plasma (PRP) treatment uses the patient’s own platelets to aid local tissue repair.
Addressing obesity is vital for promoting weight loss and reducing joint stress.

Physical Therapy and Support

Physical therapy strengthens muscles to support skeletal stability.
Assistive devices like walkers and canes enhance mobility.
Over-the-counter supplements such as glucosamine and chondroitin support joint health.
Medical marijuana may provide pain relief for some patients.

Joint Replacement Overview

Total Knee Arthroplasty (TKA) and Total Hip Arthroplasty (THA) are common orthopedic procedures.
Considered when conservative management fails.

Total Knee Replacement (TKA)

Cartilage degradation leads to pain; replacing cartilage alleviates discomfort.

Nursing Management for TKA

Emphasizes infection prevention during and after surgery.
Implement effective pain control measures, including catheters for targeted infusion.
Mobilization is critical; patients should ambulate on the day of surgery.
Continuous Passive Motion (CPM) devices enhance range of motion post-surgery.
Deep Vein Thrombosis (DVT) prevention includes mobility encouragement and anticoagulant therapy.

Post-Operative Guidelines for TKA

Use an incentive spirometer and encourage coughing and deep breathing to prevent respiratory issues.
Advise against kneeling to protect the knee incision.
Avoid hyperflexion and hyperextension to prevent dislocation risks.

Total Hip Replacement (THA)

Replaces the femur's ball and pelvis socket; a complex procedure with extensive implications.

Nursing Management for THA

Post-operative care includes dislocation prevention measures.
Use abduction pillows to maintain leg positioning.
Prohibit adduction and severe flexion at the hip.
Elevate toilet seats and monitor dressing integrity.
Collaborate closely with physical therapy for strength recovery.
Continuous Strain Devices (SCDs) and compression stockings may be necessary for circulation.

Preventing Hip Dislocation After THR

Maintain straight leg positioning with no internal rotation.
Avoid bending the hip beyond 90 degrees or moving the knee past the midline.
Provide support between legs to prevent dislocation.

Signs and Symptoms of Hip Dislocation

Sudden increased pain and swelling at the surgical site.
Acute groin pain and possible audible “popping” sounds.
Observed abnormal foot rotation and reduced mobility of the affected limb.

Discharge Planning for TKA/THA

Arrange for ongoing physical therapy.
Focus on prevention of infections, DVT, and dislocation.
Establish follow-up appointments and define red flags that warrant immediate medical attention, such as chest pain or breath shortness.

Potassium Overview

Normal serum potassium levels range from 3.5 to 5.0 mEq/L.
Potassium serves as an intracellular cation vital for muscle contraction, cardiac function, nerve impulses, and acid-base regulation.

Potassium Balance and Kidney Function

Proper kidney function is essential for potassium balance; it adjusts potassium levels via excretion or reabsorption.
Significant changes in serum potassium levels are seen with renal failure, reflected by increased potassium.

Hypokalemia Causes

Occurs with excessive intake, deficient intake, kidney failure, loss of body fluids, medications, or hypomagnesemia.
Diuretics significantly contribute to hypokalemia, leading to potential hyponatremia.
Insulin administration lowers serum potassium by driving potassium into cells.

Hyperkalemia Causes

Caused by excessive potassium intake, kidney failure, or tissue/crush injuries that release potassium from cells.

Dietary Considerations

Patients with renal disease need careful monitoring of potassium intake; holiday foods often contain high potassium levels.

Signs and Symptoms of Hypokalemia

Cardiac: Dysrhythmias and bradycardia.
CNS: Lethargy, confusion, irritability, and anxiety.
Muscular: Weakness, paralysis, shallow respirations.
GI: Nausea, vomiting, constipation, and paralytic ileus.

Signs and Symptoms of Hyperkalemia

Increased irritability and anxiety.
Muscle twitching that may progress to paralysis.
Bradycardia resulting from altered nerve impulses in muscles.

Treatment for Hypokalemia

Identify and correct the underlying cause.
Potassium replacement therapy can be oral or IV.
Nutritional therapy with potassium monitoring.
Cardiac and respiratory functions must be carefully monitored.

Treatment for Hyperkalemia

Dialysis is often required for severe hyperkalemia.
Medications like Kayexalate can help remove excess potassium.
Insulin administration can push potassium back into cells for quick action.

Administering Intravenous Potassium

Administer slowly, no faster than 10 mEq/hr, using a pump to avoid vein irritation.
Always be cautious, as excessive potassium can cause fatal cardiac dysrhythmias.
Monitor blood sugar when giving insulin with potassium.

Protocol Guidelines

Familiarize yourself with protocols and contraindications; do not memorize them as they may change.
Monitor patients on potassium; assess creatinine levels and dietary restrictions.
Ensure proper administration techniques and patient safety checks prior to administering potassium.

Special Considerations

Avoid potassium administration in patients with creatinine levels above 2 or those weighing less than 40 kg if normal creatinine.
Check potassium levels frequently if critically low; follow up within four hours post-dose as needed.

Potassium Overview

Normal serum potassium levels range from 3.5 to 5.0 mEq/L.
Potassium serves as an intracellular cation vital for muscle contraction, cardiac function, nerve impulses, and acid-base regulation.

Potassium Balance and Kidney Function

Proper kidney function is essential for potassium balance; it adjusts potassium levels via excretion or reabsorption.
Significant changes in serum potassium levels are seen with renal failure, reflected by increased potassium.

Hypokalemia Causes

Occurs with excessive intake, deficient intake, kidney failure, loss of body fluids, medications, or hypomagnesemia.
Diuretics significantly contribute to hypokalemia, leading to potential hyponatremia.
Insulin administration lowers serum potassium by driving potassium into cells.

Hyperkalemia Causes

Caused by excessive potassium intake, kidney failure, or tissue/crush injuries that release potassium from cells.

Dietary Considerations

Patients with renal disease need careful monitoring of potassium intake; holiday foods often contain high potassium levels.

Signs and Symptoms of Hypokalemia

Cardiac: Dysrhythmias and bradycardia.
CNS: Lethargy, confusion, irritability, and anxiety.
Muscular: Weakness, paralysis, shallow respirations.
GI: Nausea, vomiting, constipation, and paralytic ileus.

Signs and Symptoms of Hyperkalemia

Increased irritability and anxiety.
Muscle twitching that may progress to paralysis.
Bradycardia resulting from altered nerve impulses in muscles.

Treatment for Hypokalemia

Identify and correct the underlying cause.
Potassium replacement therapy can be oral or IV.
Nutritional therapy with potassium monitoring.
Cardiac and respiratory functions must be carefully monitored.

Treatment for Hyperkalemia

Dialysis is often required for severe hyperkalemia.
Medications like Kayexalate can help remove excess potassium.
Insulin administration can push potassium back into cells for quick action.

Administering Intravenous Potassium

Administer slowly, no faster than 10 mEq/hr, using a pump to avoid vein irritation.
Always be cautious, as excessive potassium can cause fatal cardiac dysrhythmias.
Monitor blood sugar when giving insulin with potassium.

Protocol Guidelines

Familiarize yourself with protocols and contraindications; do not memorize them as they may change.
Monitor patients on potassium; assess creatinine levels and dietary restrictions.
Ensure proper administration techniques and patient safety checks prior to administering potassium.

Special Considerations

Avoid potassium administration in patients with creatinine levels above 2 or those weighing less than 40 kg if normal creatinine.
Check potassium levels frequently if critically low; follow up within four hours post-dose as needed.

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Description

This quiz covers the care of patients with musculoskeletal disorders, including pathophysiology, clinical manifestations, diagnostic tests, and developing a plan of care.