Care of Musculoskeletal Disorders
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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:

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

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

    <p>DVT</p> Signup and view all the answers

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

    <p>False</p> Signup and view all the answers

    What is osteoporosis primarily characterized by?

    <p>Decreased bone mass</p> Signup and view all the answers

    Osteomalacia is a condition associated with decreased calcification in bones.

    <p>True</p> Signup and view all the answers

    At what age is peak bone mass typically achieved?

    <p>30</p> Signup and view all the answers

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

    <p>estrogen</p> Signup and view all the answers

    Match each term to its correct definition:

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

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

    <p>High calcium intake</p> Signup and view all the answers

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

    <p>False</p> Signup and view all the answers

    Name one type of osteoporosis.

    <p>Primary osteoporosis</p> Signup and view all the answers

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

    <p>DEXA</p> Signup and view all the answers

    What is a common lifestyle change recommended to prevent osteoporosis?

    <p>Weight-bearing exercises</p> Signup and view all the answers

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

    <p>NSAIDS</p> Signup and view all the answers

    Rheumatoid factor is detected by CP.

    <p>True</p> Signup and view all the answers

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

    <p>To detect potential adverse effects on the liver and kidneys</p> Signup and view all the answers

    Arthrocentesis checks for _______________________ in RA patients.

    <p>WBCs, inflammatory cells, RA factor</p> Signup and view all the answers

    Match the following medications with their actions in RA treatment:

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

    What is a potential adverse response to methotrexate?

    <p>All of the above</p> Signup and view all the answers

    Etanercept is a type of NSAID.

    <p>False</p> Signup and view all the answers

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

    <p>Because methotrexate is teratogenic</p> Signup and view all the answers

    What is a common adverse effect of estrogen therapy?

    <p>Stroke</p> Signup and view all the answers

    Osteomyelitis is typically seen in non-diabetic patients.

    <p>False</p> Signup and view all the answers

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

    <p>Preventing osteoporosis and maintaining bone density.</p> Signup and view all the answers

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

    <p>bone</p> Signup and view all the answers

    Hyperbaric oxygen therapy is used to treat osteomyelitis.

    <p>True</p> Signup and view all the answers

    Match the following types of fractures:

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

    What is crepitus in the context of fractures?

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

    Acute Compartment Syndrome (ACS) is a _______________________ emergency.

    <p>medical</p> Signup and view all the answers

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

    <p>All of the above</p> Signup and view all the answers

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

    <p>Use an abduction pillow</p> Signup and view all the answers

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

    <p>False</p> Signup and view all the answers

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

    <p>Sequential Compression Devices (SCDs)</p> Signup and view all the answers

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

    <p>breaths</p> Signup and view all the answers

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

    <p>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</p> Signup and view all the answers

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

    <p>Neurovascular checks are necessary.</p> Signup and view all the answers

    Physical therapy is optional after Total Hip Replacement.

    <p>False</p> Signup and view all the answers

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

    <p>To promote lung expansion and prevent pneumonia.</p> Signup and view all the answers

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

    <p>move</p> Signup and view all the answers

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

    <p>Call 911.</p> Signup and view all the answers

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

    <p>10 mEq/100 mL</p> Signup and view all the answers

    Potassium tablets should be crushed or chewed for faster absorption.

    <p>False</p> 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?

    <p>3.5</p> Signup and view all the answers

    Potassium is absorbed better and more comfortably when administered ______.

    <p>orally</p> Signup and view all the answers

    Match the following potassium levels with their corresponding actions:

    <p>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.</p> Signup and view all the answers

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

    <p>False</p> Signup and view all the answers

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

    <p>Excessive intake of potassium</p> Signup and view all the answers

    Potassium is primarily an extracellular cation.

    <p>False</p> Signup and view all the answers

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

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

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

    <p>hypokalemia</p> Signup and view all the answers

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

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

    Which of the following is a common treatment for hyperkalemia?

    <p>Sodium polystyrene sulfonate (Kayexalate)</p> Signup and view all the answers

    Hypokalemia can be caused by excessive intake of potassium.

    <p>False</p> Signup and view all the answers

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

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

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

    <p>insulin</p> Signup and view all the answers

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

    <p>False</p> Signup and view all the answers

    Which medication is used for pushing potassium into cells?

    <p>Insulin</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

    What is the maximum rate for administering intravenous potassium?

    <p>10 mEq/hr</p> Signup and view all the answers

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

    <p>cardiac</p> Signup and view all the answers

    Match the potassium treatment options with their descriptions.

    <p>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</p> Signup and view all the answers

    What is a notable contraindication for using potassium protocols?

    <p>If the patient is NPO</p> Signup and view all the answers

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

    <p>False</p> Signup and view all the answers

    What tool should always be used when administering intravenous potassium?

    <p>IV pump</p> Signup and view all the answers

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

    <p>Do not use potassium</p> Signup and view all the answers

    Potassium tablets can be crushed or chewed to increase absorption.

    <p>False</p> Signup and view all the answers

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

    <p>10</p> Signup and view all the answers

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

    <p>4</p> Signup and view all the answers

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

    <p>Always after completing the given medical instructions</p> Signup and view all the answers

    What is the maximum recommended rate for administering intravenous potassium?

    <p>10 mEq/hr</p> Signup and view all the answers

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

    <p>False</p> Signup and view all the answers

    What should be monitored closely when administering potassium intravenously?

    <p>Cardiac rhythm</p> Signup and view all the answers

    Insulin works quickly to push potassium into ______.

    <p>cells</p> Signup and view all the answers

    Match the following potassium treatment options with their functions:

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

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

    <p>Patient is NPO</p> Signup and view all the answers

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

    <p>False</p> Signup and view all the answers

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

    <p>change</p> Signup and view all the answers

    What is the primary function of potassium in the body?

    <p>Muscle contraction and nerve impulses</p> Signup and view all the answers

    Hypokalemia can result from excessive intake of potassium.

    <p>False</p> Signup and view all the answers

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

    <p>Hyperkalemia</p> Signup and view all the answers

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

    <p>normal</p> Signup and view all the answers

    Match the following potassium levels with their corresponding conditions:

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

    Which of the following is a common treatment for hypokalemia?

    <p>Potassium replacement therapy</p> Signup and view all the answers

    Diuretics can lead to hyperkalemia.

    <p>False</p> Signup and view all the answers

    Name one symptom of hypokalemia.

    <p>Muscle weakness</p> Signup and view all the answers

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

    <p>Hyperkalemia</p> Signup and view all the answers

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

    <p>Vomiting</p> 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.

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