Podcast
Questions and Answers
Which of the following is NOT a typical clinical manifestation of Muscular Dystrophy?
Which of the following is NOT a typical clinical manifestation of Muscular Dystrophy?
What is the most common bone disease affecting over 75 million people worldwide?
What is the most common bone disease affecting over 75 million people worldwide?
Which of these is a risk factor for Osteoporosis?
Which of these is a risk factor for Osteoporosis?
Which medication is specifically mentioned in the text for treating Muscular Dystrophy?
Which medication is specifically mentioned in the text for treating Muscular Dystrophy?
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What is the gold standard diagnostic tool for Muscular Dystrophy?
What is the gold standard diagnostic tool for Muscular Dystrophy?
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Which clinical manifestation of Osteoporosis is often referred to as a 'silent disease'?
Which clinical manifestation of Osteoporosis is often referred to as a 'silent disease'?
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Which of these is NOT a nursing management strategy for Muscular Dystrophy?
Which of these is NOT a nursing management strategy for Muscular Dystrophy?
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Which of these is considered a common complication associated with Muscular Dystrophy?
Which of these is considered a common complication associated with Muscular Dystrophy?
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Which of the following is NOT a commonly used diagnostic test for Osteoporosis?
Which of the following is NOT a commonly used diagnostic test for Osteoporosis?
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What is the most common complication associated with Osteoporosis?
What is the most common complication associated with Osteoporosis?
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Which of these is NOT a preventative measure for Osteoporosis?
Which of these is NOT a preventative measure for Osteoporosis?
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A patient with a T-score of -2.7 would be classified as having:
A patient with a T-score of -2.7 would be classified as having:
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Which of these is a primary goal for the management of Paget's Disease?
Which of these is a primary goal for the management of Paget's Disease?
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Which of the following medications is specifically used in the management of Paget's Disease?
Which of the following medications is specifically used in the management of Paget's Disease?
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What is a potential outcome of a long-term use of Zoledronic acid in the treatment of Paget's Disease?
What is a potential outcome of a long-term use of Zoledronic acid in the treatment of Paget's Disease?
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Which one of these is a characteristic clinical manifestation of Paget's Disease?
Which one of these is a characteristic clinical manifestation of Paget's Disease?
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What is the primary clinical hallmark of osteomyelitis?
What is the primary clinical hallmark of osteomyelitis?
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Which of the following treatments is NOT part of the medical management for osteomyelitis?
Which of the following treatments is NOT part of the medical management for osteomyelitis?
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What is the correct order of phases for osteomyelitis based on duration?
What is the correct order of phases for osteomyelitis based on duration?
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Which medication class is NOT typically used for treating osteomyelitis?
Which medication class is NOT typically used for treating osteomyelitis?
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What type of curvature defines scoliosis?
What type of curvature defines scoliosis?
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What is the most common type of muscular dystrophy?
What is the most common type of muscular dystrophy?
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Which of the following diagnostic studies is NOT used to assess the musculoskeletal system?
Which of the following diagnostic studies is NOT used to assess the musculoskeletal system?
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What is the main reason for using contrast during a CT scan to assess the musculoskeletal system?
What is the main reason for using contrast during a CT scan to assess the musculoskeletal system?
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Which of the following is NOT a common symptom of musculoskeletal disorders?
Which of the following is NOT a common symptom of musculoskeletal disorders?
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What is the main difference between Duchenne and Becker muscular dystrophy?
What is the main difference between Duchenne and Becker muscular dystrophy?
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What is a primary benefit of minimally invasive surgical techniques?
What is a primary benefit of minimally invasive surgical techniques?
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Which of the following is a complication that can arise from joint replacement surgery?
Which of the following is a complication that can arise from joint replacement surgery?
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Which nursing intervention is crucial for assessing the state of the surgical site in joint replacement patients?
Which nursing intervention is crucial for assessing the state of the surgical site in joint replacement patients?
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What is the primary purpose of using a Continuous Passive Motion (CPM) machine post-surgery?
What is the primary purpose of using a Continuous Passive Motion (CPM) machine post-surgery?
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Which of the following is essential teaching for patients undergoing joint replacement surgery?
Which of the following is essential teaching for patients undergoing joint replacement surgery?
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What is a primary characteristic of idiopathic scoliosis?
What is a primary characteristic of idiopathic scoliosis?
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What indicates a need for surgical intervention in scoliosis management?
What indicates a need for surgical intervention in scoliosis management?
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Which of the following is NOT a risk factor for developing idiopathic scoliosis?
Which of the following is NOT a risk factor for developing idiopathic scoliosis?
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What does a Cobb’s angle measurement greater than 60 degrees indicate in a scoliosis diagnosis?
What does a Cobb’s angle measurement greater than 60 degrees indicate in a scoliosis diagnosis?
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Which condition is the leading indication for joint replacement surgery?
Which condition is the leading indication for joint replacement surgery?
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What approach is preferred for younger and more active individuals undergoing joint replacement surgery?
What approach is preferred for younger and more active individuals undergoing joint replacement surgery?
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What is a common characteristic of the cemented approach in joint replacement surgery?
What is a common characteristic of the cemented approach in joint replacement surgery?
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What is a typical duration of hospital stay after joint replacement surgery?
What is a typical duration of hospital stay after joint replacement surgery?
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Study Notes
Coordinating Care for Patients with Musculoskeletal Disorders
- Objectives: Describe epidemiology and risk factors of musculoskeletal disorders to inform nursing assessments and patient education; understand diagnostic results to confirm diagnoses and guide interventions; explain interprofessional management strategies for musculoskeletal conditions; design nursing care plans incorporating pharmacological treatment, dietary modifications and lifestyle interventions to optimize outcomes; coordinate and implement interprofessional care plans for patients undergoing joint replacement surgery, ensuring effective communication and continuity;
Functions of the Musculoskeletal System
- Second largest body system
- Allows for movement
- Protects vital organs
- Produces blood cells in bone marrow
- Supports upright posture and weight-bearing
- Reservoir for essential body minerals
Assessing Past Medical History & Chief Complaint
- Key aspects to assess include pain, swelling, stiffness, deformity, weakness, instability, loss of function, color/temperature changes, numbness/tingling, treatment effectiveness, history of injuries, and family history.
Physical Assessment
- Includes posture, gait, range of motion, sensation, pulse assessment, muscle tone and strength, and skin color/temperature. Visual aids demonstrate normal and abnormal postures including Lordosis, Kyphosis, Flat back and Scoliosis
Diagnostic Studies
- X-rays: scans with or without contrast, renal and medication status assessment (e.g., metformin)
- CT scans: with or without contrast, assess renal and medication status (e.g., metformin)
- MRI: assess for claustrophobia, education regarding noise levels, remove metal and medication patches, bone density studies/scans, arthrograms, arthroscopy, arthrocentesis
Muscular Dystrophy
- Progressive muscle weakness/atrophy
- Lack of dystrophin
- Multiple types affecting over 50,000 Americans
- Most common types: Duchenne and Becker
- More common in males
- Inherited X chromosome link is the only known risk factor
- Can present at any age
- No cure
Muscular Dystrophy: Clinical Manifestations
- Progressive muscle weakness
- Chronic pain (location varies)
- Increase in fat and scar tissue
- Calf enlargement
- Spasms and fractures
- Poor dentation
- Deteriorated speech quality
- GI dysfunction
- Difficulty ambulating and frequent falls
- Scoliosis or Lordosis
- Cardiomyopathy
- Respiratory compromise
- Depression
Muscular Dystrophy: Diagnosis
- Gold standard: Muscle biopsy
- Serum enzymes
- Creatinine kinase levels
- Chest X-rays
- EKGs
- CT scans
- Genetic testing
Muscular Dystrophy: Treatment
- Prevention of deterioration
- Support to maintain function
- Pain management
- Glucocorticoids (e.g., Prednisone)
- Anti-inflammatory medications
- Supplemental medications
- Antioxidants
- Supportive care and counseling
Muscular Dystrophy: Nursing Management
- Monitor signs and symptoms
- Monitor for complications and deterioration
- Monitor vital signs (possible decreased BP & O2 and elevated heart rate)
- Monitor labs and imaging results
- Assist with ADLs as needed
- ROM and fall precautions
- Medication administration
- Collaboration with PT, OT, ST, and family
- Emotional support
- Evaluating care outcomes; promote and maintain optimal function and comfort
Osteoporosis
- Deterioration in bone tissue density
- Most common bone disease worldwide
- Affects over 75 million people globally
- 1 in 2 women and 1 in 5 men over age 50
- Affects all ethnicities
- Major health concern
Osteoporosis: Risk Factors
- Age 50+
- Female > Male
- Caucasian/Asian race
- Sedentary lifestyle
- Smoking
- Excessive alcohol consumption
- Decreased calcium and vitamin D intake
- Steroid use
- Anticonvulsants
Osteoporosis: Clinical Manifestations
- Silent disease: Typically diagnosed after a fracture
- Prevention is key
- Spine, hip, or radius common fracture sites
- Dowager's hump
- Loss of height
- Back pain
- Pain increased with activity, relieved with rest
- Restriction of movement
- History and fear of falls
Osteoporosis: Diagnosis
- Bone mineral density testing (DEXA scans with T scores)
- Osteopenia (low bone mass): Between 1 and 2.5 points lower than standard deviation
- Osteoporosis: Greater than 2.5 points lower than standard deviation
- Ultrasounds
- Quantitative CT scans
- No specific lab tests (other lab tests may be completed to rule out other diseases)
Osteoporosis: Treatment
- Prevention and screening (weight loss, weight-bearing exercises, avoid smoking/alcohol, calcium and vitamin D supplements, sunlight)
- Complications (falls, prolonged hospitalization, death)
- Treatment plan includes (medication, healthy diet, calcium and vitamin D, exercise, preventing falls)
Osteoporosis: Nursing Management
- Assessment
- Medication administration
- Fall prevention measures
- Encourage healthy diet/weight loss (PRN)
- Emotional support for body image issues
- Assist with ADLs and exercise
- Collaborate with home health
Paget's Disease
- Second most common bone disease
- Accelerated bone remodeling leading to abnormal structures
- Males age 50+
- Prevalence increases with age
- Most common in UK
- Genetics involved
- Measles potential trigger
Paget's Disease: Clinical Manifestations
- Initially asymptomatic
- Pain and deformity
- Pain increased at night
- Pain increased with weight-bearing
- Spinal curvature and compression
- Cortex fissures
- Warmth to site of deformity
Paget's Disease: Complications
- Fractures
- Osteosarcoma
- Hyperparathyroidism
- Gout
- Urolithiasis
- Heart failure
- Neurological issues (e.g., deafness)
- Facial deformities
Paget's Disease: Diagnosis
- 80% asymptomatic
- Incidental findings
- History and physical examination
- Bone turnover
- Imaging (e.g., bone scans—revealing "hot spots", CT scans, biopsy to rule out osteosarcoma)
Paget's Disease: Medical Management
- No effective treatment, goal is to decrease pain and increase functional mobility
- Non-surgical is recommended
- Calcitonin (not a long-term solution)
- Symptomatic treatment: Bisphosphonates (e.g., zoledronic acid - renal toxic), calcium and vitamin D supplements
- Surgical treatment: Joint replacement, spinal decompression, osteotomy
Paget's Disease: Nursing Management
- Assessment
- Medication administration (including monitoring)
- Pain management (non-pharmacological)
- Assist with nutritional support
- Assist with Activities of Daily Living (ADLs)
- Maintain safety
- Collaborate with home health
- Education
Osteomyelitis
- Inflammation/infection in the bone (e.g., Staph Aureus or Gram-negative bacilli)
- Spread via bloodstream or trauma/surgery
- Three phases: acute (<2 weeks), subacute (2-3 months), chronic (>3 months)
- Clinical hallmark: bone necrosis and sinus tract development
Osteomyelitis: Clinical Manifestations
- Pain unrelieved by rest
- Swelling
- Warmth/tenderness at site
- Malaise
- Fever and chills
- Nausea
- Erythema
Osteomyelitis: Diagnosis
- Labs (WBC, ESR, CRP, blood cultures)
- Bone scan
- 50% with positive blood cultures
- CT/MRI
- Gold standard: bone biopsy
Osteomyelitis: Medical Management
- Antibiotics (4-6 weeks): Penicillins, Cephalosporins, Fluoroquinolones, Vancomycin (if MRSA or allergy)
- Incision and drainage
- Surgical debridement
- Pain management
- Nutritional/Supplement support
Osteomyelitis: Nursing Management
- Assessment
- Monitor labs/cultures
- Antibiotic administration
- Pain management (non-pharmacological)
- Assist with nutritional support
- Assist with ADLs
- Maintain safety
- Collaborate with home health
- Education
Scoliosis
- Greater than 10-degree curvature of the spine
- Rotation and compression
- Cause unknown
- Three categories: neuromuscular, congenital, idiopathic
Scoliosis: Risk Factors
- Smoking
- Obesity
- Older age
- Heavy labor occupation
- Sedentary lifestyle
- Lower educational level
- 2-3% adolescent idiopathic
Scoliosis: Clinical Manifestations
- Sideways curvature of spine
- Uneven shoulders
- One shoulder blade more prominent
- Uneven waist
- Uneven hips
- Cardiopulmonary compromise in severe cases
Scoliosis: Diagnosis
- Cobb's angle: Perpendicular line from upper/lower vertebrae most affected by curvature
- 10 degrees: Scoliosis
- Greater than 50 degrees: Spinal instability
- Greater than 60 degrees: Thoracic compromise—potential cardiopulmonary compromise
Scoliosis: Medical Management
- Less than 50 degrees of curvature: Conservative treatment (thermal therapy, PT/OT, exercise schedule, pain management)
- Greater than 50 degrees of curvature: Surgery, Spinal fusion, orthotic brace (e.g., TLSO)
Scoliosis: Nursing Management
- Monitor for cardiopulmonary compromise
- Pain management
- Fall prevention
- Assist with orthotic device
- Maintain level of activity/exercise
- Thermal therapy
- Education
Joint Replacement Surgery
- Total joint replacement (arthroplasty): removal of damaged area of bone and replacement with prosthesis
- Common sites: Knee and Hip
- Increased incidence secondary to obesity
- Reduced hospital stay length
Joint Replacement Indications
- Osteoarthritis (leading indication)
- Joint destruction
- Joint dysfunction
- Joint deformities
- Immobility
- Increase in pain/inflammation
- Muscle spasms
- Conservative treatment no longer effective
- Confirmed with X-rays and MRIs
Joint Replacement Surgery (Types)
- Uncemented approach: hole in bone to allow ingrowth into prosthesis
- Younger, active population
- Cemented approach: attach prosthesis to bone
- Older patients, less likely to need revision
Joint Replacement Surgery: Traditional vs Minimal Invasive
- Traditional: 20-30cm incision, staples/sutures, semipermeable dressings, intra-operative drainage to prevent hematoma
- Minimal invasive: 10cm or less incision, faster recovery, increased patient satisfaction, less muscle damage
Joint Replacement Complications
- Blood loss
- Hypotension
- Hypovolemia
- Wound site infection
- Dislocation
- DVT/PE
Joint Replacement: Nursing Management
- Monitor vital signs
- Pain management
- Neurovascular assessment
- Incision assessment/care
- Laboratory assessment
- Mobilization
- SCD's and anticoagulation
- CPM machine (if ordered)
- Positioning and turning
- Education
- Collaboration with PT and case management
Joint Repair Considerations
- Nursing interventions (pre and post-operative teaching, administer medications, wound care, early mobilization, anti-embolic stocking, CPM, positioning/turning , educational resources)
- Nursing management (evaluate care outcomes, reduce pain, restoration of functional outcomes)
Hip Repair/Replacement
- Procedure for repairing or replacing a damaged hip joint.
Knee Repair/Replacement
- Procedure for repairing or replacing a damaged knee joint.
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Description
Test your knowledge on Muscular Dystrophy and Osteoporosis with this comprehensive quiz. Explore clinical manifestations, risk factors, diagnostic tools, and management strategies associated with these conditions. Perfect for students in health sciences and medical fields.
