Osteoarthritis and Fracture Management Quiz

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Questions and Answers

Which of the following is NOT a non-pharmacological treatment option for osteoarthritis?

Exercise

Nutritional therapy

Corticosteroid injections (correct)

Heat and cold application

Which of the following medications is categorized as a Disease-Modifying Antirheumatic Drug (DMARD)?

Acetaminophen

Celecoxib

Capsaicin

Methotrexate (correct)

What is the maximum daily dosage of acetaminophen recommended for osteoarthritis management?

4 grams (correct)

2 grams

3 grams

5 grams

Which of the following is NOT a type of corticosteroid used in osteoarthritis management?

Ibuprofen (C) Signup and view all the answers

Which imaging modality can potentially lead to an earlier diagnosis of osteoarthritis than X-ray?

Both B and C (B) Signup and view all the answers

What type of surgery might be considered for long-term osteoarthritis management?

Arthroscopic surgery (D) Signup and view all the answers

Which of the following is NOT a type of biological or targeted therapy used in osteoarthritis management?

Antibiotics (C) Signup and view all the answers

Which of the following is NOT a typical goal of collaborative care for osteoarthritis?

Promoting bone growth (D) Signup and view all the answers

What is the most common sports injury?

Anterior Cruciate Ligament injury (C) Signup and view all the answers

What might a positive Lachman test indicate?

A completely torn Anterior Cruciate Ligament (A) Signup and view all the answers

What is the main goal of fracture treatment?

Realigning bone fragments (A) Signup and view all the answers

What is the most common cause of hip fractures?

Osteoporosis (B) Signup and view all the answers

What is the most common type of surgery for a hip fracture?

Total hip replacement (C) Signup and view all the answers

What is a potential complication of a pelvic fracture?

Fat embolism syndrome (C) Signup and view all the answers

What is closed reduction?

A non-surgical procedure to realign bones (D) Signup and view all the answers

What does the acronym 'FES' stand for?

Fat Embolism Syndrome (C) Signup and view all the answers

What is the mechanism of action of denosumab in the treatment of osteoporosis?

It blocks osteoclast activation. (A) Signup and view all the answers

Which of the following medications is primarily indicated for the prevention of osteoporosis?

Raloxifene (B) Signup and view all the answers

Which of the following is a contraindication for the use of bisphosphonates in the treatment of osteoporosis?

Inability to sit upright for 30 minutes after taking the medication (B) Signup and view all the answers

What is a potential adverse effect associated with the use of SERMs (selective estrogen receptor modulators) for osteoporosis?

Increased risk of venous thromboembolism (D) Signup and view all the answers

Which of the following medications is associated with an increased risk of infections as a potential adverse effect?

Denosumab (D) Signup and view all the answers

What is a potential drug interaction to be considered when administering bisphosphonates?

Interference with the absorption of calcium supplements (C) Signup and view all the answers

Which of the following is a collaborative intervention commonly used in the management of fibromyalgia?

Symptom management and ongoing support (C) Signup and view all the answers

What is a commonality between fibromyalgia and other connective tissue diseases?

They all involve widespread musculoskeletal pain and fatigue. (B) Signup and view all the answers

What is the most common symptom of a sprain?

Pain (B) Signup and view all the answers

What is the most common symptom/s of a dislocation?

Deformity, pain, tenderness, loss of function and swelling (D) Signup and view all the answers

What is the most common nursing intervention for carpal tunnel syndrome?

Prevention (A) Signup and view all the answers

Which of the following is NOT a nursing intervention for rotator cuff injury and meniscus issues?

Corticosteroid injections (B) Signup and view all the answers

What is the priority nursing intervention in the case of a dislocation?

Realignment of the joint (A) Signup and view all the answers

What is the most common symptom of Systemic Exertion Intolerance Disease (SEID)?

Fatigue (B) Signup and view all the answers

What is the most common nursing intervention for soft tissue injuries?

Warm up exercises (A) Signup and view all the answers

Why is preventative care important for carpal tunnel syndrome?

Because it can worsen over time (C) Signup and view all the answers

What is the primary purpose of maintaining a cast dry?

To minimize the risk of infection (A) Signup and view all the answers

Which of the following is NOT a complication associated with fractures?

Hypothyroidism (C) Signup and view all the answers

What is the primary mechanism for increased compartment size in compartment syndrome?

Fracture, bleeding, and edema (C) Signup and view all the answers

Which of the following symptoms of compartment syndrome involves a change in skin color?

Pallor (D) Signup and view all the answers

Why is it important to monitor urine output in compartment syndrome?

To monitor for myoglobinuria (D) Signup and view all the answers

Which of the following best describes the ideal medium for pathogens in open fractures?

Devitalized and contaminated tissue (C) Signup and view all the answers

What type of tissue is most likely to be affected by a deep vein thrombosis?

Blood vessel tissue (D) Signup and view all the answers

Which of the following is a potential complication of a fracture that can lead to a decrease in blood flow to the affected area?

Compartment syndrome (C) Signup and view all the answers

What symptom is commonly associated with myoglobinuria?

Dark reddish brown urine (C) Signup and view all the answers

What is essential in the management of fat embolism syndrome (FES)?

Early recognition and intervention (B) Signup and view all the answers

Which step is NOT part of routine preoperative instructions?

Immediate physical therapy after anesthesia (D) Signup and view all the answers

What is the role of the scrub nurse during surgery?

Assisting with instrument handling and surgical counts (C) Signup and view all the answers

Which anesthetic method provides loss of sensation in a specific area without loss of consciousness?

Local anesthesia (B) Signup and view all the answers

What is the primary characteristic of general anesthesia?

Loss of consciousness, muscle relaxation, and analgesia (D) Signup and view all the answers

What should be done with a patient’s hair before surgery?

Clip the hair (A) Signup and view all the answers

Which of the following is a potential sign that a patient is experiencing FES?

Feeling of impending disaster (C) Signup and view all the answers

Study Notes

Musculoskeletal Overview

Presented by: Cydnee Seneviratne PhD, RN, Twyla Ens BSN, RN, Shelley Deboer MN, RN, Catherine Fox MN, RN, and Kaleigh McCartney MN, RN
Focuses on nursing management of pharmacotherapeutic regimes for individuals and their families across the lifespan experiencing chronic musculoskeletal disorders.
Lecture objectives include identifying safe and effective nursing management, nursing outcomes, and interventions related to chronic musculoskeletal disorders.

Osteoarthritis

Pathophysiology: Characterized by joint space narrowing, loss of cartilage, bone spur formation (osteophytes), and synovial inflammation.
Classifications: Diagnosed through clinical presentations with common images.
Collaborative Care: Management focuses on managing pain and inflammation, preventing disability, and maintaining/improving joint function. Non-pharmacological interventions are foundational, with drug therapy serving as an adjunct.
Diagnosis: X-ray, CT, and MRI are diagnostic tools, with MRI and CT allowing for earlier diagnosis compared to X-rays.
Interventions: Heat and cold applications, nutritional therapy, exercise, and complementary therapies (yoga, massage, acupuncture) are crucial, followed by medications. Long-term interventions might include arthroscopic surgery for removing debris.

Osteoarthritis: Medications

Acetaminophen: Maximum dose of 4 grams per day.
Topical agents: Capsaicin or diclofenac diethylamine (Voltaren Emulgel).
NSAIDs: Examples include Celebrex (celecoxib), Voltaren (diclofenac), ibuprofen, indomethacin, ketoprofen, ketorolac, meloxicam, nabumetone, paroxen, piroxicam, and sulindac; used as disease progresses.
Antibiotics: Doxycycline or minocycline.
Corticosteroids: Methylprednisolone acetate, triamcinolone, dexamethasone, hydrocortisone sodium succinate, methylprednisolone sodium succinate, prednisone, and triamcinolone.
Disease-Modifying Antirheumatic Drugs (DMARDs): Methotrexate, sulphasalazine, leflunomide, and D-penicillamine.
Gold compounds: Oral aurano-fin, parenteral gold, and sodium aurothiomalate.
Antimalarials: Hydroxychloroquine.
Immuno-suppressants: Azathioprine and cyclophosphamide.
JAK inhibitors: Tofacitinib.
Biological and Targeted Therapies: Tumor necrosis factor inhibitors, interleukin-1 receptor antagonist, interleukin-6 receptor antagonist.

Osteoporosis

Definition: Low bone density and deterioration of bone tissue.
Prevalence: 1 in 3 Canadian women and 1 in 5 Canadian men experience fractures due to osteoporosis.
Risk factors: Age over 50, gender.
Prevention: Supplementation with calcium (1200 mg daily for women over 50) and Vitamin D (800-2000 units daily for adults over 50 and high risk young adults). Exercise with weight-bearing activities is essential for bone mass maintenance.
Medications:
- Bisphosphonates: Alendronate (didrocal), etindronate disodium with calcium carbonate (Didrocal), risedronate, sodium demipentahydrate (actonel), zoledronic acid (actonel DR).
- SERMS: Raloxifene and tamoxifen.
- Calcitonin and Teriparatide: Stimulates bone formation.
- Denosumab: Prevents bone resorption.
Mechanism of Action (for mentioned medications)

Musculoskeletal Trauma & Injuries

Sprains/Strains: Edema, decreased function, bruising, and pain are common symptoms. Management of these is by the RICE method
Dislocations/Subluxations: Deformity, pain, tenderness, and loss of function/swelling.
Carpal Tunnel Syndrome: Preventative care is essential, includes wrist splints, special keyboards, and corticosteroids injections, surgical options are available.
Rotator Cuff Injuries: Acute or chronic issues require rest, ice, heat, NSAIDS, and corticosteroids. Physiotherapy. Surgical interventions may be necessary.
Meniscus Issues: Management includes RICE, NSAIDs, corticosteroids, and possibly surgery.
Anterior Cruciate Ligament (ACL) Injury: A positive Lachman test and MRI diagnosis may indicate associated conditions. Reconstruction surgery, including allograft or autograft, is a common intervention. Rehabilitation is crucial for knee functionality, taking 6-8 months.
Fractures: Realignment of bone fragments is a primary goal. Immobilization with casts, splints, or surgical fixation (internal fixation, pins) is typical.

Musculoskeletal Fractures

Surgical Procedures: Open reduction, closed reduction, external fixation.
Hip Fractures: Common in elderly related to osteoporosis; 70-90% caused by osteoporosis, 95% result from a fall. 10% die within the 1st month and 30% within 1 year. Internal fixation devices and hip replacements (partial or total) may be required.
Facial/Pelvic Fractures: Facial fractures need a patent airway and, concurrent-c-spine injury assessment. Pelvic fractures have high mortality, damage to abdominal/GI/GU organs is a concern.
Intervention & Collaborative Care: Assessment for pain and other symptoms. Stabilization of the fracture. Recovery depends on condition severity, proper treatment, and factors like osteoporosis.

Complications of Fractures

Infection: Especially in open fractures and soft tissue injuries.
Bone malunion/nonunion: Incomplete or improper healing of the fracture.
AVascular Necrosis: Loss of blood supply to the bone.
Compartment syndrome: Increased pressure in a muscle compartment resulting from restrictive dressings, splints, or premature closure of fascia. Signs include pain, tingling, paleness, loss of function and diminished pulse.
Deep Vein Thrombosis (DVT)
Fat Embolism: A significant complication and can be life threatening. Early recognition is crucial.
Traumatic or hypovolemic shock

Musculoskeletal Assessment

Comprehensive assessment crucial for accurate diagnosis and interventions.
Includes color, warmth, sensation, movement, pain, pallor, pulse, paresthesia, and paralysis

Postoperative Care

Monitoring: The status of vital signs, breathing, pain, and wound are essential. Regular assessments of renal function.
Special Needs: Provide the patient with proper support, pain management, and wound care. Monitor for complications such as infection or DVT.

Enhanced Recovery After Surgery (ERAS) Protocol

Standardized care to speed up the healing process after surgery and aid in faster recovery.
Focuses on strategies to shorten hospital stays, reduce hospital-acquired complications and includes strategies related to nutrition, mobility, and pain control

Musculoskeletal Complications:

Osteomyelitis: An infection of the bone. Collaborative care includes intravenous antibiotics, pain control, and surgical debridement.
Back Pain: Common musculoskeletal issues. Acute pain may require limited bed rest, NSAIDs, or muscle relaxants. Chronic pain necessitates treatment of the underlying issue, weight reduction, and exercise.

Pediatric Musculoskeletal Conditions

Kyphosis: Excessive outward curvature of a portion of the spine (hump back).
Lordosis: Excessive inward curvature of a portion of the spine (sway back).
Scoliosis: Abnormal lateral curvature of the spine.
Spina Bifida: A birth defect associated with either the spinal cord or meninges.
Cerebral Palsy: A disorder resulting from occurring in the development of the brain leading to muscle tone and coordination issues.

Muscular Dystrophy

DMD (Duchenne Muscular Dystrophy): Common form of muscular dystrophy, characterized by gradual degeneration of muscle fibers and affects lifespan.

Neural Tube Defects

Anencephaly: Most severe NTD where both hemispheres of the brain are absent; incompatible with life.
Encephalocele: Herniation of brain and meninges through a skull defect. Usually due to prenatal insufficiency of neural tube closing.
Spina Bifida: A complex birth defect involving incomplete closure of the spine.

Specific Surgical Procedures (with particular focus):

Total hip and hip resurfacing: Procedures for repairing or replacing damaged joints in the hip to alleviate pain, limit mobility issues and restore functionality.

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Description

Test your knowledge on non-pharmacological treatments, medications, and surgical options for osteoarthritis and fracture management. This quiz covers crucial aspects of collaborative care, imaging techniques, and common sports injuries related to osteoarthritis. Answer questions about the treatment goals and typical practices in managing these conditions.