Musculoskeletal Practice 1250 Exam 2

• Excessive bone resorption is a characteristic of osteoporosis, leading to fragile bones.
• Decreased bone mass and deterioration of bone tissue, not increased bone density or calcium levels, are characteristic features of osteoporosis.

Osteoporosis Diagnosis

• Dual-energy X-ray absorptiometry (DEXA) is the gold standard for diagnosing osteoporosis due to its ability to measure bone mineral density.

Osteoporosis Risk Factors

• Risk factors include postmenopausal status, sedentary lifestyle, smoking, and long-term corticosteroid use.
• Hormonal changes and inactivity can increase the risk of osteoporosis.

Osteoporosis Treatment

• Alendronate is a bisphosphonate commonly prescribed to reduce bone resorption in osteoporosis treatment.

Osteoarthritis (OA)

• Pain that worsens with activity and improves with rest is a characteristic symptom of osteoarthritis.
• Osteoarthritis is degenerative, unlike rheumatoid arthritis, which is systemic.

Osteoarthritis Findings

• Expected findings include Heberden's nodes, Bouchard's nodes, and crepitus.
• Swan neck deformity is associated with rheumatoid arthritis (RA), not osteoarthritis.

Total Knee Arthroplasty (TKA)

• The primary goal is to relieve pain and restore joint function by replacing damaged joints to restore mobility and reduce pain.

Rheumatoid Arthritis (RA) vs. Osteoarthritis (OA)

• The presence of systemic inflammation differentiates RA from OA, as RA is an autoimmune condition affecting multiple joints.

Rheumatoid Arthritis Medications

• Medications to treat RA include Methotrexate, NSAIDs, Corticosteroids, and Hydroxychloroquine to manage inflammation and disease progression.

Early Rheumatoid Arthritis Symptoms

• Early symptoms include warm, swollen joints with morning stiffness, differentiating RA from other joint disorders.

Femur Fracture Assessment

• The priority assessment is capillary refill and pulses to ensure blood supply is intact.
• Neurovascular checks are crucial.

Long Bone Fracture Complications

• Fat embolism is the most concerning complication, potentially fatal following long bone fractures.

Compartment Syndrome Signs

• Signs include severe pain unrelieved by medication, pallor, pulselessness, and decreased sensation.
• These are the classic "6 P's" of compartment syndrome.

Post-Laminectomy Interventions

• Logrolling the patient is essential to maintain spinal alignment and prevent injury.

Laminectomy Surgery Goal

• Laminectomy decompresses the spinal cord to relieve pain by relieving pressure on spinal nerves.

Post-Amputation Complications

• Phantom limb pain is a common post-amputation experience.

New Prosthesis Nursing Interventions

• Teaching proper skin care is crucial to prevent infection and irritation at the prosthesis site.

Gout Causes

• Increased uric acid levels cause uric acid crystal deposits in joints, triggering inflammation.

Gout Diet

• Red meat should be avoided due to its increase of uric acid production.

Acute Gout Signs

• Clinical signs include red, swollen joints and pain, commonly affecting the big toe, which causes swelling and joint damage.

Femur Fracture Traction

• Ensuring the weights hang freely is the nurse's priority action to maintain bone alignment.
• Traction must remain in place and uninterrupted.

Severe Pain and Casts

• Notify the healthcare provider immediately for severe pain unrelieved by medication.
• It is a sign of compartment syndrome, a medical emergency.

External Fixation Device Care

• Performing frequent pin care prevents infection at the insertion site.

Fracture Complications

• Complications include fat embolism, bone infection (osteomyelitis), and compartment syndrome.

Preoperative Hip Fracture

• Maintaining proper alignment of the leg prevents further injury before surgery.

Post-Total Hip Replacement (THR)

• Excessive hip flexion can cause dislocation post-surgery and needs to be avoided.

Post-Total Knee Replacement (TKR) Interventions

• CPM machines to improve mobility, early ambulation to prevent complications, and regular use of anticoagulants are essential post-op.

Post-Total Hip Replacement Complications

• Deep vein thrombosis is a complication to monitor due to increased risk of clot formation from immobility.

Sequential Compression Devices (SCDs) Post-TKR

• They help prevent blood clots by promoting venous return and reducing the risk of DVTs.

Post-Laminectomy Teaching

• Driving should be avoided immediately post-surgery.

Post-Laminectomy Nerve Damage

• Numbness may indicate nerve compression or damage, and the healthcare provider should be notified.

Post-Laminectomy Interventions

• Key post-op concerns include monitoring for urinary retention, spinal misalignment, and infection.

Post-Amputation Teaching

• Continuous elevation can cause contractures and is not recommended.

New Lower Limb Prosthesis

• Care includes gradual weight-bearing, inspecting the residual limb daily, avoiding lotion, and wearing a prosthetic sock.
• Proper skin care and gradual adaptation to the prosthesis are important.

Gout Dietary Instructions

• Limiting purine-rich foods, which increase uric acid levels, is imporant.

Acute Gout Medications

• Colchicine and NSAIDs reduce inflammation during acute attacks.

Gout Management

• Drinking plenty of fluids helps eliminate uric acid.
• Hydration prevents uric acid crystal formation.

Osteoporosis Prevention

• Increased intake of calcium and vitamin D maintains bone health.

Osteoarthritis Treatment Goals

• The primary treatment goal is to reduce joint pain and improve function through symptom control.

Fat Embolism Risk

• A 30-year-old patient with a femur fracture is at highest risk, as fat embolism syndrome is commonly associated with long bone fractures, particularly the femur.

Fat Embolism Signs

• Sudden confusion and petechiae on the chestcan happen, and can cause neurological impairment, petechiae, and respiratory distress.

Osteoarthritis Pain Relief

• Using heat therapy improves blood flow and relieves joint stiffness in OA.
• Applying cold packs before exercise reduces inflammation and numbs pain.

Rheumatoid Arthritis Teaching

• Methotrexate should be taken regularly, even when symptoms improve, to prevent disease progression.

Chronic Tophaceous Gout Complications

• Tophaceous gout leads to joint damage and increases the risk of kidney stones due to uric acid accumulation.

Phantom Limb Pain

• Administering prescribed gabapentin (Neurontin) effectively treats neuropathic pain, including phantom limb pain.