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Questions and Answers

Which of the following situations is NOT considered a secondary cause of osteoporosis?

  • Hyperparathyroidism
  • Regular participation in weight-bearing exercise (correct)
  • Long-term use of corticosteroids
  • Immobility due to a broken hip

    • What is the primary diagnostic tool for osteoporosis, providing a T-score to assess bone mineral density?

  • Blood tests for phosphate and ALP/BSAP levels
  • Quantitative ultrasound (QUS)
  • Dual-energy X-ray absorptiometry (DEXA) (correct)
  • Quantitative computed tomography (QCT)

    • A patient with a T-score of -2.8 would be classified as having:

  • Normal bone density
  • Osteoporosis (correct)
  • Osteopenia
  • Fracture

    • Which of the following is NOT a common assessment finding indicative of osteoporosis?

    <p>Restricted movement due to constipation (A)</p> Signup and view all the answers

    Which of the following is NOT a recommended lifestyle modification for osteoporosis prevention?

    <p>Regular consumption of alcohol (C)</p> Signup and view all the answers

    What is the recommended daily intake of Calcium for women?

    <p>1000 mg (D)</p> Signup and view all the answers

    Which of the following bisphosphonates is administered intravenously?

    <p>Zoledronic Acid (Reclast) (B)</p> Signup and view all the answers

    What is the method of action for bisphosphonates in the treatment of osteoporosis?

    <p>Inhibit osteoclastic activity and decrease bone loss (D)</p> Signup and view all the answers

    Which of the following is a common side effect of bisphosphonate therapy?

    <p>Esophageal irritation (C)</p> Signup and view all the answers

    What is the recommended frequency of administration for Zoledronic Acid (Reclast)?

    <p>Annually (B)</p> Signup and view all the answers

    Calcitonin is primarily used for the ____ of osteoporosis.

    <p>Treatment (B)</p> Signup and view all the answers

    What is the primary method of action for calcitonin in the treatment of osteoporosis?

    <p>Inhibiting osteoclastic activity (C)</p> Signup and view all the answers

    Which of the following drugs is a RANKL inhibitor used for the treatment of osteoporosis?

    <p>Denosumab (Prolia) (C)</p> Signup and view all the answers

    What is the recommended route of administration for Teriparatide (Forteo)?

    <p>Subcutaneous (B)</p> Signup and view all the answers

    Which of the following is NOT a potential side effect of RANKL inhibitors?

    <p>Hypocalcemia (D)</p> Signup and view all the answers

    Which of the following is a common site of Looser Zones?

    <p>Femoral neck (A)</p> Signup and view all the answers

    What is a common finding in a patient with Osteomalacia, compared to a patient with Osteoporosis?

    <p>High alkaline phosphatase (B)</p> Signup and view all the answers

    What is a key dietary recommendation for a patient diagnosed with Osteomalacia?

    <p>Increase consumption of oily fish (B)</p> Signup and view all the answers

    Which of these factors would not increase a person's risk of developing Osteomalacia?

    <p>Excessive consumption of calcium-rich foods (A)</p> Signup and view all the answers

    What is a common manifestation of Paget's Disease?

    <p>Excessive bone growth leading to bone deformities (D)</p> Signup and view all the answers

    In the management of osteoporosis, which of the following is NOT a common intervention?

    <p>Administration of chemotherapy agents (D)</p> Signup and view all the answers

    What is a primary goal in the management of patients with Osteoporosis?

    <p>Prevent further bone loss and minimize fracture risk (A)</p> Signup and view all the answers

    Which of the following is NOT a common side effect of medications used for pain management in Osteoporosis?

    <p>Development of bone spurs (B)</p> Signup and view all the answers

    What is the preferred treatment for a foot that is rotated, flexed, and rigid, making it difficult to move?

    <p>Manipulation and serial casting starting right after birth (B)</p> Signup and view all the answers

    Which of the following is NOT a clinical manifestation of Osteogenesis Imperfecta?

    <p>Increased bone density (D)</p> Signup and view all the answers

    Which of the following is a type of fracture that occurs spontaneously or with minimal trauma?

    <p>Pathologic fracture (B)</p> Signup and view all the answers

    Which of the following is a type of fracture where the bone breaks into multiple fragments?

    <p>Comminuted fracture (D)</p> Signup and view all the answers

    Which of the following is NOT a common assessment finding related to fractures?

    <p>Increased bone density (A)</p> Signup and view all the answers

    Which stage of bone healing involves the formation of a soft callus?

    <p>Soft callus formation stage (C)</p> Signup and view all the answers

    Which of the following is a type of fracture that occurs when a bone bends and breaks, often seen in children?

    <p>Greenstick fracture (B)</p> Signup and view all the answers

    Which of the following is a type of fracture that occurs when a bone is crushed, often seen in vertebral compression fractures?

    <p>Compression fracture (B)</p> Signup and view all the answers

    What is the most likely treatment option for a weight-bearing pelvic fracture?

    <p>Surgery with external fixation or ORIF (D)</p> Signup and view all the answers

    Which type of traction is primarily used to decrease painful muscle spasms?

    <p>Skin traction (C)</p> Signup and view all the answers

    What is the primary concern associated with pelvic fractures?

    <p>Hemorrhage (C)</p> Signup and view all the answers

    How long is a cast typically worn after internal fixation with nails, plates, or screws for a pelvic fracture?

    <p>4-6 weeks (C)</p> Signup and view all the answers

    Which of the following is NOT a component of traction care?

    <p>Removal of weights as needed for client comfort (C)</p> Signup and view all the answers

    What is the correct height for crutches?

    <p>The top of the crutch should be 1-2 inches below the axilla (B)</p> Signup and view all the answers

    How long does a non-weight-bearing pelvic fracture typically take to heal?

    <p>2 months (D)</p> Signup and view all the answers

    What is the main purpose of skeletal traction?

    <p>To aid in bone realignment (A)</p> Signup and view all the answers

    Which of the following symptoms is NOT commonly observed in Duchenne muscular dystrophy?

    <p>Severe muscle spasms (D)</p> Signup and view all the answers

    In Becker muscular dystrophy, the progression of the condition is typically described as:

    <p>Slow and gradual (B)</p> Signup and view all the answers

    Which of the following is a common treatment approach for scoliosis in cases where the curvature is between 20 and 40 degrees?

    <p>Brace treatment in combination with exercises (A)</p> Signup and view all the answers

    Legg-Calve-Perthes disease primarily affects which age group?

    <p>School-aged children between 4 and 8 years of age (D)</p> Signup and view all the answers

    What is the most common presentation of Legg-Calve-Perthes disease?

    <p>A painful limp and loss of motion with internal rotation and abduction (C)</p> Signup and view all the answers

    Talipes Equinovarous, commonly known as clubfoot, is primarily a result of:

    <p>A congenital malformation of various structures in the foot (B)</p> Signup and view all the answers

    Which of the following is NOT a characteristic feature of scoliosis?

    <p>A pronounced forward curvature of the thoracic spine (B)</p> Signup and view all the answers

    Which of the following statements is TRUE regarding the treatment of scoliosis?

    <p>Treatment options depend on the severity of the curvature and the age of the patient. (C)</p> Signup and view all the answers

    Flashcards

    Types of Osteoporosis

    Primary (postmenopausal women and men over 70), Secondary (medical conditions), Regional (immobilized limbs)

    Osteoporosis Prevention Tips

    Ensure calcium intake, avoid sedentary lifestyle, do weight-bearing exercises, limit alcohol, quit smoking

    Physical Assessment Findings

    Inspect posture, check for kyphosis, monitor height loss, back pain with movement, restricted movement

    Radiographic Assessments

    DEXA (measures BMD in spine/hip), QCT (3D, high radiation), QUS (low cost, heel BMD)

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    BMD T-score Thresholds

    Normal: +1.0 to -1.0, Osteopenia: -1.0 to -2.5, Osteoporosis: < -2.5

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    Calcium daily recommendation

    1000 mg for women; 1200 mg for men per day.

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    Vitamin D daily recommendation

    Recommended intake is 400-800 IU per day to maintain health.

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    Hypercalcemia symptoms

    Signs include increased heart stimulation, muscle weakness, and decreased GI stimulation.

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    Bisphosphonates

    Medications that help reabsorb calcium into bones and prevent breakdown.

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    Alendronate (Fosamax)

    A type of bisphosphonate taken orally to strengthen bones.

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    Side effects of Bisphosphonates

    Can cause bone/joint pain, GI issues, and esophagus irritation.

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    Calcitonin

    Hormone used for short-term osteoporosis treatment but not prevention.

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    RANKL Inhibitors

    Last-option drugs that block osteoclasts to reduce bone loss.

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    Parathyroid Hormones (Teriparatide)

    Medication that boosts new bone formation in osteoporosis patients with fractures.

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    Osteoporosis risk factors

    Include previous fractures, chronic diseases, and certain medications.

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    Osteosarcoma Nutritional Needs

    Key nutrients for bone formation include protein, magnesium, vitamin K, calcium, and vitamin D.

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    Post-fracture Nutrients

    After a fracture, focus on protein, vitamin C, and iron for recovery.

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    Interventions for Osteoporosis

    Include exercise, pain management, hip protectors, and orthotic devices.

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    Osteomalacia Overview

    Softening of bone due to inadequate calcium and phosphorus mineralization.

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    Vitamin D Deficiency Causes

    The primary cause of osteomalacia is a deficiency in vitamin D.

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    Lab Values: Osteomalacia vs Osteoporosis

    Osteomalacia shows high alkaline phosphate; osteoporosis shows low calcium.

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    Looser Lines

    Radiolucent bands indicating stress fractures in osteomalacia patients.

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    Paget's Disease

    A metabolic bone disorder characterized by excessive breakdown and formation of bone.

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    Duchenne Muscular Dystrophy

    A severe, progressive muscle-wasting disorder causing pelvic weakness, waddling gait, and potential cardiac and cognitive impairment.

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    Becker Muscular Dystrophy

    A milder form of muscular dystrophy with gradual progression, affecting pelvic, thigh, and shoulder muscles, allowing longer life expectancy than Duchenne.

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    Scoliosis

    A condition characterized by lateral curvature of the spine over 10 degrees, affecting posture and potentially causing pain.

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    Assessment for Scoliosis

    Nursing evaluation involving pain, posture, and gait assessments, using both standing and forward bending tests.

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    Scoliosis Treatment (Mild)

    For scoliosis <20 degrees: exercises for strength, moist heat, and pain medications are recommended.

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    Scoliosis Treatment (Moderate)

    For scoliosis 20-40 degrees: bracing combined with exercises; brace worn for at least 18 hours daily.

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    Legg-Calves-Perthes Disease

    A condition of unknown cause affecting boys aged 4-8, leading to painful limping and loss of motion in the hip.

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    Talipes Equinovarous

    Commonly known as clubfoot; a congenital malformation affecting foot alignment and movement.

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    Affected foot position

    Foot is rotated in, flexed, and rigid, hindering movement.

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    Ponseti casting

    Preferred treatment for clubfoot involving manipulation and serial casting right after birth.

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    Osteogenesis Imperfecta

    A rare genetic disorder causing fragile bones that fracture easily, leading to deformity.

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    Clinical manifestations of Osteogenesis Imperfecta

    Includes poor skeletal development, multiple fractures, blue sclerae, soft teeth, hearing loss.

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    Treatment options for Osteogenesis Imperfecta

    No cure; aims to prevent deformities and fractures using bisphosphonates, PT, casting.

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    Complete fracture

    Break is across the entire width of the bone, causing complete separation.

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    Types of fractures

    Includes normal, transverse, oblique, spiral, comminuted, segmental, avulsed, impacted, torus, greenstick fractures.

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    Signs of fracture assessment

    Changes in alignment, length, shape, pain, numbness, decreased ROM, swelling.

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    Closed Reduction Casting Duration

    Casting lasts for 6-10 weeks for closed reduction.

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    Internal Fixation Casting Duration

    After internal fixation, a long cast is required for 4-6 weeks.

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    External Fixation Duration

    External fixation lasts 6-10 weeks then a cast is applied until healed.

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    Mobility Effect of External Fixation

    Mobility is greatly affected; joints can be locked in place.

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    Hemorrhage Risk in Pelvic Fractures

    Pelvic fractures have a high risk of hemorrhage due to vascularity.

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    Non-Weight Bearing Fractures Treatment

    Heals in about 2 months; involves minimal treatment or bedrest.

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    Types of Traction: Skin

    Skin traction uses a Velcro boot to decrease muscle spasms.

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    Proper Crutch Height

    Crutches should be 1-2 inches below the axilla when standing.

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    Study Notes

    General Information

    • This document contains study notes for a nursing exam.
    • The content covers various topics related to complex health alterations.
    • The notes include questions, answers, diagnoses, interventions, and teaching points for each topic.
    • The exam appears to be for an Associate Degree Nursing program.

    End-of-Life Care

    • Multiple organ dysfunction syndrome (MODS): Insufficient blood flow deprives cells of oxygen, inducing acidosis, hyperkalemia, and tissue ischemia. This leads to the release of toxic metabolites, causing further cell damage and hypoxia.
    • Good vs. bad death: A good death prioritizes relief from suffering for the patient, family, and caregivers while respecting patient/family wishes. A bad death involves pain, unmet wishes, isolation, and fear.
    • End-of-life goals: Identifying patient needs, managing symptoms, promoting meaningful interactions between the patient and loved ones, and facilitating a peaceful passing.
    • Palliative Care: A compassionate and supportive approach for patients and families nearing the end of life, not hastening or postponing death. It involves an interdisciplinary team and other medical treatments may also be used.
    • Hospice Care: An interdisciplinary approach aiming for good quality of life and a peaceful death for terminally ill individuals. Comfort care is prioritized.
    • End-of-life clinical manifestations: Include changes in the neurosensory system (communication issues, decreased LOC, visual/hearing changes), cardiovascular system (decreased BP, heart rate, and respiratory rate, temperature regulation issues), Gl system (constipation, anorexia, nausea/ vomiting), GU system (decreased urinary output, incontinence), pain management, and respiratory changes.
    • End-of-Life Psychosocial Support: Focuses on client/family emotional and spiritual needs. Includes being realistic, encouraging reminiscence, and providing referrals to bereavement specialists.

    Musculoskeletal Disorders

    • Osteoporosis vs. osteopenia: Osteoporosis is a metabolic bone disease characterized by reduced bone density and increased risk of fractures. Osteopenia is characterized by low bone mass, a precursor to osteoporosis.
    • Affected sites: Primary sites include the wrist, hip, and vertebral column.
    • Osteoporosis classifications: Primary osteoporosis commonly occurs in postmenopausal women and men over 70. Secondary osteoporosis results from associated medical conditions or long-term drug therapy/immobility.
    • Prevention teaching: Adequate calcium intake, avoiding a sedentary lifestyle, daily weight-bearing exercise, limiting alcohol, and quitting smoking.
    • Osteoporosis assessment: Physical assessment includes posture inspection, checking for kyphosis, observing for loss of height, pain with movement, and restricted movement.
    • Osteoporosis diagnosis: Assessment of bone mineral density (BMD) using DEXA, QCT, or QUS.
    • Osteoporosis treatment: Medications like bisphosphonates (alendronate, risedronate), calcitonin, RANKL inhibitors, and parathyroid hormones. Dietary recommendations (calcium, vitamin D, protein) and exercise are crucial.

    Osteomalacia

    • Definition: Softening of bone tissue due to inadequate calcium and phosphorus mineralization.
    • Risk Factors: Malnutrition, poor diets, vitamin D deficiency

    Paget's Disease

    • Definition: Metabolic disorder where bone is excessively broken down and reformed.
    • Affected sites: Skull, spine, pelvis, femur, tibia.
    • Clinical manifestations: Bone pain, bowing of long bones, spinal curve changes, enlarged skull, and pathologic fractures.
    • Interventions: Aspirin, NSAIDs, calcitonin, bisphosphonates, mithramycin, and physical therapy.

    Osteomyelitis

    • Definition: Bone infection caused by pathogenic microorganisms.
    • Types: Exogenous (external source), endogenous (from bloodstream), contiguous (spread from nearby infection).
    • Acute vs. chronic manifestations: Fever, erythema, swelling, tenderness, localized pain (acute). Localized pain, drainage, sinus tract, ulceration (chronic).
    • Interventions: Antibiotics, pain control, wound care, and surgical management (sequesrectomy, bone grafts).

    Bone Tumors

    • Types: Osteochondroma, Chondroma, Osteoid Osteoma, Osteoblastoma, Giant Cell Tumor, Ewing's Sarcoma, Osteosarcoma, Chondrosarcoma.
    • Assessments: Pain, swelling, masses, warmth, and neurological/functional assessments.
    • Interventions: Pain control, non-surgical and surgical treatments such as curettage and joint repair.

    Hand and Foot Disorders

    • Carpal Tunnel Syndrome: Median nerve compression in the wrist, causing pain and numbness.
    • Dupuytren's Contracture: Palmar fascia thickening causing flexion contracture of the fingers.
    • Morton's Neuroma: Digital nerve tumor causing pain and burning sensations.
    • Hallux Valgus/Bunion: Lateral deviation of the big toe.
    • Hammertoes: Dorsiflexion of the metatarsophalangeal joint.
    • Plantar Fasciitis: Inflammation of the plantar fascia (arch of the foot).

    Pediatric Disorders

    • X-linked disorders: Genetic inheritance via the X chromosome, commonly affecting males. Examples include Duchenne and Becker muscular dystrophies.
    • Duchenne Muscular Dystrophy: Early onset, rapid progression, leading to loss of ambulation and death in the mid-20s due to cardiac and respiratory failure.
    • Becker Muscular Dystrophy: Slower progression, maintaining ambulation longer.
    • Scoliosis: Lateral curvature of the spine. Differentiation from Lordosis (concave curvature) and Kyphosis (front-to-back curvature).

    Musculoskeletal Trauma

    • Fracture classifications: Complete, incomplete, open (compound), closed (simple), displaced, non-displaced, pathologic, stress, compression.
    • Assessment findings: Changes in bone alignment, altered extremity length/shape, pain with movement, numbness/tingling, decreased ROM.
    • Bone healing stages: Hematoma formation, granulation tissue, callus formation, osteoblastic proliferation, bone remodeling.
    • ORIF vs. external fixation: ORIF (open reduction internal fixation) involves surgery with plates/screws, while external fixation applies external devices for traction, casting, or bracing.

    Amputations

    • Complications: Hemorrhage, infection, phantom limb pain, immobility or activity limitations, neuroma formation, and flexion contracture.

    Acute Compartment Syndrome

    • Cause: Increased pressure within a muscle compartment, reducing circulation.
    • Clinical manifestations: Sensory/motor deficits, pain, pallor, pulses, edema.
    • Emergency care: Rapid diagnosis and fasciotomy to relieve pressure within the affected compartment.

    Crush Syndrome

    • Cause: Multiple compartment injury leading to edema and reduced tissue perfusion.
    • Complications: Hypovolemia, hyperkalemia, rhabdomyolysis (muscle breakdown) leading to acute tubular necrosis.

    Fat Embolism/PE

    • Cause: Fat embolism usually follows long bone fractures.
    • Clinical manifestations: Altered mental status, hypoxia, dyspnea, tachypnea.

    Renal Disorders

    • Immunologic Renal Disorders: Diseases that damage the glomeruli (proteinuria, hematuria).
    • Acute Glomerulonephritis: Infection or disease triggers inflammation and damage to the glomeruli.
    • Clinical manifestations: Edema, increased weight, hypertension, fatigue, fluid overload, altered urine output (color, amount, dysuria).
    • Interventions: Fluid and sodium restriction, antihypertensive medications, and antibiotics.
    • Nephrotic Syndrome: Increased glomerular permeability, leading to protein loss and edema formation.

    Polycystic Kidney Disease

    • Cause: Inherited disorder causing fluid-filled cysts to develop in the nephrons.
    • Clinical manifestations: Flank or abdominal pain, nocturia, abdominal girth increase, constipation, and hematuria.
    • Interventions: Pain management (opioids, acetaminophen), fluid intake support, dietary fiber, and regular exercise.
    • Chronic Glomerulonephritis: Progressive kidney damage over years causing atrophied kidneys and reduced nephron function

    Obstructive Disorders

    • Hydronephrosis: Kidney enlargement due to urine accumulation.
    • Hydroureter: Ureter enlargement due to obstruction.
    • Urethral Stricture: Lower urinary tract obstruction, causing bladder distention.
    • Nephrostomy: Catheter placed in the renal pelvis to drain urine
    • Pyelonephritis: Upper urinary tract infection with acute or chronic presentation.
    • CVA tenderness: Pain or discomfort when the costovertebral angle is percussed.

    Renal Trauma

    • Minor trauma: Damage to small blood vessels, contusions.
    • Major trauma: Extensive bleeding, lacerations.
    • Pedicle injuries: Laceration or break in renal artery or vein.

    Diabetic Nephropathy

    • Cause: Microvascular complication of diabetes, affecting the kidneys.
    • Manifestations: Persistent albuminuria (protein in urine).

    Acute & Chronic Kidney Disease

    • Acute Kidney Injury (AKI): Sudden decrease in renal function due to inadequate perfusion, damage to the kidneys, or urinary obstruction.
    • Types of AKI: Prerenal, Intrinsic (intrarenal), Postrenal.
    • Labs affected by AKI/CKD: Serum creatinine, blood urea nitrogen (BUN), urine output, urine specific gravity.
    • Phases of AKI: Onset, oliguria, diuretic, recovery.
    • Nephrotoxic agents: Antibiotics, chemotherapy agents, NSAIDs.
    • Chronic Kidney Disease (CKD): Progressive, irreversible kidney injury leading to the loss of nephron function and buildup of waste products.
    • CKD Stages: Defined by glomerular filtration rate (GFR) levels.
    • Uremic syndrome: Build-up of waste products leading to systemic issues due to kidney failure.

    Kidney Replacement Therapy

    • Hemodialysis: Blood is filtered through an artificial membrane to remove waste.
    • Peritoneal dialysis: Dialysate is instilled into the abdominal cavity to remove waste.
    • Complications of dialysis: Dialysis disequilibrium syndrome, and arterial steal syndrome, infections (peritonitis).

    Kidney Transplantation

    • Candidates and donors: Candidates need to be free from other medical problems; donors are both living and cadaver.

    Hyperacute vs. Acute vs. Chronic Rejection

    • Hyperacute: Immediate rejection, triggered by pre-existing recipient antibodies against the donor organ.
    • Acute: Antibody-mediated or cellular rejection occurring within weeks or months.
    • Chronic: Gradual rejection due to inflammation and scarring, occurring over time.

    Nutritional needs during different stages, considerations, and treatment of Kidney Disease

    • Protein, sodium, potassium, and phosphorus restriction: vary depending on specific stage and lab values to prevent complications. Specific foods to avoid are determined via lab values.
    • Dialysis and nutritional needs: Dietary changes may differ based on specific needs during and after dialysis.
    • Important labs for monitoring: GFR, sodium, potassium, phosphorus, calcium and more.

    Fluid and sodium retention

    • Measurements: Daily weight changes and blood pressure monitoring are key.
    • Considerations: Fluids and sodium are carefully monitored.

    Medication considerations

    • Medications: Specific classifications of medications are listed and their functions, precautions and use is described.

    Emergency care considerations

    • Assessments and interventions: Specific instructions for emergency situations like acute compartment syndrome, are detailed.

    Post-procedure/post-surgical care considerations

    • Assessments: Specific post operative considerations are included.
    • Specific interventions: such as wound care, pain management, and monitoring for complications are outlined.

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