MedSurg Final Exam - Musculoskeletal Problems

Module 10 (14-16 Questions)

What is scoliosis?

An abnormally lateral curvature of the spine (“S”) shape

Common in children and younger adults

What is kyphosis?

A humpback

Common in older adults with osteoporosis

What is osteoporosis?

A chronic disease characterized by bone loss

What are the risk factors of osteoporosis?

• Women

• Older age

• Menopause

• Total hysterectomy

• White/asian

• Fractures

When is osteoporosis usually diagnosed?

When a patient has fallen and has a fracture

What happens as osteoporosis progresses?

A patient develops kyphosis (hunchback) and loses height over time

What laboratory values should be taken for a patient with osteoporosis?

• Serum calcium

• Vitamin D3

How is osteoporosis diagnosed?

With a Dexascan (measures bone mineral density)

How is osteoporosis treated through nutrition?

• Increased calcium (milk, green vegetables)

• Increased vitamin D (fish, egg yolks)

What is a good source of calcium for lactose intolerant patients?

Soy products (rice milk, tofu)

How is osteoporosis treated through exercise?

• Walking 30 minutes a day, 3-5 times a week

• Weight-bearing exercises

• Prioritize ROM → mobility → strength

What is the medication used for osteoporosis?

Biophosphonates (alendronate, risedronate, zoledronic acid) - selective estrogen receptor modulators

What is osteomyelitis?

An infection of the bony tissue

-itis =

Infection

What is acute osteomyelitis caused by?

A bloodstream infection or open fractures

What are the s/s of acute osteomyelitis

• Fever (101° F)

• Swelling

• Redness

• Tenderness

• Bone pain

What are the s/s of chronic osteomyelitis?

• Localized pain

• Drainage from the affected area

What is osteomyelitis caused by?

• Bacteria (the most common cause)

• Vireuses, parasites, or fungi

• Bone infections

• Trauma

• Foot ulcers (diabetics)

• Poor dental hygiene

• Gum infections

What is the surgical intervention for osteomyelitis?

Necrotic tissue is removed → PICC line for IV antibiotics for 6 weeks post-surgery, then oral antibiotics for 4-6 weeks.

What is the nonsurgical intervention for osteomyelitis?

IV antibiotics for 4-6 weeks

What is the primary focus in treating patients with osteomyelitis>

Control the pain!

What are the risk factors of rheumatoid arthritis?

• 35-45 year old females

• Autoimmune

What are the risk factors of osteoarthritis?

• Females aged 60 and older

• Caused by aging, genetics, obesity, and/or trauma

What are the early s/s of rheumatoid arthritis?

• Joint inflammation

• Low-grade fever

• Fatigue

• Loss of appetitie

What are the late s/s of rheumatoid arthritis?

• Joint deformity

• Weight loss

• Muscle atrophy

What are the s/s of osteoarthritis?

• Joint pain

• Stiffness

• Inflammation

• Deformities

What patient teaching should we provide for patients with rheumatoid arthritis?

• RA is bilateral and systemic

• Regular, low-impact exercise is best (swimming, walking, yoga)

• Use heat when stiffness is present

• Use ice for acute inflammation and pain

• Alternate rest during flares and activity during remission

• Perform ROM exercises daily to maintain joint mobility

• Use canes and walkers if needed, with flares

What patient teaching should we provide for patients with osteoarthritis?

• OA is unilateral and non-systemic

• Encourage weight-bearing exercise, stretching, and strength training

• Short rest periods are best because long inactivity can worsen stiffness

• Warm up before movement

• Use heat for stiffness

• Use ice for acute inflammation and pain

• Use canes and walkers if needed, with degeneration

How is rheumatoid arthritis diagnosed?

• Rheumatoid factor (RF)

• Antinuclear antibody (ANA)

• Erythrocyte sedimentation rate (ESR)

How is osteoarthritis diagnosed?

Erythrocyte sedimentation rate (ESR)

What does erythrocyte sedimentation rate (ESR) measure?

Inflammation

What drug therapies are used for rheumatoid arthritis?

• NSAIDs

• Methotrexate

• Plasma exchanges

• Other biological response modifiers

What drug therapies are used for osteoarthritis?

• Short-term NSAIDs

• Acetaminophen

• Medical marijuana

• Other pain medications

What is the most common inflammatory disease that can cause arthritis?

Gout

What are the risk factors of gout?

• Elevated uric acid

• Alcohol

• Obesity

• Cardiovascular disease

• The starvation diet

What are the s/s of gout?

Severe joint pain (mostly in the big toe)

What should serum uric acid levels be?

Less than 6

For patients with a serum acid level over 6…

• Take NSAIDs, steroids, and/or colchicine

• Avoid a high purine diet (red meats, organs, shellfish, sardines, muscles, goose, venison, and beer)

What does the cycle look like for patients with recurring gout?

Exasperations → medication → stop drinking alcohol → diet changes → feel better → relapse and drink alcohol again →