Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Care of Patients with Musculoskeletal

Problems

Chapter 53


Osteoporosis Osteomalacia Paget’s disease (osteitis deformans) Osteomyelitis

Metabolic Bone Disease


Risk factors History Genetic Culture Diet

Physical signs/symptoms

Common and Contrasting

Characteristics


Osteoporosis


Laboratory tests Imaging DEXA

Diagnostic Testing


Strength Risk for fracture Injury prevention Nutritional status

Primary Problems in Metabolic Bone

Disease


Safety precautions Medications Surgical management Patient teaching Collaborative health care team roles Community resources

Interventions


Benign bone tumors Often asymptomatic May be discovered on routine x-ray or as a cause of

pathologic fracture Bone cancer

Benign Bone Tumor vs Bone Cancer


Benign bone tumors Nondrug pain-relief measures Drug therapy (analgesics, NSAIDs) Surgical therapy (curettage, joint replacement,

arthrodesis) Bone cancer

Surgical intervention Radiation, chemotherapy Psychosocial resources

Interventions


Hand Dupuytren’s contracture Ganglion

Foot Deformities Morton’s neuroma Plantar fasciitis

Other Musculoskeletal Disorders


Back Scoliosis

Progressive muscular dystrophies

Other Musculoskeletal Disorders


Contractures Pain Mobility impairment

What types of nursing care are common to any of these disorders?

Priority Concers with other

Musculoskeletal Disorders


A 64-year-old woman is seen in the adult outpatient clinic. She was measured as standing 65 inches tall last year. You note that the patient now measures 64 inches. She has mild kyphosis.

What assessment questions would you be sure to ask at this time?

Case Study


The patient is diagnosed with possible osteoporosis.

Which diagnostic tests do you anticipate will be ordered? (Select all that apply.)

A. Sodium

B. Phosphorus

C. Serum calcium

D. Electrocardiogram

E. Thyroid function tests

F. 24-hour urine collection

G. Dual x-ray absorptiometry (DXA)

(cont’d)Case Study


The patient is diagnosed with osteoporosis. Which intervention would be appropriate?A. Suggest a diet that is high in protein and

calcium but low in vitamin D.B. Recommend walking for 30 minutes 3 to 5

times a week.C. Teach her to cut down on her cigarette-

smoking.D. Tell her to include high-impact activities, such

as running, in her exercise regimen.



Which patient statement about self-care indicates a need for further teaching by the nurse?A. “I am going to swim at the YWCA.”B. “My husband is getting rid of our throw rugs.”C. “Low-fat yogurt is on my grocery list.”D. “Joining a bowling team will help me

exercise.”



1. The provider orders calcium 1.5 g orally twice a day (1 g in the morning and 500 mg at bedtime). The patient asks why she must drink extra fluids with this medication. What is your best response?

2. The patient also asks why she can’t just take the calcium once a day. What is your best response?



What are the odds of a woman over the age of 50 breaking a bone because of osteoporosis?

A. 1 out of 10B. 1 out of 7C. 1 out of 5D. 1 out of 2

Question 1


A patient with Paget’s disease is at greatest risk for developing:

A. Chronic fatigue syndromeB. Kidney stonesC. Cardiac failureD. Pathologic bone fractures

Question 2


Which symptom is particular to older patients presenting with acute osteomyelitis?

A. PainB. FatigueC. Low-grade feverD. Elevated leukocyte count

Question 3

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

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