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LEARNING GUIDE
Musculoskeletal Disorders
Review:
a. What makes up the composition of bones?
b. What are the three types of bone cells and their function?
 The basic bone-forming cells are called ___________________________.
 The mature bone cells are called _________________________.
 Osteoclasts are responsible for__________________________________.
c. Bone serves as a site for storage of inorganic minerals such as _________________ and
_________________________.
d. How does calcium get from the GI tract to the bones?
e. What is ossification
f. What is remodeling and what is the role of osteoblasts and osteocasts?
g. What keeps the balance between bone resorption and formation?
Chapter 64:
I. Osteomyelitis
1. What is the most common causative organism? The causative organism invades the bone
via direct or indirect entry. What are examples of each. What causes ischemia of the bone?
What is sequestra and involcrum? Why are bone infections difficult to eradicate?
2. What are the systemic and local manifestations of osteomyelitis?
3. How do each of the following tests assist in diagnosing osteomyelitis?
 Blood and wound cultures
 WBC
 ERS
 Radionuclide bone scans
 MRI
** What test is the best way to determine the causative organism?
4. What are medications used to treat osteomyelitis? (p. 1622) What are common side effects
and what patient teaching is important? How long are patient’s on the antibiotics? (Hint- patients are
sent home with PICC lines and taught care)
5. How is the effectiveness of drug therapy monitored?
6. When is debridement used? What are ways that antibiotics are directly placed in the wound? When is a
wound vac used? What is related nursing care.
7. What it the purpose of hyberbaric oxygen?
8. How is the affected limb protected?
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II. Osteomalacia
9. What is the most common cause of osteomalacia? What is the etiology?
10. What are the signs and symptoms of osteomalacia?
11. What laboratory tests are used in the diagnosis of osteomalacia?
12. What medications, foods, and treatment are used in correction of the vitamin D deficiency?
III. Osteoporosis
13. Why is osteoporosis more common in women than in men? What are additional risk
factors?
14. Why is osteoporosis called the “silent disease”? Is it possible to prevent osteroporosis?
15. What diagnostic tests are used to confirm the diagnosis of osteoporosis?
16. What foods are high in calcium? What foods are poor calcium sources? Why is vitamin D
important in treatment of osteoporosis?
17. What medications are used in treatment of osteoporosis? What is the related patient
Teaching?
IV. Pagets Disease
18. The bones of patients with Paget’s Disease are larger than normal but break more easily.
Explain how/why this occurs. Do the bones return to normal size and shape following
treatment?
19. What medications are used in the treatment of Pagets disease and related patient
teaching?
20. What other supportive measures are important to teach the patient?
Chapter 65:
V. Arthritis
21. How does the autoimmune theory explain the etiology of rheumatoid arthritis? What is
pannus and how does it develop?
22. What are the clinical manifestations of Rheumatoid Arthritis (RA)? How does Rheumatoid
arthritis affect joints?
23. What are the extraarticular manifestations of RA? What are rheumatoid nodules and what
problems do they cause? What are complications of RA?
24. What specific diagnostic tests are used to confirm the diagnosis of RA?
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25. How do each of the following classification of medications assist in treatment of Ra?
a. ASA
b. NSAIDS
c. Corticosteroids
d. Drugs (DMARDS)

*methotrexate (Rheumatrex)

suflasalazine (Azulfidine)
e. Gold salts
f. Antimalarial
g. Immunosuppressants
h. Biologic targeted therapy
26. Explain how the following treatments assist with preventing pain and deformities:
Rest
Good body alignment
Joint protection
Heat and cold therapy
Exercise
VI. Gout
27. What is the difference between primary and secondary gout? What is hyperuricemia?
Why do patients with chronic gout often develop kidney disease?
28. What are the clinical manifestations? What are tophi?
29. How is a definitive diagnosis of gout determined? (What lab results, such as uric acid level,
etc)
30. How do the following mediation assist in the treatment of gout?

Colchicine

Allopurinol

Probenecid (Benemid) * Why should aspirin NOT be given to client receiving probenecid?

Sulfinapyrazor (Anturane)

Feboxostat
31. Treatment:
 Patients with gout may be instructed to eat a low purine diet. Name several foods that the patient
should avoid.
 Why is a high fluid intake very important for the patient with gout?
 What are supportive care measures used to protect the inflamed joints?
VII. Systematic Lupus Erythematosus
32. Explain the “causes” (pathophysiology) of SLE?
33. What are the clinical manifestations related to multisystem involvement? Why do they
occur?
34. Describe the anticipated findings for each of the following diagnostic tests for a patient with
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SLE:
 Antibody testing - Antinuclear antibody (ANA); Anti-Smith antibody (Anti-Sm); Anti-DNA antibody
 ESR
 LE cell prep
35. Explain how each of the following classification of medications assist in treating SLE.

NSAIDS

Corticosteroids

Steroid-sparing drugs – (Methotrexate)

Antimalarials - (Plaquenil)

Immunosuppressive
36. Patients with SLE often have impaired skin integrity. What should the nurse teach the
client as to how to minimize these effects of the disease? Include role of photosensitivity
and environmental factors that may trigger SLE.
37. What are important concepts to include in patient and family teaching and related nursing
care?
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