Hi guys it's me Professor D and welcome back to my channel. On this video I'm going to be covering musculoskeletal issues. Now I've done I think two other videos on musculoskeletal but there are two subjects that I did not touch up on those videos which was Pege. I'm going to be talking about that in this video for anyone that just needs that extra help in musculoskeletal This will be for you.
If you haven't done so already guys, please be sure to Like and subscribe below. Make sure you press that red bell notification button so you'll be notified every time a new video is released so without any further ado guys let's get started what is the pathophysiological process responsible for osteoporosis a lifelong excessive engagement in weight-bearing activity b rate of osteoclastic activity exceeding the rate of osteoblastic activity c inefficient intestinal absorption of calcium magnesium and phosphorus or d B, atrophy of the bone and skeletal muscle modeling process as a result of disuse. okay guys so the correct answer is b osteoclastic activity happens more than osteoblastic activity so osteoclastic is to break down right and osteo but but ballistic is to build up. So that's what's happening in osteoporosis.
So B is the correct answer. Now let's talk about the wrong choices. You have A, lifelong excessive engagement and weight-bearing activity. Well, that's actually a good thing.
If you watch my other videos... on the musculoskeletal process, you know that weight-bearing activity is good. Weight-bearing activities is what pushes calcium out of the blood back into the bone where it belongs to make the bone stronger, right?
So A is a good thing. So that's not the cause of osteoporosis. That's wrong. Then you have C, inefficient intestinal absorption of magnesium, phosphorus, or calcium. And that's wrong as well because the problem- with osteoporosis, osteoporosis, those bones become porous.
Why? Because of the osteoclastic activity, the breakdown of the bone. And then you have choice D, which is atrophy of the bone and skeletal muscle modeling. And that's wrong. What's happening in osteoporosis is the breakdown of the bone, not the muscle.
So the correct answer is B. Choice number two. Well, second question, I should say. Which of the following clients is most at risk for secondary osteoporosis? A, a 33-year-old man recovering from a fractured wrist.
B, a 55-year-old woman taking prednisone for asthma. C, a 72-year-old man who resides in a nursing home. Or D, a 25-year-old woman taking oral contraceptives.
And I'll give you a moment to think of the answer. And by far guys, the correct answer is B. They gave us a couple clues in this choice to make you want to choose the right answer.
The first one, she's 55. No, actually the first clue was that it's a female. females are at much higher risk for osteoporosis in males. That's our first clue.
Our second clue is that she's 55. Well, what happens to females around that age? Menopause. Menopause is another Another risk factor for osteoporosis.
What is our third clue? Prednisone. Guess what?
If you guys have been following me for a while, you've been watching my videos, you know the four biggest concerns for anybody taking steroids is what? Infection. It's very hard on the stomach.
Well, three things I should say. It's very hard on the stomach and what? Fractures, right? The steroids make the bones porous.
And this. this patient's taking prednisone. So they told you three things in that answer that should include you in to make sure that you know that that person's most at risk. Being a female, going through menopause, and of course taking prednisone, which is a type of steroid.
Now let me explain the whole menopause thing. It's not menopause, it's, well, it is the menopause that's causing the risk for fractures, but I want to explain this to you. What happens in menopause? Yes, you no longer have your menses but what else happens estrogen level the estrogen level goes down and guess what ladies and gentlemen estrogen was what was keeping calcium in the bones and keeping it from leaking back out into the blood with estrogen going down down guess what calcium's like oh party time we're out of jail and then calcium leaves the bone and goes back to the blood and it causes the patient's bones to be porous okay so you need to know that i promise you that's on a test question it's a test question So many times when it comes to musculoskeletal processes, female menopause, which means decreased estrogen and steroids, they all increase the patient's risk for osteoporosis.
OK, next question. You're performing a physical assessment on a client with osteoporosis. You know, the client changes position slowly and there's tenderness and palpation of the spinal vertebra at T8. That's T8.
That's your thoracic eight. What? What conclusion can you draw from this data? A, the client has phallophobia. B, the client is developing kyphosis.
C, the client has a compression fracture. Or D, the client should be evaluated for alcohol abuse. And the correct answer guys is C, the client has a compression fracture. That's what you should suspect that they've got a break in the bone. They've given us lots of clues in the question.
Let's go back and look. They told us the patient has osteoporosis. Guys don't mind my crazy looking nails i gotta go get them done but anyway they've got porous bones to begin with right okay and then it says that they're changing positions slowly and there's tenderness on palpation of the spine so they're moving slowly and it hurts you should suspect that that patient probably has a fracture they've got porous bones to begin with let's look at our other choices the wrong answer choices a the client has phallophobia which is a fear of falling well that fear of falling is not going to explain that tenderness on palpation of the spinal vertebrae the t8 so that's not it b the client's developing kyphosis kyphosis is hunchback again that does does not explain the slow movement or the tenderness upon palpation. And then of choice D is just crazy. The client should be evaluated for alcohol abuse.
There's nothing in that question that would even make us think that the patient is an alcoholic or they're abusing it. Okay. Next question.
A client's been advised to take supplemental calcium carbonate. What instructions should be given to this client regarding this medication? A. Take this medication with food. B.
Take tablets. Excuse me, these tablets should not be crushed. C. This medication prevents further bone loss. Or D. This medication can cause uterine bleeding.
And the correct answer is A, take this medication with food. Why? For calcium carbonate to be absorbed, it needs the hydrochloric acid that's in the stomach. Guess when hydrochloric acid is increased when it has food because obviously when you eat you produce more hydrochloric acid to break down the food right so that's why it's important for the patient to take that calcium carbonate with food because that patient needs that acid to break it down and for it to be absorbed. One more thing I want to tell you about calcium, which is very important.
I'm going to teach a patient, drink lots of fluids because what we don't want to happen is that patient's got calcium floating around in their blood, but because they're dehydrated, guess what the calcium does? It clumps up. As soon as it gets to the kidneys, patient has kidney stones. By the way, kidney stones are one of the worst pains a patient can ever have.
If you've been following my videos, you know that there are four types of pain that we have. that we treat as medical emergencies because it will affect that patient's physiological integrity. Kidney stones are one of them. And stones regardless, whether it's kidney stones, gallbladder stones, calcium stones, struvite stones, priority.
What else? Burns. What else? Sickle cells and myocardial infarction. Those four types of pain, we treat as a priority.
You know, we always say, oh, pain never kills. killed anyone except in those four situations. Okay.
So that's it about calcium. We're going to move on to the next question. A client with osteoporosis has been prescribed Avista.
What lab data would suggest an adverse effect of this drug? Decreased serum calcium, B, elevated cholesterol level, C, elevated liver function test, or D, decreased serum potassium. And the correct answer is C, elevated liver function test. This medication is hard on the liver. So we have to, every four to six months, we got to be drawing those labs, getting those labs drawn and looking at those liver function tests.
Okay. And we want to make sure that the ALT and the AST is not rising because if they rise it, that lets us know that those kidneys are in trouble. Okay.
That's an adverse effect that we have to report immediately. Which exercise to prevent bone density loss should you recommend to a client at risk for osteoporosis? A. High-impact aerobic 45 minutes once per week. B.
Walking 30 minutes three times per week. C. Jogging 30 minutes four times per week. Or D. Bowling for one hour twice a week.
And the correct answer is B, walking 30 minutes three times a week. So we're talking about osteoporosis and we want to minimize the, excuse me, bone loss. We want that patient to be doing weight-bearing activity.
But the type of weight-bearing activities you want them to be is non-jarring. So high impact, that's jarring. That's going to be hard on those joints. So is jogging.
That's going to be hard on those joints. And bowling, that's not. not a weight-bearing activity.
So walking, walking is a great weight-bearing activity that will help push the calcium that's in the blood to go back to the bone where it belongs to make the bone stronger without jarring any of those joints or being harmful to that patient. Because remember, we want to make sure that patient does not injure themselves. Which of the following interventions should the nurse implement to prevent injury in the client with severe osteoporosis?
A. Administer vitamin D as prescribed. prescribe.
B, use a lift sheet to reposition the client. C, place a pillow between the client's knees when in the sideline position. Or D, position the client as upright as possible when sitting to promote a lung expansion. And I'll give you a moment to think of the answer.
So the correct answer is B, you're going to use a lift sheet. Remember this patient has osteoporosis which means what? They have porous bones. We want to prevent injury. So when we use a lift sheet, we're preventing what from happening?
Fractures. right? Fractures. We don't want that to happen in this type of patient. Now look at these other choices.
Administering vitamin D as prescribed. That's wonderful. We love vitamin D. Guess what? Calcium cannot be absorbed without vitamin D.
What's our primary source of vitamin D? vitamin D, of course, sun rain, but we can give them supplemental vitamin D. We love that because the calcium is not going to be absorbed without that.
That's a great thing. C, placing a pillow between their knees when they're in side-lying position. We don't want pressure of one knee on top of the other. Choice D, putting them in upright position.
Yes, because it decreases the weight of the diaphragm against the lungs. It helps the patient breathe better. All of those are wonderful things to do for your patient, but it does not prevent...
injury and the questions asking us which one will prevent injury in the patient with osteoporosis so it would be using a lip sheet so that that patient doesn't get a fracture a client recently diagnosed with Pache's disease of the bone asked you how this disease was acquired what is your best response a this disease occurs in postmenopausal women who have a sedentary lifestyle be B. This disease is most often a secondary response to bacterial infection. C. This disease is thought to have a familial transmission. Or D. This disease can be acquired from intestinal parasites.
So the correct answer is C, familial transmission. We don't know 100% what causes it. That's why it says it's thought to be.
But there's been a very, very, very strong genetic link. We found that twins or first degree relatives that have it, the patient's more at risk for getting this disease. We found a very strong genetic link.
So C is the correct answer. What is the primary problem or complaint of a patient with severe Paget's disease? A.
Visual disturbance, B. Decreased energy, C. Falls, or D. Pain. So the correct answer is D, pain.
But let me be more specific. Let me tell you what kind of pain. Bone pain. Bone pain.
And bone pain is described by patients as very, very deep pain. It's pain you feel it to your core. So you got to think about what's happening in Paget's disease and it makes that they're going to have this bone pain. They're having this excessive breakdown and then rebuilding up of the bone. So these patients tend to have excessively large bone, but the bones are, they're soft.
That's why these patients. Patients are at risk for fractures. Okay.
So what happens is that excessive regrowth, the regrowth is happening so fast, it's causing that patient pain. And then, of course, you have that excessive breakdown. But even though the regrowth is happening fast, is the bone sturdy?
No, it's soft. And that's what places that patient at risk for fractures. So patients with severe Pache's disease, they're going to have bone pain.
And they're going to be on the strong. analgesics. They're going to be on those opioids. NSAIDs aren't going to cut it.
A client with Paget's disease has been prescribed treatment with a six-month course of diadronel, etidronate. What instructions would be appropriate for you to provide to this client? A, this medication will make you feel sleepy.
B. Take this medication one to two hours after breakfast. C. This medication will be increased over the course of therapy. Or D. Take a stool softener while you're on this medication because it causes constipation.
And the correct answer is B, take this medication one to two hours after breakfast. Why? It needs to be taken on an empty stomach. Okay, so let's go back to this medication, Etidronate. That ending of...
That medication. Oh Nate should kind of clued you into what class of medication we're dealing with which is a bio phosphate Alright, so what's important to know about those bio phosphate number one. You need to take that medication with a full glass of water Number two, it needs to be taken on an empty stomach.
And number three, you need to be sitting up a good two to three hours after you take that medication. Why? That medication is so harmful to the lining of the esophagus.
It can basically erode the esophagus if it reflexes up. So it's very important after that patient takes that medication that they're sitting up for a good two to three hours afterwards. OK, we got to make sure that medication is absorbed. A client submitted with acute osteomyelitis. What questions should be asked of this client to help determine the source of the infection?
A. Have you recently visited your dentist? B. Have you eaten shellfish recently? C.
Have you had a recent injury? D. Do you run or jog regularly?
So the correct answer is C, have you had a recent injury? This is a good question to ask if we're trying to find the source of osteomyelitis. What is osteomyelitis? Infection of the bone.
So the patient had an injury. If they had, who knows, somebody came up to them and stabbed them in the bone or somebody took a baseball bat and hit them in the leg or the arm, any traumatic injury, right? A traumatic injury can cause finally.
for that bone to get infected because the patient can have a break in the skin. Bacteria gets into that break, right? So it's just a skin infection at first.
Then it gets into the blood. Now it's a septic infection. Then it gets into the bone. Now this patient has osteomyelitis. So a good question to ask is, have you had a recent injury?
A client is about to begin drug therapy for osteomyelitis. What information regarding this treatment would be appropriate to provide to the client? A.
You'll need to remain in the hospital for the duration of the treatment. B. You'll need to undergo treatment with IV antibiotics for several weeks.
C. Only close family members may be permitted to visit while you're receiving treatment. Or D, once the IV medications are completed, the infection is considered cured and no further treatment is needed.
So the correct answer is B, you'll need to undergo treatment with IV antibiotics for several weeks. So guys, this is an infection that's not superficial. This is an infection in the bone and it's not something that's going to clear up right away.
patient is going to be on IV antibiotics for at least four to six weeks at the minimum. All right. So they're not going to be in the hospital the whole time. They're going to go home with a central line and a home health nurse is going to come out.
every day to give that patient their IV therapy. So choice A, C, and D are incorrect. Choice B is the correct answer.
They're going to be on IV antibiotics for at least four to six weeks. And they're not going to be in the hospital the whole time. They will be discharged home with home health.
Which of the following diagnostic procedures can determine whether a bone tumor is benign or malignant? A. Bone scan B. Bone biopsy C. Computed tomography or D.
MRI If you guys have been following my videos, I know you know the correct answer. Don't give me a heart attack. The correct answer is B, bone biopsy. Only the bone biopsy can tell you the tumor type, whether it's benign or malignant. Look at me in my eyeball when I...
tell you this only the bone biopsy you hear me only the bone biopsy now the other choices your bone scan your CT your MRI they can give you information associated with the tumor but only the bone biopsy can tell you the tumor type okay Which of the following results of maneuvers alerts the nurse to the possibility of carpal tunnel syndrome? A. Positive Trousseau sign.
B. Positive Cullen sign. C.
Positive Phelan's test. Or D. A positive Turner sign. All right, guys, and the correct answer is A, a positive phalanx test.
So that's when you put pressure on that median nerve for about a minute to a minute and a half, and the patient will feel pain or paresthesia. Okay, that medium nerve right here. So you either press it or you have the patient go like this. That compression of that median nerve for about a minute and a half, if that patient experiences pain or paresthesia, that Phelan's test was positive and they most likely have carpal tunnel syndrome.
What is carpal tunnel syndrome? It's that pain that patient has in their wrist. Well, what type of patients get it?
Patients that do a lot of what? Computer work, because look at what my hands are doing when I'm typing, right? My wrist is flexed and that median nerve is being compressed, okay?
Let's look at our wrong answer choices. We have a positive true soul sign. Positive true soul sign, that's positive for what?
Hypocalcemia, because when patients calcium is too high, too low. They have muscle and nerve irritation and excitation. So trousseau sign is when you take that patient's blood pressure and the cuff is squeezing and we see tetany of the hands, right? Trousseau tetany.
All right. Another sign and symptom of hypocalcemia is the trostec sign. Trostec starts with a C and so does your cheek.
When you touch your cheek, it goes like that. That's the trostec sign. Both are signs and symptoms of hypocalcemia. Then you have your Cullen sign. Cullen sign is that bluish color that you see around the umbilicus.
And that is significant. What does it mean? There's bleeding in that peritoneal area, most possibly, right? And that can mean patient's got ectopic pregnancy.
It could be pancreatitis. But that sign, the Cullen sign, is that the bruising and the bleeding that is is happening around that umbilicus. Choice D, the Turner sign. This is a grayish coloration that we see in the flanks. And this as well can be a sign of pancreatitis.
Which statement made by the client undergoing conservative management for carpal tunnel syndrome would indicate a need for clarification of the treatment? A. I will perform as many tasks as possible using my hands and wrists to maintain muscle strength.
B. If my fingers become cool and pale, I will loosen my wrist splint. C.
If the numbness increases, I will notify my doctor. D. I will take the prescribed NSAIDs with food. Okay, so the only one that needs clarification, which means it's wrong, is A, I'll perform as many tasks as possible with my hands and wrist to maintain muscle strength. First of all, the problem isn't muscle strength.
The problem is that median nerve. okay, being compressed so much. So we don't want them doing things with their hands.
We want them to rest those hands and more specifically resting that wrist and where that median nerve passes through. We want them to rest it until that pain subsides. Now everything. else is good we want them to do we want them um to report if they're having um uh their fingers become cool and pale because what does that mean that means they're getting decreased circulation to those extremities um and they say they'll loosen their wrist splint absolutely why do we put a wrist splint on the patient well if this is what's causing the pain we're going to put a splint so their hand stays in a neutral position so this median nerve is not compressed right but if the wrist splint is too tight what's it doing to the median nerve squeezing it's compressing it's doing the same thing as if the patient was going like this so it makes sense very good they're going to do what loosen it um choice c if the numbness increases i'm going to notify my doctor yes because that numbness is a sign and symptom of decreased circulation d i'll take prescribed NSAIDs with food absolutely the NSAIDs is for the inflammation for pain but you want to take it with food but why because NSAIDs are hard on the stomach and they can cause what stomach ulcers.
So B, C, and D are good, and A is the only one that's wrong. A is the one that needs correction and further clarification. All right, guys, we are down to our last question.
Which of the following clients is at risk of plantar fasciitis? A, a 35-year-old male runner. B, a 45-year-old female office worker.
C, a 77-year-old. male who walks with a cane or D, a 65-year-old female confined to a wheelchair. And if you chose A, you chose correctly, the 35-year-old male runner. We see plantar fasciitis in people who run a lot, right?
Such as joggers, runners, basketball players, soccer players, okay? also one more thing i want to tell you about plantar fasciitis there's also a link with obesity and it makes sense because all of that weight is going on where the feet so b c and d are all incorrect guys i hope you found this video helpful if you If you did, please go ahead, leave me a comment below. Don't forget to like and subscribe to this video. And guys, please share my videos with anyone that you think it would help, any classmates, coworkers, anyone that you know studying for nursing. Please share my videos.
Thank you so much for sharing this time with me, and I'll see you on the next video.