Musculoskeletal Conditions - NCLEX-PN

Duchenne's muscular dystrophy (DMD) is caused by dysfunctional production of dystrophin, a protein that is part of a complex of proteins that anchor the cytoskeleton of a muscle cell to the extracellular matrix, also known as the dystrophin-associated protein complex. Its absence disrupts multiple intracellular signaling pathways, leading to muscle necrosis. Dystroglycan is another protein in this complex, but it is unaffected in DMD. Actin and troponin are also unaffected in DMD.

Duchenne's muscular dystrophy is an X-linked recessive disease. Because of this, it is almost exclusively seen in males and rarely presents in females (girls would have to receive a recessive gene on both the X-chromosome from their mother and their father; historically, boys with a defective gene on their X-chromosome rarely lived past their teens, decreasing the likelihood of reproduction).

Myasthenia gravis is a condition in which the immune system makes antibodies to aceytlcholine receptors, thus blocking receptors and preventing the stimulating effect of acetylcholine at the neuromuscular junction. This results in muscle weakness that progresses during activity and improves with rest. Anti-ro antibodies are commonly seen in Sjögren’s syndrome and systemic lupus erythematosus (SLE), and anti-dsDNA antibodies are highly specific for SLE.

Osteogenesis imperfecta is a genetic condition characterized by a deficiency of normal type-1 collagen, resulting in the formation of brittle, fragile bones. Bones fracture easily, often with no obvious trauma. Osteogenesis imperfecta has many sub categories that range in severity, several of which are not compatible with life.

Ehlers–Danlos syndrome is a collagen abnormality that primarily affects the skin, joints, and vasculature, causing lax joints and general instability. Marfan syndrome is also a condition of connective tissue abnormality, which largely effects the structure and function of smooth muscle in the cardiovascular system. Legg-Calvé-Perthes syndrome is a condition of necrosis in the femoral head, not related to any alterations in collagen formation.

Active resistive range of motion is performed by the client against resistance (manual or mechanical). This exercise builds muscle strength. Isometric exercises are performed by the client without motion; rather, the client contracts and relaxes the muscle without moving the joint. This maintains strength in the muscle while the joint is immobilized. Passive range of motion is performed by the nurse without assistance from the client, which retains circulation and range of motion in the joint, Active range of motion is performed by the client without assistance of the nurse and maintains joint mobility and muscle strength. Active assistive range of motion is performed by the client with help of the nurse to increase motion in the joint.

The nurse should begin assessment to determine the cause of the complaint. Obtaining an x-ray for the leg is the best assessment; you need to rule out possible fracture before giving pain medication or bandaging the leg. Heat is inappropriate for this injury because ice is best for sports injuries such as sprains and breaks. Notifying the physician may be done after all assessments are completed.

24 hours after surgery, surgical wounds are expected to drain small to moderate amounts of serous or serosanguinous drainage. The physician does not need to be notified because this observation is expected and not emergent; however, the doctor would be notified if drainage exceeds these expectations. The soiled dressing should be removed and replaced with a new dressing, and the wound site would not be irrigated unless infected; there are no signs of infection noted. The wound should not be open to air due to the risk of infection. The nurse should always document wound appearance and dressing changes.

Osteoporosis is common among elderly women. Patients require important education on how to live with the disease. Lifestyle changes such as diet and exercise should be promoted by the patient during discharge, and should be specific to the patient’s condition. Of the available options, the most accurate and essential information for the nurse to share should concern physical activity and exercise, as osteoporosis affects bone density and body strength. A recommendation for a doctor that specializes in bone pain may be beneficial, but is not a responsibility of the nurse (education is the priority). Patients with osteoporosis that are being discharged usually take ibuprofen to manage pain (not opioids or acetaminophen). A soccer program may not be appropriate for a 70-year-old woman with osteoporosis; a flyer for an adult walking group might be better.

Polymyalgia rheumatica is an inflammatory musculoskeletal condition that presents with pain or stiffness, usually in the neck, shoulders, and hips. Amyotrophic lateral sclerosis (ALS) is a genetic disorder of muscle wasting and neuronal death. Symptoms include progressive muscular weakness, leading to paralysis and death. Guillain–Barré syndrome is a rapid-onset condition of reversible muscle paralysis and weakness following infection, most commonly C ampylobacter jejuni. Myositis is a general term for inflammation of the muscles, and can be due to various causes.

Duchenne's muscular dystrophy (DMD) is caused by dysfunctional production of dystrophin, a protein that is part of a complex of proteins that anchor the cytoskeleton of a muscle cell to the extracellular matrix, also known as the dystrophin-associated protein complex. Its absence disrupts multiple intracellular signaling pathways, leading to muscle necrosis. Dystroglycan is another protein in this complex, but it is unaffected in DMD. Actin and troponin are also unaffected in DMD.

Duchenne's muscular dystrophy is an X-linked recessive disease. Because of this, it is almost exclusively seen in males and rarely presents in females (girls would have to receive a recessive gene on both the X-chromosome from their mother and their father; historically, boys with a defective gene on their X-chromosome rarely lived past their teens, decreasing the likelihood of reproduction).

Myasthenia gravis is a condition in which the immune system makes antibodies to aceytlcholine receptors, thus blocking receptors and preventing the stimulating effect of acetylcholine at the neuromuscular junction. This results in muscle weakness that progresses during activity and improves with rest. Anti-ro antibodies are commonly seen in Sjögren’s syndrome and systemic lupus erythematosus (SLE), and anti-dsDNA antibodies are highly specific for SLE.

Osteogenesis imperfecta is a genetic condition characterized by a deficiency of normal type-1 collagen, resulting in the formation of brittle, fragile bones. Bones fracture easily, often with no obvious trauma. Osteogenesis imperfecta has many sub categories that range in severity, several of which are not compatible with life.

Ehlers–Danlos syndrome is a collagen abnormality that primarily affects the skin, joints, and vasculature, causing lax joints and general instability. Marfan syndrome is also a condition of connective tissue abnormality, which largely effects the structure and function of smooth muscle in the cardiovascular system. Legg-Calvé-Perthes syndrome is a condition of necrosis in the femoral head, not related to any alterations in collagen formation.

Active resistive range of motion is performed by the client against resistance (manual or mechanical). This exercise builds muscle strength. Isometric exercises are performed by the client without motion; rather, the client contracts and relaxes the muscle without moving the joint. This maintains strength in the muscle while the joint is immobilized. Passive range of motion is performed by the nurse without assistance from the client, which retains circulation and range of motion in the joint, Active range of motion is performed by the client without assistance of the nurse and maintains joint mobility and muscle strength. Active assistive range of motion is performed by the client with help of the nurse to increase motion in the joint.

The nurse should begin assessment to determine the cause of the complaint. Obtaining an x-ray for the leg is the best assessment; you need to rule out possible fracture before giving pain medication or bandaging the leg. Heat is inappropriate for this injury because ice is best for sports injuries such as sprains and breaks. Notifying the physician may be done after all assessments are completed.

24 hours after surgery, surgical wounds are expected to drain small to moderate amounts of serous or serosanguinous drainage. The physician does not need to be notified because this observation is expected and not emergent; however, the doctor would be notified if drainage exceeds these expectations. The soiled dressing should be removed and replaced with a new dressing, and the wound site would not be irrigated unless infected; there are no signs of infection noted. The wound should not be open to air due to the risk of infection. The nurse should always document wound appearance and dressing changes.

Osteoporosis is common among elderly women. Patients require important education on how to live with the disease. Lifestyle changes such as diet and exercise should be promoted by the patient during discharge, and should be specific to the patient’s condition. Of the available options, the most accurate and essential information for the nurse to share should concern physical activity and exercise, as osteoporosis affects bone density and body strength. A recommendation for a doctor that specializes in bone pain may be beneficial, but is not a responsibility of the nurse (education is the priority). Patients with osteoporosis that are being discharged usually take ibuprofen to manage pain (not opioids or acetaminophen). A soccer program may not be appropriate for a 70-year-old woman with osteoporosis; a flyer for an adult walking group might be better.

Osgood-Schlatter syndrome of irritation of the patellar ligament at the tibial tuberosity, characterized by painful lumps just below the knee, most often seen in young adolescents. Risk factors may include overzealous exercise but it's ultimately thought to be caused by adolescent bone growth. Osteosarcoma, the most common bone cancer in adolescent populations, can present with pain and a lump or frank swelling. This is caused by actual tumor growth, not by any ligamentous issue. Osteosarcoma does present frequently in the knee, and must be ruled out before a diagnosis of Osgood-Schlatter disease is made. Slipped capital femoral epiphysis causes pain and reduced movement in the hip, rather than the knee. Osteomalacia is a general softening of the bones caused by a deficiency in vitamin D.

Patellofemoral syndrome presents as pain in the front of the knee, sometimes caused by wearing down, roughening, or softening of the cartilage under the kneecap. Osgood-Schlatter disease is a syndrome of irritation of the patellar ligament at the tibial tuberosity, characterized by painful lumps just below the knee, most often seen in young adolescents. Legg-Calvé-Perthes syndrome is due to disruption of blood flow to the femoral head, leading to avascular necrosis. Congenital scoliosis is a spinal deformity characterized by the curving of the spine at an angle greater than 10 degrees on radiography.