LEARNING GUIDE
Musculoskeletal Disorders
I. Osteomyelitis, Osteomalacia, Osteoporosis
1. Explain how an infecting microorganism can cause an infection of the bone including the
indirect and direct entry, sequestra, and involucrum.
2. What are the clinical manifestations of osteomyelitis?
3. How do each of the following tests assist in diagnosing osteomyelitis?

Blood and wound cultures

WBC

ERS

Rationuclide bone scans

MRI
4. What are medications used to treat osteomyelitis? What are common side effects and what
patient teaching is important?
5. What type of surgery is performed to treat osteomyelitis? When is a wound vac used?
Discuss related nursing care.
6. What other treatment measures are utilized in treating osteomyelitis and the related
nursing care?
7. What is the most common cause of osteomalacia? What is the etiology?
8. What are the signs and symptoms of osteomalacia?
9. What laboratory tests are used in the diagnosis of osteomalacia?
10. What medications, foods, and treatment are used in correction of the vitamin D deficiency?
11. Why is osteoporosis more common in women than in men?
12. What is the etiology and pathophysiology of osteoporosis?
13. Why is osteoporosis called the “silent disease”?
14. What diagnostic tests are used to confirm the diagnosis of osteoporosis?
15. What foods are high in calcium? Why is vitamin D important in treatment of osteoporosis?
16. What medications are used in treatment of osteoporosis? What is the related patient
Teaching?
II. Pagets Disease
17. The bones of clients with Paget’s Disease are larger than normal but break more easily.
Explain how/why this occurs.
18. What medications are used in the treatment of Pagets disease and related patient
teaching?
19. What other supportive measures are important to teach the patient?
III. Rheumatoid Arthritis
20. How does the autoimmune theory explain the etiology of rheumatoid arthritis? What is
pannus and how does it develop?
21. What are rheumatoid factors and how do they contribute to the clinical manifestations of
Rheumatoid Arthritis (RA)?
22. How does Rheumatoid arthritis affect joints? Describe the following deformities associated
with RA:
a. Swan neck deformity
b. Boutonniere deformity
c. Hallux valgus (bunion)
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?
25. Complete the following grid for each of the medication types indicated:
Medication
ASA
NSAIDS
Corticosteroids
A. Intra-articular
injections
B. Systemic
(Solucortef)
Disease modifying
Drugs (DMARDS)
A. *methotrexate
(Rheumatrex)
B. suflasalazine
(Azulfidine)
C. penicillamine
(Cuprimine)
(how to take)
Gold Salts
A. Parenteral gold
sodium
thiomalate
(Myochrysine
Antimamalarial
A. Hydroxychlorog
uine (Plaquenil)
Mechanism of Action
Key Side Effects/Nsg Implications-Key
cautions
Immunosuppressant
A. azathioprine
(Imuran)
Biologic/targeted
Therapy
A. etanercept
(Enbrel
B. infliximab
(Remicade)
26. Explain the following nursing interventions and related patient teaching for the patient with
RA? Be able to explain how these will assist with preventing pain and deformities?
IV. Gout
27. What is the difference between primary and secondary gout? What is hyperuricemia?
Why do clients 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. Complete the table on medications used in treatment of gout:
Medication
Side Effects (major)
Nursing Implications
Colchicine
p. 1716
Allopurinol
p. 1716
Probenecid
(Benemid)
or
Sulfinapyrazole
(Anturane)
p. 1716
Febuxostat
p. 1716
* Why should aspirin NOT be given to client receiving probenecid?
31. Patients with gout are sometimes instructed to eat a low purine diet. Name several foods
that the client should avoid. Why is a high fluid intake very important for the client with
gout?
32. What else should the patient be taught as precipitating factors to gout attack?
V. Systematic Lupus Erythematosus
33. Explain the “causes” (pathophysiology) of SLE? (p. 1717) What role do certain drugs
such as hydralazine (Apresoline) play in the disease process?
34. What are the clinical manifestations related to multisystem involvement? Why do they
occur?
35. Describe the anticipated findings for each of the following diagnostic tests for a patient with
SLE: (p. 1717, 1718 -1719)

Antinuclear antibody (ANA)

Anti-DNA antibody

ESR

LE cell prep
36. Complete the table on medications used in treatment of SLE:
Medication
Steroid-sparing
drugs
(Methotrexate)
Antimalarials
(Plaquenil)
Side Effects (major)
Nursing Implications
Immunosuppressive
Cytoxan, Imuran
37. 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.
38. What are important concepts to include in patient and family teaching and related nursing
care? P. 1720-1723.