Musculoskeletal NCLEX Clinical Study Booklet · 11 cards
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Fracture. Trauma What is Fracture?
A break in the continuity of a bone. Types: closed, open (compound), comminuted, greenstick. What are the Causes / Risk Factors?
Trauma / falls Osteoporosis Repetitive stress Bone tumors / disease What are the Symptoms?
Pain, swelling Deformity, abnormal movement Crepitus Loss of function Bruising How is it Diagnosed?
X-ray CT / MRI Neurovascular assessment (5 P's) What is the Treatment?
Immobilize (cast, splint, traction) Reduction (closed or ORIF) Neurovascular checks distal to injury Elevate, ice, pain control NCLEX Tip Assess the 5 P's distal to a fracture/cast: Pain, Pallor, Pulselessness, Paresthesia, Paralysis. Unrelieved pain = compartment syndrome.
Osteoporosis. Metabolic What is Osteoporosis?
Decreased bone density → fragile, porous bones. High fracture risk (hip, spine, wrist). What are the Causes / Risk Factors?
Postmenopausal (↓estrogen) Aging Low calcium / vitamin D Sedentary lifestyle, smoking, corticosteroids What are the Symptoms?
Often silent until fracture Loss of height Kyphosis (dowager's hump) Back pain Fragility fractures How is it Diagnosed?
DEXA scan (bone density) T-score ≤ -2.5 What is the Treatment?
Calcium + vitamin D Bisphosphonates (upright 30 min, full water) Weight-bearing exercise Fall prevention; stop smoking NCLEX Tip Bisphosphonates: take with a full glass of water and stay upright 30+ minutes to prevent esophagitis.
Osteoarthritis. Degenerative What is Osteoarthritis?
'Wear-and-tear' degeneration of joint cartilage. Non-inflammatory, asymmetric, weight-bearing joints. What are the Causes / Risk Factors?
Aging Obesity Joint overuse / injury Genetics What are the Symptoms?
Joint pain WORSE with activity, better with rest Stiffness <30 min (morning) Crepitus Heberden's / Bouchard's nodes Asymmetric joints How is it Diagnosed?
X-ray (joint space narrowing, osteophytes) Clinical exam What is the Treatment?
Acetaminophen, NSAIDs Weight loss, low-impact exercise Heat/cold, assistive devices Joint replacement (severe) NCLEX Tip OA pain worsens with activity and improves with rest (opposite of RA). Morning stiffness is brief (<30 min).
Rheumatoid Arthritis. Autoimmune What is Rheumatoid Arthritis?
Autoimmune, systemic, symmetric joint inflammation. Chronic with remissions and exacerbations. What are the Causes / Risk Factors?
Autoimmune Genetic predisposition More common in women What are the Symptoms?
Symmetric joint pain & swelling Morning stiffness >1 hour Warm, tender joints Fatigue, low-grade fever Deformities (ulnar drift, swan-neck) How is it Diagnosed?
+Rheumatoid factor, anti-CCP ↑ESR/CRP X-ray (erosions) What is the Treatment?
DMARDs (methotrexate — mainstay) NSAIDs, corticosteroids, biologics Balance rest & gentle ROM Heat/cold; joint protection NCLEX Tip RA = symmetric joints + morning stiffness >1 hour. Methotrexate is the mainstay DMARD (monitor for infection).
Gout. Metabolic What is Gout?
Uric acid crystal deposition in joints. Classic site: the great toe (podagra). What are the Causes / Risk Factors?
Hyperuricemia Purine-rich diet (red meat, shellfish, alcohol) Diuretics Renal impairment What are the Symptoms?
Sudden severe joint pain (often big toe) Red, hot, swollen joint Tophi (chronic) Triggered at night / after alcohol How is it Diagnosed?
↑serum uric acid Joint aspiration (urate crystals) What is the Treatment?
Acute: NSAIDs, colchicine, corticosteroids Chronic: allopurinol (lowers uric acid) ↑fluids; avoid purines & alcohol Weight management NCLEX Tip Acute gout: NSAIDs/colchicine. Long-term prevention: allopurinol. Avoid purine-rich foods and alcohol; push fluids.
Osteomyelitis. Infection What is Osteomyelitis?
Infection of the bone. Often caused by Staphylococcus aureus. What are the Causes / Risk Factors?
Open fracture / surgery Bloodborne spread Diabetic foot ulcers Puncture wounds What are the Symptoms?
Constant bone pain (worse with movement) Fever, chills Localized redness, warmth, swelling Drainage (chronic) How is it Diagnosed?
MRI, bone scan ↑ESR/CRP, ↑WBC Blood / bone cultures What is the Treatment?
Long-term IV antibiotics (weeks) Surgical debridement Immobilize; pain control Monitor for chronic infection NCLEX Tip Osteomyelitis needs prolonged IV antibiotics (often 4–6 weeks). Emphasize completing the full course.
Compartment Syndrome. Emergency What is Compartment Syndrome?
Increased pressure within a muscle compartment compromises circulation. A limb-threatening emergency. What are the Causes / Risk Factors?
Fractures Tight casts / dressings Crush injuries Burns, bleeding What are the Symptoms?
Unrelenting pain (out of proportion, NOT relieved by opioids) Pain with passive stretch Paresthesia Pallor, pulselessness (late) Tense, swollen compartment How is it Diagnosed?
Clinical (5 P's) Compartment pressure measurement What is the Treatment?
Loosen / remove cast or dressing immediately Keep limb at heart level (do NOT elevate above) Notify surgeon — fasciotomy Neurovascular monitoring NCLEX Tip Pain unrelieved by opioids and worse with passive stretch = compartment syndrome. Loosen the cast and call the surgeon (fasciotomy).
Total Joint Replacement. Surgical What is Total Joint Replacement?
Surgical replacement of a damaged hip or knee joint (arthroplasty). Common for severe OA/RA. What are the Causes / Risk Factors?
Severe osteoarthritis Rheumatoid arthritis Fracture, avascular necrosis What are the Symptoms?
Pre-op: chronic joint pain, limited mobility Post-op focus: prevent dislocation & VTE What is the Treatment?
HIP: avoid flexion >90°, no crossing legs, abduction pillow Knee: CPM machine, early ROM VTE prophylaxis (anticoagulants, SCDs, early ambulation) Neurovascular checks; pain control NCLEX Tip After hip replacement: no hip flexion >90°, no crossing legs or adducting past midline — this prevents dislocation.
Amputation. Surgical What is Amputation?
Surgical removal of a limb or part. Often from PAD, diabetes, trauma, or infection. What are the Causes / Risk Factors?
Peripheral vascular disease Diabetes (non-healing ulcers) Trauma Severe infection / gangrene What are the Symptoms?
Post-op stump pain Phantom limb pain / sensation Grief, body-image changes How is it Diagnosed?
Vascular studies Assess healing & perfusion What is the Treatment?
Monitor stump for bleeding (tourniquet at bedside early) Elevate first 24h, then position to prevent contractures Residual limb shaping (wrapping) Phantom pain management; emotional support NCLEX Tip Keep a tourniquet at the bedside early after amputation for hemorrhage. Phantom limb pain is real — treat it.
Herniated Disc. Spine What is Herniated Disc?
Displacement of intervertebral disc material compressing nerves. Usually lumbar or cervical. What are the Causes / Risk Factors?
Aging / degeneration Improper lifting Trauma Obesity What are the Symptoms?
Back pain radiating (sciatica down the leg) Numbness, tingling, weakness +Straight-leg-raise test Worse with sitting, coughing, straining How is it Diagnosed?
MRI (definitive) Neuro exam X-ray / CT What is the Treatment?
Conservative: rest, NSAIDs, PT, muscle relaxants Proper body mechanics; firm mattress Epidural steroids Surgery (discectomy) if refractory / neuro deficits NCLEX Tip Teach proper body mechanics — bend the knees, lift with the legs, avoid twisting. New bowel/bladder changes (cauda equina) is a surgical emergency.
Fibromyalgia. Chronic What is Fibromyalgia?
Chronic widespread musculoskeletal pain with tender points. Amplified pain processing; no inflammation. What are the Causes / Risk Factors?
Unknown Genetic + triggers (stress, infection, trauma) More common in women What are the Symptoms?
Widespread pain & tender points Fatigue Sleep disturbances Cognitive issues ('fibro fog') Anxiety / depression How is it Diagnosed?
Clinical (widespread pain >3 months) Rule out other causes What is the Treatment?
Low-impact exercise, sleep hygiene Antidepressants (duloxetine), pregabalin Stress management, CBT Patient education & support NCLEX Tip Fibromyalgia has no inflammation or lab markers — it's a clinical diagnosis. Emphasize exercise, sleep, and stress management.
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