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Care of MSK Disorders Flashcards

1
Q

collaborative care for scleroderma

A
  • PT and OT
  • protect hands and feet from cold and injury (want warm moist heat)
  • small frequent meals
  • drug therapy
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2
Q

healing stages of fracture

A
  • hematoma (within 72 hours)
  • granulation tissue (3-14 days)
  • callus formation (2 weeks)
  • ossification (3 weeks to 6 months) -> usually when cast comes off
  • consolidation -> when bony union is formed (up to 1 year)
  • remodeling
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3
Q

collaborative care for osteoporosis

A
  • exercise (low impact)
  • fall and fracture prevention
  • Ca and vitamin D supplements
  • Drug therapy
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4
Q

diffuse scleroderma sxs

A

CREST

  • calcinosis: painful calcium deposits in SQ tissue
  • Raynaud’s phenomenon: restricted extremity blood flow in response to cold/stress
  • esophageal dysfunction: scarring leads to strictures
  • scelrodactyly: tightening of skin on fingers and toes; shiny and taut; facial skin appears tight and mask like
  • telangiectasia: red spots on hands/palms, forearms, face and lips
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5
Q

collaborative care for gout

A
  • hot/cold therapy
  • joint immobilization
  • steroid injections
  • avoid purine rich food
  • medication
  • adequate fluid intake
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6
Q

2 types of traction for fractures

A
  • skin traction (Buck’s traction): used commonly for hip fractures
  • skeletal traction: surgically placed pins that place traction as they heal
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7
Q

medications used for gout

A
  • colchicine
  • allopurinol
  • NSAIDs
  • prednisone
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8
Q

other clinical manifestations of RA (damage to other systems)

A
  • sjogren’s syndrome
  • lymphadenopathy
  • pericarditis/myocarditis
  • pleuritis/interstitial fibrosis
  • amyloidosis
  • myositis/tenosynovitis
  • Raynaud’s phenomenon
  • peripheral edema/neuropathy
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9
Q

characteristics of SLE

A
  • more common in women
  • higher incidence in African Americans, Hispanics, and Native Americans
  • genetic predisposition
  • risk factors include hormones, environmental triggers (sunburn), infections, and certain meds
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10
Q

diagnostic testing for fractures

A
  • physical exam
  • Xray
  • CT
  • MRI
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11
Q

characteristics of scleroderma

A
  • systemic sclerosis
  • more common in African Americans
  • usual onset at age 30-50
  • more common in women
  • unknown cause
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12
Q

how to care for a cast

A
  • neuromuscular assessments
  • evaluate extremity
  • ROM exercises on other extremities
  • if itching -> use hair dryer on cool setting
  • thoroughly dry cast w/ hair dryer if wet
  • report signs of complications
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13
Q

diagnostic tests for scleroderma

A
  • anticentromere antibody (80%)
  • UA (proteinuria)
  • elevated creatinine
  • CXR, PFTs, and EKG
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14
Q

types of fracture immobilization

A
  • casts or splint
  • external fixation (when multiple procedures needed)
  • internal fixation (rods, pins, screws, and plates)
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15
Q

collaborative care for fractures

A
  • fracture reduction
  • traction: improves bone alignment and blood flow to extremity
  • fracture immobilization
  • care for open fractures
  • adequate nutrition and fluid intake
  • neuromuscular assessments
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16
Q

describe pain/stiffness of OA

A
  • pain worsens w/ activity or use of joint
  • stiffness worse after resting (after sleeping)
  • pain as barometric pressure decreases (rain storms)
  • may have referred pain
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17
Q

collaborative care for SLE

A
  • manage exacerbations

- drug therapy

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18
Q

medication used for osteoporosis

A
  • Bisphosphonates - alendronate (Fosamax) once a week

- should be taken with a full glass of water and 30 minutes before eating or or taking other meds

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19
Q

how to prevent dislocation after hip fracture surgery

A
  • don’t allow legs to cross over midline
  • no more than 90 degree flexion of hip
  • pillows or abductor pillow between legs when turning
  • towel rolls or pillows placed on lateral sides of legs
  • avoid turning pt on affected side until approved by surgeon
  • keep hip in neutral, straight position
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20
Q

specific sxs of RA

A
  • involvement of all joints and cervical spine
  • stiffness/pain
  • limited ROM
  • signs of inflammation
  • joint stiffness w/ inactivity
  • joint deformities of bilateral hands/feet
  • contractures
  • rheumatoid nodules
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21
Q

goals for treatment of scleroderma

A

prevent and treat secondary complications

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22
Q

T/F: OA is an inflammatory process

A

False

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23
Q

diagnostic tests for OA

A
  • Xray
  • CT/MRI
  • bone scan
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24
Q

describe chronic gout

A
  • multiple joint involvement
  • tophi (visible sodium urate crystal deposits)
  • joint deformity
  • nephrolithiasis
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25
clinical manifestations of scleroderma
- tightening of skin and organs due to sclerosis/thickening - limited to cutaneous (80%) - includes face, hands, lower arms, feet and lower legs - diffuse progresses to trunk (includes lung, heart, and renal disease)
26
types of fractures
- transverse: horizontal fracture - spiral: caused by twisting motion (possible abuse in peds) - greenstick: stress causes bending/splintering (common in peds) - comminuted: crushed bone fragments - oblique - pathologic (osteoporosis and cancer) - stress: commonly occurs in feet
27
clinical manifestations of SLE
- vague sxs: fever, weight loss, and fatigue - butterfly rash - photosensitivity - alopecia - polyarthrialgia and morning stiffness - endocarditis, pericarditis, and pleural effusion - antiphospholipid syndrome - lupus nephritis - seizures, headache, and neuropathy - depression and psychosis - anemia, leukemia, and thrombocytopenia - increased risk of infection (common cause of death)
28
collaborative care of patients with OA
- balance rest/activity - avoid long periods of standing, kneeling, or squatting - ice (acute) and heat (chronic) -> caution if pt has neuropathy - weight management - exercise and ROM - mediations - surgery (remove bone spurs and replacing joints)
29
pt teaching for prevention of OA
- avoid trauma - use safety measures to avoid injury - avoid smoking - maintain healthy weight - exercise
30
diagnostic testing for osteoporosis
- bone scan (assess bone density) - gold standard is dual-energy Xray absorptiometry (DXA) - quantitative US
31
What is the primary goal and treatment of OA
- goal: pain management and maintenance of function | - treatment: non-pharmacological pain management
32
collaborative care of patients with RA
- PT and OT - drug therapy - nutritional therapy - surgery - psychosocial care
33
risk factors for OA
- obesity - sedentary lifestyle - joint injury, inflammation, or trauma - mechanical stress (repetitive activities) - neuropathy - skeletal deformities (congenital or acquired)
34
clinical manifestations of fibromyalgia
- widespread burning pain and increased sensitivity to pain - tenderness at 11 or more of 18 total points (9 spots bilaterally) - difficulty concentrating and memory problems - migraines, depression, and anxiety - nonrestorative sleep and fatigue - stiffness and paresthesias in hands/feet - IBS and increased urination - difficulty swallowing - sxs worsen during menstruation
35
clinical manifestations of OA
- joint pain and stiffness - joints affected asymmetrically - deformity at joints
36
systemic autoimmune disorder that affects skin, joints, serous (pleura and pericardium), renal, neurologic, and hematologic systems
systemic lupus erythematosus (SLE)
37
nursing care for scleroderma
- focus on body image functional status - providing assistive devices for home use - teaching should focus on coping and adapting
38
hip fracture post-op care
- neuromuscular assessment - prevent dislocation - physical therapy (weight bearing varies -> in some cases no weight bearing until 6-12 weeks) - rehabilitation - planning for care at home - don't sit in chair without arms (help pt stand) - assistive devices (elevated toilet seat and long-handled shoehorn)
39
collaborative care for fibromyalgia
- drug therapy: pregabalin (Lyrica) and antidepressants (SSRIs) - rest, stress management, and support groups - low impact exercise and PT - limit sugar, caffeine, and alcohol (muscle irritants) - vitamin and mineral supplements
40
risk factors for gout
- higher incidence in African Americans - obesity or starvation - excessive alcohol use - DM, renal impairment, HLD, or HTN - acidosis or ketosis - chemo, thiazides, and ASA - sickle cell disease - malignancy
41
clinical manifestations of osteoporosis
FRAIL - Fractures (hips, spine, and wrists) - Round upper back (kyphosis) - Asymptomatic until fracture - Inches of height lost (2-3" from young adult height) - Low back, hip, and neck pain
42
patient teaching of RA
- hot/cold therapy (ice packs, heating pads, and soaking in warm water) - rest - pace activities - exercise and ROM - joint protection - avoid heavy lifting
43
diagnostic testing for fibromyalgia
- muscle biopsy (fiber atrophy or moth eaten appearance) - diagnostic criteria - rule out other causes
44
types of fracture reductions
- closed reduction: manual realignment | - open reduction internal fixation (ORIF)
45
pt teaching for joint protection with OA
- maintain healthy weight - use assistive device if needed - avoid forceful repetitive movements - good posture and body mechanics - seek assistance w/ tasks when needed
46
What NOT to do with a cast
- get cast wet - remove padding on cast - insert objects into cast - bear weight on cast for first 48 hours - cover cast w/ plastic for long periods of time
47
drugs used for scleroderma
- diltiazem and lisinopril (treat HTN from sclerosis of blood vessels) - vasoactive drugs - immunosuppressants
48
joints most affected from OA
- cervical spine - lower lumbar spine - hips - knees - finger and toe joints
49
risk factors for osteoporosis
- increasing age (>65) - female - low body weight - White or Asian ethnicity - smoking or excessive alcohol - sedentary lifestyle - menopause - family Hx - low vitamin D intake - corticosteroids
50
nursing goals for SLE
- control pain - education about adherence to treatment and triggers - promote role function and self image - assess for fever, pain, and rash (severity increases in acute exacerbation)
51
drugs used in SLE
- DMARDs (methotrexate) - NSAIDs - prednisone - antimalarial drugs (hydroxychloroquine [Plaquenil]) - immunosuppressants
52
diagnostic tests of RA
- rheumatoid factor (80% of pts) - ESR and CRP - antinuclear antibody (ANA) and anti-citrullinated protein antibody (ACCP) - CBC - synovial fluid analysis (increased WBC) - tissue biopsy - bone scan
53
care for open fractures
- surgical debridement - prophylactic antibiotics - tetanus immunization - immobilization - monitor for complications (fat emboli)
54
clinical manifestation of fractures
- pain - edema - ecchymosis - muscle spasms - deformity - crepitation - loss of function
55
explain scleroderma
- connective tissue disorder with collagen overproduction | - causes fibrosis and degenerative changes to skin, muscle, synovial membranes, blood vessels, and organs
56
disorder where uric acid crystals build up in joints which flair and cause inflammation and pain
gout
57
chronic neuroendocrine/NT disorder that causes widespread MSK pain and fatigue
fibromyalgia
58
sxs of hip fracture
- external rotation of leg - shortening of affected leg - muscle spasms - severe pain and tenderness around fracture site
59
characteristics of fibromyalgia
- multiple tender points - 4-10 times more common in women - genetic predisposition - triggered by illness, stress, or trauma
60
how to care for patients in traction
- skin assessments - pin-site care (serious drainage normal but nothing else) - check weights and anatomical position - assist w/ ADLs and bedpan - ROM exercises on other extremities - monitor for complications of immobility (DVT, pneumonia, and atrophy of other muscles) - neurovascular assessments - psychosocial support
61
describe acute gout
- involves 1-3 joints - great toe most common initial attack site - starts at night w/ low grade fever -> then sudden swelling/pain - attacks last 2-10 days with or without tx
62
list 9 common tenderness points for fibromyalgia
- lower cervical - second rib - lateral epicondyle - knees - occiput - trapezius muscle - supraspinatus muscle - gluteal area - greater trochanter
63
complications of wearing a cast
- tingling/burning - swelling - excessive pain - changes in color or temp of fingers/toes - foul smell coming from cast (cast rubbing can cause wound)
64
What is done for hip fracture pre-op?
Buck's traction until physical condition is stable for surgery
65
initial nonspecific sxs of RA
- fatigue - weight loss - anorexia - generalized stiffness
66
characteristics of hip fractures
- 95% caused by fall - more common in women (osteoporosis) - fracture in upper 3rd of femur
67
diagnostic testing for SLE
- antinuclear antibody (ANA) -> 97% of pts - anti-DNA antibodies - anti-Smith antibodies - ESR and CRP - CBC, BUN, Cr, and UA (proteinuria) - clinical manifestations
68
disorder where bone resorption is greater than bone deposition; causes porous bone and decreased bone density
osteoporosis
69
slow progressive disorder of joints that causes cartilage destruction and decreased mobility in joints
osteoarthritis (OA)
70
characteristics of rheumatoid arthritis (RA)
- systemic autoimmune disorder w/ unknown cause - causes connective tissue inflammation of joints - genetic predisposition and increased risk w/ smoking - has remission and exacerbations - diagnosis most common between 30-50 y/o - more common in women
71
reasons why osteoporosis in more common in women
- women tend to consume less calcium - have less bone mass due to smaller frame - begin bone respiration earlier and accelerated at menopause - pregnancy and breastfeeding reserves - longer life
72
medications used for RA
- NSAIDs - DMARDs (methotrexate) -> can be toxic - corticosteroids - biologic/targeted drug therapies (Enbrel and Humira)
73
diagnostic criteria for fibromyalgia
- pain in 11 of 18 tender points - widespread pain for at least 3 months - other sxs
74
foods high in purines
- alcohol - shellfish - spinach - meat
75
medications used for OA
- acetaminophen - NSAIDs - topical salicylates (Aspercreme) - menthol (BenGay)
76
diagnostic testing for gout
- serum uric acid levels - 24 hr urine for uric acid - synovial fluid aspiration (gold standard but not usually needed) - Xray - clinical manifestations (most common)

Adult Health 2 (8 decks)

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