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Adult Health 2 > Care of MSK Disorders > Flashcards

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
Q

clinical manifestations of scleroderma

A
  • 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)
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26
Q

types of fractures

A
  • 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
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27
Q

clinical manifestations of SLE

A
  • 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)
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28
Q

collaborative care of patients with OA

A
  • 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)
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29
Q

pt teaching for prevention of OA

A
  • avoid trauma
  • use safety measures to avoid injury
  • avoid smoking
  • maintain healthy weight
  • exercise
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30
Q

diagnostic testing for osteoporosis

A
  • bone scan (assess bone density)
  • gold standard is dual-energy Xray absorptiometry (DXA)
  • quantitative US
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31
Q

What is the primary goal and treatment of OA

A
  • goal: pain management and maintenance of function

- treatment: non-pharmacological pain management

32
Q

collaborative care of patients with RA

A
  • PT and OT
  • drug therapy
  • nutritional therapy
  • surgery
  • psychosocial care
33
Q

risk factors for OA

A
  • obesity
  • sedentary lifestyle
  • joint injury, inflammation, or trauma
  • mechanical stress (repetitive activities)
  • neuropathy
  • skeletal deformities (congenital or acquired)
34
Q

clinical manifestations of fibromyalgia

A
  • 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
Q

clinical manifestations of OA

A
  • joint pain and stiffness
  • joints affected asymmetrically
  • deformity at joints
36
Q

systemic autoimmune disorder that affects skin, joints, serous (pleura and pericardium), renal, neurologic, and hematologic systems

A

systemic lupus erythematosus (SLE)

37
Q

nursing care for scleroderma

A
  • focus on body image functional status
  • providing assistive devices for home use
  • teaching should focus on coping and adapting
38
Q

hip fracture post-op care

A
  • 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
Q

collaborative care for fibromyalgia

A
  • 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
Q

risk factors for gout

A
  • 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
Q

clinical manifestations of osteoporosis

A

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
Q

patient teaching of RA

A
  • hot/cold therapy (ice packs, heating pads, and soaking in warm water)
  • rest
  • pace activities
  • exercise and ROM
  • joint protection
  • avoid heavy lifting
43
Q

diagnostic testing for fibromyalgia

A
  • muscle biopsy (fiber atrophy or moth eaten appearance)
  • diagnostic criteria
  • rule out other causes
44
Q

types of fracture reductions

A
  • closed reduction: manual realignment

- open reduction internal fixation (ORIF)

45
Q

pt teaching for joint protection with OA

A
  • maintain healthy weight
  • use assistive device if needed
  • avoid forceful repetitive movements
  • good posture and body mechanics
  • seek assistance w/ tasks when needed
46
Q

What NOT to do with a cast

A
  • 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
Q

drugs used for scleroderma

A
  • diltiazem and lisinopril (treat HTN from sclerosis of blood vessels)
  • vasoactive drugs
  • immunosuppressants
48
Q

joints most affected from OA

A
  • cervical spine
  • lower lumbar spine
  • hips
  • knees
  • finger and toe joints
49
Q

risk factors for osteoporosis

A
  • 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
Q

nursing goals for SLE

A
  • 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
Q

drugs used in SLE

A
  • DMARDs (methotrexate)
  • NSAIDs
  • prednisone
  • antimalarial drugs (hydroxychloroquine [Plaquenil])
  • immunosuppressants
52
Q

diagnostic tests of RA

A
  • 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
Q

care for open fractures

A
  • surgical debridement
  • prophylactic antibiotics
  • tetanus immunization
  • immobilization
  • monitor for complications (fat emboli)
54
Q

clinical manifestation of fractures

A
  • pain
  • edema
  • ecchymosis
  • muscle spasms
  • deformity
  • crepitation
  • loss of function
55
Q

explain scleroderma

A
  • connective tissue disorder with collagen overproduction

- causes fibrosis and degenerative changes to skin, muscle, synovial membranes, blood vessels, and organs

56
Q

disorder where uric acid crystals build up in joints which flair and cause inflammation and pain

A

gout

57
Q

chronic neuroendocrine/NT disorder that causes widespread MSK pain and fatigue

A

fibromyalgia

58
Q

sxs of hip fracture

A
  • external rotation of leg
  • shortening of affected leg
  • muscle spasms
  • severe pain and tenderness around fracture site
59
Q

characteristics of fibromyalgia

A
  • multiple tender points
  • 4-10 times more common in women
  • genetic predisposition
  • triggered by illness, stress, or trauma
60
Q

how to care for patients in traction

A
  • 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
Q

describe acute gout

A
  • 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
Q

list 9 common tenderness points for fibromyalgia

A
  • lower cervical
  • second rib
  • lateral epicondyle
  • knees
  • occiput
  • trapezius muscle
  • supraspinatus muscle
  • gluteal area
  • greater trochanter
63
Q

complications of wearing a cast

A
  • tingling/burning
  • swelling
  • excessive pain
  • changes in color or temp of fingers/toes
  • foul smell coming from cast (cast rubbing can cause wound)
64
Q

What is done for hip fracture pre-op?

A

Buck’s traction until physical condition is stable for surgery

65
Q

initial nonspecific sxs of RA

A
  • fatigue
  • weight loss
  • anorexia
  • generalized stiffness
66
Q

characteristics of hip fractures

A
  • 95% caused by fall
  • more common in women (osteoporosis)
  • fracture in upper 3rd of femur
67
Q

diagnostic testing for SLE

A
  • antinuclear antibody (ANA) -> 97% of pts
  • anti-DNA antibodies
  • anti-Smith antibodies
  • ESR and CRP
  • CBC, BUN, Cr, and UA (proteinuria)
  • clinical manifestations
68
Q

disorder where bone resorption is greater than bone deposition; causes porous bone and decreased bone density

A

osteoporosis

69
Q

slow progressive disorder of joints that causes cartilage destruction and decreased mobility in joints

A

osteoarthritis (OA)

70
Q

characteristics of rheumatoid arthritis (RA)

A
  • 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
Q

reasons why osteoporosis in more common in women

A
  • 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
Q

medications used for RA

A
  • NSAIDs
  • DMARDs (methotrexate) -> can be toxic
  • corticosteroids
  • biologic/targeted drug therapies (Enbrel and Humira)
73
Q

diagnostic criteria for fibromyalgia

A
  • pain in 11 of 18 tender points
  • widespread pain for at least 3 months
  • other sxs
74
Q

foods high in purines

A
  • alcohol
  • shellfish
  • spinach
  • meat
75
Q

medications used for OA

A
  • acetaminophen
  • NSAIDs
  • topical salicylates (Aspercreme)
  • menthol (BenGay)
76
Q

diagnostic testing for gout

A
  • 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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