Exam #2 Flashcards
1
Q
musculoskeletal system anatomy
A
- muscle
- connective tissue: bones, cartilage, ligaments, tendons, fascia
2
Q
Bone Functions
A
- support
- protection
- voluntary movement
- blood cell production
- mineral storage
3
Q
types of bones
A
- cortical: compact and dense
- cancellous: spongy
4
Q
three types of bone cells
A
- osteoblasts: build bone
- osteocytes: mature bone cells;
- osteoclasts: break down bone
5
Q
Gross Bone Structure
A
- epiphysis: top of bone
- diaphysis: middle long bone
- metaphysis: the curved part of the bone between the epiphysis and diaphysis
- epiphyseal plate:
6
Q
Gross Bone Structure
A
- epiphysis: top of bone
- diaphysis: middle long bone
- metaphysis: the curved part of the bone between the epiphysis and diaphysis
- epiphyseal plate: The epiphyseal plate (or epiphysial plate, physis, or growth plate) is a hyaline cartilage plate in the metaphysis at each end of a long bone. The plate is found in children and adolescents; in adults, who have stopped growing, the plate is replaced by an epiphyseal line.
- periosteum: membrane that covers the outer surface of all bones
7
Q
Bone Types
A
- long bone: femur, humerus, tibia
- short bone: carpals tarsals
- flat bone: ribs, skull, scapula, sternum
- irregular bone: sacrum, mandible, ear ossicles
8
Q
Joints
A
- articulation where two bones are in proximity to each other
- classified by the degree of movement
TYPES OF JOINTS
1) hinge joint - elbow, knee
2) ball and socket - shoulder, hip
3) pivot (rotary) - radioulnar joint
4) condyloid
5) saddle
6) gliding
9
Q
Joints
A
- articulation where two bones are in proximity to each other
- classified by the degree of movement
TYPES OF JOINTS
1) hinge joint - elbow, knee
2) ball and socket - shoulder, hip
3) pivot (rotary) - radioulnar joint
4) condyloid - wrist joint between radial and carpals
5) saddle - carpometacarpal joint of thumb
6) gliding - between tarsal bones
10
Q
Joints
A
- articulation where two bones are in proximity to each other
- classified by the degree of movement
TYPES OF JOINTS
1) hinge joint - elbow, knee
2) ball and socket - shoulder, hip
3) pivot (rotary) - radioulnar joint
4) condyloid - wrist joint between radial and carpals
5) saddle - carpometacarpal joint of thumb
6) gliding - between carpal bones
11
Q
cartilage
A
- hyaline: bronchi, trachea
- elastic: ear, epiglottis, larynx
- fibrous: shock absorber, verterae, pelvis, knee, shoulder
* functions: support, articulation, protection, growth
12
Q
cartilage
A
- hyaline: bronchi, trachea
- elastic: ear, epiglottis, larynx
- fibrous: shock absorber, verterae, pelvis, knee, shoulder
- functions: support, articulation, protection, growth
13
Q
muscles
A
- cardiac: striated, involuntary
- smooth: nonstriated, involuntary
- Skeletal: striated, voluntary (requires a nerve impulse to contract)
14
Q
Tendons
A
- attach muscle to bone
15
Q
ligaments
A
- attach bone to bone
16
Q
fascia
A
- layers of connective tissue
- provide strength to muscle
17
Q
bursae
A
- sacs of connective tissue lined with synovial membrane containing synovial fluid
- bursitis: inflammation of bursae
18
Q
Gerontologic considerations
A
- decreased bone density = osteopenia (first) and osteoporosis (progressed)
- decreased muscle mass and strength
- decreased flexibility
- functional problems: balance issues, functional status (get patients to do as much for themselves as they can)
19
Q
Gerontologic Age Groups
A
- 65-74: young old
- 75-84: middle old
- 84-100: old old (fastest growing population in US)
- 100+: elite old
20
Q
Gerontologic considerations
A
- decreased bone density = osteopenia (first) and osteoporosis (progressed)
- decreased muscle mass and strength
- decreased flexibility
- functional problems: balance issues, functional status (get patients to do as much for themselves as they can, prominant indicator of outcome)
21
Q
muskuloskeletal assessment subjective
A
- past health history: TB, polio, diabetes, parathyroid problems, hemophillia, rickets, bacterial infections
- medications: bad for bones = steroids, antiseizure meds, phenothiazines, diuretics; good for bones = vit d, calcium, Hormone replacement therapy
- nutrition: vit c & d, calcium, protein, obesity
- occupation: extremes can lead to MSK problems
22
Q
musckuloskeletal assessment objective
A
- inspeciton
- palpation: cephalopedally (head to toe), warm hands
- range of motion: goniometer, active vs. passive
- muscle strength
- measurement: limb length, muscle mass
- scoliosis: can cause lung and heart problems
- straight leg raising test: tests for disc herniation, supine leg lift assess for pain
- gait: get up and go test
- assistive devices: safety, proper use
23
Q
common musculoskeletal abnormalities
A
- Rheumatoid arthritis
- genu varum: bow legged
- Genu valgum: knock knees
- torticolis
- osteoarthritis
24
Q
muskuloskeletal diagnostic studies
A
- Xray: most common
- diskogram: cray with contrast
- CT scan: injected with contrast - assess iodine and seafood allergies
- myelogram: disc herniation, spinal stenosis - injection into spine, common side effect is headache
- MRI: views soft tissue
- Bone mineral density: determines osteopenia or osteoporosis
- bone scan: osteomueltis, cancer; radioisotope attaches to abnormal tissue and bone
- arthrocentesis: joint aspiration - apsirate to see if infected or inflamed
- EMG: painful muscle test, needle put into muscle to wartch for electric impulses
- duplex venous doppler: US looking for DVT
- SSEP: similar to EMG but uses electrodes instead of needles
25
Q
arthroscopy
A
- examines interior of joint cavity
- anesthesia
- needle inserted and cleans up area and repairs tissue
26
Q
lab tests for musckuloskeletal system
A
- alkaline phosphatase: produced by osteoblasts, needed for mineralization; osteoporosis, osteomualgia, paget’s
- serum calcium
- serum phosphorus: related to calcium: kidney diesase
- Rheumatoid factor
- erythrocyte sedimentation rate: indicated inflamamation; RA, osteomyelitis
- ANA: can destroy nucleous of cell; positive in 95% of patients w lupus or scleroderma
- uric acid: gout
- C-reactive protein: diagnoses inflammation dieases, infection, presents in serum 24 hours after tissue damage
- cratine kinase: muscle damage = inceased CK
- serium potassium: increased muscle trauma, when cells are destroyed they release k+, dysrhythmias
27
Q
contusion
A
- bruise
- soft tissue injury from blunt force
- overlying skin intact, becomes black and blue from localized hemorrhage
- usually only painful if palpated
28
Q
hematoma
A
- more concerning than contusion
- blood collecting from torn blood vessel
- pain occurs as blod accumualtes and places pressure on nerves
- pain occurs without palpation
- may burst or become infected
29
Q
strain
A
- tendon
30
Q
sprain
A
- ligament
31
Q
RICE
A
rest, ice, compress, elevate
- analgesia as necessary
- after 24-48 hours, warm moist heat
- strains: change ergonomics, splints, heal in 3-6 weeks
- sprains: may need surgery if the ligament is torn
32
Q
subluxation/dislocation
A
- dislocation is an emergency
- joint capsule and ligaments can be damaged
- S/S: shortened affected limb, loss of function, swelling, pain, deformity
- complications: joint fx, neurovascular damage, avascular necrosis
33
Q
Fractures
A
- disruption of break in continuity of structure of bone
- majority of fractures from traumatic injuries
- some fractures secondary to disease process: cancer or osteoporosis
- open vs closed
- complete vs incomplete
- displaced: two ends separated from one another VS nondisplaced: periosteum is intact and bone is aligned
34
Q
signs and symptoms of fracture
A
- S/S:
- swelling: can occlude circulation and damage nerves (compartment syndrome)
- deformity: can lead to union and functional problems if not corrected
- muscle spasm: can displace a nondisplaced fracture or prevent it from reducing on its own
- crepitation: can increase change for nonunion if bone ends are allowed to move about freely
35
Q
healing process of bone
A
1) fracture hematoma
2) granulation tissue
3) callus formation
4) ossification
5) consolidation
6) remodeling
36
Q
factors influencing healing
A
- displacement and site of fracture
- blood supply to area (can cause compartment syndrome)
- immobilization
- internal fixation devices
- infection of poor nutrition
- age
- smoking (constricts vessels)
37
Q
complications of fracture healing
A
- delayed union (longer than expected to heal)
- nonunion (no callus forms)
- malunion (no realligning correctly)
- angulation (?)
- pseudoarthrosis (nonunion at fracture site, can develop false joint)
- refracture
- myositis ossificans (calcium in muscle tissue after blunt trauma)
38
Q
goals of treatment for fracture
A
- anatomic realignment (reduction)
- immobilization
- restoration of normal or near normal function
39
Q
closed reduction
A
- nonsurgical, manual realignment of bone fragments
- traction and countertraction applied
- under local or general anesthesia
- immobilization afterwords until it heals
40
Q
open reduction
A
- incision required
- internal fixation
- risk for infection
- early ROM of joint to prevent adhesions
- facilitates early ambulation
- ORIF = open reduction internal fixation
41
Q
traction
A
- prevent or decrease pain and muscle spasm
- immobilize joint or part of body
- reduce fracture or dislocation
- treat a pathologic joint condition
- pulling force to attain realignment - countertraction pulls in opposite direction
- two most common types of traction: skin and skeletal
42
Q
skin traction
A
- used for short term treatment until skeletal traction is ok (48-72 hours)
- tape, boots, splints applied directly to skin
- traction weights 5-10lbs
- skin assessment and prevention of breakdown imperative
- assess skin (6Ps) every 4 hours
- buck’s traction is an example (boot)
43
Q
skeletal traction
A
- long term pull to maintain alignment
- pin or wire inserted into bone
- weight 5-45lbs
- risk for infection
- complications of immobility
- maintain counter-traction, eelvate end of bed
- maintain continous traction
- keep weights off floor
- inspect skin and pin sites carefully
- pin clean site every shift to prevent infection
- maintain ROM of inaffected joints
44
Q
casts
A
- Arms: sugar tong splint, short arm, long arm
- slings: pad axillary area, be careful of neck, encourage movement of fingers
- long leg, short leg, jones dressing
- Hip spica: used for femoral fracture in peds, dont move using the support bar, can put pt prone, use fracture bedpan
- body jacket for vert immobilization: risk for cast syndrome, listen to bowel sounds, may need NG
- cast syndrome: compression of superior mesenteric artery against duodenum
45
Q
cast care interventions
A
- do not cover a drying cast
- handle a wet cast with palms only, can support cast with pillows when wet
- elevate at or above heart level
- pad or petal rough cast edges
- do not scratch skin with any objects
- can use cool air form hair drying for itching
- apply ice for first 24-36 hours
- do not get cast wet
46
Q
prevention of musckuloskeletal problems in older adults
A
- use ramps
- eliminate scatter rugs
- treat pain and discomfort from osteoarthritis
- use walker or cain
- proper nutrition, avoid obesity which adds extra stress to bones
- use shoes with good support
- gradually initiate and decrease activities
47
Q
6Ps
A
- parasthesia, pain, pressure, pallor, paralysis, pulselessness
- asses with muskuloskeletal injuries
48
Q
use of crutches
A
- never bear weight on axillary, bear weight in hands
- elbows at 15 degree angle
- canes held in opposite hand of involved extremity. cane and weak leg go together
- flat ground: involved limb and device first, followed by uninvolved limb
- stairs: good leg first going up, bad leg first going down
49
Q
fracture complications
A
- direct: infection, inadequate bone union, avascular necrosis (bone death from lack of blood supply)
- indirect: compartment syndrome, VTE, rhabdo (can damage kidneys), fat embolism, shock
50
Q
bone infection
A
- high incidence with open fracture or soft tissue injury
- need aggressive debridgement
- antibiotic beads
51
Q
VTE
A
- venous thromboembolism
- esp after a hip fracture, total knee
- prevention - anticoags, SCDs, rom to unaffecte joints
52
Q
compartment syndrome
A
- pressure that compromises neurovascular function
- causes: restrictive dressings, edema
- S/S: early = pain, unrelieved by drugs and out of proportion; late = no pulses, paralysis, dark brown urine
- tx: quick recognition, do NOT elevate, NO ice, loosen dressing, fasciotomy (opens muscle and relieves pressure)
53
Q
Fat embolism syndrome
A
- main contibuting factor to death with people with fractures
- far globules transported to lungs cause a hemorrhagic interstitial pneumonitis
- risk with long bone, ribs, tibia, pelvis fx
- S/S: chest pain, tachypnea, dyspnea, change in mental status, hypoxia, petechiae on neck, chest, axilla, eyes, sense of impending doom
- tx: early recognition, reposition as little as possible, oxygen
- immobilize to drecrease risk of disloding fat embolism
- within 24-48 hours of broken bone
54
Q
facial fractures
A
- maintain patent airway, provide adequate ventilation
- assume that they have a cervical injury
- always have suction available
55
Q
jaw fractures
A
- position pt on the side with head slightly elevated
- wire cutter at bedside
- tach tray always available
- NG tube for decompression
- oral hygeine is important
- protein suppliments
- liquid diets
56
Q
Pelvic Fracture
A
- can be life-threatening
- s/s: bruising on abdomen, pelvis instability, swelling, tenderness
- tx: bed rest, may need traction, hip spica cast, ORIF, only turn when ordered by HCP
- complications: paralytic ileus, internal bleeding, fat embolism, other GI problems
- rule out internal bleeding first
57
Q
hip fracture
A
- 30% die within 1 year of injury
- s/s: external rotation, spasm, shortening of affected leg, severe pain
- complications: nonunion, avascular necrosis, dislocation, arthritis, DVT
- tx: surgery, may temp use buck’s traction
- can shorten the leg and impair mobility
58
Q
femoral shaft fracture
A
- can have lots of blood loss, risk of fat embolism
- tx: ORIF with traction after, hip spica cast
59
Q
tibia fracture
A
- risk of compartment syndrome
- neurovascular assessment q 2 hours x 48 hours
60
Q
stable vertebral fracture
A
- fracture with no spinal cord injury
- logroll, orthotic devices, ard vervial collar
- vertebroplasty (inject cement)
- kyphoplasty (balloon and then cement)
61
Q
joint procedures
A
- synovectomy: removal of synovial membrane
- osteotomy: remove a wedge of bone
- debridement: removal of degenerative debris
- arthroplasty: reconstruction or replacement of a joint
62
Q
knee arthoplasty
A
- reason: unremitting pain and instability r/t severe destructive deterioriation of the knee joint
- may replace all or part of the knee joint
- post op: will be in extension while abulating for 4 weeks, exercises on 1st day progressing to gentle ROM until 90 degree flexion, CPM, full weight bearing before discharge
63
Q
total hip arthroplasty
A
- pillow abductor splint between knees esp when turning, avoid extreme hip flexion, dont turn on affected side, OOB on first post op day, in hispital for 3-4 days
- posterior and anterior (bettwe outcomes) approach
- home care instructions: cant drive or take tub bath for 4-6 weeks; knees must be kept apart; dont cross legs; dont twist to reach behind; quadriceps and hip muscle exercises; high risk for thromboembolism; no high-impact exercises/sports
64
Q
teaching for amputation
A
- sterile technique for dressing changes
- immedaite prosthesis vs delayed
- dont sit in chair > 1 hr
- lie on abdomen 3-4 times a day to keep hip in extension
- residual limb bandaging
65
Q
osteomyelitis
A
- severe infection of bone, bone marrow, and surrounding soft tissue
- most common microorganism is STAPHYLOCOCCUS AUREUS but can be caused by many organisms
- etiology: indirect entry - hematogenous, young boys, blunt trauam, DM, GI and respiratory infections; direct entry - via open wound, foreign body presence
- patho: microorganisms frow in area of slow cirrculation –> increase pressure in bone –> ischemia and vascular compromise
- infection spreads through bone –> cortex devascularization and necrosis
- dead bone separates from living bone forming sequestra
- sequestra is surrounded by pus and is very hard for antibiotics and WBCs to get
- must be removed surgically or will turn into chronic infection
66
Q
clinical manifestations of acute osteomyelitis
A
- infection of 10 days after symptoms appear
67
Q
clinical manifestations of chronic osteomyelitis
A
- infection losting longer than >1 month or has failed to respond to initial course of antibiotic therapy
- continuous and persistent or process of exacerbations and remissions (flair ups)
- may result in amputation
- systemic signs diminished
- local signs of infection more common (pain, swelling, warmth)
- granulation tissue turns to scar tissue –> avascular –> ideal sire for microorganisms to grow –> impenetrable by antibiotics
68
Q
collaborate care, acute osteomyelitis
A
- vigorous and prolonged IV antibiotic therapy (4 weeks to 6 months)
- cultures or bone biopsy prior to
- surgical debridement and decompression if antibiotic therapy delayed
69
Q
collaborate care, chronic osteomyelitis
A
- surgical removal of dead bone (amputate)
- extended use of antibiotics
- antibiotic impregnated beads
- intermittent or constant irrigation with antibiotics
- wound VAC
- hyperbaric oxygen
- removal of prosthetic devices
70
Q
osteomyelitis interventions
A
- absorbent dressings using sterile technique
- bed rest
- immobilization, NSAIDS
- no exercise or heat application
- observe for antibitoic side effects: hearing problems, jaundice, photosensitivity, achilles tendon rupture
- follow up: monitor patient response to therapy with bone scans and ESR
- rare complications: septicemia, septic arthritis, pathologic fractures, amyloidosis
71
Q
osteoporosis risk factors
A
Alcohol use Corticosteroid use Calcium low Estrogen low Smoking Sedentary lifestyle - heredity, sex, race, early menopause, poor nutrition, sedentary lifestyle, thinness, smoking, alcohol, low testosterone, endocrine diseases, - drug related causes: glucocorticosteroids, anticonvulsants, some antacids, diuretics, thyroid meds
72
Q
osteoporosis
A
- 44 million people have it in US
- 1/2 women and 1/4 men over 50 will sustain an osteoporosis-related fracture
- known as the “silent thief”
- porous bone
- chronic, progressive metabolic bone disease characterized by low bone mass, structural deterioration, increased bone fragility
73
Q
etiology and patho of osteoporosis
A
- remodeling: osteoblasts deposit bone, osteoclasts resorb bone
- bone resorption exceeds bone deposition
74
Q
clinical manifestations of osteoporosis
A
- occurs most commonly in spine, hips, and wrists
- back pain
- spontaneous fractures
- gradual loss of height
- dowager’s hump (kyphosis)
75
Q
osteoporosis prevention
A
- regular weight-bearing exercise
- fluoride
- calcium and vitamin d
- stop smoking
- decrease alcohol intake
- nutrition - foods high in calcium (milk, cheese, yogurt, seafood)
76
Q
screening guidelines for osteoporosis
A
- intial bone scane in women before age 65
- repeat in 15 years if normal
- earlier and more frequent if high risk
- men screened before age 70, by age 50 if iat high risk (history of prostate cancer)
77
Q
osteoporosis collaborate care
A
- treatment of existing disease
- prevent further loss with supplements and meds
- keep ambulatory
- gait aid to prevent falls/fractures
- brace for vertebral fracture
- vertebroplasty and kyphoplasty to treat osteoporotic vertebral fracture
78
Q
drug therapy for osteoporosis
A
- bisphophonates: inhibit bone resportion
- side effects: anorexia, weight loss, gastritis
- proper administration: take with full glass of water, take 30 minutes before food or other meds, remain upright for 30 minutes
*calcitonin: inhibits bone resportion, give IM form at night to minimize side effects, alternate nostrils when using nasal form, must use calcium supplementation
79
Q
low back pain
A
- very common
- causes: strain, instability, osteoarthritis, Degenerative Disk Disease, disk herniation
- straight leg raising test: test for disk herniation (usually in low back) - supine lift leg 60 degrees assess for pain
80
Q
low back pain treatment
A
- analgesics, muscle relaxants, massage, heat and cold
- avoid prolonged bed rest
- ## stop smoking
81
Q
nursing care for back pain
A
- proper body mechanics
- no twisting
- sleep with head up and knees flexed and no pillows under upper back
- dont life above level of elbows
- avoid prolonged sitting or standing
- exercise to strengthen back and abs
- may sometimes use a corset-like brace to provide support
82
Q
Intervertebral disk disease
A
- progressive degeneration: normal process of aging that can lead to herniated disks
- most common sites of slipped disks: l4-5, l5-s1, c5-6, c6-7 (low lumbar and neck area)
- s/s: low back pain, radiuclar pain to buttox and below the knee, for cervical disk have radicular pain to arms/hands, static nerve
83
Q
diagnosis and treatment of back pain
A
- straight leg test is usually positive
- xrya, myelogram, MRI, CT
- conservative treatment first
- may need laminectomy, diskectomy, or spinal fusion
84
Q
spinal fusion
A
- must maintain proper alignment until healing has occured
- oullows under thights when supine, between legs when side laying
- IV opioids for 24-48 hours, muscle relaxants
- watch for CSF leak
- movement and sensation should be unchanged after surgery, check every 2-4 for 48 hours
- clarify if they need brace or corset
- check donor site, usually more painful
- avoid sitting or standing for prolonged times
- no twisting movement of the spine
- firm mattress or bed board
85
Q
NSAIDS
A
- block production of prostaglandins by inhibiting cox1 and cox2
- ibuprofen, naproxen, indomethacin, diclofenac, celecoxib
- side effects: GI irritation, bleeding, renal problems, cardiac problems
- nursing care: give with food, watch for bleeding s/s, don’t combine with aspirin
86
Q
salicylates
A
- inhibit synthesis of prostaglandins
- aspirin most common
- side effects: GI irritation, bleeding, tinnitus, worsening of asthma
- nursing care: give with good, watch for bleeding, don’t combine with NSAIDS
87
Q
acetaminophen
A
- tylenol
- analgesic and antipyretic, not an antiinflammatory
- side effects: live toxicity
- nursing care: primary tx for OA and mild pain, limit to 4 grams/day, DO NOT take if alcoholic or have liver disease
88
Q
topical analgesics
A
- block pain by locally interfering with substance P thus interrupting pain signals to the brain
- capsaicin cream, voltaren gel
- side effects: skin irritation
- nursing care: dont use creams with a heating pad, avoid oral NSAIDs
89
Q
corticosteroids (intraarticular injections)
A
- inhibit synthesis and/or release of mediators of inflammation
- methylprednisolone, triamcinolone
- side effects: local osteoporosis, tendon rupture, skin changes, local infection
nursing care: HCP should use strict sterile technique, often makes the pt feel worse for 24-48 hours, can last for weeks to months
90
Q
corticosteroids (systemic)
A
- inhibit synthesis and/or release of mediators of inflammation
- solu-cortef, solu-medrol, dexamethasone, prednisone
- side effects: cushing syndrome, HTN, psychosis, diabetes, acne, menstrual problems, hirsutism, immunosupression, bruising
- nursing care: tape dose and use shrot term when possible, watch for side effects closely, nt for osteoarthritis
91
Q
hyaluronic acid (HA)
A
- lubricates, maintains normal joint cushioning
- orthovisc, synvisc, hyalgen
- side effects: not many, pain, redness, rare to have an allergy
- nursing care: typically given as 3 weekly injections directly into joint space, may give pain relief up to 6 months
92
Q
antimalarials
A
- unknown acton, but may supress formation of antigens
- plaquenil
- side effects: retinopathy, ototoxicity, low BP, ecg changes
- nursing care: have pt immediately report vision changes and hearing changes, may take up to 6 months to take full effect
93
Q
diease modifyin antirheumatic drugs (DMARDs)
A
- rapid, antiinflammatory effect, inhbiits DNA, blocks immunce cell over production
- methotrexate, sulfasalazine, arava
- used aggresively for RA to prevent irreversible join changes
- side effects: hepatotoxicity, bone marrow dpression, teratogenic
- nursing care: monitor CBC, hepatic, and renal function
94
Q
biologic/targeted therapy
A
- slows disease progression in RA
95
Q
immunosupressants
A
- inhibit DNA, RNA, and protein synthesis
- imuran, cytoxan, cellcept
- side effects: n/v, rash, anorexia, teratogenic, hemorrhagic cystistis with cytoxan, infection
- nursing care: avoid live vaccines, watch for bleeding, infection
- may take up to 3 months to work
96
Q
disease modifying osteoarthritis drugs (DMOADs)
A
- slow progression or support joint healing
- still under investigation
97
Q
arthritis
A
- number one chronic complaint and cause of disability in the US
- rheumatic disease incolving bone, muscle and joints
- 2 common types: osteoarthritis, Rheumatoid arthritis, gout
98
Q
osteoarthritis
A
- involves formation of new joint tissue in response to cartilage destruction
- not a normal part of aging
- lose flexibility
- bone on bone, decreased cartilage
- risk factors: age, menopause, genetics, obesity, overuse, trauma
99
Q
OA signs and symptoms
A
- no systemic symptoms
- joint pain ranging from mild discomfort to significant disability; pain worse with joint use;
- early morning stiffness resolving within 30 minutes, stiffness worse with rest or static positions
- over activity may cause mild joint effusion, stiffness
- crepitus
- deformities: heberdens nodes, bouchards nodes, knee joint misalignment, leg length discrepancy
100
Q
OA diagnosis and treatment
A
- xrays, mri, ct scan, bone scan
- labs: will be normal, synovial fluid will be clear yellow with little/no sign of inflammation
- tx: aimed at symptom reduction - exercise, prevent joint stress, coping/managing pain, control weight, assure patient that OA is localized disease and severe deforming arthritis is not the usual course
- rest/joint protection: balance rest and activity, rest and splint with acute inflammation, use assistive devices
- heat/cold
- drugs: tylenol q 6 hours, topicals, nsaids for more severe pain, intraarticular corticosteroids
101
Q
Rheumatoid arthritis
A
- more common in women than men
- characterized by gradual onset and remissions and exacerbations of inflammation within the joint
- fingers, wrists, knees, spine
- chronic inflamm that can cause severe joint deformities and loss of function over time
- thought to be an autoimmune disease
102
Q
RA risk factors
A
- women
- predisposing gene
- exposure to an infection
- advanced age
- smoking over a period of years
103
Q
RA S/S
A
- malaise/fatigue
- symmetirical pattern of joint inflamm
- pain, stiffness, swelling
- gelling, joints stiff after rest
- elevated sedimentation rate
- presence of serum rheumatoid factor
- elevated WBC in synovial fluid of inflamed joint
- erosion of bone
- pain more prevealanet
- more debilitaiton than with OA
104
Q
RA goals of care
A
- can avoid permanent joint damage if diagnosis and tx start early
- educate: exercise and mobility, individual PT/OT, independence with ADLs
105
Q
RA diagnosis
A
- labs: RF, ESR, CRP, ANA titers, anti-cpa
- synovial fluid is straw colored with fibrin flecks and high WBC count
- ## bone scan can diagnose, not xrays
106
Q
RA complications
A
- joint destruction
- cataracts, vision loss
- ulcerated nodules
- hoarseness
- cardipulmonary effects
- carpal tunnel syndrome
107
Q
RA Nursing care
A
- prevention is not possible
- refer to arthritis foundation
- help make easy drug regimen
- plan around morning stiffness
- alternate scheduled rest periods with activity
- encourage positions of extension, not flexion
- no pillows under the knees an use only a small pillow under the head and shoulders
- heat cold and exercise
108
Q
gerontologic considerations
A
- OA is most common type of arthritis in elderly, but consider other types
- lab values may be affected by aging
- be careful with NSAIDs and corticosteroids
109
Q
gouty arthritis
A
- disease in which acute attacks of arthrits pain occur as a result of elevated levels of serum uric acid
- joint inflamm caused by sodium urate crystals in joint
- most commonly affected joint is great toe
- affected joint becomes hot, reddened, tender
- most common in middle aged men
- risk factors: obesity, HTN, diuretic use, excessive alcohol use, genetics, AA; diet high in purine wont cause gout but can trigger an attack
110
Q
S/S of goutry arthritis
A
- may occur in 1-3 joints
- joints may be cyanotic, tender
- onset usually at night with sudden swelling and excruciating pain
- may have low grade fever
- tophi
111
Q
diagnosis and treatment of gouty arthritis
A
- uric acid >6, may need 24 hour uric acid levels, joint aspiration
- if colchicine works, then diagnostic
- tx: colchine, NSAIDs, prevent future attacks with alloprinol
- ## avoid alcohol and high purine foods
112
Q
nursing care for gouty arthritis
A
- nutrtion: weight control, limit alchol, limit foods with purine
- nursing: careful jandling to avoid causing pain, bed rest with joint immobilization, elevation doesnt help = pain is due to crystals
113
Q
Lyme Disease
A
- spriochetal infection caused by borrelia burgdorferi (transmitted by bite of deer tick), no person-to-person transmission
- minics MS, mono, meningitis
- S/S: erythema migran appearing 2-30 days after exposure
- actue viral like symptoms
114
Q
lyme disease diagnosis and treatment
A
- dx: E lesion , hx of exposure, CBC/ESR are noral
- tx: oral antibiotics, doxycycline can be given to prevent infection within 3 days after tick bite
- prevention: DEET, remove attached ticks with tweezers and pull out, wash with soap and water
115
Q
septic arthritis
A
- infectious or bacterial arthritis with invasion of the joint cavity with microorganisms (staph aurus)
- usually affects large joints; severe pain, swelling, erythema; fever and chills
- diagnosis by joint aspiration
- tx: antibiotics, may take 2-8 weeks, getnle ROM, local hot compression
116
Q
spondyloarthropathies
A
- group of interrelated multisystem inflammatory disorders that affect the spine, peripheral joints, and peri-articular structures
- all are negative for RF
- HLA-B27 antigen is strongl assocaited with these
- most common is ankylosing spondylitis, psoriatic arthritis, reactive arthritis
117
Q
ankylosing spondylitis
A
- primarily affects the SI joints, disc spaces, costovertebral joints
- men are 3-5 times more likely,
118
Q
S/S anylosing spondylitis
A
- symmetric sacrolitis
- low back pain, and stiffness with limitation of motion worse during the night and in the morn but improvs with mild activity
- chest pain, sternal costal cartilage tenderness
- fixed kyphosis
- can have heart and lung complications
119
Q
diagnosis and treatment of ankylosing spondylitis
A
- xray, Ct scan, mri
- elevated ESR, mild anemia, HLA-B27
- tx: cant prevent, heat, NSAIDS, asa, local corticosteroids, exercise once pain and stiffness are better, postural control, hydrotherapy, surgery for severe deformities
120
Q
nursing care of ankylosing spondylitis
A
- baseline ROM
- stop smoking
- proper positioning at rest
- firm mattress
- sleep in bac with flat pillow
- avoid heavy lifting, prolonged exercise
121
Q
psoriatic arthritis
A
- inflammatory skin disorder with red, scaly patches
- 4 forms: small joints of hands/feet, asymmetric extremely joints, symmetric polyarthritis, arthrisits of SI joings and spine
- looks a lot like RA
- elevated ESR, mild anemia, elevated uric acid
- tx: splinting, PT, NSAIDs, DMARDs
- psoriasis of skin, plaques of skin
122
Q
reactive arthritis (reiter’s syndrome)
A
- more common in young men
- includes conjuntctiviti, muscotaneous lesions
- caused by GU or GI infections (chylmidia)
- disease develops within 1-2 weeks after infection
- asymmetric involvement of large joints of lower extremeties and toes
- tx: doxycycline, OT
- most pts recover within 2-16 weeks
123
Q
systemic lupus erythematosus
A
- SLE
- multisystem inflammatory autoimune disease n which circulating immune complexes are deposited in organs causing inflammation
- can be genetic, hormonoal (worses with onset of menarche), sun exposure, sunburns, infection; drugs: procainamide, hydralazine, antiseizure
- affects skin, joints, serious membranes, renal, hematologic, neurologic systems
- usually occurs in women of child-bearing age
124
Q
S/S systemic lupus erythematosus
A
- renal: lupus nephritis in 50%
- nervous system: neuropsychiatric symptoms, seizures, anxiety, psychosis, headaches
- hematologic: antibidoies against blood cells
- infection: increase susceptibility, major cause of death esp pneumonia
- dx: no specific test to diagnos, ANA positive
- tx: manage the active phase of the disease while preventing complications of tx that cause long term tissue damage
125
Q
SLE medications
A
- NSAIDs
- hydroxychloroquine for fatigue and skin/joint problems
- need regular eye exams
- limit corticosteroid use except when severe
- immunosupressants
- anticoagulants for blood clots
126
Q
SLE nursing care
A
- prevention is not possible
- disease is unpredictable, even with regimented meds
- many psychosocial issues to deal with
- avoid sun
127
Q
systemic sclerosis
A
- fibrotic, degenerative and inflamm changes in skin, blood vessels, synovium, skeletal muscle and internal organs
- 2 types: limited cutaneous disease, diiffuse cutanous
- more common in AA
128
Q
systemic sclerosis patho and etio
A
- cause is unknown, think autoimmune
- risk factors include occupational exposure to coal, plastics, silica dust
- collagen is overproduced
129
Q
systemic sclerosis: CREST
A
- calcium deposits
- raynaud’s syndrome
- esophageal dysfunction
- sclerodactly - tightening of skin
- telangiectasia - red spots on hands, forearm, palms
130
Q
systemic sclerodis: diagnosis treatment
A
- dx: labs - SCL-70 or anticentromere antibody
- xray to show calcification
- tx: PT, OT, no drugs are affective
131
Q
systemic sclerosis nursing care
A
- prevention is not possible
- no finger stick blood tests
- good oral hygeine, job modifications
132
Q
polymyositis and dermatomyositis
A
- diffues, idiopathic, inflamm myopathies of striated muscle that produce bilateral weaknes
- common in women 45-65
- etio/patho: associated with humoral immunity
- dx: MRI, EMG, muscle bipsy, CK elevated, myoglobin elevated, ESR elevated in active disease
133
Q
S/S polymyositis and dermatomyositis
A
- weight loss, fatigue, weakness
- unable to move muscles against resistenace or gravity
- demal: classic violet colored cyanotic or erythematous symmetric rash with eema around eyelids
- joint redness, pain, inflamm
- weka pharyngeal muscles
- interstitial lung disease
134
Q
treatment and nursing care polymyositis and dermatomyositis
A
- high dose corticosteroids, if that doesnt work use immunosupressants
- IV immunoglobin for dermatomyositis
- PT, massage
- daily ROM
135
Q
sjorgren’s syndrome
A
- comomon autoimmune disease that targets moisture producing glands causing xerostomia and keratoconjuncitivits sicca
- affects mainly women (90%0 > age 40
- s/s: tearing, gritty sensation in the eyes, burining, blurry vision
- risk of non-hodgkin’s lymphoma
- dx: eye exam, salivary gland tests
- tx: symptomatic, artifical tears, increased fluids with meals, good dental hygeine
136
Q
soft tissue rheumatic syndromes
A
- myofacial pain syndrome
- fibromyalgia syndrome
- chronic fatigue syndrome
- need multidisciplinary approach
137
Q
myofacial pain syndrome
A
- chronic muscle pain typically in chest, neck, shoulders, hips, low back
- results from muscle trauma or chornic strained muscles
- deep, aching, burning stinging, stiffness pain
- simialr to fybromyalgia
- dx: palpation of trigger pints with hardness and muscle twitch
- tx: PT, lidocaine, acupuncture
138
Q
fibromyalgia syndrome
A
- chornic, widespread, nonarticular musculoskeletal pain and fatiuge with multiple tender pints, nonrestorative sleep, morning stiffness, IBS, anxiety
- major cause of disability
- patho: recent viral illness or trauma may trigger
- dx: must have pain at 11 tender points and hx of widespread pain for at least 3 months
- S/S: widespread burning pain that worsesn and improves thorughout teh day, 11 tender pints, difficiuly concencentrating depression, IBS, diff swallowing, diffi menstruating
139
Q
tx and nursing care fibromylagia
A
- rest
- motivated pt
- low dose flexeril, SSRIs at high dose
- manage with NSAIDs
- antianxiety meds
- neurontin, lyrica, cymbalta
- nursing care: massage, heat and cold, yoga, limit sugar, caffeine, alcohol, relaxation strategies
140
Q
chornic fatigue syndrome
A
- debillitating fatigue an immune problems
- recover is more common if disease has acute onset
- may be triggered by flu like illness
- dx: need to rule out other disorders
- nursing care: take all complaints seriously, NSAIDs, exercise, well-balanced diet
