Exam 2: Arthritis, musculoskeletal Flashcards
Assessment of Osteoarthritis (OA) (Degenerative Joint Disease)
- Usually older than 60
- Joint pain and stiffness
- Crepitus
- Heberden’s nodes
- Bouchard’s nodes
- Joint effusions
- Atrophy of skeletal muscle
Nonsurgical management of Osteoarthritis (OA) (Degenerative Joint Disease)
Drug therapy:
- Oral: acetaminophen drug of choice
- NSAIDS if needed and can tolerate
- Topical: lidocaine patches, trolamine salicylate; capsaicin, buspirone
- Injections: cortisone; hyaluronic acid
Rest, immobilization CAM Positioning Thermal modalities Weight control - Integrative therapies - Glucosamine, chondroitin
Post-op care of joint replacement
Pain control
- Peripheral nerve blockade or
- Continuous femoral nerve blockade (CFNB)
Collaborate with patient/family to become safety partners to prevent complications
- Hip dislocation or subluxation
- —-Abduction pillow
- VTE
- Infection
- Anemia
- Neurovascular compromise
Post-op care of joint replacement Patient teaching
- do not sit or stand for prolonged periods
- Do not cross legs beyond the midline of your body
- Do not bend your hips more than 90 degrees.
- Do not twist body when standing
- Use ambulatory aid
- Resume sexual intercourse as usual if surgeon says so
Rheumatoid Arthritis management with pharmacological aid
DMARDs (Disease modifying antirheumatic drugs)
- Methotrexate (Rheumatrex) (risk of infection, use another form of birth control, avoid alcohol)
- Leflunomide (Arava)
- Hydroxychloroquine (Plaquenil) (avoid being in the sun)
NSAIDs
COX-2 inhibitor
- Celecoxib
BRMs (Biological response modifiers)
- Etanercept (Enbrel)
- Adalimumab (Humira)
- infliximab (Remicade)
Other:
- Glucocorticoids
- Immunosuppressive agents
Associated Syndromes and complications with Rheumatoid Arthritis
- Sjögren’s syndrome
Dry eyes, dry mouth, dry vagina - Secondary osteoporosis
- Felty’s syndrome
RA, hepatosplenomegaly, leukopenia - Caplan’s syndrome
RA nodules in lungs and pneumoconiosis
Gout drug therapy
Drugs: fabroestotate, cultrosine
Acute
Chronic- allopurinol
Greater than 6.5 uric acid is abnormal
Gout nutritional therapy
- Limit proteins
- Avoid trigger foods
- Plenty of fluids
- pH increased with alkaline foods
- Low purine diet
Musculoskeletal system Diagnostic assessment and procedures- Electromyography (EMG)
- Helps diagnose neuromuscular, lower motor neuron, peripheral nerve disorders
- Low electrical currents pass through flat electrodes placed along nerve
- If needles used, inspect needle sites for hematoma formation
Osteoporosis and osteopenia preventions
- Biphsphonates (upright 30 min afterwards and take with water) alendronate (Fosamax) ibandronate ( Boniva) risedronate (Actonel) pamidronate (Aredia) zoledronic acid (Reclast)
- Estrogen ( agonists/antagonists
raloxifene (Evista)
Osteoporosis and osteopenia treatments
- Lifestyle changes
- Nutrition
- Exercise
- OTC supplements
Calcium with D, divided doses - Monoclonal antibodies
denosumab (Prolia) - Other
teriparatide (Forteo)
calcitonin
Osteomalacia etiology
Loss of bone related to a vitamin D deficiency, causing softening of bone
Paget’s Disease etiology
Chronic metabolic disorder
- Excessive osteoclastic activity and osteoblastic activity
- Structurally disorganized, weak bones
- Familial, Sporadic
Phases
- Active
- Mixed
- inactive
Bone tumors: Ewing’s sarcoma lab work
A blood test for levels of an enzyme called lactate dehydrogenase (LDH) is typically done at diagnosis. A high LDH level is often a sign that there is more cancer in the body.
Care of fractures: traction
Goals of traction
- Prevent soft tissue injury
- Realign bone fragments
- Decrease muscle spasms and pain
- Correct deformities
Types of traction
- Straight or running
- Balanced suspension
- Manual
- Skeletal
- Skin
