Exam 3 - Chpt 36 Musculo. Disorders Flashcards
most common form of athritis
osteoarthritis (OA)
osteoarthritis used to be called what?
degenerative joint disease (DJD)
slow, progressive, non-systemic, non-inflammatory disease
affects articulating and weight bearing joints
osteoarthritis (OA)
OA risk factors
trauma repetitive activities inflammation obesity neuro disorders skeletal deformities hema/endocrine disorders meds aging genetics
s/sx of OA
pain loss of function loss of mobility coordination, posture joint stiffness crepitation malalignment, deformity subluxation Herbenden's nodes Bouchard's nodes
Herbenden’s nodes location
joint closest to finger tip
Bouchard’s node location
joint mid finger
multiple compartment arthritis effects the __ joint
whole
single compartment arthritis effects ___ joint
partical
OA s/sx in hips/knees
disabling uni, bilateral pain difficulty sitting, rising crepitus flexion deformities decrease ROM one leg shorter
Dx OA
H&P XR CT MRI bone scan ESR synovial fluid aspiration (not useful in Dx OA but r/o autoimmune disease of the joint such as RA)
OA treatment goals
control pain
prevent progression, disability
maintain, restore joint function
OA complementary/alternative therapy
acupuncture massage Tai Chi Yoga TENS
OTC OA supplements
Glucosamine
Chondroitin
Other OTC OA meds
Acetaminophen (no more than 4G daily)
NSAIDs
Topicals
ASA
Rx OA meds
Arthrotec (Diclofenac)
Hyaluronic acid derivatives
Intraarticular corticosteroids
OA health promotion measures
eliminate excess strain on joints
proper body mechanics, posture
reduce trauma on joints
no acute, strenuous, repetitive exercise/activity
OA home care
safety pain relief rest joints - splints heat/cold exercise stretch gloves sexual counseling
long-term corticosteroid use decreases
bone density
types of joint surgeries
synovectomy osteotomy debridement arthrodesis arthroplasty -reconstruction, replacement of joint; can part of or all the joint
acute arthritis characterized by elevation of uric acid in the blood, depositing uric acid crystals into the joint
gout
how long can gout flares last
last days to weeks followed by long periods without s/sx
how many joints does gout usually occur in
1
gout risk factors
more common in men
hyperuricemia
postmenopausal
organ transplant
primary hyperuricemia
heredity (error of purine metabolism/overproduction/retention of uric acid)
severe dieting/starvation
excessive intake of high purine foods
secondary hyperuricemia
r/t to another disorder:
- meds that inhibit uric acid excretion
- increased cell turn over (leukemia, MM, psoriasis, some types of anemia)
causes of hyperuricemia
acidosis, ketosis alcohol atherosclerosis chemo drugs DM drug-induced renal impairment lead exposure hyperlipidemia HTN malignant disease myeloproliferative disorders obesity, starvation renal insufficiency sickle cell anemia
common drugs that can lead to hyperuricemia
ASA
diuretics: thiazide, furosemide
niacin
*ethanol (in book, not PPT)
will a diet high in purines cause gout?
No but it will lead to a gout attack
high purine foods
red meat
organ meat
shellfish
fructose drinks
acute gout s/sx
precipitating event dusky, cyanotic joint extreme tenderness low grade fever podagra 1 or more joints, but less than 4 subsides 2-10 days
chronic gout s/sx
multiple joints
tophi
gout complications
joint deformity OA tophaceous deposits infection kidney/urinary stones renal disease
how to Dx gout
synovial fluid analysis serum uric acid levels 24 hour urine specimen CBC ESR XR
gout treatment goals
terminate acute attacks
prevent future attacks
prevent complications
gout medication management
Colchicine (Colcrys) NSAIDs corticosteriods Benemid Zyloprim (Allopurinol_ Oxypurinol
nutritional management of gout
low purine diet
limit alcohol
increase fluids
support care for gout
bed rest, immobilize joint
careful handling of joint
application of heat, cold
splint/brace for OA immobilization should not be worn more than how long?
> 1 week
is heat or cold therapy more often used for OA?
heat
heat therapy is used for ___ whereas cold therapy is used for ___.
heat: stiffness
cold: acute inflammation
Rx therapist for OA
PT
OT
Why are medications taken by OA pts?
symptom management
initial analgesic therapy for OA
Acetaminophen
caution using Celecoxib in pts with what health issues?
cardiovascular
Arthrotec is used where?
hands
knees
what occurs with viscosupplementation?
injection of gel-like substance (hyaluronate) into a joint (intra-auricular)
*thought to supplement synovial fluid; aim to prevent loss of cartilage, repair defects
acute nursing interventions for OA
meds balance rest/activity rest the joint heat, cold assist with ADLs body alignment, posture educate
polypharmacy can lead to ___ changes or overlapping side effects in older adults
arthritic
older adults with musculoskeletal pain may not have arthritis but their symptoms may be caused by what?
depression
physical inactivity
hyperuricemia is > than
6.8
where is tophi usually located?
ear
hands
great toe
symptom free period between gout attacks
intercritical stage
