M/S & Rheumatic Problems Labs & Dx (Exam 3) Flashcards
Standard X-Ray
Anterior-Posterior provides one-dimensional view of any bone in the body
Lateral Provides two-dimensional
Standard X-ray: Nursing Responsibilites
Remove radiopaque object (metal in bra)
Avoid excessive exposure
CT scan
3 dimensional pictures
CT scans are used more for
Soft tissue and bone abnormalities
Some types of trauma (more quick than MRI)
CT: NSG Consideration
Explain that is painless
If contrast — confirm no shellfish allergies
Encourage fluids after
MRI
Radio and magnetic waves to view soft tissue
MRI: NSG consideration
Inform that it is painless
Inform loud ticking noises normal
Ensure no metal on or in patient
Anti-anxiety medicine prn r/t claustrophobia (BENZO)
What medication might you have to give someone before an MRI
Anti-anxiety medicine PRN
r/t claustrophobia (BENZO)
Serologic Study: Rheumatoid Factor
Asses for presence of autoantibody (RF) in serum
Is RF specific to RA?
NO, Not specific to RA/seen in other tissues and in small percentage of normal population
What is normal RF test result?
Negative is expected
Erythrocyte Sedimentation Rate
Non-specific indication of inflammation
(osteomyelitis)
(RA)
ERS is elevated in what two disease that we are discussing?
Rheumatoid Arthritis
Osteomyelitis
Normal ESR
<30 mm/hr is the normal expected
Serologic Study: C-reactive Protein
Used to diagnose ACUTE inflammatory disease, infection and active widespread malignancies
Non specfic
Serologic Study: Uric Acid
End product of protein metabolism (normally excreted via urine)
Uric Acid levels are typically increased with
GOUT
Not specific to Gout
Serologic Study: Anti-citrullinated protein antibody (ACPA)
Anti-CCP (another name)
Important for diagnosis of RA
More specific than RF for RA; may allow for earlier more accurate diagnosis
What is an important diagnostic test of Rheumatoid Arthritis?
Anti-CCP
ACPA
What is more specific for RA, RF or ACPA?
ACPA
Anti-citrullinated protein antibody
Serologic Study: Antinuclear Antibody (ANA)
Assess for antibodies capable of destroying nucleus of body tissues
Postive ANA is really indicative of what disease?
SLE (99% positive)
or
RA
What is the normal antinuclear antibody level?
Negative
Serologic Study: Anti-DNA antibody
Detects antibodies that react to DNA
What is the most specific test for Lupus
Anti-DNA antibody
Serologic Study: Complement Levels
Complement-normal body protein, is essential to both immune and inflammatory reaction
Complement levels are depleted with
Immune or inflammatory responses
Depletion of complement levels may be found in patient with
RA or SLE
Radiologic Study: Myelogram w/ or w/o contrast
Asses pathology of spinal cord
Test for Nerve impingement
Myelogram helps us look for what?
Nerve impingement
Myelogram w/ contrast procedure
X-rays after injection of contrast into subarachnoid space
Sedate PRN
Done on tilt table (move contrast up and down)
Encourage fluids
Myelogram: Nursing Assessment
Risk of spinal headache (HORRIFIC)
Should resolve in 1-2 days with rest and fluids
Blood patch may be indicated
How do we try and prevent a spinal headache after a myelogram procedure?
Have patient lie flat for a period of time post procedure
How do we treat a spinal headache?
Blood patch
Blood Patch
Procedure for someone with spinal headache
20-30 ml of blood drawn from periphery and slowly inject into spine = give immediate relief from H/A
Bone Density Scan (Dexa)
Gold standard for measuring bone mineral density
Reported as T-scores
Bone Density Scan is used for assessing?
Osteoporosis
What is the gold standard for measuring bone mineral density?
DEXA scan
Dual energy x-ray absorptiometry
What are the most common places that are scanned with Dexa Scan?
Spine – hips – wirst
Who Should Get a Bone Density Scan?
Women <65… with risk factors in addition to menopause
All women > 65 years
Individual receiving long term steroids
Measure the response to osteoporosis drug therapy
(DOES NOT MEAN MEN DO NOT GET SCANS AS WELL)
Bone Scan
(different than bone density scan)
Injection of radioisotope that is taken up by the bone
Bone Scan Increase in uptake is seen with
-Osteomyelitis (infected)
-Osteoporosis (hallow)
-Malignancies
-Certain Fractures
Bone scan decrease in uptake is seen with
Avascular necrosis (death of bone due to lack of blood supply)
Avascular Necrosis
Death of bone due to lack of blood supply
Bone Scan: Nursing Responsibility
-Radioisotope is given 2 hours before procedure
-Procedure takes one hour of patient lying still
-Not harmful
-Increase fluids after procedure
With bone scan the radioisotope is given how long before the procedure?
2 hours
Alkaline Phosphatase
Enzyme produced by osteoblast of bone
Alkaline Phosphatase is elevated with
Healing fractures
Bone cancer
Osteoporosis
What is the primary organ that stores calcium?
Bone
Circulating serum calcium decreases with
Renal Disease
Hypoparathyroidism
Blood transfusions
Circulating Serum Calcium Increase with
Hyperparathyroidism
Some bone tumors
Phosphorus is ______ related to calcium
So if calcium increases, ______
Indirectly
Phosphorus decrease
Electromyogram
Evaluates electrical potential associated with skeletal muscle contraction
Electromyogram: Procedure
Small gauge needles inserted into muscles and attached to leads that feed information to machine
Electromyogram: Nursing Responsibilities
Usually conducted in EMG lab
Needs to cooperate with voluntary movement (follow commands)
Some discomfort (very tender)
Avoid stimulants / sedatives 24 hours before procedure
