Med Surg: Care of patient with musculoskeletal problems Flashcards
What is rheumatoid arthritis?
Chronic, progressive, systemic, inflammatory disease
Cause may be related to a combination of environmental and genetic factor
Leads to destruction of connective tissue and synovial membrane within joints
Transforming autoantibodies form, attack healthy tissue causing inflammation
Weakens the joint, leading to dislocation and permanent deformity or fusion of the joint
Pannus forms at junction of synovial tissue and articular cartilage and projects into joint cavity
Exacerbation occur during periods of physical or emotional stress and fatigue
Risk factors include exposure to infectious agents
Vasculitis can impede blood flow: leads to organ or organ system malfucntion and failure r/t tissue ischemia
What is the assessment for Rheumatoid arthritis?
Inflammation, tenderness and stiffness of the joints
Moderate to severe pain with morning stiffness lasting longer than 30 minutes
Joint deformaties, muscle atrophy and decreased ROM in affected joints
Spongy, soft feeling in the joints
Low grade fever, fatigue and weakness
Anorexia, weight loss and anemia
Elevated ESR, positive rheumatoid factor, ANA, SRP
x-ray shoing joint deterioration
synovial tissue biopsy reveals inflammation
What is the treatment of Rheumatoid Arthritis?
NSAIDS: COX-2 inhibitors
DMARDs: antimalraial, methotrexate-mod-severe disease, gold compounds, azathioprine and D-penicillamine, combination therapy
Glucocortiods
Biological response modifiers
Others: antibiotics
What is the physical treatment of Rheymatoid arthritis?
Preserve joint function
Provide ROM exercises to maintain joint motion and muscle strength
Balance rest and activity
Splinting during acute inflammation to prevent deformity
Prevent flexion contractures
Use heat and cold therapy, paraffin baths, massage
Exercise program
Avoid weight bearing on inflamed joints
What are the ADL and self-care treatment of rheumatoid arthritis?
Assistive devices-raised toilet seats, self rising chairs, W/C and scooters
adaptive equipment
alternative stratigies for ADL
What is treatment for fatigue in Rheumatoid arthritis?
Identify factors that contribute
Monitor for signs on anemia
Monitor for blood loss
Teach patient to pace activiteis and use assistance when possible
What is the surgical interventions for Rheumatoid Arthritis?
Synovectomy: surgical removal of the synovia to help maintain joint function
Arthrodesis: bony fusion of a joint to regain mobility
Joint replacement or arthroplasty: surgical replacement of diseased joints with artificial joints to restore motion to a joint and function to the muscles, ligaments and other soft tissue stuctures that control a joint
What is osteoarthritis?
Progressive degenerative of joints as result of wear and tear
Cuases bone buildup and loss of articular cartilage in perpheral and axial joints
Affects eight-bearing joints and joints that receive greatest stress
Cause unknown but factors may include trauma, fractures, infections, obesity, smoking and job related repetivitve stress activities
What is the assessment of osteoarthritis?
Joint pain that diminishes after rest and intensifies after activity
Pain occurs slight motion or even at rest
Symptoms aggravated by temp change and climate humidity
Heberden’s nodes or Bouchard’s nodes
Joint swelling, crepitus and limited ROM
Difficulty getting up after prolonged sitting
Skeletal muscle disuse atropy
Inability to perfom ADL
Compression of spine-radiating pain, stiffness and muscle spasms in one or both extremities
What is pain control treatment?
NSAIDS, muscle relaxants and other meds
Corticosteriod injection into joints
Position joints in fucntional position and acoid flexion of hip and knee
Immobilize joints with splint or brace when inflamed
AVoid large pillows under head or knees
Moist heat, hot pack/compresses and paraffin dip
Cold apllication for acute inflammation
Adequate rest
What is the nutrition treatment os osteoarthritis?
Well balanced diet
Maintain/attain normal weight
What is physcial mobility treatment of osteoarthritis?
Balance rest and actiivty
Exercise program that limits stressing affected joints
Active exercise rather than passive-stop if pain occurs
Limit exercise when joint inflammation is severe
What is the surgical management of osteoarthritis?
Osteotomy: bone resected to correct joint deformity, promote alignment and reduce joint stress
Total joint replacement or arthroplasty
- used when all other measures fail
- most common: hips and kneee
- contraindicated if infection anywhere in body, advanced osteoporosis or severe inflammation is present
What is total joint replacements?
Cemented or cemenless
varied approaches: antior or posterior
Activity restrictions
Pain control
Monitor CMS
Prevent complications: hemorrhage, DVT, pneumonia, dislocation and infection
What is a total knee replacement?
Monitor CMS
Pain control
Prevention of complications:
- hemorrhage
- DVT/PE
- Infection
- Limited motion
What is osteoporosis?
Age related metabolic disease
Bone demineralies, losing calcium and phosphorus salts resulting in fragile bones and fractures
Bone resorption accelerates as bone formation slows
Occurs commonly in wrist, hip & vertebral column
Can ossur post-menopausally or as result of a metabolic disorder or calcium deficiency
May be asymptomatic until bones become fragile and a minor injury or movment causes a fracture
What is a primary osteoporosis?
Most often occurs in post menopausal women
Risk factors include decreased calcium intake, deficient estrogen and limited resources
What is secondary osteoporosis?
Causes include prolonged therapy with corticosteriods, thyroid-reducing meds, aluminum-containing antacids, or anticonvulsants
Associated with immobility, alcoholism, malnutrition or malabsorption
What are risk factors of osteoporosis?
Cigarette smoking
early menopause
excessive use of alcohol
family history
female gender
increasing age
insufficient intake of calcium
sedentary life
thin, small frame
White or Asian race
What is the assessment of Osteoporosis?
May be asymptomatic
Back pain occurs after lifting, bending or stooping
Back pain increases with palpation
Pelvic or hip pain espeically with wight bearing
Problems with balance
Decline in height from vertebral compression
Kyphosis of the dorsal spine
Pathological fractures
Degeneration of lower throax and lumbar vertebrae on x-ray
What is the treatment of Osteoporosis?
Decrease risk of injury: safe home environment, assistive devices, firm mattress to decrease bending
ADL: move client gently when turning and repositioning, gental ROM exercises, assist to ambulate is unsteady, back brace during acute phase to stablize/support spine
Optimize health and function: body mechanics, abdominal and abck muscle strengthening exercise, avoid activites that can cause compression, diet high in protein, calcium and vitamins C&D&iron, adequate fluid intake to prevent renal calculi
Medications: calcium, vitmain D, phosphorus, calcitonin to inhibit bone loss, estrogen or androgens to decrease rate of bone resorption, analgesics, muscle relaxants and anti-inflammatory meds for pain
What are drug therapaies for osteoporosis?
Estrogen replacement
Calcitonin
Biphosphornates
Estrogen receptor modulators
Teriparatide
What is Scoliosis?
Occurs when vertebrate rotate and begin to compress
As curvurture increases damage to vertebral bodies occur
Curvature inccrease during periods of growth
What is Gout?
Systemic disease in which urate crystals deposit in joints and body tissues
Results from abnormal amounts of uric acid in the body
Primary gout results from disorder of purine metabolism
Secondary gout incolves excessive uric acid in blood caused by another disease
What are the phases of Gout?
Asymptomatic: serum uric acid level elevated, no symptom
Acute: excruciating pain and inflammation of small joints
Intermittent: periods w/o symptoms between acute attacks
Chronic: repeated episodes of acute attacks
What is the assessment of Gout?
Swelling and inflammation of the joints with excrucitating pain
Tophi: hard, irregular shaped nodules in the skin containing chalky deposits of sodium urate
Low-grade fever, malaise, headache
pruritis from urate crystals in skin
renal stones from elevated uric acid levels
What are interventions of gout?
low purine diet: avoid organ meants, wines and aged cheese
High fluid intake to prevent stone formation 2000 ml/day
Weight reduction if appropiate
Avoid alcohol and starvation diets
Avoid ASA and diuretics and precipitate attack
Increase urinary pH (above 6) by eating alkaline ash foods such as citris fruits, juices, milk and dairy
Bedrest and elevate affected extremitiy during acute attacks
Protect joint, position in mild flexion, monitor ROM
What is systemic lupus erythematosis?
Chronic, inflammatory, autoimmune disorder affecting connective tissue
2 forms:
- Discoid: affects only skin
- Systemic: affects multiple organs and can be fatal
What is the susceptibility of SLE?
Genetic predisposition
Stress
Streptococcal or viral infections
Exposure to sunlight or UV light
Immunization
Pregnancy
Abnormal estrogen metabolism
Drugs
What are the clinical manifestations of SLE?
Onset may be acute or insidious
fever
Anorexa, N&V, diarrhea, constipation
Weight loss
Malaise, fatigue
Abdominal pain
Rashes
Polyarthralgia
Blood disorders: anemia, leukopenia, thrombocytopenia, elevated ESR
Irrregular menstraution or amenorrhea
What are systemic signs of SLE?
Skin: rash on area exposed to light
CV: chest pain, dyspnea, tachycardia, central cyanosis and hypotension
Neuro: seizure disorders, confusion, emotional liability, psychosis, headaches, irritability, stroke, depression
Urinary: infrequent urination, urinary frequency, painful urination, bladder spasms
What is the drug therapy of SLE?
Topical corisone drugs
Plaquenil
Tylenol or NSAIDs
Chronic steriod therapy
Immunosupressive agents
New drugs in clinical trials: Lupozor, Belimumab
