Med-Surg: Musculoskeletal/2 Flashcards
gouty arthritis GA
systemic inflammatory disease caused by problems with purine metabolism (primary gout) or hyperuricemia (secondary gout)
systemic inflammatory disease caused by problems with purine metabolism (primary gout) or hyperuricemia (secondary gout)
GA
GA CFs
5
- family hx
- excessive alcohol
- high purine intake - organ meats, yeast, sardines, spinach
- obesity
- comorbid conditions of DM and/or KD
high purine intake =
GA
GA manifs.
4
- excruciating pain and inflammation in one or more small joints - big toes most common
- tophi - deposits of sodium urate crystals, generally appear after years of GA
- progressive joint damage and deformity
- increased incident of uric acid renal stone
GA dx procedures
3
- serum uric acid > 7
- ESR
- synovial fluid analysis - will show uric acid crystals
GA NIs
4
- maintain best rest during attacks
- use bed cradle to keep linen off joint
- 3l fluid/day
- limit high purines
GA acute phase and chronic tx meds
acute - colchicine
chronic - allopurinol
colchine is to
GA acute attack med
allopurinol is to
GA chronic rx treatment
GA and weight loss
lose weight slowly; rapid weight loss can cause attack or increase the incidence of uric acid renal stones
comminuted fractures aka
fragmented
bone fracture 6 P’s
pain pressure paralysis pallor pulselessness paresthesia
fat emoblism s/s
7
- confusion
- anxiety
- tachycardia
- chest pain
- tachypnea
- hemoptysis
- petechiae over neck, upper arms, chest, abd (late sign)
compartment syndrome is irreversible if compromise persists beyond
4-6 hours
compartment syndrome s/s
- pain unrelieved by position or meds
- cyanosis
- tingling
- paralysis
precursor of Osteoporosis
osteopenia
osteoporosis CFs - primary
8
- women 65+
- men 75+
- asian, white
- family hx
- estrogen or androgen def
- protein def
- sedentary life
- smoking alcohol
osteoporosis CFs - secondary
7
- bone cancer
- cushing’s
- DM
- meds
- paget’s disease
- prolonged immobilization
- RA
osteoporosis manifs.
4
- shortened height
- hx of fractures
- thoracic kyphosis
- decreased bone mass
PTH route
sq, daily, for osteoporosis tx
osteomyelitis CFs
5
- DM
- hemodialysis
- injection drug use
- poor blood supply
- recent trauma
osteomyelitis manifs. - main ones
4
- bone pain
- fever
- general discomfort
- local swelling, redness, warmth
osteomyelitis dx proc. - not extensive list
2
- bone biopsy - which is then cultured
2. bone scan
osteomyelitis NIs
3
- IV antibiotics
- if wound drainage - do contact precautions
- implement wound irrigation
osteomyelitis therapeutic measures
2
- surgical excision of dead and infected bone may be needed
2. bone grafting may be performed in large impacted areas
total joint arthroplasty post op for hip
3
keep abductor pillow in place while in bed, do not flex hip more than 90 degrees, do not position on operative side
total joint arthroplasty post op for knee
maintain continuous passive motion CPM machine to promote joint mobility
total joint arthroplasty opioid rxs
2
extended release epidural morphine or PCA
amputation meds
5
- opioids for residual limp pain
- calcitonin to reduce phantom pain
- antispasmodics for muscle spams
- beta blockers for constant, dull, burning pain
- antiepileptic drugs for knife-like or sharp burning pain
amputation - calcitonin
reduces phantom pain
amputation - beta blockers
relieves constant, dull, burning pain
amputation - antiepileptic meds
relieve knife-like or sharp burning pain
