Mobility Flashcards
MSK
Bone - Weight-bearing supporting structures, protect organs, lever for movement, bone marrow, store calcium and phosphate
Joint/cartilage - where 2 bones meet, can be synarthrodial, diathrodial, arthrodial, absorb shock, bacteria can be trapped
Muscle - cardiac, smooth, skeletal, neuromuscular junction release ATCH
Tendon - Muscle and bone
Ligament - Bone and bone
= Low blood supply so longer to heal
Fractures
Can be open vs closed, complete vs incomplete and direction of fracture (transverse/spiral)
May require surgery or not
Clinical manifestation
- localised pain
- decreased function of bone
- edema/swelling
- crepitus
- bruising
Pathological fractures
Fractures without trauma - occurs in cancer patients or osteoporosis
Fracture complications
1) Infection
Esp in open or surgery -> warmth, redness, swelling, pain, fever
higher risk in immunocompromised
2) compartment syndrome
commonly in leg or forearm
internal factors like bleeding, swelling
external fracture like too tight cast
Obstruction of blood flow causes ischemia very quick in 4-8 hrs
6 Ps - pain, pressure, paresthesia, pallor, pulselesness, paralysis
3) Venous thrombo-embolism
Venous status (hip surgery or knee etc.)
Virchows triad - endothelial damage, venous status, hypercoagulability
Unilateral leg pain and swelling
Prophlyaxtic anticoagulant
4) Fat embolism
When bone breaks, esp long bones like pelvis or ribs
Symptoms - tachycardia, tachypnea, dyspnea
Pulmonary circulation - chest pain, dyspnea, cyanosis, neurological changes as well
Osteoarthritis
Degenerative disease - wear and tear
Risk factor - obesity, trauma, repetitive use, post menopausal, family hX
Thickening of subarticular bones
Osteophysts/bone spurs around the effect joint
Clinical manifestation
- Localised
- Joint pain
- Stiffness worse in AM and with use
- Heberden nodes and Bouchard nodes
- Crepitus
- Asymmetrical
Rheumatoid arthritis
Autoimmune disease where body attacks joints, remissiona nd exacerbation
Cause - genetics, environmental triggers
Clinical manifestations
- General = fatigue, fever, anorexia, weight loss, stiffness
- Pain worse in AM, better with movement
- Bilateral
- Flares, swelling, heat
- Limited movement
Deformities include
1) Ulner drift
2) Swan neck deformity
3) Boutonniere deformity
4) Halluz valgus deformity of foot/bunion
Gout
Rapid onset caused by accumulation of uric acid crystals stuck in small joint spaces
Risk factors - male, obesity, HTN, kidney disease, diuretic, excessive alcohol use, diet high in purinw
1) Hyperuricemia - alcohol esp beer, dehydration, protein-rich meal
2) Underexcertion of uric acid - Body not quick enough to eliminate uric acid - kidney function, fasting, excessive alcohol
3) Diet high in purine - organs, alcohol, seafood
Gout manifestation
1) Acute
Triggered by trauma, surgery, stress, infection, alcogol, ingestion
- Podagra = inflammation of big toe
- Symptoms begin as swelling, pain, low grade fever, usually at night
- Subside in 2-10 days
2) Chronic
Multiple joint
Visible deposits called tophi - occur in synovium, tendons, skin and cartilage
Usually painless but less mobility and risk of infection
Can lead to secondary OA
Osteoporosis
Loss of bone mass - porous, fragile, susceptible to fractures
Risk factors
Low calcium/vit D, estrogen
Smoking, alcohol, drugs, physical inactivity
Primary - normal aging, esp in post menopausal
Secondary - turner, crushing, diabetes, ra etc
Osteoporosis clinical manifestation
1) Pathological fractures
Minimal movement like coughing can cause fracture, spinal column common
2) Pain esp in lower back - better with rest
3) Loss of vertebral height at age 60
4) Kyphosis by age 70
NSAID
Block prostaglandin, used in RA for symptom management as other drugs take longer to kick in
1st generation - ibuprofen, naproxen (Cox 1 and 2)
2nd generation - celecoxib (cox 2 only) (- more GI protection, related to Sulfa Allergy)
Aspirin
Causes reyes syndrome in 18 younger (CI)
AE
Cox 1 = gastric erosion, bleeding, renal impairment
Cox 2 = renal impairment, promotion of MI/stroke (suppress vasodilation)
Ibuprofen = steven johnsons syndrome rarely
Blistering of skin/mucous membranes
NC
- take with food
- monitor kidney, HTN, bleeding
- CI - Pregnancy!!!
Prednisone
Glucocoricoid
MOA - Mimic cortisol to reduce inflammation and increase blood sugar
AE
- Fluid retention, HTN
- Hyperglycemia
- Hypokalemia
- Weight gain
- Increased risk of infection
- Slow wound healing
- Peptic ulcers
- Osteoporosis
CI - Active infections
AE
Peptic ulcer - do NOT use with NSAID
Adrenal suppression
Adrenal crisis if abruptly stopped
NC
- Monitor intake/output, edema, weight, lungs, electrolyte, glucose
- Take with food -GI
- Adrenal insufficiency - anorexia, N/V, weakness, fatigue, dyspnea, hypotension, hypoglycemia
Methotrexate
Disease Modifying Antirheumatic drug
Also used in cancer (antimetabolie - folic analog)
MOA - interfere with folic acid to inhibit DNA synthesis, T/B lymphocytes
Kills rapidly dividing cells
AE
Hepatic fibrosis
Bone marrow suppression (Cancer!)
GI ulceration (GI cells proliferate fast!!)
Pneumonitis***
CI - immunosuppressed, hepatic impairment, pregnancy as teratogenic
NC
PO/Subcut/IM
Assess VS - Infection, low grade fever, bleeding, GI , SOB
Pulmonary toxicity - dry cough is early sign
Antiemetic prophylactically
Infliximab
DMARD + TNF antagonist
Can be used in IBD (UC, Crohns)
MOA - Neutralize TNF
AE
- immunosuppression - high risk of opportunistic infection
- HF
CI - Active infection, pt w recurrent infection
NC
I) Infusion reactions - cause systemic cardiopulmonary reactions (hypotension, dyspnea, urticaria) = stop immediately
II) Infection - signs of new onset, fever/chils
III) Neutropenia - monitor CBC
IV) HF - edema, weight gain, SOB, crackles
Allopurinol (Zyloprim)
Gout
Xanthine oxidase inhibitor - enzyme that forms uric acid
AE
Generally well tolerated
Hypersenitivity - rash, fever, liver/kidney
MIld GI
May initially worsen attack
Kidney stone
NC - Encourage fluid, caution with kidney disease
Calcium
For NS, MSK, CVS, bones, esp in post-menopausal
Usually regulated by small intestine absorption, kidney excretion and resorption from bones
Adverse effect = hypercalcemia - CNS effects
GI disturbances N/V/C
Renal dyfunstion - polyuria, nephrolithiasis (most common cause of kidney stones is calcium)
Cardiac dysrhythmias, MI, stroke
Vitamin D3
Increase plasma calcium levels
Alendronate (Fosamax)
Bisphosphonate
Osteoporosis
MOA - reduce no. and activity of osteoclasts
AE
- Esophagitis
- MSK pain in initial dose, not reason to stop as will subside, manage pain with other meds
- Rare = ocular inflammation, atypical femur fractures
NC
1) Maximize bioavailability
Morning on empty stomach
No food 30 minutes after
2) Minimize risk of oesophagal injury
full glass of water
Stay upright for 30 min
Avoid chewing on tablet
MSK Assessment
all the subjective - past, meds, surgery, self care, ADL, OPQRSTU
Objective
Muscles - tenderness, swelling, muscle tone, symmetry, size
Joints - ROM, size, heat, pain, crepitus
Bones - deformity, alignment, symmetry
Motion can be
Passive - someone else moves the joint
Active - pt moves the joint
= always compare bilaterally
Stop passive if painful
Neurovascular/MSK injury assessment
i) peripheral vascular = colour, temp, cap refill, peripheral pulse, edema
ii) peripheral neurological - sensation, motor function, pain
Fractures
Pain management
Prevent complication of immobility
= Pressure ulcer, falls, pneumonia, DVT, constipation, contractures (permeant stiffness), muscle atrophy
Prevent complication of swelling = pain, compartment syndrome
Arthritis differentiation
1) Osteoarthritis
Unilateral, wear and tear, pain improves with rest
Heberdun nodes, Bouchard nodes
2) Rheumatoid arthritis
Systemic, bilateral, pain worse in AM better with use
Ulner drift, swan neck deformity, boutonniere deformity, hallux valgus of toe/bunion
3) Gout
Sudden onset (male, obesity, HTN, stress, diuretic, alcohol, purine diet, kidney disease)
Podagra or Tophi
Diagnostics
1) Osteoarthritis
X-ray, CT scan, can joint aspirate to rule out infection
2) Rheumatoid arthritis
Positive rheumatoid factors, high ESR/CRP, joint aspirate as MAY contain inflammatory markers, Xray only in advance
3) Gout
Serum uric acid although non specific, joint aspirate MAY, x-ray only in chronic
Best is clinical symptoms
Aspiration = Arthrocentesis
Osteoporosis diagnostics
1) Serum calcium and vit G
2) Xray
3) Dual-energy xray absorptiometry (DEXA) - assess BMD with less radiation and invasion
