MSK disorders - part 3 Flashcards
Juvenile idiopathic arthritis: - begins at or before \_\_\_ years of age - rheumatic disease, \_\_\_\_\_\_\_ disorder - \_\_\_\_\_\_ delays - Symptoms similar to adult \_\_\_\_ - Positive RF \_\_\_\_\_ occurs in children gender?
16 autoimmune growth RA rarely girls 4x more than boys
To maintain joint ROM and muscle strength, what is recommended for children with juvenile idiopathic arthritis?
Swimming
Why are regular eye exams recommended for children with juvenile idiopathic arthritis?
Because the most common form of JIA is oligoarticular arthritis, which is associated with a high risk of uveitis (inflammation of the eye)
Why do we monitor growth in children with JIA?
JIA might cause early closure of growth plates and stunt growth
Patients with arthritis have chronic pain which is exhausting. What is critical patient teaching that we do?
Teach patients to PACE THEIR ACTIVITIES
What does an OT focus on?
Focus on helping patients with ADLs
What is important for the administration of drugs for patients with arthritis?
Have regularly scheduled pain meds which need a steady state concentration for chronic pain management
Chronic inflammation of the axial skeleton
Ankylosing spondylitis
Inflammatory skin disorder
Psoriatic arthritis
Reactive arthritis of adult males post viral infection
Reiter syndrome
Infectious or bacterial arthritis
Septic arthritis
From deer tick, spirochetal infection
Lyme disease
To the lay person and HCPs, this patient will look normal and healthy (since no obvious deformitis), but the pain is debilitating - which has been the plight of these patients their whole life - may be difficult to convince insurance or worker’s comp of disease.
Ankylosing spondylitis
What is used to treat Psoriatic arthritis?
Humera and remedade (monoclonal antibodies)
Soft-tissue rheumatic syndromes:
A - Generalized non-articular MSK pain
B - regional pain from tendon or ligament issues
C - Diagnosed by exclusion, debilitating fatigue
A - fibromyalgia
B - myofascial pain syndrome
C - Chronic fatigue syndrome
How is fibromyalgia similar to ankylosing spondylitis?
Both are called hypochondriacs or whiners as their is no obvious external deformity, although the pain is debilitating
What is the typical presentation of fibromyalgia?
Typically a women in her 30s shows up to the doctor complaining of terrible upper back pain - nothing is found, and then the pain shifts to the lower back, and keeps switching sites
What is the treatment for fibromyalgia?
Deep rest REQUIRED
anti-inflammatories too
Treatment for chronic pain syndrome
rest
in most cases, firbomyalgia is the result of hypometabolism of selection tissue - i.e. the clinical manifestation of inadquate ______ hormones.
thyroid
What is primary gout caused by?
What is secondary gout caused by?
Primary - caused by an increase in uric acid production (90%)
Secondary - decreased excretion of uric acid by kidneys from other disorders, or drugs that inhibit uric acid secretions; or high intake of purines, excessive alcohol use, or prolonged fasting
What joint is mostly affected in gout?
Big toe joint
What is the cause of gout?
Uric acid crystals - high uric acid levels isn’t sufficient
Gout:
Acute _____ and _______ in the joint results from the accumulation of _____ ______ _____ in the joint
- a diet high in ______-rich foods will not cause gout, but can trigger an acute attack if a person is susceptible
pain, inflammation
uric acid crystals
purines
Describe the pharmaceutical treatment of gout/
Colchicine is used for acute gout attacks
Allopurinol is used for recurrent gout (life-long)
SLE:
- _____-system ______ disease assocaited with abnormalities of the immune system
- most cases are _____ in _____-bearing years
- classic ______ rash over cheeks and bridge of nose in 50% of clients
multi-system inflammatory disease
women, child
butterfly
Where is the classic butterfly rash for SLE?
Over cheeks and bridge of nose
Episodic vasospastic disorder of small cutaneous arteries
Raynaud’s phenomenon
Fingers and toes arteries – get occluded and blood supply to the ends of toes and fingers are blocked – become gangrenous and necrotic
Raynaud’s phenomenon (SLE)
Disorder of CT. fibrotic, degenerative, occasionally inflammatory changes in skin, blood vessels, synovium, skeletal muscle, and internal organs
Scleroderma
Scleroderma is in the same family as ______.
Gender influence?
SLE
4x more common in women
Inflammatory diseases tend to follow a _______ pattern.
familial
Describe skin changes in scleroderma.
Skin hardens, tightens or thickens
Skin colour changes and becomes shiny
The affected area loses hair
See a reduction in skin creases
Is scleroderma exclusive to the outside of the body?
No, see the same thing inside the body - e.g. esophagus strictured, tight and inelastic
The nurse is caring for several clients on an orthopedic unit. If the following requests were made simultaneously, which should the nurse do first?
A - A client with a cast reports itching inside the cast.
B - A client with a fractured leg requests pain medications.
C - A family member calls and requests to speak to the nurse about a client.
D - A client with a fractured femur complains of pleuritic pain and reports a rash on the chest and under the arms
D - chest pain trumps everything
The charge nurse on the ortho unit is giving instructions to a student nurse caring for a client in skeletal traction. Which is most important for the charge nurse to tell the student to report?
A - Complaints of mild pain
B - Requests for a position change
C - Looseness of the pins on the traction device
D - Small amounts of clear drainage from the pin sites
C - all the other ones are normal
