MSK disorders - part 3

Question 1

Juvenile idiopathic arthritis:
- begins at or before \_\_\_ years of age
- rheumatic disease, \_\_\_\_\_\_\_ disorder
- \_\_\_\_\_\_ delays
- Symptoms similar to adult \_\_\_\_
- Positive RF \_\_\_\_\_ occurs in children
gender?

Answer 1

16
autoimmune
growth
RA
rarely
girls 4x more than boys

Question 2

To maintain joint ROM and muscle strength, what is recommended for children with juvenile idiopathic arthritis?

Answer 2

Swimming

Question 3

Why are regular eye exams recommended for children with juvenile idiopathic arthritis?

Answer 3

Because the most common form of JIA is oligoarticular arthritis, which is associated with a high risk of uveitis (inflammation of the eye)

Question 4

Why do we monitor growth in children with JIA?

Answer 4

JIA might cause early closure of growth plates and stunt growth

Question 5

Patients with arthritis have chronic pain which is exhausting. What is critical patient teaching that we do?

Answer 5

Teach patients to PACE THEIR ACTIVITIES

Question 6

What does an OT focus on?

Answer 6

Focus on helping patients with ADLs

Question 7

What is important for the administration of drugs for patients with arthritis?

Answer 7

Have regularly scheduled pain meds which need a steady state concentration for chronic pain management

Question 8

Chronic inflammation of the axial skeleton

Answer 8

Ankylosing spondylitis

Question 9

Inflammatory skin disorder

Answer 9

Psoriatic arthritis

Question 10

Reactive arthritis of adult males post viral infection

Answer 10

Reiter syndrome

Question 11

Infectious or bacterial arthritis

Answer 11

Septic arthritis

Question 12

From deer tick, spirochetal infection

Answer 12

Lyme disease

Question 13

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.

Answer 13

Ankylosing spondylitis

Question 14

What is used to treat Psoriatic arthritis?

Answer 14

Humera and remedade (monoclonal antibodies)

Question 15

Soft-tissue rheumatic syndromes:

A - Generalized non-articular MSK pain

B - regional pain from tendon or ligament issues

C - Diagnosed by exclusion, debilitating fatigue

Answer 15

A - fibromyalgia

B - myofascial pain syndrome

C - Chronic fatigue syndrome

Question 16

How is fibromyalgia similar to ankylosing spondylitis?

Answer 16

Both are called hypochondriacs or whiners as their is no obvious external deformity, although the pain is debilitating

Question 17

What is the typical presentation of fibromyalgia?

Answer 17

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

Question 18

What is the treatment for fibromyalgia?

Answer 18

Deep rest REQUIRED

anti-inflammatories too

Question 19

Treatment for chronic pain syndrome

Answer 19

rest

Question 20

in most cases, firbomyalgia is the result of hypometabolism of selection tissue - i.e. the clinical manifestation of inadquate ______ hormones.

Answer 20

thyroid

Question 21

What is primary gout caused by?

What is secondary gout caused by?

Answer 21

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

Question 22

What joint is mostly affected in gout?

Answer 22

Big toe joint

Question 23

What is the cause of gout?

Answer 23

Uric acid crystals - high uric acid levels isn’t sufficient

Question 24

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

Answer 24

pain, inflammation
uric acid crystals
purines

Question 25

Describe the pharmaceutical treatment of gout/

Answer 25

Colchicine is used for acute gout attacks

Allopurinol is used for recurrent gout (life-long)

Question 26

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

Answer 26

multi-system inflammatory disease
women, child
butterfly

Question 27

Where is the classic butterfly rash for SLE?

Answer 27

Over cheeks and bridge of nose

Question 28

Episodic vasospastic disorder of small cutaneous arteries

Answer 28

Raynaud’s phenomenon

Question 29

Fingers and toes arteries – get occluded and blood supply to the ends of toes and fingers are blocked – become gangrenous and necrotic

Answer 29

Raynaud’s phenomenon (SLE)

Question 30

Disorder of CT. fibrotic, degenerative, occasionally inflammatory changes in skin, blood vessels, synovium, skeletal muscle, and internal organs

Answer 30

Scleroderma

Question 31

Scleroderma is in the same family as ______.

Gender influence?

Answer 31

SLE

4x more common in women

Question 32

Inflammatory diseases tend to follow a _______ pattern.

Answer 32

familial

Question 33

Describe skin changes in scleroderma.

Answer 33

Skin hardens, tightens or thickens
Skin colour changes and becomes shiny
The affected area loses hair
See a reduction in skin creases

Question 34

Is scleroderma exclusive to the outside of the body?

Answer 34

No, see the same thing inside the body - e.g. esophagus strictured, tight and inelastic

Question 35

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

Answer 35

D - chest pain trumps everything

Question 36

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

Answer 36

C - all the other ones are normal