Muscoskeletal Flashcards
T or F. Chronic muscoskeletal disorders includes diseases of the joints, muscles, and bone.
TRUE
Osteoarthritis (OA), Gout, and Rheumatoid Arthritis are all examples of what?
Joint disease
Inflammatory and non-inflammatory joint disease are differentiated by? (HINT: There are 3)
- Absence of synovial membrane inflammation 2. Lack of systemic signs and symptoms 3. Normal synovial fluid analysis.
T or F. Osteoarthritis is considered an “inflammatory” joint disease?
False. Non-inflammatory.
T or F. Rheumatoid arthritis is considered an “inflammatory” joint disease?
True. It is characterized by inflammation.
A degenerative joint disorder with a progressive LOSS of articular cartilage accompanied by NEW BONE formation and capsular fibrosis?
Osteoarthritis. It usually affects weight bearing joints
S/S of OA included:
Joint pain that increases with activity and improves with rest, stiffness (especially in the morning), joint enlargement and bony nodules, limited movement/motion(LROM), asymmetry of affected joints, crepitus, visible joint abnormality/deformity.
Herberden’s nodes and Bouchard’s nodes are examples of what?
Common joint deformities that occur in patients with OA.
Osteoarthritis (OA)
Characterized by local areas of damage and loss of articular cartilage, new bone formation of joint margins, subchondral bone changes, and variable degrees of mild synovitis and thickening of the joint capsule
T or F. Osteoarthritis is the most common form of arthritis, and is also referred to as degenerative arthritis.
True, it is defined as a common form of arthritis with progressive destruction of cartilage in both synovial and vertebrae.
Besides chronic pain, what other Nursing Diagnoses would you expect to see for a patient with OA?
Impaired physical mobility, Deficient self-care, Deficient knowledge (specify)
In regards to treating OA, what are 5 common goals of therapy?
Early elimination of risk factors, early diagnosis, disease surveillance, appropriate treatment of pain, maximize mobility.
Why is it so important to maximize mobility in patients with OA?
Too much rest can lead to a patient being entirely immobilized. Also, moving helps the to loosen the synovial capsule
This disorder affects the hands, feet, shoulders, lumbar and cervical spine, hips, and knees.
Osteoarthritis (OA)
T or F. Common meds used to treat OA include Acetaminophen and NSAIDS?
True. ASA, Gold salts, COX-2 (Celebrex) are all examples.
T or F. High doses of NSAIDs and Acetaminophen can damage the kidneys and liver?
True. All are renal excreted meds. GI bleeding (NSAIDs) and Liver damage (Tylenol) can also occur from high doses.
Surgical interventions for OA include:
Arthroscopy, Osteotomy, Arthrodesis, Joint replacement
T or F. Patients that undergo Arthrodesis will lose joint mobility?
True. This procedure involves removing the joint capsule which results with bone resting on bone.
Common nursing issues for patients with muscoskeletal disorders, such as OA include:
Mobility, pain, risk for injury, pre-op and post-op care.
In what ways are patients with OA at risk for injury?
Falls, surgical complications, medication toxicity
There are many (7) elements involved in the Chronic Illness Cycle. What are they?
Pain, Reduced activity/ guarding, Deconditioning, Fatigue, Anger/ depression, Stress, Muscle tension
A chronic, progressive, SYSTEMIC, autoimmune disease that is characterized by inflammation and deformity.
Rheumatoid Arthritis (RA). It is characterized by RECURRENT inflammation and progressive deterioration of the connective tissue (synovium) of the joints, which leads to destructive changes.
T or F. Unlike patients with OA, joint involvement in patients with RA is bilateral and symmetrical?
True. RA is characterized by bilateral and symmetrical inflammation of the joints and surrounding structures; multiple joints are usually involved.
T or F. Symptoms of RA are similar to osteoarthritis and LUPUS?
True. The symptoms include: Fatigue, generalized weakness, weight loss, anorexia, morning stiffness, joint deformity, and inflammation of the joints w/ LROM, pain, and warmth, edema, and erythema
When performing your initial assessment on a patient you suspect has RA, what clinical manifestations in their HANDS and FEET would support this diagnosis?
Stiffness, symmetrical swelling, paresthesias
Systemic clinical manifestations of RA include?
Malaise, fever, myalgia, anemia, weight loss, lymphadenopathy, splenomeagaly, vasculitis.
T or F. RA is similar to Lupus because it spreads systemically?
True. Like lupus, it affects visceral organs, such as the heart, lungs, kidneys, brain, and eyes. OA does NOT spread systemically.
In patients with RA, joint fluid presents with inflammatory exudate
True. However, synovial fluid should always be CLEAR and not contain any protein, RBCs, or exudate material/ fluid.
ESR(increases with inflammation), C reactive protein (positive), Rh factor (positive), ANA, CBC, Immune complexes (IgG), and Hypoalbuminemia are all examples of what?
Common diagnostic tests used to dx RA.
Why is Hypoalbuminemia often seen in patients with RA?
Due to use of LOTS of plasma protein
An xray of a patient with RA would most likely show:
Periarticular osteoporosis, bony erosions, narrow joint spaces, and/ or total destruction.
T or F. Surgery is the only treatment option available for patients with RA?
False. There are many medications used to treat this disease.
Examples of medications used to Tx pain associated RA include?
Salicylates, NSAIDS (COX-1, COX-2) ASA, Ibuprofen, Celebrex. GI distress can result from ALL except COX-2 (Celebrex)
T or F. Disease Modifying Anti-Rheumatic Drugs (DMARDs) and Chemotherapy are medications used to tx Gout?
False, RA.
DMARDs for RA
Include immunosuppressants, such as Azathioprine and Cyclosporine
Anti-inflammatory meds for RA:
Gold salts, Sulfasalazine, Leflunomide
Chemotherapy meds for RA include:
Methotrexate
T or F. Other medications used to treat RA include Hydroxychloroquine, Penicillamine, and Corticosteroids?
False. All except Penicillamine are used. This med is not given anymore.
In regards to treating RA, how do corticosteroids work?
They block the immune response.
Nursing issues for patients with RA include?
Mobility, pain, risk for injury, monitoring drug toxicity, and patient education in regards to DIET and ACTIVITY.
Vasculitis, anemia, and extrasynovial rheumatoid nodules on the heart, lungs, eyes, or spleen are all examples of what?
Systemic complications that can occur in patients with RA
T or F. In regards to RA, immunoglobulin G (IgG) is formed in response to an inflammatory response (antigen), but for ab unknown reason, the body produces antibodies (Rheumatoid factors) against IgG?
True. Rheumatoid factors combine with IgG to form immune complexes.
What labs provide the most definitive information about patient nutrition at home?
Albumin and Iron values
Gout
Inflammatory arthritis caused by the deposits of uric acid crystals in the joints
Can patients get kidney failure from gout?
Yes
What happens when you aren’t mobile? What are the risks of immobilization?
DVT, Decreased peristalsis (decreased appetite, altered elimination/constipation, medication toxicity), Decreased ventilation (l/t infection), Muscle atrophy, Decreased bone density (d/t calcium loss in bones).
T or F. Gout can progress in 4 stages?
True: Interval or Intercritical; Chronic Tophaceous; Asymptomatic Hyperuricemia; Acute Gout or Acute Gouty Arthritis.
In this stage, a person has elevated levels of uric acid in the blood (hyperuricemia), but no other symptoms. Treatment is usually not required.
Asymptomatic hyperuricemia stage
In this stage, hyperuricemia has caused the deposit of uric acid crystals in joint spaces. This leads to a sudden onset of intense pain and swelling in the joints, which also may be warm and very tender.
Acute gout or acute gouty arthritis stage
This is the most disabling stage of gout:
Chronic tophaceous; it usually develops over a long period, such as 10 years. In this stage, the disease may have caused permanent damage to the affected joints and sometimes to the kidneys. With proper treatment, most people with gout do not progress to this advanced stage.
Interval or intercritical stage
In this stage, a person does not have any symptoms. This is the period between acute attacks.
During the _______ stage, an acute attack commonly occurs at night and can be triggered by stressful events, alcohol or drugs, or the presence of another illness.
Acute gout or acute gouty arthritis stage; Attacks usually subside within 3 to 10 days, even without treatment, and the next attack may not occur for months or even years. Over time, however, attacks can last longer and occur more frequently.
A metabolic disease marked by increased serum uricacid levels and joint inflammation
Gout (def)
T or F. Many people with gout have a family history of the disease?
True. Estimates range from 20 to 80 percent.
T or F. Gout is more common in MEN than in women and more common in ADULTS than in children.
TRUE
T or F. Obesity is not a risk factor for Gout?
False. Being overweight increases the risk of developing hyperuricemia and gout because there is more tissue available for turnover or breakdown, which leads to excess uric acid production.
T or F. Drinking too much alcohol can lead to hyperuricemia, because alcohol interferes with the removal of uric acid from the body.
TRUE
T or F. Eating too many foods that are rich in purines can cause or aggravate gout in some people?
TRUE
Anchovies, asparagus, sardines, scallops, beef kidneys, liver, game meats, mackerel, dried beans, and mushrooms are example of?
High- purine foods
Diuretics, Salicylates, Niacin, Cyclosporine, and Levodopa are all examples of meds that contribute to _____?
Gout.
When caring for patients with a history of HTN, Hypothyroidism, and lead exposure, what is important to keep in mind
These conditions can increase the risk of developing gout.
What are common s/s that you would expect to see in a patient with gout?
Hyperuricemia, presence of uric acid in joint fluid, more than 1 attack of acute arthritis, arthritis that develops in a day (producing a swollen, red, and warm joint), sudden onset of pain/ attack in a single joint (most often the toe, ankle, or knee), hard, movable, nodules with irregular surfaces (Tophi).
How is Gout most often diagnosed?
Arthroscopy, Synovial sample (this sample would be positive for uric acid crystals), CBC- WBC and ESR increase during acute episodes.
Serum uric acid level >7.5 would indicate?
Gout
Common meds used to treat Gout include:
NSAIDS, Corticosteroids, Colchicines, Allopurinal
Allopurinal and Colchicines:
Uric acid inhibiting dugs.
Mobility, Pain, Systems review, Pre-op and Post-op care are all important nursing issues for?
Knee and hip joint replacement
A term used to describe a temporary displacement of two bones
Dislocation. It occurs when there is a loss of contact between articular cartilage
______ occurs when contact between articular surfaces is only partially lost.
Subluxation
T or F. Dislocation and subluxation are associated with fractures, muscle imbalance, rheumatoid arthritis, or other forms of joint instability
TRUE
In this skeletal muscle disorder, muscle fiber shortening occurs without an action potential
Contractures. It is caused by failure of the sarcoplasmic reticulum (calcium pump) even with available ATP
Neck stiffness, back pain, clenching teeth, hand gripping, and headaches are clinical manifestations of which skeletal muscle disorder?
Stress-induced muscle tension. It is commonly associated with chronic anxiety.
Disuse Atrophy
Causes a reduction in the normal size of muscle cells due to prolonged inactivity.
Bed rest, trauma, casting, and/ or nerve damage all contribute to which skeletal muscle disorder?
Disuse Atrophy
After a lengthy stay on your med-surg floor, your patient Felicia has developed disuse atrophy. What TREATMENT interventions should be implemented in her plan of care?
Encourage isometric movements and passive lengthening exercises.
Muscle Strain
Local muscle damage resulting from a sudden, forced motion that causes the muscle to become stretched beyond its normal capacity
T or F. Muscle strains can involve the tendons?
TRUE
What areas of the body are most at risk for Muscle Strains?
Hamstrings, Rectus femoris, Medial gastroemius, Biceps brachii
What is RICE?
RICE is the best treatment for muscle sprains. It consists of Rest, Ice, Compression, and Elevation
What are 2 examples of Muscle Membrane Abnormalities?
Myotonia (causes muscle stiffness that can interfere with movement) and Periodic Paralysis (causes episodes of weakness or paralysis)
There are 2 types of Periodic Paralysis, what are they?
Hypokalemic periodic paralysis and Hyperkalemic periodic paralysis
T or F. The most common cause of Toxic Myopathies is drug abuse, such as cocaine?
False. Alcohol abuse
T or F. Surgery is usually always performed for Gout?
False. It is usually never performed
This condition results in necrosis of individual muscle fibers and is characterized by an acute onset/attack of weakness, pain, and swelling.
Toxic Myopathy. In patients who have abused alcohol or were drinkers of long duration, their weakness is chronic.
Inflammation of muscular tissue with subsequent calcification and ossification of the muscle is commonly referred to as?
Myositis Ossifican; a complication of local muscle injury
“Rider’s bone” in equestrians, “Drill” bone in infantry soldiers, and “thigh” muscles in football players are all examples of local muscles at risk for injury and the development of which disorder?
Myositis Ossification
A life-threatening complication of severe muscle trauma with muscle cell loss
Rhabdomyolysis (myoglobinuria)
T or F. Crush syndrome and Compartment syndromes can lead to Rhabdomyolysis?
True. These are both examples of muscle trauma.
T or F. The basic PATHOPHYSIOLOGY of Juvenile Rheumatoid Arthritis is the same as the adult form?
True. One difference is the mode of onset (arthritis in fewer than 5 joints; arthritis in more than5 joints; systemic disease.
A collective group of inherited noninflammatory but progressive muscle disorders without a central or peripheral nerve abnormality.
Muscle Dystrophies (MD). This disease affects the muscles with definite fiber degeneration but without evidence of morphologic.
T or F. Muscular dystrophies cause progressive, symmetric weakness and wasting of skeletal muscle groups?
TRUE
How are Muscular Dystrophies (MDs) classified?
MDs are classified according to the clinical phenotype, the pathology, and mode of inheritance.
In regards to MD, the different modes of inheritance include?
Sex-linked MDs, Autosomal dominant MDs, and Autosomal recessive MDs.
Duchenne, Becker, and Emery-Dreifuss are all examples of which inheritance pattern for MDs?
Sex-linked MDs
Examples of Autosomal dominant MDs include?
Distal, Ocular, Oculopharyngeal, and Facioscapulohumeral
Limb- girdle form
Autosomal recessive MD
T or F. A patient with MD would have an decreased CPK lab value?
False. CPK would be elevated
What would an Ultrasound for your patient with MD show?
Bone and muscle deficits.
Duchenne MD
Symptoms present around 2-3 yrs of age with frequent falls. Common symptoms include WADDLING gait and toe walking, walking LATER and then loss of ambulation and progressive immobility. This is the most rapidly progressing and most COMMON form of MD. (sex-linked recessive MD)
Becker’s MD
S/S include generalized muscle involvement. This is a slower- progressing form of MD (sex-linked recessive)
Facioscapulohumeral
In this disorder, the face, neck, and shoulder muscles are involved with muscle inflammation. This is also a slower-progressing form of MD (autosomal dominant)
Limb-girdle MD
S/S include shoulder and pelvic muscle involvement and upper- and lower extremity weakness in proximal muscles. (Autosomal recessive MD).
T or F. In addition to walking later, waddling gait, and then eventually loss of ambulation, mental deficits is another common clinical manifestation of MD?
TRUE
For patients diagnosed with Duchenne’s MD, why does death in early adulthood usually occur?
Death in early adulthood occurs secondary to respiratory or cardiac failure. As a nurse caring for patients with MD, it is extremely important to help prevent upper respiratory infections.
T or F. No meds are recommended for MD?
True. Nurses should access available resources and refer patients and families to support groups.
Give an example of collaborate care for patients with OA?
Collaborate with PT regarding the development of an aerobic exercise program to reduce and eliminate strain on the joints (swimming, biking) and collaborate with OT for approp assistive devices for ADLs
What are the most common potential risks for patients with MD?
Social isolation, depression, aspiration, breathing.
