Muscoskeletal lec 1 Flashcards
How does someone get osteoarthritis
with age synovial joint cartilage losses elasticity and becomes depressed which lead to changes that cause damaged joint cartilage
Where in the body is most at risk for osteoarthritis
weight baring joints are most at risk
What are some interventions for osteoarthritis
moist heat, assess ADL’s and mobility, teach isometric exercises, and do NOT rush the patient
What can osteoporosis lead to
kyphosis
What is kyphosis
outward curvature of the spine (humped back) can result in gait changes increasing the risk of fractures – shift in their center of gravity
What are some interventions for kyphosis
proper body mechanics, assessed need for ambulatory devices
What could weakness mean if it’s proximal or near the trunk of the body
may indicate myopathy a problem in muscle tissue
what could weakness mean if it’s distal to the trunk of the body
neuropathy a problem with nerve tissue
what does an X-ray show you for musculoskeletal problems
can be used to visualize the skeletal system can visualize bone density, alignment, swelling the conditions of the joints can be seen, smoothness of articular cartilage and synovial swelling
what does a CT scan show you for musculoskeletal problems
go to for injuries or pathology that involves only bone can detect musculoskeletal problems including vertebral column and joints
what should you confirm before a CT scan is performed
the patient doesn’t have any allergies to contrast and has efficient renal function
what does a nuclear bone scan show you for musculoskeletal problems
it is a radionuclide test using radioactive material used primarily to detect tumors arthritis osteomyelitis osteoporosis vertebral compression fractures and unexplained bone pain could be very useful to identify hairline fractures with unexplained bone pain
what does an MRI scan show you for musculoskeletal problems
it is more accurate than a CT scan from any spinal and knee problems it is the most appropriate for joints, soft tissue, and bone tumors involving soft tissue
what should you confirm before an MRI scan
but the patient does not have any metal in their body
what does an Mr arthrography show you
it’s the combination of an MRI and arthrography useful for determining degree of rotator cuff injuries or shoulder injuries
what does an ultrasound show you for musculoskeletal problems
can be used for soft tissues disorders masses or fluid accumulation, traumatic joint injuries, osteomyelitis, surgical hardware placement
What is osteopenia
bone loss
what are some interventions for osteopenia
safety from falls, reinforced need for exercise, protect Bony prominences, vitamin D supplements
what does severe osteopenia lead to
osteoporosis
who is most at risk for osteoporosis
white, thin, women
what are some causes for primary osteoporosis
most common in postmenopausal women, men aged 70 to 80
what are some causes for secondary osteoporosis
hyperparathyroidism, cortico steroids, prolonged decreased mobility
how could nutrition lead to osteoporosis
from lack of calcium estrogen or testosterone like in post menopause woman calcium lost third carbonated drinks, protein deficiency contributes to decreased calcium,
how does the body try and combat low calcium
vitamin D and calcium loss stimulates parathyroid hormone production which triggers calcium release
What will you see on radio graphic test for osteoporosis
bone loss and fractures
What are some risk factors for osteoporosis
Age over 50, euro-caucasian or Asian ethnicity, parental history (mother), meopause, total hysterectomy, low trauma fracture after 50 years, thin low body weight, low calcium/vit D intake, eating disorders, hormone deficiency, rheumatoid arthritis, smoking, alcohol, sedentary life
What would you see on an X-ray for osteoporosis
fractures, decreased bone density of spinal or long bones
How should screening be done for osteoporosis
recommended for a baseline assessment by many PCP for women over the age of 40 with multiple risk factors and recommended to be repeated every 2 years in patients who have osteopenia (loss of bone mass).
What kind of nutrition interventions should be done for someone with osteoporosis
need for calcium and Vitamin D, avoid excess alcohol and caffeine, lactose intolerant alternatives fortifies with vitamin D such as soy and rice products; emphasize a diet rich in fruits and vegetables, low-fat dairy and protein sources, increased fiber
What kind of lifestyle changes should be done for someone with osteoporosis
exercise increased mobility and ROM; suggest weight baring activities such as walking for 30 minutes 3-5 times a week , avoid activities that jar the body, smoking cessation and avoidance of tobacco products
What is osteomalacia
bone softening by lack of calcification due to lack of vitamin D,
What lab changes do you notice with osteomalacia
normal or low calcoium, normal or low phosphate, high or normal PTH level, high alkaline level
What do bisphosphates med do for ostemalacia
slow bone resorption by binding with crystal elements in bone — Most common drugs used for osteoporosis prevention and treatment, not recommended for treatment greater than 2 year due to potential adverse effects
What does RANKL med do for osteomalacia
newer, receptor activator of nuclear factor kappa-B ligand inhibitors) – prevents the protein from activating it receptor decreasing bone loss ; given subcutaneously twice a year
What is osteomyelitis
Infection in the bony tissue - very hard to treat and have serious complications such as chronic recurrence, persistent pain, result in amputation, or even result in death in the presence of sepsis
What are some causes of osteomyelitis
bacteria, viruses, parasites, or fungi
What is exogenous osteomyelitis
the organism was transported to the site by the bloodstream from another infected area in the body (salmonella in the GI tract can spread to the bone)
What is contiguous osteomyeltits
when the bone infection results from a skin infection in the area (poor dental hygiene/periodontal gum infection in the facial bones)
Why are bone infections hard to treat
process occurs the bone is trying to heal itself with osteoblasts (contractors) laying new bone tissue overtop of infected tissue encasing the infection making penetration of the drug therapy very difficult.
What are some ss of acute osteomyeltits
pain, fever, ulcerations, elevated WBC, ESR, - infections signs
What are some ss of chronic osteomyeltits
most commonly presenting with ulcerations or or previous bone surgery, localized pain, and drainage from the bone area most likely indicating a bone abscess
What are some non surgical interventions for osteomyelitis
aggressive prolonged IV antibiotic therapy delivered by cvad such as a PICC line (unless renal failure because it ruins chance of getting fishtula in the future), wound care, hyperbaric oxygen therapy
What are some surgical interventions for osteomyelitis
I&D, debridement, bone excision, amputation
What is septic arthritis
Infected joints are characteristically painful and usually demonstrate an effusion, both of which are associated with limited active and passive range of
What are some ss of septic arthritis
External findings such as swelling, erythema, and warmth may be less prominent in the setting of septic arthritis involving the hip, shoulder or spine joints
Why would physical exam findings be less promintent for someone with septic arthritis
may be less prominent in patients who are older adults and/or immunocompromised
What are the risk factors for septic arthritis
age, pre-existing joint disease, recent joint surgery or infection, skin or soft tissue infection, IV drug use, indwelling catheter, immunosuppression
What is the treatment for septic arthritis and what would happen if there was no treatment
- joint drainage and antibiotic therapy – if not then it could cause osteomyelitits
what are some ss of osteoarthritis
Heberden’s nodes – at the distal interphalangeal joints, Bouchard’s nodes – proximal interphalangeal joints, Joint effusions – excess joint fluid, common in knees , Atrophy of skeletal muscle : pain and stiffness can lead to contractures, atrophy, loss of function
how do you diagnose osteoarthritis
Xray, MRI
what are some nonsurgical management for osteoarthritis
drug therapy for pain (acetaminophen, topical for temp refief), rest balanced with exercise, joint positioning, hot/cold, weight control
what are some surgical options for oseteoarthritis
arthroscopy, arthroplasty
what is rheumatoid arthritis
connective tissue disease, chronic progressive systemic inflammatory autoimmune disease affects primarily synovial joints, WBCs attack synovial tissues causing inflammation and thickening extends to cartilage and bones causes joint deformity and bone erosion leading to decreased range of motion and function
what are the causes and ss of early rheumatoid arthritis
inflammation; systemic - generalized weakness, fatigue, anorexia, persistent low-grade fever
what are the causes and ss of late rheumatoid arthritis
joint deformities (swan neck, ulnar deviation) and pain; systemic- secondary osteoporosis, severe fatigue, anemia, weight loss, subcutaneous nodules, vasculitis, pericarditis/ myocarditis , fibrotic lung disease, Sjogren’s syndrome
what are the risk factors for rheumatoid arthritis
Female, 30-60 yrs old, genetics, bacterial/viral infection, physical and emotional stress, smoking
what is a complication that can occur from rheumatoid arthritis
Vasculitis, Paresthesia’s (burning/ tingling sensation)
what is Vasculitis
if this occurs the organ supplied with blood from this vessel can be affected and late in the disease leading to eventual failure of the organ or system
what are some syndromes that can occur bc of rheumatoid arthritis
o Sjogren’s syndrome : dry eyes, dry mouth (dryness caused by obstruction of secretory ducts and glands)- gritty eye
o Extensive wrist involvement can result in carpal tunnel syndrome
what are some interventions for rheumatoid arthritis
maintain joint mobility by encouraging activity, monitor for progressive and systemic symptoms, maximize function, minimize pain, nutrition ( high in vitamins protein iron small frequent meals), education
what are some meds given for rheumatoid arthritis
NSAIDs, GI protection (NSAIDs cause stomach ulcers eat away at it), corticosteroids (predisone), DMARDs
what are some procedures that can be done for rheumatoid arthritis
plasmapheresis, TJA, synovectomy
what are some lab changes noticed for rheumatoid arthritis
Anti-CCP antiboides, rheumatoid factor antibody, erythrocyte sedmentation rate, C-reactive protein, antinuclear antibody titer, CBC
how do you diagnose rheumatoid arthritis
– Arthrocentesis synovial fluid aspiration, Xray for degree of joint destruction, monitor progression
what is the purpose of arthroscopy
to assess the condition of a joint, allows repair, most utilized in the evaluation of the knee and shoulder joints, performed in the OR sterile using local or general anesthesia usually outpatient, contraindicated if immobilization or infection or present
what are the pre op interventions for joint surgires
Review diagnostics (labs) to assess surgical readiness, rule out anemia, infection, organ failure; Chest x-ray, ECG; Education! IS, drains and dressings, activity, site prep
what is the post op for joint surgries
recovery monitoring, site and dressing care, NV assessment, infection, DVT/PE, bleeding, pain meds for early ambulation, ABX, how to use ambulatory assist devices
what are the nursing interventions for knee joint surgires
avoid pillows under the knee, apply ice, avoid kneeling and deep knee bends, manage continuous passive motion (CPM) machine
what are the interventions for hip joint surgeries
early ambulation, wight-baring status, positioning (abduction), DO NOT turn on operative side, raised seating, externally rotate toes, no crossing legs
what is carpal tunnel
It is a narrow passageway surrounded by bones and ligaments of the palm side of your hand caused by pressure on the median nerve when the median nerve is compressed the symptoms can include numbness tingling and weakness in the hand and arm
what are the risk factors for carpal tunnel syndrome
wrist fracture, or dislocation, arthritis, women, obesity, chronic illnesses such as diabetes increase risk of nerve damage, RA and other conditions that have inflammatory component, anastrozole (drug to treat breast cancer), fluid retention common during pregnancy and menopause
what is the treatment for carpal tunnel syndrome
rest the hands, avoid activities that make it worse, apply cold packs to reduce swelling, wrist splinting, surgical, Meds (NSAIDs, corticosteroids
how does endoscopic surgrey work for rheumatoid arthritis
Your surgeon uses a telescope-like device with a tiny camera attached to it (endoscope) to see inside your carpal tunnel. Your surgeon cuts the ligament through one or two small incisions in your hand or wrist. Some surgeons may use ultrasound instead of a telescope to guide the tool that cuts the ligament.
how does open surgrey work for rheumatoid arthritis
Your surgeon makes an incision in the palm of your hand over the carpal tunnel and cuts through the ligament to free the nerve
how can you prevent rheumatoid arthritis
Minimize stress on your hands and wrists: reduce your force and relax your grip; take short, frequent breaks; watch your form; improve your posture; change your computer mouse; keep your hands warm
what is bursae
small sacs lined with synovial membrane located at the joints and bony prominences
what is inflammaed bursae called
bursitis
how do you treat bursitis
rest, ice, anti-inflammatory meds, and needle aspiration in extreme situations
what is gout
A systemic disease in which urate crystals deposit in joints and other body tissues, causing inflammation, Caused by hyperuricemia (increase in serum uric acid)
what are the risk factors for gout
obesity, starvation diet, alcohol use, diuretic use, chronic kidney failure
what lab changes do you notice with gout
: ESR, serum uric acid, BUN, creatinine
how do you diagnose gout
Aspiration of synovial fluid for uric acid crystals
what are some nutritional changes that should be made for gout
Limit proteins, Avoid trigger foods, Plenty of fluids, Low purine diet, NO organ meats
what are some meds used for gout
NSAIDs, Corticosteroids (all to treat inflammation); chronic: allopurinol to promote uric acid excretion and decrease its production
what are some interventions for gout
Low purine diet: no organ meats or shellfish, Avoid aspirin, diuretics, and starvation diets, Low physical and emotions stress, Increase fluid intake
what is scleroderma
chronic inflammatory, autoimmune connective tissue, hardening of the skin
what are some interventions for scleroderma
comfort, GI management, mobility, identifying early organ involvement skin protective measurements
what does CREST stand for - for scleroderma ss
o Calcinosis - calcium deposits on the skin
o Raynaud’s phenomenon - spasm of blood vessels in response to colder stress
o esophageal dysfunction acid reflux and decrease in motility of esophagus
o Sclerodactyl - thickening and tightening of the skin on the fingers and hands
o Telangiectasis - dilation of capillaries causing red marks on surface of skin
what is Fibromyalgia Syndrome
chronic pain syndrome not an inflammatory disease
what are some ss of Fibromyalgia Syndrome
burning gnawing pain, stiffness, tenderness at certain areas of neck upper chest trunk lower back and extremities, sleep disturbances generalized muscle weakness and chronic fatigue
what are the risk factors for fibromyalgia Syndrome
commonly effects females 30 to 50 years old individuals with rheumatic conditions Lyme disease trauma deep sleep deprivation
what are the meds used for fibromyalgia Syndrome
pregabalin, Cymbalta, NSAIDs, tricyclic antidepressants, tramadol
what is lupus erythematous
autoimmune disorder an atypical immune response leads to chronic inflammation and destruction of healthy tissue
what is the difference between discoid and systemic lupus erythematous
o Discoid - skin diagnosed by skin biopsy
o Systemic - connective tissue, organs
what medications could cause lupus erythematous
procainamide, hydralazine, isoniazid – resolved if stopped
what are the risk factors for lupus erythematous
females 20 to 40, Asian, Hispanic, Native American descent, decreased risk for females following menopause, environmental and genetic factors, difficult diagnosis and older adults
what is the goal of treatment for lupus erythematous
to control symptoms and decrease the number of exacerbations occurrence of autoimmune disorders increase with age
what are the ss of lupus erythematous
fatigue, alopecia, blurred vision, pleuritic pain, weight loss, depression, joint pain, fever, anemia, plural friction rub, Raynaud’s phenomenon, butterfly rash
how do you diagnose lupus erythematous
skin biopsy – confirms, immunologic tests, antinuclear antibodies, dsDNA, serum complete (C3, C4), CBC, BUN, Creatine
what are some interventions for lupus erythematous
monitor pain, mobility, fatigue, skin, systemic manifestations, nutritional status and most importantly kidney function
what meds can you use for lupus erythematous
NSAIDs (watch kidneys), caorticosteriods, imunosuppresant agents (watch for infection), antimalarial (hydroxychloroquine)
what should you educate with the management of lupus erythematous
cover all skin, mild protein shampoo and avoid harsh hair treatments, use steroid cream for skin rash, infection precautions, avoid crowds, cleanse skin with mild soap and aspect for open wounds and skin rashes daily, apply lotion to dry skin, avoid drying skin agents like rubbing alcohol and powder, pat to dry skin and avoid rubbing
what is Marfan Syndrome
Caused by a defect in the gene that enables your body to produce a protein that helps give connective tissue its elasticity and strength
what is the main cause of death from Marfan Syndrome
Aortic disease: leading to aneurysmal dilatation aortic regurgitation, and dissection, is the main cause of morbidity and mortality
what are some ss of Marfan Syndrome
Mitral valve prolapse (MVP); Heart murmurs, Arachnodactyly with positive thumb and wrist signs, Tall and slender build; Disproportionately long arms, legs and fingers, A breastbone that protrudes outward or dips inward - pectus carinatum (MFS specific), pectus excavatum or chest asymmetry, A high, arched palate and crowded teeth, Extreme nearsightedness, lens dislocation, retinal problems, An abnormally curved spine – scoliosis or kyphosis, Flat feet
how do you diagnose Marfan Syndrome
Echocardigram, CT/MRI, slit-lamp exam, eye pressure test
how is Marfan Syndrome managed
Strict BP management: help prevent the aorta from enlarging and to reduce the risk of dissection and rupture, Vision problems associated with a dislocated lens in your eye often can be corrected with glasses or contact lenses, aortic repair/replace, scoliosis corrections, eye surgires, coping and support
what is Ehler Danlos Syndrome
- Group of connective tissue disorders, can be inherited and are varied both in how affect the body and in their genetic causes
what are the ss of Ehler Danlos Syndrome
Generally characterized by joint hypermobility (joints that stretch further than normal), skin hyperextensibility (skin that can be stretched further than normal), and tissue fragility, brain fog, neck pain, POTS, increased tendancy to bleed – cant get them to stop, stress incontinence, at risk for infection
how do you manage Ehler Danlos Syndrome
exercise to strengthen and stabilize muscle/joint, brace to stabilize joints, BP monitoring to keep BP low and stable
what meds can be used to help Ehler Danlos Syndrome
NSAIDS, tricyclic antidepressants and SNRI’s, muscle relaxants and magnesium, opiods for severe pain
what is osteosarcoma cancer
most common type of malignant bone tumor; acute pain and swelling, warm due to increased blood flow; sclerotic center of tumor, soft periphery through the bone cortex classic sunburst appearance on X-ray; typically metastasizes (spreads)
what is chondrosarcoma cancer
(cartilage cells) can result in dull pain and swelling for long periods; typically affects the pelvis and proximal femur; destroys the bone and often calcifies; better prognosis than osteogenic carcinoma
what is fibrosarcoma cancer
arises from the fibrous tissue
what is ewing sarcoma cancer
most malignant, rare, systemic manifestations; pelvic involvement = poor prognostic sign
what is primary tissue cancer
of the prostate, breast, kidney, thyroid, and lung are bone seeking cancers; they spread to the bone more than other primary tumors
