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Med surg Exam 3 > Muscoskeletal lec 1 > Flashcards

Muscoskeletal lec 1 Flashcards

1
Q

How does someone get osteoarthritis

A

with age synovial joint cartilage losses elasticity and becomes depressed which lead to changes that cause damaged joint cartilage

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2
Q

Where in the body is most at risk for osteoarthritis

A

weight baring joints are most at risk

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3
Q

What are some interventions for osteoarthritis

A

moist heat, assess ADL’s and mobility, teach isometric exercises, and do NOT rush the patient

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4
Q

What can osteoporosis lead to

A

kyphosis

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5
Q

What is kyphosis

A

outward curvature of the spine (humped back) can result in gait changes increasing the risk of fractures – shift in their center of gravity

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6
Q

What are some interventions for kyphosis

A

proper body mechanics, assessed need for ambulatory devices

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7
Q

What could weakness mean if it’s proximal or near the trunk of the body

A

may indicate myopathy a problem in muscle tissue

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8
Q

what could weakness mean if it’s distal to the trunk of the body

A

neuropathy a problem with nerve tissue

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9
Q

what does an X-ray show you for musculoskeletal problems

A

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

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10
Q

what does a CT scan show you for musculoskeletal problems

A

go to for injuries or pathology that involves only bone can detect musculoskeletal problems including vertebral column and joints

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11
Q

what should you confirm before a CT scan is performed

A

the patient doesn’t have any allergies to contrast and has efficient renal function

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12
Q

what does a nuclear bone scan show you for musculoskeletal problems

A

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

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13
Q

what does an MRI scan show you for musculoskeletal problems

A

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

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14
Q

what should you confirm before an MRI scan

A

but the patient does not have any metal in their body

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15
Q

what does an Mr arthrography show you

A

it’s the combination of an MRI and arthrography useful for determining degree of rotator cuff injuries or shoulder injuries

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16
Q

what does an ultrasound show you for musculoskeletal problems

A

can be used for soft tissues disorders masses or fluid accumulation, traumatic joint injuries, osteomyelitis, surgical hardware placement

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17
Q

What is osteopenia

A

bone loss

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18
Q

what are some interventions for osteopenia

A

safety from falls, reinforced need for exercise, protect Bony prominences, vitamin D supplements

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19
Q

what does severe osteopenia lead to

A

osteoporosis

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20
Q

who is most at risk for osteoporosis

A

white, thin, women

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21
Q

what are some causes for primary osteoporosis

A

most common in postmenopausal women, men aged 70 to 80

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22
Q

what are some causes for secondary osteoporosis

A

hyperparathyroidism, cortico steroids, prolonged decreased mobility

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23
Q

how could nutrition lead to osteoporosis

A

from lack of calcium estrogen or testosterone like in post menopause woman calcium lost third carbonated drinks, protein deficiency contributes to decreased calcium,

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24
Q

how does the body try and combat low calcium

A

vitamin D and calcium loss stimulates parathyroid hormone production which triggers calcium release

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25
Q

What will you see on radio graphic test for osteoporosis

A

bone loss and fractures

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26
Q

What are some risk factors for osteoporosis

A

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

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27
Q

What would you see on an X-ray for osteoporosis

A

fractures, decreased bone density of spinal or long bones

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28
Q

How should screening be done for osteoporosis

A

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).

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29
Q

What kind of nutrition interventions should be done for someone with osteoporosis

A

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

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30
Q

What kind of lifestyle changes should be done for someone with osteoporosis

A

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

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31
Q

What is osteomalacia

A

bone softening by lack of calcification due to lack of vitamin D,

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32
Q

What lab changes do you notice with osteomalacia

A

normal or low calcoium, normal or low phosphate, high or normal PTH level, high alkaline level

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33
Q

What do bisphosphates med do for ostemalacia

A

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

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34
Q

What does RANKL med do for osteomalacia

A

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

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35
Q

What is osteomyelitis

A

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

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36
Q

What are some causes of osteomyelitis

A

bacteria, viruses, parasites, or fungi

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37
Q

What is exogenous osteomyelitis

A

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)

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38
Q

What is contiguous osteomyeltits

A

when the bone infection results from a skin infection in the area (poor dental hygiene/periodontal gum infection in the facial bones)

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39
Q

Why are bone infections hard to treat

A

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.

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40
Q

What are some ss of acute osteomyeltits

A

pain, fever, ulcerations, elevated WBC, ESR, - infections signs

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41
Q

What are some ss of chronic osteomyeltits

A

most commonly presenting with ulcerations or or previous bone surgery, localized pain, and drainage from the bone area most likely indicating a bone abscess

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42
Q

What are some non surgical interventions for osteomyelitis

A

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

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43
Q

What are some surgical interventions for osteomyelitis

A

I&D, debridement, bone excision, amputation

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44
Q

What is septic arthritis

A

Infected joints are characteristically painful and usually demonstrate an effusion, both of which are associated with limited active and passive range of

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45
Q

What are some ss of septic arthritis

A

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

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46
Q

Why would physical exam findings be less promintent for someone with septic arthritis

A

may be less prominent in patients who are older adults and/or immunocompromised

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47
Q

What are the risk factors for septic arthritis

A

age, pre-existing joint disease, recent joint surgery or infection, skin or soft tissue infection, IV drug use, indwelling catheter, immunosuppression

48
Q

What is the treatment for septic arthritis and what would happen if there was no treatment

A
  • joint drainage and antibiotic therapy – if not then it could cause osteomyelitits
49
Q

what are some ss of osteoarthritis

A

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

50
Q

how do you diagnose osteoarthritis

A

Xray, MRI

51
Q

what are some nonsurgical management for osteoarthritis

A

drug therapy for pain (acetaminophen, topical for temp refief), rest balanced with exercise, joint positioning, hot/cold, weight control

52
Q

what are some surgical options for oseteoarthritis

A

arthroscopy, arthroplasty

53
Q

what is rheumatoid arthritis

A

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

54
Q

what are the causes and ss of early rheumatoid arthritis

A

inflammation; systemic - generalized weakness, fatigue, anorexia, persistent low-grade fever

55
Q

what are the causes and ss of late rheumatoid arthritis

A

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

56
Q

what are the risk factors for rheumatoid arthritis

A

Female, 30-60 yrs old, genetics, bacterial/viral infection, physical and emotional stress, smoking

57
Q

what is a complication that can occur from rheumatoid arthritis

A

Vasculitis, Paresthesia’s (burning/ tingling sensation)

58
Q

what is Vasculitis

A

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

59
Q

what are some syndromes that can occur bc of rheumatoid arthritis

A

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

60
Q

what are some interventions for rheumatoid arthritis

A

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

61
Q

what are some meds given for rheumatoid arthritis

A

NSAIDs, GI protection (NSAIDs cause stomach ulcers eat away at it), corticosteroids (predisone), DMARDs

62
Q

what are some procedures that can be done for rheumatoid arthritis

A

plasmapheresis, TJA, synovectomy

63
Q

what are some lab changes noticed for rheumatoid arthritis

A

Anti-CCP antiboides, rheumatoid factor antibody, erythrocyte sedmentation rate, C-reactive protein, antinuclear antibody titer, CBC

64
Q

how do you diagnose rheumatoid arthritis

A

– Arthrocentesis synovial fluid aspiration, Xray for degree of joint destruction, monitor progression

65
Q

what is the purpose of arthroscopy

A

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

66
Q

what are the pre op interventions for joint surgires

A

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

67
Q

what is the post op for joint surgries

A

recovery monitoring, site and dressing care, NV assessment, infection, DVT/PE, bleeding, pain meds for early ambulation, ABX, how to use ambulatory assist devices

68
Q

what are the nursing interventions for knee joint surgires

A

avoid pillows under the knee, apply ice, avoid kneeling and deep knee bends, manage continuous passive motion (CPM) machine

69
Q

what are the interventions for hip joint surgeries

A

early ambulation, wight-baring status, positioning (abduction), DO NOT turn on operative side, raised seating, externally rotate toes, no crossing legs

70
Q

what is carpal tunnel

A

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

71
Q

what are the risk factors for carpal tunnel syndrome

A

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

72
Q

what is the treatment for carpal tunnel syndrome

A

rest the hands, avoid activities that make it worse, apply cold packs to reduce swelling, wrist splinting, surgical, Meds (NSAIDs, corticosteroids

73
Q

how does endoscopic surgrey work for rheumatoid arthritis

A

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.

74
Q

how does open surgrey work for rheumatoid arthritis

A

Your surgeon makes an incision in the palm of your hand over the carpal tunnel and cuts through the ligament to free the nerve

75
Q

how can you prevent rheumatoid arthritis

A

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

76
Q

what is bursae

A

small sacs lined with synovial membrane located at the joints and bony prominences

77
Q

what is inflammaed bursae called

A

bursitis

78
Q

how do you treat bursitis

A

rest, ice, anti-inflammatory meds, and needle aspiration in extreme situations

79
Q

what is gout

A

A systemic disease in which urate crystals deposit in joints and other body tissues, causing inflammation, Caused by hyperuricemia (increase in serum uric acid)

80
Q

what are the risk factors for gout

A

obesity, starvation diet, alcohol use, diuretic use, chronic kidney failure

81
Q

what lab changes do you notice with gout

A

: ESR, serum uric acid, BUN, creatinine

82
Q

how do you diagnose gout

A

Aspiration of synovial fluid for uric acid crystals

83
Q

what are some nutritional changes that should be made for gout

A

Limit proteins, Avoid trigger foods, Plenty of fluids, Low purine diet, NO organ meats

84
Q

what are some meds used for gout

A

NSAIDs, Corticosteroids (all to treat inflammation); chronic: allopurinol to promote uric acid excretion and decrease its production

85
Q

what are some interventions for gout

A

Low purine diet: no organ meats or shellfish, Avoid aspirin, diuretics, and starvation diets, Low physical and emotions stress, Increase fluid intake

86
Q

what is scleroderma

A

chronic inflammatory, autoimmune connective tissue, hardening of the skin

87
Q

what are some interventions for scleroderma

A

comfort, GI management, mobility, identifying early organ involvement skin protective measurements

88
Q

what does CREST stand for - for scleroderma ss

A

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

89
Q

what is Fibromyalgia Syndrome

A

chronic pain syndrome not an inflammatory disease

90
Q

what are some ss of Fibromyalgia Syndrome

A

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

91
Q

what are the risk factors for fibromyalgia Syndrome

A

commonly effects females 30 to 50 years old individuals with rheumatic conditions Lyme disease trauma deep sleep deprivation

92
Q

what are the meds used for fibromyalgia Syndrome

A

pregabalin, Cymbalta, NSAIDs, tricyclic antidepressants, tramadol

93
Q

what is lupus erythematous

A

autoimmune disorder an atypical immune response leads to chronic inflammation and destruction of healthy tissue

94
Q

what is the difference between discoid and systemic lupus erythematous

A

o Discoid - skin diagnosed by skin biopsy
o Systemic - connective tissue, organs

95
Q

what medications could cause lupus erythematous

A

procainamide, hydralazine, isoniazid – resolved if stopped

96
Q

what are the risk factors for lupus erythematous

A

females 20 to 40, Asian, Hispanic, Native American descent, decreased risk for females following menopause, environmental and genetic factors, difficult diagnosis and older adults

97
Q

what is the goal of treatment for lupus erythematous

A

to control symptoms and decrease the number of exacerbations occurrence of autoimmune disorders increase with age

98
Q

what are the ss of lupus erythematous

A

fatigue, alopecia, blurred vision, pleuritic pain, weight loss, depression, joint pain, fever, anemia, plural friction rub, Raynaud’s phenomenon, butterfly rash

99
Q

how do you diagnose lupus erythematous

A

skin biopsy – confirms, immunologic tests, antinuclear antibodies, dsDNA, serum complete (C3, C4), CBC, BUN, Creatine

100
Q

what are some interventions for lupus erythematous

A

monitor pain, mobility, fatigue, skin, systemic manifestations, nutritional status and most importantly kidney function

101
Q

what meds can you use for lupus erythematous

A

NSAIDs (watch kidneys), caorticosteriods, imunosuppresant agents (watch for infection), antimalarial (hydroxychloroquine)

102
Q

what should you educate with the management of lupus erythematous

A

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

103
Q

what is Marfan Syndrome

A

Caused by a defect in the gene that enables your body to produce a protein that helps give connective tissue its elasticity and strength

104
Q

what is the main cause of death from Marfan Syndrome

A

Aortic disease: leading to aneurysmal dilatation aortic regurgitation, and dissection, is the main cause of morbidity and mortality

105
Q

what are some ss of Marfan Syndrome

A

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

106
Q

how do you diagnose Marfan Syndrome

A

Echocardigram, CT/MRI, slit-lamp exam, eye pressure test

107
Q

how is Marfan Syndrome managed

A

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

108
Q

what is Ehler Danlos Syndrome

A
  • Group of connective tissue disorders, can be inherited and are varied both in how affect the body and in their genetic causes
109
Q

what are the ss of Ehler Danlos Syndrome

A

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

110
Q

how do you manage Ehler Danlos Syndrome

A

exercise to strengthen and stabilize muscle/joint, brace to stabilize joints, BP monitoring to keep BP low and stable

111
Q

what meds can be used to help Ehler Danlos Syndrome

A

NSAIDS, tricyclic antidepressants and SNRI’s, muscle relaxants and magnesium, opiods for severe pain

112
Q

what is osteosarcoma cancer

A

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)

113
Q

what is chondrosarcoma cancer

A

(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

114
Q

what is fibrosarcoma cancer

A

arises from the fibrous tissue

115
Q

what is ewing sarcoma cancer

A

most malignant, rare, systemic manifestations; pelvic involvement = poor prognostic sign

116
Q

what is primary tissue cancer

A

of the prostate, breast, kidney, thyroid, and lung are bone seeking cancers; they spread to the bone more than other primary tumors

Med surg Exam 3 (6 decks)

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