Musculoskeletal Flashcards

Question

5 P's

Answer 1

``` pain paresthesia pallor paralysis pulse ```

Answer 2

fracture near a good blood supply minimal damage to soft tissue anatomic rduction fragments are in a good position to heal immobilization weight can be borne on lone bones

Answer 3

poor blood supply severe damage to soft tissue separation of fragments improper fixation allows bones to move or rotate pre-exisiting factors: - obesity - diabetes - steroid use - smoking severely comminuted fractures bone loss infection

Answer 4

acute condition involving the breakdown of skeletal muscle tissue occurs when trauma to the muscle compresses tissue, it causes ischemia and necrosis

Answer 5

myalgia - muscle pain weakness myoglobinuria - tea colored urine triad of symptoms

Answer 6

elevated CK level = most sensitive serum creatinine - elevated - can indicate kidney injury serum electrolytes - hyperkalemia

Answer 7

early recognition and management of ABCs intervention will focus on: - preserving renal function - preventing acute kidney injury by administering large volumes of IV fluid

Answer 8

degenerationg of the aritcular cartilage and formation of bones

Answer 9

primary OA: - idiopathic and is most often related to aging process - symptoms appear in middle age and progresses with age secondary OA: resulting from predisposing condition or trauma - obesity, family hx of degenerative joint disease - joint abnormality - excessive wear - repetitive stress common in certain occupations - mostly in caucasian women

Answer 10

joint stiffness after period of rest pain in a movable joint, typically worse with action and relieved by rest paresthesia joint enlargement - Heberden's nodes: joint closest to fingernail gets enlarged - Bouchard's nodes: middle joint of the finger and closest to body gets enlarged joint deformities tenderness on palpation joint surfaces no longer fit together muscle spasm and contract joints are blocked by osteophytes and loose bodies creptitation and crunching ocurrs when joints are moved eventual ankylosis or stiffening of joint changes to gait occur shortneed stance abnormal antalgic gait - limp that help avoid pain widened base of support shortened step length

Answer 11

``` x-rays bone scans MRI and/or CT scan history physical exam ```

Answer 12

functional and mobility assessment pain management correct use of assistive devices implementation of prescribed heat and/or cold therapies proper posture and body mechnics weight reduction if obese collaboration with physical and occupational therapy referral to support agencies home safety

Answer 13

aspirin - can cause tinnitus, gastritis, peptic ulcer disease NSAIDs - ibuprofen, naproxen - celexicob, indomethacin - meloxican - may cause GI bleeding corticosteroid injections hyaluronic acid injections opioids analgesics

Answer 14

assistive devices TENS has been shown effective for pain relief physical exercise relaxationtechniques appropriate nutrition and weight loss active stretching and non-weight bearing activities like swimming acupuncture and massage therapy may help lessen the pain

Answer 15

compression of the median nerve that neters the hand through a tunnel of ligaments and bone at wrist repetitive strain injury dibaetes, peripheral vascular disease and rheumatoid arthritis have higher incidence of CTS

Answer 16

``` weakness pain, tingling numbness or decreased sensation in the affected hand difficulties with fine motor movement atrophy of thumb muscles ```

Answer 17

history physical exam identification of risk/precipitating factors corresponding clinical symptomaology postitive Tinels sign - compress with 2 fingers at wrist and see if there is tingling positive phalen's sign - put both wrists at a 90 degree downward and see if there is tingling

Answer 18

relieving underlying cause of nerve compression wrist splint ergonometry with workstation modification physical therapy hand/wrist exercise NSAIDs rest, ice if conservative treatment does not work, then more invasive treatment may includes: - corticosteroid injection - surgery

Answer 19

inflammation of the plantar fascia, located on the arch of the foot often seen in middle age and older adults, esp runners obesity is a contributing factor

Answer 20

severe pain in arch of foot, esp when getting out of bed pain worsens with weight bearing most have unilateral plantar fascitis, it can affect both feet

Answer 21

history and physical exam identification of risk factors corresponding clinical symptomalogy

Answer 22

rest, ice physical therapy stretching exercises shoes with good support orthotic shoe inserts NSAIDs steroid for pain and inflammation if these are unsuccessful then endoscopic surgery is needed to remove the inflamed tissue if taking corticosteroid, important to NOT abruptly stop taking them - take with food to prevent GI upset if diabetic, monitor for higher than usual blood sugar levels

Answer 23

chronic, systemic inflammatory disease of the connective tissue does have genetic tendency - more common in women than men irreversible and will lead to ankyloses of the joint - abnormal stiffening and immobility of a joint

Answer 24

``` general signs: fatigue loss of appetite weight loss enlarged lymph nodes ``` early RA: painful, stiff joints warm, red, swollen and incapable of full ROM ``` late RA: bony ankyloses destruction of joint adhesions inflammation and effusions Raynauds syndrome ``` may present with ulnar deviation - deformed hands and fingers, including swan neck of fingers and joints

Answer 25

history and physical exam radiographic studies aspiration of synovial fluid ``` labs: decreased ESR increased RBC positive c-reactive protein positive antinuclear antibody positive rheumatic fever ```

Answer 26

surgical intervention splinting adequate rest ice for joint inflammation heat for joint stiffness nutrition therapy: weight reduction if obese calcium supplements

Answer 27

``` gamma-linolenic acid fish oil ginger, boswelia green tea turmeric - the three have ongoing research ```

Answer 28

psychosocial support education related to corticosteroids promotion of self care and independence pain control is priority assessment administration of meds balancing exercise and rest, energy conservation assistive devices speak HCP before using herbal or OTC medications

Answer 29

chronic, systemic inflammatory disease of the collagen tissues african americans, hispanics, asians and antive americans are 2-3 time more likely to have lupus - most cases are found in women may experience kidney damage that is progressive and can lead to end-stage renal dsease - requiring dialysis or kidney transplantation

Answer 30

SLE more likely to present if client has 4 or more findings: - arthritis - butterfly rash: malar rassh - discoid lupus skin lesions - photosensitivity - oral ulcers - serositis - renal disorder: persistent proteinuria - seizures or psychosis in absence of drugs - hemolytic anemia - positive lupus erythematosus cell preparation - abrnomal titer of antinuclear antibody

Answer 31

control system involvement monitor findigns promote remission ``` pharmacological interventions: salicylates NSAIDs corticosteroids anti-infectives anti-cancer drugs antimalarial drugs ```

Answer 32

maintaining skin integrity weight management energy conservation techniques sun protection well balanced diet - no specific diet needed or avoided

Answer 33

metabolic disease marked by painful inflammation of joints deposits of urates in and around the joints usually an excessive amount of uric acid in the blood peak incidence between 40-60 years old does have familial tendency abdnormal purine metabolism or excessive purine intake results deposits most often found in the metatarsophalangeal joint of the greater toe or in ankle

Answer 34

tight, reddened skin over inflamed joint elevated temperature edema of involved area severe pain in affected joint hyperuricemia because uric acid levels are in bloodstream acute attacks begin at night and last 3-5 days ``` may follow trauma, diuretics increased alcohol consumption a high purine diet stress suddently stopping maintenance meds ``` g

Answer 35

synovial fluid analysis will revel uric acid crystals blood work will show hyperuricemia

Answer 36

pharamcological interventions NSAIDs - indomethacin colchine - used when NSAIDs are contraindicated - enhances the excretion of uric acid antihyperuricemic agents - allopurinol heat or cold therapy dietary changes to low purine diet

Answer 37

pain management elevate affected limb bedrest and immobilize joint avoid putting pressure or bedding on affected joint ``` reinforce need for dietary management low purine diet: - protein is okay - avoid organ meats - shellfish (shrimp) - sardines ``` incrase fluid intake to prevent renal calculi use aspirin and diuretics cautiously and avoid if possible HALLMARK of gout are: flareups or acute episodes of sevre pain, lasting days to weeks - during an acute attack --> goal is to treat with colchine and manage pain

Answer 38

occurs when mineralization is delayed, resulting in a soft weak bonew rickets caused by vitamin D deficiency - not having enouhg calcium and phosphorus

Answer 39

generalized muscle pain and skeletal pain in hips and lower back waddling gait wide stance and may not want to walk at all deformities in weight bearing bones scoliotic or kyphotic deformities of the spine bones tend to break easily

Answer 40

radiiographic findings lab tests: - decreased calcium and phosphorus - alkaline pshophatase will be moderately elevated

Answer 41

pharmacological interventions; - calcium gluconate - vit D daily, until signs of healing take place - high protein diet - UV radiation therapy

Answer 42

teach about intake of dietary vit D | importance of safe sun exposure to gain vit D

Answer 43

reduction in bone mass, loss of bone strength and an increased risk of fracture

Answer 44

``` aging heredity nutrition lifestyle medications ```

Answer 45

``` low bone density history of scoliosis female - northern european and asian neruological impairement - stroke parkinsons decreasd vision complications of diabetes ```

Answer 46

acute fractures hisotyr of falls pain greater when active and typically occurs in mid-low thoracic spine kyphosis: dowagers humps - may lose 2 or more inches in height

Answer 47

CBC of calcium, phosphate, alkaline phosphatase x-rays DEXA scan - assess cortical and trabecular bones in the spine and hip T-score of -2.5 ore lower indicates osteoporosis

Answer 48

weight bearing exercises nutritional changes pharmacological interventions: antiresportive agents - do not increase bone mass but prevetnt further bone loss ``` estrogen therapy calcitonin peptide hormone biphosphonates - inhibit bone resoprtion ``` androgen -taken long term surical intervention - Vertebroplasty - kyphoplasty clients taking oral biphosphonates should be instructed to: - take them with a full glass of water - take them at least 30 minutes before food and other meds - stay upright for at lesat 30 min after taking them

Answer 49

slow progressing resporption and irregular remodeling of bone cause is unknown - viral implication and family tendencies bone is resolved and new bone develops poorly ``` bone is weak and fractures easily - affects the skull - femur 0 tibia - pelvis - vertebrae ```

Answer 50

initially asymptomatic as disease progresses: - pain and point tenderness of affected limbs develops pathologic fractures - femur or tibia deformity of long bones

Answer 51

radiographic studies - show a bowing of long bones - thickened areas of bones labs - increase in alkaline phosphataste - increase in urinary hydroxyproline - calcium will be normal

Answer 52

pharmacological interventions: NSAIDs biphosphonates - alendronate - slows bone resportion calcitonin - slows bone resportion plicamycin - used when nerve ares damaged and the client is unresponsive to other treatments surgicla interventions

Answer 53

administer meds pain management increase mobility physical therapies cllaborate collaborate with nutrition therapy firm mattress for sleep some may need to wear a corset or back brace

Answer 54

bacterial infection of the bone | staph aureus is the most common

Answer 55

pain, loclized, tenderness erythema over the involved bone decreased ROM at affected bone irritability restlessness fever

Answer 56

``` lab tests: - increased ESR blood cultures and bone aspirate cultures CBC increased WBC ``` radiographic tests - often negative for 10-14 days bone scan

Answer 57

IV atibiotics will be administered long term IV access -4-6 weeks surgery and/or immobilization

Answer 58

monitor antibiotic levels - peak and trough monitor level of comfort encourage to perform ROM exercises if possible - but DO NOT allow weight bearing exercises monitor clients nutritional intake and status hpysical therapy at home IV access for antibiotic therapy

Answer 59

replacing the entire hip joint, either total hip of the femoral head and acetabulum or partial hip replacement - femoral head only

Answer 60

``` OA RA femoral neck fractures avascular necrosis of femoral head caused by steroids failure of previous prosthesis ```

Answer 61

immediate post op care: - benefite from PCA using peripheral or epidural catheter for first 48 hours after - PCA will aid in early mobilization intermediate to long term post op care: - monitor neurovascular status of leg - pulmonary hygiene - prevent abduction of hip - used in the first postoperative week while the clients sits in a chair or bed - turn client by logrolling - use fraacture bedpan - monitor for hip dislocation - low molecular weight heparin - collaborate with physical therapist for early ambulation and exercise

Answer 62

correctly use assistive device implement strategies to prevent dislocation - raised toilet seat perform prescribed exercises at home avoid sitting for more than one hour at a time wear antiembolism stocking adhere to anticoagulant therapy fall prevention measures

Answer 63

apply ice to knees physical therapy will be started within 24 hours to promote bone function continuous passive motion (CPM) in use when not in use, a knee immobilizer might be used

Answer 64

``` progressive periphera vascular disease gangrene trauma congenital deformities malignant tumors ```

Answer 65

phantom limb pain can be relieved with: - stump desensitization through kneading or massaging of the stump - TENs - distraction - beta adrenergic blocking agents for burning, dull pain - anticonvulsants for sharp and cramping pain phantom limb pain may occur any time up to 3 months or longer post-amputation - most common with above the knee amputation use aseptic dressing change compression wrapped in a figure eight fashion casting to control edema early rehabilitation prostatic preparation is key to restoring mobility below the knee amputation; - client should lie SUPINE with the affected leg fully extended for 20-30 minutes, 3-4 times/day above the knee amputation: - client should lie PRONE with the affected leg fully extended for 20-30 min, 3-4 times/day convey body image acceptance * * not ALL clients are candidates for a prosthesis after amputation, it required a lot of upper body strength. - for those who struggle in these areas, should use a wheelchair

Answer 66

pharmacological interventions: - NSAIDs - hydroxychloroquine sulfate immunosuppressant agents like: - azathioprine - cyclophosphamide - methotrexate - prednisone - sulfasalazine - lefluromide - anakinra biological response modifiers: - etanercept - infliximab - adalimumba

Answer 67

crystalluria - drink 8 glasses of water to produce 1200- 1500mL/day photosensitivity risk of sunburn folic acid deficiency - so take folic acid 1mg/day agranulocytosis (leukopenia) - report sore throat immediately stevens johnson syndrome - stop if getting rash urine and skin will turn orange but normal - will go away once discontinued