Musculoskeletal Flashcards
1
Q
what is the function of bones?
A
support
protection of internal organs
voluntary movement
blood cell production
mineral storage
2
Q
how many bones does a skeleton have?
A
206 (long, short, flat, and irregular bones)
3
Q
what is epiphysis and what is it made of?
A
the widened area at each end of bone thats made of cancellous bone
4
Q
what is metaphysis and what is it made of?
A
the flared area btwn epiphysis and the diaphysis and made of cancellous bone
5
Q
what does the diaphysis do and what is it made of?
A
provides structural support and its made of cortical bone
6
Q
What is the periosteum?
A
Fibourous connective tissue that covers the bone
7
Q
What is the epiphyseal plate?
A
The growth plate
8
Q
What does the medullary cavity contain?
A
Red or yellow bone marrow
9
Q
What is cancellous bone?
A
Spongy bone
10
Q
What does red bone marrow do?
A
Produces red and white blood cells (hematopoeisis)
11
Q
What do osteoblast do?
A
Secretes bone matrix to help bone formation
12
Q
What does osteocytes do?
A
Helps make bones hard and mature the osteoblast
13
Q
What do osteoclasts do?
A
Absorb bone tissue during growth and healing
14
Q
What is ossification?
A
Depositing of new bone by osteoblasts
15
Q
What is modeling?
A
Bone that has been altered by genetic or nutritional circumstances
16
Q
What is remodeling?
A
The natural process occuring every 3 mon
17
Q
What are joints?
A
Where the bones come into close contact at their “ends” but do not actually touch
18
Q
What is synarthrotic?
A
No movement in joints (skull)
19
Q
What is amphiarthrotic?
A
Limited movement in joints ex. Vertebrea and symphysis pubis
20
Q
What is diarthrodial?
A
Synovial, freely moveable joints ex. Knees and elbows
21
Q
What are the diathrodial joint movements?
A
Hinge: single direction
Ball & socket: full freedom
Pivot: rotation
Condyioid: wrist
Saddle: movement at two places up to right angles (base of thumb)
Gliding: limited in all driections (carpals of wrist and tarsals of ankle)
22
Q
What joints are hinge movement?
A
Elbows and knees
23
Q
What joints are ball and socket moevment?
A
Hip and shoulders
24
Q
What joints have pivot movement?
A
Radius, ulna, skul, and spine
25
What are tendons and what do they do?
Connective tissue thats fibrous and attaches muscle to bone, soft tissues or other muscles
Creates strength, extensibility and flexibility
26
What are ligaments and what do they do?
Connective tissue that is fibrous and connects the ends of bones together
Creates joint stability
27
What is bursea?
Sacs filled with synovial fluid near joints to cushion movement of tendons, ligamnets, and bones during friction
28
What is fascia?
Layers of connective tissue that surround muscles, blodd vessels, and nerves
29
What is isotonic activity?
Muscle length shortens with increasing muscle tension
30
What is isometric activity?
Muscle length does not change but the tension increases
31
What is atrophy muscle size?
Decrease in muscle size resulting from absence in muscle activity
32
What does vitamin D do for the bones and muscles?
Helps increase calcium absorbed from GI and reduces lost in urine
33
What does vitamine D deficiency cause?
Bone mineralization deficit and often deformaties and fractures
Requires sunlight
34
What does parathromone or parathyrin do for muscles and bones?
Regulates calcium homeostasis, stimulates osteoclast to form and production of calcitrol
35
Why is the growth hormone needed for muscles and bones?
Increases calcium, height, and muscle mass. It also affects bone modeling through liver stimulation (producing insulin which then stimulates osteoblasts)
36
If an older adult has low growth hormone levels, what will they have?
Increased fat and decreased muscle and energy
37
Why is testosterone needed for muscle and bone?
Helps growth of muscles and skeleton
38
What does cortisol do to muscle and bone?
It increases bone resorption and decreases bone formation
Long term use can increase risk for osteopenia and fractures
39
Why are thyroid hormones needed for muscle and bone?
Low levels of thyroid hormones can result in dwarfism
High levels of Th can cause osteoporosis
40
Why does blood supply effect bone and muscle?
When blood supply is decreased osteogenesis is decreased (bone formation)
41
What type of meds should be assessed when dealiing with muscle and bone?
OTC, supplements, herbs, relaxants, opiotes, and NSAIDS
42
What can antiepileptic drugs cause in bones and muscles?
Osteomalacia
43
What can potassium sparing diuretics cause in bone and muscles?
Muscle cramps and weakness
44
What can corticosteroids cause in bone and muscles?
Avascular necrosiscand decreased muscle mass
45
What is a DEXA scan?
Measures bone density, size, thickness, and mineral content
Used for early detection of osteoporosis
46
what can a CT identify?
Tumors, fractures and joint abnormalties with contrast
47
what can a MRI identify?
if a tumor is bedside or inside a bone
48
what is a bone scan?
shows hot/dark spots to indicated abnormalities (4hr)
49
what is an arthrography and what can it see?
an injection of air or contrast is put into joint then examined by an xray , CT, or MRI
can see cartliage in knees and shoulders
50
what do increased calcium lab studies show?
bone tumers and hyperparathyroidism
51
what lab studies have a normal negative result?
C-reactive protein (CRP) and rheumatoid factor (RH)
52
what lab studies identify inflammation or necrosis?
Erythrocyte sedumentation rate (ESR)
53
what is a arthroscopy?
direct visulilization of joint and used to perform biopsy
54
what is an arthrocentesis?
evaluates synovial fluid in a joint and relieves pain
55
what is the duplex venous doppler?
explores blood flow in extremities
56
what is a sprain?
injury to a ligament by a twisting motion
57
what are the degrees of sprains?
1st: mild tenderness and minimal swelling
2nd: moderate tenderness and swelling
3rd: complete tear of ligament with severe swelling
58
what is the discharge teaching for a sprain? *
elevate to decrease swelling
ice for the first 24-48 hours to decrease swelling
use compression bandages
rest/immobilize
59
what is a strain?
excess stretching of muscle involving tendons
60
what are the degrees of strains?
1: mild pulled muscle
2: moderatly torn muscle
3: severely torn or ruptured muscle
61
what can a severe sprain cause?
an avulsion fracture: ligaments pull off a fragment of a bone
62
if a pt is returning to work with a strain, what should you educate them on? *
take breaks
modify movements
wear a brace
if they keep doing movements the same way as they did when they pulled it, then they can get it again
63
what are the signs of sprains and strains?
pain, edema, decrease fucntion and bruising
64
how long does it take for a mild sprain or strain to heal?
within 3-6 weeks
65
what is used in the diagnosis of a sprain or strain and why?
xray to r/o fracture
66
what is the treatment of a sprain or strain?
RICE and NSAIDS to decrease inflammation
rest, ice (24-48hr), compression, elevation (above heart for 24-48 hr)
67
what do you do after 24-48 hours of a sprian or strain?
use warm moist heat and encourage pt to use limb if joint is protected with a cast/splint/brace
68
what is dislocation and what are the common locations ?
complete displacement, no movement most common in thumb, elbow, shoulder and hip
69
what is subluxation and what are the common locations?
partial or imcomplete displacemement of joint, limited movement most common in shoulder, kneww, fingers, and toes
70
what must occur is dislocation occurs in a joint?
reduction to prevent avascular necrosis
71
what is a cumulative strain?
injury of tendons, ligaments, ot muscles from repeated forceful movements (scarring and decreased tissue perfusion)
72
who is at most risk for a cumulative sprain?
musicians, dancers, athletes, miners bc its hard to modify their movements so they keep doing the same ones
73
how can you avoid a cumulative sprain?
good ergonomics, heat/cold applications when sore, stretching/conditioning
74
what is carpal tunnel syndrome?
compression of median nerve r/t continuous wrist movement
75
what are the signs of carpal tunnell syndrome?
pain, numbness, paresthsia, burning, weak thumb
76
what are the 2 diagnostics for carpal tunnel syndrome?
Tinels sign: tapping inside of writst and eliciiting pain response
Phalens sign: extreme wrist flexion eliciiting pain/numb in fingers
77
how can you prevent/treat carpal tunnel syndrome?
evaluate ergonomics of equipment (adjust chair)
stretching of wrist and fingers frequently
they can still continue their activites but take precaution
pain meds will not prevent
78
what can cause a rotator cuff injury?
aging, repetive stress, injury to shoulder while falling (swimming, weight lifting, or swinging a racket)
79
what are the signs of a rotater cuff injury?
shoulder weakness, pain , decreased ROM, positive drop arm test
80
what is used to diagnose a rotator cuff injury?
MRI
81
what is the treatment of a partial rotater cuff tear?
rest, ice/heat, NSAIDS
82
what is the treatment for a full rotator cuff tear?
surgery
83
what is a postop complication of a rotator cuff injury and how can you prevent it?
arthrofibrosis (frozen shoulder) so begin PT on 1st day postop
84
what is a meniscus tear and how can it happen?
common knee injury thats results from a ligament sprain (basketball, football, soccer, hockey)
older people get it from squatting or kneeling at work
85
what are the signs of a meniscus tear?
pain and knee will click, pop, lock or give out
86
what is used to diagnose a meniscus tear?
MRI
87
what is the treatment of a meniscus tear?
arthroscopy and rest
88
what is an anterior cruciate ligament injury (ACL)?
most common knee injury caused from coming down to hard on knee, twisting and hearing a pop
89
what is the diagnosis of an ACL injury?
Lachmen test and MRI
90
what is the treatment for an ACL injury?
rest, ice, NSAIDS, elevation, ambulate with crutches
severe requires surgery with autologous or allograft tissue
91
what is bursitits and where are the common sites?
inflammation of fluid around joints that result from excess trauma/friction, gout, RA or infection
hands, elbows, shoulders, knees, greater trochanter of hips
92
what are the symptoms of bursitits?
warmth, pain, swelling, and limited ROM
93
what is the treatment for bursitis?
immobilize, ice and NSAIDS
asiration of fluid
corticosteroid injection
94
what are the characteristics of normal synovial fluid? *
scant, pale yellow/ straw colored NOT CLOUDY
95
what fracture is most commonly indicated as child abuse? *
spiral
96
what is a greenstick fracture?
slit in bone (does not go all the way through)
97
what is a comminuted fracture?
bone shattered in the middle of shaft
98
what is an oblique fracture?
diagonal crack in bone
99
what is a pathological fracture?
like a transcerse crack but goes all the way through bone and bone is pulled away from each other
100
what is a stress fracture?
tiny crack in bone by overuse
101
what are the symptoms of a fracture?
loacalized pain, decreased function, gaurding, deformity by displacment, shortening of extremity, crepitus, swelling/discoloration
102
what is crepitus?
grating sound or sensation
103
if a pt has a right lower leg fracture what do you assess? *
pedal pulses for circulation
104
what are the 6 steps of fracture healing?
1. fracture hematoma
2. granulation tissue
3. callus formation
4. ossification
5. consolidation
6. remodeling
105
what do you assess frequently for a fracture?
color, motion, sensation on extremities
neurovascular states distal (below) site
106
what are the treatments of a fracture?
closed reduction
cast/spplint/brace
traction (skin or skeletal)
surgery (open reduction)
pain meds
diet modifications
IMMOBILIZE IMMEDIATLY
107
a patient complains they cant breath after a large break to the tibia. What could it be and what do you do? *
pulmonary embolism and O2 immediatly
108
what is a closed reduction? *
nonsurgical with conscious sedation and pain meds, they yank bone to put bone back in place (manual traction)
109
what is the home treatment for a fracture? *
immobilize, elevate, Ice and pain meds
110
what is Bucks/ skin traction?
short term (48-72hr) with the use of tape, boot, or splint to apply weight (5-10lb) to pull bone back in place
111
what are complications of skin traction?
skin breakdown, nerve damage, and circulatory impairment
112
what is skeletal traction?
longterm for several weeks, pin wire directly into bone and apply weight (5-45lbs) to pull bone back in place
113
what are the complications of skeletal traction?
atelactasis/ pneumonia, constipation, anorexia, urinary stasis, infection and DVT
114
what are the rules of skeletal traction? *
maintain counter traction (elevate end of bed), maintain continuous traction, keep weights off of the floor
115
what education should you give for a cast? *
elevate, dont get wet, do ROM above and below the site, prevent contractures, and dont insert anything into cast
116
what can occur if the pt starts to swell under the cast?
compartment syndrome
117
what is open reduction external fixation?
metal pins/rods that apply traction and compressess fragments that is made for shattered bones/ cast has failed
118
if a patient goes home with an open reduction external fixation, what should they be taught? *
site care, check and clean sites daily, elevate, pain meds, no need to immobilize, do not remove, and no ATB prophylatic is needed
119
what do you do for assessment of complications if a patient has a pelvic fracture?*
inspect abdomin for distention, listen to bowel sounds in each quadrant for 3-5 min and palpate for pain in abd
120
what does an electric bone growth stimulation do for the treatment of a fracture?
increases calcium uptake and bone growth
121
what are the medications used for a fracture?*
Muscle relaxers ( Carisoprodol, Cyciobenzaprine, Methocarbamol)
Analgesics (Hydrocodone)
Bone penetrating ATB (Cephalosporins, Cefazolin)
Anticoagulants (Lovenox, Fragmin, Coumadin)
Tetnastoxoid
122
what is the diet modification for fractures?
increase protein, vitamin B,C, and D, calcium, phosphorous, magnesium, fluid, and fiber
123
what medications need to be assed with fractures?
estorgen replacements bc they can cause fx and calcium supplements
124
what can cause increase sensation?
excess blood or swelling
125
what education is needed to prevent falls?*
remove rugs, daily ROM, and nondlip shoes with good support
most falls happen inside the home
126
what are the complications of immobility?
constipation, renal calculi, cardiopulmonary deconditioning, DVT
127
If a pt comes in with a long bone fracture and a pulmonary embolism, what do you do? *
admin O2, assess leg swelling/tenderness and provide emotional support for breathing
128
what are the complications of fractures?
hypovolemic shock
infections (check immunization status)
compartment syndrome
venous thromboembolism
fatty embolism
129
if a patient comes in with a fatty emboli and a tibial fracture, what do you do? *
administer O2
130
what is an indirect entry of osteomylitis?
results from blunt force trauma and common in boys under 13.
(tibia, pelvis, or vertebrea)
131
who is at increased risk for indirect entry of osteomylitis?
adults with GU, respiratory infections, or vascular disorders
132
what are the local signs of osteomylitis?
pain worsens with activity and with rest
swelling/tender/warm
restricted movement
133
what are the systemic symptoms of osteomylitis?
fever/ chills
night sweats
restlessness
nausea
malaise
drainage
134
what are the complications of osteomylitis?
Septicemia, septic arthritis, pathologic fx, and amyloidosis
135
if a patient comes in with osteomylitis, what do you do in order? *
blood culture, ATB, acetiaminophen, and then a CT
136
what ATB is often given for osteomylitis and what needs to be monitored? *
Gentamycin, its nephrotoxic so monitor BUN and creatnine
137
what is the discharge teaching for osteomylitis? *
IV ATB for several mon
s/s of infection at IV site
avoid exercise and heat
138
what is compartment syndrome?
decreased tissue perfusion within limited space decreases neurovascular function
artial flow decreased, ischemia, cell death, loss of function
139
what can happen 4-8 hr with compartment syndrome and what do you do?
ischmeia and permanent function loss
do regular neurovascular assessmenets
assess urine output and kidney fucntion (BUN Creatnine)
notify HCP if pain is not releived with meds
140
what orders would you anticipate with compartment syndrome?
no elevation above heart, no ice, surgical decompression
141
what do you asses for a neurovascular assessment?
Pain
Pulse
Pallor
paresthsia
Paralysis
Pressure
142
how do you prevewnt a venous thromboembolism (VTE)?
prophalactic anticoagulants
SCD or ted hose
ROM
143
what are signs of a VTE?
pain fullness erythema and high temp
144
what are signs of a fat embolism (FES)?
24-48 hr after injury to long bone NOT IMMEDIATLY
-petechiea
-feeling of impending doom
-pallor or cyanosis
-comatose
145
what are the diagnostics for a fat embolism?
fat cells in blood/urine/speutun
decreased paco2 <60
ST segment and T wave change
decreased platelets and HCT levels
increased ESR
infiltrate in chest xray
146
what is the prevention of a fat embolism?
careful immobilization and handling of long bone fractures
147
how do you prevent contractures with an amputation?
turn prone for 30min 4x daily
148
what are the immediate post op priorities of an amputation?
ABC, VS, pain control, prevent hemmorage
uniform pressure to stump prepares site fot prosetic
apply ACE wrap then limb shrinker to decrease edema
149
What is a synovectomy?
Removal of synovial membranes done early in disease when there is minimal bone or cartliage destruction
150
What is an osteotomy?
Removing slice of bone to restore alignment and shoft weight bearing to relieve pain
151
What is an arthroplasty?
Reconstruction of a joint
152
what are the benign bone tumors?
osteochondroma
osteoclastoma
enchondroma
REMOVED SURGICALLY
153
what are the signs of benign bone tumors?
painless, hard, immobile mass
sore muscles close to tumor
one arm or leg longer than the other
pressure/irritation with exercise
154
what is a malignant bone tumor?
osteosarcoma: aggresive and rapidly spreads
common in pelvis, distal femur, and proximal tibia and humerous
most common in children
155
what are the signs of malignant bone tumors?
gradual onset of pain and swelling worse at night and increases with activity
156
what is the nursing management for bone cancer?
monitor for swelling, circulation, decrease movement/sensation
prevent pathological fractures
treat hypercalcemia
pain asses and treat
emotional support
157
what is muscular dystrophy?
genetic disease, progressive symmetric wasting of skeletal muscle without neurovascular involvment with loss of strength with increased disability and deformity
158
what are the diagnostics of muscular dystrophy?
genetic testing
159
what is used in the treatment of muscular dystrophy?
no definitive treatment but coritcosteroids can help symptoms and nurses need to prevent skiin breakdown
160
what can happen to respiratory and cardiac with muscular dystrophy?
dysrythmias can cause death, cardiomyopathy causes heart failure and decreased respiratory function leads to CPAP, trah or vent
161
what are the signs of low back pain?
fatigue
pain radiating down leg
change in gair, reflexes, motor, strenth, and sensory
162
what is acute and chronic back pain?
acute is <4 weeks chronic is >3 mon
163
what are the risk factors for low back pain? *
excess body weight
stress
cig smokijg
congenital spine problems
vibration
164
what can indicate acute low back pain?
symptoms within 24 hours of injury ( not immediatly), straight leg test
165
what is spinal stenosis?
narrowing of spinal canal that results from osteoarthritis, RA, tumors, pagets and trauma
166
what are the signs of spinal stenosis?
pain in low back that radiates to butt/leg
increased pain with walking or prolonged standing
numb/tingle, weak, heaviness in legs
pain is decreased when bending or sitting
167
what are the nursing interventions for low back pain?
educate on body mechanics, improve body weight, improve sleep, hygeiene, and positioning, use a firm mattress, smoking cessation
168
what is the discharge teaching for acute back pain? *
avoid activity that puts stress or strain
avoid prolonged sitting/twisting
avoid sleeping prone
use ibuprofen/acetaminophen
avoid keeping knees straight when bending
169
what is intervertebral disc disease?
intervertabrea disc seperate vertebrea and help absorb shock, they deteriorate or herniate
170
what is degenerative disc disease (DDD)?
loss of elastcity, flexibility, and shock absorbing capabilities
disc thin, nucleus pulposus dries, load is shifted to annulus fibrosus, progressive destruction, pulposus seeps out (herniates)
171
what are the symptoms of intervertebral disc disease?
radiating pain
numb/tingle/weak
decreased strength/ROM/reflexs
low back pain
positive straight leg test
172
what are the signs of multiple nerve root compression?
severe low back pain
progressive weakness
increased pain
bowel/bladder incontinance
MEDICAL EMERGENCY
173
what is cervical disc disease?
pain radiates to arms and hands
decreased reflexes/handgrip
shoulder pain and dysfunction
174
how often should back strengthening exercises be done for intervertebral disc disease?
2 times daily for lifetime
pt can heal in 6 month
175
what is intradiscal electrothermoplasty (IDET)?
noninvasive, needle inserted into disc, wire threaded through disc and heated (degenerates nerves)
176
what is a radiofrequency discal nucleoplasty?
noninvasive, needle inserted into disc, radiofrequency probe generates energy and breaks up nucleus pulposus (decompresses disc)
177
Interspinous process decompression (XSTOP) treats what?
spinal stenosis (titanium and lifts vertebrea off of pinched nerve)
178
if a patient just had spine surgery, when should you notofy surgeon immediatly?*
NEW onset of numbness/tingling (symptoms should unchange or improve)
bowel/bladder incontinence
179
if a patient had a post lumbar fusion what should you do?
pillows under thigh when supine and btwn legs ehrn side laying
180
what should you monitor for post op spine surgery?
CSF leak or severe HA (clear yellow drainage and positive for glucose)
peripheral neuro assessment every 2-4 hr for 48hr
circulation
GI function (give stool softener)
bladder emptying
181
what do you assess post op spinal fusion?
bone graft donor site (illec crest or fibula)
usually is more painful than the fusion area
pressure dressing
neurovascular assessment if fibula is the donor
182
what should you teach after a spinal surgery?
proper body mechanics
avoid prolonged sitting/standing
no lifting or twisting
encouarge walking/lying down and shifting weight
use thighs and knees to absorb shock
firm matress or bed board
183
what is osteomalacia and what is it caused by?
bones soften
vitamin D defiency, decreased sun exposure, pregancy, malabsorption, and chronic diarrhea
184
what are the signs of osteomalacia?
bone pain and muscle weakness
185
what is the treatment for osteomalacia?
increase vitamin D, calcium and phosphorous
diet of eggs, meat, oily fish, milk and cereal
increase sun
weight bearing activities
186
what is osteoporosis?
chronic, progressive reduction of total bone mass “silent theif”
187
what does frequent corticosteroid use lead to? *
skeletal problems such as osteoporosis and avascular necrosis
Ex. pt with asthma
188
if a patient has osteoporosis, what can they not have? *
joint replacements
189
if a patient comes in and has lost 2in in 30 mon, what needs to be taught to them? *
osteoporosis education
190
what are signs of osteoporosis?
pathological fx
back pain
gradual loss of height
kyphosis or dowagers hump
191
what is the gold standard diagnostic for osteoporosis or if somone is losing height?*
DEXA
192
when does treatment for osteoporosis begin?
T score less than -2.5
193
what diet should a pt with osteoporosis be on? *
1000mg calcium
milk, yogurt, cottage cheese, ice cream, turnip greens, spinach, sardines
decrease ETOH and smoking
194
what is osteoarthritis (OA)?
slowly progressive noninflammatory disorder of diarthrodial (synovial) joint, loss of articular cartliage, and osteophytes are formed
195
what are modifiable risk factors? *
something you can fix, smoking
196
what are nonmodifiable risk factors? *
cant fix, gender, age, genetics
197
what are the risk factors for osteoarthritis?
age
decreased estrogen at menopause
obeistiy
anterior cruciate ligament injury
frequent kneeling or stooping
198
what does obeisity increase the risk for? *
musculoskeletal problems
199
what happens to cartliage with osteoarthritis?
turns dull, yellow, granular, softer and decreased elastic with decreased ability to resist water with heavy use
200
what are the joint pain characteristics with osteoarthritis?
early: rest relieves pain
late: pain with rest and trouble sleeping
sitting and getting up is difficult
OA in intervertebral (apophyseal joints cause stiffness
201
what are the deformity characteristics with osteoarthritis?
Heberdens nodes (DIP and Bouchard node (PIP) are red swollen and tender, no sign of decreased function with visible deformity
Knee: bowleg or knock knee
Hip: one leg is shorter
202
what do you use for inflammation and stiffness with OA?
ice for inflammation and heat for stiffness
203
what is used for mild to moderate joint pain in OA?
acetaminophen
topical cream (capsaicin)
OTC cream (bengay, arthricare)
topical salicylates ( aspercreme)
204
what is used for moderate to severe joint pain?
NSAIDS
ibuprofen
misoprostol for GI
arthrotec
Diclofenac gel
celecoxib
205
what do you do for a patient post op arthroscopic repair in a rotary cuff? *
physical therpay begins 1st day to prevent frozen shoulder
immobilizer will be placd immediatly after surgery and removed after 1st day
after rehab they will be able to do everything they did before ex. golf
206
what is an arthroscopic repair r/t osteoarthitis?
removes lose bodies from joint
207
what is some education for OA?
alter modifiable risk factors such as lose weight and reduce occupational/recreational hazard activites
208
what education would you give a patient with an injured left leg and walker? *
move walker forward, then left leg, then right leg
209
what is rheumatoid arthritis?
Genetic may need mobility aids or joint reconstruction
210
what needs to be assessed for the diagnosis of rheumatoid arthritis? *
Genetic link disorders (ankloysing spondilitis, RA, and SLE lupus)
211
what is the first stage of RA?
synovitis, swelling, osteoporosis but no joint destruction
212
what is the second stage of RA?
joint inflammation, gradual destruction, narrowing joint space from decreased cartliage
213
what is the third stage of RA?
synovial pannus, extensive decreasing cartliage, erosion at joint margins
214
what is the fourth stage of RA?
inflammatory process subsides, loss of joint function, subcutaneous nodules form
215
what are the signs of RA?
fatigue, anorexia, wt loss, stiffness
history of infection, stress, exertion, childbirth, surgery, emotional upset
symetrrical
216
what are the key features of RA?
symptoms longer than 6 weeks-life
inflmmatory synovitis that have palpable swelling and morning stiffness longer than 1hr with fatigue
symetrical and polyarticullar
high titer is BAD
217
what is PIP swelling with RA?
swelling confined to joint area with synovial thickening that feels like a firm sponge
218
what are the medications for RA?
NSAIDS, prednisone, intrarticular steroid for flares
219
if a patient has an exerbation of RA what lab needs to be assessed for inflammation while giving steroids? *
CRP c-reactive protein
220
what meds can decrease permanent effects of RA?
Methotrexate (monitor for bone marrow supression and hepatoxcity)
Sulfasalzine
Hydroxychlorquine (yealry eye exam)
Leflunomide (teratogenic)
Tofacitninib
221
what education needs to be given for methotrexate? *
take with food
if lacerations in mouth, tounge, or throat its a sign of toxicity
frequent lab moniotring ( CBC and blood chemistry CMP)
dont get pregnant
222
what education needs to be given for a vertebralpalsy procedure? *
dont drive and you can remove the dressing the next day
223
what should you monitor when giving DMARDS for the treatment of RA?
blood, liver, lung, and kidney lab monitoring, 3-6 times a year in 4-8 week intervals
224
what are biological response modifiers (BRMS) that are used in the treatment of RA?
used to treat RA when DMARDS arent working
decreases inflammation and slows the progression
225
what should be taught when recieving BRMS for the treatment of RA?
a TB and CXR will be given before starting, s/s of infection to report bruising, bleeding and fever, and avoid live vaccines
226
If giving prednisone for the treatment of RA, what needs to be monitored?
glucose, swelling, clubbing and round face
227
what is the surgical therapyy for RA?
Synovectomy and arthroplasty (joint replacment)
228
what happens nutritioanlly with RA?
loss of appetite and inability to prepare food can cause weight loss but corticosteroids can cause weight gain
229
what is the primary goal of RA managment?
decrease inflammation
manage pain
protect/correct joint deformity
maintain joint function
230
to relieve joint stiffness and increase ADL with RA, what should the nurse do? *
REST PERIODS NEED TO BE PLANNED
sit/stand in warm shower, or with warm towels wrapped around shoulders, soak hands in warm water
231
when giving meds for RA, what lab needs to be assessed for effectivness?
decreased CRP n=mean decreased inflamation
232
what is primary gout?
hereditary error of purines
233
what is secondary gout?
r/t another acquired disorder or drugs
234
what is post menopausal gout?
pateints recieving immunosuppresive agents are at high risk for gout
235
what are the signs of gout?
joints are dusky and cyanotic, extremely tender and sensitive
low grade fever
inflammation of great toe
236
what are the diagnostics for gout and what is not useful?
serum uric acid above 6
synovial fluid aspiration **
xrays are not useful
237
what patients are given Colchicine for the treatment of gout? *
patients with hepatic impairment
238
what patients are given cozaar for the treatment of gout?
patients with HTN
239
what is the nutritional therapyy for gout? *
decrease alcohol and avoid purines
sardines
herring
mussels
liver and kidney
goose
vension
meat soups s
sweet breads
240
what are patients with gout at increased risk for and what should you do? *
kidney stones, increase fluids
241
what should you do for a patient in a nursing home with a gout flareupp of the great toe? *
put sheets over footboard so they arent touching toe
242
how is lyme disease transmitted?
transmitted by bite of a deer tick, vector borne
243
what are the signs of lymes disease?
erythema migrans “bullseye rash”
low grade fever and chills
HA
stiff neck
fatigue
swollen lymph nodes
muscle/joint pain
244
what can happen if lymes disease is left untreated?
spirochete can disseminate to the heart, joints and CNS
short term memory loss
cognitive impairment
shooting pain
numb/tingle in feet
bells palsy
heart block and myocarditis
chronic arthritis/ swelling in joints
245
what is the treatment od active lesions of lymes disease?
ATB (Doxycycline, Cefuroximine, Amoxicillin)
Ceftriaxone or Penicillin for cardiac or neuro probelms
246
what are the signs of septic arthritis? *
decreased BP, increased HR
fever
joints are swollen, red, and warm
247
what are the diagnostics for septic arthritis?
joint aspiration/ synovial fluid cultures and blood cultures
248
what is the treatment for septic arthritis?
broad spectrum ATB for 2-6 weeks
249
what is the nursing management for septic arthritis?
assess joint inflammation, pain and fever
use resting splints or traction to immobilize
hot compresses to decrease pain
gentle ROM
educate on ATB compliance
250
what is ankylosing spndylitis?
chronic inflammatory disease that affects axial skeleton, joints, vertebrea disc, and costovertebral articulations
251
what are the signs of ankylosing spondylitis?
symetric sacralitis and inflammatory arthritis
low back pain
stiffness
limit motion
abnormal posture
altered vision
aortic insufficency
pulmonary fibrosis
252
what are the diagnostics for ankylosing spondylitis?
xray, MRI, presence of HLA-B27
253
what is the treatment of ankylosing spondylitis?
NSAIDS and salicylates, local corticosteroid shot, TNF inhibitors to decrease inflammation and increase spinal mobility
254
what is psoriatic arthritis?
progressive inflammatory disease in pt with psoriasis
255
what is given for psoratic arthritis and the medications?
Splinting, joint protection and PT
NSAIDS
DMARDS (Methotrexate, Sulfasalazine)
BRM (Entarecept, Adalimumab)
Otezla
256
what is lupus (SLE) and what does it affect?
multisystem inflammatory autoimmune disease
skin and membranes
renal, hematolgic and neurologic systems
joints
257
what are the general complaints of lupus?
fever, weight loss, joint pain, and excess fatigue
258
what are the dermatolgic problems with lupus?
skin lesions
butterfly rash (discoid lesions)
oral/ nasopharyngeal ulcers
alopecia
259
what are the musculaskeletal problems of lupus? *
polyarthralgia with morning stiffness
arthritis (swan neck, ulnar deviation, and subluxation with hyperlaxity of joints in fingers)
increased risk of bone loss and fractures
myositis
synovitis
260
what are the cardio problems of lupus?
tachypnea
cough
pleurisy
dysrythmias
pericarditits
antiphospholipid syndrome
261
what are the renal problems with lupus and what can you give? *
mild proteinuria
glomerulonephritis (scarring)
Hematuria
give corticosteroids, cytotoxic agents, and immunosuppresive agents
262
what indicates lupus nephritis and what should you do? *
increased BUN/creatnine
change therapy to avoid renal damage
263
what are the nervous system problems with lupus? *
seizures
peripheral neuropathy
cog dysfunction (disordered thinking, memory deficits)
psychiatric disorders
stroke
264
what are the hematologic problems with lupus?
anemia
leukopenia
thrombocytopenia
coagulation disorders
splenomegaly
265
what is a majot cause of death with lupus?
infection, early diagnosis is a must
266
what are the diagnostics for lupus? *
present ANA
24 hour urine for proteinuria
history and physical
267
what is the drug therapy for lupus?
NSAIDS to decrease inflammation
antumalarial drugs
steroid sparing srugs
corticosteroids
immunosuppresants
anticoagulants
268
what do you observe for in lupus?
fever, joint inflammation, limited motion, location/degree of discomfort, and fatigue
269
what is the nursing management for lupus?
weight and I/O
24 hour urine sample
assess neuro status (visual disturb, HA, seixures, personality changes, memory loss)
educate pt on disease
provide emotional support
limit sun exposure
270
what is the nursing managment for women with lupus? *
monitor for pregnancy
do not take oral contraceptives because they can exerbate lupus
271
what is scleroderma?
body makes to much collagen which leads to progressive tissue fibrosis and occlusion of blood vessells
onset is 30-50 yo
272
what are the risk factors of scleroderma?
enviromental or occupational exposure to coal, plastics, and silica dust
273
what are the signs of scleroderma?
CREST
calcinosis: calcium in skin
raynauds: intermittent vasospams of fingers due to cold/stress
esophageal dysfunctions: dif swallowing due to scarring
sclerodactyly: tightning of skin on fingers/toes
telangiectasia: red spots on hands, foreaems, palms, face, and lips
274
what are the diagnostics for scleroderma?
labs are normal
xray showes subQ Calcification, distal esophageal hypomotility and bibasilar pulmonary fibrosis
275
what is used in the treatment of scleroderma?
treat symptoms
PT/OT for joint mobility
vasoactive agents
calcium channel blockers for Raynaud
Respirine increase blood flow
NSAIDS for pain
276
what is the nursing managment for scleroderma?
avoid finger sticks
avoid smoking
exercise to prevent skin retraction
protect hands/feet from cold, heat or cuts
reduce dysohagia with small frequent meals
277
what is polymyositis (PM)?
idiopathic, imflammatory myopathy of striated muscle that causes weakness
278
what is dermatomyositis (DM)?
muscle changes associated with PM are accumpanies with skin changes
279
what are the signs od polymyositis and dermatomyositis?
weight loss, fatigue, muscle weakness (NO muscle discomfort or tenderness)
dysphagia and dysphonia
Rash with DM
calcium nodules
joint redness, pain and inflammation
contractures/muscle atrophy
interstituaal lung disease
280
what is Heliotrope rash with DM?
red or purple symmetric with edema around eyelids
281
what is a gottron papule rash with DM?
scaly, smooth, raised rash on knuckles and side of hands
282
what us a gottran sign rash with DM?
Scaly, smooth, red patch in interphalangeal spaces
283
what is a poikiloderma rash with DM?
Red scaly rash on back, butt, and v shaped area on neck/chest
284
what are the diagnostics of PM and DM?
Biopsy is GOLD standard
MRI
labs are helpful but not diagnostic
Increased ESR and CRP
285
what is used to treat PM and DM?
corticosteroids
immunosupressants
IVIG
synthetic ACTH injection for muscle spasms
286
what is sjogrens syndrome?
autoimmune disease that targets moisture producing exocrine glands
287
what doe sjogrens syndrome lead to?
dry mouth and eyes and increases risk for non hodgkin lymphoma
288
what are the sign of sjogrens syndrome?
dry eyes
dry mouth (buccal fissures)
vaginal dryness
change in taste
joint/muscle pain
thyroid problems
289
what are the diagnostics of sjogrens syndrome?
eye exam (schirmer)
measure of salvary functions
lower lip biopsy
290
what is the treatment for sjogrens syndrome?
treat symptoms
artifical tears
punctal occlusion
increase fluids
dental hygeine
Pilocarpine and Cevimeline for dry mouth
291
where is the pain with myofascial pain?
chronic pain in chest, neck shoulders, hips, and lower back
referred pain to butt, hands and head
292
what can myofascial pain cause?
temporomandibular joint pain (TMJ)
293
what kind of pain is myofascial pain?
worsens with activity and stress
deep aching pain with burning, stinging, and stiffness
294
what is used in the treatment of myofascial pain?
PT (spray and stretch, iced and coolant)
topical patch
trigger point injection
massage, accupuncture, biofeedback and US
295
what is fibromyalgia?
chronic central pain/CNS (nerves)
Multiple tender points
nonrestorative sleep, IBS, morning stiffness and anxiety
296
what does fibromyalgia NOT have?*
joint inflammation/swelling, cardiac palpatations, and dizziness
297
what are the signs of fibromyalgia? *
Burning pain
Sleep disturbances/fatigue
Multiple tender points
Worsens and improves throughout day
Head/facial pain, migranes
TMJ dysfunction
Difficult concentration/ memory/ overwhelmed
Depression/ anxiety
Paresthsia and stiffness
Restless leg syndrome
IBS
Dysphasia
Urinary frequency
Difficult menstruation
298
What are the diagnostics of fibromyalgia?
No definitive diagnosis
Labs r/o other disorders
Decreased ANA
Muscle biopsy
Pain in 11 of 18 tender points
Pain for at least 3 mon
299
What drugs are given for fibromyalgia?
Pain meds (pregabalin, duloxetin, Milnacipin)
Tricyclic antidepressants
Muscle relaxers
Nonopiod analgesics
Zolpidem for sleep
300
What is the nursing management for fibromyalgia?
Massage
Heat/cold
Gentle stretching
Yoga
Aerobic exercise
Limit sugar, caffeine, and alcohol
Vitamins
Relaxation
301
What is systemic exertion intolerance disease (SEID)?
Chronic fatigue syndrome
302
What is systemic exertion intolerance disease (SEID) characterized by? *
Fatigue longer than 6 min
Unrefreshing sleep
Brain fog
Symptoms get worse with standing and exercise
303
What education should be given for (SEID)? *
Gradually increase ADLS and exercise to decrease fatigue
Give antihistamines and decongestants for symptoms
High fiber diet
Does not progress with age
304
What are the diagnostics for SEID?
R/o other disorders, no labs
305
What meds are given for SEID?
NSAIDS
Antihistamines and decongestants
Tricyclic antidepressants/ SSRI
CLonazepam
Hydrocortisone
306
What is the nursing management for SEID?
Avoid total rest
Increase fiber and dark colored fruits and veggies
Behavioral therapy
307
Which labs need to be assed for RA?
CRP, RH, ESR, and ANA
308
What is a main clinical manifestation of OA?
Joint pain that is relieved by rest
309
Following an arthroscopy or total joint replacement what could happen?
DVT
310
What should a pt who had a lumbar laminectomy avoid?
Prolonged sitting
