Musculoskeletal Flashcards by Sydney Book

what is the function of bones?

support
protection of internal organs
voluntary movement
blood cell production
mineral storage

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how many bones does a skeleton have?

206 (long, short, flat, and irregular bones)

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what is epiphysis and what is it made of?

the widened area at each end of bone thats made of cancellous bone

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what is metaphysis and what is it made of?

the flared area btwn epiphysis and the diaphysis and made of cancellous bone

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what does the diaphysis do and what is it made of?

provides structural support and its made of cortical bone

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What is the periosteum?

Fibourous connective tissue that covers the bone

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What is the epiphyseal plate?

The growth plate

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What does the medullary cavity contain?

Red or yellow bone marrow

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What is cancellous bone?

Spongy bone

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What does red bone marrow do?

Produces red and white blood cells (hematopoeisis)

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What do osteoblast do?

Secretes bone matrix to help bone formation

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What does osteocytes do?

Helps make bones hard and mature the osteoblast

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What do osteoclasts do?

Absorb bone tissue during growth and healing

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What is ossification?

Depositing of new bone by osteoblasts

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What is modeling?

Bone that has been altered by genetic or nutritional circumstances

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What is remodeling?

The natural process occuring every 3 mon

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What are joints?

Where the bones come into close contact at their “ends” but do not actually touch

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What is synarthrotic?

No movement in joints (skull)

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What is amphiarthrotic?

Limited movement in joints ex. Vertebrea and symphysis pubis

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What is diarthrodial?

Synovial, freely moveable joints ex. Knees and elbows

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What are the diathrodial joint movements?

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)

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What joints are hinge movement?

Elbows and knees

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What joints are ball and socket moevment?

Hip and shoulders

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What joints have pivot movement?

Radius, ulna, skul, and spine

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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

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What are ligaments and what do they do?

Connective tissue that is fibrous and connects the ends of bones together
Creates joint stability

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What is bursea?

Sacs filled with synovial fluid near joints to cushion movement of tendons, ligamnets, and bones during friction

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What is fascia?

Layers of connective tissue that surround muscles, blodd vessels, and nerves

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What is isotonic activity?

Muscle length shortens with increasing muscle tension

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What is isometric activity?

Muscle length does not change but the tension increases

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What is atrophy muscle size?

Decrease in muscle size resulting from absence in muscle activity

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What does vitamin D do for the bones and muscles?

Helps increase calcium absorbed from GI and reduces lost in urine

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What does vitamine D deficiency cause?

Bone mineralization deficit and often deformaties and fractures
Requires sunlight

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What does parathromone or parathyrin do for muscles and bones?

Regulates calcium homeostasis, stimulates osteoclast to form and production of calcitrol

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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)

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If an older adult has low growth hormone levels, what will they have?

Increased fat and decreased muscle and energy

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Why is testosterone needed for muscle and bone?

Helps growth of muscles and skeleton

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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

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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

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Why does blood supply effect bone and muscle?

When blood supply is decreased osteogenesis is decreased (bone formation)

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What type of meds should be assessed when dealiing with muscle and bone?

OTC, supplements, herbs, relaxants, opiotes, and NSAIDS

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What can antiepileptic drugs cause in bones and muscles?

Osteomalacia

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What can potassium sparing diuretics cause in bone and muscles?

Muscle cramps and weakness

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What can corticosteroids cause in bone and muscles?

Avascular necrosiscand decreased muscle mass

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What is a DEXA scan?

Measures bone density, size, thickness, and mineral content
Used for early detection of osteoporosis

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what can a CT identify?

Tumors, fractures and joint abnormalties with contrast

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what can a MRI identify?

if a tumor is bedside or inside a bone

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what is a bone scan?

shows hot/dark spots to indicated abnormalities (4hr)

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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

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what do increased calcium lab studies show?

bone tumers and hyperparathyroidism

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what lab studies have a normal negative result?

C-reactive protein (CRP) and rheumatoid factor (RH)

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what lab studies identify inflammation or necrosis?

Erythrocyte sedumentation rate (ESR)

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what is a arthroscopy?

direct visulilization of joint and used to perform biopsy

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what is an arthrocentesis?

evaluates synovial fluid in a joint and relieves pain

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what is the duplex venous doppler?

explores blood flow in extremities

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what is a sprain?

injury to a ligament by a twisting motion

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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

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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

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what is a strain?

excess stretching of muscle involving tendons

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what are the degrees of strains?

1: mild pulled muscle
2: moderatly torn muscle
3: severely torn or ruptured muscle

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what can a severe sprain cause?

an avulsion fracture: ligaments pull off a fragment of a bone

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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

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what are the signs of sprains and strains?

pain, edema, decrease fucntion and bruising

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how long does it take for a mild sprain or strain to heal?

within 3-6 weeks

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what is used in the diagnosis of a sprain or strain and why?

xray to r/o fracture

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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)

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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

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what is dislocation and what are the common locations ?

complete displacement, no movement most common in thumb, elbow, shoulder and hip

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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

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what must occur is dislocation occurs in a joint?

reduction to prevent avascular necrosis

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what is a cumulative strain?

injury of tendons, ligaments, ot muscles from repeated forceful movements (scarring and decreased tissue perfusion)

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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

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how can you avoid a cumulative sprain?

good ergonomics, heat/cold applications when sore, stretching/conditioning

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what is carpal tunnel syndrome?

compression of median nerve r/t continuous wrist movement

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what are the signs of carpal tunnell syndrome?

pain, numbness, paresthsia, burning, weak thumb

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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

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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

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what can cause a rotator cuff injury?

aging, repetive stress, injury to shoulder while falling (swimming, weight lifting, or swinging a racket)

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what are the signs of a rotater cuff injury?

shoulder weakness, pain , decreased ROM, positive drop arm test

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what is used to diagnose a rotator cuff injury?

MRI

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what is the treatment of a partial rotater cuff tear?

rest, ice/heat, NSAIDS

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what is the treatment for a full rotator cuff tear?

surgery

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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

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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

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what are the signs of a meniscus tear?

pain and knee will click, pop, lock or give out

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what is used to diagnose a meniscus tear?

MRI

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what is the treatment of a meniscus tear?

arthroscopy and rest

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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

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what is the diagnosis of an ACL injury?

Lachmen test and MRI

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what is the treatment for an ACL injury?

rest, ice, NSAIDS, elevation, ambulate with crutches
severe requires surgery with autologous or allograft tissue

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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

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what are the symptoms of bursitits?

warmth, pain, swelling, and limited ROM

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what is the treatment for bursitis?

immobilize, ice and NSAIDS
asiration of fluid
corticosteroid injection

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what are the characteristics of normal synovial fluid? *

scant, pale yellow/ straw colored NOT CLOUDY

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what fracture is most commonly indicated as child abuse? *

spiral

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what is a greenstick fracture?

slit in bone (does not go all the way through)

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what is a comminuted fracture?

bone shattered in the middle of shaft

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what is an oblique fracture?

diagonal crack in bone

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what is a pathological fracture?

like a transcerse crack but goes all the way through bone and bone is pulled away from each other

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what is a stress fracture?

tiny crack in bone by overuse

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what are the symptoms of a fracture?

loacalized pain, decreased function, gaurding, deformity by displacment, shortening of extremity, crepitus, swelling/discoloration

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what is crepitus?

grating sound or sensation

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if a pt has a right lower leg fracture what do you assess? *

pedal pulses for circulation

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what are the 6 steps of fracture healing?

fracture hematoma
granulation tissue
callus formation
ossification
consolidation
remodeling

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what do you assess frequently for a fracture?

color, motion, sensation on extremities
neurovascular states distal (below) site

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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

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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

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what is a closed reduction? *

nonsurgical with conscious sedation and pain meds, they yank bone to put bone back in place (manual traction)

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what is the home treatment for a fracture? *

immobilize, elevate, Ice and pain meds

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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

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what are complications of skin traction?

skin breakdown, nerve damage, and circulatory impairment

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what is skeletal traction?

longterm for several weeks, pin wire directly into bone and apply weight (5-45lbs) to pull bone back in place

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what are the complications of skeletal traction?

atelactasis/ pneumonia, constipation, anorexia, urinary stasis, infection and DVT

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what are the rules of skeletal traction? *

maintain counter traction (elevate end of bed), maintain continuous traction, keep weights off of the floor

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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

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what can occur if the pt starts to swell under the cast?

compartment syndrome

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what is open reduction external fixation?

metal pins/rods that apply traction and compressess fragments that is made for shattered bones/ cast has failed

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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

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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

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what does an electric bone growth stimulation do for the treatment of a fracture?

increases calcium uptake and bone growth

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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

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what is the diet modification for fractures?

increase protein, vitamin B,C, and D, calcium, phosphorous, magnesium, fluid, and fiber

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what medications need to be assed with fractures?

estorgen replacements bc they can cause fx and calcium supplements

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what can cause increase sensation?

excess blood or swelling

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what education is needed to prevent falls?*

remove rugs, daily ROM, and nondlip shoes with good support
most falls happen inside the home

what are the complications of immobility?

constipation, renal calculi, cardiopulmonary deconditioning, DVT

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

what are the complications of fractures?

hypovolemic shock
infections (check immunization status)
compartment syndrome
venous thromboembolism
fatty embolism

if a patient comes in with a fatty emboli and a tibial fracture, what do you do? *

administer O2

what is an indirect entry of osteomylitis?

results from blunt force trauma and common in boys under 13.
(tibia, pelvis, or vertebrea)

who is at increased risk for indirect entry of osteomylitis?

adults with GU, respiratory infections, or vascular disorders

what are the local signs of osteomylitis?

pain worsens with activity and with rest
swelling/tender/warm
restricted movement

what are the systemic symptoms of osteomylitis?

fever/ chills
night sweats
restlessness
nausea
malaise
drainage

what are the complications of osteomylitis?

Septicemia, septic arthritis, pathologic fx, and amyloidosis

if a patient comes in with osteomylitis, what do you do in order? *

blood culture, ATB, acetiaminophen, and then a CT

what ATB is often given for osteomylitis and what needs to be monitored? *

Gentamycin, its nephrotoxic so monitor BUN and creatnine

what is the discharge teaching for osteomylitis? *

IV ATB for several mon
s/s of infection at IV site
avoid exercise and heat

what is compartment syndrome?

decreased tissue perfusion within limited space decreases neurovascular function
artial flow decreased, ischemia, cell death, loss of function

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

what orders would you anticipate with compartment syndrome?

no elevation above heart, no ice, surgical decompression

what do you asses for a neurovascular assessment?

Pain
Pulse
Pallor
paresthsia
Paralysis
Pressure

how do you prevewnt a venous thromboembolism (VTE)?

prophalactic anticoagulants
SCD or ted hose
ROM

what are signs of a VTE?

pain fullness erythema and high temp

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

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

what is the prevention of a fat embolism?

careful immobilization and handling of long bone fractures

how do you prevent contractures with an amputation?

turn prone for 30min 4x daily

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

What is a synovectomy?

Removal of synovial membranes done early in disease when there is minimal bone or cartliage destruction

What is an osteotomy?

Removing slice of bone to restore alignment and shoft weight bearing to relieve pain

What is an arthroplasty?

Reconstruction of a joint

what are the benign bone tumors?

osteochondroma
osteoclastoma
enchondroma

REMOVED SURGICALLY

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

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

what are the signs of malignant bone tumors?

gradual onset of pain and swelling worse at night and increases with activity

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

what is muscular dystrophy?

genetic disease, progressive symmetric wasting of skeletal muscle without neurovascular involvment with loss of strength with increased disability and deformity

what are the diagnostics of muscular dystrophy?

genetic testing

what is used in the treatment of muscular dystrophy?

no definitive treatment but coritcosteroids can help symptoms and nurses need to prevent skiin breakdown

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

what are the signs of low back pain?

fatigue
pain radiating down leg
change in gair, reflexes, motor, strenth, and sensory

what is acute and chronic back pain?

acute is <4 weeks chronic is >3 mon

what are the risk factors for low back pain? *

excess body weight
stress
cig smokijg
congenital spine problems
vibration

what can indicate acute low back pain?

symptoms within 24 hours of injury ( not immediatly), straight leg test

what is spinal stenosis?

narrowing of spinal canal that results from osteoarthritis, RA, tumors, pagets and trauma

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

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

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

what is intervertebral disc disease?

intervertabrea disc seperate vertebrea and help absorb shock, they deteriorate or herniate

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)

what are the symptoms of intervertebral disc disease?

radiating pain
numb/tingle/weak
decreased strength/ROM/reflexs
low back pain
positive straight leg test

what are the signs of multiple nerve root compression?

severe low back pain
progressive weakness
increased pain
bowel/bladder incontinance
MEDICAL EMERGENCY

what is cervical disc disease?

pain radiates to arms and hands
decreased reflexes/handgrip
shoulder pain and dysfunction

how often should back strengthening exercises be done for intervertebral disc disease?

2 times daily for lifetime
pt can heal in 6 month

what is intradiscal electrothermoplasty (IDET)?

noninvasive, needle inserted into disc, wire threaded through disc and heated (degenerates nerves)

what is a radiofrequency discal nucleoplasty?

noninvasive, needle inserted into disc, radiofrequency probe generates energy and breaks up nucleus pulposus (decompresses disc)

Interspinous process decompression (XSTOP) treats what?

spinal stenosis (titanium and lifts vertebrea off of pinched nerve)

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

if a patient had a post lumbar fusion what should you do?

pillows under thigh when supine and btwn legs ehrn side laying

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

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

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

what is osteomalacia and what is it caused by?

bones soften
vitamin D defiency, decreased sun exposure, pregancy, malabsorption, and chronic diarrhea

what are the signs of osteomalacia?

bone pain and muscle weakness

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

what is osteoporosis?

chronic, progressive reduction of total bone mass “silent theif”

what does frequent corticosteroid use lead to? *

skeletal problems such as osteoporosis and avascular necrosis
Ex. pt with asthma

if a patient has osteoporosis, what can they not have? *

joint replacements

if a patient comes in and has lost 2in in 30 mon, what needs to be taught to them? *

osteoporosis education

what are signs of osteoporosis?

pathological fx
back pain
gradual loss of height
kyphosis or dowagers hump

what is the gold standard diagnostic for osteoporosis or if somone is losing height?*

DEXA

when does treatment for osteoporosis begin?

T score less than -2.5

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

what is osteoarthritis (OA)?

slowly progressive noninflammatory disorder of diarthrodial (synovial) joint, loss of articular cartliage, and osteophytes are formed

what are modifiable risk factors? *

something you can fix, smoking

what are nonmodifiable risk factors? *

cant fix, gender, age, genetics

what are the risk factors for osteoarthritis?

age
decreased estrogen at menopause
obeistiy
anterior cruciate ligament injury
frequent kneeling or stooping

what does obeisity increase the risk for? *

musculoskeletal problems

what happens to cartliage with osteoarthritis?

turns dull, yellow, granular, softer and decreased elastic with decreased ability to resist water with heavy use

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

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

what do you use for inflammation and stiffness with OA?

ice for inflammation and heat for stiffness

what is used for mild to moderate joint pain in OA?

acetaminophen
topical cream (capsaicin)
OTC cream (bengay, arthricare)
topical salicylates ( aspercreme)

what is used for moderate to severe joint pain?

NSAIDS
ibuprofen
misoprostol for GI
arthrotec
Diclofenac gel
celecoxib

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

what is an arthroscopic repair r/t osteoarthitis?

removes lose bodies from joint

what is some education for OA?

alter modifiable risk factors such as lose weight and reduce occupational/recreational hazard activites

what education would you give a patient with an injured left leg and walker? *

move walker forward, then left leg, then right leg

what is rheumatoid arthritis?

Genetic may need mobility aids or joint reconstruction

what needs to be assessed for the diagnosis of rheumatoid arthritis? *

Genetic link disorders (ankloysing spondilitis, RA, and SLE lupus)

what is the first stage of RA?

synovitis, swelling, osteoporosis but no joint destruction

what is the second stage of RA?

joint inflammation, gradual destruction, narrowing joint space from decreased cartliage

what is the third stage of RA?

synovial pannus, extensive decreasing cartliage, erosion at joint margins

what is the fourth stage of RA?

inflammatory process subsides, loss of joint function, subcutaneous nodules form

what are the signs of RA?

fatigue, anorexia, wt loss, stiffness
history of infection, stress, exertion, childbirth, surgery, emotional upset
symetrrical

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

what is PIP swelling with RA?

swelling confined to joint area with synovial thickening that feels like a firm sponge

what are the medications for RA?

NSAIDS, prednisone, intrarticular steroid for flares

if a patient has an exerbation of RA what lab needs to be assessed for inflammation while giving steroids? *

CRP c-reactive protein

what meds can decrease permanent effects of RA?

Methotrexate (monitor for bone marrow supression and hepatoxcity)
Sulfasalzine
Hydroxychlorquine (yealry eye exam)
Leflunomide (teratogenic)
Tofacitninib

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

what education needs to be given for a vertebralpalsy procedure? *

dont drive and you can remove the dressing the next day

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

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

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

If giving prednisone for the treatment of RA, what needs to be monitored?

glucose, swelling, clubbing and round face

what is the surgical therapyy for RA?

Synovectomy and arthroplasty (joint replacment)

what happens nutritioanlly with RA?

loss of appetite and inability to prepare food can cause weight loss but corticosteroids can cause weight gain

what is the primary goal of RA managment?

decrease inflammation
manage pain
protect/correct joint deformity
maintain joint function

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

when giving meds for RA, what lab needs to be assessed for effectivness?

decreased CRP n=mean decreased inflamation

what is primary gout?

hereditary error of purines

what is secondary gout?

r/t another acquired disorder or drugs

what is post menopausal gout?

pateints recieving immunosuppresive agents are at high risk for gout

what are the signs of gout?

joints are dusky and cyanotic, extremely tender and sensitive
low grade fever
inflammation of great toe

what are the diagnostics for gout and what is not useful?

serum uric acid above 6
synovial fluid aspiration **
xrays are not useful

what patients are given Colchicine for the treatment of gout? *

patients with hepatic impairment

what patients are given cozaar for the treatment of gout?

patients with HTN

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

what are patients with gout at increased risk for and what should you do? *

kidney stones, increase fluids

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

how is lyme disease transmitted?

transmitted by bite of a deer tick, vector borne

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

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

what is the treatment od active lesions of lymes disease?

ATB (Doxycycline, Cefuroximine, Amoxicillin)
Ceftriaxone or Penicillin for cardiac or neuro probelms

what are the signs of septic arthritis? *

decreased BP, increased HR
fever
joints are swollen, red, and warm

what are the diagnostics for septic arthritis?

joint aspiration/ synovial fluid cultures and blood cultures

what is the treatment for septic arthritis?

broad spectrum ATB for 2-6 weeks

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

what is ankylosing spndylitis?

chronic inflammatory disease that affects axial skeleton, joints, vertebrea disc, and costovertebral articulations

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

what are the diagnostics for ankylosing spondylitis?

xray, MRI, presence of HLA-B27

what is the treatment of ankylosing spondylitis?

NSAIDS and salicylates, local corticosteroid shot, TNF inhibitors to decrease inflammation and increase spinal mobility

what is psoriatic arthritis?

progressive inflammatory disease in pt with psoriasis

what is given for psoratic arthritis and the medications?

Splinting, joint protection and PT
NSAIDS
DMARDS (Methotrexate, Sulfasalazine)
BRM (Entarecept, Adalimumab)
Otezla

what is lupus (SLE) and what does it affect?

multisystem inflammatory autoimmune disease
skin and membranes
renal, hematolgic and neurologic systems
joints

what are the general complaints of lupus?

fever, weight loss, joint pain, and excess fatigue

what are the dermatolgic problems with lupus?

skin lesions
butterfly rash (discoid lesions)
oral/ nasopharyngeal ulcers
alopecia

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

what are the cardio problems of lupus?

tachypnea
cough
pleurisy
dysrythmias
pericarditits
antiphospholipid syndrome

what are the renal problems with lupus and what can you give? *

mild proteinuria
glomerulonephritis (scarring)
Hematuria

give corticosteroids, cytotoxic agents, and immunosuppresive agents

what indicates lupus nephritis and what should you do? *

increased BUN/creatnine
change therapy to avoid renal damage

what are the nervous system problems with lupus? *

seizures
peripheral neuropathy
cog dysfunction (disordered thinking, memory deficits)
psychiatric disorders
stroke

what are the hematologic problems with lupus?

anemia
leukopenia
thrombocytopenia
coagulation disorders
splenomegaly

what is a majot cause of death with lupus?

infection, early diagnosis is a must

what are the diagnostics for lupus? *

present ANA
24 hour urine for proteinuria
history and physical

what is the drug therapy for lupus?

NSAIDS to decrease inflammation
antumalarial drugs
steroid sparing srugs
corticosteroids
immunosuppresants
anticoagulants

what do you observe for in lupus?

fever, joint inflammation, limited motion, location/degree of discomfort, and fatigue

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

what is the nursing managment for women with lupus? *

monitor for pregnancy
do not take oral contraceptives because they can exerbate lupus

what is scleroderma?

body makes to much collagen which leads to progressive tissue fibrosis and occlusion of blood vessells
onset is 30-50 yo

what are the risk factors of scleroderma?

enviromental or occupational exposure to coal, plastics, and silica dust

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

what are the diagnostics for scleroderma?

labs are normal
xray showes subQ Calcification, distal esophageal hypomotility and bibasilar pulmonary fibrosis

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

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

what is polymyositis (PM)?

idiopathic, imflammatory myopathy of striated muscle that causes weakness

what is dermatomyositis (DM)?

muscle changes associated with PM are accumpanies with skin changes

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

what is Heliotrope rash with DM?

red or purple symmetric with edema around eyelids

what is a gottron papule rash with DM?

scaly, smooth, raised rash on knuckles and side of hands

what us a gottran sign rash with DM?

Scaly, smooth, red patch in interphalangeal spaces

what is a poikiloderma rash with DM?

Red scaly rash on back, butt, and v shaped area on neck/chest

what are the diagnostics of PM and DM?

Biopsy is GOLD standard
MRI
labs are helpful but not diagnostic
Increased ESR and CRP

what is used to treat PM and DM?

corticosteroids
immunosupressants
IVIG
synthetic ACTH injection for muscle spasms

what is sjogrens syndrome?

autoimmune disease that targets moisture producing exocrine glands

what doe sjogrens syndrome lead to?

dry mouth and eyes and increases risk for non hodgkin lymphoma

what are the sign of sjogrens syndrome?

dry eyes
dry mouth (buccal fissures)
vaginal dryness
change in taste
joint/muscle pain
thyroid problems

what are the diagnostics of sjogrens syndrome?

eye exam (schirmer)
measure of salvary functions
lower lip biopsy

what is the treatment for sjogrens syndrome?

treat symptoms
artifical tears
punctal occlusion
increase fluids
dental hygeine
Pilocarpine and Cevimeline for dry mouth

where is the pain with myofascial pain?

chronic pain in chest, neck shoulders, hips, and lower back
referred pain to butt, hands and head

what can myofascial pain cause?

temporomandibular joint pain (TMJ)

what kind of pain is myofascial pain?

worsens with activity and stress
deep aching pain with burning, stinging, and stiffness

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

what is fibromyalgia?

chronic central pain/CNS (nerves)
Multiple tender points
nonrestorative sleep, IBS, morning stiffness and anxiety

what does fibromyalgia NOT have?*

joint inflammation/swelling, cardiac palpatations, and dizziness

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

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

What drugs are given for fibromyalgia?

Pain meds (pregabalin, duloxetin, Milnacipin)
Tricyclic antidepressants
Muscle relaxers
Nonopiod analgesics
Zolpidem for sleep

What is the nursing management for fibromyalgia?

Massage
Heat/cold
Gentle stretching
Yoga
Aerobic exercise
Limit sugar, caffeine, and alcohol
Vitamins
Relaxation

What is systemic exertion intolerance disease (SEID)?

Chronic fatigue syndrome

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

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

What are the diagnostics for SEID?

R/o other disorders, no labs

What meds are given for SEID?

NSAIDS
Antihistamines and decongestants
Tricyclic antidepressants/ SSRI
CLonazepam
Hydrocortisone

What is the nursing management for SEID?

Avoid total rest
Increase fiber and dark colored fruits and veggies
Behavioral therapy

Which labs need to be assed for RA?

CRP, RH, ESR, and ANA

What is a main clinical manifestation of OA?

Joint pain that is relieved by rest

Following an arthroscopy or total joint replacement what could happen?

DVT

What should a pt who had a lumbar laminectomy avoid?

Prolonged sitting

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Musculoskeletal Flashcards

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