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MED SURG > TOPIC 10 - musculoskeletal and arthritis > Flashcards

TOPIC 10 - musculoskeletal and arthritis Flashcards

1
Q

causes of osteoarthritis

A

aging
genes
joint injury
obesity
heavy manual occupations
trauma

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2
Q

what does inflammation indicate in clients with osteoarthritis

A

secondary synovitis

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3
Q

osteoarthritis is sometimes accompanied by what other diseases

A

psoriasis, crohns, hemophilia
(progressive loss of cartilage and bones)

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4
Q

osteoarthritis assessment

A

complains of chronic joint pain and stiffness
enlarged joints related to hypertrophy
joint tenderness on palpitation
crepitus with ROM
joints are hard
inflammation = secondary synovitis
herberdens nodes
bouchards nodes

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5
Q

hebderdens nodes

A

bony nodules at distal interphalangeal joints

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6
Q

bouchards nodes

A

bony nodules at proximal interphalangeal joints

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7
Q

osteoarthritis diagnostics

A

labs : ESR, CRP
imaging : xray, MRI, CT

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8
Q

drug therapy for chronic pain related to cartilage deterioration

A

acetaminophen
lidocaine
SNAID
flexeril (muscle spasms)
ultram

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9
Q

alternative therapies for chronic pain related to cartilage deterioration

A

rest balanced with exercise
joint positioning
heat or cold
weight control

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10
Q

therapies related to impaired mobility related to joint main and muscle atrophy

A

ROM
light exercise
physical therapy
positioning

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11
Q

purpose of drug therapy

A

reduce pain and secondary joint inflammation

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12
Q

diet with osteoarthritis

A

are prone to the disease to eat a well-balanced diet, follow a weight reduction program if obese, avoid trauma, and limit strenuous weight-bearing activities

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13
Q

reducing pain

A

use multiple modalities for pain relief, ice and heat, rest, positioning, CAMS, meds, energy conservation, exercise, joint protection

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14
Q

osteoporosis risk factors

A

Older age
Female
Low body weight
White & Asian ethnicity
Smoker
Sedentary (Lack of physical exercise)
Estrogen deficiency
Family history
Chronic low calcium or vitamin D (Osteomalacia)
High alcohol intake
Low testosterone in men
Long term corticosteroid use

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15
Q

when do osteoporosis and osteopenia occur

A

when bone resorption activity is greater than bone building activity

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16
Q

BMD determines

A

bone strength

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17
Q

peak years for osteoporosis

A

25-30 years old

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18
Q

after peak years

A

BMD decreases and bone resorption activity exceeds bone building activity

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19
Q

modifiable risk factors for osteoporosis

A

inadequate vitamin D or calcium, smoking, alcohol, sedentary lifestyle, large amounts of carbonated beverages

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20
Q

when do patients realize they have osteoporosis

A

if they have a fracture
usually it is silent and they are unaware

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21
Q

osteoporosis definition

A

chronic metabolic disease in which bone loss causes decreased density and increased risk of fracture

22
Q

osteoporosis physical assessment

A

Back pain, Restrictive movements, loss of height
Dowager’s hump
Risk of fractures-radius and femur/hip*

23
Q

diagnostic testing for osteoporosis

A

Bone mineral density (BDM)
Osteoporosis = T-score < -2.5
Serum Calcium, Vitamin D, and ALP

24
Q

medications for osteoporosis

A

biophosphonates - raloxifene mimics estrogen without stimulation of breast or uterus

25
Q

osteomyelitis definition

A

severe infection of bone, bone marrow, and surrounding soft tissue

26
Q

risk factors for osteomyelitis

A

diabetes, orthopedic prosthetic implants, vascular insufficiency

27
Q

osteomyelitis definition

A

Soft tissue biopsy
Blood, wound, bone cultures
WBC, ESR, CRP
X-ray: it will not initially appear until 2-4 weeks
CT can show the extend of infection
MRI can show bone marrow edema (early sign)
Radionucleotide scans will show abnormalities earlier than an x-ray

28
Q

systemic s/s of osteomyelitis

A

fever, night sweats, chills, restless, nausea, malaise

bone pain, swelling, tenderness, warmth, restricted movement

29
Q

interprofessional care for osteomyelitis

A

aggressive and long term IV antibiotic therapy when there is no bone ischemia

related soft tissue damage and abscesses are debrided and drained

30
Q

pain control for osteomyelitis

A

how is the limb handled
muscle spasms
NSAIDs, opioids, muscle relaxants
CAMS

31
Q

reactions to high dose antibiotic therapy

A

Hearing deficit,
Impaired renal function
Neurotoxicity (weakness, numbness, cognitive changes
Vision changes
Headache
Behavioral problems

32
Q

gout primary vs secondary

A

Primary – hereditary error of purine metabolism (↑production)
Secondary – caused by other diseases or medications

33
Q

diagnostics for gout

A

serum uric acid >6mg/dL, 24hr urine collection (from decreased excretion vs. ↑production), synovial fluid tests, x-ray

34
Q

risk factors for gout

A

Obesity
Intake of: red & organ meat, shellfish, fructose
ETOH
Prolonged fasting
Medications

35
Q

meds and diseases that cause gout

A

a) Medications:
Thiazide diuretics
B-Blockers
ACE inhibitors
Aspirin
Niacin
Immunosuppressive for transplants
b) Diseases:
Diabetes
Hyperlipidemia
Hypertension
Atherosclerosis
Renal Insufficiency
Sickle Cell Anemia

36
Q

tophi definition

A

bone erosion

37
Q

rheumatoid arthritis

A

common connective tissue disease, destruction to joint

chronic, progressive, systemic inflammatory autoimmune disease

38
Q

what joints are primarily affected in rheumatoid arthritis

A

synovial joints

39
Q

what are the antibodies doing in rheumatoid arthritis

A

transform and attach healthy tissue = inflammation

40
Q

RA assessment early manifestations

A

joint inflammation
systemic : low grade fever, fatigue, weakness, anorexia, paresthesia

41
Q

RA assessment late manifestations

A

osteoporosis, severe fatigue, anemia, weight loss, SQ nodules, peripheral neuropathy, vasculitis, pericarditis, fibrotic lung disease, sjogrens syndrome, kidney disease, felty syndrome

42
Q

RA deformities

A

ulnar drift, boutonniere deformity, hallux valgus, swan neck deformity

43
Q

labs for RA

A

ESR, CRP
Anti-CPP
Rheumatoid factor
Antinuclear antibody (ANA)

44
Q

diagnostics for RA

A

Synovial fluid analysis for MMP-3
X-ray

45
Q

RA drug therapy

A

Disease Modifying Antirheumatic drugs (DMARDs)
Biological Response Modifiers
Immunosuppressants
Corticosteroids

46
Q

RA surgeries

A

synovectomy - removal of joint lining
arthroplasty - removal of diseased joint

47
Q

acute vs chronic care for RA

A

Acute Care – when clients experience systemic complications or uncontrolled pain

Chronic Care -
Balance rest & activity
Joint Protection
Cold & heat therapy
Exercises
Client and Caregiver Teaching
Psychological Support
Gerontological Considerations

48
Q

methotrexate

A

used early on to slow progression
lower risk for toxicity
rare side effects of bone marrow suppression and hepatotoxicity
frequent lab monitoring for CBC, CMP
starts to work within 4-6 weeks
given with other DMARDs or corticosteroids if not providing adequate relief

49
Q

humira - BRM

A

Store in refrigerator

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Protect the medicine from direct light

Monitor patients closely for signs and symptoms of infection during and after treatment

50
Q

nutritional considerations for RA

A

may have loss of appetite and fatigue or decreased mobility and endurance makes food shopping and prep difficult

MED SURG (30 decks)

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