TOPIC 10 - musculoskeletal and arthritis Flashcards
causes of osteoarthritis
aging
genes
joint injury
obesity
heavy manual occupations
trauma
what does inflammation indicate in clients with osteoarthritis
secondary synovitis
osteoarthritis is sometimes accompanied by what other diseases
psoriasis, crohns, hemophilia
(progressive loss of cartilage and bones)
osteoarthritis assessment
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
hebderdens nodes
bony nodules at distal interphalangeal joints
bouchards nodes
bony nodules at proximal interphalangeal joints
osteoarthritis diagnostics
labs : ESR, CRP
imaging : xray, MRI, CT
drug therapy for chronic pain related to cartilage deterioration
acetaminophen
lidocaine
SNAID
flexeril (muscle spasms)
ultram
alternative therapies for chronic pain related to cartilage deterioration
rest balanced with exercise
joint positioning
heat or cold
weight control
therapies related to impaired mobility related to joint main and muscle atrophy
ROM
light exercise
physical therapy
positioning
purpose of drug therapy
reduce pain and secondary joint inflammation
diet with osteoarthritis
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
reducing pain
use multiple modalities for pain relief, ice and heat, rest, positioning, CAMS, meds, energy conservation, exercise, joint protection
osteoporosis risk factors
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
when do osteoporosis and osteopenia occur
when bone resorption activity is greater than bone building activity
BMD determines
bone strength
peak years for osteoporosis
25-30 years old
after peak years
BMD decreases and bone resorption activity exceeds bone building activity
modifiable risk factors for osteoporosis
inadequate vitamin D or calcium, smoking, alcohol, sedentary lifestyle, large amounts of carbonated beverages
when do patients realize they have osteoporosis
if they have a fracture
usually it is silent and they are unaware
osteoporosis definition
chronic metabolic disease in which bone loss causes decreased density and increased risk of fracture
osteoporosis physical assessment
Back pain, Restrictive movements, loss of height
Dowager’s hump
Risk of fractures-radius and femur/hip*
diagnostic testing for osteoporosis
Bone mineral density (BDM)
Osteoporosis = T-score < -2.5
Serum Calcium, Vitamin D, and ALP
medications for osteoporosis
biophosphonates - raloxifene mimics estrogen without stimulation of breast or uterus
osteomyelitis definition
severe infection of bone, bone marrow, and surrounding soft tissue
risk factors for osteomyelitis
diabetes, orthopedic prosthetic implants, vascular insufficiency
osteomyelitis definition
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
systemic s/s of osteomyelitis
fever, night sweats, chills, restless, nausea, malaise
bone pain, swelling, tenderness, warmth, restricted movement
interprofessional care for osteomyelitis
aggressive and long term IV antibiotic therapy when there is no bone ischemia
related soft tissue damage and abscesses are debrided and drained
pain control for osteomyelitis
how is the limb handled
muscle spasms
NSAIDs, opioids, muscle relaxants
CAMS
reactions to high dose antibiotic therapy
Hearing deficit,
Impaired renal function
Neurotoxicity (weakness, numbness, cognitive changes
Vision changes
Headache
Behavioral problems
gout primary vs secondary
Primary – hereditary error of purine metabolism (↑production)
Secondary – caused by other diseases or medications
diagnostics for gout
serum uric acid >6mg/dL, 24hr urine collection (from decreased excretion vs. ↑production), synovial fluid tests, x-ray
risk factors for gout
Obesity
Intake of: red & organ meat, shellfish, fructose
ETOH
Prolonged fasting
Medications
meds and diseases that cause gout
a) Medications:
Thiazide diuretics
B-Blockers
ACE inhibitors
Aspirin
Niacin
Immunosuppressive for transplants
b) Diseases:
Diabetes
Hyperlipidemia
Hypertension
Atherosclerosis
Renal Insufficiency
Sickle Cell Anemia
tophi definition
bone erosion
rheumatoid arthritis
common connective tissue disease, destruction to joint
chronic, progressive, systemic inflammatory autoimmune disease
what joints are primarily affected in rheumatoid arthritis
synovial joints
what are the antibodies doing in rheumatoid arthritis
transform and attach healthy tissue = inflammation
RA assessment early manifestations
joint inflammation
systemic : low grade fever, fatigue, weakness, anorexia, paresthesia
RA assessment late manifestations
osteoporosis, severe fatigue, anemia, weight loss, SQ nodules, peripheral neuropathy, vasculitis, pericarditis, fibrotic lung disease, sjogrens syndrome, kidney disease, felty syndrome
RA deformities
ulnar drift, boutonniere deformity, hallux valgus, swan neck deformity
labs for RA
ESR, CRP
Anti-CPP
Rheumatoid factor
Antinuclear antibody (ANA)
diagnostics for RA
Synovial fluid analysis for MMP-3
X-ray
RA drug therapy
Disease Modifying Antirheumatic drugs (DMARDs)
Biological Response Modifiers
Immunosuppressants
Corticosteroids
RA surgeries
synovectomy - removal of joint lining
arthroplasty - removal of diseased joint
acute vs chronic care for RA
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
methotrexate
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
humira - BRM
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
nutritional considerations for RA
may have loss of appetite and fatigue or decreased mobility and endurance makes food shopping and prep difficult
