w5 notes Flashcards

Question 1

Q

Radiologic studies: ______

Injection of radioisotope that is taken up by bone
Increased uptake = osteomyelitis, osteoporosis, malignancies, and some fx
Decreased uptake = avascular necrosis (death of bone d/t lack of vessels/blood supply)
Nurse – give radioisotope 2 hour prior to procedure, lie still for 1 hour, radioisotope not harmful, force fluids after

Answer

A

bone scan

Question 2

Q

SLE Dx
T/F
1- pt hx, physical exam, lab finding
2- there is one specific dx test for SLE
3- ANA (Antinuclear antibody ) test positive in most SLE pt
4- anti-DNA antibody test
5- elevated ESR and CRP
6- increased serum complement
7- CBC = pancytopenia
8- urinalysis = proteinuria, hematuria, blood cell casts (indicates kidney involvement)

Answer

A

1 T
2 F - not one specific dx test for SLE
3 T
4 T (more specific to SLE b/c antibodies are rarely found in other disorders)
5 T
6 F - decreased serum complement
7 T
8 T

Question 3

Q

________ arthritis: Risk factors
- age, gender, race, ethnicity
- hyperuricemia
- obesity
- HTN
- HLD
- ischemic CV disease
- DM
- CKD
- dietary factors
- Alcohol
- medications altering urate balance

Question 4

Q

osteomyelitis Care
- IV ____ – vigorous, prolonged, central line
- __________ debridement
- initially – ____ rest
- some immobilization of affected limb
- pain control

Answer

A

Care
- IV abx – vigorous, prolonged, central line
- surgical debridement
- initially – bed rest
- some immobilization of affected limb
- pain control

Question 5

Q

Radiologic studies: ______
- Radio and magnetic waves to view soft tissue
- Place inside scanner chamber
- Nurse – explain painless, loud ticking noise, remove metal, if claustrophic admin anti-anxiety meds

Question 6

Q

Radiologic studies: ______
- 3-demensional picture
- For soft tissue, bone abnormalities and some trauma
- w/ or w/out contrast
- Nurse – explain painless, remain still, if w/ contrast assess allergies and etc.

Question 7

Q

Total hip arthroplasty
- replacement
- 2 types

________
- hip muscle left intact = more stable hip post op
- ROM restriction = hyperextension
__________
- ROM restrictions =
- No extreme internal rotations
- No adduction (may have abduction wedge between legs)
- No >90 degree flexion (may have elevated toilet seat)

Answer

A

anterior
posterior

Question 8

Q

this traction involves suspending the entire leg in a flexed position using a splint or frame, counterbalanced by weights or a pulley system

Answer

A

Balanced suspension traction

Question 9

Q

s/s
- pain
- Intense
- In joint - often great toe but can be other joints like knees and ankles
- Early morning
- inflammation/edema
- tenderness
- red
- fever
- malaise
- flare peaks 24-48 hours, takes 5-10 days to go away

Answer

A

gouty arthritis

Question 10

Q

Balanced suspension traction = involves suspending the entire leg in a flexed position using a splint or frame, counterbalanced by weights or a pulley system
T/F
1- used with skin or skeletal traction?
2-uses countertraction or running traction?
3 - disadv: pt sliding down in bed
4 - continuous pulling force
5 - allows for more movement and care
6 nurse must maintain constant traction, no interruption in weights, nothing interrupting the line of pull (direction of pulling force)

Answer

A

1 both
2 countertraction
3 F - prevents pt from sliding down in bed
4 T
5 T
6 T

Question 11

Q

emergency care: fractures
- ABC
- ______ injury
- splint fracture in normal body alignment
- immobilize fracture
- maintain normal body alignment
- elevate fractured body part – __crease venous return and __crease swelling
- apply _____ pack 1st 24 hours – increase vasoconstriction and decrease swelling

Answer

A

emergency care: fractures
- ABC
- head injury
- splint fracture in normal body alignment
- immobilize fracture
- maintain normal body alignment
- elevate fractured body part – increase venous return and decrease swelling
- apply cold pack 1st 24 hours – increase vasoconstriction and decrease swelling
Fractures = ongoing predictable pain which indicates ATC dosing/meds

Question 12

Q

SLE Treatment
- highly individualized
- ___________ (most all pts will be on this)
PLUS
- Mild SLE
- NSAIDS maybe
- Short term low dose glucocorticoids maybe (prednisone)
- Moderate SLE
- Short term therapy (prednisone)
- Taper once hydroxychloroquine takes effect
- severe/life threatening
- Intensive immunosuppressants
- High dose steroids to halt tissue injury

Answer

A

Treatment
- highly individualized
- hydroxychloroquine (most all pts will be on this)
PLUS
- Mild SLE
- NSAIDS maybe
- Short term low dose glucocorticoids maybe (prednisone)
- Moderate SLE
- Short term therapy (prednisone)
- Taper once hydroxychloroquine takes effect
- severe/life threatening
- Intensive immunosuppressants
- High dose steroids to halt tissue injury

Question 13

Q

osteoporosis s/s
- _________ fx – break in vertebral body of bone d/t loss of bone mass
- ______ pain
- progressive _________ deformities
- “silent disease”
- Loss of _______ over time due to vertebral fractures and compression

Answer

A

compression fx – break in vertebral body of bone d/t loss of bone mass
back pain
progressive vertebral deformities
“silent disease”
loss of height

Question 14

Q

cast complications
- _________ r/t pressure necrosis
- Circulation impairment
- _________ damage
- Immobility
- Watch for pressure areas – where ________ are

Answer

A

cast complications
- Infection r/t pressure necrosis
- Circulation impairment
- Peripheral nerve damage
- Immobility
- Watch for pressure areas – where bony prominences are

Question 15

Q

Serum studies (blood tests): Antinuclear antibody (ANA)

Assess for antibodies capable of destroying nucleus of body’s tissue cells
Normal = negative
Positive in most ____ patients,
positive maybe in ____ patients, and very few normal population

Answer

A

Antinuclear antibody (ANA)
- Assess for antibodies capable of destroying nucleus of body’s tissue cells
- Normal = negative
- Positive in most SLE patients,
also maybe RA patients, and very few normal population

Question 16

Q

herniated disc: Dx
_________
- Uses magnetic energy
- Images
- Non-invasive
- No metal
- Sedation if claustrophobic

_________
- Xray/thin cross sections
- w/ or w/out contrast

_________
- xrays after injection of contrast into subarachnoid space
- sedate prn
- done on tilt table
- encourage fluids

Answer

A

MRI
CT scan
myelogram

Question 17

Q

Goals for fracture treatment
(3)

Answer

A

Goals for fracture treatment
1. reduce (align)
2. immobilize
3. restore function

Question 18

Q

OA vs RA
6. anti-ccp antibody
= positive
= negative

ESR and CRP
= normal
= elevated
Age at onset
= Young to middle age.
= Usually older than 40 years.

9 Gender
= Females 2:1 after age 60; except for traumatic arthritis, men less affected until age 70 or 80.
= Female-to-male ratio is 3:1. Less marked difference after age 60.

Answer

A

anti-ccp antibody
RA = positive
OA = negative
ESR and CRP
OA = normal
RA = elevated
Age at onset
RA = Young to middle age.
OA = Usually older than 40 years.

9 Gender
OA = Females 2:1 after age 60; except for traumatic arthritis, men less affected until age 70 or 80.
RA = Female-to-male ratio is 3:1. Less marked difference after age 60.

Question 19

Q

complications of amputations
- possible VTE
- acute pain
- impaired mobility
- peripheral NV dysfunction
- risk for injury
- risk for impaired skin integrity

which is #1?

Answer

A

possible VTE

Question 20

Q

procedure to replace the damaged knee joint with an artificial prosthetic joint

Answer

A

Total Knee Arthroplasty (TKA)

Question 21

Q

Serum studies (blood tests): rheumatoid factor (RF)

T/F
- Used to assess for presence of autoantibody (RF)
- Used to dx _____
- specific or non-specific to RA?
- Normal = negative
- when dx RA - is RF or ACPA/anti-CCP is more specific?

Answer

A

T - Used to assess for presence of autoantibody (RF)
- Used to dx RA
F - not specific to RA - Can be in various tissues, and normal population
T - Normal = negative
- ACPA/anti-CCP is more specific to RA

Question 22

Q

OA, RA, SLE
1. local
2. systemic
3. symmetrical
4. asymmetrical
5. joint pain worsens with use or change in temp/pressure
6. fatigue
7. debilitating fatigue
8. anorexia
9. joint pain relieved with rest
10. weight loss
11. generalized stiffness that worsens over time
12. AM stiffness lasts > 60 mins
13. joint stiffness worsens in AM
14. AM stiffness < 30 mins
15. multi joints affected
16. multi systems affected
17. Pain/stiffness moves from one part of the body to the other
18. crepitus
19. pain
20. limited ROM
21. swollen warm joints
22. photosensitivity
23. heberdens nodes
24. disability
25. butterfly rash
26. kidney failure
27. pancytopenia
28. sjogrens syndrome
29. fever
30. raynauds phenomenon
31. rheumatoid nodules
32. hair loss
33. edema
34. ulners drift
35. bouchards nodes
36. bowlegged knees
37. knuckle and wrist subluxation
38. mouth and nose ulcers
39. pleurisy and pericarditis
40. swan neck fingers
41. boutineniere fingers
42. nervous system dysfunction
43. z shaped thumb
44. concentration difficulty
45. confusion
46. depression
47. h/a
48. seizures
49. cerebritis

Answer

A

OA
RA, SLE
RA
OA, SLE
OA
RA
SLE
RA
OA
RA
RA
RA
OA, RA, SLE
OA
SLE
SLE
SLE
OA
OA, RA, SLE
RA
SLE
SLE
OA
RA
SLE
SLE
SLE
RA
SLE
SLE
RA
SLE
SLE
RA
OA
OA
RA
SLE
SLE
RA
RA
SLE
RA
SLE
SLE
SLE
SLE
SLE
SLE

Question 23

Q

joint surgery: Care
Depends on which joint is replaced/repaired
- neurovascular assessment
- Original surgical dressing
removed by =
reinforced prn by =
- maintain specific ROM ________
- restore strength, muscle tone and ROM

Answer

A

Care
Depends on which joint is replaced/repaired
- neurovascular assessment
- Original surgical dressing
removed only by surgeon,
reinforce prn by surgeon
- maintain specific ROM limitations
- restore strength, muscle tone and ROM

Question 24

Q

Complications of amputations
- __________ – increased HR, saturated dressing
- infection
- phantom limb pain
- _________contractures – esp at hip

Answer

A

Complications
- hemorrhage – increased HR, saturated dressing
- infection
- phantom limb pain
- flexion contractures – esp at hip

Question 25

Q

delayed ID/treatment of osteomyelitis can lead to:
T/F
- Chronic pain, infection, and drainage
- Loss of function
- Amputation
- Death (from sepsis)

Question 26

Q

external fixation devices: _______________

screws are placed into the bone above and below the fracture
device is attached to the screws from the outside
device can be adjusted to realign the bone
allows pt to not be confined to bed
(with any method that involves pins/screws into skin/bone – assess pin site for pin loosening, infection, perform pin care with NS, avoid using ointments which attract bacteria, teach to avoid touching)

Answer

A

external fixators

Question 27

Q

herniated disk: treatment

nonsurgical/conservative
- brace, corset, belt
- heat/ice
- massage
- traction
- _______ – electrical nerve stimulatior, helps with pain control
- NSAIDS, short term narcotics, muscle relaxants
- back and core strengthening exercises
Surgical
-___________ – excision/removal or lamina (posterior arch of vertebra) to gain access to protruding disc to remove it, nerves are no longer compressed
- ___________ – remove part of disk so nerve has more room
- __________– add bone graft/synthetic product for stabilization, keeps bone off bone, fuses spine

Answer

A

TENS
laminectomy
diskectomy
spinal fusion

Question 28

Q

external fixation devices: casts
- temporary circumferential __________ device
- common treatment after __________ reduction
- cast material – fiberglass, plaster of paris (rare, old)

Answer

A

external fixation devices: casts
- temporary circumferential immobilization device
- common treatment after closed reduction
- cast material – fiberglass, plaster of paris (rare, old)

Question 29

Q

purpose – to hold broken bones together (or close approximation) until healing takes place

Answer

A

immobilize

(After the reduction, the fracture can be stabilized/immobilized with:
-internal fixation devices
- metal plates
- screws
- nails
- pins
- bone grafts
-external fixation devices
- cast
- splint
- brace
- traction
- external fixators)

Question 30

Q

osteoarthritis pt
RA pt
Congenital deformities pt

commonly get _______ surgery

Question 31

Q

Total hip arthroplasty
- hip replacement

2 types:
1. anterior
2. posterior

which one?
1- hip muscle left intact
2 ROM restrictions = No extreme internal rotations
3 ROM restrictions = No adduction (may have abduction wedge between legs)
4. ROM restrictions = hyperextension
5. ROM restrictions = No >90 degree flexion (may have elevated toilet seat)
6. more stable hip post op

Question 32

Q

2 types of traction

Answer

A

skin
skeletal

Question 33

Q

OA treatment
1. _______ and _______joint
- Maintain functional position prn (orthotics)
- Avoid prolonged immobilization
- Use assistive devices prn
2. heat/cold
- ____ helps with stiffness, 20 min on/off
3. weight reduction prn
4. aerobic exercise
5. complementary therapies - Yoga, Acupuncture, biofeedback
6. drug therapy

Answer

A

rest and protect joint
- Maintain functional position prn (orthotics)
- Avoid prolonged immobilization
- Use assistive devices prn
heat/cold
- Heat helps with stiffness, 20 min on/off
weight reduction prn
aerobic exercise
complementary therapies - Yoga, Acupuncture, biofeedback
drug therapy

Question 34

Q

Radiologic studies: ______
- Anterior-posterior on- dimensional view
- Lateral two-dimensional view
- Nurse – remove radioopaque/metal objects from pt, avoid excessive exposure

Question 35

Q

when caring for pt with a fracture a sudden inability of pain medications to relieve pain =

Answer

A

compartment syndrome

Question 36

Q

joint surgery: Why?
- relieve_______
- improve ________
- ________ deformity and mal-alignment
- remove intra-articular causes of erosion

Answer

A

Why?
- relieve pain
- improve motion
- correct deformity and mal-alignment
- remove intra-articular causes of erosion

Question 37

Q

Serum studies (blood tests): ESR
T/F
- Non-specific or specific indicator of inflammation?
- chronic or acute?
- associated with RA, osteomyelitis
-Normal = <30

Serum studies (blood tests): CRP
- Non-specific or specific indicator of inflammation?
- chronic or acute?
- indicates infections
- indicates active widespread malignancies

Answer

A

nonspecific
chronic
T
T

nonspecific
acute
T
T

Question 38

Q

Radiologic studies: ______
- w/ or w/out contrast
- assess pathology of the spinal cord
- sensitive test for nerve impingement

procedure -
- xrays after injection of contrast into subarachnoid space
- sedate PRN
- done on a tilt table
- encourage fluids

nurse -
- risk of spinal h/a

Answer

A

myelogram

Question 39

Q

myelogram: nursing care r/t risk of spinal h/a
- to prevent spinal h/a position pt ________
- spinal h/a should resolve in 1-2 days w/ _____ and _______
- if not ________ may be indicated
- blood patch - blood draw from ______ and is injected into _______ which often provides _________ relief from spinal h/a

Answer

A

to prevent spinal h/a lay flat
spinal h/a should resolve in 1-2 days w/ rest and fluids
if not blood patch may be indicated –
blood draw from periphery is injected into spine, which often provides immediate relief from spinal h/a

Question 40

Q

Systemic inflammatory disorder
autoimmune
multisystem inflammatory disease
chronic, unpredictable remissions and exacerbations

Answer

A

SLE
(RA - more joint thing vs lupus - more multisystem thing)

Question 41

Q

which pts are at risk for VTE and fat embolisms?

_________ - fat globules released from long bone fracture (femur, humerus) enter the bloodstream and travel to lungs, brain, etc.

Answer

A

fracture pt, fat embolism - long bone fracture (femur, humerus)

fat embolism

Question 42

Q

osteoporosis: drug therapy

Class: Bisphosphonates
-Drugs: alendronate, ibandronate
-MOA: inhibits osteo___last resorption
-Directions:
- take w/ water or doesn’t matter?
- take on empty stomach or with food?
- remain in what position for 30 mins after taking?
Class: selective estrogen receptor modulator (SERM)
-Drugs: raloxifene
-MOA: mimic estrogen effects on bone by reducing bone _________ w/o stimulating breast/uterus

Answer

A

Class: Bisphosphonates
-Drugs: alendronate, ibandronate
-MOA: inhibits osteoclast resorption
-Directions:
- take w/ full glass of water,
- take on empty stomach (atleast 30 mins before food/other meds),
- remain upright for 30 mins after taking)
Class: selective estrogen receptor modulator (SERM)
-Drugs: raloxifene
-MOA: mimic estrogen effects on bone by reducing bone resorption w/o stimulating breast/uterus

Question 43

Q

Joint disorder 2ndary to another disease
urate crystals in synovial fluid
acute, painful inflammation
recurring acute arthritis characterized by accumulation of uric acid crystals in one or more joints (common in big toe, but can be other joints like knees and ankles)

Answer

A

Gouty arthritis

Question 44

Q

Serum studies (blood tests): complement levels

Normal body protein
Essential for ______ and ___________ reactions
______ levels = RA or SLE

Answer

A

complement levels
Normal body protein
Essential for immune and inflammatory reactions
Low levels = RA or SLE

Question 45

Q

RA treatment
T/F
1. rest joints
2. sleep + nap daily
3. exercise - prevents and reverses effects
4. ROM exercise for joint motion
5. Improve strength – isometric, isotonic, isokinetic
6. Increase endurance – walk, swim, cycle
7. hand/finger splint
8. OT/PT
9. heat - 20 mins on
10. cold is contraindicated
11. overweight or anorexia – nutrition
12. meds - DMARDS, NSAIDs, steroids
13. meds require regular medical care and blood tests

Answer

A

T 1. rest joints
T 2. sleep + nap daily
T 3. exercise - prevents and reverses effects
T 4. ROM exercise for joint motion
T 5. Improve strength – isometric, isotonic, isokinetic
T 6. Increase endurance – walk, swim, cycle
T 7. hand/finger splint
T 8. OT/PT
T 9. heat - 20 mins on
F 10. cold - 10-15 mins on
T 11. overweight or anorexia – nutrition
T 12. meds - DMARDS, NSAIDs, steroids
T 13. meds require regular medical care and blood tests

Question 46

Q

this type of skin traction uses counteraction - Allows pt to move more in bed
Permits flexion of knee joint
Relieves muscles spasms/back pain

Question 47

Q

Weight bearing restrictions types
- Non-weight bearing = extremity shouldn’t touch floor
- Toe touch weight bearing = can touch floor for ______, not for ___________
- partial weight bearing = 30-50%
- weight bearing as tolerated = without _______ or ________
- full weight bearing = no restrictions

Answer

A

Weight bearing restrictions types
- Non-weight bearing = extremity shouldn’t touch floor
- Toe touch weight bearing = can touch floor for balance, not weight bearing
- partial weight bearing = 30-50%
- weight bearing as tolerated = without undue strain or pain
- full weight bearing = no restrictions

Question 48

Q

2 types of traction

Skin
______ term
_______ lbs
Involves using ____________ attached to traction device
Skeletal
Tolerated better
Can handle more weight _______ lbs
Involves using ______________ attach to the traction device

Answer

A

2 types of traction
- Skin
- Short term – skin can’t tolerate for long
- 5-10 lbs
- Involves using tapes, splints, or boots attached to traction device
-
- Skeletal
- Tolerated better
- Can handle more weight 5-45 lbs
- Involves using pins through the bone to immobilize part and attach to the traction device

Question 49

Q

OA treatment: drug therapy
- __________ – if no inflammation
- tylenol limit?
- monitor what labs?
- __________ – if unrelieved with acetaminophen or inflammation present
- NSAIDS - monitor for _____, _____, ______, and _____ problems)
- ________– NSAID, cox 2 inhibitor if GI s/e are a problem
- Topical NSAIDS or capsaicin (chili peppers)

Answer

A

Acetaminophen – if no inflammation
(3 gram limit, 4 gram limit if medically supervised
monitor LFTs)
NSAIDS – if unrelieved with acetaminophen or inflammation
(monitor for bleeding, ulcer, stomach upset, and renal problems)
Celecoxib – NSAID, cox 2 inhibitor if GI s/e are a problem
Topical NSAIDS or capsaicin (chili peppers)

Question 50

Q

Chronic vs Acute: osteomyelitis

___________
- shorter than one month duration
local s/s
- constant bone pain that worsen with activity and unrelieved by rest
- swelling, tenderness, and warmth at infection site
- restricted movement of affected part
- Systemic s/s
- fever, chills, night sweats
- restlessness, nausea, malaise

____________
- longer than one month duration or has failed to respond to initial abx
- can be continuous/persistent or remissions/exacerbations
- Systemic s/s reduced
- Local s/s
- constant bone pain
- swelling
- warm at site

Answer

A

acute
chronic

Question 51

Q

General nursing care: fractures
1- assess _____ site
2-______technique
3- culture site prn
4- admin abx
5- monitor _____ and WBC
6- examine potential ______ areas Q4 – braden scale daily
7-_____ plaster of paris cast edges
8- teach - don’t ______ anything in cast
9- teach report s/s of warmth, increased ____, foul ____
10- ventilation is good – moisture contributes to ______
11- turn if permissible, avoid friction/shear
12- control ______ before ROM exercises
13- know weight bearing/non-weight bearing
14- instruct use in assistive devices

Answer

A

1- assess pin site
2- aseptic technique
3- culture site prn
4- admin abx
5- monitor temp and WBC
6- examine potential pressure areas Q4 – braden scale daily
7- petal plaster of paris cast edges
8- teach don’t insert anything in cast
9- teach report s/s of warmth, increased pain, foul odor
10- ventilation is good – moisture contributes to breakdown
11- turn if permissible, avoid friction/shear
12- control pain before ROM exercises
13- know weight bearing/non-weight bearing
14- instruct use in assistive devices

Question 52

Q

Gout
- uric acid metabolism
- Deposit of urate salts

Chronic tophaceous gout
- advanced stage of gout (many years after onset)
- _________– painless nodules filled with uric acid crystals

Answer

A

Gout
- uric acid metabolism
- Deposit of urate salts

Chronic tophaceous gout
- advanced stage of gout (many years after onset)
- tophi – painless nodules filled with uric acid crystals

Question 53

Q

gouty arthritis Care
- address modifiable risk factors
- pain control and joint immobilization during ________
-________ – to maintain high urine volume and prevent precipitation of uric acid in kindeys
- drug therapy – acute and chronic gout
- Acute gout = _________ (relief in 12-24 hours) and NSAIDS
- __________ = allopurinol (improvement in 2-6 weeks)

Answer

A

Care
- address modifiable risk factors
- pain control and joint immobilization during flare
- fluids – to maintain high urine volume and prevent precipitation of uric acid in kindeys
- drug therapy – acute and chronic gout
- Acute gout = colchicine (relief in 12-24 hours) and NSAIDS
- Prophylactic = allopurinol (improvement in 2-6 weeks)

Question 54

Q

Post op care: amputation
- assess tissue perfusion
- pain management
- prevent infection
- promote proper position, ambulation, exercise
- _______ position 30 min 4x/day or elevate stump
- initially – compression bandage to foster _______ and molding of limb for eventual prosthesis fitting, also promotes limb ________ and maturation,
wear _____ except for PT and bathing,
should remove and reapply _______ times daily
- figure 8 wrapping – prevents restriction of _________
- Psychosocial issues
- prosthesis

Answer

A

Post op care: amputation
- assess tissue perfusion
- pain management
- prevent infection
- promote proper position, ambulation, exercise
- prone position 30 min 4x/day or elevate stump
- initially – compression bandage to foster shape and molding of limb for eventual prosthesis fitting, also promotes limb shrinkage and maturation, wear AAT except for PT and bathing, should remove and reapply several times daily
- figure 8 wrapping – prevents restriction of blood flow
- Psychosocial issues
- prosthesis

Question 55

Q

osteoporosis Facts:
T/F
1- women 8x more likely than men to develop osteoporosis
2- women have higher calcium intake
3- women have less bone mass and smaller frames
4- women’s bone resorption begins sooner and accelerates at menopause
5- women have higher longevity

Answer

A

1 T
2. F - lower
3. T
4 T
5 T

Question 56

Q

Systemic inflammatory disorder
autoimmune
symmetrical
progressive
insidious
highly inflammatory connective tissue in synovial joints
remissions and exacerbations

Question 57

Q

cast care
- no covering – requires ___________ until set
- _________ q 1-2 hours until set
- ___________ checks (5 P’s) q 1 hr x 24 hrs – distal to cast
- 5 P’s =
- _____ fingers should be able to be inserted into cast
- ______ first 24-36 hours – vasoconstriction to reduce swelling
- If plaster of paris – normal to feel ______ as the cast dries and hardens, hand with _____ while wet (not fingers), ______ edges (so edges of cast don’t dig into skin)

Answer

A

cast care
- no covering – requires ventilation until set
- resposition q 1-2 hours until set
- neurovascular checks (5 P’s) q 1 hr x 24 hrs – distal to cast
- pain (1st sign), pallor, pulselessness, paresthesia, paralysis
- 1-2 fingers should be able to be inserted into cast
- Ice first 24-36 hours – vasoconstriction to reduce swelling
- If plaster of paris – normal to feel warmth or heat as the cast dries and hardens, hand with palms while wet (not fingers), petal edges (so edges of cast don’t dig into skin)

Question 58

Q

OA dx:

bone scan, CT, MRI - _____ joint changes
xray - Staging _______
Joint narrowing, bony sclerosis, osteophyte formation
correlate to degree of pain experienced?
_____ biomarkers for OA
ESR _______ (unless synovitis present)
synovial fluid will be clear yellow, no signs of _________

Answer

A

Dx
- bone scan, CT, MRI - Early joint changes

xray - Staging progression
Joint narrowing, bony sclerosis, osteophyte formation
Doesn’t correlate to degree of pain experienced
no biomarkers for OA
ESR normal (unless synovitis present)
synovial fluid will be clear yellow, no signs of inflammation

Question 59

Q

SLE Affects
T/F
- skin
- joints
- serous membranes – pleura effusions and pericardium effusions
- bones
- renal system
- hematologic system
- neurologic system

Answer

A

skin
joints
serous membranes – pleura effusions and pericardium effusions
F - bones
renal system
hematologic system
neurologic system

Question 60

Q

replacing/aligning bone fragments in the correct anatomic position

Answer

A

Fracture reduction

Question 61

Q

Gout vs gouty arthritis

_______ = buildup of uric acid crystals in the body

____________ = these uric acid crystal deposits accumulate within the joints, causing inflammation, swelling, and intense pain.

Answer

A

Gout
Gouty arthritis

Question 62

Q

Risk factors: osteoporosis
- women or men?
- family hx?
- _____ body weight
- long term use of ________
- age?
- diet low in ________
- inadequate physical activity – especially _________ exercises
- tobacco and excessive alcohol

Answer

A

Risk factors
- women
- family hx
- low body weight
- long term use of corticosteroids
- advanced age
- diet low in calcium
- inadequate physical activity – weight bearing exercises
- tobacco and excessive alcohol

Question 63

Q

OA vs RA
14. Effusions
= Uncommon.
= Common.

Nodules
= Present, especially on extensor surfaces.
= Heberden (DIPs) and Bouchard (PIPs) nodes.
Synovial fluid
= WBC count 5000–60,000/μL with mostly neutrophils; ↓ viscosity.
= WBC count < 2000/μL (mild leukocytosis); normal viscosity.
X-rays
= Joint space narrowing and erosion with bony overgrowths, subluxation with advanced disease. Osteoporosis related to decreased activity, corticosteroid use.
= Joint space narrowing, osteophytes, subchondral cysts, sclerosis.

Answer

A

Effusions
OA = Uncommon.
RA = Common.
Nodules
RA = Present, especially on extensor surfaces.
OA = Heberden (DIPs) and Bouchard (PIPs) nodes.
Synovial fluid
RA = WBC count 5000–60,000/μL with mostly neutrophils; ↓ viscosity.
OA = WBC count < 2000/μL (mild leukocytosis); normal viscosity.
X-rays
RA = Joint space narrowing and erosion with bony overgrowths, subluxation with advanced disease. Osteoporosis related to decreased activity, corticosteroid use.
OA = Joint space narrowing, osteophytes, subchondral cysts, sclerosis.

Question 64

Q

________ surgery
- hip
- knee
- elbow
- shoulder
- wrist
- phalangeal joints of finger
- ankle
- foot

Answer

A

joint surgery

Answer 56

A

Post op care: herniated disk surgery
- lie flat – avoid pressure on spine
- log rolling – avoid movement of spine
- pain management
- assess for CSF leak – c/o h/a, clear or light yellow drainage
- peripheral neurovascular checks
- spinal fusion - recovery longer, assess donor site
- avoid sitting/standing for long periods of time
- avoid twisting

Answer 57

A

Laboratory findings
RA = Rheumatoid factor positive in about 80% of patients; negative titers in early disease for about 25%.
OA = Rheumatoid factor negative.

OA = ANA negative.
RA = ↑ Antinuclear antibodies (ANAs) titer likely.

OA = Anti-CCP negative.
RA = Positive anti-CCP (anti-citrullinated peptide) in 60%–80%.

RA = ↑ ESR, CRP indicative of active inflammation, used to test disease activity. Not specific to RA.
OA = Transient elevation in ESR related to synovitis.

Answer 58

A

T
T
T
T
T
T

Answer 59

A

closed
open

Answer 60

A

Types of fractures
- Comminuted fracture - The bone is shattered into pieces.
- Transverse fracture - The fracture line is perpendicular to the bone’s long axis.
- Oblique fracture - The fracture line is angled across the bone’s long axis.
- Spiral fracture - The fracture line wraps around the bone’s shaft like a corkscrew.
- Greenstick fracture - The bone is bent and partially cracked, not completely separated. (splinters, common in kids)
- Pathologic fracture - The break occurs in a bone weakened by an underlying disease.
- stress fracture - a small crack in the bone caused by repetitive stress or overuse, often seen in athletes

Answer 61

A

Primary joints affected
OA = distal interphalangeal
RA = metacarpophalangeal
heberdens nodes
RA = none
OA = present
joint characteristics
RA = soft, warm, tender
OA = hard and bony
stiffness
OA = morning stiffness resolves within 30 mins
RA = worse after resting (ex: early morning stiffness >60 mins)
rheumatoid factor (RF)
RA = positive
OA = negative

Answer 62

A

uric acid
- End product of protein metabolism
- Normally excreted by kidneys via urine
- Non-specific
- Usually levels are high with gout

Answer 63

A

Compartment syndrome

Answer 64

A

T - Women <65 w/ risk factors + menopause
F - Women >65
T - women and men with Long term steroid therapy use (causes porous bones)
T - To measure response to osteoporosis drug therapy

Answer 65

A

Spinal anatomy
- cervical = 7
- thoracic = 12
- Lumbar = 5
- sacral = 5
- coccyx = 4
- more moveable and more at risk for problems = cervical and lumbar

Answer 66

A

internal fixation devices: pins, nails, screws, plates
- assess 5 P’s
- elevate extremity above heart (esp. 1st 48-96 hours) – increases venous return and decreased swelling
- apply ice – vasoconstrict and reduce swelling
- notify provider if pain increases/unrelieved with meds
- teach signs of neurovascular dysfunction

Answer 67

A

Who gets amputations?
- peripheral vascular diases (esp OA with DM)
- trauma
- thermal injuries
- osteomyelitis
- tumors
- congenital limb disorders

Answer 68

A

fasciotomy (incision in skin and fascia to release pressure, vessels are no longer compressed, capillaries are functional

Answer 69

A

Dx
- inflammatory arthritis w/ 3+ joints
- positive RF
- positive ACPA and anti-CCP
- elevated ESR and CRP
- s/s > 6 weeks

Answer 70

A

external fixation devices: traction
- applies pulling force on fractured extremity
- must be continuous pulling force (unless ordered intermittent)

Answer 71

A

Types of amputations
- open (guillotine) – indicated if infected area, don’t want to close it yet
- closed
- elective
- traumatic

Answer 72

A

bone density scan/DEXA

Answer 73

A

FE
FE
VTE
VTE
FE
VTE
FE
FE
VTE
VTE
FE
VTE
FE
FE
VTE
FE
VTE
FE
VTE
FE
FE

Answer 74

A

bone scan
Injection of radioisotope that is taken up by bone
Increased uptake = osteomyelitis, osteoporosis, malignancies, and some fx
Decreased uptake = avascular necrosis (death of bone d/t lack of vessels/blood supply)
Nurse – give radioisotope 2 hour prior to procedure, lie still for 1 hour, radioisotope not harmful, force fluids after

Answer 75

A

Rheumatoid nodules

Answer 76

A

Class: DMARDS
drugs: methotrexate and hydrochloroquine
- Reduce inflammation
- Reduce joint damage
- Preserve joint
- Methotrexate – improvement 4-6 weeks, used early in RA, within 3 months of dx, can lessen permanent effects of RA
- Hydrochloroquine – improvement in 2-3 months

NSAIDS
- More immediate relief from pain and minor inflammation
- Does not reduce long term damage
- Must be taken contiuously, at specific doses, for several weeks for anti-inflammatory effects
- Monitor for s/e – bleeding and kidney problems
- Once DMARDs are working, NSAIDS are withdrawn

Glucocorticoids (steroids) = prednisone and prednisolone
- Rapid inflammation suppression
- Short term use only
- Route – PO, IV, directly into joint
- Many s/e
- Goal = lowest possible dose for shortest possible time period

Answer 77

A

Herniated disK

Answer 78

A

glucocorticoid/steroid joint injections joint injections – if other measures didn’t work and arthritis is confined to a few joint
- Suppresses inflammation
- Temporary
- May have brief flare up after injection
- Risk for infection
- Frequent injections can cause joint damage
- No more than 3-4 x/year

hyaluronate injections – usually indicated when pt is waiting joint replacement
Substance in joints allows joint fluid to be slippery
s/e same as steroids

Answer 79

A

Bucks
Russells

Answer 80

A

Mineral metabolism studies
1. alkaline phosphates
- Enzyme produced by osteoblasts of bones
- increased = healing fx, bone cancer, osteoporosis

calcium
- Stores mainly in bone
- Indirectly related to phosphorus (inverse relationship - increase/decrease)
- Decreased = renal disease, hypoparathyroidism
- Increased = hyperparathyroidism, bone tumors
phosphorus
- Indirectly related to calcium (inverse relationship - increase/decrease)

Answer 81

A

Running
Counter-traction

Answer 82

A

anti-DNA antibody
Detects antibodies that react to DNA
Most specific test for SLE

Answer 83

A

sjogrens syndrome

Answer 84

A

calcium

amount
-premenopausal = 1000 mg
-postmenopausal + taking estrogen = 1000 mg
-postmenopausal = 1500 mg

vitamin D (800-1000 intake daily)
exercise - load bearing, 30 mins for 3x/week
avoid tobacco and excessive alcohol
corset to prevent vertebral collapse
drug therapy

Answer 85

A

2 types of skin traction
- Bucks
- Simplest form of skin traction
- Uses running traction - Provides straight pull-on affected extremity, unidirectional, one-way traction
- Relieve muscle spasm or temporary immobilization before ORIF

Russell
Uses counteraction Allows pt to move more in bed
Permits flexion of knee joint
Relieves muscles spasms/back pain

Answer 86

A

Hip fracture with ORIF
- repair
- ROM restriction = limited weight bearing for 6-12 weeks
- PT prn

isometric exercises = joint doesn’t move, contract/release muscle
isotonic exercises = joint moves

1 isometric - Quadriceps setting
2 isometric - Gluteal muscle setting
3 isotonic - Leg raises
4 isotonic - Leg abduction

Answer 87

A

Weight
OA = Often overweight or obese.
RA = Lost or maintained weight.
Disease
OA = Localized disease with variable, progressive course.
RA = Systemic disease with exacerbations and remissions.
Affected joints
RA = Small joints typically affected first (PIPs, MCPs, MTPs), wrists, elbows, shoulders, knees. Usually bilateral, symmetric joint involvement.
Oa = Weight-bearing joints of knees and hips, small joints (MCPs, DIPs, PIPs), cervical and lumbar spine. Often asymmetric.
Pain characteristics
RA = Stiffness lasts 1 h to all day and may ↓ with joint use. Pain is variable, may disrupt sleep.
OA = Stiffness occurs on arising but usually subsides after 30 min. Pain gradually worsens with joint use and disease progression, relieved with joint rest but may disrupt sleep.

Answer 88

A

-dairy products
X-bananas
-milk
-yogurt
-cheese
X-red meat
-leafy green vegetables
-kale
-broccoli
X-eggs
-bok choy
-sardines
-tofu
-almonds
-cereals
X-carrots

Answer 89

A

Gout diet
- high adipose tissue/weight = high gout
- low adipose tissue/weight = low gout
- caloric restriction
- high protein
- from low fat dairy and plant protein, not fish and red meat
- complex carbs
- low sat fat
- avoid sugar sweetened beverages
- avoid foods that cause flares or increase serum urate levels – fatty meals, organ rich foods, beer, distilled spirits)
- goal = lose weight, take meds, follow gout diet

Answer 90

A

OA
- Local joint disorder with local inflammation
- involves the formation of new joint tissue in response to cartilage destruction,
- bone on bone rubbing, bones may also form spurs/osteophytes
- Not a normal part of aging process
- s/s are local, not systemic
- low level inflammation in joint area

Answer 91

A

Running – unidirectional, one-way traction
Countertraction – traction/pulling in different directions

Answer 92

A

females 20-40 more likely

autoimmune, genetic, hormonal, environmental and immunologic

Answer 93

A

bone density scan/DEXA
assess for osteoporosis (normal, osteopenia, osteoporosis, severe osteoporosis)
gold standard for measuring bone mineral density (BMD)
scan – hips, wrist, spine
reported as T scores (compared to a standard deviation)
nurse – explain painless, non-invasive

Answer 94

A

internal fixation devices
external fixation devices

Answer 95

A

Important dx for RA
May allow earlier/more accurate dx
(when dx RA - ACPA/anti-CCP is more specific than RF)

Answer 96

A

gouty arthritis Caused by:
- high uric acid production
- low uric acid excretion in the kidneys (most common)
- high intake of purine containing foods (purine is normally metabolized into uric acid)
- primary – most common
- secondary – drug induced

Answer 97

A

serum uric acid = elevated
24 hour urine for uric acid = helps determine cause - decreased renal excretion or over production of uric acid
synovial fluid = contains needle like crystals of sodium urate

Answer 98

A

Dx
- Bone/tissue biopsy – determines causative organism
- positive blood/wound culture
- increased WBC
- increased ESR
- xray changes (10 days + into infection)
- radionuclide bone scans preferred
- MRI

Answer 99

A

osteoporosis
loss of bone density and subsequent (pathological) fractures
- silent disease
- most affected – wrist, hip, vertebral column
- low bone mineral density
- bone remodeling – requires a balance between bone formation by osteoblasts and bone resorption by osteoclasts

Answer 100

A

1- take with food
2- chewable form preferred
3- most common – carbonate and citrate
4- difficult to absorb in single doses >500 m

Answer 101

A

Electromyogram (EMG)

Answer 102

A

T- Supportive
T- Oxygen
T- fluids

Answer 103

A

T -UV light?
T -Abruptly stopping drugs?
T -Avoid infections?
F -Avoid foods that cause flares or increase serum urate levels – fatty meals, organ rich foods, beer, distilled spirits (this is for gout)

Answer 104

A

Acute osteomyelitis
- shorter than one month duration
local s/s
- constant bone pain that worsen with activity and unrelieved by rest
- swelling, tenderness, and warmth at infection site
- restricted movement of affected part
Systemic s/s
- fever, chills, night sweats
- restlessness, nausea, malaise

Chronic osteomyelitis
- longer than one month duration or has failed to respond to initial abx
- can be continuous/persistent or remissions/exacerbations
Local s/s
- constant bone pain
- swelling
- warm at site
Systemic s/s reduced

Answer 105

A

Osteomyelitis
Severe infection of the bone, bone marrow, and surrounding soft tissue

most common infecting organism = staph aureus
Indirect entry – blood stream
Direct entry – open wound
difficult to cure

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