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NURS 401 > Week 7: Muculoskeletal Disorders > Flashcards

Week 7: Muculoskeletal Disorders Flashcards

1
Q

What can cause a shortening of the trunk in older adults?

A

Vertebral disks become thinner as a result of gravity and dehydration, spontaneous and unknown spinal fractures may occur as the result of osteoporosis (OP) causing a shortening of the trunk.

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2
Q

What causes postural and structural changes to occur?

A

Primarily because of age-related bone calcium loss and atrophic cartilage and muscle.

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3
Q

Aging of the Musculoskeletal System: Bones

A

Bone renewal cannot keep pace with resorption -> results in reduced bone mineral density -> bones become brittle and fracture more easily.

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4
Q

What are factors that affect bone loss in older adults?

A
  • Genetics
  • Hormonal factors (estrogen and testosterone levels)
  • Decreased bone development
  • Nutritional deficiencies (especially calcium, magnesium and vitamin D)
  • Underlying conditions (i.e immune disorders, thyroid disease)
  • Lifestyle choices (i.e physical inactivity, smoking and alcohol intake)
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5
Q

Excessive loss of bone mineral density can lead to what?

A

Osteopenia or osteoporosis

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6
Q

What can cause age related deterioration in articular cartilage?

A

Biochemical changes

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7
Q

The aging of the musculoskeletal system: Joints

A

As joints dry, movement is less fluid and pain may result if changes progress to the extent where bone rubs bone.

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8
Q

The aging of the musculoskeletal system

A
  • Approximately 1% of the bulk and strength of skeletal muscle decline for each year after the age of 50.
  • Accelerated loss occurs with disuse and deconditioning
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9
Q

Sarcopenia

A

..

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10
Q

What are the most common musculoskeletal disorders?

A

Osteoarthritis
Rheumatoid Arthritis
Gout

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11
Q

Psuedogout

A

Form of arthritis in which calcium crystals deposit in the joints causing pain

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12
Q

Polymyalgia Rheumatica

A

Inflammatory disorder causing muscle pain and stiffness around the shoulders and hips

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13
Q

Osteoporosis: Major Risk Factors

A
  • Caucasians and Asians at highest risk
  • Low body weight
  • Family history of osteoporosis
  • Estrogen deficiency
  • Inadequate calcium and vitamin D intake
  • Lack of weight-bearing activities
  • Excess alcohol use (>1 drink daily for women and >2 for men)
  • Smoking/exposure to tobacco smoke
  • Eating disorders
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14
Q

DEXA Scan

A

Determines the presence of reduced bone mineral

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15
Q

Osteoporosis: Etiology

A

-Results from gradual loss of cortical and trabecular bone and micro architectural deterioration.

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16
Q

Primary osteoporosis

A

is likely a normal change of aging, particularly in postmenopausal women who do not take hormone replacement therapy.

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17
Q

Secondary Osteoporosis

A

can be caused by a number of factors including dietary deficiencies of calcium and vitamin D, medications such as steroids, and autoimmune disorders.

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18
Q

What are complications of osteoporosis?

A

Morbidity and mortality resulting from an osteoporosis related fall (hip fractures leads to high degree of morbidity and premature mortality)

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19
Q

Where are the most common sites for fractures?

A
  • Hips
  • Vertebra
  • Wrist
  • Pelvis
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20
Q

FRAX Tool

A

A computerized calculator for determining 10-year probability of fracture.

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21
Q

Osteoarthritis

A
  • Slow, progressive, non-inflammatory disorder of the diarthrodial (synovial) joints
  • Involves the entire joint including the cartilage, joint lining, ligaments and underlying bones.
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22
Q

Is osteoarthritis a part of the aging process?

A

NOT a normal part of aging process (aging is only a risk factor)

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23
Q

Joints commonly affected by osteoarthritis include

A
  • Knees
  • Hips
  • Hands
  • Spine
24
Q

What are causes of osteoarthritis?

A
  • The specific causes are unknown; however, it is believed to be a combination of mechanical forces and molecular events in the affected joint.
  • Idiopathic
  • Conditions that directly damage the cartilage or causes joint instability (trauma, mechanical stress, inflammation, skeletal deformities, hematological disorders, endocrine disorders, and medications such as steroids)
25
Q

What are modifiable risk factors for osteoarthritis?

A
  • Obesity
  • Joint injury
  • Knee pain
  • Occupation requiring excessive or repeated mechanical stress
  • Muscle weakness
26
Q

What are non-modifiable risk factors for osteoarthritis?

A
  • Gender (female)
  • Age (increases until about 75)
  • Race (Asians with lowest risk)
  • Genetic predisposition
  • Poor proprioception
27
Q

Diagnostics Criteria for osteoarthritis include

A
  • Stiffness in a joint when getting in and out of bed or sitting for a long time.
  • Swelling or tenderness in one or more joints.
  • Crepitus in the joint (feeling of ‘crunching’ as bones rub together).
  • May or may not include x-rays of the joint, which may show narrowed space within the joint.
28
Q

Signs and Symptoms of Osteoarthritis include

A
  • Stiffness with inactivity (greater in the morning but usually resolves within 20-30 minutes after movement begins)
  • Pain with activity that is relieved at rest
  • Subluxation and joint instability may be found
  • Crepitus is common
  • Spinal stenosis develops in the lumbar region
  • Osteophytes develop in the joints of the fingers
29
Q

Complications of Osteoarthritis include

A
  • Degenerative changes on function

- Side effects of the treatment RT pain

30
Q

Nursing Care for Osteoarthritis: Focus is on

A

1) Managing pain and inflammation
2) Preventing disability
3) Maintaining and improving joint function

31
Q

Nursing Care for Osteoarthritis: Interventions include

A
  • Rest and joint protection (immobilization should not exceed 1 week) with the use of assistive device.
  • Ice for inflammation
  • Heat for stiffness
  • Nutritional therapy and exercise
  • Complementary and alternative therapies include acupuncture, yoga and glucosamine and Chondroitin.
32
Q

Pharmacological Interventions for Osteoarthritis

A

Based on severity of patient symptoms:

  • Acetaminophen (1000 mg every 6 hours)
  • Topical agent (e.g capsaicin cream [Zostrix])
  • Topical salicylates (e.g Aspercreme)
  • Other OTC (Bengay)
  • NSAIDs: Ibuprofen 200 mg up to 4x daily
33
Q

Rheumatoid Arthritis

A

A systemic inflammatory autoimmune disorder affecting primarily the joints, where it causes pain, swelling, stiffness and los of function.

34
Q

Infalmmation of the synovium causes

A

Destruction of the surrounding cartilage and bone.

35
Q

Why is rapid diagnosis of rheumatoid arthritis necessary?

A

So treatment can begin as early as possible, providing greatest chance the joints can be preserved

36
Q

Signs and Symptoms of RA include

A
  • Tender, warm, swollen joints
  • Symmetrical pattern of affected joints
  • Joint inflammation often affecting the wrist and finger joints closest to the hand
  • Joint inflammation sometimes affecting other joints, including the neck, shoulders, elbows, hips, knees, ankles and feet.
  • Fatigue, occasional fevers and loss of energy
  • Pain and stiffness lasting >30 minutes in the morning or after a long rest**
  • Symptoms last for many years
37
Q

What are the causes of RA?

A
  • Etiology unknown, but now believed to be the result of interaction between environmental exposures, genetic factors and age-related increased autoimmunity.
  • Single nucleotide polymorphism
38
Q

What are the three variations of RA?

A
  • Monocyclic
  • Polycyclic
  • Progressive
39
Q

Monocyclic RA

A

One episode lasting 3-5 years

40
Q

Polycyclic RA

A

Intensity of symptoms varies over time

41
Q

Progressive RA

A

Increase in severity and present all the time

42
Q

What are complications of RA?

A
  • Boutonnière Deformity or flexion of the distal inter phalange always (DIP) joint with flexion of the proximal interphalangeal (PIP) joint
  • More likely to die to heart disease at a higher rate than general population
43
Q

What are the most common co-morbidities of RA?

A
  • Cardiovascular disease
  • Infections such as TB
  • Depression
  • Anxiety
  • Lymphoproliferative malignancies
44
Q

Gout

A

An inflammatory arthritis characterized by the deposition of uric acid crystals in the tissue and fluid in the body.

45
Q

Where is the most common site for gout?

A

The joint of the great toe, however it may occur in the ankle, knee, wrist or elbow.

46
Q

Etiology: Gout

A
  • Cytokine-mediated inflammatory response to the accumulation of uric acid in the blood and other body fluids, such as synovial fluid of a joint or joints.
  • Clinical manifestation of either overproduction of uric acid or inadequate excretion of uric acid.
  • Excessive alcohol consumption, lead toxicity and a high purine diet can also cause gout.
47
Q

Signs and Symptoms of Gout

A
  • Pain in the affected joint or joints, often starting in the middle of the night awakening one from sleep.
  • Joint is bright red, hot and too painful to touch.
48
Q

Complications of Gout include

A

Crystallization of uric acid, forming insoluble precipitates that gather in the SQ tissue.

  • Seen as small, white tophi that may be quite painful.
  • Can collect in the kidneys and form irate renal stones and cause renal failure.
49
Q

Osteoporosis education and preventative strategies:

A
  • Nutrition: Calcium and Vitamin D
  • Exercise
  • Education
  • Pharmacological approaches
50
Q

What are goals when treating OA and RA?

A

The goals are to minimize disability by preventing further damage and assuring adequate pain relief.

51
Q

Pharmacological treatment of OA and RA

A

NSAIDs or COX-2 inhibitors

DMARDs

52
Q

The first goal of treatment during an acute attack of gout is to

A

Stop it as promptly as possible.

53
Q

Pharmacological treatment for gout includes

A
  • NSAIDs
  • Colchicine
  • Long-acting steroids into joint
54
Q

After an acute attack of gout, the goal is to

A
  • Prevent another attack
  • Prevent systemic spread of the disease
  • Prevent the development of chronic gout
55
Q

Nursing Care for Gout: Nutrition

A

Foods high in purines

  • Meat, poultry and fish (limit 4-6 oz daily)
  • Organ meats such as hearing, anchovies and mackerel
  • Alcohol (limit or avoid)
  • Foods sweetened with high-fructose corn syrup (limit or avoid)

NURS 401 (26 decks)

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