WK 8: Musculoskeletal Disorders Flashcards
1
Q
What is osteoporosis?
A
A type of metabolic bone disease characterised by abnormal bone structure
2
Q
Identify the 3 characteristics of osteoporosis
A
- Decreased bone density
- Loss structural integrity of trabecular (spongy bone)
- Cortical (compact) bone weakens thins and becomes porous
3
Q
Identify the cause osteoporosis
A
Altered metabolism
4
Q
Identify 3 risk factors of osteoporosis
A
- Genetics (predisposed to decreased bone mass)
- Ageing (65 years due to endocrine disorders inhibit bone loss)
- Exercise (need stress for bone maintenance)
5
Q
Identify the 2 types of osteoporosis
A
Generalised
Regional
6
Q
Describe generalised osteoporosis
A
Involves major portions of the axial skeleton
7
Q
Describe regional osteoporosis
A
Involves 1 segment of appendicular skeleton
8
Q
Identify 2 of the associated diseases with osteoporosis
A
Inflammatory bowel disease
Diabetes mellitus
9
Q
Identify 2 complications with osteoporosis
A
Disability
Pathological fractures
10
Q
Identify the main form of prevention in osteoporosis
A
Lifestyle modification e..g balanced diet, regular weight baring exercise
11
Q
Describe the pathophysiology of osteoporosis
A
Rate of resorption > Rate of bone formation = Bone loss and bone becomes weak, brittle, fragile, porous
12
Q
Identify 2 common and 2 rare clinical manifestations associated with osteoporosis
A
Common: Pain, fractures, diminished height
Rare: Pneumonia, fat embolism
13
Q
Identify 2 investigations in the diagnosis of osteoporosis
A
Dual energy X-Ray absorpiometry (DEXA scan)
Bone mineral density testing
14
Q
Identify the 2 aims of treatment in osteoporosis
A
Slow the rate of calcium and bone loss
Prevent deterioration
15
Q
Identify 2 nursing considerations associated with osteoporosis
A
Education about condition/treatment
Management of pain = increased quality of life
16
Q
Describe the effects of back pain
A
Can be emotional, social and economical, leading cause of absence from activity limitation and work
17
Q
Identity the 4 classifications of back pain
A
Upper
Lower
Acute
Chronic
18
Q
Describe upper back pain and identify a cause
A
Pain/discomfort felt from neck base to thoracic region
Herniation of intervertebral discs
19
Q
Identify 2 risks of back pain
A
Obesity, stress
20
Q
Describe lower back pain and identify a cause
A
Most common, has many nerve roots at high risk of injury, Osteoarthrirtis, DDD
21
Q
Describe acute Back pain
A
<4 weeks, caused by trauma activity, onset 24hrs after cause as aches, spasm, shooting pain
22
Q
Describe chronic back pain
A
Lasts >3months, repeated incapacitating event, progressive. DDD is leading cause of lower back pain
23
Q
What is DDD?
A
Degenerative Disc Disease: Occurs as a result of normal ageing processes combined with deterioration and herniation of intervertebral discs
24
Q
Describe the 3 purposes of intervertebral discs
A
Seperate the vertebrae of the spine
- provide shock absorption
- Allow ROM
- Protect the joints
25
Identify the cause of DDD
Structural degeneration
26
Identify 2 risk factors of DDD
Ageing
Family history
Modifiable risk factors
Excessive strain
27
Identify 2 complications of DDD
Chronic Pain
| Incontinence
28
Describe the pathophysiology of DDD
Nucleus pulposus starts to dry out and shrink, pressure transferred to annulus fibrosis, nucleus pulpous seeps (herniates through annulus) , herniated discs press against the spinal nerves = CM
29
What is a herniated disc
Occurs when spinal intervertebral disc bulges out between the vertebrae
30
Identify the main clinical manifestation associated with DDD
Radioculpathy: Constant pressure on nerve endings = altered sensation and motor responses. Increases with prolonged sitting, bending twisting etc.
31
Identify the 4 types of back pain (clinical manifestations)
Localised: Pain on area palpation
Diffuse: Spread over large area
Radicular: Irritation of nerve root, herniated disc
Referred: Pain felt in one area, radiating to another area
32
Identify 2 goals of treatment in DDD
Increase quality of life
| Improve mobility
33
Identify two forms of assessment in diagnosis of DDD
Straight leg raising test = Pt unable to perform = Positive DDD)
On edge of beg straightening leg to flex = Pain = DDD
34
Identify 2 forms of nursing management in DDD
```
Non pharmacological (Heat pack, ice pack, massage)
Education
```
35
What is arthritis?
Inflammatory joint disease
36
Identify 3 risk factors of arthritis
Low SES
Modifiable RF e.g. obesity, smoking, poor diet
Age
Genetics
37
Identify the 2 types of arthritis
Infectious
| Non infectious
38
Describe infectious arthritis
Invasion of the joint by bacteria, mycoplasma, fungi leading to inflammation e.g. septic arthritis
39
Describe non infectious arthritis
Inappropriate immune response (Rheumatoid) or deposition of crystals in synovial fluid (Gout)
40
What is osteoarthritis?
Chronic, slow progressive non inflammatory disorder of the synovial joint = cartilage destruction and joint degeneration
41
Identify the 6 classifications of osteoarthritis
Primary / secondary
Localised/Generalised
Early/moderate/advanced
42
Identify 2 causes of osteoarthritis
Usually by a known event/condition
Trauma
Mechanical stress
43
Identify 2 risk factors associated with osteoarthritis
Increasing age
Modifiable risk factors
Repetitive use
44
Describe the pathophysiology of osteoarthritis
Articular cartilage degradation, bone stiffening, reactive inflammation of synovial fluid leading to contact of exposed bony joint surfaces and thickening of joint capsule by constant friction between two bone surfaces
45
Identify 3 clinical manifestations with osteoarthritis
Pain (mild discomfort - severe disability)
Joint stiffness
Functional inpairment/joint deformity
46
Describe inflammatory arthritis
A group of disease that result in joint inflammation swelling, stiffness, decrease ROM
47
Identify 2 types of inflammatory arthritis
Rheumatoid arthritis
| Psoratic arthritis
48
Describe Rheumatoid arthritis
Inflammation of connective tissue in synovial joints, periods of remission and exacerbation
49
Identify the cause of Rheumatoid arthritis
Likely link with genetics and environmental triggers interacting with inflammatory mediators
50
Identify 2 risks factors of Rheumatoid arthritis
Increasing age
Smoking
Obesity
stress
51
Describe the classification of Rheumatoid arthritis
Classifed according to number of joints involved, serology inflammatory markers and duration of symptoms
52
Describe the pathophysiology of Rheumatoid arthritis
Initial immune response to antigen triggers autoantibodies to develop (Rheumatoid factor). These cause an inflammatory response causing cartilage breakdown and thickening of synovial lining and membrane. This leads to tissue breakdown and erosion of a articular cartilage = immobilisation/joint stiffness
53
Identify 3 early clinical manifestations with Rheumatoid arthritis
```
Fever
Fatigue
Rash
Weight loss
Malaise (discomfort)
```
54
Identify the late clinical manifestations with Rheumatoid arthritis
Localised CM e.g. joint pain/tenderness/stiffness
| Disability
55
Identify 2 complications associated with Rheumatoid arthritis
Osteoporosis
Infections
Carpel tunnel
56
What is Psoriatic Arthritis
Chronic, immune mediated inflammatory joint disorder . Part of a group of disorders called seronegative spondyloarthropathy, can be oglioarthritis
57
What is oglioarthritis
Chronic, inflammatory arthritis of unknown origin affecting <5 joints, with an onset that occurs <6yrs of age and lasts for 6 weeks
58
Describe Psoriasis
Chronic autoimmune disorder characterised by the rapid build up of skin cells that form patches of scaly, itchy dry skin
59
Identify the cause of Psoriatic Arthritis
Strong genetic link combined with immune and environmental factors
60
Identify 2 risk factors associated with Psoriatic Arthritis
Psoriasis
Age
Obesity
61
Identify the 5 types of Psoriatic Arthritis
```
Symmetric
Asymmetric
Distal
Spondylitic
Arthritis Mutilans
```
62
Describe symmetric Psoriatic Arthritis
Affects joints on both sides of the body at the same time
63
Describe asymmetric Psoriatic Arthritis
Affects one side of the body at a time
64
Describe distal Psoriatic Arthritis
Inflammation/stiffness to ends of toes and fingers including nails. Causes pitting and lifting from nail bed
65
Describe spondylitis Psoriatic Arthritis
Pain/stiffness of the spine and neck, affects men>women
66
Describe arthritis mutilans Psoriatic Arthritis
Most severe, deformities of small joints
67
Describe the pathophysiology of Psoriatic Arthritis
"Not understood"
68
Identify 3 clinical manifestations associated with Psoriatic Arthritis
```
Joint inflammation (stiffness/painful)
Swollen fingers/toes
Skin changes
```
69
Identify 3 complications of Psoriatic Arthritis
"Pencil in a cup"deformity of distal joints in fingers
Depression/anxiety
Chronic fatigue
70
Identify 2 associated comorbidities of Psoriatic Arthritis
Psoriasis
| Depression
71
What is gout
Metabolic disorder characterised by an acute exacerbation with long period of remission. results in high levels of serum uric acid
72
Identify the 4 classifications of gout
Primary
Secondary
Acute
Chronic
73
Describe primary gout
Herediatry, 90%
74
Describe secondary gout
Related to other risk factors
75
Describe acute gout
Sudden onset of symptoms, 1-4 joints involved, usually a peripheral joint with symptoms occurring at night, resolving in 2-10 days
76
Describe chronic gout
Multiple joints involved, visible deposits of sodium urate crystals called "tophi" can be found in synovium etc.
77
Identify the cause of gout
Caused by defects in uric acid metabolism attributed to one of the following:
1. Increased uric acid production
2. Decrese in uric acid secretion
3. Increase in consumption of food/drinsk with high levels of purine e.g. seafood
78
What are the 3 primary causes of gout
1. Increased uric acid production
2. Decrese in uric acid secretion
3. Increase in consumption of food/drinsk with high levels of purine e.g. seafood
79
Identify 3 risk factors associated with gout
Obesity
Trauma (surgery, injury)
Excessive alcohol consumption
80
Describe the pathophysiology of gout
In conjunction with increased urate reabsorption and decreased secretion, monosodium crystals are deposited in renal tissues impairing urine flow and leading to accumulation of crystals in connective tissue. This causes an inflammatory response
81
What is Purine
Natural chemical compounds found in food/roduced in the body. Uric acid is the major end product of purine metabolism therefore those with gout will have accelerated purine synthesis and poor breakdown/secretion of uric acid in kidneys
82
Identify 2 aggravating mechanisms for crystal deposition
Decreased body temperature (decreased solubility)
| Trauma (promotes crystal deposition)
83
Identify the 3 stages of gout
Asymptomatic hyperuricaemia
Acute gouty arthritis
Tophaceous gout
84
Describe Asymptomatic hyperuricaemia
Serum rate increased, arthritic symptoms not present
85
Describe acute gouty arthritis
Exacerbation of symptoms with increased serum rate concentration, occurs with sudden , sustained increased in urate levels
86
Describe tophacecous gout
Chronic stage, occurs as early as 3 years post initial episode or 40 years. progressive inability to excrete uric acid = tophi appearance in cartilage
87
Identify 2 acute symptoms associated with gout
Difficulty weight bearing
| Systemic inflammation signs (Fever)
88
Identify 2 chronic symptoms associated with gout
Joint discomfort
Limited ROM
Chronic joint inflammation
89
Identify 2 complications associated with gout
Kidney dysfunction
| Tophi (visible crystals)
90
Describe septic arthritis
Infectious arthritis caused by invasion of bacteria into a joint cavity. Bacteria can travel through the blood stream and deposit in any joint cavity
91
Identify 2 causes of septic arthritis
Active infection in the body (bacteriacemia)
| Surgical incision
92
Identify the causative organism of septic arthritis
Any bacterial organism e.g. Staphlococcus
93
Identify 2 risks associated with septic arthritis
Immunocompromised
| Recent infections
94
Describe the pathophysiology of septic arthritis
Bacterial colonisation leads to rapid bacterial proliferation, joint infection, increased colonisation of bacteria leads to an acute inflmmatory response
95
Identify 3 clinical manifestations associated with septic arthritis
Single joint severe pain, worse with movement
Poor ROM
Symptoms of inflammation/infection
96
Identify 2 complications of septic arthritis
Irreversible cartilage damage if not treated in 8 hours
Unstable VS
osteoarthritis
97
Identify a diagnostic for osteoarthritis
Imaging to identify joint damage e.g. loss of space
98
Identify a diagnostic for rheumatoid arthritis
Blood pathology (for rheumatoid factor), imaging, specific criteria for >6weeks
99
Identify a diagnostic for gout
Presence of tophi, blood pathology for serum uric acid levels
100
Identify a diagnostic for septic arthritis
Blood pathology for aerobic/anaerobic organisms, Xray
101
Identify a diagnostic for psoriatic arthritis
Diagnosis made on clinical presentation and history of CM
102
Identify 3 treatment forms for arthritis
Improve functional capacity
Symptom management
Limit exacerbations
103
Identify a treatment for rheumatoid arthritis
Early commencement of disease modifying anti rheumatic drugs (DMARD)
104
Identify a treatment for gout
Allouprinol
105
Identify a treatment for Septic arthritis
Antibiotics, prompt treatment to prevent joint breakdown
106
Identify a treatment for psoriatic arthritis
Cytokine inhibitors
107
Identify 2 forms of surgical management for arthritis
Total joint replacement
| Arthroplasty (repair joints)
108
Identify 2 nursing considerations of arthritis
Assist with ADL's
Pharmacology
Non pharmacological management
lifestyle modifications
109
What is a fracture?
A break in the continuity of a bone. Occur when force exceeded on a bone is too much
110
Identify 2 potential causes of a fracture
Trauma
Overuse
Pathological (disease processes)
111
Identify 3 risks factors associated with fractures
```
Ages factors (young and older at increased risk)
Comorbidities Lifestyle (smoking, increased alcohol)
```
112
Identify 2 complications associated with fractures
Permanent disability
| Comaprtment syndrome
113
Identify 2 ways to prevent fractures
Adequate calcium/vitmain D intake
Lifestyle modifications e.g. smoking
avoid falls
114
Describe a displaced fracture
Bone breaks into two or more parts, ends do not align
115
Describe a non displaced fracture
Bone breaks into two or more parts, ends do align
116
Describe an open fracture
Bone breaks through the skin
117
Describe a closed fracture
No break/puncture wound on skin
118
Describe a greenstick fracture
Bone is bent but does not seperate into two pieces
119
Describe a buckle fracture
Two bones drive into each other
120
Describe a growth plate fracture
Fracture through joint impacts the growth plate, shortening the bone
121
Describe a comminuted fracture
Bone breaks 3 or more fragments
122
Describe an oblique fracture
Bone breaks on an angle through the bone
123
Describe a spiral fracture
spiral break around the bone caused by twisting injury
124
Describe a transverse fracture
Also known as a linear fracture, fracture line perpendicular to the bone shaft
125
Describe a compression fracture
Bones are crushed resulting in flatter, wider bones
126
Describe an impacted fracture
Broken ends of a bone are driven together by the force of the injury
127
Describe a pathological fracture
Caused by disease that weakens the bone
128
Describe a stress fracture
fatigue and insufficiency causes a hairline crack, results from repetitive motion
129
Describe an avulsion fracture
bone fragment is pulled off the bone by a tendon or ligament
130
Describe a hip fracture
Called a #NOF, a break occurring at the upper third of the femur
131
Identify the 2 classifications of a hip fracture
Extracapsular (Of trocahnteric region)
| Intracapsular (Of NOF)
132
Identify a complications of hip fractures
Delirium due to shock/hypovolaemia and pain
133
Describe the pathophysiology of a fracture
Force exceeds what the bone can absorb due to imperfect bones, weakened bones, fatigued bones( due to repetition)
134
Identify the 3 stages of fracture healing and the corresponding time frames
1. Inflammatory phase: 0-2 weeks
2. Reparative phase: 2-6 weeks
3. Remodelling phase: 6 weeks - several months
135
Describe the inflammatory phase
1. Bleeding occurs due to damage
2. Fracture haematoma forms between medullary canal/periosteum
3. Decreased o2 supply
4. Inflammatory response
5. Pro callus formation
136
Describe the reparative phase
1. Capillary network forms at haematoma
2. Increased blood flow
3. Phagocytes engulf debris
4. Granulation tissue forms
5. Bone callus is formed
137
Describe the remodelling phase
1. Gradual spread of callus
2. Creation of compact/cancellous bone
3. Osteoclasts absorb dead fragments and clean up
4. Structure formed
138
Identify the 3 components of the fracture timeline
48 hours: angiogenesis occurs, new blood vessels formed
3 weeks: new bone splinted, not strong enough yet to withhold prior force
6 weeks: new bone supports movement/normal function
139
Identify 3 factors which affect healing of fractures
Genetics
increasing age
Complexity/type of fracture
140
Identify 3 clinical manifestations associated with fractures
Immediate localised pain
Swelling
Bruising
141
Identify 3 forms of initial management in fractures
RICE
Open fractures, saturate gauze with saline and apply over wound
Do not attempt to reduce fractures
142
Describe RICE
Rest
Ice
Compression
Elevation
143
What is ORIF
Open reduction and Internal fixation (surgery in fracture)
144
Describe the process of reduction
Performed to reestablish alignment
145
Describe immobilisation
Casting
146
Describe traction
```
Application of pulling force to obtain realignment.
Short term (Tape, boots, splint )
Long Term (pins, wires)
```
147
Outline the 6 P's in a NVA assessment for fractures
```
Pain
Paraestheisa
Pallor
Polar
Paralysis
Pulses
```
148
Identify 3 nursing interventions in fracture management
1. Symptom/pain management
2. IDC inserted in #NOF
3. Log roll (To prevent rotation of hip) in #NOF
4. Education: post surgery care
149
Describe the function of a muscle
Attached to a bone by tendons, made up of fibres that shorten/lengthen to produce movement
150
Describe the function of a tendon
Tough band of slightly elastic connective tissue connects muscle to bone
151
Describe the function of a ligament
Strong band of inelastic connective tissue that connects bone to bone
152
Describe a sprain
Occur in response to a tear or the stretching of a ligament surrounding a joint usually from a traumatic event e.g. inversion/eversion of ankle
153
Describe a strain
Occur in reaction to a twist, tear or excessive stretch of a muscle, it's muscle sheath or tendon usually from overexertion trauma or repetitive movement
154
Identify 2 risk factors of sprains/strains
Increasing age
Obesity
Poor physical fitness
155
Identify 2 clinical manifestations associated with sprains/strains
Severe sprains can lead to fractures
Dislocation
Loss of function/strength
156
Identify 2 ways to prevent sprains/strains
Balanced nutrition
| Healthy weight
157
Identify the 3 classifications of sprains/strains
Grade 1
Grade 2
Grade 3
158
Describe Grade 1 sprains/strains
Mild stretching of a ligament (Only few fibres torn) without joint instability
159
Describe Grade 2 sprains/strains
Partial tear (rupture) of ligament without joint instability or mild instability
160
Describe Grade 3 sprains/strains
Severe sprain: complete rupture of ligament with instability of joint
161
Describe the pathophysiology of sprains/strains
Torn tendon/ligament causes the inflammatory process to begin, fluids accumulate at ends of damaged tissue, inflammatory cells e.g. macrophages grow inwards from surrounding tissue to commence repair, new collagen formed, 4-5 weeks post injury new ligament/tendon will withhold pier strength
162
Identify 3 clinical manifestations associated with sprains/strains
Pain/tenderness
Swelling
Difficulty weight baring
163
Identify 3 forms of nursing management in sprains/strains
```
RICE
simple analgesia (multimodal approach)
Education
NSAIDS
Surgical intervention
Avoid HARM
```
164
What does HARM stand for
Avoid heat alcohol running and massage for 72 hours
165
Identify the aim of joint surgery
Manage/relieve pain
Improve function/mobility
Correct deformity/malalignment
166
Identify 2 types of joint surgery
Osteotomy
Arthoplasty
Arthrodesis
167
Identify 2 indications for joint surgery
Arthritis, failed prior procedures, sepsis, connective tissue disease
168
Identify 2 complications of joint surgery
Surgical site infection
| Thromboembolsim
169
Tramadol
- Class
- Indication
- Action
- Adverse effects
- Nursing consideration
- Analgesia
- Moderate-severe pain
- Centrally acting synthetic analgesic, blocks reuptake of noradrenaline and serotonin without causing histamine release
- Dyspepsia, drowsiness
- Do not chew/break/divide tablet
170
Indomethicin
- Class
- Indication
- Action
- Adverse effects
- Nursing consideration
- NSAID
- RA, Gout, OA, Sprains Strains, Lower BP, Fractures
- Inhibit COX-1 non selectively and selectively binds to COX-2 decreasing inflammation
- Dizziness, headache
- Should be taken with food
171
Celecoxib
- Class
- Indication
- Action
- Adverse effects
- Nursing consideration
- NSAID
- RA, OA, post op pain management, pain with dysmenorrhea
- COX-2 inhibitor which prevents prostaglandin synthesis decreasing pain and inflammation
- Dizziness, headache
- Should be taken with food
172
Meloxicam
- Class
- Indication
- Action
- Adverse effects
- Nursing consideration
- NSAID
- RA and OA
- COX-2 inhibitor which prevents prostaglandin synthesis decreasing inflammation and pain
- Dizziness, headache
- Should be taken with food
173
Naproxen
- Class
- Indication
- Action
- Adverse effects
- Nursing consideration
- NSAID
- RA, OA, Gout, Generalised acute/chronic inflammatory pain
- COX-2 inhibitor which prevents prostaglandin synthesis decreasing inflammation and pain
- Dizziness, headache
- Should be taken with food
174
Allopurinol
- Class
- Indication
- Action
- Adverse effects
- Nursing consideration
- Anti uricaemic agent
- Chronic gout
- Reduces uric acid levels in body fluid and urine by inhibiting xanthine oxidase which promotes the conversion of xanthine to urate
- Diarrhoea, Headache
- Should be taken with or after food
175
Colchicine
- Class
- Indication
- Action
- Adverse effects
- Nursing consideration
- Anti-gout
- Acute gout (When NSAIDS will not be effective or can't be used)
- Inhibits leucocyte migration in gouty joints thereby decreasing inflammatory response to urate crystals, decreases deposition of rate crystals
- Diarrhoea, muscle weakness
- Increased risk of bleeding with NSAIDS
176
Identify the 4 examples of NSAIDS used in musculoskeletal disorders
- Indometacin
- Celecoxib
- Meloxicam
- Naproxen
177
Identify the two examples of anti-gout medication
Allopurinol
| Colchicine
178
Identify an example of a biphosphonate
Zoledronic acid
179
Zoledronic Acid
- Class
- Indication
- Action
- Adverse effects
- Nursing consideration
- Biphosphonates
- Osteoporosis, can be used to prevent fractures
- Increases total bone mass, inhibits bone resorption by impairing osteoclast function and osteoclast numbers without inhibiting bone formation
- headache, myalgia
- Ensure vitamin D and calcium status are adequate
