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MedSurg 1 > Chronic Musculoskeletal Dysfunctions > Flashcards

Chronic Musculoskeletal Dysfunctions Flashcards

1
Q

Osteoporosis

A

metabolic bone disorder resulting in loss of bone mass, increase fx risk

osteopenia: precursor to osteoporosis, decrease in density of bone in relation to age

secondary osteoporosis d/t:

  • hyperparathyroidism
  • long term corticosteroid use
  • long term immobility
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2
Q

Osteoporosis: Risk Factors

A 
> 60yo
postmenopausal
estrogen deficiency
thin, lean body build
smoking
high ETOH intake
sedentary lifestyle/prolonged immobility
low calcium, Vit D
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3
Q

Osteoporosis: S/O

A 
no sx
back pain
thoracic kyphosis
loss of height
fractures
diagnostic test (x-rays, DEXA scan - screen for early changes in bone density)
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4
Q

Osteoporosis: P/I

A
  • dietary sources of calcium
  • calcium supplement (1000 mg/day - premenopausal or post-menopausal and on estrogen; 1500 mg/day - postmenopausal and not on estrogen)
  • vitamin D3 (2000 units daily)
  • moderate exercise (weight bearing)
  • stop smoking, no ETOH
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5
Q

Osteoporosis: P/I Medications

A
  • estrogen replacement therpay: post menopausal in combo with Calcium/Vit D, > benefit first 10 years after menopause
  • increase risk breast and endometrial cancer, DVT
  • biphosphonates
  • risk esophagitis

-calcitonin: secreted by thyroid, available in SQ, IM or intranasally forms, take with Calcium

  • selective estrogen receptor modulator (SER)
  • contraindicated in hx DVT

-Forteo (human parathyroid hormone) increase action of osteoblast (bone building)

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6
Q

Osteoarthritis (OA)

A

aka Degenerative Joint Disease (DJD)

  • progressive deterioration of articular cartilage
  • NON-INFLAMMATORY and NON-SYSTEMIC
  • osteophyte formation
  • changes within joint lead to pain, immobility, muscle spasm, potential inflammation
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7
Q

OA: Risk Factors

A

obesity, familial tendency, age, injury or bleeding into joint, muscle weakness

overuse of joints: high impact sports, construction workers, dancers, office workers p computers, cell phone (texting)

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8
Q

OA: S/O

A

-joint pain w/ activity, IMPROVES WITH REST
(AM stiffness <1 hour)
-no systemic sx
-affects joint UNILATERALLY although can be bilaterally (hypertrophy, crepitus, pain with ROJM, palpation)
-Heberden (DIP joint) and Bouchard’s (PIP joint) nodes (these can be bilateral)
-dx tests: structural changes in joints, join space narrowing
-ESR or CRP: normal or slightly elevated (mostly normal)

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9
Q

OA: Assessment

A 
chronic pain
impaired physical mobility
activity intolerance
self care deficit
disturbed body image
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10
Q

OA: P/I

A 
rest/activity balance
weight loss
heat or cold therapies
hyaluronic acid join injections: 
-improves viscosity of synovial fluid and articular cartilage
-series of 3 injections 
-pain relief up to 6 mos
-used in conjunction with glucosamine and chondroitin
analgesics:
-acetominophen, ASA, NSAIDS
-topical salicylates
glucosamine and chondroitin supplement (improves articular cartilage)
corticosteroid injections into joint
exercise (low-impact, ROJM, proper body mechanics)
complementary and alternative therapies
schedule high-energy activities in AM
splinting
assistive devices
joint replacement surgery - TKR, THR
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11
Q

Gouty Arthritis

A

Inflammatory arthritis caused by urate crystals forming in and around any joint (esp great toe - 1st metatarsophalangeal)

  • hereditary: abnormal purine metabolism leads to uric acid build up
  • other joints affected: wrist, ankle, knee, mid-tarsal of foot
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12
Q

Gouty Arthritis: Sx

A

acute onset pain pain of one joint (usually)
red, swollen, very tender
onset > at night
tophi-large amt uric acid crystals accumulate in joint

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13
Q

Gouty Arthritis: P/I

A

NSAIDS: tx pain and inflammation
Allopurinol: prevent by decreases uric acid production (keep uric acid level <6)
Colchicine or Colcrys: treats severe painful attacks
No ETOH
Avoid Purines and uric acid foods (organ and red meats, dk leafy veggies, shellfish, chicken, beans)

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14
Q

RA

A

chronic inflammation and destruction of connective tissue and synovial membrane in joints. Exacerbations and remissions.

  • autoimmune
  • extra-aricular manifestations (SYSTEMIC)
  • SYMMETRICAL BILATERAL joint involvement
  • increase women, increase age (esp 20s-50s), genetics
  • increase chance and severity with smoking

Pannus formation: projects into joint cavity causing necrosis of articular cartilage; shortens tendons and ligaments leading to dislocation, contractures

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15
Q

RA: S/O

A

insidious sx (non-specific): fatigue, anorexia, wt loss, LG fever, generalized stiffness

Joints:

  • SYMMETRICAL JOINT involvement (pain, stiffness, decreased ROJM, inflammation, deformity)
  • PAIN WITH REST AND ACTIVITY
  • small joints and large joints affected (PIP and MCP of hands, MTP of feet)

AM stiffness (1 to several hours)

early disease

  • spindle like fingers - synovial hypertrophy
  • inflamed joints, wrist tenosynovitis (difficulty with grasp)

progression: joint weakens leading to dislocation and permanent deformity, atrophy of muscles, ulnar drift

extraarticular- can affect all body systems

  • nodules 25% RA pts, subcutaneous, firm non-tender granulomatous mass usually over extensor surfaces of joints (fingers, elbow), base of spine, back of head
  • insidious onset, comes and goes
  • not removed d/t recurrence rate
  • nodules on sclera or lungs = active disease or poorer prognosis

Sjorgen syndrome (10-15% RA pts) - excessive dryness of eyes and mouth

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16
Q

RA: Complications

A

w/o tx w/in 1 year of dx = joint deformity
flexion contractures - decrease grasp d/t decrease ADLs
cataracts, decrease vision d/t scleral nodules
hoarseness - vocal cord nodules
later - cardiopulmonary effects

17
Q

RA: Diagnostic Testing

A

H&P (often diagnostic)
+RF (rheumatoid factor) - 80% RA pts (increase during active disease)
increase ESR and CRP (active inflammation)
+ANA titers
ACPA (more specific for RA than doin plain ANA)
X-rays (useful to monitor disease progression and tx effectiveness (bone scans more useful)

18
Q

RA: Assessment

A 
fatigue
impaired physical mobility
chronic pain
disturbed body image
risk for injury
19
Q

RA: P/I Primary Goals

A 
primary goals:
decrease inflammation 
pain management
fatigue control
maintain joint function (prevention and correction of deformity)
pt and family education
20
Q

RA: P/I Medications

A

medications:
acute exacerbations
-ASA and NSAIDS (monitor for GI bleeding and renal toxicity esp in older pts (guiac testing))
-corticosteroids (temporarily used to relieve exacerbation sx, avoid long-term use)

long term (chronic)
-DMARDS: lessens the permanent RA effects
methotrexate: drug of choice, effects seen days to weeks, low cost, less toxicity
antimalarial drugs: for mild to moderate disease
-Biological therapy meds (if no response (use with moderate to severe disease)
decrease inflammation and damage to tissues by interrupting cascade of events that drive inflammation
*these meds increase pt susceptibility to infection ; need to have PPD done first

21
Q

RA: P/I Rest

A

alternate active/ rest periods during day

  • avoid exhaustion, fatigue (can lead to exacerbations)
  • avoid total bed rest (can lead to increased stiffness and immobility)
  • proper body alignment (avoid flexion positions), increase extension positions
  • splints to joints helpful, no pillows under knees
22
Q

RA: P/I Join Protection and Procedures

A

Protection: work in short periods with breaks

  • avoid stair use or periods of standing
  • time saving devices
  • OT: utensils, drawer handles, door knobs, raised toilet seat, velcro fasteners for shoes

Joint Procedures:

  • replacement surgeries
  • tendon reconstruction surgeries
  • synovectomy - removed inflamed synovial tissue
23
Q

RA: P/I Heat and Cold Therapy, Exercise Program

A

Heat and Cold therapy:

  • ice for acute disease exacerbation (20min)
  • heat for chronic stiffness (10-15min)

Exercise Program: improve flexibility, strength and endurance; avoid overaggressive exercises

  • prevents progressive joint immobility
  • include gentle ROJM daily (usually not achieved with ADLs)
  • aquatic exercise: easier joint movement with resistance
24
Q

RA: P/I Pt and Family Teaching

A

-educate re disease and progression, therapy goals
(especially about fatigue, decreased function, need for rest periods, loss of self-esteem, fear of disability and deformity, alt in sexual function r/t vaginal dryness)

-evaluate family support system/community resource connection
(may need CHN, PT/OT services)

MedSurg 1 (18 decks)

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