M/S & Rheumatic Problems Labs & Dx (Exam 3)

Question 1

Standard X-Ray

Answer 1

Anterior-Posterior provides one-dimensional view of any bone in the body

Lateral Provides two-dimensional

Question 2

Standard X-ray: Nursing Responsibilites

Answer 2

Remove radiopaque object (metal in bra)

Avoid excessive exposure

Question 3

CT scan

Answer 3

3 dimensional pictures

Question 4

CT scans are used more for

Answer 4

Soft tissue and bone abnormalities

Some types of trauma (more quick than MRI)

Question 5

CT: NSG Consideration

Answer 5

Explain that is painless

If contrast — confirm no shellfish allergies

Encourage fluids after

Question 6

MRI

Answer 6

Radio and magnetic waves to view soft tissue

Question 7

MRI: NSG consideration

Answer 7

Inform that it is painless

Inform loud ticking noises normal

Ensure no metal on or in patient

Anti-anxiety medicine prn r/t claustrophobia (BENZO)

Question 8

What medication might you have to give someone before an MRI

Answer 8

Anti-anxiety medicine PRN

r/t claustrophobia (BENZO)

Question 9

Serologic Study: Rheumatoid Factor

Answer 9

Asses for presence of autoantibody (RF) in serum

Question 10

Is RF specific to RA?

Answer 10

NO, Not specific to RA/seen in other tissues and in small percentage of normal population

Question 11

What is normal RF test result?

Answer 11

Negative is expected

Question 12

Erythrocyte Sedimentation Rate

Answer 12

Non-specific indication of inflammation

(osteomyelitis)
(RA)

Question 13

ERS is elevated in what two disease that we are discussing?

Answer 13

Rheumatoid Arthritis

Osteomyelitis

Question 14

Normal ESR

Answer 14

<30 mm/hr is the normal expected

Question 15

Serologic Study: C-reactive Protein

Answer 15

Used to diagnose ACUTE inflammatory disease, infection and active widespread malignancies

Non specfic

Question 16

Serologic Study: Uric Acid

Answer 16

End product of protein metabolism (normally excreted via urine)

Question 17

Uric Acid levels are typically increased with

Answer 17

GOUT

Not specific to Gout

Question 18

Serologic Study: Anti-citrullinated protein antibody (ACPA)

Answer 18

Anti-CCP (another name)

Important for diagnosis of RA

More specific than RF for RA; may allow for earlier more accurate diagnosis

Question 19

What is an important diagnostic test of Rheumatoid Arthritis?

Answer 19

Anti-CCP

ACPA

Question 20

What is more specific for RA, RF or ACPA?

Answer 20

ACPA

Anti-citrullinated protein antibody

Question 21

Serologic Study: Antinuclear Antibody (ANA)

Answer 21

Assess for antibodies capable of destroying nucleus of body tissues

Question 22

Postive ANA is really indicative of what disease?

Answer 22

SLE (99% positive)
or
RA

Question 23

What is the normal antinuclear antibody level?

Answer 23

Negative

Question 24

Serologic Study: Anti-DNA antibody

Answer 24

Detects antibodies that react to DNA

Question 25

What is the most specific test for Lupus

Answer 25

Anti-DNA antibody

Question 26

Serologic Study: Complement Levels

Answer 26

Complement-normal body protein, is essential to both immune and inflammatory reaction

Question 27

Complement levels are depleted with

Answer 27

Immune or inflammatory responses

Question 28

Depletion of complement levels may be found in patient with

Answer 28

RA or SLE

Question 29

Radiologic Study: Myelogram w/ or w/o contrast

Answer 29

Asses pathology of spinal cord Test for Nerve impingement

Question 30

Myelogram helps us look for what?

Answer 30

Nerve impingement

Question 31

Myelogram w/ contrast procedure

Answer 31

X-rays after injection of contrast into subarachnoid space Sedate PRN Done on tilt table (move contrast up and down) Encourage fluids

Question 32

Myelogram: Nursing Assessment

Answer 32

Risk of spinal headache (HORRIFIC) Should resolve in 1-2 days with rest and fluids Blood patch may be indicated

Question 33

How do we try and prevent a spinal headache after a myelogram procedure?

Answer 33

Have patient lie flat for a period of time post procedure

Question 34

How do we treat a spinal headache?

Answer 34

Blood patch

Question 35

Blood Patch

Answer 35

Procedure for someone with spinal headache 20-30 ml of blood drawn from periphery and slowly inject into spine = give immediate relief from H/A

Question 36

Bone Density Scan (Dexa)

Answer 36

Gold standard for measuring bone mineral density Reported as T-scores

Question 37

Bone Density Scan is used for assessing?

Answer 37

Osteoporosis

Question 38

What is the gold standard for measuring bone mineral density?

Answer 38

DEXA scan Dual energy x-ray absorptiometry

Question 39

What are the most common places that are scanned with Dexa Scan?

Answer 39

Spine -- hips -- wirst

Question 40

Who Should Get a Bone Density Scan?

Answer 40

Women <65… with risk factors in addition to menopause All women > 65 years Individual receiving long term steroids Measure the response to osteoporosis drug therapy (DOES NOT MEAN MEN DO NOT GET SCANS AS WELL)

Question 41

Bone Scan

Answer 41

(different than bone density scan) Injection of radioisotope that is taken up by the bone

Question 42

Bone Scan Increase in uptake is seen with

Answer 42

-Osteomyelitis (infected) -Osteoporosis (hallow) -Malignancies -Certain Fractures

Question 43

Bone scan decrease in uptake is seen with

Answer 43

Avascular necrosis (death of bone due to lack of blood supply)

Question 44

Avascular Necrosis

Answer 44

Death of bone due to lack of blood supply

Question 45

Bone Scan: Nursing Responsibility

Answer 45

-Radioisotope is given 2 hours before procedure -Procedure takes one hour of patient lying still -Not harmful -Increase fluids after procedure

Question 46

With bone scan the radioisotope is given how long before the procedure?

Answer 46

2 hours

Question 47

Alkaline Phosphatase

Answer 47

Enzyme produced by osteoblast of bone

Question 48

Alkaline Phosphatase is elevated with

Answer 48

Healing fractures Bone cancer Osteoporosis

Question 49

What is the primary organ that stores calcium?

Answer 49

Bone

Question 50

Circulating serum calcium decreases with

Answer 50

Renal Disease Hypoparathyroidism Blood transfusions

Question 51

Circulating Serum Calcium Increase with

Answer 51

Hyperparathyroidism Some bone tumors

Question 52

Phosphorus is ______ related to calcium So if calcium increases, ______

Answer 52

Indirectly Phosphorus decrease

Question 53

Electromyogram

Answer 53

Evaluates electrical potential associated with skeletal muscle contraction

Question 54

Electromyogram: Procedure

Answer 54

Small gauge needles inserted into muscles and attached to leads that feed information to machine

Question 55

Electromyogram: Nursing Responsibilities

Answer 55

Usually conducted in EMG lab Needs to cooperate with voluntary movement (follow commands) Some discomfort (very tender) Avoid stimulants / sedatives 24 hours before procedure