Med Surg: Care of patient with musculoskeletal problems Flashcards Preview

Med Surg Test 7: Neuro/Muscular > Med Surg: Care of patient with musculoskeletal problems > Flashcards

Flashcards in Med Surg: Care of patient with musculoskeletal problems Deck (33)
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What is rheumatoid arthritis?

Chronic, progressive, systemic, inflammatory disease

Cause may be related to a combination of environmental and genetic factor

Leads to destruction of connective tissue and synovial membrane within joints

Transforming autoantibodies form, attack healthy tissue causing inflammation

Weakens the joint, leading to dislocation and permanent deformity or fusion of the joint

Pannus forms at junction of synovial tissue and articular cartilage and projects into joint cavity

Exacerbation occur during periods of physical or emotional stress and fatigue

Risk factors include exposure to infectious agents

Vasculitis can impede blood flow: leads to organ or organ system malfucntion and failure r/t tissue ischemia


What is the assessment for Rheumatoid arthritis?

Inflammation, tenderness and stiffness of the joints

Moderate to severe pain with morning stiffness lasting longer than 30 minutes

Joint deformaties, muscle atrophy and decreased ROM in affected joints

Spongy, soft feeling in the joints

Low grade fever, fatigue and weakness

Anorexia, weight loss and anemia

Elevated ESR, positive rheumatoid factor, ANA, SRP

x-ray shoing joint deterioration

synovial tissue biopsy reveals inflammation


What is the treatment of Rheumatoid Arthritis?

NSAIDS: COX-2 inhibitors

DMARDs: antimalraial, methotrexate-mod-severe disease, gold compounds, azathioprine and D-penicillamine, combination therapy


Biological response modifiers

Others: antibiotics


What is the physical treatment of Rheymatoid arthritis?

Preserve joint function

Provide ROM exercises to maintain joint motion and muscle strength

Balance rest and activity

Splinting during acute inflammation to prevent deformity

Prevent flexion contractures

Use heat and cold therapy, paraffin baths, massage

Exercise program

Avoid weight bearing on inflamed joints


What are the ADL and self-care treatment of rheumatoid arthritis?

Assistive devices-raised toilet seats, self rising chairs, W/C and scooters

adaptive equipment

alternative stratigies for ADL


What is treatment for fatigue in Rheumatoid arthritis?

Identify factors that contribute

Monitor for signs on anemia

Monitor for blood loss

Teach patient to pace activiteis and use assistance when possible


What is the surgical interventions for Rheumatoid Arthritis?

Synovectomy: surgical removal of the synovia to help maintain joint function

Arthrodesis: bony fusion of a joint to regain mobility

Joint replacement or arthroplasty: surgical replacement of diseased joints with artificial joints to restore motion to a joint and function to the muscles, ligaments and other soft tissue stuctures that control a joint


What is osteoarthritis?

Progressive degenerative of joints as result of wear and tear

Cuases bone buildup and loss of articular cartilage in perpheral and axial joints

Affects eight-bearing joints and joints that receive greatest stress

Cause unknown but factors may include trauma, fractures, infections, obesity, smoking and job related repetivitve stress activities


What is the assessment of osteoarthritis?

Joint pain that diminishes after rest and intensifies after activity

Pain occurs slight motion or even at rest

Symptoms aggravated by temp change and climate humidity

Heberden's nodes or Bouchard's nodes

Joint swelling, crepitus and limited ROM

Difficulty getting up after prolonged sitting

Skeletal muscle disuse atropy

Inability to perfom ADL

Compression of spine-radiating pain, stiffness and muscle spasms in one or both extremities


What is pain control treatment?

NSAIDS, muscle relaxants and other meds

Corticosteriod injection into joints

Position joints in fucntional position and acoid flexion of hip and knee

Immobilize joints with splint or brace when inflamed

AVoid large pillows under head or knees

Moist heat, hot pack/compresses and paraffin dip

Cold apllication for acute inflammation

Adequate rest


What is the nutrition treatment os osteoarthritis?

Well balanced diet

Maintain/attain normal weight


What is physcial mobility treatment of osteoarthritis?

Balance rest and actiivty

Exercise program that limits stressing affected joints

Active exercise rather than passive-stop if pain occurs

Limit exercise when joint inflammation is severe


What is the surgical management of osteoarthritis?

Osteotomy: bone resected to correct joint deformity, promote alignment and reduce joint stress

Total joint replacement or arthroplasty

- used when all other measures fail

- most common: hips and kneee

- contraindicated if infection anywhere in body, advanced osteoporosis or severe inflammation is present


What is total joint replacements?

Cemented or cemenless

varied approaches: antior or posterior

Activity restrictions

Pain control

Monitor CMS

Prevent complications: hemorrhage, DVT, pneumonia, dislocation and infection


What is a total knee replacement?

Monitor CMS

Pain control

Prevention of complications:

- hemorrhage


- Infection

- Limited motion


What is osteoporosis?

Age related metabolic disease

Bone demineralies, losing calcium and phosphorus salts resulting in fragile bones and fractures

Bone resorption accelerates as bone formation slows

Occurs commonly in wrist, hip & vertebral column

Can ossur post-menopausally or as result of a metabolic disorder or calcium deficiency

May be asymptomatic until bones become fragile and a minor injury or movment causes a fracture


What is a primary osteoporosis?

Most often occurs in post menopausal women

Risk factors include decreased calcium intake, deficient estrogen and limited resources


What is secondary osteoporosis?

Causes include prolonged therapy with corticosteriods, thyroid-reducing meds, aluminum-containing antacids, or anticonvulsants

Associated with immobility, alcoholism, malnutrition or malabsorption


What are risk factors of osteoporosis?

Cigarette smoking

early menopause

excessive use of alcohol

family history

female gender

increasing age

insufficient intake of calcium

sedentary life

thin, small frame

White or Asian race


What is the assessment of Osteoporosis?

May be asymptomatic

Back pain occurs after lifting, bending or stooping

Back pain increases with palpation

Pelvic or hip pain espeically with wight bearing

Problems with balance

Decline in height from vertebral compression

Kyphosis of the dorsal spine

Pathological fractures

Degeneration of lower throax and lumbar vertebrae on x-ray


What is the treatment of Osteoporosis?

Decrease risk of injury: safe home environment, assistive devices, firm mattress to decrease bending

ADL: move client gently when turning and repositioning, gental ROM exercises, assist to ambulate is unsteady, back brace during acute phase to stablize/support spine

Optimize health and function: body mechanics, abdominal and abck muscle strengthening exercise, avoid activites that can cause compression, diet high in protein, calcium and vitamins C&D&iron, adequate fluid intake to prevent renal calculi

Medications: calcium, vitmain D, phosphorus, calcitonin to inhibit bone loss, estrogen or androgens to decrease rate of bone resorption, analgesics, muscle relaxants and anti-inflammatory meds for pain


What are drug therapaies for osteoporosis?

Estrogen replacement



Estrogen receptor modulators



What is Scoliosis?

Occurs when vertebrate rotate and begin to compress

As curvurture increases damage to vertebral bodies occur

Curvature inccrease during periods of growth


What is Gout?

Systemic disease in which urate crystals deposit in joints and body tissues

Results from abnormal amounts of uric acid in the body

Primary gout results from disorder of purine metabolism

Secondary gout incolves excessive uric acid in blood caused by another disease


What are the phases of Gout?

Asymptomatic: serum uric acid level elevated, no symptom

Acute: excruciating pain and inflammation of small joints

Intermittent: periods w/o symptoms between acute attacks

Chronic: repeated episodes of acute attacks


What is the assessment of Gout?

Swelling and inflammation of the joints with excrucitating pain

Tophi: hard, irregular shaped nodules in the skin containing chalky deposits of sodium urate

Low-grade fever, malaise, headache

pruritis from urate crystals in skin

renal stones from elevated uric acid levels


What are interventions of gout?

low purine diet: avoid organ meants, wines and aged cheese

High fluid intake to prevent stone formation 2000 ml/day

Weight reduction if appropiate

Avoid alcohol and starvation diets

Avoid ASA and diuretics and precipitate attack

Increase urinary pH (above 6) by eating alkaline ash foods such as citris fruits, juices, milk and dairy

Bedrest and elevate affected extremitiy during acute attacks

Protect joint, position in mild flexion, monitor ROM


What is systemic lupus erythematosis?

Chronic, inflammatory, autoimmune disorder affecting connective tissue

2 forms:

-Discoid: affects only skin

-Systemic: affects multiple organs and can be fatal


What is the susceptibility of SLE?

Genetic predisposition


Streptococcal or viral infections

Exposure to sunlight or UV light



Abnormal estrogen metabolism



What are the clinical manifestations of SLE?

Onset may be acute or insidious


Anorexa, N&V, diarrhea, constipation

Weight loss

Malaise, fatigue

Abdominal pain



Blood disorders: anemia, leukopenia, thrombocytopenia, elevated ESR

Irrregular menstraution or amenorrhea