Med-Surg: Musculoskeletal/2

Question 1

gouty arthritis GA

Answer 1

systemic inflammatory disease caused by problems with purine metabolism (primary gout) or hyperuricemia (secondary gout)

Question 2

systemic inflammatory disease caused by problems with purine metabolism (primary gout) or hyperuricemia (secondary gout)

Answer 2

GA

Question 3

GA CFs

5

Answer 3

1. family hx
2. excessive alcohol
3. high purine intake - organ meats, yeast, sardines, spinach
4. obesity
5. comorbid conditions of DM and/or KD

Question 4

high purine intake =

Answer 4

GA

Question 5

GA manifs.

4

Answer 5

1. excruciating pain and inflammation in one or more small joints - big toes most common
2. tophi - deposits of sodium urate crystals, generally appear after years of GA
3. progressive joint damage and deformity
4. increased incident of uric acid renal stone

Question 6

GA dx procedures

3

Answer 6

1. serum uric acid > 7
2. ESR
3. synovial fluid analysis - will show uric acid crystals

Question 7

GA NIs

4

Answer 7

1. maintain best rest during attacks
2. use bed cradle to keep linen off joint
3. 3l fluid/day
4. limit high purines

Question 8

GA acute phase and chronic tx meds

Answer 8

acute - colchicine

chronic - allopurinol

Question 9

colchine is to

Answer 9

GA acute attack med

Question 10

allopurinol is to

Answer 10

GA chronic rx treatment

Question 11

GA and weight loss

Answer 11

lose weight slowly; rapid weight loss can cause attack or increase the incidence of uric acid renal stones

Question 12

comminuted fractures aka

Answer 12

fragmented

Question 13

bone fracture 6 P’s

Answer 13

pain
pressure
paralysis
pallor
pulselessness
paresthesia

Question 14

fat emoblism s/s

7

Answer 14

1. confusion
2. anxiety
3. tachycardia
4. chest pain
5. tachypnea
6. hemoptysis
7. petechiae over neck, upper arms, chest, abd (late sign)

Question 15

compartment syndrome is irreversible if compromise persists beyond

Answer 15

4-6 hours

Question 16

compartment syndrome s/s

Answer 16

1. pain unrelieved by position or meds
2. cyanosis
3. tingling
4. paralysis

Question 17

precursor of Osteoporosis

Answer 17

osteopenia

Question 18

osteoporosis CFs - primary

8

Answer 18

1. women 65+
2. men 75+
3. asian, white
4. family hx
5. estrogen or androgen def
6. protein def
7. sedentary life
8. smoking alcohol

Question 19

osteoporosis CFs - secondary

7

Answer 19

1. bone cancer
2. cushing’s
3. DM
4. meds
5. paget’s disease
6. prolonged immobilization
7. RA

Question 20

osteoporosis manifs.

4

Answer 20

1. shortened height
2. hx of fractures
3. thoracic kyphosis
4. decreased bone mass

Question 21

PTH route

Answer 21

sq, daily, for osteoporosis tx

Question 22

osteomyelitis CFs

5

Answer 22

1. DM
2. hemodialysis
3. injection drug use
4. poor blood supply
5. recent trauma

Question 23

osteomyelitis manifs. - main ones

4

Answer 23

1. bone pain
2. fever
3. general discomfort
4. local swelling, redness, warmth

Question 24

osteomyelitis dx proc. - not extensive list

2

Answer 24

1. bone biopsy - which is then cultured

2. bone scan

Question 25

osteomyelitis NIs | 3

Answer 25

1. IV antibiotics 2. if wound drainage - do contact precautions 3. implement wound irrigation

Question 26

osteomyelitis therapeutic measures | 2

Answer 26

1. surgical excision of dead and infected bone may be needed | 2. bone grafting may be performed in large impacted areas

Question 27

total joint arthroplasty post op for hip | 3

Answer 27

keep abductor pillow in place while in bed, do not flex hip more than 90 degrees, do not position on operative side

Question 28

total joint arthroplasty post op for knee

Answer 28

maintain continuous passive motion CPM machine to promote joint mobility

Question 29

total joint arthroplasty opioid rxs | 2

Answer 29

extended release epidural morphine or PCA

Question 30

amputation meds | 5

Answer 30

1. opioids for residual limp pain 2. calcitonin to reduce phantom pain 3. antispasmodics for muscle spams 4. beta blockers for constant, dull, burning pain 5. antiepileptic drugs for knife-like or sharp burning pain

Question 31

amputation - calcitonin

Answer 31

reduces phantom pain

Question 32

amputation - beta blockers

Answer 32

relieves constant, dull, burning pain

Question 33

amputation - antiepileptic meds

Answer 33

relieve knife-like or sharp burning pain