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Fluid And Electrolyte > Musculoskeletal disorders > Flashcards

Musculoskeletal disorders Flashcards

1
Q

Difference between dorsiflexion and plantar flexion.

A

Dorsiflexion is pointing toes toward shin. Plantar is pointing toes toward floor.

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2
Q

What is a goniometer used for?

A

Assessing ROM by measuring the angle. Looks like a protractor.

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3
Q

What are some wording for normal assessment of spine?

A

Ordinary spinal curvatures

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4
Q

Wording for normal assessment of muscles.

A

No muscle atrophy or asymmetry.
Muscle strength 5/5.

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5
Q

Wording for normal assessment of joints.

A

No joint swelling, deformity or crepitation.
Full ROM of all joints without pain or laxity.

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6
Q

Wording for normal assessment of palpation of musculoskeletal system.

A

No tenderness on palpation of spine, joints, muscles.

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7
Q

What is stiffness and fixation of a joint called?

A

Ankylosis-(possible cause is joint inflammation and destruction)

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8
Q

What is thickening or scarring of connective tissue called?

A

Fibrosis

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9
Q

Resistance of movement of muscle or joint.

A

Contracture (usually caused by fibrosis of supporting tissue)

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10
Q

Audible crackling sound with palpable grating.

A

Crepitus (fracture, dislocation, TMJ, osteoarthritis)

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11
Q

Exaggerated thoracic curvature

A

Kyphosis (dowagers hump)

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12
Q

Exaggerated lumbar curvature

A

Lordosis (swayback)

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13
Q

What does alkaline phosphatase labs test for? Normal range.

A

Seen as ALP
30-120 U/L
Part of CMP and liver panel.
Indicative of liver dysfunction or bone damage.
Can give false positive if lab draw is hemolyzed.
High in kids during growth spurt.
Many meds that are hard on liver can raise ALP.
Elevated in bone cancers, osteoporosis, healing fractures, Paget disease, osteomalacia and rickets.

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14
Q

What is rheumatoid factor in labs?

A

Indicative of RA, SLE, ankylosing spondylitis, osteoarthritis, psoriatic arthritis
Normal finding should be negative or a titer of less than 1:17

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15
Q

What is acetylcholine receptor antibody test?

A

Seen as AChR test
Lab for myasthenia gravis (remember this a disease that attacks ACh-a neurotransmitter affecting skeletal muscle)
Attacks the ability of ACh to function. Antibodies are indicative of Myasthenia gravis

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16
Q

What is antinuclear antibody test?

A

Seen as ANA in lab
Normal findings are negative to 1:40 dilution
If antibodies are present usually means SLE (present in 95% of SLE)
but can mean RA or scleroderma

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17
Q

What is an anti-DNA antibody test?

A

Most specific marker for SLE
Normal findings are <5 IU/mL

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18
Q

Different types of bone cells and functions.

A

Osteoblasts-build up bone
Osteoclasts-break down bone
Osteocytes-mature bone cells

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19
Q

What is a uric acid lab for?

A

Increased levels in gout

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20
Q

What is C-reactive protein? (CRP)

A

Normal is <1.0 mg/dL
Indicative of inflammation or infection
Increased in SLE and RA

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21
Q

What is an erythrocyte sedimentation rate?

A

Marker for inflammation and infection. Usually this lab is ran with CRP.

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22
Q

What is creatine kinase? (CK)

A

Normal is 20-200 U/L.
Highest concentration in skeletal muscle.
Increased in injury, muscular dystrophy

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23
Q

What are the NSAIDs?

A

Ibuprofen and Naproxen
meloxicam (Mobic)
celecoxib (Celebrex)
diclofenac sodium (Voltaren) gel

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24
Q

What are the injectable steroids?

A

methylprednisolone acetate (Depot-Medrol)
triamcinolone (Aristospan)

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25
Q

What are the oral steroids?

A

methylprednisolone (Solu-Medrol)
dexamethasone
prednisone

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26
Q

What are biphosphonates used for?

A

Osteoporosis

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27
Q

What are some common DMARDs?
(disease modifying anti rheumatic drugs)

A

methotrexate (Trexall)
sulfasalazine (Azulfidine)
leflunomide (Arava)
penicillamine (Cuprimine)
hydroxychloroquine (Plaquenil)

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28
Q

What does RICE stand for?

A

Rest
Ice-20 min at time for first 24-48 then warm compresses
Compress-wrap from distal to proximal for 30 min, then leave unwrapped for 15 min
Elevate-above heart for first 24-48 hours

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29
Q

What is difference between ACL and meniscus injury?

A

ACL-characterized by pivoting or odd positioning of lower limb-tearing of ligament in knee
Meniscus-characterized by popping, clicking, tearing sensations in knee. Injury to fibrocartilage

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30
Q

What is partial dislocation called?

A

Sublaxation

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31
Q

What is repetitive strain injury?

A

Injury from prolonged force or repetitive movements. Causes tiny tears in tissues that become chronically inflamed. Also called work related, overuse or cumulative trauma injuries.

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32
Q

What is compartment syndrome?

A

Swelling in limited space leads to decreased blood supply»necrosis
6 P’s that are classic s/sx
1. Pain (uncontrolled and out of proportion)
2. Pressure
3. Parasthesia (numbness and tingling like limb is asleep)–early sign
4. Pallor
5. Paralysis
6. Pulselessness

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33
Q

What is fat embolism syndrome?

A

Fat globules enter bloodstream after a fracture. Collect in lungs and brain.

34
Q

What is rhabdomyolysis?

A

Damage to skeletal muscles cause breakdown and release of myoglobin in blood. Myoglobin gets stuck in kidney tubules and causes acute kidney injury. Watch for reddish brown urine and low output.

35
Q

What is a Colles fracture?

A

Fracture of distal radial usually after a fall with outstretched arm. Presents as wrist deformity. Common in people over 50

36
Q

Four ways fractures are classified.

A
  1. Open or closed
  2. Complete of incomplete (did it go through the bone completely?)
  3. Direction of fracture line. (see another card on details)
  4. Displaced or non displaced. (are the ends of break still together?)
37
Q

Different types of directional fracture classifications.

A

Transverse-straight across
Spiral-wraps around
Greenstick-one side sticks out like you have broken a popsicle stick
Comminuted-broken into small pieces
Oblique-across at diagonal
Pathologic-spontaneous break of diseased bone
Stress-repeated stress (runners toes)

38
Q

What’s the difference between a sprain and a strain?

A

Sprain is injury to ligaments or capsule of joint
Strain is injury to tendons or muscles

39
Q

What is an osteotomy?

A

Removing of a wedge or slice of bone to restore alignment, usually in spine or joint.

40
Q

What is arthroplasty?

A

Joint replacement or reconstruction

41
Q

What is arthrodesis?

A

Fusion of joint that cannot be repaired otherwise. Immobilizes joint

42
Q

What are common muscle relaxants given for musculoskeletal disorders?

A

Carisoprodol (Soma)
Cyclobenzaprine (Flexeril)
Methocarbamol (Robaxin)

43
Q

Which antibiotic class is commonly used for bone infection?

A

Cephalosporins

44
Q

What is med term for bowlegs?

A

Genu Varum- knees apaRt

45
Q

What is med term for knock knees?

A

Genu Valgum-knees toGether

46
Q

What is Legg-Calve-Perthes disease?

A

Disease thought to be from a growth disorder
Causes the femoral head to die from lack of blood supply. When new bone is laid down it is deformed, flat and larger
Children from 4-8 yo, mostly boys. Will be in considerable hip pain. Decreased ability to internally rotate and abduct leg
Wasting of muscles in butt and thigh
Shortening of extremity

47
Q

What is talipes equinovarus?

A

Clubfoot- a congenital dysplasia of all tissue below the knee. The most common skeletal birth defect. 1/1000 births. Males twice as likely. Treatment is realignment. Referred to ortho. Treatment is very effective and commonly involves a Ponseti casting method.

48
Q

Info on muscular dystrophy.

A

Many different types but they all result in same thing. Muscle fibers break down and are replaced by fat and connective tissue. Respiratory and cardiac muscle wasting is cause of death.
DMD (Duchennes MD is the most common). Occurs only in males. An X-linked recessive trait. Most have developmental delays. Life expectancy is late teens.
Nursing interventions are all aimed at maintaining ambulation as long as possible and support to family.

49
Q

What is achondroplasia?

A

Most common cause of dwarfism.

50
Q

What is an osteochondroma?

A

Benign bone tumor. Usually shows up in teens and young adults. Careful monitoring because can turn into cancer later in life.

51
Q

What is an osteosarcoma?

A

Very aggressive bone cancer.
Occurs most often in boys ages 10-25
Pelvis or long bones of arms and legs
Pain and swelling the first indicators

52
Q

What is metastatic bone cancer?

A

Cancer that has metastasized to bone from any location.
Fractures occur along weakened bone and hypercalcemia is sign.

53
Q

What is osteomalacia?

A

Vitamin D deficiency leads to calcium loss and softening of bones
Called Rickets in kids

54
Q

What is major drug class in treatment for osteoporosis?

A

Biphosphonates-take with full glass of water, on empty stomach and 30 min before anything else

55
Q

What is Paget disease?

A

Called osteitis deformans
Chronic skeletal breakdown with replacement of weaker, larger, more disorganized connective tissue
More common in men than women
Early symptoms are fatigue, waddling gait, headaches. Head becomes larger. Serum Alkaline phosphatase is high.

56
Q

What is osteopenia?

A

Decreased bone density-weakness that is precursor to osteoporosis

57
Q

What is metatarsus adductus?

A

Inward turned foot. Occurs in 1/1000 live births. Babies with this are more likely to have hip dysplasia. Usually corrects itself as baby grows

58
Q

What is gout caused by?

A

Type of arthritis. Caused by increased uric acid in body. Swelling, erythema, tenderness and pain (usually in big toe) uric acid forms crystals in joint

59
Q

What is a positive Gowers Sign?

A

Sign of Muscular Dystrophy. When standing from sitting on floor they will brace hands on leg to support self

60
Q

What is radicular pain?

A

Radiates

61
Q

What is referred pain?

A

Pain in area unrelated to injured area

62
Q

Osteoarthritis facts.

A

Non inflammatory of synovial joints
Formation of osteophytes (bone spurs) in joint
Joint pain that worsens with use
Joint pain that in worse the first 30 min after waking
Stiffness and pain
No systemic involvement

63
Q

What types of drugs are commonly used to treat osteoarthritis (OA)?

A

NSAIDS
Diclofenac gel (Voltaren)
OTC creams
Intraarticular corticosteroid injections

64
Q

Rheumatoid Arthritis info.

A

Systemic inflammation of connective tissue in synovial joints
Remission/flare ups
Autoimmune disease
Symmetrical involvement and often affects small joints of fingers and toes
Morning stiffness of 60 min
Ulnar drift (fingers start pointing away from thumb)
Swan neck (fingers start to look like have a dip in middle and make fingertip point down)
Boutonniere deformity (most distal joint makes finger point toward ceiling)

65
Q

How to diagnose RA?

A

Diagnosis: Elevated ESR, CRP

Synovial fluid analysis reveals cloudy and straw colored synovial fluid, WBCs and MMP-3s (a protein made in synovial joints that is involved in joint destruction in RA) elevated in synovial fluid

Tissue biopsy
Bone scans

66
Q

Treatments for RA

A

DMARDs (the earlier the better to prevent joint destruction)
Types of DMARDs:
1. Methotrexate (monitor CBCs and blood chem because it lowers platelet and WBC count)
2. Sulfasalazine (Azulfidine)
3. Hydroxychloroquine (Plaquenil)
4. Leflunomide (Arava) (teratogenic)

Corticosteroids for short term during flare ups
Surgeries: Synovectomy
Arthroplasty

67
Q

What is Sjogrens syndrome?
—Pronounced Show-gruns—

A

Autoimmune disease that targets moisture producing exocrine glands
Lymphocytes attack lacrimal and salivary glands (most affected organs) but also involve the stomach, pancreas and intestines
Increases risk for non-hodgkins lymphoma

68
Q

Symptoms of Sjogrens syndrome.

A

Dry mouth (xerostomia)
Dry eyes (keratoconjunctivitis sicca)
Dry skin (xerosis)

69
Q

Treatments for Sjogrens syndrome.

A

Artificial tears
Surgical punctual occlusion
Increase fluids
Dental hygiene
Increase humidity
Pilocarpine —Pie-lo-CAR-peen– (increased salivary gland secretion)
Cevimeline—Sa-VIM-a-leen–(cholinergic increases salivary gland secretion)

70
Q

Diagnostics in gout.

A

Synovial fluid inspiration is gold standard (but usually not necessary)
Serum uric acid levels may be normal and high levels are not diagnostic of gout
Usually diagnosed based on symptoms

71
Q

Treatment for gout.

A

Colchicine—-CALL-cha-seen—
(an antiinflammatory given during flares and given prophalactically)

NSAIDS

Corticosteroid oral or injection

Allopurinol (given prophalactically)

Uricosuric (given to increase urinary excretion of uric acid) can’t take with aspirin

72
Q

What is systemic lupus erythematosus (SLE)?

A

Multisystem inflammatory autoimmune
Complex factors that cause:
Hormones (usually childbearing age women)
Genetics (family history)
Environment (sun, stress, chemicals or meds)
Immune system (after Epstein Barr infection)

73
Q

What are characteristics of SLE?

A

Affects many body systems

Characterized by flares and remission

Most commonly affects:
Skin–butterfly rash, erythema
Muscles–Inflammation
Lung lining–Inflammation
Cardio–Usually fatal Inflammation-Peri, Myo and Endocarditis
Raynaud’s (Ray-nose—-cold and numb hands)
Neuro–neuropathy, CVA (because of coagulation issues) seizures, psychosis, brain fog
Kidneys—Ususally fatal inflammation (glomerulonephritis) that decreases kidney function

Excessive fatigue
Joint Pain
Weight loss

74
Q

How to diagnose SLE?

A

ANA (anti-nuclear antibodies) present in 97% of SLE
Increased ESR, CRP
Complex to diagnose

75
Q

Treatment for SLE.

A

NSAIDs
Antimalarial drugs
Corticosteroids
Immunosuppressive drugs
Anticoags
Topical immunomodulators for skin conditions

76
Q

Lyme disease info.

A

Borrelia burgdorferi infection transmitted by tick
Characteristic bulls eye rash within 1 month in 80% of patients
Flu like symptoms
Causes widespread inflammation in several symptoms most commonly:
Arthritis, Lyme carditis, Bell’s palsy (facial nerve palsy creates a muscle weakness on one side of face)
Treatment is doxycycline. Long term AB may be needed.

77
Q

What is scleroderma?

A

Overproduction of collagen of unknown etiology

Causes tissue fibrosis and blood vessel occlusion (especially small vessels)

Connective tissue disease causing fibrosis, degeneration and sometimes inflammation to several systems.

78
Q

Two types of scleroderma.

A

Localized (in children) that causes skin changes in a few places. Affects face, fingers, hands, lower arms and legs.

Systemic (in adults) that causes internal organ changes. Widespread thickening of skin, especially hands, arms, thighs, chest, abdomen and face. Damages blood vessels, heart, lungs, joints, muscles, esophagus, intestines.

79
Q

What is CREST syndrome and what is it a hallmark of?

A

Scleroderma
C-Calcinosis-Calcium deposits on skin
R-Raynauds
E-Esophageal dysfunction-usually acid reflux
S-Sclerodactyly-thickening and tightening of skin on hands and fingers
T-Telangiectasia-dilation of capillaries causing red marks on skin

80
Q

Nursing management of scleroderma.

A

No finger sticks with Raynauds
Moist heat and paraffin
Protect hands from cold
Watch for infection

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