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MED SURG > TOPIC 10 - musculoskeletal and arthritis > Flashcards

TOPIC 10 - musculoskeletal and arthritis Flashcards

(50 cards)

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1
Q

causes of osteoarthritis

A

aging
genes
joint injury
obesity
heavy manual occupations
trauma

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2
Q

what does inflammation indicate in clients with osteoarthritis

A

secondary synovitis

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3
Q

osteoarthritis is sometimes accompanied by what other diseases

A

psoriasis, crohns, hemophilia
(progressive loss of cartilage and bones)

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4
Q

osteoarthritis assessment

A

complains of chronic joint pain and stiffness
enlarged joints related to hypertrophy
joint tenderness on palpitation
crepitus with ROM
joints are hard
inflammation = secondary synovitis
herberdens nodes
bouchards nodes

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5
Q

hebderdens nodes

A

bony nodules at distal interphalangeal joints

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6
Q

bouchards nodes

A

bony nodules at proximal interphalangeal joints

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7
Q

osteoarthritis diagnostics

A

labs : ESR, CRP
imaging : xray, MRI, CT

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8
Q

drug therapy for chronic pain related to cartilage deterioration

A

acetaminophen
lidocaine
SNAID
flexeril (muscle spasms)
ultram

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9
Q

alternative therapies for chronic pain related to cartilage deterioration

A

rest balanced with exercise
joint positioning
heat or cold
weight control

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10
Q

therapies related to impaired mobility related to joint main and muscle atrophy

A

ROM
light exercise
physical therapy
positioning

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11
Q

purpose of drug therapy

A

reduce pain and secondary joint inflammation

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12
Q

diet with osteoarthritis

A

are prone to the disease to eat a well-balanced diet, follow a weight reduction program if obese, avoid trauma, and limit strenuous weight-bearing activities

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13
Q

reducing pain

A

use multiple modalities for pain relief, ice and heat, rest, positioning, CAMS, meds, energy conservation, exercise, joint protection

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14
Q

osteoporosis risk factors

A

Older age
Female
Low body weight
White & Asian ethnicity
Smoker
Sedentary (Lack of physical exercise)
Estrogen deficiency
Family history
Chronic low calcium or vitamin D (Osteomalacia)
High alcohol intake
Low testosterone in men
Long term corticosteroid use

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15
Q

when do osteoporosis and osteopenia occur

A

when bone resorption activity is greater than bone building activity

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16
Q

BMD determines

A

bone strength

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17
Q

peak years for osteoporosis

A

25-30 years old

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18
Q

after peak years

A

BMD decreases and bone resorption activity exceeds bone building activity

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19
Q

modifiable risk factors for osteoporosis

A

inadequate vitamin D or calcium, smoking, alcohol, sedentary lifestyle, large amounts of carbonated beverages

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20
Q

when do patients realize they have osteoporosis

A

if they have a fracture
usually it is silent and they are unaware

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21
Q

osteoporosis definition

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A

chronic metabolic disease in which bone loss causes decreased density and increased risk of fracture

22
Q

osteoporosis physical assessment

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A

Back pain, Restrictive movements, loss of height
Dowager’s hump
Risk of fractures-radius and femur/hip*

23
Q

diagnostic testing for osteoporosis

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A

Bone mineral density (BDM)
Osteoporosis = T-score < -2.5
Serum Calcium, Vitamin D, and ALP

24
Q

medications for osteoporosis

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A

biophosphonates - raloxifene mimics estrogen without stimulation of breast or uterus

25
osteomyelitis definition
severe infection of bone, bone marrow, and surrounding soft tissue
26
risk factors for osteomyelitis
diabetes, orthopedic prosthetic implants, vascular insufficiency
27
osteomyelitis definition
Soft tissue biopsy Blood, wound, bone cultures WBC, ESR, CRP X-ray: it will not initially appear until 2-4 weeks CT can show the extend of infection MRI can show bone marrow edema (early sign) Radionucleotide scans will show abnormalities earlier than an x-ray
28
systemic s/s of osteomyelitis
fever, night sweats, chills, restless, nausea, malaise bone pain, swelling, tenderness, warmth, restricted movement
29
interprofessional care for osteomyelitis
aggressive and long term IV antibiotic therapy when there is no bone ischemia related soft tissue damage and abscesses are debrided and drained
30
pain control for osteomyelitis
how is the limb handled muscle spasms NSAIDs, opioids, muscle relaxants CAMS
31
reactions to high dose antibiotic therapy
Hearing deficit, Impaired renal function Neurotoxicity (weakness, numbness, cognitive changes Vision changes Headache Behavioral problems
32
gout primary vs secondary
Primary – hereditary error of purine metabolism (↑production) Secondary – caused by other diseases or medications
33
diagnostics for gout
serum uric acid >6mg/dL, 24hr urine collection (from decreased excretion vs. ↑production), synovial fluid tests, x-ray
34
risk factors for gout
Obesity Intake of: red & organ meat, shellfish, fructose ETOH Prolonged fasting Medications
35
meds and diseases that cause gout
a) Medications: Thiazide diuretics B-Blockers ACE inhibitors Aspirin Niacin Immunosuppressive for transplants b) Diseases: Diabetes Hyperlipidemia Hypertension Atherosclerosis Renal Insufficiency Sickle Cell Anemia
36
tophi definition
bone erosion
37
rheumatoid arthritis
common connective tissue disease, destruction to joint chronic, progressive, systemic inflammatory autoimmune disease
38
what joints are primarily affected in rheumatoid arthritis
synovial joints
39
what are the antibodies doing in rheumatoid arthritis
transform and attach healthy tissue = inflammation
40
RA assessment early manifestations
joint inflammation systemic : low grade fever, fatigue, weakness, anorexia, paresthesia
41
RA assessment late manifestations
osteoporosis, severe fatigue, anemia, weight loss, SQ nodules, peripheral neuropathy, vasculitis, pericarditis, fibrotic lung disease, sjogrens syndrome, kidney disease, felty syndrome
42
RA deformities
ulnar drift, boutonniere deformity, hallux valgus, swan neck deformity
43
labs for RA
ESR, CRP Anti-CPP Rheumatoid factor Antinuclear antibody (ANA)
44
diagnostics for RA
Synovial fluid analysis for MMP-3 X-ray
45
RA drug therapy
Disease Modifying Antirheumatic drugs (DMARDs) Biological Response Modifiers Immunosuppressants Corticosteroids
46
RA surgeries
synovectomy - removal of joint lining arthroplasty - removal of diseased joint
47
acute vs chronic care for RA
Acute Care – when clients experience systemic complications or uncontrolled pain Chronic Care - Balance rest & activity Joint Protection Cold & heat therapy Exercises Client and Caregiver Teaching Psychological Support Gerontological Considerations
48
methotrexate
used early on to slow progression lower risk for toxicity rare side effects of bone marrow suppression and hepatotoxicity frequent lab monitoring for CBC, CMP starts to work within 4-6 weeks given with other DMARDs or corticosteroids if not providing adequate relief
49
humira - BRM
Store in refrigerator If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. Protect the medicine from direct light Monitor patients closely for signs and symptoms of infection during and after treatment
50
nutritional considerations for RA
may have loss of appetite and fatigue or decreased mobility and endurance makes food shopping and prep difficult

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