w5 notes Flashcards
(120 cards)
1
Q
Radiologic studies: ______
- Injection of radioisotope that is taken up by bone
- Increased uptake = osteomyelitis, osteoporosis, malignancies, and some fx
- Decreased uptake = avascular necrosis (death of bone d/t lack of vessels/blood supply)
- Nurse – give radioisotope 2 hour prior to procedure, lie still for 1 hour, radioisotope not harmful, force fluids after
A
bone scan
2
Q
SLE Dx
T/F
1- pt hx, physical exam, lab finding
2- there is one specific dx test for SLE
3- ANA (Antinuclear antibody ) test positive in most SLE pt
4- anti-DNA antibody test
5- elevated ESR and CRP
6- increased serum complement
7- CBC = pancytopenia
8- urinalysis = proteinuria, hematuria, blood cell casts (indicates kidney involvement)
A
1 T
2 F - not one specific dx test for SLE
3 T
4 T (more specific to SLE b/c antibodies are rarely found in other disorders)
5 T
6 F - decreased serum complement
7 T
8 T
3
Q
________ arthritis: Risk factors
- age, gender, race, ethnicity
- hyperuricemia
- obesity
- HTN
- HLD
- ischemic CV disease
- DM
- CKD
- dietary factors
- Alcohol
- medications altering urate balance
A
gouty
4
Q
osteomyelitis Care
- IV ____ – vigorous, prolonged, central line
- __________ debridement
- initially – ____ rest
- some immobilization of affected limb
- pain control
A
Care
- IV abx – vigorous, prolonged, central line
- surgical debridement
- initially – bed rest
- some immobilization of affected limb
- pain control
5
Q
Radiologic studies: ______
- Radio and magnetic waves to view soft tissue
- Place inside scanner chamber
- Nurse – explain painless, loud ticking noise, remove metal, if claustrophic admin anti-anxiety meds
A
MRI
6
Q
Radiologic studies: ______
- 3-demensional picture
- For soft tissue, bone abnormalities and some trauma
- w/ or w/out contrast
- Nurse – explain painless, remain still, if w/ contrast assess allergies and etc.
A
- CT scan
7
Q
Total hip arthroplasty
- replacement
- 2 types
- ________
- hip muscle left intact = more stable hip post op
- ROM restriction = hyperextension - __________
- ROM restrictions =
- No extreme internal rotations
- No adduction (may have abduction wedge between legs)
- No >90 degree flexion (may have elevated toilet seat)
A
anterior
posterior
8
Q
this traction involves suspending the entire leg in a flexed position using a splint or frame, counterbalanced by weights or a pulley system
A
Balanced suspension traction
9
Q
s/s
- pain
- Intense
- In joint - often great toe but can be other joints like knees and ankles
- Early morning
- inflammation/edema
- tenderness
- red
- fever
- malaise
- flare peaks 24-48 hours, takes 5-10 days to go away
A
gouty arthritis
10
Q
Balanced suspension traction = involves suspending the entire leg in a flexed position using a splint or frame, counterbalanced by weights or a pulley system
T/F
1- used with skin or skeletal traction?
2-uses countertraction or running traction?
3 - disadv: pt sliding down in bed
4 - continuous pulling force
5 - allows for more movement and care
6 nurse must maintain constant traction, no interruption in weights, nothing interrupting the line of pull (direction of pulling force)
A
1 both
2 countertraction
3 F - prevents pt from sliding down in bed
4 T
5 T
6 T
11
Q
emergency care: fractures
- ABC
- ______ injury
- splint fracture in normal body alignment
- immobilize fracture
- maintain normal body alignment
- elevate fractured body part – __crease venous return and __crease swelling
- apply _____ pack 1st 24 hours – increase vasoconstriction and decrease swelling
A
emergency care: fractures
- ABC
- head injury
- splint fracture in normal body alignment
- immobilize fracture
- maintain normal body alignment
- elevate fractured body part – increase venous return and decrease swelling
- apply cold pack 1st 24 hours – increase vasoconstriction and decrease swelling
Fractures = ongoing predictable pain which indicates ATC dosing/meds
12
Q
SLE Treatment
- highly individualized
- ___________ (most all pts will be on this)
PLUS
- Mild SLE
- NSAIDS maybe
- Short term low dose glucocorticoids maybe (prednisone)
- Moderate SLE
- Short term therapy (prednisone)
- Taper once hydroxychloroquine takes effect
- severe/life threatening
- Intensive immunosuppressants
- High dose steroids to halt tissue injury
A
Treatment
- highly individualized
- hydroxychloroquine (most all pts will be on this)
PLUS
- Mild SLE
- NSAIDS maybe
- Short term low dose glucocorticoids maybe (prednisone)
- Moderate SLE
- Short term therapy (prednisone)
- Taper once hydroxychloroquine takes effect
- severe/life threatening
- Intensive immunosuppressants
- High dose steroids to halt tissue injury
13
Q
osteoporosis s/s
- _________ fx – break in vertebral body of bone d/t loss of bone mass
- ______ pain
- progressive _________ deformities
- “silent disease”
- Loss of _______ over time due to vertebral fractures and compression
A
- compression fx – break in vertebral body of bone d/t loss of bone mass
- back pain
- progressive vertebral deformities
- “silent disease”
- loss of height
14
Q
cast complications
- _________ r/t pressure necrosis
- Circulation impairment
- _________ damage
- Immobility
- Watch for pressure areas – where ________ are
A
cast complications
- Infection r/t pressure necrosis
- Circulation impairment
- Peripheral nerve damage
- Immobility
- Watch for pressure areas – where bony prominences are
15
Q
Serum studies (blood tests): Antinuclear antibody (ANA)
- Assess for antibodies capable of destroying nucleus of body’s tissue cells
- Normal = negative
- Positive in most ____ patients,
- positive maybe in ____ patients, and very few normal population
A
Antinuclear antibody (ANA)
- Assess for antibodies capable of destroying nucleus of body’s tissue cells
- Normal = negative
- Positive in most SLE patients,
also maybe RA patients, and very few normal population
16
Q
herniated disc: Dx
_________
- Uses magnetic energy
- Images
- Non-invasive
- No metal
- Sedation if claustrophobic
_________
- Xray/thin cross sections
- w/ or w/out contrast
_________
- xrays after injection of contrast into subarachnoid space
- sedate prn
- done on tilt table
- encourage fluids
A
- MRI
- CT scan
- myelogram
17
Q
Goals for fracture treatment
(3)
A
Goals for fracture treatment
1. reduce (align)
2. immobilize
3. restore function
18
Q
OA vs RA
6. anti-ccp antibody
= positive
= negative
- ESR and CRP
= normal
= elevated - Age at onset
= Young to middle age.
= Usually older than 40 years.
9 Gender
= Females 2:1 after age 60; except for traumatic arthritis, men less affected until age 70 or 80.
= Female-to-male ratio is 3:1. Less marked difference after age 60.
A
- anti-ccp antibody
RA = positive
OA = negative - ESR and CRP
OA = normal
RA = elevated - Age at onset
RA = Young to middle age.
OA = Usually older than 40 years.
9 Gender
OA = Females 2:1 after age 60; except for traumatic arthritis, men less affected until age 70 or 80.
RA = Female-to-male ratio is 3:1. Less marked difference after age 60.
19
Q
complications of amputations
- possible VTE
- acute pain
- impaired mobility
- peripheral NV dysfunction
- risk for injury
- risk for impaired skin integrity
which is #1?
A
- possible VTE
20
Q
- procedure to replace the damaged knee joint with an artificial prosthetic joint
A
Total Knee Arthroplasty (TKA)
21
Q
Serum studies (blood tests): rheumatoid factor (RF)
T/F
- Used to assess for presence of autoantibody (RF)
- Used to dx _____
- specific or non-specific to RA?
- Normal = negative
- when dx RA - is RF or ACPA/anti-CCP is more specific?
A
T - Used to assess for presence of autoantibody (RF)
- Used to dx RA
F - not specific to RA - Can be in various tissues, and normal population
T - Normal = negative
- ACPA/anti-CCP is more specific to RA
22
Q
OA, RA, SLE
1. local
2. systemic
3. symmetrical
4. asymmetrical
5. joint pain worsens with use or change in temp/pressure
6. fatigue
7. debilitating fatigue
8. anorexia
9. joint pain relieved with rest
10. weight loss
11. generalized stiffness that worsens over time
12. AM stiffness lasts > 60 mins
13. joint stiffness worsens in AM
14. AM stiffness < 30 mins
15. multi joints affected
16. multi systems affected
17. Pain/stiffness moves from one part of the body to the other
18. crepitus
19. pain
20. limited ROM
21. swollen warm joints
22. photosensitivity
23. heberdens nodes
24. disability
25. butterfly rash
26. kidney failure
27. pancytopenia
28. sjogrens syndrome
29. fever
30. raynauds phenomenon
31. rheumatoid nodules
32. hair loss
33. edema
34. ulners drift
35. bouchards nodes
36. bowlegged knees
37. knuckle and wrist subluxation
38. mouth and nose ulcers
39. pleurisy and pericarditis
40. swan neck fingers
41. boutineniere fingers
42. nervous system dysfunction
43. z shaped thumb
44. concentration difficulty
45. confusion
46. depression
47. h/a
48. seizures
49. cerebritis
A
- OA
- RA, SLE
- RA
- OA, SLE
- OA
- RA
- SLE
- RA
- OA
- RA
- RA
- RA
- OA, RA, SLE
- OA
- SLE
- SLE
- SLE
- OA
- OA, RA, SLE
- RA
- SLE
- SLE
- OA
- RA
- SLE
- SLE
- SLE
- RA
- SLE
- SLE
- RA
- SLE
- SLE
- RA
- OA
- OA
- RA
- SLE
- SLE
- RA
- RA
- SLE
- RA
- SLE
- SLE
- SLE
- SLE
- SLE
- SLE
23
Q
joint surgery: Care
Depends on which joint is replaced/repaired
- neurovascular assessment
- Original surgical dressing
removed by =
reinforced prn by =
- maintain specific ROM ________
- restore strength, muscle tone and ROM
A
Care
Depends on which joint is replaced/repaired
- neurovascular assessment
- Original surgical dressing
removed only by surgeon,
reinforce prn by surgeon
- maintain specific ROM limitations
- restore strength, muscle tone and ROM
24
Q
Complications of amputations
- __________ – increased HR, saturated dressing
- infection
- phantom limb pain
- _________contractures – esp at hip
A
Complications
- hemorrhage – increased HR, saturated dressing
- infection
- phantom limb pain
- flexion contractures – esp at hip
25
delayed ID/treatment of osteomyelitis can lead to:
T/F
- Chronic pain, infection, and drainage
- Loss of function
- Amputation
- Death (from sepsis)
T
T
T
T
26
external fixation devices: _______________
- screws are placed into the bone above and below the fracture
- device is attached to the screws from the outside
- device can be adjusted to realign the bone
- allows pt to not be confined to bed
- (with any method that involves pins/screws into skin/bone – assess pin site for pin loosening, infection, perform pin care with NS, avoid using ointments which attract bacteria, teach to avoid touching)
external fixators
27
herniated disk: treatment
1. nonsurgical/conservative
- brace, corset, belt
- heat/ice
- massage
- traction
- _______ – electrical nerve stimulatior, helps with pain control
- NSAIDS, short term narcotics, muscle relaxants
- back and core strengthening exercises
2. Surgical
-___________ – excision/removal or lamina (posterior arch of vertebra) to gain access to protruding disc to remove it, nerves are no longer compressed
- ___________ – remove part of disk so nerve has more room
- __________– add bone graft/synthetic product for stabilization, keeps bone off bone, fuses spine
TENS
laminectomy
diskectomy
spinal fusion
28
external fixation devices: casts
- temporary circumferential __________ device
- common treatment after __________ reduction
- cast material – fiberglass, plaster of paris (rare, old)
external fixation devices: casts
- temporary circumferential immobilization device
- common treatment after closed reduction
- cast material – fiberglass, plaster of paris (rare, old)
29
purpose – to hold broken bones together (or close approximation) until healing takes place
immobilize
(After the reduction, the fracture can be stabilized/immobilized with:
-internal fixation devices
- metal plates
- screws
- nails
- pins
- bone grafts
-external fixation devices
- cast
- splint
- brace
- traction
- external fixators)
30
- osteoarthritis pt
- RA pt
- Congenital deformities pt
commonly get _______ surgery
joint
31
Total hip arthroplasty
- hip replacement
2 types:
1. anterior
2. posterior
which one?
1- hip muscle left intact
2 ROM restrictions = No extreme internal rotations
3 ROM restrictions = No adduction (may have abduction wedge between legs)
4. ROM restrictions = hyperextension
5. ROM restrictions = No >90 degree flexion (may have elevated toilet seat)
6. more stable hip post op
1. A
2. P
3. P
4. A
5. P
6. A
32
2 types of traction
skin
skeletal
33
OA treatment
1. _______ and _______joint
- Maintain functional position prn (orthotics)
- Avoid prolonged immobilization
- Use assistive devices prn
2. heat/cold
- ____ helps with stiffness, 20 min on/off
3. weight reduction prn
4. aerobic exercise
5. complementary therapies - Yoga, Acupuncture, biofeedback
6. drug therapy
1. rest and protect joint
- Maintain functional position prn (orthotics)
- Avoid prolonged immobilization
- Use assistive devices prn
2. heat/cold
- Heat helps with stiffness, 20 min on/off
3. weight reduction prn
4. aerobic exercise
5. complementary therapies - Yoga, Acupuncture, biofeedback
6. drug therapy
34
Radiologic studies: ______
- Anterior-posterior on- dimensional view
- Lateral two-dimensional view
- Nurse – remove radioopaque/metal objects from pt, avoid excessive exposure
- xray
35
when caring for pt with a fracture a sudden inability of pain medications to relieve pain =
compartment syndrome
36
joint surgery: Why?
- relieve_______
- improve ________
- ________ deformity and mal-alignment
- remove intra-articular causes of erosion
Why?
- relieve pain
- improve motion
- correct deformity and mal-alignment
- remove intra-articular causes of erosion
37
Serum studies (blood tests): ESR
T/F
- Non-specific or specific indicator of inflammation?
- chronic or acute?
- associated with RA, osteomyelitis
-Normal = <30
Serum studies (blood tests): CRP
- Non-specific or specific indicator of inflammation?
- chronic or acute?
- indicates infections
- indicates active widespread malignancies
nonspecific
chronic
T
T
nonspecific
acute
T
T
38
Radiologic studies: ______
- w/ or w/out contrast
- assess pathology of the spinal cord
- sensitive test for nerve impingement
procedure -
- xrays after injection of contrast into subarachnoid space
- sedate PRN
- done on a tilt table
- encourage fluids
nurse -
- risk of spinal h/a
- myelogram
39
myelogram: nursing care r/t risk of spinal h/a
- to prevent spinal h/a position pt ________
- spinal h/a should resolve in 1-2 days w/ _____ and _______
- if not ________ may be indicated
- blood patch - blood draw from ______ and is injected into _______ which often provides _________ relief from spinal h/a
- to prevent spinal h/a lay flat
- spinal h/a should resolve in 1-2 days w/ rest and fluids
- if not blood patch may be indicated –
- blood draw from periphery is injected into spine, which often provides immediate relief from spinal h/a
40
- Systemic inflammatory disorder
- autoimmune
- multisystem inflammatory disease
- chronic, unpredictable remissions and exacerbations
SLE
(RA - more joint thing vs lupus - more multisystem thing)
41
which pts are at risk for VTE and fat embolisms?
_________ - fat globules released from long bone fracture (femur, humerus) enter the bloodstream and travel to lungs, brain, etc.
fracture pt, fat embolism - long bone fracture (femur, humerus)
fat embolism
42
osteoporosis: drug therapy
1. Class: Bisphosphonates
-Drugs: alendronate, ibandronate
-MOA: inhibits osteo___last resorption
-Directions:
- take w/ water or doesn't matter?
- take on empty stomach or with food?
- remain in what position for 30 mins after taking?
2. Class: selective estrogen receptor modulator (SERM)
-Drugs: raloxifene
-MOA: mimic estrogen effects on bone by reducing bone _________ w/o stimulating breast/uterus
1. Class: Bisphosphonates
-Drugs: alendronate, ibandronate
-MOA: inhibits osteoclast resorption
-Directions:
- take w/ full glass of water,
- take on empty stomach (atleast 30 mins before food/other meds),
- remain upright for 30 mins after taking)
2. Class: selective estrogen receptor modulator (SERM)
-Drugs: raloxifene
-MOA: mimic estrogen effects on bone by reducing bone resorption w/o stimulating breast/uterus
43
- Joint disorder 2ndary to another disease
- urate crystals in synovial fluid
- acute, painful inflammation
- recurring acute arthritis characterized by accumulation of uric acid crystals in one or more joints (common in big toe, but can be other joints like knees and ankles)
Gouty arthritis
44
Serum studies (blood tests): complement levels
- Normal body protein
- Essential for ______ and ___________ reactions
- ______ levels = RA or SLE
- complement levels
- Normal body protein
- Essential for immune and inflammatory reactions
- Low levels = RA or SLE
45
RA treatment
T/F
1. rest joints
2. sleep + nap daily
3. exercise - prevents and reverses effects
4. ROM exercise for joint motion
5. Improve strength – isometric, isotonic, isokinetic
6. Increase endurance – walk, swim, cycle
7. hand/finger splint
8. OT/PT
9. heat - 20 mins on
10. cold is contraindicated
11. overweight or anorexia – nutrition
12. meds - DMARDS, NSAIDs, steroids
13. meds require regular medical care and blood tests
T 1. rest joints
T 2. sleep + nap daily
T 3. exercise - prevents and reverses effects
T 4. ROM exercise for joint motion
T 5. Improve strength – isometric, isotonic, isokinetic
T 6. Increase endurance – walk, swim, cycle
T 7. hand/finger splint
T 8. OT/PT
T 9. heat - 20 mins on
F 10. cold - 10-15 mins on
T 11. overweight or anorexia – nutrition
T 12. meds - DMARDS, NSAIDs, steroids
T 13. meds require regular medical care and blood tests
46
- this type of skin traction uses counteraction - Allows pt to move more in bed
- Permits flexion of knee joint
- Relieves muscles spasms/back pain
Russells
47
Weight bearing restrictions types
- Non-weight bearing = extremity shouldn’t touch floor
- Toe touch weight bearing = can touch floor for ______, not for ___________
- partial weight bearing = 30-50%
- weight bearing as tolerated = without _______ or ________
- full weight bearing = no restrictions
Weight bearing restrictions types
- Non-weight bearing = extremity shouldn’t touch floor
- Toe touch weight bearing = can touch floor for balance, not weight bearing
- partial weight bearing = 30-50%
- weight bearing as tolerated = without undue strain or pain
- full weight bearing = no restrictions
48
2 types of traction
- Skin
- ______ term
- _______ lbs
- Involves using ____________ attached to traction device
- Skeletal
- Tolerated better
- Can handle more weight _______ lbs
- Involves using ______________ attach to the traction device
2 types of traction
- Skin
- Short term – skin can’t tolerate for long
- 5-10 lbs
- Involves using tapes, splints, or boots attached to traction device
-
- Skeletal
- Tolerated better
- Can handle more weight 5-45 lbs
- Involves using pins through the bone to immobilize part and attach to the traction device
49
OA treatment: drug therapy
- __________ – if no inflammation
- tylenol limit?
- monitor what labs?
- __________ – if unrelieved with acetaminophen or inflammation present
- NSAIDS - monitor for _____, _____, ______, and _____ problems)
- ________– NSAID, cox 2 inhibitor if GI s/e are a problem
- Topical NSAIDS or capsaicin (chili peppers)
- Acetaminophen – if no inflammation
- (3 gram limit, 4 gram limit if medically supervised
- monitor LFTs)
- NSAIDS – if unrelieved with acetaminophen or inflammation
- (monitor for bleeding, ulcer, stomach upset, and renal problems)
- Celecoxib – NSAID, cox 2 inhibitor if GI s/e are a problem
- Topical NSAIDS or capsaicin (chili peppers)
50
Chronic vs Acute: osteomyelitis
___________
- shorter than one month duration
local s/s
- constant bone pain that worsen with activity and unrelieved by rest
- swelling, tenderness, and warmth at infection site
- restricted movement of affected part
- Systemic s/s
- fever, chills, night sweats
- restlessness, nausea, malaise
____________
- longer than one month duration or has failed to respond to initial abx
- can be continuous/persistent or remissions/exacerbations
- Systemic s/s reduced
- Local s/s
- constant bone pain
- swelling
- warm at site
acute
chronic
51
General nursing care: fractures
1- assess _____ site
2-______technique
3- culture site prn
4- admin abx
5- monitor _____ and WBC
6- examine potential ______ areas Q4 – braden scale daily
7-_____ plaster of paris cast edges
8- teach - don’t ______ anything in cast
9- teach report s/s of warmth, increased ____, foul ____
10- ventilation is good – moisture contributes to ______
11- turn if permissible, avoid friction/shear
12- control ______ before ROM exercises
13- know weight bearing/non-weight bearing
14- instruct use in assistive devices
1- assess pin site
2- aseptic technique
3- culture site prn
4- admin abx
5- monitor temp and WBC
6- examine potential pressure areas Q4 – braden scale daily
7- petal plaster of paris cast edges
8- teach don’t insert anything in cast
9- teach report s/s of warmth, increased pain, foul odor
10- ventilation is good – moisture contributes to breakdown
11- turn if permissible, avoid friction/shear
12- control pain before ROM exercises
13- know weight bearing/non-weight bearing
14- instruct use in assistive devices
52
Gout
- uric acid metabolism
- Deposit of urate salts
Chronic tophaceous gout
- advanced stage of gout (many years after onset)
- _________– painless nodules filled with uric acid crystals
Gout
- uric acid metabolism
- Deposit of urate salts
Chronic tophaceous gout
- advanced stage of gout (many years after onset)
- tophi – painless nodules filled with uric acid crystals
53
gouty arthritis Care
- address modifiable risk factors
- pain control and joint immobilization during ________
-________ – to maintain high urine volume and prevent precipitation of uric acid in kindeys
- drug therapy – acute and chronic gout
- Acute gout = _________ (relief in 12-24 hours) and NSAIDS
- __________ = allopurinol (improvement in 2-6 weeks)
Care
- address modifiable risk factors
- pain control and joint immobilization during flare
- fluids – to maintain high urine volume and prevent precipitation of uric acid in kindeys
- drug therapy – acute and chronic gout
- Acute gout = colchicine (relief in 12-24 hours) and NSAIDS
- Prophylactic = allopurinol (improvement in 2-6 weeks)
54
Post op care: amputation
- assess tissue perfusion
- pain management
- prevent infection
- promote proper position, ambulation, exercise
- _______ position 30 min 4x/day or elevate stump
- initially – compression bandage to foster _______ and molding of limb for eventual prosthesis fitting, also promotes limb ________ and maturation,
wear _____ except for PT and bathing,
should remove and reapply _______ times daily
- figure 8 wrapping – prevents restriction of _________
- Psychosocial issues
- prosthesis
Post op care: amputation
- assess tissue perfusion
- pain management
- prevent infection
- promote proper position, ambulation, exercise
- prone position 30 min 4x/day or elevate stump
- initially – compression bandage to foster shape and molding of limb for eventual prosthesis fitting, also promotes limb shrinkage and maturation, wear AAT except for PT and bathing, should remove and reapply several times daily
- figure 8 wrapping – prevents restriction of blood flow
- Psychosocial issues
- prosthesis
55
osteoporosis Facts:
T/F
1- women 8x more likely than men to develop osteoporosis
2- women have higher calcium intake
3- women have less bone mass and smaller frames
4- women’s bone resorption begins sooner and accelerates at menopause
5- women have higher longevity
1 T
2. F - lower
3. T
4 T
5 T
56
- Systemic inflammatory disorder
- autoimmune
- symmetrical
- progressive
- insidious
- highly inflammatory connective tissue in synovial joints
- remissions and exacerbations
RA
57
cast care
- no covering – requires ___________ until set
- _________ q 1-2 hours until set
- ___________ checks (5 P’s) q 1 hr x 24 hrs – distal to cast
- 5 P's =
- _____ fingers should be able to be inserted into cast
- ______ first 24-36 hours – vasoconstriction to reduce swelling
- If plaster of paris – normal to feel ______ as the cast dries and hardens, hand with _____ while wet (not fingers), ______ edges (so edges of cast don’t dig into skin)
cast care
- no covering – requires ventilation until set
- resposition q 1-2 hours until set
- neurovascular checks (5 P’s) q 1 hr x 24 hrs – distal to cast
- pain (1st sign), pallor, pulselessness, paresthesia, paralysis
- 1-2 fingers should be able to be inserted into cast
- Ice first 24-36 hours – vasoconstriction to reduce swelling
- If plaster of paris – normal to feel warmth or heat as the cast dries and hardens, hand with palms while wet (not fingers), petal edges (so edges of cast don’t dig into skin)
58
OA dx:
- bone scan, CT, MRI - _____ joint changes
- xray - Staging _______
- Joint narrowing, bony sclerosis, osteophyte formation
- correlate to degree of pain experienced?
- _____ biomarkers for OA
- ESR _______ (unless synovitis present)
- synovial fluid will be clear yellow, no signs of _________
Dx
- bone scan, CT, MRI - Early joint changes
- xray - Staging progression
- Joint narrowing, bony sclerosis, osteophyte formation
- Doesn’t correlate to degree of pain experienced
- no biomarkers for OA
- ESR normal (unless synovitis present)
- synovial fluid will be clear yellow, no signs of inflammation
59
SLE Affects
T/F
- skin
- joints
- serous membranes – pleura effusions and pericardium effusions
- bones
- renal system
- hematologic system
- neurologic system
- skin
- joints
- serous membranes – pleura effusions and pericardium effusions
F - bones
- renal system
- hematologic system
- neurologic system
60
replacing/aligning bone fragments in the correct anatomic position
Fracture reduction
61
Gout vs gouty arthritis
_______ = buildup of uric acid crystals in the body
____________ = these uric acid crystal deposits accumulate within the joints, causing inflammation, swelling, and intense pain.
- Gout
- Gouty arthritis
62
Risk factors: osteoporosis
- women or men?
- family hx?
- _____ body weight
- long term use of ________
- age?
- diet low in ________
- inadequate physical activity – especially _________ exercises
- tobacco and excessive alcohol
Risk factors
- women
- family hx
- low body weight
- long term use of corticosteroids
- advanced age
- diet low in calcium
- inadequate physical activity – weight bearing exercises
- tobacco and excessive alcohol
63
OA vs RA
14. Effusions
= Uncommon.
= Common.
15. Nodules
= Present, especially on extensor surfaces.
= Heberden (DIPs) and Bouchard (PIPs) nodes.
16. Synovial fluid
= WBC count 5000–60,000/μL with mostly neutrophils; ↓ viscosity.
= WBC count < 2000/μL (mild leukocytosis); normal viscosity.
17. X-rays
= Joint space narrowing and erosion with bony overgrowths, subluxation with advanced disease. Osteoporosis related to decreased activity, corticosteroid use.
= Joint space narrowing, osteophytes, subchondral cysts, sclerosis.
14. Effusions
OA = Uncommon.
RA = Common.
15. Nodules
RA = Present, especially on extensor surfaces.
OA = Heberden (DIPs) and Bouchard (PIPs) nodes.
16. Synovial fluid
RA = WBC count 5000–60,000/μL with mostly neutrophils; ↓ viscosity.
OA = WBC count < 2000/μL (mild leukocytosis); normal viscosity.
17. X-rays
RA = Joint space narrowing and erosion with bony overgrowths, subluxation with advanced disease. Osteoporosis related to decreased activity, corticosteroid use.
OA = Joint space narrowing, osteophytes, subchondral cysts, sclerosis.
64
________ surgery
- hip
- knee
- elbow
- shoulder
- wrist
- phalangeal joints of finger
- ankle
- foot
joint surgery
65
- Simplest form of skin traction
- Uses running traction - Provides straight pull-on affected extremity, unidirectional, one-way traction
- Relieve muscle spasm or temporary immobilization before ORIF
Bucks
66
Post op care: herniated disk surgery
- position? – avoid pressure on spine
- technique to avoid movement of spine ?
- pain management
- assess for _____ leak – c/o h/a, clear or light yellow drainage
- peripheral neurovascular checks
- surgery with recovery longer, assess donor site ?
- avoid __________ for long periods of time
- avoid __________
Post op care: herniated disk surgery
- lie flat – avoid pressure on spine
- log rolling – avoid movement of spine
- pain management
- assess for CSF leak – c/o h/a, clear or light yellow drainage
- peripheral neurovascular checks
- spinal fusion - recovery longer, assess donor site
- avoid sitting/standing for long periods of time
- avoid twisting
67
RA vs OA
18. Laboratory findings
= Rheumatoid factor positive in about 80% of patients; negative titers in early disease for about 25%.
= Rheumatoid factor negative.
= ANA negative.
= ↑ Antinuclear antibodies (ANAs) titer likely.
= Anti-CCP negative.
= Positive anti-CCP (anti-citrullinated peptide) in 60%–80%.
= ↑ ESR, CRP indicative of active inflammation, used to test disease activity. Not specific to __
= Transient elevation in ESR related to synovitis.
18. Laboratory findings
RA = Rheumatoid factor positive in about 80% of patients; negative titers in early disease for about 25%.
OA = Rheumatoid factor negative.
OA = ANA negative.
RA = ↑ Antinuclear antibodies (ANAs) titer likely.
OA = Anti-CCP negative.
RA = Positive anti-CCP (anti-citrullinated peptide) in 60%–80%.
RA = ↑ ESR, CRP indicative of active inflammation, used to test disease activity. Not specific to RA.
OA = Transient elevation in ESR related to synovitis.
68
osteomyelitis: Risk factors
T/F
- IV drug use
- DM
- immunosuppression
- hx of blood infections
- presence of pressure ulcers/chronic open wounds
- malnutrition, alcoholism, liver failure (contributes to spread)
T
T
T
T
T
T
69
2 ways to reduce (align) a fracture
- _______ reduction – non-surgical, manual realignment of bone fragments, local anesthesia
- ______ reduction - surgical exposure of the fracture site to realign the bone fragments under direct visualization
closed
open
70
Types of fractures
- ________fracture - The bone is shattered into pieces.
- ________ fracture - The fracture line is perpendicular to the bone's long axis.
- ________ fracture - The fracture line is angled across the bone's long axis.
- _______ fracture - The fracture line wraps around the bone's shaft like a corkscrew.
- _________ fracture - The bone is bent and partially cracked, not completely separated. (splinters, common in kids)
- _________ fracture - The break occurs in a bone weakened by an underlying disease.
- __________ fracture - a small crack in the bone caused by repetitive stress or overuse, often seen in athletes
Types of fractures
- Comminuted fracture - The bone is shattered into pieces.
- Transverse fracture - The fracture line is perpendicular to the bone's long axis.
- Oblique fracture - The fracture line is angled across the bone's long axis.
- Spiral fracture - The fracture line wraps around the bone's shaft like a corkscrew.
- Greenstick fracture - The bone is bent and partially cracked, not completely separated. (splinters, common in kids)
- Pathologic fracture - The break occurs in a bone weakened by an underlying disease.
- stress fracture - a small crack in the bone caused by repetitive stress or overuse, often seen in athletes
71
RA vs OA
1. Primary joints affected
= distal interphalangeal
= metacarpophalangeal
2. heberdens nodes
= none
= present
3. joint characteristics
= soft, warm, tender
= hard and bony
4. stiffness
= morning stiffness resolves within 30 mins
= worse after resting (ex: early morning stiffness >60 mins)
5. rheumatoid factor (RF)
= positive
= negative
1. Primary joints affected
OA = distal interphalangeal
RA = metacarpophalangeal
2. heberdens nodes
RA = none
OA = present
3. joint characteristics
RA = soft, warm, tender
OA = hard and bony
4. stiffness
OA = morning stiffness resolves within 30 mins
RA = worse after resting (ex: early morning stiffness >60 mins)
5. rheumatoid factor (RF)
RA = positive
OA = negative
72
Serum studies (blood tests): uric acid
-End product of _________ metabolism
-Normally excreted by __________
-Non-specific or specific
-Usually levels are high with _______
uric acid
- End product of protein metabolism
- Normally excreted by kidneys via urine
- Non-specific
- Usually levels are high with gout
73
s/s
- joint pain – 1st sign
- Polyarthralgia – multi-joint
- Morning stiffness
- Pain and stiffness move from one part of body to another
- Asymmetrical
- Only a few joints affected at a time
- Common joints – fingers, wrists, knees
- Swollen and warm joints (arthritis)
- photosensitivity – rash after exposure
- butterfly rash – after being in sun, lasts a couple of days
- lupus nephritis – kidney failure
- pancytopenia – anemia, thrombocytopenia, leukopenia
- fever (unexplained)
- extreme and debilitating fatigue
- Raynaud’s phenomenon
- unusual hair loss
- edema – legs or eyes
- ulcers – mouth and nose (painless)
- pleurisy and pericarditis
- nervous system dysfunction
- Difficulty concentrating, confusion
- Depression
- h/a
- seizures
- lupus cerebritis – inflammatory brain disease
- lupus arthritis
SLE
74
fractures: complications
________________
- serious condition caused by increased pressure within a confined muscle compartment, resulting in impaired blood flow and potential permanent muscle and nerve damage.
- out of control swelling within body in hours
- vessels are compressed d/t increased pressure and are no longer functional
Compartment syndrome
75
who gets the bone desnsity scan/DEXA?
T/F
- Women <65 w/ risk factors + menopause
- Women and men >65
- women and men with Long term steroid therapy use (causes porous bones)
- To measure response to osteoporosis drug therapy
T - Women <65 w/ risk factors + menopause
F - Women >65
T - women and men with Long term steroid therapy use (causes porous bones)
T - To measure response to osteoporosis drug therapy
76
Spinal anatomy
- ________ = 7
- _________ = 12
- _______ = 5
- ________= 5
- ________= 4
- more moveable and more at risk for problems = _______ and _______
Spinal anatomy
- cervical = 7
- thoracic = 12
- Lumbar = 5
- sacral = 5
- coccyx = 4
- more moveable and more at risk for problems = cervical and lumbar
77
internal fixation devices: pins, nails, screws, plates
- assess _______
- elevate ______ above heart (esp. 1st 48-96 hours) – __creases venous return and __creased swelling
- apply _____ – vasoconstrict and reduce swelling
- notify provider if _______
- teach signs of __________ dysfunction
internal fixation devices: pins, nails, screws, plates
- assess 5 P’s
- elevate extremity above heart (esp. 1st 48-96 hours) – increases venous return and decreased swelling
- apply ice – vasoconstrict and reduce swelling
- notify provider if pain increases/unrelieved with meds
- teach signs of neurovascular dysfunction
78
Who gets amputations?
- peripheral vascular diases (esp ___ with ___)
- trauma
- thermal injuries
- osteo_______
- tumors
- congenital limb disorders
Who gets amputations?
- peripheral vascular diases (esp OA with DM)
- trauma
- thermal injuries
- osteomyelitis
- tumors
- congenital limb disorders
79
treatment for compartment syndrome =
fasciotomy (incision in skin and fascia to release pressure, vessels are no longer compressed, capillaries are functional
80
RA Dx
- inflammatory arthritis w/ ___ joints
-________ RF
-________ ACPA
-________ anti-CCP
- _________ ESR and CRP
- s/s > 6 weeks
Dx
- inflammatory arthritis w/ 3+ joints
- positive RF
- positive ACPA and anti-CCP
- elevated ESR and CRP
- s/s > 6 weeks
81
external fixation devices: traction
- applies ________ force on fractured extremity
- must be _______ pulling force (unless ordered intermittent)
external fixation devices: traction
- applies pulling force on fractured extremity
- must be continuous pulling force (unless ordered intermittent)
82
Types of amputations
- ________ – indicated if infected area, don’t want to close it yet
- _________
timing
______ vs _______
Types of amputations
- open (guillotine) – indicated if infected area, don’t want to close it yet
- closed
- elective
- traumatic
83
Radiologic studies: ______
- assess for osteoporosis (normal, osteopenia, osteoporosis, severe osteoporosis)
- gold standard for measuring bone mineral density (BMD)
- scan – hips, wrist, spine
- reported as T scores (compared to a standard deviation)
- nurse – explain painless, non-invasive
- bone density scan/DEXA
84
s/s fat embolism vs VTE in the leg?
1- chest pain
2- tachypnea
3- unilateral leg edema
4- pain
5- cyanosis
6- tenderness
7- apprehension
8- tachycardia
9- dilated veins
10- a sense of fullness
11- hypoxemia
12- paresthesias
13- AMS
14- Petechiae rash on skin and eyes
15- warmth
16- CXR – shadows
17- redness
18- Crackles
19- fever
20- Hypoxia
21- dyspnea
1. FE
2. FE
3. VTE
4. VTE
5. FE
6. VTE
7. FE
8. FE
9. VTE
10. VTE
11. FE
12. VTE
13. FE
14. FE
15. VTE
16. FE
17. VTE
18. FE
19. VTE
20. FE
21. FE
85
- bone scan
- Injection of ________ that is taken up by bone
- __creased uptake = osteomyelitis, osteoporosis, malignancies, and some fx
- __creased uptake = avascular necrosis (death of bone d/t lack of vessels/blood supply)
- Nurse – give radioisotope 2 hour prior to procedure, lie still for 1 hour, radioisotope not harmful, force fluids after
- bone scan
- Injection of radioisotope that is taken up by bone
- Increased uptake = osteomyelitis, osteoporosis, malignancies, and some fx
- Decreased uptake = avascular necrosis (death of bone d/t lack of vessels/blood supply)
- Nurse – give radioisotope 2 hour prior to procedure, lie still for 1 hour, radioisotope not harmful, force fluids after
86
__________ nodules
- subcutaneous
- firm
- non-tender
- location – fingers and elbows
- seen in RA
Rheumatoid nodules
87
RA treatment: drug therapy
Class: DMARDS
drugs: methotrexate and hydrochloroquine
- Reduce inflammation
- Reduce joint damage
- Preserve joint
- Methotrexate – improvement 4-6 weeks, used early in RA, within 3 months of dx, can lessen permanent effects of RA
- Hydrochloroquine – improvement in 2-3 months
NSAIDS
- More immediate relief from pain and minor inflammation
- Does not reduce long term damage
- Must be taken contiuously, at specific doses, for several weeks for anti-inflammatory effects
- Monitor for s/e – bleeding and kidney problems
- Once DMARDs are working, NSAIDS are withdrawn
Glucocorticoids (steroids) = prednisone and prednisolone
- Rapid inflammation suppression
- Short term use only
- Route – PO, IV, directly into joint
- Many s/e
- Goal = lowest possible dose for shortest possible time period
Class: DMARDS
drugs: methotrexate and hydrochloroquine
- Reduce inflammation
- Reduce joint damage
- Preserve joint
- Methotrexate – improvement 4-6 weeks, used early in RA, within 3 months of dx, can lessen permanent effects of RA
- Hydrochloroquine – improvement in 2-3 months
NSAIDS
- More immediate relief from pain and minor inflammation
- Does not reduce long term damage
- Must be taken contiuously, at specific doses, for several weeks for anti-inflammatory effects
- Monitor for s/e – bleeding and kidney problems
- Once DMARDs are working, NSAIDS are withdrawn
Glucocorticoids (steroids) = prednisone and prednisolone
- Rapid inflammation suppression
- Short term use only
- Route – PO, IV, directly into joint
- Many s/e
- Goal = lowest possible dose for shortest possible time period
88
____________
occurs when the soft inner material (nucleus pulposus) of an intervertebral disc protrudes through a tear in the tough outer layer (annulus fibrosus) of the dic.
This puts pressure on nerves and can compress and irritate nearby nerves.
Disk – cushion sits between vertebra bones
Herniated disK
89
s/s
- not systemic
- joint pain - Worsens with use, initially relieved by rest
- Change in temp or barometric pressure can trigger pain
- stiffness
- Worsens with activity or in AM
- Resolves within 30 mins
- crepitus
- asymmetrical
- deformities
- Heberden’s nodes (fingers)
- Bouchard’s nodes (fingers)
- Bowlegged (knees)
OA
90
OA treatment: injections
- ___________ joint injections – if other measures didn’t work and arthritis is confined to a few joint
- Suppresses inflammation
- Temporary
- May have brief flare up after injection
- Risk for infection
- Frequent injections can cause joint damage
- No more than 3-4 x/year
---------------------
- __________ injections – usually indicated when pt is waiting joint replacement
- Substance in joints allows joint fluid to be slippery
- s/e same as steroids
glucocorticoid/steroid joint injections joint injections – if other measures didn’t work and arthritis is confined to a few joint
- Suppresses inflammation
- Temporary
- May have brief flare up after injection
- Risk for infection
- Frequent injections can cause joint damage
- No more than 3-4 x/year
- hyaluronate injections – usually indicated when pt is waiting joint replacement
- Substance in joints allows joint fluid to be slippery
- s/e same as steroids
91
2 types of skin traction
Bucks
Russells
92
Mineral metabolism studies
1. alkaline phosphates
- Enzyme produced by osteo______ of bones
- ___creased = healing fx, bone cancer, osteoporosis
2. calcium
- Stored mainly in ______
-Indirectly related to ___________ (inverse relationship - increase/decrease)
-___creased = renal disease, hypoparathyroidism
-___creased = hyperparathyroidism, bone tumors
3. phosphorus
- Indirectly related to _________ (inverse relationship - increase/decrease)
Mineral metabolism studies
1. alkaline phosphates
- Enzyme produced by osteoblasts of bones
- increased = healing fx, bone cancer, osteoporosis
2. calcium
- Stores mainly in bone
- Indirectly related to phosphorus (inverse relationship - increase/decrease)
- Decreased = renal disease, hypoparathyroidism
- Increased = hyperparathyroidism, bone tumors
3. phosphorus
- Indirectly related to calcium (inverse relationship - increase/decrease)
93
2 types of pulling force
- _________ –
unidirectional,
one-way traction
-__________ – traction/pulling in different directions
Running
Counter-traction
94
Serum studies (blood tests):anti-DNA antibody
-Detects antibodies that react to _____
-Most specific test for ____
- anti-DNA antibody
- Detects antibodies that react to DNA
- Most specific test for SLE
95
_____________
- ocular symptoms
- diminished lacrimal secretion/decreased tearing
- burning, itching, gritty eyes
AND
- oral symptoms
- decreased salivary gland secretion (dry mouth)
- dry, erythematous mouth
- depapillation/smooth tongue
AND
- photosensitivity
- associated with RA and SLE
sjogrens syndrome
96
osteoporosis Treatment
1. prevention with adequate ________ intake
amount:
-p___menopausal = 1000 mg
-p___menopausal + taking estrogen = 1000 mg
-p___menopausal = 1500 mg
2. vitamin ____
3. exercise
4. avoid tobacco and excessive alcohol
5. corset to prevent ________ collapse
6. drug therapy
1. calcium
amount
-premenopausal = 1000 mg
-postmenopausal + taking estrogen = 1000 mg
-postmenopausal = 1500 mg
2. vitamin D (800-1000 intake daily)
3. exercise - load bearing, 30 mins for 3x/week
4. avoid tobacco and excessive alcohol
5. corset to prevent vertebral collapse
6. drug therapy
97
2 types of skin traction
Bucks
- Simplest form of skin traction
- Uses running or counter-traction?
- Provides straight pull-on affected extremity, unidirectional, one-way traction
- Relieve muscle spasm or ________ immobilization before ORIF
Russell
- Uses running or counter-traction?
- Allows pt to _____ more in bed
- Permits ________ of knee joint
- Relieves muscles spasms/______ pain
2 types of skin traction
- Bucks
- Simplest form of skin traction
- Uses running traction - Provides straight pull-on affected extremity, unidirectional, one-way traction
- Relieve muscle spasm or temporary immobilization before ORIF
- Russell
- Uses counteraction Allows pt to move more in bed
- Permits flexion of knee joint
- Relieves muscles spasms/back pain
98
Hip fracture with ORIF
- replacement or repair?
- ROM restriction = limited __________ for 6-12 weeks
- PT prn
exercises: isotonic vs isometric?
_________ exercises = joint doesn’t move, contract/release muscle
________ = joint moves
exercises: isotonic vs isometric?
1- Quadriceps setting
2- Gluteal muscle setting
3- Leg raises
4- Leg abduction
Hip fracture with ORIF
- repair
- ROM restriction = limited weight bearing for 6-12 weeks
- PT prn
- isometric exercises = joint doesn’t move, contract/release muscle
- isotonic exercises = joint moves
1 isometric - Quadriceps setting
2 isometric - Gluteal muscle setting
3 isotonic - Leg raises
4 isotonic - Leg abduction
99
RA vs OA
10. Weight
= Often overweight or obese.
= Lost or maintained weight.
11. Disease
= Localized disease with variable, progressive course.
= Systemic disease with exacerbations and remissions.
12. Affected joints
= Small joints typically affected first (PIPs, MCPs, MTPs), wrists, elbows, shoulders, knees. Usually bilateral, symmetric joint involvement.
= Weight-bearing joints of knees and hips, small joints (MCPs, DIPs, PIPs), cervical and lumbar spine. Often asymmetric.
13. Pain characteristics
= Stiffness lasts 1 h to all day and may ↓ with joint use. Pain is variable, may disrupt sleep.
= Stiffness occurs on arising but usually subsides after 30 min. Pain gradually worsens with joint use and disease progression, relieved with joint rest but may disrupt sleep.
10. Weight
OA = Often overweight or obese.
RA = Lost or maintained weight.
11. Disease
OA = Localized disease with variable, progressive course.
RA = Systemic disease with exacerbations and remissions.
12. Affected joints
RA = Small joints typically affected first (PIPs, MCPs, MTPs), wrists, elbows, shoulders, knees. Usually bilateral, symmetric joint involvement.
Oa = Weight-bearing joints of knees and hips, small joints (MCPs, DIPs, PIPs), cervical and lumbar spine. Often asymmetric.
13. Pain characteristics
RA = Stiffness lasts 1 h to all day and may ↓ with joint use. Pain is variable, may disrupt sleep.
OA = Stiffness occurs on arising but usually subsides after 30 min. Pain gradually worsens with joint use and disease progression, relieved with joint rest but may disrupt sleep.
100
Fractures T/F
ongoing predictable pain which indicates ATC dosing/meds?
can happen to any bone in body?
T
T
101
sources of calcium
-dairy products
-bananas
-milk
-yogurt
-cheese
-red meat
-leafy green vegetables
-kale
-broccoli
-eggs
-bok choy
-sardines
-tofu
-almonds
-cereals
-carrots
-dairy products
X-bananas
-milk
-yogurt
-cheese
X-red meat
-leafy green vegetables
-kale
-broccoli
X-eggs
-bok choy
-sardines
-tofu
-almonds
-cereals
X-carrots
102
Gout diet
- high adipose tissue/weight = ______ gout
- low adipose tissue/weight = _____ gout
- caloric restriction
- _____ protein
- protein from non-fat dairy and plant protein or fish and red meat?
- complex or simple carbs?
- ___ sat fat
- avoid ______ sweetened beverages
- avoid foods that cause flares or increase serum urate levels – _____ meals, _____ rich foods, beer, distilled spirits)
- goal = lose weight, take meds, follow gout diet
Gout diet
- high adipose tissue/weight = high gout
- low adipose tissue/weight = low gout
- caloric restriction
- high protein
- from low fat dairy and plant protein, not fish and red meat
- complex carbs
- low sat fat
- avoid sugar sweetened beverages
- avoid foods that cause flares or increase serum urate levels – fatty meals, organ rich foods, beer, distilled spirits)
- goal = lose weight, take meds, follow gout diet
103
s/s
early and Systemic
- fatigue
-anorexia
- weight loss
- generalized stiffness
Progresses to
- pain
- worsening stiffness
- morning stiffness >60 min
- limited motion
- deformity
- disability
Extra-articular (systemic) changes
- sjogrens syndrome
- Rheumatoid nodules
Deformities
- ulnar drift
- knuckle subluxation
- wrist subluxation
- finger swan neck and boutonniere
- z shaped thumb
RA
104
OA
- _____ joint disorder with ______ inflammation
- involves the formation of new joint tissue in response to ________ destruction
- bone on bone rubbing, bones may also form _________
- normal part of aging process?
- s/s are local or systemic ?
- low level inflammation in ______ area
OA
- Local joint disorder with local inflammation
- involves the formation of new joint tissue in response to cartilage destruction,
- bone on bone rubbing, bones may also form spurs/osteophytes
- Not a normal part of aging process
- s/s are local, not systemic
- low level inflammation in joint area
105
2 types of pulling force
- Running – unidirectional, one-way traction
- Countertraction – traction/pulling in different directions
106
RA
Risk factors
(1)
Etiology
- females 20-40 more likely
autoimmune, genetic, hormonal, environmental and immunologic
107
- bone density scan/DEXA
- assess for ________
- gold standard for measuring _________
- scans (3) parts of body?
- reported as T scores (compared to a standard deviation)
- nurse – explain painless, non-invasive
- bone density scan/DEXA
- assess for osteoporosis (normal, osteopenia, osteoporosis, severe osteoporosis)
- gold standard for measuring bone mineral density (BMD)
- scan – hips, wrist, spine
- reported as T scores (compared to a standard deviation)
- nurse – explain painless, non-invasive
108
After the reduction, the fracture can be stabilized/immobilized with:
-________ devices
- metal plates
- screws
- nails
- pins
- bone grafts
-________ devices
- cast
- splint
- brace
- traction
- external fixators
internal fixation devices
external fixation devices
109
Serum studies (blood tests): - ACPA/anti-CCP
-Important dx for ____
- May allow earlier/more accurate dx
- when dx RA - is RF or ACPA/anti-CCP is more specific?
- Important dx for RA
- May allow earlier/more accurate dx
- (when dx RA - ACPA/anti-CCP is more specific than RF)
110
gouty arthritis Caused by:
- high _________ production
- low uric acid excretion in ________ (most common)
- high intake of ______ containing foods (purine is normally metabolized into uric acid)
- primary – most common
- secondary – _____ induced
gouty arthritis Caused by:
- high uric acid production
- low uric acid excretion in the kidneys (most common)
- high intake of purine containing foods (purine is normally metabolized into uric acid)
- primary – most common
- secondary – drug induced
111
gouty arthritis Dx
- serum uric acid = ________
- 24 hour urine for ________ = helps determine cause - decreased renal excretion or over production of uric acid
- synovial fluid = contains ________ like crystals of sodium urate
- serum uric acid = elevated
- 24 hour urine for uric acid = helps determine cause - decreased renal excretion or over production of uric acid
- synovial fluid = contains needle like crystals of sodium urate
112
osteomyelitis: Dx
- Bone/tissue _______ – determines causative organism
- ________ blood/wound culture
- __creased WBC
- __creased ESR
- xray changes (10 days + into infection)
- radionuclide bone scans preferred
- MRI
Dx
- Bone/tissue biopsy – determines causative organism
- positive blood/wound culture
- increased WBC
- increased ESR
- xray changes (10 days + into infection)
- radionuclide bone scans preferred
- MRI
113
osteoporosis = loss of _________ and subsequent (pathological) fractures
- silent disease
- most affected – (3)
- ____ bone mineral density
- bone remodeling – requires a balance between bone formation by osteo___lasts and bone resorption by osteo___lasts
osteoporosis
loss of bone density and subsequent (pathological) fractures
- silent disease
- most affected – wrist, hip, vertebral column
- low bone mineral density
- bone remodeling – requires a balance between bone formation by osteoblasts and bone resorption by osteoclasts
114
calcium supplements
1. take with food or empty stomach
2. chewable or SL form preferred
3. most common or most potent– carbonate and citrate?
4. difficult or easy to absorb in single doses >500 mg?
1- take with food
2- chewable form preferred
3- most common – carbonate and citrate
4- difficult to absorb in single doses >500 m
115
- Evaluates electrical potential associated with skeletal muscle contractions
- Small gauge needles inserted into muscles and attached to leads that feed information to machine
Nurse –
conducted in EMG lab,
some discomfort,
avoid stimulants/sedatives 24 hours before procedure
Electromyogram (EMG)
116
VTE and FE treatment
T/F
- Supportive
- Oxygen
- fluids
T- Supportive
T- Oxygen
T- fluids
117
SLE Care
- teaching – avoid triggers
T/F
-UV light?
-Abruptly stopping drugs?
-Avoid infections?
-Avoid foods that cause flares or increase serum urate levels – fatty meals, organ rich foods, beer, distilled spirits)
T -UV light?
T -Abruptly stopping drugs?
T -Avoid infections?
F -Avoid foods that cause flares or increase serum urate levels – fatty meals, organ rich foods, beer, distilled spirits (this is for gout)
118
Acute osteomyelitis
- ________ than one month duration
local s/s:
- constant bone pain that worsen with_______ and unrelieved by ______
- swelling, tenderness, and warmth at ________ site
- restricted ________ of affected part
Systemic s/s: several
- fever, chills, night sweats
- restlessness, nausea, malaise
Chronic osteomyelitis
- _________ than one month duration or has failed to respond to ________
- can be continuous/persistent or remissions/exacerbations
Local s/s:
- constant bone pain
- swelling
- warm at site
Systemic s/s:
- __________
Acute osteomyelitis
- shorter than one month duration
local s/s
- constant bone pain that worsen with activity and unrelieved by rest
- swelling, tenderness, and warmth at infection site
- restricted movement of affected part
Systemic s/s
- fever, chills, night sweats
- restlessness, nausea, malaise
Chronic osteomyelitis
- longer than one month duration or has failed to respond to initial abx
- can be continuous/persistent or remissions/exacerbations
Local s/s
- constant bone pain
- swelling
- warm at site
Systemic s/s reduced
119
____________ -
Severe infection of the bone, bone marrow, and surrounding soft tissue
- most common infecting organism = _________
- Indirect or direct? entry – blood stream
- Indirect or direct? entry – open wound
- easy or difficult to cure?
Osteomyelitis
Severe infection of the bone, bone marrow, and surrounding soft tissue
- most common infecting organism = staph aureus
- Indirect entry – blood stream
- Direct entry – open wound
- difficult to cure
120
OA, RA, SLE
