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Muscolo disorders
| Question | Answer |
|---|---|
| OSTEOARTHRITIS | degeneration of articular cartilage with hypertrophy of the underlying and adjacent bone |
| OSTEOARTHRITIS - s/s | pain in the affected joint, stiffness, limitation of movement, mild tenderness, swelling and deformity or enlargement of the joint. HEBERDEN NODES and BOUCHARD NODES |
| OSTEOARTHRITIS - MED DX | health history and radiographic studies, arthroscopy & MRI, synovial fluid aspiration (are there wbc's?) |
| OSTEOARTHRITIS - MED TX | drugs - acetaminophen, NSAIDs, DMARDS. COX-3 inhibitors, or low does of aspirin. SURGERY - arthroscopic surgery & arthroplasty. PHYSICAL THERAPY - improvement of ROM; maintain muscle mass & strength |
| OSTEOARTHRITIS - ASSESSMENT | joint pain or tenderness; examine joints for crepitus, enlargement, deformity & decreased ROM. |
| OSTEOARTHRITIS - INTERVENTIONS | chronic pain; impaired physical movement, ineffective coping, ineffective therapeautic regimen mgmt |
| OSTEOARTHRITIS - CARE | ASSESS - VS (Q15 X 4, Q30 X 2, QHR X 4 HRS); LOC, I&O, RESP & NEURO STATUS, URINARY FUNCTION, BOWEL ELIMINATION, WOUND CONDITION & COMFORT. Circulation and sensation in the affected extremity |
| RHEUMATOID ARTHRITIS - s/s | pain in the affected joint aggravated by movement. Morning stiffness lasting more than an hour. Weakness, easy fatigue, anorexia, wt loss, muscle aches & tenderness, warmth of the affected joints. |
| RHEUMATOID ARTHRITIS - MED DX | health history & physical examination. Lab studies - RF, ESR, CRP. MRI, bone scans and DEXA scans |
| RHEUMATOID ARTHRITIS - MED TX | drug - aspirin & NSAIDS (tremedal) for several moths. Physical & occupational therapy. Surgery: arthroplasty, synovectomy, tenosynovectomy & arthrodesis. |
| RHEUMATOID ARTHRITIS - ASSESSMENT | pain, joint swelling, tenderness, joint deformities & limitation of movement, fatigue and decrease ability to perform ADLs. |
| RHEUMATOID ARTHRITIS - INTERVENTIONS | chronic pain; activity tolerance, ineffective coping, social isolation, ineffective therapeutic regimen mgmt |
| OSTEOPEROSIS | bone constantly formed and absorbed. Until adolescence, bone formation exceeds bone absorption so that bones grow and strenghten. |
| OSTEOPEROSIS - s/s | back pain, fractures, loss of ht due to vertebral compression, kyphosis. Bone deterioration in the jaw can cause dentures to fit poorly. Collapsed vertebrae can cause chronic pain |
| OSTEOPEROSIS - MED DX | absorptiometry, radiographs, bone specimen |
| OSTEOPEROSIS - MED TX | calcium supplementation & estrogen replacement. Regular excersise, percutaneous vertebroplastly. |
| OSTEOPEROSIS - ASSESSMENT | diet, calcium intake & exercise plan. Note whether pt is menopausal or has had an oophorectomy. Compare ht with previous measurements. Posture, note the prescence & degree of deformity. |
| OSTEOPEROSIS - INTERVENTIONS | risk for trauma. Chronic pain. Ineffective therapeutic regimen mgmt |
| GOUT | characterized by hyperuricemia. r/t excessive uric acid production or decreased uric acid excretion by the kidneys. |
| GOUT - four stages | asymptomatic hyperuricemia, acute gouty arthritis (most severe), asymptomatic intercritical period, chronic tophaceous gout |
| GOUT - MED DX | history and physical examination, urate crystals in synovial fluid, urinary uric acid. Blood uric acid |
| GOUT - MED TX | NSAID alone or with colchicine for acute gouty arthritis. Avoid foods high in purines |
| GOUT - ASSESSMENT | pain, joint swelling, tophi, uric acid stones, fever, and a history of trauma, injury or surgery. |
| GOUT - INTERVENTIONS | acute pain, impaired physical mobility, altered urinary elimination, ineffective therapeutic regimen mgmt |
| PROGRESSIVE SYSTEMIC SCLEROSIS (SCLERODERMA) - | primary vessel injury/dysfunction of immune system. Manifestations: from inflammation to degeneration of tissues, that results in decreased elasticity, stenosis, and occlusion of vessels |
| PROGRESSIVE SYSTEMIC SCLEROSIS (SCLERODERMA) - s/s | raynaud's phenomenon (vascular spasm), symmetric painless swelling or thickening of the skin, taut and shiny skin, morning stiffness, freguent reflux of gastric acid, difficulty swallowing, wt loss, dyspnea, pericarditis, renal insufficiency |
| PROGRESSIVE SYSTEMIC SCLEROSIS (SCLERODERMA) - MED DX | hx and physical exam may lead the physician to suspect fibrotic changes typical to PSS in the skin, lungs, heart or esophagus. Positive ANA assay result, elevated ESR and increased serum muscle enzyme levels |
| PROGRESSIVE SYSTEMIC SCLEROSIS (SCLERODERMA) - MED TX | no cure. High doses of steroids or other Immunosuppresants bring about remission. Physical therapy. D-penicillamine. Anti htn |
| PROGRESSIVE SYSTEMIC SCLEROSIS (SCLERODERMA) - ASSESSMENT | pain & stiffness in the fingers; intolerance for cold. s/s suggestive cardiovascular, resp, renal & gi problems. Skin rash, loss of wrinkles on the face, limitations of joint range of motion, muscle weakness & dry mucous membranes |
| PROGRESSIVE SYSTEMIC SCLEROSIS (SCLERODERMA) - INTERVENTIONS | impaired skin integrity, self-care deficit, chronic pain, social isolation, imbalanced nutrition: less than body requirements, ineffective therapeutic regimen mgmt |
| POLYMYOSITIS - | infiltration of inflammatory cells, causing destruction of muscle fibers. Inflammation of tissues surrounding blood vessels is an outstanding pathologic feature of the disease. |
| POLYMYOSITIS - s/s | muscle weakness, raynaud's phenomenon, joint pain and inflammation. |
| DERMATOMYOSITIS - s/s | periorbital edema |
| POLYMYOSITIS - MED DX | proximal muscle weakness, a muscle biopsy positive for muscle degeneration, elevated muscle enzymes and myopathic electromyographic changes |
| POLYMYOSITIS - MED TX | drug: high dose glucocorticoids such as prednisone and chemotherapeutic agents such as methothrexate. Supportive tx: balancing rest and exercise to prevent contractures. |
| CARPAL TUNNEL SYNDROME | common condition in w/c the median nerve in the wrist becomes compressed, causing pain and numbness. |
| CARPAL TUNNEL SYNDROME -MED TX | splinting to prevent flexion & hyperextension. Glucocorticoid injections. Surgical release of transverse carpal ligament. Post surgery: assess color and temp of hand. Notify dr of pallor, cyanosis or numbness |
| ANKYLOSING SPONDYLITIS | inflammatory disease that affects vertebral column, causing spinal deformities. Chronic but not usually disabling. |
| ANKYLOSING SPONDYLITIS - s/s | usually dull, aching pain in buttocks, low back morning stiffness of several hour's duration that improves with activity. Fatigue. |
| DRUGS - Aelndronate sodium (Fosamax) (OSTEOPEROSIS) | INC bone mineral density by impairing bone resorption. Take w 6-8oz h2o on arising in AM. NPO for 30 mins. Pt shld not lie down 30 mins after taking. S/E abd & muscle pain, diarrhea, constipation, severe Gi distrubance with od. hypocalcemia. NO ANTACIDS |
| DRUGS - Leflunomide (Arava) RA | treats active RA, retards structural damage. Monitor liver studies. Tell pt to report severe diarrhea, known cause of fetal harm. Women of childbearing age should avoid conception. Avoid alcohol. |
| DRUGS - Allopurinol (Zyloprim) ANTIGOUT | inhibits synthesis of uric acid. Tell pt to drink 8-10 glasses of fluid daily to maintain output of at least 2000 ml/day. Assess urine for abnormal charac. Safety precautions if drowsy. Tell pt it takes several wks for full effect. |
Created by:
jekjes
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