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Musculoskeletal. IGG
Carlson's requried readings
| Question | Answer |
|---|---|
| Connective tissue disease (CTD) is the major focus of | rheumatology, the study of rheumatic disease |
| A rheumatic disease is any disease or condition involving | the musculoskeletal system. |
| Noninflammatory arthritis such as osteoarthritis (OA) | is not systemic; OA is not an autoimmune disease |
| Systemic autoimmune diseases, such as RA and systemic lupus erythematosus, | are connective tissue diseases that are inflammatory. |
| What is the most common arthritis and a major cause of disability among adults in the United States and the world | Osteoarthritis degenerative joint disease (DJD) |
| What is characterized by the progressive deterioration and loss of cartilage in one or more joints. | Osteoarthritis (DJD) |
| What are the 2 forms of osteoarthritis | primary (idiopathic) form of the disease; secondary OA can result from other musculoskeletal conditions or from trauma. |
| Nodal and non-nodal refers to | hand involvement or no hand involvement |
| Joint cartilage consists of a _______________. Enzymes, such as____________, break down this matrix in patients with OA. | matrix of proteoglycans and collagen and stromelysin |
| How do proteoglycans react in patients with OA | Proteoglycans then can no longer manage the amount of fluid in the joint space, and cartilage loses some of its strength |
| As cartilage and the bone beneath the cartilage begin to erode, the joint space narrows and__________________ form | osteophytes (bone spurs) |
| Inflammation occurring in OA causes damage and can result in | Bone cysts and secondary synovitis (synovial inflammation) are common in advanced disease. |
| __________________and _____________________eventually lead to immobility, pain, muscle spasm, and localized inflammation. | Subluxation (partial joint dislocation) and joint deformities |
| Although the exact etiology of primary OA has not been identified, the disease may be triggered by | aging, genetic changes, obesity, smoking, and/or trauma. |
| The largest risk factor in the elderly population is deterioration of the soft tissue (cartilage). Prolonged weight bearing effects the | knees and weight bearing joints (wear and tear) |
| The distinction between OA and RA becomes more evident as | the disease progresses. |
| Common characteristics of OA | Degenerative, may be unilateral, single joint, affects weight-bearing joints and hands, spine; metacarpophalangeal joints spared; nonsystemic |
| Lab findings for OA | Normal or slightly elevated ESR (sed rates) |
| ________________is a unique NSAID, not only because of its many uses, but because it is the only NSAID that inhibits the clotting of blood for a prolonged period | Aspirin (salsalate) |
| Acetaminophen can cause | liver damage |
| Monitor for this with NSAIDs | signs and symptoms of GI bleeds (get a complete CBC) |
| ________________, a continuous grating sensation caused by irregular cartilage, may be felt or heard as the joint goes through range of motion | Crepitus |
| __________________(at the distal interphalangeal [DIP] joints) and _______________(at the proximal interphalangeal [PIP] joints), are secondary synovitis associated with OA. | Heberden's nodes & Bouchard's nodes |
| Joint effusions (excess joint fluid) are common when the knees are involved. How are they assessed | by attempting to displace the fluid under the knee. Normal synovial fluid will not move around or on top of the knee. |
| Osteoarthritis (OA) can affect the spine, especially the ________lumbar region or the ______cervical region at | L3-4 C4-6 (neck) |
| The patient typically reports radiating pain, stiffness, and muscle spasms in one or both extremities, with this condition | Compression of spinal nerve roots may occur as a result of vertebral facet bone spurs |
| RA main characteristics/risk factors | 35-45 yr Female (3:1), Autoimmune (genetic basis), Emotional stress (triggers exacerbation), Environmental factors |
| RA disease process/pattern | Inflammatory; Bilateral, symmetric, multiple joints; Usually affects upper extremities first; Distal interphalangeal joints of hands spared; Systemic |
| Lab findings in RA | Elevated rheumatoid factor, antinuclear antibody, ESR (sed rate) |
| Common drug therapy for RA | NSAIDs (short-term use); Methotrexate; Leflunomide (Arava); Corticosteroids; Biological response modifiers; Other immunosuppressive agents |
| Common drug therapy for OA | NSAIDs, Acetaminophen, topical analgesics, steroid injections, opioids |
| Common drugs for Osteoporosis | Alendronate (Fosamax), Risedronate (Actonel), Ibandronate (Boniva), Raloxifene (Evista), Calcitonin nasal spray |
| Non-surgical treatment for OA | combination of modalities is often used, including analgesics, rest, positioning, thermal modalities, weight control, and integrative therapies |
| erythrocyte sedimentation rate measures | inflammation |
| What are the most widely used nonprescription supplements taken to decrease pain and improve functional ability in OA | Glucosamine and chondroitin |
| The most common surgical procedure performed is | total joint arthroplasty (TJA) (surgical creation of a joint), also known as total joint replacement (TJR). |
| A less invasive procedure using arthroscopy may be used to remove damaged cartilage in OA | An osteotomy (bone resection) |
| Total joint arthroplasty (total hip replacement) is a procedure used most often to manage the | pain of OA and to improve mobility, although other conditions causing cartilage destruction may require the surgery. |
| The contraindications for TJA are | active infection anywhere in the body, advanced osteoporosis, and rapidly progressive inflammation |
| What is a bony necrosis secondary to lack of blood flow, usually from trauma or chronic steroid therapy | Osteonecrosis |
| After TJA surgery, the client must take extreme care not to acquire an infection that could migrate to the surgical area and cause prosthetic failure. What is suggested | Patients are also told to have any necessary dental procedures done before surgery |
| Because venous thromboembolism (VTE) is a serious postoperative complication, what measures are taken to reduce risks | reduce NSAIDs, hormones, start low weight heparin or other anticoagulants before or after surgery |
| What other post-operational meds may be given | recombinant human erythropoietin, a cytokine that is essential for developing red blood cells |
| Two components are used in the THA | the acetabular component and the femoral component. |
| Considerations of a non-cemented prosthesis include protection of | weight-bearing status to allow bone to in-grow into the prosthesis and decreased problems with loosening of the prosthesis. |
| What are the disadvantages of a cemented procedure | cement can fracture or deteriorate over time, leading to loosening of the prosthesis, which causes pain and can lead to the need for a revision arthroplasty. |
| A common complication of THA is | subluxation (partial dislocation) or total dislocation. |
| What is the main goal of post surgery positioning | prevent adduction beyond the midline of the body |
| Prevention/Intervention of subluxation involves | Position correctly; For hip, keep leg slightly abducted; prevent hip flexion beyond 90 degrees; Assess for pain, rotation, and extremity shortening; Report immediately to physician. |
| What are normal complications of TJA | dislocation, infection, DVT, hypotention, bleeding |
| Preventions/Interventions of hypotension, bleeding, or infection | take vital signs at least every 4 hours; Observe patient for bleeding; report excessively low blood pressure or bleeding to physician. |
| Post-operative care of the elderly with TJA | confusion is often a sign of infection, prevent heel ulcers, move slowly, breath or cough 2 hours to prevent atelectasis and pneumonia, ambulate, Rx’s, reorientate after anesthesia |
| Possible signs of hip dislocation, include | increased hip pain, shortening of the affected leg, and leg rotation. |
| The most potentially life-threatening complication after THA is | venous thromboembolism (VTE), which includes deep venous thrombosis (DVT) and pulmonary embolism (PE). |
| Anticoagulants are given to prevent DVT. How are they dosed | based on weight |
| The common side effect of anticoagulants | thrombocytopenia |
| Infections are a serious consideration. Monitor the surgical incision and vital signs carefully—every | 4 hours for the first 24 hours and every 8 hours thereafter. |
| Some surgeons prescribe a ________________machine after knee surgery to increase joint mobility. | continuous passive motion (CPM) |
| In this procedure, the anesthesiologist injects the femoral or sciatic nerve with local anesthetic and the patient receives a continuous infusion by portable pump. | continuous peripheral nerve blockade (CPNB) |
| The patient with osteoarthritis (OA) is expected to move in his or her own environment independently, with or without an assistive device. Indicators include that he or she will have no problems with: | •Balance and coordination• Gait• Joint movement• Transfer performance• Walking |
| It is a chronic, progressive, systemic inflammatory autoimmune disease process that affects primarily the synovial joints | RA |
| The____________ is vascular granulation tissue composed of inflammatory cells; it erodes articular cartilage and eventually destroys bone | pannus |
| In late RA, fibrous adhesions, bony ankylosis, and calcifications occur; bone loses density, and | secondary osteoporosis occurs. |
| RA is a disease characterized by natural | remissions and exacerbations. |
| Early s/s of RA are | joint inflammation, (SYSTEMIC)• Low-grade fever • Fatigue • Weakness • Anorexia • Paresthesias, |
| Late s/s of RA are | (JOINT)• Deformities (e.g., swan neck or ulnar deviation) • Moderate to severe pain and morning stiffness, (SYSTEMIC)Osteoporosis • Severe fatigue • Anemia • Weight loss •Subcutaneous nodules • Peripheral neuropathy • Vasculitis • Pericarditis • |
| As the RA worsens, the joints become progressively inflamed and very painful. The patient usually has | frequent morning stiffness lasting 45 minutes-several hours |
| (RA) Cervical disease may result in subluxation, especially with the 1st & 2nd vertebrae. This complication may be | life threatening because branches of the phrenic nerve that supply the diaphragm are restricted and respiratory function may be compromised. |
| If you identify cervical pain or loss of range of motion in the | cervical spine of a person with RA, report this information to the physician, generally the rheumatologist. |
| ischemic skin lesions that appear in groups as small, brownish spots, most commonly around the nail bed | periungual lesions |
| In RA respiratory complications may manifest as | pleurisy, pneumonitis, diffuse interstitial fibrosis, and pulmonary hypertension. |
| In RA cardiac complications may manifest as | pericarditis and myocarditis |
| Felty's syndrome, which is characterized by RA, | hepatosplenomegaly (enlarged liver and spleen), and leukopenia. |
| Caplan's syndrome is characterized by the presence of | rheumatoid nodules in the lungs and pneumoconiosis, which is noted primarily in coal miners and asbestos removal workers. |
| Lab tests for RA | RF,ANA, serum compliment, ESR (sed rate< 20), SPEP, albumin <3.5, gobulin |
| Elevated ANA’s are common in | SLE, SSc, RA, and other inflammatory CTDs (5% of healthy adults have positive ANA results) |
| ESR>20 | Increased in inflammatory diseases, like RA, SLE, PMR, temporal arteritis; also elevated in patients with bacterial infections or severe anemias |
| ESR is used to detect | inflammation or infection |
| What CBC values should you expect to find with RA | An increase in white blood cell (WBC) count is consistent with an inflammatory response, low hemoglobin, hematocrit, and red blood cell (RBC) count, Thrombocytosis (is common) |
| An invasive procedure that may be used for patients with joint swelling caused by excess synovial fluid (effusion) | Arthrocentisis |
| Methotrexate (Rheumatrex), an immunosuppressive medication is a | disease-modifying antirheumatic drugs (DMARDs). As the name implies, these drugs are given to slow the progression of the disease. Used for RA, Lupus & SSc: Monitor WBC/liver enzymes |
| Hydroxychloroquine sulfate (Plaquenil) used for | RA, Lupus, SSc: side effect renal damage |
| Hydrocortisone (Prednisone) used in | RA, Lupus, SSc:side effect drug suppresses immune system (lymphocytes) and increases risk of infection or decreased healing. |
| Teaching for Hydrocortisone (Prednisone) | avoid being exposed to infections/viruses, |
| Methotrexate (Ruematrix) | RA, Lupus,SSc:, The side effects and toxic effects of these drugs can be devastating. Immune suppression increases the risk of infection.**first drug given |
| Etanercept (Enbrel) | RA,Lupus, SSC: SQ can decrease vaccines, monitor site, CBC, serum creatinine, and a liver panel to be drawn regularly |
| Infliximab (Remicade) | RA, Lupus, SSc monitor for ss of infection, may cause lupus like symptoms |
| Adalimumab (Humira) | RA,Lupus, SSc monitor for ss of infection |
| Abatocept (Orencia) | RA,Lupus, SSC: infection |
| Rituximab (Rituxan) | RA, Lupus, SSC: infections and s/s of pulmonary distress, BP |
| In addition to identifying and managing specific reasons for fatigue, determine the patient's usual daily activities and teach principles of | energy conservation |
| Antinuclear antibodies (ANAs) primarily affect the DNA within the cell nuclei. As a result, immune complexes form in the serum and organ tissues, which cause inflammation. These complexes invade organs directly or cause vasculitis (vessel inflammation), w | Lupus |
| The two main classifications of lupus are | discoid lupus erythematosus (DLE) and systemic lupus erythematosus (SLE). |
| systemic lupus erythematosus is a | chronic, progressive, inflammatory connective tissue disorder that can cause major body organs and systems to fail. |
| Discoid Lupus Erythematosus (DLE) is | effects the skin only |
| The leading cause of death for SLE patients is | kidney failure, followed by cardiac and CNS |
| What are the changes in the renal glomeruli in SLE effecting the kidneys | minimal nephritis, mild nephritis (s/s show) and severe proliferative nephritis (renal failure) |
| Skin manifestations for SLE | Inflamed, red rash; Discoid lesions |
| Skin manifestations for SSc | Inflamed Fibrotic; Sclerotic; Edematous |
| The major skin manifestation of DLE and SLE is a | dry, scaly, raised rash on the face (“butterfly” rash) |
| Individual round _________________are the scarring lesions of _______lupus. | discoid (coinlike) lesions and discoid |
| In addition to skin changes, _______________occurs in most patients with ______. | polyarthritis/ and SLE |
| _________________ is often seen in those who have been treated for at least 5 years with steroids like prednisone. | Osteonecrosis (bone necrosis from lack of oxygen) constriction of small blood vessels supplying the joint, which causes the tissue to die. |
| What is the most common area affected by osteonecrosis | the hip (THA may be preformed) |
| Disuse, from skeletal muscle invasion by the immune complexes may result in | muscle atrophy (myositis) |
| What are classic signs of SLE | fever and fatigue, generalized weakness, fatigue, anorexia, and weight loss may occur. Fever is the classic sign of a flare, or exacerbation. |
| Any or all body systems may be affected by SLE. Because lupus nephritis is the leading cause of death, carefully assess for signs | of renal involvement (e.g., changes in urine output, proteinuria, hematuria, fluid retention). |
| Pulmonary restrictive or obstructive changes may not result in overt clinical signs; however, progressive involvement can lead to | dyspnea and arterial blood gas abnormalities. Pleural effusions or pneumonia in ½ of patients. |
| What is the most common cardiovascular manifestation in SLE. | Pericarditis and causes tachycardia, chest pain, and myocardial ischemia. Anemia, leukopenia, and thrombocytopenia are also common in patients with SLE |
| In SLE exposure to cold or extreme stress, the patient reports the characteristic red, white, and blue color changes and severe pain in the digits; these changes are caused by arteriolar vasospasm. This is called | Reynaud’s phenomenon |
| In SLE, Neurologic manifestations are | psychoses, paresis, seizures, migraine headaches, and cranial nerve palsies. Peripheral neuropathies are also common. |
| Mesenteric arteritis, pancreatitis from arteritis of the pancreatic artery, and colonic ulcers also can cause | abdominal pain with lupus |
| Common side effects from chronic steroid use for SLE | side effects such as acne, striae, fat pads, and weight gain intensify the problem of an already altered body image. |
| Because discoid lupus erythematosus (DLE) is not a systemic condition, the only significant test is | a skin biopsy |
| Lab tests for SLE include | rheumatoid factor (RH), antinuclear antibody (ANA), erythrocyte sedimentation rate (ESR sed rate), serum protein electrophoresis (SPEP), serum complement (especially C3 and C4), and immunoglobulins |
| In SLE, lab tests for VDRL can result in a false-positive for | syphilis |
| A complete blood count (CBC) commonly shows | pancytopenia (a decrease of all cell types), probably caused by direct attack of the blood cells or bone marrow by immune complexes. |
| Anti-malarial agent hydroxychloroquine (Plaquenil) is prescribed for some patients to | decrease the inflammatory response in patients with SLE |
| Immunosuppressive agents such as, Methotrexate (Rheumatrex) or azathioprine (Imuran) is prescribed for | renal or central nervous system lupus |
| Immunosuppressive agents make the patient susceptible to | infection. Stress the importance of avoiding large crowds and people who are ill. |
| In patients with SLE, who have sever renal impairment, immunosuppressive drugs are given with | steroids |
| Teach a patient with SLE to protect their skin by | avoiding prolonged exposure to sunlight and other forms of ultraviolet lighting, including certain types of fluorescent light. |
| In scleroderma the only clinical manifestation is | hardening of the skin. It is a chronic, inflammatory, autoimmune connective tissue disease. |
| Scleroderma (SSc) is less common than systemic lupus erythematosus (SLE) but is associated with | a higher mortality rate. |
| In SSc, the leading cause of death is | renal failure, respiratory and HTN are also common |
| Two classifications of SSc are | Diffuse Scleroderma and Limited Scleroderma |
| Diffuse scleroderma is | skin thickening on the trunk, face, and proximal and distal extremities |
| Limited scleroderma is | thick skin limited to sites distal to the elbows and knees but also involves the face and neck. |
| Patients with SSc often have this syndrome | CREST syndrome |
| CREST syndrome stands for | Calcinosis (calcium deposits)♦Raynaud's phenomenon♦Esophageal dysmotility♦Sclerodactyly (scleroderma of the digits)♦Telangiectasia (spider-like hemangiomas) |
| Skin assessment of patients with SSc, | the hands: a painless, symmetric, pitting edema of the hands (sausage like fingers), Edema on UE & LE and face. |
| If diffuse scleroderma occurs, swelling is replaced by | tightening, hardening, and thickening of skin tissue; this phase is sometimes called the indurative phase. ↓elasticity & hardening occur |
| Major organ damage is likely to develop with diffuse scleroderma, specifically affecting the | GI and Cardiovascular systems, Pulmonary and Renal |
| In SSC, the GI tract is effected, resulting in | Reflux→ulcerations, ↓peristalsis →malabsorption & malodorous diarrhea stools |
| In patients with SSC, cardiovascular manifestations such as Reynaud’s phenomenon and can result in | digit necrosis, excruciating pain, and autoamputation of the distal digits |
| In SSc, periungual lesions are | vasculitic lesions, often around the nail beds |
| Another common problem of SSc, is evidenced by electrocardiographic (ECG) changes, cardiac dysrhythmias, and chest pain. | Myocardial fibrosis |
| What lung condition is almost always present in patients with SSc | Fibrosis of the alveoli and interstitial tissues. Patients with SSc & pulmonary arterial hypertension have a more serious prognosis |
| Nursing implications for patients with SSc | head 60% for 1 hr after meals; SFM, small bites, semisoft foods, Colab w/nutritionsist, avoid foods that ↑gastric secretions, give anti-acids & histamine antagonists |
| A systemic disease in which urate crystals deposit in the joints and other body tissues, causing inflammation. | Gout, the most common inflammatory arthritis in older adults |
| Primary gout is the most common type and is | the production of uric acid exceeds the excretion capability of the kidneys. Sodium urate is deposited in synovium and other tissues, resulting in inflammation. |
| Secondary gout involves | hyperuricemia (excessive uric acid in the blood) caused by another disease or factors: renal insufficiency, diuretic therapy, “crash” diets, and certain chemotherapeutic agents decrease |
| Hyperuricemia and gout are often seen in older patients with | cardiovascular health problems. |
| The three clinical stages of primary gout disease process are | asymptomatic hyperuricemic, acute gouty arthritis, and chronic or tophaceous gout |
| What would the ESR be in an acute attack of primary gout | >20 |
| After repeated episodes of acute gout, deposits of | urate crystals develop under the skin and within the major organs, particularly in the renal system (kidneys). Classified as chronic tophaceous gout |
| the most common clinical finding in acute gout is | joint inflammation |
| The lab test that confirms gout is | serum uric acid test. |
| What serum uric acid level Is considered abnormal | > 8.5 mg/dL |
| Abnormal urine uric acid levels are | 750 mg/24 hr |
| To monitor possible kidney problems associated with gout, what test can be performed | BUN, & serum creatine |
| A definitive diagnostic test for gout is | synovial fluid aspiration (arthrocentesis) to detect the needle-like crystals in the affected joint that are characteristic of the disorder. |
| Tophi | or deposits of sodium urate crystals, is typical on the fingers, arms and ears in chronic gout |
| Teach gout patients that excessive | alcohol intake and fad “starvation” diets can cause a gouty attack. Avoid high protein and organ meats |
| In addition to food and beverage restrictions, patients with gout should avoid all forms of | aspirin and diuretics because they may precipitate an attack |
| Fibromyalgia is considered | a chronic pain syndrome, not an inflammatory disease. |
| In FM, trigger points and can typically be palpated to elicit pain in a predictable, reproducible pattern. They are located | back of the neck, upper chest, trunk and extremities |
| FM pain is typically described as | burning and gnawing |
| In FM, inability to tolerate pain may result in dysfunctions of the brain especially the | thalamus and hypothalamus |
| FM pain and tenderness tend to come and go but typically worsen in response to | stress, increased activity, and weather conditions. |
| Symptoms of FM | Pain in pressure points, blurred vision, dry eyes; dysrhythmias, dyspnea, pelvic pain, ↑urination and difficulty, abdominal pain, diarrhea, constipation & heartburn |
| This is often referred to as the ‘silent disease’. It is a chronic metabolic disease in which bone loss causes decreased density and possible fracture | Osteoporosis |
| What areas are most often effected with osteoporosis | hip, spine and wrist |
| Osteopenia | low bone mass |
| Osteoporosis and osteopenia occur when | osteoclast production is higher than osteoblast, result is a decreased bone mineral density (BMD) |
| After 30 yrs of age, bone resorption activity exceeds bone-building activity, and | bone density decreases. |
| Trabecular, or cancellous (spongy), bone is lost first, followed by loss of cortical (compact) bone. This results in | thin, fragile bone tissue that is at risk for fracture |
| Standards for the diagnosis of osteoporosis are based on BMD testing that provides a | T-score for the patient. |
| Osteopenia is present when the T-score is at | at -2 1 and above −22.5. |
| Osteoporosisis diagnosed in a person who has a T-score at or lower than | −22.5. |
| Osteoporosis is divided into two categories | generalized and regional |
| Generalized osteoporosis involves many structures in the skeleton and is further divided into two categories | primary and secondary |
| Secondary osteoporosis may result from other medical conditions, such as | hyperparathyroidism; long-term drug therapy, such as with corticosteroids; or prolonged immobility, such as that seen with spinal cord injury |
| Regional osteoporosis, an example of secondary disease, occurs when | a limb is immobilized related to a fracture, injury, or paralysis. Immobility for longer than 8 to 12 weeks can result in this type of osteoporosis. |
| Secondary causes of osteoporosis include diseases | • Diabetes mellitus • Hyperthyroidism •Hyperparathyroidism • Cushing's syndrome • Growth hormone deficiency • Metabolic acidosis • Female hypogonadism • Paget's disease • Osteogenesis imperfecta • Rheumatoid arthritis • Prolonged immobilization • Bone ca |
| Chronic use from drugs can cause osteoporosis | • Corticosteroids • Heparin • Anticonvulsants (phenobarbital, phenytoin) • Ethanol (alcohol) • Drugs that induce hypogonadism (decreased levels of sex hormones) • High levels of thyroid hormone • Cytotoxic agents • Immunosuppressants • Loop diuretics |
| Primary risks associated with osteoporosis | smoking, age, low weight, Caucasian or Asian, low calcium intake, alcohol abuse and low activity. |
| What effect does excessive caffeine intake have on calcium | causes it to be excreted in the urine |
| A diet lacking enough calcium and vitamin D stimulates the | parathyroid gland to produce parathyroid hormone (PTH). PTH triggers the release of calcium from the bony matrix. |
| What effect does high phosphorus intake have on calcium | calcium loss when phosphorus high (inverse relationship) |
| Protein is needed for bone healing when a fracture occurs. Protein is needed for calcium synthesis. Too much protein has what effect | causes increased calcium in the urine |
| Acidosis has what effect on bone loss | increases bone loss |
| Eating disorders | decrease calcium absorption and increase bone loss |
| What factors in the body help to control osteoclasts | interleukin, hormones and tumor necrosis factor |
| The focus of osteoporosis prevention is to | decrease modifiable risk factors |
| Teach osteoporosis patients who do not include enough dietary calcium which foods should be included, such as | dairy products and dark green, leafy vegetables |
| In osteoporosis, pain is | worsened with activity and decreased with rest |
| In osteoporosis, which vertebrae are mostly effected | the lower lumbar and thoracic in kyphosis (T8 and L3) |
| What is the most common type of osteoporosis fracture | compression |
| Back pain accompanied by _____________________________ suggests one or more compression vertebral fractures | tenderness and voluntary restriction of spinal movement |
| Movement restriction and spinal deformity may result in | constipation, abdominal distention, reflux esophagitis, and respiratory compromise in severe cases. |
| In osteoporosis, fractures are also common in the | distal end of the radius (wrist) and the upper third of the femur (hip). |
| There are no definitive laboratory tests that confirm a diagnosis of primary osteoporosis, although a number of | biochemical markers can provide information about bone resorption and formation activity |
| These ______ _______ are sensitive to bone changes and can be used to monitor effectiveness of treatment for osteoporosis. | biochemical markers |
| Increased levels of biological markers are found in patients with | osteoporosis, Paget's disease, and bone tumors |
| Some biological markers are | Bone-specific alkaline phosphatase (BSAP), Osteocalcin, Pyridinium (PYD), N-teleopeptide (NTX) and C-teleopeptide (CTX) |
| A battery of tests can be performed to rule out secondary osteoporosis or other metabolic bone diseases, such as osteomalacia and Paget's disease. These include measurements of | serum calcium, vitamin D, and phosphorus, serum calcium and serum protein (to rule out hyperthyroidism) |
| It is the best tool currently available for a definite diagnosis of osteoporosis. | dual x-ray absorptiometry (DXA) |
| This procedure analyzes trabecular and cortical bone separately and is especially sensitive to changes in the vertebral column. | Quantitative computed tomography (QCT) |
| This is an effective and low-cost screening tool that can detect osteoporosis and predict risk for hip fracture. | Qualitative ultrasound (QUS) of the heel |
| Drug therapy should begin when the BMD T-score for the hip is | below −2.0 with no other risk factors or when the T-score is below −1.5 with one or more risk factors or previous fracture. |
| What drug therapy is used primarily for preventative in post-menopausal women | hormones and calcium |
| Side effects of hormone therapy are | increase a woman's risk for cardiovascular disease, breast cancer, and venous thromboembolism (VTE) |
| BISPHOSPHONATES used for osteoporosis | Alendronate (Fosamax), Risedronate (Actonel) or (Actonel with Calcium), Ibandronate (Boniva), |
| Bisphosphonates (BPs) | slow bone resorption by binding with crystal elements in bone, especially spongy, trabecular bone tissue. |
| What are the most common drugs used for osteoporosis, but some are also approved for Paget's disease and hypercalcemia related to cancer. | Bisphosphonates (BPs) |
| Basic teaching with bisphosphonates | Patients with poor renal function, hypocalcemia, or gastroesophageal reflux disease (GERD) should not take BPs. Take 30 mins before food/drink/drugs & upright for 30 mins after |
| Nursing interventions for Alendronate (Fosamax) or (Fosamax plus D) | Take on an empty stomach, first thing in the morning with a full glass of water. Take 30 minutes before food, drink, or other drugs. Remain upright, sitting or standing, for 30 minutes after administration. |
| Side effects of Risedronate (Actonel) | Observe for CNS side/adverse effects, such as drowsiness, anxiety, agitation. |
| Nursing interventions for Risendronte (Actonel) | Take on the same day each month. Take on an empty stomach, first thing in the morning with a full glass of water. Take 60 minutes before food, drink, or other drugs. Remain upright for 1 hour after administration. |
| Side effects for ibandronate (Boniva) | diarrhea, dyspepsia, musculoskeletal pain, pain in arms/legs |
| Nursing implications for ibandronate (Boniva) | sit or stand at least 60 mins after taking. Calcium- , aluminum- , magnesium- , and iron- containing products, including antacids ↓ absorption. NSAIDs & aspirin ↑stomach irritation |
| What are Selective Estrogen Receptor Modulators | a class of drugs designed to mimic estrogen in some parts of the body while blocking its effect elsewhere |
| SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERMs) for osteoporosis | Raloxifene (Evista), Calcitonin |
| Reloxifene (Evista) does what in the body | increases BMD, reduces bone resorption, and reduces the incidence of osteoporotic vertebral fractures. |
| Side effects of Raloxifene | leg cramps., hot flashe, May alter effects of warfarin and other highly protein-bound drugs, can worsen hepatic diseases. |
| What is a thyroid hormone that inhibits osteoclastic activity, thus decreasing bone loss | Calcitonin, It is used for the treatment of osteoporosis, Paget's disease, and hypercalcemia associated with cancer |
| Side effects of Calcitonin | Rhinitis, nausea, vomiting, injection site reactions, facial flushing |
| Nursing implications for Calcitonin | Assess patient for signs of hypocalcemic tetany, Patients may require a holiday from this treatment to maintain effectiveness. |
| Nursing implications for Raloxifene | Discuss the importance of adequate calcium and vitamin D intake or supplementation. Advise patient to discontinue smoking and alcohol consumption. Teach importance of weight baring exercises |
| Vertebroplasty is the | injection of bone cement into the vertebral body to reduce a fracture or fill the space created by osteoporosis |
| Kyphoplasty includes the use of a | balloon in the vertebral body to contain the bone cement. |
| These procedures greatly reduce pain and increase function in patients with back pain related to osteoporosis | Kyphoplasty and vertebroplasty |
| Paget's disease, or osteitis deformans, is a chronic metabolic disorder in which bone is excessively | broken down (osteoclastic activity) and re-formed (osteoblastic activity). Result is bone structurally disorganized, causing weak bones & increased risk for bowing of long bones and fractures. Two types of Paget's disease can occur—familial and sporadic. |
| Bacteria, viruses, or fungi can cause infection in bone known as | osteomyelitis. |
| Osteomyelitis is categorized as _________, in which infectious organisms enter from outside the body as in an open fracture, or_____________, in which organisms are carried by the bloodstream from other areas of infection in the body. | exogenous or endogenous |
| Osteomyelitis can be further divided into two major types: | acute osteomyelitis and chronic osteomyelitis. |
| A third category is_____________, in which bone infection results from skin infection of adjacent tissues | contiguous |
| Poor dental hygiene and periodontal (gum) infection can be a causative factor in | contiguous osteomyelitis in facial bones. |
| Inadequate care management results when the treatment period is too short or when the treatment is delayed or inappropriate results in | chronic osteomyelitis |
| The most common type of osteomyelitis is | Hematogenous osteomyelitis (chronic infection is more common in adults, acute in children) |
| Pain with osteomyelitis is described as | constant, localized, pulsating sensation that worsens with movement |
| Main symptom with acute osteomyelitis is | • Fever; temperature usually above 101° F (38° C)• Swelling around the affected area • Erythema of the affected area• Tenderness of the affected area • Bone pain that is constant, localized, and pulsating; intensifies with movement |
| Fever, swelling, and erythema are less common in those with | chronic osteomyelitis |
| Symptoms of chronic osteomyelitis | • Ulceration of the skin• Sinus tract formation• Localized pain • Drainage from the affected area |
| The patient with osteomyelitis usually has an | elevated white blood cell (leukocyte) count, which may be double the normal value |
| The erythrocyte sedimentation rate (ESR) may be | normal early in the course of the disease but rises as the condition progresses. It may remain elevated for as long as 3 months after drug therapy is discontinued. |
| To reverse acute osteomyelitis, the health care provider starts | antimicrobial (e.g., antibiotic) therapy as soon as possible. |
| Medications to treat osteomyelitis are | vancomycin or clindamycin or third gen cephalosporin |
| The excision of dead and infected bone often results in a sizable cavity, or bone defect. It is called | sequestrectomy ,the use of bone grafts to repair bone defects is also widely used. |
| When infected bone is extensively resected, reconstruction with | microvascular bone transfers may be done |
| Renal manifestations for SLE | nephritis |
| Renal manifestations for SSc | renal failure |
| Cardiovascular manifestations for SLE | pericarditis, Reynauds phenom |
| Cardiovascular manifestations for SSc | myocardial fibrosis, Reynauds phenom |
| Pulmonary manifestations for SLE | pleural effusions |
| Pulmonary manifestations for SSc | interstitial fibrosis, pulmonary HTN |
| Neurological for SLE | CNS lupus |
| GI manifestations for SLE | abdominal pain |
| GI manifestations for SSc | Ulcers, esophagitis |
| Musculoskeletal for SLE | joint inflammation, myositis |
| Musculoskeletal for SSc | joint inflammation, myositis |
| Other manifestations for SLE | fatigue, fever, anorexia, vasculitis, CNS |
| Other manifestations for SSc | fatigue, fever, anorexia, vasculitis |
| Drugs used for fibromyalgia | Pregabalin (Lyrica) |
| Common side effects for Pregabalin | dizziness, drowsiness, and blurred vision, dry mouth |
| An important nursing implementation for Pregabalin is | Assess renal functions and CK levels |
| Drug for DVT | Lovenox (enoxaparin) and Fragmin (dalteparin) {HEPRINS} |
| Side effects of Lovenox | bleeding, anemia |
| Nursing implication for Lovenox | Assess for signs of bleeding and hemorrhage; fall in hematocrit or blood pressure; guaiac-positive stools; bleeding from surgical site. Notify health care professional if these occur. May cause hyperkalemia |
| Side effect for Fragmin | bleeding, anemia..don’t combine with NSAIDs and aspirin |
| Nursing implications for Fragmin | Assess for signs of bleeding and hemorrhage; fall in hematocrit or blood pressure; guaiac-positive stools; bleeding from surgical site. Notify health care professional if these occur. |
| Areas most effected by osteoarthritis |
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