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MUSCULOSKELETAL KQ
Musculoskeletal and Connective Tissue Disorders
| Question | Answer |
|---|---|
| What is the most common type of connective tissue disorder? | OA osteoarthritis |
| What does the term arthritis mean? | inflammation of the joint |
| When does OA occur? | when the articular cartilage and bone ends of joints deteriorate |
| What joints are most affected in OA? | weight bearing: hips, knees hands and vertebral column |
| What risk factors have been identified with OA? | aging, obesity, physical activity that create stress on joints |
| What ethnic group is more affected than any other with OA? | native americans (reason unknown) |
| How does secondary OA develop? | as a result of trauma, sepsis, congenital abnormalities, certain metabolic diseases or inflammatory connective tissue disorders |
| If the vetebral column is involved what type of pain is reported? | radiating pain, muscle spasms |
| What are the bony nodes on the hands called with OA? | heberden's and bouchard's nodes |
| What diagnostics are used with OA? | xray, CT or MRI |
| What is the treatment for OA? | pain control or surgery |
| What is synvisc? | injected cushioning fluid that acts like synovial fluid providing lubrication and cushion |
| What drug class is used for OA for pain? | NSAIDS or COX-2 inhibitors |
| When is pain less severe with OA ? am or pm | am |
| What type of therapy is used with OA ? heat or cold? | heat |
| If a patient is on corticosteroids what type of diet may be ordered? | low sodium p. 765 |
| What is a TJR? | total joint replacement |
| What is RA? | rheumatoid arthritis |
| What causes RA? | etiology unknown however, genetic predisposition and the environment play a role in triggering development |
| What is the definition of RA? | chronic progressive systemic inflammatory disease that destroys synovial joints and other connective tissues including major organs |
| What is JRA? | juvenile RA |
| What is the age of peak onset in RA? | 30-60 years of age |
| What ethnicity does RA affect more? | native american |
| What sex does RA affect more? | women (3x more than men) |
| What is synovitis? | inflammation of the synovium |
| What other connective tissue may be affected with RA? | blood vessels, nerves, kidneys, pericardium, lungs and subcutaneous tissue |
| When does an exacerbation of RA usually occur? | when there is physical or emotional stress ie: surgery or infection |
| What is the cause of RA? | etiology unknown |
| What is the rheumatoid factor? | antibodies found inpatients with RA |
| What are the signs and symptoms of RA? | typical bilateral and symmetrical joint inflammation |
| How do joints present with RA? | slightly reddened, warm, swollen, stiff, and painful |
| What may be the systemic reaction to RA? | low grade fever, malaise, depression, lymphadeopathy, weakness, fatigue, anorexia, weight loss |
| Joint deformities in RA- late symptom or early symptom? | late |
| What is Sjogrens syndrome? | inflammation of tear ducts and salivary glands (associated with RA) |
| What is Felty's syndrome? | liver and spleen enlargement and leukopenia (associated with RA) |
| What labs help support dx of RA? | incr. WBC and platelets (unless they have Felty's syndrome), RF in serum, decr. RBC, decr. C4 complement, incr. ESR, + ANA test, + CRP |
| What is a DMARD? | disease modifying antirheumatic drugs |
| What do DMARDS do? | prevent joint destruction deformity and disability with early use |
| For those with RA with acutely inflamed joints what type of therapy is preferred hot or cold? | cold |
| What is gout? | systemic connective tissue disorder associated with uric acid crystal deposits in joints and other connective tissues causing inflammation |
| What is hyperuricemia? | excessive uric acid |
| Where does gout usually cause pain (classic sign) | big toe |
| What are urate deposits iunder the skin called? | tophi |
| If uric acid builds up in the kidneys what forms? | renal calculi |
| What is primary gout caused by? | inherited problem with purine metabolism |
| What is secondary gout caused by? | another underlying condition such as renal insufficiency, or meds |
| What is the sign and symptom of acute gout? | severely inflamed joints |
| What is the dx of gout based upon? | serum uric acid level |
| What is the normal level of uric acid ? | 7.5 mg/dL |
| What is the treatment for acute gout? | colchicine or an NSAID |
| What is the drug of choice for chronic gout? | allopurinol |
| What med is sued with gout that increases renal excretion of uric acid? | Probenecid (benemid) |
| What are the diet provisions for those with gout? | avoid high purines, (organ meat, shellfish, oily fish), avoid alcohol |
| What two medications should a person with gout avoid? | ASA and diuretics |
| Why should someone with gout increase fluid intake? | to avoid kidney stones |
| What is the name for lupus that affects skin only? | discoid |
| What is the difference in the threat to life between systemic lupus and discoid lupus? | systemic lupus can be life threatening because it is progressive and causes major system and organ failure |
| What type of tissue does SLE affect? | connective |
| What is are the leading causes of death in those with SLE? | kidney, heart, failure and CNS involvement |
| What ages of women are affected with SLE? | between 15 and 40 years old |
| What ethnicity is at greater risk for SLE? | african american women |
| True or False: Chinese women have an incrased risk for SLE? | true |
| What is the classic feature of systemic lupus? | the butterfly rash |
| What triggers the butterfly rash in SLE? | exposure to the sun or UV light or by physical stressors such as pregnancy or infection |
| What symptoms present during a flare up of SLE? | fever, fatugue, arthralgia, myalgia, malaise, weight loss, mucosal ulcers and alopecia |
| What does the treatment of SLE focus on? | decreasing inflammation and preventing life threatening organ damage |
| What is the therapy of choice include for SLE? | medication |
| What classes of meds are commonly prescribed for those with SLE? | NSAIDS, APAP, corticosteroids, antimalarials and immunomodulating drugs |
| What is the name of the drug used to treat discoid or systemic lupus (antimalarial) | Aralen (chloroquine) |
| What is one of the most important nursing roles in dealing with SLE? | coordination of care and education |
| What is the expected outcome for those with SLE? | that the pt can function daily without severe pain or fatigue and can avoid exacerbations of the disease |
| What should the pt with SLE be taught regarding skin care? | avoid sunlight, UV light and use mild soap |
| What does exercise do for one with SLE? | prevents muscle weakness and fatigue |
| As the disease scleroderma progresses what happens to the patient? | they lose range of motion and become contracted |
| What body systems does scleroderma affect? | kidney, lung, hear, and GI tract |
| What is CREST syndrome? | a group of signs and symptoms occuring at the same time |
| What are the signs and symptoms that CREST stands for? | calcinosis, rayndauds, esophageal dysmotility, sclerodactyly and telangiectasia |
| what is sclerodactyly | scleroderma of the finger digits |
| What is telangiectasia? | spider like skin lesions |
| What is the goal of medical management of those with scleroderma? | to slow the progression of the disease |
| What is the intervention for those with difficulty swallowing secondary to scleroderma? | frequent, small , bland meals, cutting the food into smaller pieces or puree |
| What classification of drugs are used that help promote circulation in scleroderma pts? | ca channel blockers, antiadrenergic agents and ACE inhibitors |
| What is polymyositis? | diffuse inflammation of skeletal muscle leading to weakness atrophy and degeneration |
| What muscle groups are most commonly affected with polymyositis? | pelvic girdle and shoulder |
| What is a heliotrope rash? | lilac rash |
| What is the drug of choice in those with polymyositis? | prednisone |
| What is muscular dystrophy? | a group of disorders that results in loss of muscle tissue and progressive weakness |
| Why are patients living longer with MD than with previous years? | due to advances in treatment |
| When do signs and symptoms usually become apparent in those with MD? | in early childhood |
| What are the childhood signs and symptoms of MD? | difficulty raising arms above the head, or difficulty climbing stairs, frequent falls, developmental delays, drooping eye, drooling, intellectual retardation, contractures and skeletal deformities |
| What is the goal of treatment for MD? | supportive care and prevention of complications, controlling the symptoms and maximizing quality of life |
| What is the goal for ineffective breathing pattern for one with MD? | maintain ABGs within normal limits |
| How often should respiratory rate be monitored in one with MD? | every 4 hours |
| How often should a patient shift their weight if they have MD? | every 15 minutes |
| What is avascular necrosis? | AVN- bone tissue dies (usually femoral head) as a result of impaired blood supply |
| What are the 2 most common types of joint replacements? | THR and TKR (hip and knee) |
| What is arthroplasty? | another term for joint replacement |
| What are prosthesis made of? | metal, ceramic, plastic or a combination |
| What are bone substitutes? | biologics- they provide a base of support when there is not enough bone left to support a prosthesis |
| What is Osteoset and Proosteon? | bone glue and filler |
| How many pieces of a hip device are used in THR? | 2 pieces - the acetabular cap and the femoral component |
| What is an autologous blood transfusion? | the pt donates blood prior to surgery and then it will be made available to them during the procedure if needed |
| What is the most common post op complication with THR? | subluxation (partial dislocation) or total dislocation |
| What is the sign / symptom of hip dislocation? | hip pain and shortening of the surgical leg |
| What is a major nursing responsibility post op for THR? | prevent dislocation |
| What are the positioning standards for THR? | prevent adduction and hyperflexion |
| What 2 areas are most vulnerable to breakdown after a THR? | sacrum and heel |
| Who usually removes the intial hip dressing post op? | the physician |
| How long after a THR can one see an infection? | first day post up up to 1 or more years later |
| What is a neurovascular check? | assessment for color, warmth, circulation, movement and sensation |
| When does a patient with a THR get up out of bed? | normally the night of the operation or the next morning |
| What does early ambulation do for the THR pt? | helps prevent DVT, or PE |
| What are SCDs? | sequential compression devices |
| When are leg exercises started post op with a THR? | immediately and until the pt is fully ambulatory |
| How many devices does a TKR require? | 3 - femoral component, tibial component and a patellar button |
| Is a pt likely at risk for dislocation with a TKR? | No |
| What is a CPM and why is it used with TKR? | is is a continuous passive motion machine, it keeps the joint mobile |
| What 2 classifications of amputations are there? | surgical and traumatic |
| What is the main indication for a surgical amp? | ischemia from PVD |
| How do traumatic amps occur? | MVAs lawn mowers, chain saws, snow blowers |
| What is replantation? | an attempt to reattach the amputated body part |
| What type of LE amputation is preferred? | midfoot preferred over BKA |
| IF the lower leg is amputated what is preferred the BKA or AKA? | BKA |
| Why is the BKA preferred over the AKA? | the higher the level of amputation the more energy is required for ambulation |
| What class med is preferred for knifelike pain in the amputee? | anticonvulsants, dilantin |
| What class med is preferred for burning sensation in the amputee? | beta blockers, inderal |
| What class med is used for the amputee with nerve pain? | neurontin or Elavil |
| What will happen to an amputee who remains with the continued use of a pillow for support of the limb? | flexion contractures |
| What will lying prone do for an amputee? | help prevent contracture |
| What action is taken when the stump is 'ultrasensitive' to the touch | rub it with a washcloth 3-4x a day |
| How is the limb prepared for an amputee (knee) | wrapped in elastic bandages in stump wrap fashion to shrink and form the stump waiting prosthesis |
| What is a strain? | soft tissue injury that occurs when a muscle or tendon is excessively stretched |
| What are the degrees of strain and their description? | Mild-minimal inflammation Moderate- parital tearing of mucle or tendon and Severe-tendon or muscle rupture |
| What does RICE stand for? | rest, ice , compression and elevation |
| When is heat applied to a strain? | after the inflammation has subsides |
| When can exercise begin after a strain? | as early as 2 to 5 days depending on the injury |
| What is a sprain? | excessive stretching of one or more ligaments |
| What are the classes of sprains and their descriptors? | mild- tearing of a few ligament, moderate-more fibers are torn but joint is still stable and severe- instability of the joint is present |
| What is carpel tunnel syndrome? | compression of the median nerve |
| What is the phalen's test? | numbness with with wrist flexion |
| What is the major reason for a fracture? | trauma |
| What is an open fracture? | bone breaks skin |
| What is a closed fracture? | fracture does not disrupt the skin |
| What is a closed reduction? | the MD manipulates the bone into realignment |
| What is bivalving a cast for? | to allow a decrease in pressure to relieve compartment syndrome |
| How long is a casted limb elevated for? | 24 to 48 hours after application |
| Where is ice applied after casting | above and below the cast to prevent swelling |
| How is wet cast handled? | with palms |
| Which traction is used solely for pain management? | Bucks and Russel's |
| What are Steinmanns? | pins |
| What are Kirchners? | wires |
| What are Crutchfields? | tongs |
| Where are steinmanns Kirchners and Crutchfields applied? | through the skin and to the bone from the outside |
| How many pounds is used for wt with skin traction? | 5 - 10 pounds |
| How many pounds of wt is used for skeletal traction? | 20 to 40 pounds |
| What is normal drainage from pin sites (if any) | clear odorless fluid |
| What is an ORIF? | open reduction internal fixation |
| What is the advantage of an ORIF of the hip? | it allows early mobilization while bone is healing |
| What is an external fixator? | it is an external metal frame used to stabilize a fracture from crushing or splintering |
| What treatments are used for non union healing? | e-stim, bone grafting, ultrasound |
| What is osteoporosis? | bone losing density |
| Where is osteoporosis more likely found (in what bones) | wrist, hip and vertebral column |
| What is the mortality rate for a hip fracture? | 50% (within first year after fracture) |
| What predisposes a person to osteoporosis with regards to their diet? | excess caffeine or alcohol intake |
| What activity stimulates bone building? | weight bearing exercise |
| What is Paget's disease? | bone loss results in large bone deposits throughout the body |
| What thyroid hormone med is used to address Paget's? | Calcitonin |
| Where do primary malignant tumors occur that have tendency to mets? | prostate, lung, breast and thyroid (bone seeking cancers) |
Created by:
Kelly Quijano
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