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MUSCULOSKELETAL KQ

Musculoskeletal and Connective Tissue Disorders

QuestionAnswer
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