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Musculoskeletal 1of4

QuestionAnswer
How many bones in the body? 206
Types of muscles skeletal, smooth, cardiac
junction between two or more bones; free-moving or diarthrodial joints joints
cord-like structures that attach muscles to the periosteum of the bone; attachments of the muscle tendons
fibrous tissue connecting two adjacent, freely movable bones ligaments
firm, dense type of connective tissue cartilage
5 types of cartilage hyaline (or articular), costal, semilunar, fibrous, elastic
small sac filled with synovial fluid; reduces friction between areas bursae
Tests that determines if the disorder is inflammatory or noninflammatory ESR (erythrocyte sedimentation rate); C-reactive protein
Test that detects antibodies present with rheumatoid arthritis RF (rheumatoid factor)
Test that evaluates for anemia, infection or inflammation CBC
May indicate bone tumor and healing fractures elevated alkaline phosphatase level
may indicate Paget's disease and metastatic cancer elevated acid phosphatase level
may indicate osteomalacia (rickets), osteoporosis and bone tumors decreased serum calcium
may indicate bone tumors and healing fractures increased serum phosphorus level
may indicate gout elevated serum uric acid level
may indicate lupus erythematosus (a connective tissue disorder) elevated antinuclear antibody level
What do imaging procedures help identify? traumatic disorders - fractures and dislocations; bone disorders - malignant bone lesions, joint deformities, calcification, degenerative changes, osteoporosis and joint disease
Nursing Management for radiography no preparation needed
nursing management for CT-NPO Nothing by mouth for 6-8 hours
nursing management for CT with contrast find out if pt has allergy to iodine or shellfish
nursing management for MRI ask if ALL metal is removed and if client is claustrophobic
internal inspection of a joint using an instrument called an arthroscope arthroscope
most common location for arthroscopy knee joint
aspiration of synovial fluid; may be done to alleviate discomfort caused by excessive accumulation in the joint space or to inject a drug such as a corticosteroid arthrocentesis
radiographic exam of a joint (usually shoulder or knee) with use of a contrast medium (pt may hear clicking or crackling for up to 2 days after procedure) arthrogram
estimates bone density; radiography of the wrist, hip or spine - helps determine bone mineral density; nurse should watch for drainage after these tests bone densitometry
uses IV injection of a radio-nuclide to detect the uptake fo the radioactive substance by the bone; detects metastatic bone lesions, fractures, and certain types of inflammatory disorders; radio-nuclide is taken up in areas of increased metabolism bone scan
tests the electrical potential of the muscle and nerves leading to the muscle electromyography
Why is electromyography done? to differentiate muscle and nerve problems
detects levels of uric acid and calcium excretion 24-hour urine test
Why would synovial fluid be aspirated and examined? to diagnose disorders such as traumatic arthritis, septic arthritis (caused by a micro-organism), gout, rheumatic fever, and systemic lupus erythematosis
What color is normal synovial fluid? clar and nearly colorless
What may be present in joint space after an injury? blood cells, crystals, and formed debris
most common form of arthritis osteoarthritis
Osteoarthritis is sometimes called: degenerative joint disease
Osteoarthritis affects: weight-bearing joints (mostly in people over 50)
Osteoarthritis is characterized by: degeneration of articular cartilage with hypertrophy of the underlying and adjacent bone; bone surfaces rub together (hips, ankles); bone grows as bone spurs; shock absorbing protection is gradually lost; pt will have leukocytosis
Risk factors of osteoarthritis older clients; previous joint injury; obesity; decrease in bone density
Early symptoms for osteoarthritis: brief joint stiffness and pain after a period of inactivity; pain usually increases with heavy use and is relieved by rest; later - even rest may not relieve pain
Later symptoms of osteoarthritis: may include joint enlargement with increased limitation of movement; crepetus (creaking) may be heard and felt when the joint is moved
When osteoarthritis affects the hands, fingers frequently develop _________. bony nodules called Heberden's nodes and Bouchard's nodes
S/S of osteoarthritis: pain along affected joint, stiffness and limitation of movement, mild tenderness, swelling and deformity or enlargement of a joint
Osteoarthritis usually affects how many joints? usually a single joint or only a few
How is osteoarthritis diagnosed? by health history and radiography studies; plain x-rays may not show cartilage abnormalities, and arthroscopy or MRI may be necessary
Medical treatment for osteoarthritis heat therapy; splints; canes; weight loss; drug therapy; begins with Tylenol and NSAIDs; Cox-2 inhibitors or low-dose aspirin; Vioxx; Celebrex; narcotics (if other methods are not controlling pain); intra-articular injections of steroids 3 or 4 times/year
Risk factors of osteoarthritis older clients; previous joint injury; obesity; decrease in bone density
Early symptoms for osteoarthritis: brief joint stiffness and pain after a period of inactivity; pain usually increases with heavy use and is relieved by rest; later - even rest may not relieve pain
Later symptoms of osteoarthritis: may include joint enlargement with increased limitation of movement; crepetus (creaking) may be heard and felt when the joint is moved
When osteoarthritis affects the hands, fingers frequently develop _________. bony nodules called Heberden's nodes and Bouchard's nodes
S/S of osteoarthritis: pain along affected joint, stiffness and limitation of movement, mild tenderness, swelling and deformity or enlargement of a joint
Osteoarthritis usually affects how many joints? usually a single joint or only a few
How is osteoarthritis diagnosed? by health history and radiography studies; plain x-rays may not show cartilage abnormalities, and arthroscopy or MRI may be necessary
Medical treatment for osteoarthritis heat therapy; splints; canes; weight loss; drug therapy; begins with Tylenol and NSAIDs; Cox-2 inhibitors or low-dose aspirin; Vioxx; Celebrex; narcotics (if other methods are not controlling pain); intra-articular injections of steroids 3 or 4 times/year
Surgical management for osteoarthritis is usally reserved for _________ people with severe disease who respond poorly to conventional treatment
total joint replacement arthroplasty
surgery to remove cartilage debris arthroscopic surgery
orthopedic surgery complications hemorrhage, sublixation, infection, thromboembolism, avascular necrosis, loosening of cemented prosthesis
most common joints replaced hip and knee (shoulder, ankle, wrist and finger joings can also be replaced)
After total joint replacement, monitor for: circulation and sensation in the affected extremity; 6 P's
6 P's (Signs that there isn't adequate circulation) pain, pressure, parasthesia (tingling), paralysis, palor, pulselessness
Client will most likely need a blood _____. transfusion (may donate their own blood prior to surgery)
How to assess patient's pain after surgery: describe it's location, nature, and severity (may have pain in other joints)
Notify surgeon if sudden, severe pain in the surgical area. This could indicate: prosthesis dislocation
How long before physical therapy should you give pain medication to the client? 30 minutes to 1 hour
After hip replacement, keep the leg in a: position of abduction (to prevent dislocation)
After hip replacement, instruct the patient not to cross the legs or flex the hips more than: 90 degrees
After hip replacement, instruct patient to never ___________ when seated. cross the legs
After hip replacement, avoid _________ when seated. A raised _________ should be ued. bending over; toilet seat
After knee replacement, what type of exercisers may be used? continuous passive motion (CPM)
CPM promotes what after knee replacement? healing and flexibility in the knee. It also increases circulation.
Keep wounds __________________ to help prevent infection. dry and clean
Monitor for ________ after total joint replacement. temperature elevations
Monitor incisions after total joint replacement for: redness, swelling, warmth, and foul discharge
Later after surgery, implanted hardware may provide a medium for: bacteria to grow.
Preoperative nursing management: obtain complete history; assess complications from previous treatment; assist in reducing pain, risk of infection, and increasing mobility; help control anxiety and be sure pt understands post-op instructions
Postoperative nursing management includes: required demonstrations; postsurgery devices; reduce risk for excessive bleeding; review physician orders; flexion of CPM devices and movement; help reduce pain and inflammation; prevent post-op complications
Orthopedic surgery client and family teaching: be sure there is a support system after discharge (help at home); explore kinds of assistance needed (transportation, financial); modifications needed in home (stairs, rugs, etc.); information about home care; referral to home health agency
Be sure pt has this when discharging. Printed discharge instructions that include: activity, physical therapy; symptoms to report
Chronic, progressive inflammatory disease rheumatoid arthritis (RA)
RA is a systemic disorder of: connective tissue and joints
RA is characterized by: remissions and exacerbations
RA is more common in: females
Peak onset age of RA is: 20-40 years
RA is considered to be a/an: autoimmune disorder.
RA affects ____________ joints early on and later affects __________ joints. small; large
Onset of RA is characterized by inflammation of: the synovial tissue.
Synovial tissue _____________ and _________ ____________ in the joint space from inflammation. thickens; fluid accumulates
This forms in the joint tissue and breaks down tissue and bone in adjacent cartilage, joint capsule, and bone. pannus (destructive vascular granulation tissue)
Fibrous tissue converts to ___________ and then to __________. scar tissue; bone
Result of pannus and scar tissue turning to bone is: loss of joint mobility.
What percentage of people with RA have an increase in rheumatoid factor (RF)? 70-80%
Antibody that reacts with a fragment of the IgG (immunoglobin antibody) rheumatoid factor (RF)
Created by: akgalyean