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Musculoskeletal 2of4

S/S of RA pain in the affected joint; morning stiffness that lasts more than an hour; weakness; fatigue; anorexia; muscle aches, atrophy and tenderess; swelling and pain that comes and goes; fluid on joints
In RA, _______________ over bony nodules may be present. rheumatoid nodules
With RA, flexion _________ can occur. contractures
What organ of the body can be affected by RA? any organ
With RA, blood vessels may become inflamed, impairing blood flow to organs with possible: ischemia or infarction of the organ.
RA may produce inflmmatory changes in the tissues of the: heart, lungs, kidneys and eyes.
Pleural effusion and pulmonary fibrosis can lead to: respiratory impairment, pulmonary HTN, and eventual heart failure
Medical diagnosis of RA: S/S along with elevated C-reactive protein levels and ESR
Medical treatment of RA involves: medicine, nursing, physical therapy, occupational therapy, and social services
____________ makes for better results of treament of RA. Early treatment
Drugs that provide systemic relief for RA: aspirin, NSAIDs, gold compounds, antimalarials or sulfasalazine, Cox-2 inhibitors (Celebrex and Vioxx), immunomodulatory agents, steroid injections (3 or 4 times a year)
Other therapy for RA includes: supportive treatments, rest, splinting of joints, orthotic devises, assistance in modifying ADL's (activities of daily living)
Nursing Management of RA includes: education (about disease and process and meds), pain relief, stress reduction, referral to OT/PT, splints, ROM exercises, nurtition
Until adolescence, bone formation exceeds: bone resorption
Bone formation and resorption remains equal through your: 20's
Age at which bone resorption surpasses bone formation: 30's
Result of bone resorption happening more than bone formation: loss of bone mass, making thept more susceptible to fractures
Age related loss of bone mass without apparent underlying medical causes is called: primary osteoporosis
Loss of bone to factors such as hyperthyroidism, long term steroids, or Heparin is called: secondary osteoporosis
Levels of estrogen (which inhibits bone breakdown) is decreased in who? menopausal women
Greatest risk factors for osteoporosis are: elderly women with small frame, white, fair skinned, blond or red hair
S/S of osteoporosis Back pain from fractures, fractures, loss of height due to vertebral compression, kyphosis or lordosis, poorly fitting dentures (because of lack of calcium and Vitamin D)
Assessment findings with osteoporosis: frequent complaint of lumbosacral pain, thoracic pain, or both (may be the result of tiny compression fractures in the vertebrae); pathologic fractures in the long bones (happends because of low-density bones or other bone disease)
Diagnositic test that measures bone mineral density of the spine and hip: DEXA
Diagnostic test that measures heel density and provides baseline information for diagnosing osteoporosis and predicting risk of fractures: Quantative Ultrasound
What do post-menopausal women need to help bones? calcium supplements, estrogen replacement, and Vitamin D (for calcium absorption)
Drugs like __________ inhibit bone resorption (breakdown) without retarding mineralization. Fosomax
What exercise promotes strength of bones? regular weight-bearing exercise
Spinal compression fractures are caused when: the spine press together and fracture.
Spinal compression fractures are treated with: percutanious vertebroplasty (when a needle is inserted into the vertebra and a special type of cement is injected)
Percutanious vertebroplasty is minimally __________, risks are _________,and recovery time is ___________. invasive; minimized; short
Painful metabolic disorder involving an inlammatory reaction in the joints, usually affects the feet (esp the big toe), hands, elbows, and knees; it is characterized by the deposition of urate crystals in the joints. Gout
Gout is more prevalent among men of what age? 40's and 50's
Kidney stones develop in about what percentage of pts with gout? 20%
Primary hyperuricemia (uric acid in the blood) occurs from severe dieting or starvation; excessive ingestion of purines (organ meats, shellfish, sardines); heredity
Secondary hyperuricemia (uric acid in the blood) occurs from: abnormal purine metabolism (when the protein is broken down, acid is produced); increased rate of protein synthesis with overprodction or under-excretion of uric acid; increased cellular turnover; altered renal tubular function
Increased celluar turnover (that can be a secondary cause of gout) can be caused by these diseases: leukemia, multiple myeloma and other cancers, some anemia, and psoriasis
Altered renal tubular function can be related to: use of diuretics and salicylates and excessive alcohol intake
S/S of gout: elevated blood uric aid level; severe crushing pain in one joint; hypersensivity to touch (cannot bear even the bedsheets); skin turns red and joint swells; may have tophi (deposits of sodium urate crystals under the skin)
The onset of gout is _________ and usually occurs at __________. abrupt; night
A gout attack may last how long? 1-2 weeks
Repeated episodes of gout in the same joint may cause: deformity of the joint
Medical diagnosis of gout is determined by: history and physical exam; elevated uric acid level (in blood and urine); x-rays; urate crystals in the synovial fluid
Salt of uric acid crystalizes in the body tissue and deposits in soft and bony tissues. These deposits accumulate and produce a: swollen, deformed appearance
Drug that treats initial attack of gout and abort impending attacks: colchicine
Drugs used during asymptomatic periods to prevent uric acid synthesis: Allopurinol, Probenecid, indomethacin, and sulfinapyrazone.
When should Colchicine be discontinued and the doctor called? if there is nausea, vomiting, or intestinal cramping.
Diet for gout should be high in: proteins and carbs (to increase urate excretion), low fat (fats retard urate excretion; low in purines
Surgery may be performed to remove large _________ and correct ____________. tophi; deformities
Nursing care with gout - the extremity should be ___________. elevated
Nursing care with gout includes: administering prescribed medications, using a bed cradle, encourage bed rest, sift urine for stones, do 24-hour urine exams
Chronic, multisystem autoimmune disease that takes its name from the characteristic hardening of the skin: progressive systemic sclerosis (also called scleroderma)
Organs affected by scleroderma: blood vessels, gastrointestinal tract, lungs, heart, kidneys
Death can occur due to what with scleroderma? infection, kidney or heart failure
S/S of scleroderma Raynaud's phenomenon; symmetric painless swelling or thickening of skin; taut and shiny skin; morning stiffness; frequent reflux or gastric acid; difficulty swallowing; weight loss; dypsnea; pericarditis; renal inusufficiency
spasm of the digital arteries with blanching and numbness or pain in the fingers - causes variably red, white and blue fingers Raynaud's phenomenon
affects blood vessels in gastric area frequent reflux of gastric acid
inflammation of pericardium pericarditis
Medical diagnosis of scleroderma is made by: positive ANA; elevated ESR; increased serum muscle enzyme levels
Medical treatment of scleroderma: high doses of steroids or other immunosuppressants; medical management of symptoms to prevent complications
Cure for scleroderma: has no cure
An inflammation of the bursa bursitis
fluid filled sac that cushions bone ends to enhance a gliding movment bursa
What causes bursitis? (pathophysiology) Most often result of trauma; infection, secondary effects of gout and RA
common symptom of bursitis pain and sweling with compromised function
Assessing for bursitis: Lump seen on x-ray. Aspiration reveals what fluid is composed of.
Treatment for bursitis: joint rest; salicylates or NSAIDs; corticosteroid may be injected into the joint; ROM exercise
Chronic connective tissue disorder of the spine and surrounding cartilaginous joints. Causes progressive immobility and fixation of the joints (ankylosis) in the hips and ascends the vertebrae. Ankylosing spondylitis
Ankylosing spondylitis is also called: Marie-Strumpell disease.
Characteristics of ankylosing spondylitis are: spondylosis and fusion of the vertibrae
Ankylosing spondylitis usually begins at what age? early adulthood
AS is more common in ________. men
AS may be automimmune and have ___________ tendencies. heredity
In ankylosing spondylitis, respiratory function may be compromised if ___________ is present. kyphosis
In a few cases of ankylosing spondylitis, inflammation of _________ may occur. May also have ______________. the aorta, iris, and ciliary body of the eye; pulmonary fibrosis
S/S of ankylosing spondylitis: low back pain and stiffness; spind and hip become immobile; lumbar curve may be flattened; neck may become permanently flexed; lung sounds may be reduced, especially in the apical areas; aortic regurgitation or AV node conduction problems
Ankylosing spondylitis is diagnosed by: Elevated ESR (indicates inflammation); negative culture of synovial fluid (autoimmune); elevated alkaline phosphatase and creatinine phosphokinase; x-rays and CT scan show erosion, ossification, and fusion of joints in spine and hip
Ankylosing spondylitis is treated by: administering prescribed meds: anti-inflammatory, Indomethacin (an NSAID), NSAIDs; mild exercise to reduce stiffness and pain; back brace; hip replacement
Goal of treatment of ankylosing spondylitis: to maintain functional posture
Created by: akgalyean