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Musculoskeletal 2of4
| Question | Answer |
|---|---|
| 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
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