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