Musculoskeletal 1of4
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| How many bones in the body? | 206
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| Types of muscles | skeletal, smooth, cardiac
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| junction between two or more bones; free-moving or diarthrodial joints | joints
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| cord-like structures that attach muscles to the periosteum of the bone; attachments of the muscle | tendons
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| fibrous tissue connecting two adjacent, freely movable bones | ligaments
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| firm, dense type of connective tissue | cartilage
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| 5 types of cartilage | hyaline (or articular), costal, semilunar, fibrous, elastic
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| small sac filled with synovial fluid; reduces friction between areas | bursae
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| Tests that determines if the disorder is inflammatory or noninflammatory | ESR (erythrocyte sedimentation rate); C-reactive protein
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| Test that detects antibodies present with rheumatoid arthritis | RF (rheumatoid factor)
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| Test that evaluates for anemia, infection or inflammation | CBC
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| May indicate bone tumor and healing fractures | elevated alkaline phosphatase level
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| may indicate Paget's disease and metastatic cancer | elevated acid phosphatase level
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| may indicate osteomalacia (rickets), osteoporosis and bone tumors | decreased serum calcium
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| may indicate bone tumors and healing fractures | increased serum phosphorus level
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| may indicate gout | elevated serum uric acid level
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| may indicate lupus erythematosus (a connective tissue disorder) | elevated antinuclear antibody level
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| 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
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| Nursing Management for radiography | no preparation needed
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| nursing management for CT-NPO | Nothing by mouth for 6-8 hours
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| nursing management for CT with contrast | find out if pt has allergy to iodine or shellfish
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| nursing management for MRI | ask if ALL metal is removed and if client is claustrophobic
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| internal inspection of a joint using an instrument called an arthroscope | arthroscope
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| most common location for arthroscopy | knee joint
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| 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
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| 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
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| 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
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| 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
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| tests the electrical potential of the muscle and nerves leading to the muscle | electromyography
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| Why is electromyography done? | to differentiate muscle and nerve problems
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| detects levels of uric acid and calcium excretion | 24-hour urine test
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| 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
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| What color is normal synovial fluid? | clar and nearly colorless
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| What may be present in joint space after an injury? | blood cells, crystals, and formed debris
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| most common form of arthritis | osteoarthritis
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| Osteoarthritis is sometimes called: | degenerative joint disease
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| Osteoarthritis affects: | weight-bearing joints (mostly in people over 50)
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| 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
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| Risk factors of osteoarthritis | older clients; previous joint injury; obesity; decrease in bone density
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| 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
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| 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
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| When osteoarthritis affects the hands, fingers frequently develop _________. | bony nodules called Heberden's nodes and Bouchard's nodes
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| S/S of osteoarthritis: | pain along affected joint, stiffness and limitation of movement, mild tenderness, swelling and deformity or enlargement of a joint
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| Osteoarthritis usually affects how many joints? | usually a single joint or only a few
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| 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
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| 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
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| Risk factors of osteoarthritis | older clients; previous joint injury; obesity; decrease in bone density
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| 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
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| 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
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| When osteoarthritis affects the hands, fingers frequently develop _________. | bony nodules called Heberden's nodes and Bouchard's nodes
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| S/S of osteoarthritis: | pain along affected joint, stiffness and limitation of movement, mild tenderness, swelling and deformity or enlargement of a joint
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| Osteoarthritis usually affects how many joints? | usually a single joint or only a few
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| 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
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| 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
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| Surgical management for osteoarthritis is usally reserved for _________ | people with severe disease who respond poorly to conventional treatment
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| total joint replacement | arthroplasty
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| surgery to remove cartilage debris | arthroscopic surgery
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| orthopedic surgery complications | hemorrhage, sublixation, infection, thromboembolism, avascular necrosis, loosening of cemented prosthesis
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| most common joints replaced | hip and knee (shoulder, ankle, wrist and finger joings can also be replaced)
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| After total joint replacement, monitor for: | circulation and sensation in the affected extremity; 6 P's
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| 6 P's (Signs that there isn't adequate circulation) | pain, pressure, parasthesia (tingling), paralysis, palor, pulselessness
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| Client will most likely need a blood _____. | transfusion (may donate their own blood prior to surgery)
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| How to assess patient's pain after surgery: | describe it's location, nature, and severity (may have pain in other joints)
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| Notify surgeon if sudden, severe pain in the surgical area. This could indicate: | prosthesis dislocation
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| How long before physical therapy should you give pain medication to the client? | 30 minutes to 1 hour
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| After hip replacement, keep the leg in a: | position of abduction (to prevent dislocation)
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| After hip replacement, instruct the patient not to cross the legs or flex the hips more than: | 90 degrees
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| After hip replacement, instruct patient to never ___________ when seated. | cross the legs
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| After hip replacement, avoid _________ when seated. A raised _________ should be ued. | bending over; toilet seat
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| After knee replacement, what type of exercisers may be used? | continuous passive motion (CPM)
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| CPM promotes what after knee replacement? | healing and flexibility in the knee. It also increases circulation.
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| Keep wounds __________________ to help prevent infection. | dry and clean
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| Monitor for ________ after total joint replacement. | temperature elevations
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| Monitor incisions after total joint replacement for: | redness, swelling, warmth, and foul discharge
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| Later after surgery, implanted hardware may provide a medium for: | bacteria to grow.
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| 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
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| 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
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| 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
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| Be sure pt has this when discharging. | Printed discharge instructions that include: activity, physical therapy; symptoms to report
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| Chronic, progressive inflammatory disease | rheumatoid arthritis (RA)
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| RA is a systemic disorder of: | connective tissue and joints
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| RA is characterized by: | remissions and exacerbations
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| RA is more common in: | females
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| Peak onset age of RA is: | 20-40 years
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| RA is considered to be a/an: | autoimmune disorder.
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| RA affects ____________ joints early on and later affects __________ joints. | small; large
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| Onset of RA is characterized by inflammation of: | the synovial tissue.
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| Synovial tissue _____________ and _________ ____________ in the joint space from inflammation. | thickens; fluid accumulates
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| This forms in the joint tissue and breaks down tissue and bone in adjacent cartilage, joint capsule, and bone. | pannus (destructive vascular granulation tissue)
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| Fibrous tissue converts to ___________ and then to __________. | scar tissue; bone
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| Result of pannus and scar tissue turning to bone is: | loss of joint mobility.
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| What percentage of people with RA have an increase in rheumatoid factor (RF)? | 70-80%
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| Antibody that reacts with a fragment of the IgG (immunoglobin antibody) | rheumatoid factor (RF)
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Created by:
akgalyean
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