Hehi 2 Final Exam - Chronic Musculoskeletal Disorders

Front 1

What is osteoarthritis?

Back 1

A progressive, degenerative disease of joint surfaces that is characterized by erosion of articular cartilage, increased underlying bone density and osteophyte formation

Front 2

Osteophyte

Back 2

Small abnormal bony outgrowth - affects approximately 17 million Americans

Front 3

Prevalence

Back 3

More prevalent in males before age 45; More prominent in females after age 55.

In U.S. all races are affected equally; Higher incidence in Japanese population; Lower prevalence in South African blacks, East Indians, and Southern Chinese

Front 4

Clinical Manifestations of Osteoarthritis

Back 4

- enlarged joints, due to bony hypertrophy
- Herberned's nodes - at distal interphalangeal joints
- Bouchard's nodes - proximal interphalageal nodes
- fluid in knee
- muscle atrophy possible
- radiating pain, stiffness, or muscle spasms due to compressed nerves in lumbar region of spine
- Decreased range of motion
- Joint pain that improves with rest
- Crepitus (knees)

Front 5

Clinical Management of Osteoarthritis

Back 5

1. X-Ray confirmation
2. Pharmacologic interventions - NSAIDS, steroids, and adjunctive analgesics
3. Rest
4. Exercise
5. Weight control
6. Heat/Cold - generally heat; cold is reserved for acutely inflamed joints
7. Joint protection
8. Nutrition - high in protein and vitamin C to promote healing, antioxidants C and D
9. Surgery - arthroplasty - joint replacement

Front 6

Non-Pharmacologic Management of Osteoarthritis

Back 6

1. Self Management
2. Personalized Social network - online, telephone support groups
3. Aerobic Exercise - weight loss/ management
4. Physical Therapy
5. Range of Motion exercises
6. Muscle strengthening
7. Assist devices
8. Occupational Therapy
9. Joint protection
10. Energy conservation

Front 7

Pharmacological Recommendations

Back 7

*Pharmacologic interventions are most effective when combined with non-Pharm. therapy.

1. Initial Therapeutic Aooroach - mild-moderate pain and symptom control = Acetaminophen

2. Topical capsaicin or methylsalicylate cream should be considered for patients who do not respond to systemic therapy

Front 8

Pharm. Interventions for Osteoarthritis - mild- moderate severe

Back 8

1. NSAIDS
2. Cooxygenase inhbitors - low doses to higher doses; proton pump inhibitors for patients at high risk for GI issues
3. Tramadol - patients in moderate to severe pain who have contraindications to COX 2 inhibitors and NSAIDS

Front 9

Surgical Management of Osteoarthritis

Back 9

Used in patients with severe symptomatic OA who do not respond to medical treatment
1. Arthroscopic debridement
2. Arthroplasty
3. Osteotomy
4. Arthrodesis

Front 10

Arthroscopic Debridement (chondroplasty)

Back 10

1. Trim rough edges of cartilage and remove loose fragments
2. It is only intended to be a short-term solution

Front 11

Arthroplasty (joint replacement)

Back 11

Partial joint replacement: performed when only one compartment of a joint is replaced

Total joint replacement:both articular surfaces are completely replaced by prosthesis

Front 12

Total hip arthroplasty - goals

Back 12

Screws in the acetabulum; stabilize porous coated cup and help bony ingrowth

Nursing Management Goals:
1. Pain Relief
2. Restoration of Mobility
3. Correction of structural deformities

Front 13

Osteotomy

Back 13

Procedure in which a surgeon removes a wedge of bone near a damaged joint

Front 14

Arthodesis (Joint Fusion)

Back 14

Nursing Management Goals:
1. Pain Relief
2. Restor skeletal stability
3. Align in people with advanced arthritis

Front 15

Principles of Joint Protection

Back 15

1. do gental range of motion exercises daily
2. Adjust your activity level according to your pain level
3. Make an effort to maintain your ideal weight
4. Pace yourself by balancing rest and activity
5. Use assistive devices to preserve your joints
6. Use the larges or strongest joint possible when doing a specific task
7. Avoid excessive pressure or stress on small joints of the hand
8. Extend your joints as opposed to contracting them.

Front 16

Osteoarthritis at a glance

Back 16

1. Joint inflammation that resutls from cartilege degeneration
2. Caused by aging, heredity, and injury from trauma or disease
3. No blood test for diagnosis
4. Most common symptom is pain in the affected joint after repetitive use

Goal of treatment: Reduce joint pain and inflammation while improving and maintaining joint function

Front 17

Rheumatoid Arthritis

Back 17

A chronic autoimmune disease mainly characterized by inflammation of the lining,or synovium of the joints

It can lead to long-term joint damage, resulting in chronic pain,loss of function and disability

Front 18

Prevalence of rheumatoid arthritis

Back 18

1. Affects approximately 1% of population
2. It can affect anyone, including children, but 70% are women
3. 3:1 women: men
4. Onset usually occurs between 30-50 yrs of age
5. Lifespan is significantly less (3-8 years)

Front 19

Rheumatoid Factor Test

Back 19

A positive RF test results:
1. endocarditis
2. Sstemic lupus erythematosus
3. TB
4. Syphilis
5.Sarcoidosis
6. Cancer
7. Viral infections
8. Disease of the liver, lung, or kidney

Front 20

Pharmacologic Treatment of Rheumatoid Arthritis

Back 20

1. NSAIDS
2. Corticosteroids
3. Remitive agents or DMARDS (disease modifying antirheumatic drugs)

Front 21

Arthroplasty (joint replacement)

Back 21

Partial joint replacement: performed when only one compartment of a joint is replaced

Total joint replacement:both articular surfaces are completely replaced by prosthesis

Front 22

Total hip arthroplasty - goals

Back 22

Screws in the acetabulum; stabilize porous coated cup and help bony ingrowth

Nursing Management Goals:
1. Pain Relief
2. Restoration of Mobility
3. Correction of structural deformities

Front 23

Osteotomy

Back 23

Procedure in which a surgeon removes a wedge of bone near a damaged joint

Front 24

Arthodesis (Joint Fusion)

Back 24

Nursing Management Goals:
1. Pain Relief
2. Restor skeletal stability
3. Align in people with advanced arthritis

Front 25

Principles of Joint Protection

Back 25

1. do gental range of motion exercises daily
2. Adjust your activity level according to your pain level
3. Make an effort to maintain your ideal weight
4. Pace yourself by balancing rest and activity
5. Use assistive devices to preserve your joints
6. Use the larges or strongest joint possible when doing a specific task
7. Avoid excessive pressure or stress on small joints of the hand
8. Extend your joints as opposed to contracting them.

Front 26

Osteoarthritis at a glance

Back 26

1. Joint inflammation that resutls from cartilege degeneration
2. Caused by aging, heredity, and injury from trauma or disease
3. No blood test for diagnosis
4. Most common symptom is pain in the affected joint after repetitive use

Goal of treatment: Reduce joint pain and inflammation while improving and maintaining joint function

Front 27

Rheumatoid Arthritis

Back 27

A chronic autoimmune disease mainly characterized by inflammation of the lining,or synovium of the joints

It can lead to long-term joint damage, resulting in chronic pain,loss of function and disability

Front 28

Prevalence of rheumatoid arthritis

Back 28

1. Affects approximately 1% of population
2. It can affect anyone, including children, but 70% are women
3. 3:1 women: men
4. Onset usually occurs between 30-50 yrs of age
5. Lifespan is significantly less (3-8 years)

Front 29

Rheumatoid Factor Test

Back 29

A positive RF test results:
1. endocarditis
2. Sstemic lupus erythematosus
3. TB
4. Syphilis
5.Sarcoidosis
6. Cancer
7. Viral infections
8. Disease of the liver, lung, or kidney

Front 30

Pharmacologic Treatment of Rheumatoid Arthritis

Back 30

1. NSAIDS
2. Corticosteroids
3. Remitive agents or DMARDS (disease modifying antirheumatic drugs)

Front 31

GOUT

Back 31

Cause is unknown, but thought to be linked to a genetic defect in pyrine metabolism

Secondary causes include: diabetes, hypertension,obesity, SSA, renal disease and use of HCT

Front 32

Pathophysiology of GOUT

Back 32

1. Increased concentration of uric acid leads to trophi (additional tussue that is not supposed to be there) in joints
2. The crystals trigger an immune response
3. Local necrosis and fibrosis

Front 33

Stages of GOUT

Back 33

1. Asymptomatic Stage
2. Acute Stage
3. Intercritical Stage
4. Chronic Stage

Front 34

Pharmacological Treatment of COUT

Back 34

1. NSAIDS - first line treatment of acute gout depending on patient co-morbidities
2. Colchicine - second line therapy, but in high doses the risks outweigh the benefits
3. Allopurinol (Zyloprim)- first line urate lowering therapy
4. Uricosuric agents are second-line therapy for patients who are intolerant of allopurinol or they may be used in combination with allopurinol
5. Probenecid (Benemid, Probalan) is the most used uricosuric agent in the U.S.

Front 35

Osteomyelitis

Back 35

Infection that causes osteomyelitis often is in another part of the body and spreads to the bone via the blood

Chronic osteomyelitis results when bone tissue dies as a result of the lost blood supply, Chronic infection can persis intermittently for years

Front 36

Risk Factors for osteomyelitis

Back 36

1. Diabetes
2. Hemodialysis
3. Drug Abuse
4. Splenectomy

Front 37

Symptoms of Osteomyelitis

Back 37

1. Pain in bone
2. Swelling
3. Fever
4. Malaise
5. Purulent Drainage

Front 38

Tests for Osteomyelitis

Back 38

1. Bone Scan
2. CBC
3. ESR
4. Blood Culture
5. MRI with aspiration
6. Biopsy

Front 39

Treatment of Osteomyelitis

Back 39

1. IV antibiotics
2. Chronic infection - surgical removal of necrotic bone tissue
3. Tissue may be filled by bone graft or packing material (antibiotics 3 more weeks)
4. Infection may require prosthesis removal
5.New prosthesis when healed

Front 40

Osteosarcomas

Back 40

Malignant tumor of the bone

Progression of local disease on chemotherapy and major motor nerve incolvement that would severely compromise resultant function of the affected limb are also common indications for amputation

Front 41

Post Operative Nursing Care for Osteosarcoma

Back 41

1. Vital signs per unit protocol
2. Pain management
3. Infection prophylaxis
4. Monitored activity
5. DVT prophylaxis
6. Anticoagulants
7. Monitor HCT and Hbg
8. Patient and family education

Front 42

Paget's Disease

Back 42

Cause: unknown; Theory: early viral infection causes dormant skeletal infection

Front 43

Pathophysiology of Paget's Disease

Back 43

Early phase - osteoclasitc phase - excessive bone reabsorption

Second Phase- osteoblastic excessive abnormal bone formation

Front 44

Tests for Paget's Disease

Back 44

!. X-rays
2. bone scan
3. bone biopsy
4. blood tests
5. Urine tests

Front 45

Treatment for Paget's disease

Back 45

1. Calcitronin
2. Etidronate