Fibromyalgia and Arthritis Overview

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which demographic predominantly experiences fibromyalgia syndrome?

Young men

Middle-aged women (correct)

Elderly individuals

Children and adolescents

What is a primary goal of nursing management in patients with fibromyalgia?

Promote social interactions

Decrease pain and improve sleep (correct)

Encourage dietary changes

Increase physical activity

Which type of medication can help with sleep in patients with fibromyalgia?

Antibiotics

Antidepressants (correct)

Beta-blockers

Antihistamines

What characterizes the assessment findings of fibromyalgia syndrome?

Chronic musculoskeletal pain and fatigue Signup and view all the answers

What is a necessary step to diagnose fibromyalgia syndrome?

Ruling out other conditions Signup and view all the answers

What is a characteristic of osteoarthritis regarding the affected joints?

It is usually asymmetrical and affects weight-bearing joints. Signup and view all the answers

Which of the following symptoms is most commonly associated with Temporomandibular Disorder (TMD)?

Jaw pain and pronounced muscle spasm. Signup and view all the answers

What type of medical management may be recommended for a patient with TMD?

Prescribing NSAIDs and muscle relaxants. Signup and view all the answers

What is a common misconception regarding the progression of osteoarthritis?

It progresses slowly over years. Signup and view all the answers

Which dietary consideration can benefit patients with degenerative joint disease?

Focus on foods that are easily consumed without chewing. Signup and view all the answers

What distinguishes rheumatoid arthritis from osteoarthritis?

Rheumatoid arthritis is an autoimmune disorder. Signup and view all the answers

Which of the following joints are most commonly affected by rheumatoid arthritis?

Hands, wrists, knees, and ankles Signup and view all the answers

What is the typical onset age range for rheumatoid arthritis?

20 to 40 years Signup and view all the answers

Which symptom is associated with rheumatoid arthritis?

Stiffness and joint pain Signup and view all the answers

What role do cytokines play in rheumatoid arthritis?

They trigger the immune response. Signup and view all the answers

What is the primary cause of primary gout?

Inherited metabolic disorder Signup and view all the answers

Which condition is characterized by degeneration due to wear and tear of the joints?

Osteoarthritis Signup and view all the answers

Which of the following is NOT a recommended management strategy for gout?

High-fat diet Signup and view all the answers

What is the potential systemic involvement associated with systemic lupus erythematosus?

Multi-organ dysfunction Signup and view all the answers

What are tophi in the context of gout?

Urate crystals deposits Signup and view all the answers

Which of the following factors is commonly associated with the development of osteoporosis?

Genetic predisposition Signup and view all the answers

What dietary component is encouraged to help manage gout?

Complex carbohydrates Signup and view all the answers

Which factor can lead to secondary hyperuricemia?

Increased cellular turnover Signup and view all the answers

What is one of the common assessment findings in gout?

Fever and tenderness in joints Signup and view all the answers

Which medication is commonly used to manage gout symptoms effectively?

Colchicine Signup and view all the answers

In patients with gout, which lifestyle change is advised?

Weight loss for overweight individuals Signup and view all the answers

What is a key dietary recommendation for managing osteoporosis?

Focus on a well-balanced diet with high calcium Signup and view all the answers

Which of the following medications is NOT typically used in the management of osteoporosis?

Steroids Signup and view all the answers

In Osteomalacia, which condition contributes to the softening of the bones?

Phosphate deficiency Signup and view all the answers

Paget disease is characterized by which of the following pathophysiological changes?

Abnormal bone remodeling Signup and view all the answers

What is a common diagnostic finding for structural disorders like Osteoporosis?

Radiography Signup and view all the answers

What is a common assessment finding in individuals with Osteomalacia?

Bone pain and weakness Signup and view all the answers

Which of the following treatments is part of the surgical management of Paget disease?

Surgery for misaligned limbs Signup and view all the answers

Which nursing intervention is important for managing the safety of patients with Osteomalacia?

Address dietary deficiencies Signup and view all the answers

What is a common cause of bursitis?

Repetitive motion Signup and view all the answers

Which of the following is NOT a typical assessment finding for ankylosing spondylitis?

Distinct lump on the joint Signup and view all the answers

Which diagnostic finding is commonly used for spondylitis evaluation?

ESR Signup and view all the answers

What type of treatment is primarily emphasized for ankylosing spondylitis?

Supportive treatment Signup and view all the answers

What is a key characteristic of systemic lupus erythematosus (SLE)?

Autoimmune disease with unknown etiology Signup and view all the answers

Which of the following management strategies is commonly used for bursitis?

Corticosteroids Signup and view all the answers

What effect can kyphosis have on lung sounds?

Decreased lung sounds Signup and view all the answers

What is one of the main goals of nursing management for patients with spondylitis?

Increased flexibility and strength Signup and view all the answers

What is a characteristic clinical finding in patients with fibromyalgia syndrome?

Widespread chronic pain for 3 months Signup and view all the answers

Which alternative therapy is commonly used to help manage symptoms of fibromyalgia?

Acupuncture Signup and view all the answers

Which medication class is utilized in the management of fibromyalgia for both pain reduction and sleep improvement?

Antiseizure medication Signup and view all the answers

In managing fibromyalgia, what is the primary role of nursing professionals?

Providing patient education and support Signup and view all the answers

Which demographic is predominantly affected by fibromyalgia syndrome?

Middle-aged women Signup and view all the answers

What distinguishes rheumatoid arthritis from other forms of arthritis?

It is an autoimmune inflammatory disorder. Signup and view all the answers

Which of the following is a common clinical manifestation of rheumatoid arthritis?

Symmetrical joint involvement. Signup and view all the answers

Which process is primarily involved in the pathophysiology of rheumatoid arthritis?

Immune system attack on synovial tissue. Signup and view all the answers

What is a common age range for the onset of symptoms related to rheumatoid arthritis?

20s to 40s. Signup and view all the answers

What characterizes the progression of rheumatoid arthritis in most patients?

Chronicity with episodes of remissions and exacerbations. Signup and view all the answers

What role do cytokines play in rheumatoid arthritis?

They trigger inflammation by attacking joint synovial tissue. Signup and view all the answers

Which of the following systemic effects can potentially occur due to rheumatoid arthritis?

Heart, lung, and eye involvement. Signup and view all the answers

What is the underlying cause of osteoarthritis as a type of arthritis?

Chronic wear and tear on the joints. Signup and view all the answers

Which of the following dietary changes is recommended for managing gout?

Limit purine-rich foods while increasing carbohydrates Signup and view all the answers

What is a common characteristic of the diagnosis of gout?

Presence of tophi and recurrent joint pain Signup and view all the answers

Which of the following medications is typically NOT used in the management of gout?

Diuretics Signup and view all the answers

What is a significant risk factor for primary gout?

Family history of metabolic disorders Signup and view all the answers

In secondary gout, which of the following conditions may lead to increased uric acid levels?

Chronic kidney disease Signup and view all the answers

Which of the following symptoms is NOT typically associated with gout?

Persistent cough Signup and view all the answers

What is the primary purpose of fluid intake for patients with gout?

To assist in uric acid excretion Signup and view all the answers

Which assessment finding is likely indicative of gout?

Localized tenderness with fever and tophi Signup and view all the answers

What is the primary cause of inflammation in bursitis?

Repetitive motion and trauma Signup and view all the answers

Which assessment finding is characteristic of ankylosing spondylitis?

Flattened lumbar curve Signup and view all the answers

What is commonly used to assess systemic lupus erythematosus (SLE)?

Autoantibody tests Signup and view all the answers

Which treatment option is NOT typically recommended for managing bursitis?

Chemotherapy Signup and view all the answers

In cases of ankylosing spondylitis, what is one expected effect of kyphosis on lung function?

Reduced lung sounds Signup and view all the answers

What main goal does supportive management aim to achieve in ankylosing spondylitis?

Maintain functional posture Signup and view all the answers

Which fluid analysis might be performed for diagnostic findings in bursitis?

Fluid aspiration Signup and view all the answers

What characteristic distinguishes systemic lupus erythematosus from other inflammatory disorders?

Autoimmune mechanism affecting multiple systems Signup and view all the answers

Which of the following foods should be emphasized for patients managing osteoporosis?

Dairy products high in calcium Signup and view all the answers

What is the expected therapeutic effect of Denosumab in osteoporosis management?

Increase bone density Signup and view all the answers

Which of the following is a common symptom associated with Paget disease?

Skeletal deformity Signup and view all the answers

What primary dietary deficiency is associated with Osteomalacia?

Lack of phosphate Signup and view all the answers

Which management strategy is generally NOT recommended for treating foot disorders?

Regular foot massages Signup and view all the answers

Which exercise component is essential for the nursing management of osteoporosis?

Resistance training Signup and view all the answers

What is a key diagnostic tool for assessing Osteoporosis?

DEXA scan for bone density Signup and view all the answers

In Osteomalacia, which clinical finding is commonly assessed?

Bone tenderness Signup and view all the answers

What is a key characteristic of Lyme disease in its late stage?

Short term memory loss Signup and view all the answers

Which of the following correctly describes the risk factors associated with osteoporosis?

Postmenopausal women of any ethnicity Signup and view all the answers

How does Lyme disease primarily spread to humans?

Bites from infected ticks Signup and view all the answers

What signifies the early removal of ticks in preventing Lyme disease transmission?

Ticks require 36 to 48 hours to transmit Lyme disease Signup and view all the answers

Which diagnostic test is used after a positive ELISA test for Lyme disease?

Western blot test Signup and view all the answers

What is common among the first stage symptoms of Lyme disease?

Localized rash and feelings of being unwell Signup and view all the answers

Which of the following should NOT be considered a treatment for late-stage Lyme disease?

Placebo treatment for symptomatic relief Signup and view all the answers

What is one possible consequence of misdiagnosing Lyme disease?

Mental health issues and confusion Signup and view all the answers

Study Notes

Introduction to Medical-Surgical Nursing, 13e, Chapter 63: Caring for Clients With Orthopedic and Connective Tissue Disorders

Objectives: Cover rheumatoid arthritis, degenerative joint disease, temporomandibular disorder (TMD), gout, fibromyalgia, bursitis, ankylosing spondylitis, systemic lupus erythematosus, osteomyelitis, Lyme disease, osteoporosis, osteomalacia, Paget's disease, benign and malignant bone tumors, and foot deformities.

Inflammatory Disorder Arthritis

Arthritis: Inflammation and/or degeneration of joints.
Osteoarthritis: Degenerative condition, often related to wear and tear.
Rheumatoid Arthritis (RA): Autoimmune inflammatory disorder of connective tissues.
- Chronic, with remissions and exacerbations.
- Affects hands, wrists, knees, and ankles (symmetrically).
- Typically onset in the 20-40s; genetic predisposition; mostly female.
- Characterized by stiffness, joint pain, and warmth around joints.

Rheumatoid Arthritis (RA) - Pathophysiology and Etiology

Immune system attacks joint synovial tissue.
Cytokines cause immune system response; affect eyes, heart, lungs.

Rheumatoid Arthritis (RA) - Assessment Findings

Subcutaneous nodules, muscle atrophy, flexion contractures, deformities, chronic pain (worse in the morning), weight loss.

Rheumatoid Arthritis (RA) - Diagnostic Findings

Radiography, serum protein electrophoresis, rheumatoid factor, arthrocentesis, C-reactive protein, and antinuclear antibody tests.

Rheumatoid Arthritis (RA) - Management

Medical strategies for decreasing inflammation and preventing deformities; restoring function. (Refer to Drug Therapy Table 63-1 for detailed information). DMARDS included in some of therapies.

Rheumatoid Blood Tests

Rheumatoid Factor (RF): Antibody found in autoimmune diseases; approximately 80% of RA patients.
Erythrocyte Sedimentation Rate (ESR): Measures inflammation in the body.
C-reactive protein: Measures inflammation.
Antinuclear Antibody (ANA) test: Identifies antibodies in the nucleus of cells, indicating an autoimmune disorder.

Foot Deformities

Bunions and Hammer Toes: Hereditary or arthritic disorders, causing pain and deformity.

Degenerative Joint Disease (Osteoarthritis)

Pathophysiology: Repeated trauma, degenerative changes.
Typically occurs after age 40.
Primary - without known cause; Secondary – identified cause (injury or congenital).
Assessment Findings: Joint stiffness, pain (especially with movement), painless nodules (Heberden's and Bouchard's), cartilage degeneration, reduced ROM, crepitus, joint deformities, bony spurs

Osteoarthritis - Management

Rest, exercise, TENS unit, drug therapy, joint surgery, intra-articular injection.
Client Teaching: Medication, weight loss, dietary changes, avoid stress on joints.

Degenerative Joint Disease (Osteoarthritis) cont

Exacerbated by overuse.
Primarily affects weight-bearing joints.
Often asymmetrical.
Diagnosed more commonly after age 40.
Usually only painful with movement initially. (Pain with motion).
Joint stiffness tends to occur later (or after inactivity).
Stiffness is localized to affected joints.

Temporomandibular Disorder (TMD)

Pathophysiology: Degenerative arthritis, malocclusion of teeth, bruxism, jaw dislocation, and/or trauma.
Assessment: Jaw pain, muscle spasms, tenderness of masseter and temporalis, headache, tinnitus, and ear pain.
Management: Dentist referral, NSAIDs, mouth guards, TENS, muscle relaxants, or reconstructive surgery.
Nursing: Educate on foods digestible without chewing. Dietary consultation may be useful.

Gout Hyperuricemia

Primary: Inflammatory disorder with uric acid buildup (hyperuricemia).
- Results from excessive purine ingestion (organ meats, shellfish), heredity, or starvation.
Secondary: Problems like abnormal purine metabolism, increased protein synthesis/excretion, increased cell turnover, and decreased excretion due to conditions like leukemia/ cancer, and medications (diuretics, steroids).

Gout Hyperuricemia Assessment and Management

Assessment Findings:
Inflammatory response. Joint pain; tenderness. Tophi (urate deposits) may be palpable. Elevated uric acid levels. Affected joints (feet, hands, elbows, ankles, knees)
Management: Medications: Decreased food purine ingestion; NSAIDs, colchicine, phenylbutazone, corticosteroids; uricosuric drugs, increased uric acid excretion; see Drug Therapy table 63-2.

Gout - Management of Diet

Limit purine-rich foods (organ meats, shellfish) to avoid exacerbating the condition.
Incorporate foods high in complex carbohydrates (to increase uric acid excretion) and low in fat (fat retards excretion).
Clients who are overweight should lose weight to flush out excess uric acid.

Fibromyalgia Syndrome

Pathophysiology and Etiology: Widespread inflammatory illness with an unknown cause.
Assessment Findings: Musculoskeletal pain, fatigue, and sleep disturbances. Affects muscles, ligaments, tendons.
Diagnostic Findings: Difficult; rule out other conditions. Chronic widespread pain for at least 3 months.
Management: Analgesics, steroids, and other non-traditional therapies (refer to Evidence-Based Practice section 63-1 for specifics/potential therapies including a rheumatologist's input).

Fibromyalgia - Nursing Management and Treatment

Goal: Decrease pain, improve sleep, and reduce fatigue.
Medication: Anti-seizure medication (for sleep), antidepressants, and muscle relaxers may be used in treatment.
Complementary/alternative therapies (CAM): Include massage therapy, acupuncture, biofeedback, water therapy, guided imagery, and meditation. Guidance on how to manage chronic pain alongside work and other life/personal commitments may be of use.
Role of the nurse: Education, support, resources, and encouragement to live a healthy lifestyle.

Bursitis

Pathophysiology and Etiology: Inflammation of bursae, often caused by repetitive motion, trauma, infection, or related conditions (such as RA, gout).
Assessment Findings: Painful joint movement (elbow, knee, or shoulder), a distinct lump (bursa).
Diagnostic: Radiography and fluid aspiration.
Management: Rest and therapy (such as medications like salicylates, NSAIDs, corticosteroids; mild ROM exercises).

Ankylosing Spondylitis

Pathophysiology and Etiology: Chronic connective tissue disorder, progressive immobility and fusing of vertebrae. Etiology (cause) is essentially unknown.
Assessment Findings: Low back pain, flattened lumbar curve, aortic regurgitation, and respiratory/lung sound issues.
Diagnostic: ESR, CT scan, radiographs, CX-SF.
Management: Primarily supportive involving medications, back braces, sleeping/posture position instructions, and exercise. No cure.
Nursing: Education, support, and strategies to increase flexibility and strength.

Systemic Lupus Erythematosus (SLE)

Pathophysiology and Etiology: Autoimmune disorder with unknown cause; destruction of connective tissues and body systems; affects multiple body systems (skin, joints, kidneys, heart/lungs, brain).
Assessment Findings: The "Great Imitator" symptom mimics other inflammatory diseases (like Lyme disease), making diagnosis challenging. Often shows in Black, Hispanic or Asian women. Skin rashes (facial rash, possible chronic skin rash, etc.), joint swelling. kidney involvement, heart issues and lungs, and generalized pain.
Diagnostic: Symptoms and signs, blood tests, renal biopsy, urinalysis, and tests for elevated levels of specific proteins . Positive ANA, may indicate a functioning immune system.
Management: Producing a remission; preventing/treating exacerbations (flare-ups); medications for involved organ systems (renal, cardiac, GI). Supportive Care.

Musculoskeletal Disorders: Osteomyelitis

Pathophysiology and Etiology: Pathogens (often Staphylococcus aureus) cause infection within the bone.
Assessment: Rapid onset of infection typically (sudden), bone pain, swelling, fever, possibly local warmth and redness.
Diagnostic: Elevated leukocyte count, positive blood culture, anemia, and diagnostic imaging studies (radiographs, bone scans, MRI).
Management: Immobilization; surgical debridement of necrotic bone; saline irrigation, antibacterial impregnated beads, bone or muscle flap grafting. Amputation (as a last resort) may be required.

Musculoskeletal Disorders: Lyme Disease

Pathophysiology and Etiology: Bacteria transmitted by deer ticks. Chronic inflammatory disorder affecting various body systems (joints, brain, heart, and skin).
Assessment Findings: Stages:
- Early Stage: Localized bull's eye rash, fatigue, fever, and possible numbness/tingling.
- Intermediate Stage: Similar symptoms from first stage, spreading to other systems, and/or worsen of symptoms with further dissemination to other body parts.
- Late Stage: More severe. Possible nervous system problems (brain), musculoskeletal pain, arthritis (joints).
Diagnostic: Presenting symptoms, antibody test (ELISA and Western blot).
Management: Antibiotics (in early stages), supportive measures.
Nursing: Support for potential complications; education about prevention (tick avoidance/removal techniques).

Osteoporosis

Pathophysiology and Etiology: Loss of bone mass (generally more common in women, but also men).
Risk Factors: Female sex, small frame, white/European ancestry, postmenopause, family history.
Assessment Findings: Back pain, a hunched posture (kyphosis), brittle & porous bones, vertebrae compression.
Diagnostic: Radiography, DEXA scans.
Treatment/Management: Adequate nutrition, calcium/vitamin D supplements, medication (bisphosphonates/etc). exercise programs.
Nursing: Patient safety (preventing falls), exercise programs, and education on nutrition and healthy habits.

Osteomalacia and Paget's Disease

Osteomalacia: Insufficient calcium absorption, phosphate deficiency.
Paget's Disease: Abnormal bone remodeling; bones grow larger but weaker.
Assessment: Bone pain/tenderness, skeletal deformities, waddling gait (with osteomalacia)
Diagnostics: Radiography, blood studies.
Management: Correct nutritional deficiencies (calcium, Vit D, minerals), increased exposure to sunlight. Medications, possible surgery if there is misalignment or deformity involving bone structure.

Benign and Malignant Bone Tumors

Benign: Overgrown clusters of normal bone cells.
Signs and Symptoms: Pain, visible deformity, and swelling.
Diagnosis: Imaging studies (radiographs/bone scans), and often biopsy.
Treatment: Surgical removal, curettage (scraping), bone grafts, splints or casts.
Malignant: Associated with factors like radiation, toxic chemicals, genetics.
Symptoms: Pain, possibly a primary tumor, difficulty with movement/mobility, bony deformity, possible pathologic fractures, or pain related to misalignment or inflammation of the bone structures. (See further symptoms below).
Diagnosis: Imaging studies (radiography, MRI, bone scan), and biopsy.
Treatment: Surgery, radiation, chemotherapy to address and control spread of tumor.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz explores key concepts related to fibromyalgia, rheumatoid arthritis, and temporomandibular disorders. It covers demographics, nursing management goals, medication options, and assessment findings. Ideal for students and professionals in healthcare seeking to deepen their understanding of these conditions.