Fibromyalgia and Gout Management Quiz

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Questions and Answers

What is the primary characteristic of fibromyalgia syndrome?

Nerve damage in extremities

Acute pain in specific areas

Chronic musculoskeletal pain (correct)

Localized joint inflammation

Which group is most commonly affected by fibromyalgia syndrome?

Middle-aged women (correct)

Children

Teenagers

Elderly men

Which of the following is a common approach in managing fibromyalgia symptoms?

Antiseizure medications and antidepressants (correct)

Physical therapy only

Immediate surgical intervention

Exclusive use of opioids

What is the primary goal of nursing management for fibromyalgia patients?

Decrease pain and improve sleep Signup and view all the answers

Which alternative therapy is NOT commonly included in the management of fibromyalgia?

High-intensity interval training Signup and view all the answers

What is the primary cause of primary gout?

Inherited conditions Signup and view all the answers

Which joint is commonly affected in gout due to an inflammatory reaction?

Jaw Signup and view all the answers

How can a diet contribute to managing gout?

By limiting purine-rich foods Signup and view all the answers

What type of medication is used to manage gout effectively?

Uricosuric drugs Signup and view all the answers

Which of the following findings is associated with gout?

Hyperuricemia Signup and view all the answers

How does the consumption of complex carbohydrates affect uric acid excretion?

It increases uric acid excretion Signup and view all the answers

What is a common diagnostic test for gout?

Urine test Signup and view all the answers

Which demographic is more likely to be affected by gout?

Older men Signup and view all the answers

Which blood test is primarily used to evaluate inflammation in the body related to rheumatoid arthritis?

Erythrocyte sedimentation rate (ESR) Signup and view all the answers

What is the main goal of medical and surgical management for rheumatoid arthritis?

Restoring function and preventing deformities Signup and view all the answers

Which of the following is NOT a commonly identified assessment finding in a patient with rheumatoid arthritis?

Painless nodules Signup and view all the answers

What type of drugs are used to calm the immune system in rheumatoid arthritis management?

Immunosuppressants Signup and view all the answers

Which of these is a common assessment finding in osteoarthritis?

Heberden’s nodes Signup and view all the answers

What is the purpose of physical therapy in the management of rheumatoid arthritis?

To maintain flexibility and function Signup and view all the answers

Which medication type is commonly prescribed to relieve discomfort in rheumatoid arthritis patients?

NSAIDs Signup and view all the answers

What distinguishes primary osteoarthritis from secondary osteoarthritis?

Known causes such as injury or congenital issues Signup and view all the answers

What is the primary vector responsible for transmitting bacteria in Lyme disease?

Deer ticks Signup and view all the answers

Which stage of Lyme disease is characterized by the presence of a bulls-eye rash?

First stage Signup and view all the answers

What symptom is NOT typically associated with the first stage of Lyme disease?

Short term memory loss Signup and view all the answers

Which of the following tests is used to confirm Lyme disease after a positive ElISA test?

Western blot test Signup and view all the answers

Which factor is considered a significant risk for developing osteoporosis?

Postmenopausal women Signup and view all the answers

What is a common assessment finding in patients with osteoporosis?

Compression of vertebrae Signup and view all the answers

Which of the following describes the etiology of Lyme disease?

Bacterial infection transmitted by ticks Signup and view all the answers

What is the primary nursing management focus for patients at risk of amputation due to infection?

Infection management Signup and view all the answers

What are common clinical signs of Lyme disease?

Facial rash and joint swelling Signup and view all the answers

Which demographic is most frequently affected by Lyme disease?

Black American women Signup and view all the answers

Which type of lupus is characterized by chronic rash, red papules, and scaling?

Discoid Lupus Signup and view all the answers

Which symptom is NOT typically associated with Systemic Lupus Erythematosus (SLE)?

Chronic rash Signup and view all the answers

What is a primary focus of nursing management in patients with Systemic Lupus Erythematosus?

Reduce triggering factors Signup and view all the answers

Which diagnostic finding is more specific to systemic lupus erythematosus?

Anti-dsDNA antibodies Signup and view all the answers

What pathogen is most commonly associated with osteomyelitis?

Staphylococcus aureus Signup and view all the answers

Which assessment finding would indicate an acute bone infection?

Sudden acute pain Signup and view all the answers

What is the primary focus of nursing management for osteoporosis?

Emphasizing a well-balanced diet high in calcium and vitamin D Signup and view all the answers

What diagnostic finding is commonly associated with osteomalacia?

Radiography and serum levels of calcium Signup and view all the answers

Which diagnostic finding is associated with Paget's disease?

Radiography and bone scans Signup and view all the answers

What is a common medical management strategy for osteoporosis?

Administration of bisphosphonates Signup and view all the answers

Which symptom is characteristic of structural disorders of the feet?

Corns and calluses Signup and view all the answers

What lifestyle factor contributes to the development of osteomalacia?

Insufficient calcium absorption Signup and view all the answers

What type of exercises are recommended for patients with osteoporosis?

Weight-bearing exercises Signup and view all the answers

Which medication is typically used to manage Paget's disease?

Drug therapy for bone remodeling Signup and view all the answers

Study Notes

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

This chapter covers various orthopedic and connective tissue disorders, including their pathophysiology, clinical manifestations, nursing management, and treatment.

Objectives

Differentiate between rheumatoid arthritis and osteoarthritis.
Outline nursing management of clients with arthritis.
Summarize presentations of temporomandibular disorder (TMD).
Define the pathophysiology of gout, fibromyalgia, bursitis, and ankylosing spondylitis.
Detail the nursing care required for gout, fibromyalgia, bursitis, and ankylosing spondylitis.
Discuss multisystem involvement related to systemic lupus erythematosus.
Identify causes of osteomyelitis.
Explain the inflammatory process associated with Lyme disease.
Identify risk factors for osteoporosis.
Differentiate osteomalacia and Paget's disease.
Differentiate between bunions and hammer toe.
Discuss benign and malignant bone tumors.

Inflammatory Disorder Arthritis

Arthritis

Inflammation and/or degeneration of the joints.

Osteoarthritis

Degenerative; a wearing-away process.

Rheumatoid Arthritis

Autoimmune inflammatory disorder of connective tissue.
Chronic condition with remissions, exacerbations, and chronic pain, worse in the morning.
Most common in hands, wrists, knees, and ankles.
Onset typically 20s-40s, with mostly women affected.
Presents with joint stiffness, pain, and warmth.
Pathophysiology and Etiology: Immune system attacks synovial tissue, releasing cytokines.
Assessment Findings: subcutaneous nodules, muscle atrophy, flexion contractures, chronic pain, weight loss.
Diagnostic findings: radiography, serum protein, rheumatoid factor (RF) electrophoresis, arthrocentesis, CRP, and ANA tests.
Medical and Surgical Management: decreasing joint inflammation, providing comfort, preventing deformities, helping restore function (DMARDS are mentioned).

Joint Changes

Diagrams showing inflamed synovial membranes, synovial fluid, pannus, and loss of cartilage in joints.

Rheumatoid Blood Tests

Rheumatoid factor (RF) - antibody in autoimmune diseases (80% in RA).
Erythrocyte sedimentation rate (ESR) - measures inflammation.
C-reactive protein - indicates inflammation.
Antinuclear antibody (ANA) test - identifies autoimmune disorders, detecting antibodies in cell nuclei.

Deformity of Fingers

Images: early and late stages of finger deformities in RA.

RA Continued: Nursing Management

Educate clients on disease management, treatments
Anti-inflammatory drugs (NSAIDs, DMARDS)
Steroids
Immunosuppressants (calm the immune system)
Physical therapy
Nutrition
Maintain independence/adaptive devices
Relaxation techniques
Sleep strategies

RA Remission

1.5 million adults with RA in the US
10%–33% remission rates without early RA treatment
60% (or higher) remission rates with early and aggressive treatment
Costs associated with RA treatments (a significant amount of money).

Inflammatory Disorders Degenerative Joint Disease/Osteoarthritis (OA)

Pathophysiology: repeated trauma, degenerative joint changes (after 40).
- Primary OA: without identifiable cause
- Secondary OA: due to a known cause (e.g., injury, congenital condition).
Assessment:
- Stiffness, pain, painless nodules (Heberden's, Bouchard's), degenerative cartilage wear.
- ROM (range of motion) limitations, crepitation, deformity.
Diagnostic finding: radiography.
Management: rest, exercise, drug therapy, joint procedures, intra-articular injections.
Client education: medication, weight reduction, dietary modifications, avoidance of stress on the joints.

Degenerative Joint Disease Osteoarthritis cont.

OA is exacerbated by overuse; a wear-and-tear disease impacting weight-bearing joints (asymmetrical).
More prevalent after age 40.
Slow progression, pain with motion in the early stages, localized stiffness in affected areas.
No observed remissions.

Heberden and Bouchard Nodes

Images showing these joint abnormalities.

Joint Changes in Osteoarthritis

Images showcasing bone cysts, osteophytes, joint space narrowing, and cartilage and bone erosion in OA.

Osteoarthritis vs. Rheumatoid Arthritis

Comparisons between OA and RA regarding onset, progression, affected areas, localization of stiffness, symptoms, and treatment approaches.

Inflammatory Disorders: Temporomandibular Disorder (TMD)

Etiology: degenerative arthritis, malocclusion, bruxism, jaw injuries/trauma.
Assessment: jaw pain, muscle spasms, tenderness (masseter, temporalis), headache, tinnitus, ear pain.
Medical: dentist referral, NSAIDs, mouthguards, TENS, muscle relaxants, tricyclics, reconstructive surgery.
Nursing: dietary adjustments (avoiding chewing) and nutrition consultation.

Temporomandibular Joint (TMJ)

Anatomical diagram of the TMJ.

Gout Hyperuricemia

Primary: inflammatory disorder with uric acid buildup (hyperuricemia) in the blood.
- Excessive purine intake (organ meats, shellfish).
Secondary: hyperuricemia can be caused by conditions like leukemia, abnormal purine metabolism, decreased uric acid excretion, or certain medications.

Inflammatory Disorders Gout

Pathophysiology: inherited, painful metabolic disorder leading to inflammation in joints (predominantly affecting men).
Assessment: edema, recurring jaw pain, tenderness of one joint, fever, tophi (urate crystals).
Diagnostic: clinical signs, urine tests, arthrocentesis, radiography, ultrasound.
Management: uricosuric drugs, reduced purine intake, NSAIDs, colchicine, phenylbutazone, and steroids.
Nursing: managing pain, considering meds' side effects, fluid intake, and dietary guidance.

Management of Diet

Dietary restrictions to reduce purine intake.
Emphasis on complex carbohydrates and reducing fats.
Encouragement for weight reduction to help remove uric acid.

Inflammatory Disorders: Fibromyalgia Syndrome

Pathophysiology: widespread inflammatory illness; unknown etiology.
Assessment: chronic musculoskeletal pain, fatigue, sleep disturbances; commonly affects middle-aged women; impacts muscles, ligaments, and tendons.
Diagnostic: difficult diagnosis, ruling out other conditions; pain lasting 3 months+.
Management: analgesics, steroids, non-traditional therapies (with a consult from a rheumatologist).

Fibromyalgia Syndrome and Treatment

Nursing: management focusing on reducing pain, improving sleep, addressing fatigue.
Complementary alternative therapies: massage therapy, acupuncture, biofeedback.
Counseling and education support for better management of the condition.

Inflammatory Disorders: Bursitis

Etiology: inflammation within the bursae (small fluid-filled sacs).
Potential causes include repetitive motion, trauma, infection, rheumatoid arthritis, or gout.
Assessment: painful joint movement, distinct lump (bursa) in affected joints (e.g., elbow, knee, or shoulder).
Diagnostics: radiography, fluid aspiration.
Management: rest, anti-inflammatory medications (salicylates, NSAIDs, corticosteroids), mild range-of-motion exercises.
Nursing: support, education, and resources.

Bursitis of the Knee

Image displaying the swollen knee characteristic of bursitis.

Inflammatory Disorders: Ankylosing Spondylitis (Spine Inflammation)

Etiology: chronic connective tissue disorder; progressive immobility and fusion of vertebrae (unknown cause).
Assessment: low back pain, flattened lumbar curve, reduced lung sounds (kyphosis if present), aortic regurgitation.
Diagnostic: ESR (erythrocyte sedimentation rate), CT scan, radiographs, and CX-SF (other relevant tests).
Management: supportive treatment (medications, back brace, sleeping positions, exercise) is used to maintain posture and alleviate inflammation.
No cure for Ankylosing Spondylitis.

Inflammatory Disorders: Systemic Lupus Erythematosus (SLE)

Etiology: autoimmune condition impacting multiple body systems (e.g., skin, joints, kidneys, heart, lungs, brain, lymph nodes).
Assessment: "great imitator" appearing as several other conditions. Common in women, more common in black/hispanic/asian women.
Symptoms: facial rashes, proteinuria, hematuria, ECG changes, lung problems, enlarged spleen, Raynaud's, musculoskeletal issues.
Diagnostic findings: various tests (blood tests, renal biopsy, urinalysis).
Management: remission induction, addressing kidney/liver/heart problems, mitigating symptoms, treatment of exacerbations.

Lupus cont.:

Other manifestations noted in Discoid Lupus and Subacute Cutaneous Lupus.
Discoid Lupus: chronic rash (red papules and scaling).
Subacute Cutaneous Lupus: papulosquamous lesions.

Systemic Lupus Erythematosus (SLE) #2

Medical Management: inducing remission, addressing exacerbations, and managing organ involvement.
Diagnostic Findings: assessing symptoms, various blood tests (e.g., ANA, Anti-dsDNA), biopsy.
Other Tests: cardiac, GI, Repertory, Epstein Barr, etc.,
Nursing: client and family education, support, addressing mobility issues and safety concerns, and managing skin care.
Exposure reduction to triggering factors, stress reduction, avoidance of cigarette smoke and sunlight.

Classic Butterfly Rash

Image of a classic butterfly rash.

Musculoskeletal Infectious Disorders: Osteomyelitis

Pathophysiology: infection in the bone (typically caused by Staphylococcus aureus).
Assessment: the infection may be acute or chronic.
Diagnostic: leukocyte count elevation, ESR increase, positive blood culture, anemia, X-rays, bone scans, MRI.
Medical & Surgical: immobilization, surgical debridement, antibiotic treatment, bone/muscle flap grafts, or amputation.
Nursing: support, infection management, and surgical care.

Musculoskeletal Infectious Disorders: Lyme Disease

Pathophysiology: ticks transmit bacteria; inflammatory/multisystem disorder.
Assessment: three stages (early, acute, late). Stages:
- Stage 1: localized distinctive rash resembling a bullseye, unspecific symptoms, feeling unwell.
- Stage 2: spread to other areas; symptoms worsen, memory loss, short-term memory loss.
- Stage 3: late onset, mental health issues, misdiagnosis.
Diagnostic: based on presenting signs & symptoms, ELISA/western blot tests (confirmation).
Management: antibiotics for early Lyme disease patients.
Nursing: education, support.
Early removal of ticks is crucial.

3 Stages of Lyme Disease

Detailed description of each stage.

Lyme Disease cont.:

Diagnostic findings: presenting symptoms, detecting B. burgdorferi antibodies through Elisa and Western blot tests.
Medical: antibiotics and supportive care.
Nursing: educating clients and families on prevention/prevention methods, education and support, and management of symptoms.

Question #1

Gout affects men more than women. (False)

Question #2

No cure for ankylosing spondylitis. (True)

Question #3

Lyme disease is spread via mosquito bites (False)

Structural Disorders: Osteoporosis

Pathophysiology: loss of bone mass (more common in women than men); likely factors include smaller frame, ethnicity, and genetic predisposition.
Risk factors include women, smaller frame, and postmenopausal women.
Assessment: Lumbosacral, thoracic back pain, kyphosis, brittle and porous bones, bone loss, and vertebral compression.
Diagnostic: radiography, DEXA scan.

Osteoporosis and Aging

Images illustrating spinal posture changes associated with osteoporosis and age.

Structural Disorders: Osteomalacia

Pathophysiology: insufficient calcium absorption, phosphate deficiency causing bone softening.
Assessment: bone pain, weakness, deformities, and waddling gait.
Diagnostic: radiography, serum levels.
Management: appropriate nutrition, exposure to sunlight, exercise, braces, and surgery.

Structural Disorders: Paget's Disease

Pathophysiology: abnormal bone remodeling leading to larger, weaker bones.
Assessment: bone pain, tenderness, and skeletal deformity.
Affecting areas: long bones, spine, pelvis, skull, and legs.
Diagnostic: radiography, bone scans.
Management: drug therapy, surgery.

Structural Disorders: The Feet

Focuses on bunions, hammertoes, mallet toes and their causes, assessment, diagnosis, treatment, and nursing management.
Related to heredity, arthritis, and/or the fit of shoes.

Foot Deformities

Images depicting hallux valgus (bunion) deformities and hammertoe.

Benign Bone Tumors

Etiology: increased growth of normal bone cells.
Assessment: pain, deformity, and swelling.
Diagnostics: X-rays, bone scans, biopsy.
Management: surgery, curettage (scraping), bone grafts, splints, casts.

Malignant Bone Tumors

Etiology: radiation, toxic chemicals, heredity.
Assessment: primary tumors, pathologic fractures, difficulty in movement, pain, and abnormal gait.
- Diagnostic: X-rays, MRI, bone scans, biopsy.
- Management: surgery, radiation, chemotherapy.

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Description

Test your knowledge on fibromyalgia and gout. This quiz covers the characteristics, management strategies, and demographic factors related to fibromyalgia and gout conditions. Explore how diet and medication play a role in the management of these syndromes.