Podcast
Questions and Answers
What is the primary purpose of an electromyogram (EMG)?
What is the primary purpose of an electromyogram (EMG)?
Which diagnostic tool requires a patient to be NPO prior to the procedure?
Which diagnostic tool requires a patient to be NPO prior to the procedure?
What position is particularly important during a myelogram procedure?
What position is particularly important during a myelogram procedure?
What is a potential consequence of unrelieved positioning issues after surgery?
What is a potential consequence of unrelieved positioning issues after surgery?
Signup and view all the answers
What is an early symptom associated with arterial impairment?
What is an early symptom associated with arterial impairment?
Signup and view all the answers
What differentiates rheumatoid arthritis from other forms of arthritis?
What differentiates rheumatoid arthritis from other forms of arthritis?
Signup and view all the answers
Which of the following procedures involves a dye injection for visualization of joints?
Which of the following procedures involves a dye injection for visualization of joints?
Signup and view all the answers
What can result from neglecting neurovascular assessments after surgery?
What can result from neglecting neurovascular assessments after surgery?
Signup and view all the answers
What is the primary function of bones in the musculoskeletal system?
What is the primary function of bones in the musculoskeletal system?
Signup and view all the answers
Which type of assessment includes questions about the client's ability to perform self-care activities?
Which type of assessment includes questions about the client's ability to perform self-care activities?
Signup and view all the answers
What is the function of tendons in the musculoskeletal system?
What is the function of tendons in the musculoskeletal system?
Signup and view all the answers
Which of the following is NOT one of the Five Ps of musculoskeletal assessment?
Which of the following is NOT one of the Five Ps of musculoskeletal assessment?
Signup and view all the answers
What does an elevated Erythrocyte Sedimentation Rate (ESR) indicate?
What does an elevated Erythrocyte Sedimentation Rate (ESR) indicate?
Signup and view all the answers
Which diagnostic test is used to assess for autoimmune disorders?
Which diagnostic test is used to assess for autoimmune disorders?
Signup and view all the answers
Which symptom is associated with paralysis in the musculoskeletal assessment?
Which symptom is associated with paralysis in the musculoskeletal assessment?
Signup and view all the answers
What is a normal calcium level in the body?
What is a normal calcium level in the body?
Signup and view all the answers
Which joint symptoms are characteristic of rheumatoid arthritis?
Which joint symptoms are characteristic of rheumatoid arthritis?
Signup and view all the answers
Which demographic is more frequently affected by rheumatoid arthritis?
Which demographic is more frequently affected by rheumatoid arthritis?
Signup and view all the answers
What kind of inflammation is characteristic of rheumatoid arthritis?
What kind of inflammation is characteristic of rheumatoid arthritis?
Signup and view all the answers
Which of the following is a common diagnostic test for rheumatoid arthritis?
Which of the following is a common diagnostic test for rheumatoid arthritis?
Signup and view all the answers
What is the primary cause of bone degradation in osteoarthritis?
What is the primary cause of bone degradation in osteoarthritis?
Signup and view all the answers
What is a common treatment for acute gout attacks?
What is a common treatment for acute gout attacks?
Signup and view all the answers
What dietary change should be advised for someone with gouty arthritis?
What dietary change should be advised for someone with gouty arthritis?
Signup and view all the answers
What are the classic symptoms of ankylosing spondylitis?
What are the classic symptoms of ankylosing spondylitis?
Signup and view all the answers
In which area does ankylosing spondylitis primarily manifest?
In which area does ankylosing spondylitis primarily manifest?
Signup and view all the answers
What complication can arise from surgical interventions for osteoarthritis?
What complication can arise from surgical interventions for osteoarthritis?
Signup and view all the answers
Which of the following medications is contraindicated in patients with gout?
Which of the following medications is contraindicated in patients with gout?
Signup and view all the answers
Which of the following nursing interventions can alleviate stiffness in rheumatoid arthritis?
Which of the following nursing interventions can alleviate stiffness in rheumatoid arthritis?
Signup and view all the answers
What is a significant risk factor for developing rheumatoid arthritis?
What is a significant risk factor for developing rheumatoid arthritis?
Signup and view all the answers
Study Notes
Musculoskeletal System Review
- Functions as the structural framework of the body, the primary component is the skeleton (bones)
- Bones protect internal organs
- Bones facilitate movement of muscles
- Bones store calcium, phosphorus, and magnesium
- Bones (specifically red bone marrow) manufacture blood cells
- Muscles are connected to bones via tendons
- Muscle contraction causes movement
- Tendons anchor muscles to bones.
- Ligaments anchor bone to bone.
Body Movements
- Movement terms such as abduction, adduction are important for understanding the chapter
Musculoskeletal System Assessment
- Subjective Assessments include questions about self-care (bathing, dressing), and any numbness.
- Objective Assessments evaluate body alignment, symmetry, edema (pitting/non-pitting, degree), pulses, skin color, and ADLs.
- Range of Motion (ROM) assessments prevent contractures; they can be active (client performs) or passive (healthcare provider performs).
- Muscle Strength assessments involve evaluating strength equality and bilaterally, with client performing specific movements (squeezing fingers, pushing against hands).
The Five Ps of Musculoskeletal Assessment
- Pain
- Paresthesia (numbness, tingling)
- Paralysis (loss of movement)
- Pulse
- Pallor (pale skin color)
Diagnostic Tests and Procedures
- Erythrocyte Sedimentation Rate (ESR) is elevated with inflammation, normal values 0 to 15 in males and 0 to 20 in females.
- Complete Blood Count (CBC) includes red blood cells, white blood cells, hematocrit, hemoglobin, and platelets.
- Low red blood cell count indicates anemia
- Low white blood cell count indicates an issue with immunity.
- High white blood cell count indicates infection.
- Rheumatoid Factor is elevated in autoimmune diseases like rheumatoid arthritis, normal range is 40 to 60 units per milliliter.
- Calcium levels: 9 to 10.5 mg/dL.
- Phosphorus levels: 2.5 to 4.5 mg/dL.
- Anti-Nuclear Antibody (ANA) evaluates autoimmune disorders and diagnoses lupus; elevated in some rheumatoid arthritis patients.
- Uric Acid is elevated in gout.
- X-ray diagnoses fractures and tumors.
- Arthroscopy is minimally invasive surgery (general or local anesthesia).
- Arthrocentesis drains synovial fluid from joints.
- Arthrogram uses x-rays after dye injection (water, air, or combination) to visualize joint details.
- Magnetic Resonance Imaging (MRI) uses a magnetic field for detailed images.
- Computed Tomography (CT) Scan requires consent, NPO status, and can be performed with or without contrast.
- Electromyogram (EMG) measures muscle electrical activity.
- Bone Scan uses IV radioisotope to visualize bone structure.
- Dexa Scan (Dual-Energy X-ray Absorptiometry) measures bone density for osteoporosis.
- Myelogram involves injecting radiopaque dye into the subarachnoid space (lumbar spine) to assess tumors, herniated discs, and infections; a tilting table is required.
Patient Positioning
- Positioning prevents complications from immobility.
- Proper positioning and turning maintain neurovascular integrity, preventing limb loss from impairment
Neurovascular Assessment (The Five Ps & the Seven Ps)
- Venous Impairment causes edema, pain, calf cramps, skin discoloration, venous ulcers, visible veins.
- Arterial Impairment leads to intermittent claudication, cool extremities, hair loss, skin color changes, shiny skin, weak/absent pulse, wounds, cyanosis, erectile dysfunction.
- Causes include trauma, tight bandages, surgery, splints, and casts.
Assessment of the Musculoskeletal System
- Compare one side of the body to the other for symmetry.
- Assess sensation, color, pain, pulses, and capillary refill at least every 30 minutes post-surgery or cast application. 15-minute assessments are recommended first hour.
Pain Assessment
- Fractures: Initially cause acute deep pain until reduced.
- Fractured Hip: Often causes severe pain, primarily due to muscle spasms.
- Spinal Column Disorders: Can result in chronic or sharp, sudden pain radiating down extremities.
Rheumatoid Arthritis
- Most serious form of arthritis, autoimmune disorder
- Affects synovial membranes, most common ages 30-60
- Progressive deformity over time.
- Primarily affects finger, foot, and wrist joints.
- Women are 3x more likely than men to develop RA
- Insidious or acute onset, periods of remission/exacerbations, permanent damages from exacerbations
- Smoking increases risk for genetically susceptible individuals
- Can affect lungs, heart, blood vessels, muscles, eyes, and skin
- Chronic inflammation of synovial membrane of diarthrodial joints (freely moving joints)
Rheumatoid Arthritis: Classic Symptoms
- Morning stiffness lasting 30 minutes or longer
- Joint pain, tenderness, swelling, and stiffness lasting 6 weeks or longer
- Muscle weakness
- Fatigue
Rheumatoid Arthritis: Other Affected Areas
- Eyes: Dryness and light sensitivity
- Oral Cavity: Irritation and ulcerations
- Skin: Rheumatoid arthritis nodules
- Lungs and Blood Vessels: Inflammation
- Bone Marrow: Anemia
Rheumatoid Arthritis: Assessment
- Weight loss
- Muscle aches
- Fever
- Malaise
- Swollen, tender joints
- Joint stiffness, especially in the morning
- Decreased range of motion
- Muscle spasms
- Elevated rheumatoid factor
- Elevated erythrocyte sedimentation rate (ESR)
- X-rays show joint damage/deformities in later stages
- Muscle tenderness causing poor grip
Rheumatoid Arthritis: Diagnostic Tests
- Elevated rheumatoid factor
- Elevated ESR
- Anti-CCP antibody test (present in RA)
- Anti-nuclear antibody test (usually elevated in RA)
- C-reactive protein (CRP) identifies inflammation
- Red blood cell count (shows anemia)
- Synovial fluid aspiration (cloudy, yellow, less viscous, protein)
- Synovial fluid biopsy (shows changes in synovial tissue)
- X-rays (show joint damage)
Rheumatoid Arthritis: Treatment
- Anti-inflammatory medications
- Disease-modifying antirheumatic drugs (DMARDs)
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Salicylates (aspirin)
- Capsaicin (topical)
- Fish oil, vitamin C, E, and beta-carotene
- Methotrexate (reduces symptoms and prolongs joint function)
- Physical therapy (PT)
- Traction
- Splints
- Exercise regimen
- Weight management
- Joint replacement (severe cases)
Rheumatoid Arthritis: Nursing Interventions
- Positioning: Extremities straight, no pillows under knees, trochanter roll, back straight, avoid flexion
- Fatigue: Planned activity, rest periods, naps during exacerbations
- Medications: Give with food to reduce GI upset, monitor side effects
- Functional assessment
- Exercise: Gentle ROM exercises (yoga, strength training, aerobic), 2-3 times/week, 10-15 minutes
- Heat: Warm packs, heat lamps, paraffin wax
- Cold therapy
- Education (meds, avoiding crowds, energy conservation, rest/activity, devices, nutrition, weight)
Ankylosing Spondylitis
- Chronic, progressive rheumatic disorder affecting spine (sacroiliac joint, hip joins, fingers, toes)
- Type of arthritis (psoriatic arthritis is another)
- Causes back pain, stiffness, edema
- Can affect fingernails/toenails (indentations, discoloration), spine (deformities, fusion, posture), neck, jaw, shoulders, knees, and hips
- Ligaments ossify (hardened) affecting heart (enlargement, pericarditis), respiration (rib cage expansion), IBS, and vision
- Periods of exacerbation and remission (damage is permanent).
Ankylosing Spondylitis: Assessment
- Decreased hemoglobin
- Elevated ESR
- Elevated CRP
- Elevated serum alkaline phosphatase (immobile clients)
- Elevated HLA-B27
- X-rays show sacroiliac/intervertebral disc inflammation, bone erosion, joint space fusion
Ankylosing Spondylitis: Treatment
- Oral analgesics and NSAIDs for pain
- Corticosteroids (Prednisone) for inflammation
- TNF inhibitors (target immune cells)
- Exercise
- Surgery (joint replacements, endoscopic microsurgery)
Ankylosing Spondylitis: Nursing Interventions
- Firm mattress, bed board, back brace, no pillow
- Prone position 15-30 min, 4x/day
- Turning/repositioning every 2 hours
- Postural/breathing exercises
- Heat for pain/stiffness
- Cold for inflammation/edema
- Education
Osteoarthritis
- Non-inflammatory disorder (primary unknown cause, secondary related to another condition)
- Result of aging and obesity
- Affects hands, cervical/lumbar vertebrae, hips, and knees
- Articular cartilage loss causes bone-on-bone rubbing
- Wear & tear on joints.
Osteoarthritis: Secondary Causes
- Infection
- Trauma
- Previous fractures
- Rheumatoid arthritis
- Stress on weight-bearing joints (obesity)
- Certain occupations (athletes)
Osteoarthritis: Assessment
- Pain on movement
- Morning stiffness, reduced with activity
- Grinding sounds
- Decreased grip and strength
- Joint edema
- Joint instability
- Deformities (Heberden's/Bouchard's nodes)
Osteoarthritis: Treatment
- Weight reduction
- Exercise/rest program
- Analgesics (acetaminophen, NSAIDs, aspirin)
- Hydrocortisone injections into the joint
- Moist heat (decreases pain/stiffness)
Osteoarthritis: Other Treatment Options
- NSAIDs may increase blood pressure
- Glucosamine supplements (repair joint function)
- Alternative therapies: Chiropractic, acupuncture, massage, reflexology, Rolfing, cupping
Osteoarthritis: Surgical Interventions
- Arthrodesis (surgical fusion)
- Arthroplasty (increases joint mobility)
- Arthroscopy (examines joint damage)
- Hip replacement
- Osteotomy (corrects alignment)
Osteoarthritis: Complications for Surgical Interventions
- Phlebitis
- Infection
- Poor circulation
Gouty Arthritis
- Accumulation of uric acid in the blood (primary, secondary, idiopathic)
- Typically affects middle-aged men more often than women
- Most attacks in the great toe joint (often at night)
- Diagnosed with uric acid level >8 mg/dL
Gouty Arthritis: Affected Areas
- Great toe
- Foot
- Fingers
- Wrist
Gouty Arthritis: Assessment
- Excruciating pain, especially at night
- Edema and inflammation
- Heat and discoloration (purplish)
- Tophi (uric acid deposits in joints, kidneys)
Gouty Arthritis: Treatment
- Colchicine (acute attacks)
- Indocin
- Allopurinol/Xyloprine (reduces uric acid production)
- Febuxostat
- Probenecid (increases uric acid secretion)
Gouty Arthritis: Management
- Avoid purine-rich foods (organ meats, brain, kidney, liver, herring, anchovies, yeast, mackerel, scallops, sardines)
- Avoid alcohol
- High water intake (2000+ cc)
- Corticosteroids (acute attacks)
- Bed rest (acute attacks)
Gouty Arthritis: Diagnostic Tests
- Uric acid level
- CBC (leukocytosis, anemia)
- Elevated ESR
Gouty Arthritis: Physical Assessment
- Affected joint appears purple or red
- Limited movement
- Vital sign changes (temp, BP, HR, RR)
Gouty Arthritis: Medication Considerations
- Colchicine: Watch for nausea, vomiting, diarrhea
- Aspirin: Interferes with probenecid, contraindicated
- Febuxostat (Euloric): Increased risk of heart-related deaths
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Explore the key components and functions of the musculoskeletal system, including bones, muscles, tendons, and ligaments. Understand the significance of subjective and objective assessments in evaluating musculoskeletal health and body movements. This quiz covers essential concepts for students studying anatomy and physiology.
