Musculoskeletal Quiz

• Study notes on the concept of immunity and other mobility disorders

Rheumatoid Arthritis

• Autoimmune disease: The immune system attacks the body's own tissues
• A chronic, progressive, and systemic disease that affects multiple joints throughout the body
• It is characterized by recurrent inflammation of diarthrotic joints, specifically targeting articulating surfaces
• Marked by periods of remission and exacerbation that vary in duration and intensity
• Pathophysiology: Autoimmune response targets the synovium, leading to inflammation, and overtime joint deformities and loss of function
• Joint Manifestations: - Boutonniere - Ulnar deviation - Common sites for rheumatoid nodules

Stages of RA

• Early Stage: Generalized weakness; warm, tender, swollen, and painful joints; mild to moderate pain
• Late Stage: Joint stiffness, chronic pain, muscular atrophy
• Recognizing Cues: Fever, loss of appetite (anorexia), fatigue, and symmetrical joint deformity during exacerbation
• Diagnostic Studies involve Laboratory and imaging studies
  • Laboratory: C-reactive protein, rheumatoid factor, CBC, erythrocyte sedimentation rate, anti-CCP antibodies-anti-cyclic citrullinated peptide test is positive
• Imaging Studies:
  • X-ray
  • MRI
• Pharmacotherapy includes NSAIDs, Corticosteroids, DMARDs
• Generate Solutions:
  • promote exercise, rest, assistive devices, proper body alignment, moist heat before activity and cold after activity, complementary/nonpharmacologic therapies, and a balanced nutrition
• Surgical Management: Arthrodesis- fusion of two or more bones in joints and Synovectomy- removal of the synovial lining in a joint
• Goals of Patient Care
  • Maintain joint mobility and function
  • Decrease pain and inflammation
  • Control disease process with appropriate interventions

Osteoarthritis

• Osteoarthritis
  • Pathophysiology involves the erosion of joint articular cartilage, leads to overgrowth of bone, is chronic, painful, and mild swelling, affecting hands and weight bearing joints
• The joints most commonly affected by osteoarthritis include the neck, shoulders, hands, back, hips, knees, and big toes/foot
• Recognizing Cues: The initial symptom is pain with joint movement, stiffness, crepitus and decreased range of motion (ROM) - Deformities: - Heberden's node is in the Distal Interphalangeal joints (DIP) - Bouchard's node is Proximal Interphalangeal joints (PIP) - Analyzing Cues: Age - 55 and above, BMI, repetitive stress work, Gender as women, weight as obesity and Genetic influences - Diagnostic Studies: - Lab results: CRP (C-reactive protein), ESR (erythrocyte sedimentation rate, rheumatoid factor- negative, Synovial Fluid -Imaging: X-ray, MRI - Pharmacotherapy: Medication to control pain/inflammation Non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, local injection, topical analgesic - Take Action: Collaborative interventions includes lifestyle, physical therapy/ exercise, promote rest, assistive devices, and heat and cold

Surgical Management

• Arthroplasty: knee (TKA) or hip (THA) - Goal: Remove damage, relieve pain, and restore function of the joint
  • Post Joint surgery monitoring: VS monitoring, Wound assessment, Promote early ambulation and Pain Relief, Infection Prevention, Neurovascular assessment which checks pain, pulselessness, pallor, paresthesia and paralysis
• Early Mobilization: Assistive devices, continuous passive motion, hip precautions
• Joint Surgery: Complications include DVT, Hip dislocation, joint infection and bleeding Take Action: Hip Precautions Avoid adduction and hyperflexion and Do not rotate leg when standing. Keep leg straight Avoid adduction and hyperflexion Do not bend body forward to pick objects and Do not bend hip above 90 degree

Gout

• Gout is an inflammatory joint disorder resulting from deposition of uric acid crystals in joints, cause is a ↑ in uric acid production and under excretion of uric acid by the kidneys.
• Four stages of Gout: - Hyperuricemia - Acute gouty arthritis - Intercritical gout - Chronic tophaceous gout
• Pathophysiology progression:
  1. Uric Acid Builds
  2. Uric Acid Crystals Form
  3. Inflammation
  4. Repeated Attacks Can Damage Joints

Stages of Gout

• Hyperuricemia: What happens-Uric Acid Crystals, What you feel Asymptomatic and is in the Silent Stage, Risk may start to develop crystals in the joints
• Acute Gout Arthritis: What happens- Triggers Inflammatory Response in joints (often in big toe), What you feel warmth, swelling, redness, pain, and flare ups last 3-10 days, Risk Crystals Developing putting you at risk for more flare ups in the future
• Intercritical Gout: Symptoms disappear for a couple of months to a couple of years, Feel like its gone while crystals may still be building, Risk is even though may have gone away, uric acid crystals are still building, at risk for another attack/flare up. At risk for chronic gout.
• Chronic Tophaceous Gout: Permanent joint damage, you feel Pain, Tenderness, Stiffness, Joint Deformities. You are at risk for Kidney stones (made of uric acid )
• Analyzing Cues: Family history, excessive alcohol consumption, diet, medicines, medical conditions
• Diagnosis: History and physical, Serum uric acid levels, 24-hour urine, and Synovial fluid aspiration
• Pharmacotherapy: Colchicine, NSAIDs, Corticosteroids, Allopurinol USP, Probenecid
• Take Action: Collaborative approach includes activity and rest, dietary restrictions, ↑ fluid intake, heat/cold therapy, weight loss, and joint protection
• Low-Purine Diet for Gout encourages certain foods. - Eat more Fruits, Vegetables, Whole grains, Low-fat dairy, Legumes, Nuts - Eat less Shellfish and Organ meats (liver), Alcoholic beverages, Soft drinks

Osteoporosis

• Osteoporosis Overview Chronic, progressive bone disease characterized by low bone mass and deterioration of bone tissue Bone resorption (osteoclast) exceeds bone deposition (osteoblast) "Silent disease" - occurs without signs or symptoms. Affects an estimated 54 million Americans
• Results in about 2 million bone fractures each year
• What is Normal Bone Tissue:
  • Bone remodeling is a continuous process where old bone is removed (resorption) by osteoclasts, and new bone is formed (formation) bv osteoblasts. This maintains
• What is Abnormal Bone Tissue: - Pathophysiology: After age 30, pace of osteoclasts outpaces osteoblasts (rate of bone resorption exceeds rate of bone formation)
• Risk Factors:
  • C - Calcium & Vitamin D intake low
  • A - Age
  • L - Lifestyle
  • C - Caucasian or Asian female
  • I - Inherited (family history)
  • U – Underweight
  • M - Medications Recognizing Cues (signs & symptoms)
• Loss of height
• Kyphosis (Dowager's hump)
• Low back pain
• Fragility-related fractures
• Diagnostic Studies:* Dual-energy X-ray absorptiometry (DEXA) scan Ultrasound and X-ray Calcium Vitamin D
• PharmacoTherapy:* Bisphosphonates Alendronate (Fosamax) Hormonal Agents Calcium, Vitamin D Surgical Intervention-VertebroPlasty and Kyphoplasty Take Action: Collaboration Assess for risk factors: Smoking Lifestyle changes
• Educate on ways to prevent osteoporosis*: -Encourage weight-bearing exercises -Consume foods rich in calcium & vitamin D
• Teach about preventing falls*: -Teach adequate calcium and vitamin D -Smoking cessation

Fractures

• SAME pathophysiology as osteoporosis

• -The integrity of the bone or joint has been altered

• Most common in trauma and older adults direct injury.

• Etiology and Risk Factor: - Trauma and abuse cause Direct Injury - Neoplasms, Malnutrition, Medication and Osteoporosis are Pathologic Causes

• Fractures are Classified based on their characteristics, location, and severity.

• Types based of bone alignement:

  • Closed (Simple) Fracture: The bone breaks but does not penetrate the skin. +Open (Compound) Fracture: : The broken bone pierces through the skin, increasing the risk of infection

• Types based on fracture line type: A straight horizontal break across the bone.

• Transverse Fracture

• Oblique Fracture:

• Spiral Fracture: The bone is twisted, causing a spiral-shaped break.

• Comminuted Fracture: The diagonal break across the bone.

• Greenstick Fracture: one side of the bone bends and the other The bone shatters into three or more fragments. An incomplete fracture where

Types baseed on severity:

• Complete Fracture or more parts.
• Incomplete Fracture way through : The bone is completely broken into two :The bone cracks but does not break all the
• Stress Fraction: the bone has repetitive break
• Pathological Fracture: The bone has been weakened
• Skull Fracture: Involves the bones of the skull.
• Hip Fracture: A break in the femur near the hip joint, common in older
• Vertebrae Fracture: fracture and may effect spinal cord function
• Signs: Edema, deformity, muscle spasm
• Recognizing Cues: Pain, Edema, Deformity, Muscle Spasm, Bruising, and crepitus, limited ROM
• Analyze Cues: Complications can include: hemorrage, DVT, nuero compromise compartment syndrome
• Recognizing Cues: Compartment Syndrome, Patients may experience Pain, Pressure, Paralysis, Pallor, and Paresthesia
• The serious cause of comprmentsyndrome when the muscle build sup to much pressure.
• If their is swelling the fascia traps the swelling inside can cut off blood flow to the musscles and itsuse.
• If untreated, comprant syndrome can leed to loss of function or even amputation .
• Intervention; fascitomy : The surgical intervention of the facia to relieve preassure.
• Fat embolisms is the presents of neurolagic detrition, respiratory distress.
• Petecia: Pin point area of hrmrrage
• Diagnostics history physical Exam XRAY, CT, and MRI Diagnostics: History, Physical exam, Xray, CT, MRI If surgey indicated, additional testing will be needed.
• Nursing Management: Immediate care, resting and elecation
• Treatment goal: Restore function and anatonic bone alignment
• Collaborative teatments.
  • Cast or spint - rigid device - immoblizes
• Treatmet evalutaiton, pain management, -Cast can not get wet
• cast care preform neuro vascular assesment Rest: Keep Limb stationary Ice: Reduces the pain of inflammation Intermittent application for 2448 Compression: Reduces swelling and assists with immobilization. Elevation: Reduces swelling
• Collaborative care:
  • Encourage patient with safe mobiligy
• Pain Mangament, pharmacologic and non pharmacoloc