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149 Cards in this Set
- Front
- Back
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Osteoarthritis
Pt education: example of warm compresses? |
Warm compresses, paraffin wax dips prn
(heat may help decrease the muscle tension around the tender joint and thereby decrease pain) |
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Osteoarthritis
Pt education: use cold applications when? |
when joint is inflamed –cold numbs nerve endings and decreases joint inflammation
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Osteoarthritis
Pt education: should you use pillows? |
• position joints in their functional position (do not use pillows under knees – may result in flexion contractures)
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Osteoarthritis
Pt education: Try complementary therapies like (2) |
like acupuncture and OTC mineral supplements that keep the integrity of cartilage to increase function
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Osteoarthritis
-Treatment Tylenol is the #1 choice. what should you monitor? if tylenol doesn't work, then try |
LFT
Salicylates such as buffered aspirin --NSAID’s such as (Naprosyn, Indocin, Motrin, Celebrex, and Hyalgan-joint injection for the knee) --- |
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Osteoarthritis
-Treatment what 2 other medications are used |
Muscle relaxant: Flexeril (given for muscles spasms, esp in the back)
Chemotherapeutic agents • Imuran, Cytoxan & Methotrexate, Steroids: Prednisone, Kenalog |
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Osteoarthritis
-Complications Surgical interventions may be necessary when |
other measures cant provide pain control, when mobility becomes restricted that the pt cannot participate in activities that they enjoy, or when they cant maintain the desired quality of life
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Osteoarthritis
-Complications Surgical Arthroscopy – Osteotomy – Arthroplasty- Arthrodesis- |
Surgical Arthroscopy – to remove damaged cartilage
Osteotomy – joint resection - excision of a section of bone; corrects joint deformity Arthroplasty – surgical creation of a joint -done through a scope Arthrodesis – surgical fusion of bones |
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Osteoarthritis
-Complications Arthroplasty – Arthrodesis – |
Arthroplasty – surgical creation of a joint -done through a scope
Arthrodesis – surgical fusion of bones |
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Osteoarthritis
-Surgical complications: |
•DVT (venous, not atrial) and pulmonary embolism
•Pneumonia •Hypovolemia •Impaired mobility –precursor of DVT •Joint dislocation •Infection |
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Rheumatoid Arthritis
is one of the most common ____________ diseases and is the most destructive to the joints. |
connective tissue
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Rheumatoid Arthritis
-what kind of disease is this?? |
It is a chronic, progressive, systemic, inflammatory autoimmune disease process
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Rheumatoid Arthritis - what does this primarily affect?
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the synovial joints
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Rheumatoid Arthritis
-what happens? |
Antibodies form and attack health tissue, esp. synovium, causing inflammation
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Rheumatoid Arthritis
-The chronic, progressive, systemic inflammatory process that primarily affects what? |
the synovial joints and surrounding muscles, tendons, ligaments, and blood vessels
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Rheumatoid Arthritis
-symmetrical / bilateral? |
multiple joints are usually inflamed in a symmetrical pattern (both sides of the body are affected) osteoarthritis is bilateral (1 sided)
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Rheumatoid Arthritis
-onset is characterized by? |
synovitis
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Rheumatoid Arthritis
what breaks down joint cartilage |
• Inflammatory mediators such as cytokines, chemokines, & proteases, attract & activate neutrophils & other cells which break down joint cartilage
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Rheumatoid Arthritis
what forms the pannus? |
Synovium thickens, fluid accumulates in the joint space & a pannus forms.
The pannus is a vascular granulation tissue composed of inflammatory cells; it erodes articular cartilage & destroys bone |
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Rheumatoid Arthritis
-what occurs secondary to this disease? |
• Fibrous adhesions, bony ankylosis, calcifications, bone density loss, & secondary osteoporosis occurs!
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Rheumatoid Arthritis
if blood vessel involvement occurs, what happens? |
(vasculitis)
-- the organ supplied by the blood vessel can be affected, resulting in malfunction/failure of that organ! |
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Rheumatoid Arthritis
-Permanent joint changes/damage will occur, disease can be suppressed through medication to retard destruction of the joint: |
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Rheumatoid Arthritis
s/s |
-Swelling of the joint
-Morning stiffness (may see in hands first) -Tender joint -Effusions (typically see in knees) |
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Rheumatoid Arthritis
what is a late manifestation? |
Joint deformity is a late manifestation of the disease
Inflammation of bld vessels (vasculitis) -Pulmonary and cardiac (pleurisy, interstitial fibrosis,pericarditits and myocarditis) |
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Rheumatoid Arthritis
will the joint feel hot or cold |
Joint will be hot (it is infected and has inflammation..infection through cytokine activation)
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Rheumatoid Arthritis
what does the joints feel like? what are other s/s? |
Spongy, soft feeling in joints
Low grade temp, fatigue, weakness |
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Rheumatoid Arthritis
what are the 3 late s/s? |
Joint deformities,
muscle atrophy, decreased ROM |
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Rheumatoid Arthritis
-what are the names of the nodes on the hands? |
Boutonnier of the hand (proximal)
Swan neck (distal) |
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Rheumatoid Arthritis
-How is it diagnosised ESR RF |
Elevated ESR (non specific – shows areas of inflammation in all areas of body - so all these labs tests have to be grouped together)
• Rheumatic factor (RF) measure the presence of unusual antibodies (IgG and IgM). Usually this test is negative for normal people. |
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Rheumatoid Arthritis
-How is it diagnosised Antinuclear antibody (ANA) Serum albumin |
Antinuclear antibody (ANA) measures the titer of unusual antibodies that destroy the nuclei of cells and cause tissue death in autoimmune diseases. –usually test is negative
-serum albumin (normal Is 3.5-5.0) pts with RA would have decreased levels due to chronic inflammatory or infection |
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Rheumatoid Arthritis
Pt education -balance activity with rest. take one or two naps each day -pace yourself, don’t plan too much for one day |
-set priorities. determine which activities are more important and do them 1st
-delegate responsibilities and tasks to your family and friends |
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Rheumatoid Arthritis
Pt education |
-plan ahead to prevent last minute rushing and stress
-learn your own activity tolerance, do not exceed it |
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Rheumatoid Arthritis
Treatment |
Plasmapheresis AKA plasma exchange. The plasma is treated to remove the antibodies causing the disease.
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Rheumatoid Arthritis
preserve joint functiom how? |
Aquatic exercises are the best thing – it removes the human body weight and allows them to be able to move joint more easily
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Rheumatoid Arthritis
ROM & strengthening exercises - what kind of ROM? |
–use active ROM when possible
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Rheumatoid Arthritis
-newest treatment? |
Enbrel (subQ x2/wk) BIOLOGIC RESPONSE MODIFIER
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Rheumatoid Arthritis
-drug therapy, such as: |
Drug Therapy such as ASA (pain), NSAID’s, -help relieve chronic pain by inhibiting prostaglandin synthesis
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Rheumatoid Arthritis
-Medications -Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) -why are they used |
to relieve pain and inflammation
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Rheumatoid Arthritis
-Medications Analgesic Drugs – may be prescribed to |
supplement the pain relief property in anti-inflammatory drugs
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Rheumatoid Arthritis
-Medications Glucocorticoids or Prednisone usually given for what reason? |
their fast acting antiinflammatory and immunosuppresive effects
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Rheumatoid Arthritis
-Medications Disease Modifying Antirheumatic Drugs (DMARDs) |
--These are used with NSAIDs and/or prednisone to slow joint destruction caused by RA over time.
•methotrexate, injectable gold, penicillamine, azathioprine, chloroquine, hydroxychloroquine, sulfasalazine and oral gold. |
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Rheumatoid Arthritis
-Medications Biologic Response Modifiers – These drugs directly modify |
the immune system by inhibiting proteins called cytokines, which contribute to inflammation. Examples of these are etanercept, infliximab, adaliumumab and anakinra.
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Rheumatoid Arthritis
-Medications -Protein-A Immuoadsorption Therapy Plasmapheresis: |
a therapy that filters your blood to remove antibodies and immune complexes that promote inflammation.
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Rheumatoid Arthritis
complications of plasmapheresis |
can alter the bodies normal immunity so need to watch very closely
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Rheumatoid Arthritis
--Surgery for arthritis: Synovectomy – |
surgical removal of the synovial membrane to help maintain joint function
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Rheumatoid Arthritis
--Surgery for arthritis: Arthrodesis – |
Bony fusion of a joint to regain mobility
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tension vs cluster headache
muscle tension which causes pain |
tension
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tension vs cluster headache
common in makes 20-50 years of age, men are affected 3x more than women |
cluster
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tension vs cluster headache
exact cause is unknown |
cluster
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tension vs cluster headache
neck and shoulder stiffness/tenderness |
tension
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tension vs cluster headache
linked to oxyhemoglobin desaturation and overactive hypothalamus |
cluster (low oxygen and sleep / hunger)
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tension vs cluster headache
pain is at the base or frontal region of the head |
tension
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tension vs cluster headache
typically occurs bilaterally |
tension
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tension vs cluster headache
hyperactive hypothalamus |
cluster
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tension vs cluster headache
also called a vascular headache |
cluster
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tension vs cluster headache
dilatory headache |
cluster
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tension vs cluster headache
nonpulsatile |
tension
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tension vs cluster headache
aggravation of the headache with activity |
tension
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tension vs cluster headache
lasts longer than 4 hours |
tension
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tension vs cluster headache
very clear define presentation: usually pain is located in 1 specific area (above eye or temporal region) |
cluster
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tension vs cluster headache
occurs unilateral |
cluster
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tension vs cluster headache
caused by stress and tension |
tension
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tension vs cluster headache
characterized by neck and shoulder muscle tenderness |
tension
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tension vs cluster headache
bilateral pain of the skull and in the forehead |
tension
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tension vs cluster headache
a very brief intense unilateral pain that occurs most often in spring and fall |
cluster
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tension vs cluster headache
pain lasting less than 4 hours |
cluster
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tension vs cluster headache
pain is 1 sided oculotemporal or oculofrontal headaches |
cluster
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tension vs cluster headache
the pain is described as excruciating, boring, nonthrobbing |
cluster
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tension vs cluster headache
the intense pain is felt deep in and around the eye |
cluster
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tension vs cluster headache
the headache lasts from 8-24 hours each day at the same time for about 4-12 weeks with the average duration of each headache being 30-90 minutes |
cluster
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tension vs cluster headache
the pain may radiate to the forehead, temple, or cheek |
cluster
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tension vs cluster headache
the temporal artery may be prominent and tender |
cluster
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tension vs cluster headache
the patient often paces, walks, sits, and rocks during an attack |
cluster
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tension vs cluster headache
the onset of the pain is associated with relaxation, napping, or rapid eye movement |
cluster
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tension vs cluster headache
the headache usually occurs with ipsilateral tearing of the eye |
cluster (same side)
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tension vs cluster headache
the headache usually occurs with rhinorrhea or congestion |
cluster (runny nose)
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tension vs cluster headache
ptosis |
cluster (drooping eyelid)
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tension vs cluster headache
the headache usually occurs with eyelid edema |
cluster
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tension vs cluster headache
facial sweating |
cluster
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tension vs cluster headache
miosis is common |
constriction of pupils
cluster |
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tension vs cluster headache
nonthrobbing pain |
cluster
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tension vs cluster headache
you can take tylneol, excedrine migraine but nothing will make this headache better |
cluster
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tension vs cluster headache
flushing and pallor are common |
cluster
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tension vs cluster headache
bradycardia |
cluster
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tension vs cluster headache
increased skin temperature |
cluster
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tension vs cluster headache
Typically occurs in a series lasting 10-15 minutes to two or more hours. |
cluster
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tension vs cluster headache
Throbbing pain over one eye, nasal congestion, may occur 1-2x’s a day. |
cluster
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tension vs cluster headache
Usually mistaken for a sinus headache y? cuz there can be nasal congestion nthat goes along with it and the pain can be in ur maxillary sinuses |
cluster
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tension vs cluster headache
Oxygen: via mask x10-15 minutes – treatment of choice |
cluster
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tension vs cluster headache
Treatment: Anti-inflammatories Prednisone |
cluster
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tension vs cluster headache
Selective serotonin agonists: Imitrex SL, do not combine with others |
cluster
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tension vs cluster headache
Treatment: Ergots |
cluster
They block (antagonists) inflammation that occurs within the vessels |
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tension vs cluster headache
constriction of muscles in the neck that could lead to a migraine headache |
tension
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tension vs cluster headache
Usually a band type feeling around the head, tight feeling, pressure “inside” feeling. |
tension
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tension vs cluster headache
precipitating factors: Stress, fatigue, depression, insomnia, prolonged position, neck tension from sitting, ergonomics of a work area, computer work, vision problems, head aches |
tension
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tension vs cluster headache
Similar to migraine headaches..the classic signs of nausea, vomiting, photophobia ( light sensitivity) and phonophobia (noise sensitivity) and aggravation of the headache with activity are common |
tension
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Migraines
what is the ideology? |
vascular
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Migraines
what happens in the arteries? |
vascular spasm
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Migraines
blood vessels overact to an event and that causes vascular spasm in the arteries..this causes what: |
constriction and a decrease in cerebral blood flow
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Migraines
what happens to the cerebral tissue? |
hypoxia
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Migraines
there is a increased serotonin release which causes what |
more constriction
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what kind of headache
a vascular phenomenon that resulted from intracranial vasoconstriction followed by rebound vasodilation |
migraine
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Migraines
what happens when the arteries dilate? |
prostaglandins are released which causes inflammation, swelling, and pain
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Migraines
what does the dilatory headache result from |
blood vessels dilating. it's an increase in pressure
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Migraines
lasts longer than 4 hours T or F |
true
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Migraine headaches are mediated via the trigeminal vascular system and its central projections. Blood vessels in the brain overreact to a triggering event, causing spasm in the arteries at the base of the brain. This response is followed by arterial constriction and a decrease in cerebral blood flow.
What can occur? What happens next? |
Cerebral hypoxia may occur.
Platelets clump together, and serotonin, a vasoconstrictor is released. Other arteries dilate, which triggers the release of prostaglandins (chemicals that cause inflammation and swelling) and other substances that increase sensitivity to pain |
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Migraine Characteristics:
unilateral or bilateral |
unilateral
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Migraine Characteristics:
wherei s the pain located? |
frontotemporal
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Migraine Characteristics:
nonthrobbing or throbbing pain |
throbbing
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Migraine Characteristics:
what are the visual changes that occur |
photophobia
diplopia (double vision) |
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Migraine Characteristics:
what hearing changes occur |
phonophobia (hearing sensitivity)
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Migraine Characteristics:
is there nausea and vomiting |
yes
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Migraine Characteristics:
what are 3 other common s/s that affect movement/ambulation |
vertigo
weakness fatigue |
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what kind of headache is the only one to have the sign and symptoms of running nose
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cluster
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Migraine Characteristics:
Symptoms are preceded by an “Aura” which is what? |
signal that headache is happening
a sensation such as visual changes that signals the onset of a headache or seizure. |
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Migraine Characteristics:
When does the aura occur? |
The aura of migraine headaches usually occurs immediately before the migraine episode
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Migraine Characteristics:
the aura can last how long |
minutes and lasts no longer than an hour
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Migraine Characteristics:
aura: what are some examples |
food cravings, mood changes, physical sensations, olfactory changes
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Migraine with aura (classic)
phase 1 or prodromal phase -consists of focal neurologic changes that affect function such as: |
-eyes are blurry
-numbness, tingling of lips or tongue -vertigo -unilateral weakness |
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Migraine with aura (classic)
phase 1 or prodromal phase -pain is preceded by _____ changes? give examples |
vision changes
visual disturbances flashing lgihts lines or spots shimmering or zigzag lights |
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Migraine with aura (classic)
phase 2 -what new sign and symptom results from intensity of pain |
nausea and vomitting
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Migraine with aura (classic)
phase 2 -pain (where does it begin) |
begins in the temple but increases in intesnsity and becomes throbbing within 1 hour
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Migraine with aura (classic)
in what phase do we want to get treatment/care? |
phase 1 or 2
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Migraine with aura (classic)
phase 3 -the pain changes from _____ to _______ |
throbbing to DULL
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Migraine with aura (classic)
phase 3 -headache, nausea, and vomitting may last how long |
several hours to days
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Migraine without aura (common migraine)
the migraine begins without an auora before the onset of the headache - when does pain begin? |
at onset
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Migraine without aura (common migraine)
-what makes the pain worse? |
physical activity
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Migraine without aura (common migraine)
describe the pain |
pulsating (throbbing)
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Migraine without aura (common migraine)
is the pain unilateral or bilateral? |
unilateral
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Migraine without aura (common migraine)
usually has 1 of the following s/s? |
nausea and/or vomiting
photophobia - light sensitivity phonophobia - sound sensitivity |
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Migraine without aura (common migraine)
how long do these headaches last? |
few hours or can linger for days
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Migraine without aura (common migraine)
often occur at what time of hte day? |
early morning
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Migraine without aura (common migraine)
these can occur during periods of: |
stress
those with premenstrual tension (hormonal changes - PMS) fluid retention |
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Treatments for tension headaches
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non-opiod analgesics (toradol / tylenol )
ASA NSAIDS (most effective combined with caffeine) |
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Treatment for cluster headaches
administration of oxygen via mask at 5-12L/min for 15 minutes What is the abortive treatment |
Sumatriptan SQ (Imitrex) it is a vasoconstricter
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Treatments for cluster headaches
during periods of attack, teach the patient to do what 2 things |
wear sunglasses and to sit facing away from the window to help decraese exposure to light and glare
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Treatment for cluster headaches
administration of oxygen via mask at 5-12L/min for 15 minutes why does oxygen do |
Oxygen reduces cerebral blood flow and inhibits activity of the carotid bodies, which are sensitive to oxygen levels in the body
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Preventive treatment for cluster headaches
short term use of: Ergots (Migranal) which is what? if Ergots doesn't work, they can try what? |
corticosteriods
alpha blocker-produces vascular constriction verapamil (dilates) |
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what is the cornerstone for the management of Migraine headaches
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Prevention
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Migraine headache treatment
-types of drugs initially prescribed |
NSAIDS (ibuprofen / naproxen)
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Prevention of migraine headaches
what type of medication is used for prevention |
beta blockers (Propranolol - Inderal) and timolol
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Migraine headache acute treatment
The goal of treatment is to terminate the symptoms of pain as soon as possible or stop the progression of the headache in the aura phase if present. 2 kinds of drugs |
Ergots
NSAIDS Block (antagonists) inflammation associated with the trigeminal vascular system (help inflammation that occurs within the vessels) |
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Migraine headache acute treatment
ED Cocktail: IVP consists of what 3 drugs |
Diphenhydramine (Benadryl) 25 mg, antihistamine works on swelling
Ketorolac (Toradol) 30mg anti-inflammatory (works good with tylenol) Prochlorperazine (Compazine) 10mg works on nasuea and it works on dopamine receptors in the brain, works on sedation and reducing n/v |
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Migraine headache treatment
Selective Serotonin agonists (triptans): -what do they do? -what should you include in your teaching of this? |
Enhance the receptor action
Do not combine –triptan drugs together take 1 product only. If you take Amerge and it doesn’t work, you do NOT try imitrex. They are constricters and they constrict everywhere, including your heart. It could cause a stroke or a heart attack. |
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Migraine headache treatment
Triptans -only work for patients who have what kind of headache? |
Only work for pts who has a dilatory headache because they are constrictors
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Migraine headache treatment
Triptans -how does it relieve the headache & associated symptoms? |
by activating serotonin receptors on arteries to produce a vasoconstrictive effect
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Selective Serotonin agonists (triptans):
Can cause vasoconstriction of the cerebral/cardio vascular system and produce an anti-inflammatory effect Prior to administration, the patient should be evaluated for what |
for any coronary or cerebral risk factors by their primary health care provider (coronary and stroke risk factors
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Adverse effects for triptans:
When should patients take these? Teaching: what should you tell the patient to report? |
Coronary vasospasm --> angina --> hypertension
-Teach pts taking triptan drugs to take them as soon as the migraine symptoms develop. Instruct pts to report chest pain or tightness because they may develop angina |
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Tell patients who are taking triptans that they cannot take them with what other medication?
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SSRIs
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