Musculoskeletal 2 (Exam 2)

Front 1

Risk factors for osteoporosis

Back 1

Lack of Ca, lack of weight bearing excercise, smoker, sedentary, low estrogen, non child bearing, stress (releases cortisol a STEROID), female, family hx

Front 2

Meds that increase risk of osteoporosis

Back 2

Steroids, Methotrexate, Anticonvulsants, Cyclosporine, Heparin

Front 3

Bone mineral density measurements

Back 3

Healthy - above 1
Osteopenia - -1- -2.5
Osteoporosis - less than -2.5

Front 4

Biphosphonate drugs

Back 4

-dronates
-Fosamax and Boniva

Front 5

Biphosphonates - how do they work?

Back 5

Cause osteoclast apoptosis, so the decrease bone breakdown.

Front 6

Nursing responsibilities for biphosphonates...

Back 6

They cause esophagus erosions, so the pt is to remain sitting/standing for 30 min after taking them.
Take them in the am before eating or drinking.

Front 7

Human PTH

Back 7

Used for osteoporosis.
Forteo.
Stimulates osteoblasts for bone growth.

Front 8

Biophosphonate side effects

Back 8

esophagus erosions. jaw necrosis and femur fractures because there are mini fractures from less bone turnover.

Front 9

Human PTH nursing responsibility

Back 9

Assess for bone pain b/c Forteo causes increased risk for bone cancer.

Front 10

How does calcitonin work?

Back 10

It inhibits osetoclasts, so it keeps Ca in the bones. Used for osteoporosis.

Front 11

Nursing responsibility for Calcitonin

Back 11

Monitor for hypocalcemia b/c Ca isn't going out of the bones in to the blood.

Front 12

Assessment in osteoarthritis...

Back 12

Client experiences joint pain that diminishes after rest and intensifies after activity.

Front 13

Interventions for osteoarthritis

Back 13

NSAIDs, muscle relaxants, corticosteroid injections.
Immobilize affected joint.
Avoid lg pillows under head or knees.
Hot and cold.
Encourage rest, 10 hrs of sleep at night and a 1 to 2 hour nap in the afternoon.
Manage weight.

Front 14

Difference in osteoathritis from RA

Back 14

No systemic manifestations like fatigue or fever. RA is worse when they wake up and get better with movement. RA is symmetrical.

Front 15

Synovial fluid in OA is

Back 15

clear to yellow

Front 16

Synovial fluid in RA has

Back 16

>20,000/u WBC

Front 17

Labs in OA and RA

Back 17

ESR is elevated in RA, but not in OA

Front 18

Rx for RA

Back 18

DMARD's. They decrease the immune response like chemo drugs. Monitor for pancytopenia, infections, and flu-like symptoms. Methotrexate, cyclosporine, sulfasalazine (causes orange pee/tears), azithropine

Front 19

First line Rx for RA

Back 19

Methotrexate

Front 20

Primary nursing dx with arthritis

Back 20

PAIN

Front 21

how to use a walker

Back 21

Move the walker forward, the weaker foot, then the stronger foot.

Front 22

Cane use

Back 22

Position cane on the unaffected side 6in away so that the cane and the weaker leg work together with each step.

Front 23

Side FX of corticosteroids

Back 23

Cushings syndrome, lowered immunity, increased blood sugar, decreased K and Ca, Na and H2O retention May need to increase dose with surgery

Front 24

Hallmark of RA

Back 24

Early a.m. stiffness or when there is inactivity.

Front 25

Systemic effects of RA

Back 25

ANEMIA
Rheuthmatoid nodules (non tender) may occur on lungs and eyes
Sjogren's syndrome - autoimmune disorder that attacks the moisture producing glands (eyes, mouth)
Felty syndrome - splenomegaly, blood dycrasis, lymphadenapathy, inflamed eyes, and pulmonary disorders

Front 26

Synovial fluid in RA

Back 26

Straw colored due to fibrin flecks, elevated WBC's

Front 27

RA drugs

Back 27

DMARD's
ASA
NSAIDS
Glucocorticoids

Front 28

Positioning with RA

Back 28

Use extension, not flexion. Never place pillows under the knees, and always use a flat pillow for the head.

Front 29

Osteomylitis

Back 29

Infection of the bone

Front 30

Osteomylitis sucks b/c

Back 30

Antibiotics don't get in to the bone very well. Sequestra form (island of infected bone) and produce pus continuously.

Front 31

S/S of osteomylitis

Back 31

Tremendous pain, WBC count sky high, inflammatory tests all elevated (ESR, WBC, neutrophil)

Front 32

People at high risk of osteomylitis

Back 32

Diabetics, immunocompromised persons, and people with orthopedic implants. Compound fractures.

Front 33

Skeletal muscle relaxants

Back 33

Watch liver tests. They have anticholinergic FX, so contraindicated with glaucoma and urinary retention. Dantrium. Flexyrl

Front 34

Rx for osteomylitis

Back 34

Antibiotics for 6-8 weeks, skeletal muscle relaxants, traction

Front 35

Osteomylitis contraindication

Back 35

Avoid heat application as it spreads the infection.

Front 36

Osteomylitis teaching

Back 36

Teach potential toxic reactions for prolonged high-dose antibiotic therapy. Ototoxicity, Nephrotoxicity, Hepatotoxicity, colitis. Teach to report thrush S/S.

Front 37

What do you watch for with post op back surgery?

Back 37

CSF leak

Front 38

Complications of back surgery

Back 38

decreased blood flow, nerve damage. High injuries affect respirations, low injuries affect urinary and bowel (incontinence)

Front 39

Teaching with back injuries

Back 39

Get them excercising and doing ADL's. Sleep side lying most of the time, teach good body mechanics.

Front 40

Uric acid is excreted

Back 40

by the kidneys

Front 41

Gout meds

Back 41

colchine
allopurinol
propenicid
anturane

Front 42

Do you take ASA with gout meds?

Back 42

NO!!

Front 43

Teaching for gout

Back 43

Drink 2-3L of H2O to prevent renal stones
Avoid alcohol, caffiene, wine, organ meats, sardines, scallops, gravy.

Front 44

Drug/Drug interactions for gout meds

Back 44

Coumadin and oral hypoglycemics. Increase their effect.

Front 45

Teaching for gout meds

Back 45

Use cautiously with GI, renal, hepatic, or cardiac disease. Side effects: blood dycrasias, kidney stones.
Take with food.

Front 46

Difference b/w fibromyalgia and RA

Back 46

Fibromyalgia causes irritable bowel, RLS, depression, sleeping problems, headaches

Front 47

Fibromyalgia meds

Back 47

Neurontin, tricyclic antidepressants

Front 48

S/S of fibromyalgia

Back 48

Widespread burning pain that worsens and improves throughout the day, tender points, depression, nonrestorative sleep, RLS

Front 49

Fibromyalgia patho

Back 49

serotonin, substance P, low blood flow to thalamus

Front 50

Dx of fibromyalgia

Back 50

11 of 18 tender points in all 4 quadrants hurt for >3months

Front 51

Dietary considerations for fibromyalgia

Back 51

Limit sugar, alcohol, and caffiene b/c they are muscle irritants

Front 52

Lyme disease is spread by

Back 52

the deer tick

Front 53

Lyme disease S/S

Back 53

Bullseye erythmia, fever, headache, fatigue, still neck, swollen lymph nodes migratory joint and muscle pain.

Front 54

Lyme disease is treated with

Back 54

antibiotics like doxycycline and cefuroxime and amoxicillin

Front 55

How do you remove a tick?

Back 55

Pull him close to his mouth away from the skin. Don't use kerosene, matches, or vasoline