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89 Cards in this Set
- Front
- Back
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Define arthritis:
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The inflammation of one or more joints
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Define osteoarthritis:
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The progressive deterioration and loss of cartilage in one or more joints
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What joints are most affected in OA?
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Hips, knees, spine, and hands
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Delineate nodal vs. non-nodal OA:
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Nodal involves the hands, non-nodal does not
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Is primary or secondary OA more common?
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Primary (idiopathic)
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Factors leading to OA:
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Age, smoking, obesity, female
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How long does joint stiffness last in OA after inactivity?
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30 minutes
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What causes pain in OA?
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Activity
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How do joints appear in OA?
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Can be enlarged; rarely hot or inflamed
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Where are Heberden's nodes located?
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Distal interphalangeal joints
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Where are Bouchard's nodes located?
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Proximal interphalangeal joints
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Nursing diagnoses for OA:
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Chronic pain
Impaired physical mobility |
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What analgesic is recommended for OA pain as the primary drug of choice?
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Tylenol
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What analgesics are used for OA pain?
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Tylenol
Topical lidocaine NSAIDs Opioids Cortisone injections |
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Contraindications for total joint replacement:
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Active infection
Advanced osteoporosis |
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Common complication of a total hip replacement:
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Subluxation (partial dislocation) or total dislocation
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What limitations on movement does a patient have after a total hip replacement?
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Do not flex the hip more than 90 degrees
Do not abduct the hip across the midline |
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Post-operative care for a total knee replacement:
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Pain management (more severe than hip replacement)
Continuous passive motion machine Ice packs/cold therapy to decrease swelling |
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Care of a patient with a continuous peripheral nerve block:
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Neurovascular assessments q2-4hr
Check for signs that infusion is going systemic (CNS changes) |
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What is a pannus in a joint affected by RA?
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Vascular granulation tissue composed of inflammatory cells that erodes cartilage and bone
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What are the typical reported symptoms of RA?
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Joint stiffness and swelling
Pain Fatigue Generalized weakness and stiffness in the mornings |
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What joints are initially involved in RA?
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Upper extremity joints, especially PIP and metacarpo-phalangeal joints
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How does an RA-affected joint appear?
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Reddened, warm, stiff, swollen, and tender
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What's the pattern of joint involvement with RA?
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Bilateral and symmetric, with the number of joints involved increasing as disease progresses
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How long does morning stiffness last in RA?
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45 minutes to several hours
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Why is cervical disease in RA so critical to assess and monitor?
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Subluxation of these joints can restrict the phrenic nerve, which innervates the diaphragm
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How do you assess for vasculitis in an RA patient?
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Ischemic skin lesions that appear in groups as small, brown spots (especially around the nail bed)
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Sjogren's syndrome consists of:
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Dry eyes
Dry mouth Dry vagina |
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Drug therapy of choice for most RA patients:
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DMARDs (esp. methotrexate)
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Types of pharmaceutical therapy used for RA:
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DMARDs
NSAIDs Steroids Biological response modifiers Immunosuppressants |
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Osteoporosis vs. osteopenia:
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Osteoporosis is decreased bone density
Osteopenia is low bone mass |
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What type of bone tissue is the first to diminish in density?
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Trabecular/cancellous
(Followed by cortical) |
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T-score diagnosing osteoporosis:
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-22.5
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Generalized vs. regional osteoporosis:
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Generalized involves many skeletal structures
Regionalized comes from immobilization of a limb, etc |
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What's the best prevention of osteoporosis?
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Building strong bones in early adulthood
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How does a lack of dietary calcium and vit D cause osteoporosis?
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Their lack triggers parathyroid hormone, which triggers the release of calcium from bones
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What symptoms suggest a compression vertebral fracture?
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Back pain, tenderness, and voluntary restriction of spinal movement
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Common nursing diagnoses for osteoporosis:
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Risk for falls
Impaired physical mobility Acute/chronic pain Potential for fractures |
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Therapy for osteoporosis:
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Nutritional therapy
Exercise Drug therapy |
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Pharmaceutical therapy used for osteoporosis:
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ERT/HRT
Parathyroid hormone Calcium/vit D supplements Bisphosphonates SERMs |
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Define osteomalacia:
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Loss/softening of bone caused by vitamin D deficiency
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What can cause a vitamin D deficiency?
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Inadequate nutritional intake
Inadequate sun exposure Small bowel removal or disease |
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Define Paget's disease:
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A chronic metabolic disorder in which bone is excessively broken down and reformed
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Manifestations of Paget's disease:
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Deformed, vascular, structurally weak bone
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Most common sites of involvement for Paget's disease:
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Vertebrae, femur, skull, clavicle, humerus, and pelvis
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What Paget's symptom causes most people to seek medical attention?
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Bone pain (poorly described and aching), especially in the hip/pelvis, aggravated by walking
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Changes in the skull seen in Paget's disease:
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Soft, thick, and enlarged typically
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Drug therapy for Paget's disease:
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NSAIDs for pain
Oral bisphosphonates Calcitonin Mithracin in extreme cases |
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Define osteomyelitis:
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Infection in a bone
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Describe the cycle of osteomyelitis:
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Bone becomes infected
Soft tissue gets inflamed and edematous Exudate released into bony tissue Bone becomes necrotic Necrotic bone/sequestrum prevents healing and causes superimposed infection |
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Manifestations of osteomyelitis:
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Bone pain
Fever Swelling, erythema, heat and tenderness at site Ulcerations distal to site if vascular insufficiency is present |
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Nursing diagnoses for osteomyelitis:
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Acute/chronic pain
Hyperthermia Ineffective tissue perfusion Potential for sepsis |
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Drug therapy for osteomyelitis:
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IV antibiotics
Analgesia Hyperbaric oxygen therapy |
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The 6 P's of assessment of neurovascular compromise:
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Pain
Paresis Paralysis Paresthesias Pallor Pulselessness |
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Complete vs. incomplete fracture:
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Complete: two pieces of bone
Incomplete: still one piece |
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Open/compound vs. closed/simple fractures:
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Compound: skin disrupted
Simple: skin intact |
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Define a pathologic fracture:
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Occurs after minimal trauma to diseased bone
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Define fatigue/stress fracture:
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Results from excessive strain/stress on bone
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Define compression fracture:
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Caused by loading force applied to long axis of cancellous bone
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Common site of compression fracture:
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Vertebrae
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Stages of fracture healing:
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Hematoma - granulation tissue/fibrocartilage - vascular/cellular proliferation/callus - bone tissue - bone consolidation/remodeling
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Speed of fracture healing in healthy young adult:
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4-6 weeks
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Define compartment syndrome:
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Increased pressure in one or more compartments reduces circulation to the area
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Describe the ischemia-edema cycle:
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Ischemia causes capillaries to become more permeable, causing edema, which causes pressure and pain, then reduced blood flow, hence further ischemia
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What deficits are first noted in compartment syndrome?
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Sensory deficits/parasthesias
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When do pulses disappear in compartment syndrome?
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They rarely ever do
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How long can compartment syndrome last before irreversible damage occurs?
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4-6 hours
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How long can compartment syndrome last before the limb is useless?
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24-48 hours
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Define fasciotomy:
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Surgical opening of a compartment
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Define myoglobinuric renal failure:
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Injured muscle releases myoglobin into circulation, where it clogs renal tubules
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Cardiac implications of muscle damage:
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Renal failure can lead to hyperkalemia and dysrhythmias/arrest
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Post-injury time frame for compartment syndrome:
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6 hours - 2 days post injury
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Define crush syndrome:
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External crush injury compresses one or more compartments in leg/arm/pelvis
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Indications of crush syndrome:
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Compartment syndrome
Hypovolemia Hyperkalemia Rhabdomyolysis Tubular necrosis Muscle weakness/pain Dark brown urine |
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Define fat embolism syndrome:
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Fat globules from bone marrow are released into circulation and clog organ vessels
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What organ is typically affected by fat embolism syndrome?
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Lungs
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What injury typically causes fat embolism syndrome?
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Long bone fractures or fracture repair
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Who is at greatest risk of fat embolism syndrome?
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Young men 20-40yo
Older adults 70-80yo Fractured hips |
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What's the earliest manifestation of fat embolism syndrome?
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Altered mental status
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What is a classic but possibly late sign of fat embolism syndrome?
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Petechiae on the neck/upper arms/chest/abdomen
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Lab findings with fat embolism syndrome:
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Increased ESR
Decreased Ca+ Decreased RBC/Plt Increased lipase |
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Most common complication of lower extremity surgery or trauma:
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Venous thromboembolism
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Late complications of fracture:
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Avascular necrosis and delayed union
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Most common fracture in adult population:
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Rib
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Three major compoments of a neurovascular check:
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Circulation
Movement Sensation |
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Define skin/Buck's traction:
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Velcro boot around leg and weight pulling on it
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Weight limit for Buck's traction:
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5-10lbs
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Define skeletal traction:
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Pins in bone
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Weight limit for skeletal traction:
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15-30lbs
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