Class 12 Muscoloskelectal

define osteoporosis

progressive metabolic bone disease marked by low bine mass and deterioration of bone tissues that leads to bone fragility

why is osteoporosis more common in women

lower calcium intake, less bone mass, resorption of bone begins early and increases after menopause, pregnancy & breastfeeding, longevity

what are risk factors for osteoporosis?

estrogen deficiency, increasing age >65, women, low body weight, white/asian, cigarette smoking, sedentary lifestyle, low calcium/vit D, excessive use of alcohol, low testosterone, certain drugs (ex. phenytoin, aluminum antacids, corticosteroids)

how do osteoclasts and osteoblasts relate to osteoporosis

bone resorption (osteoclasts) exceeds bone deposition (osteoblasts)

what are the main physical effects of osteoporosis

kyphosis (humpback) and decrease in height

what is nursing care/patient education focused on for osteoporosis

proper nutrition, calcium supplements and vitamin D tablets, weight bearing exercise for prevention, low impact exercise, prevention of falls, drug therapy

what is the recommended calcium intake for younger men/women vs older mne/women

- younger: 1000 mg/day

- older: 1200 mg/day

what are good sources of calcium

milk, yogurt, cottage cheese, spinach, salmon, greens, white beans, broccoli

what are the function of biophosphonates and give an example med

- inhibit bone resorption

- ex. alendronate (Fosamax)

describe the proper med admin for alendronate (Fosamax)

- take with NO other meds with full glass of water & empty stomach

- can cause GI upset

- sit up for 30 mins after taking and do not eat for 1 hour after

describe the use of calcitonin for osteoporosis and considerations

- inhibits bone resorption by replicating the hormone produced by the thyroid gland, decreasing osteoclast activity

- can decrease calcium so pt needs calcium supplements

describe osteoarthritis

progressive unilateral non-inflammatory disorder of diarthrodial/synovial (freely movable) joints, that causes loss of articular cartilage and formation of osteophytes ("bone spurs")

when does osteoarthritis begin and when do symptoms become present

begins around age 20-30 and manifests after age 50-60

what are risk factors for osteoarthritis

increased age, decreased estrogen, frequent kneeling/stooping, overuse of joints, smoking, anterior cruciate ligament injury

what are general clinical manifestation of osteoarthritis

localized joint pain upon movement, stiffness, tenderness, enlarged joint, reduced flexibility, crepitation, asymmetrical, joint space narrowing

what are joint specific manifestations of osteoarthritis in the knee

bowleg, knock-kneed

what are joint specific manifestations of osteoarthritis in the hip

one leg appears shorter

what are joint specific manifestations of osteoarthritis in the fingers

herberden's nodes (DIP joint), bouchard's nodes (PIP joint), red/swollen/tender, loss of function, deformity

what is involved with nursing care for osteoarthritis

PT, assistive devices, well fitting shoes, splints, drugs, heat for stiffness, cold for inflammation, proper body mechanics, exercise, protect joints

how do you encourage rest and join protection for osteoarthritis

high energy activities in morning, avoid long immobilization, do not bend knees past 90 degrees, avoid forceful/repetitive movements, avoid prolonged standing/sitting/kneeling

what drugs are involved with managing osteroarthritis

acetaminophen, nsaids, capsaicin cream, intra-articular corticosteroid injections

describe rheumatoid arthritis

systemic bilateral autoimmune disorders that causes IGG antibodies to deposit in synovial membranes and activate the inflammatory response which damages cartilage and thickens synovial lining

list and describes the stages of rheumatoid arthritis

- stage I (early): inflammation of synovial membrane w/ high WBCS, but no destructive changes

- stage II (moderate): inflammation of cartilage + joint cavity, gradual destruction

- stage III (severe): synovial pannus formation, eroded cartilage and exposure of bone

- stage IV (end): loss of function, subcutaneous nodules

what are clinical manifestations of rheumatoid arthritis

joint pain, rheumatoid nodules on fingers/elbows, high WBC count, deformity, swelling, stiffness in morning, spindle shaped fingers

what are typical distortions of the hand in rheumatoid arthritis

- ulnar drift: "zig-zag" of fingers away from midline

- boutonniere: flexion of PIP joint and hyperextension of DIP jpint

- hallux vagus: bunion

- swan neck: hyperextension of PIP joint, inwards bending of fingers

what are other systemic manifestations of rheumatoid arthritis

felty syndrome (enlagred spleen and low wbc), cataracts, depression, sjogrens syndrome

what labs help diagnose rheumatoid arthritis

positive anti-ccp antibodies, elevated rheumatoid factor, elevated ESR, positive ANA titer, elevated c-reactive protein, increased WBCs, decreased RBCs

what bodily positions should be encouraged and discouraged in rheumatoid arthritis

- encourage positions of extension and firm mattress/bed board

- discourage flexions positions and excessive pillows

describe DMARDS

disease modifying anti-rheumatic drugs decrease the permanent effects of rheumatoid arthritis

describe BRMS

biologic response modifiers slow the progression of rheumatoid arthritis

what other drugs can be used for rheumatoid arthritis

corticosteroids, NSAIDS, salicylates

describe gout

acute arthritis characterized by elevation of uric acid and deposit of uric acid crystals in joints

what causes gout

increased uric acid production, reduced excretion of uric acid by kidneys, increased purine food intake, obesity, excessive alcohol

what is involved in patient education of gout

reduce weight, avoid alcohol and purine foods, apply local heat/cold, limit movement to reduce symptoms, increase water intake to remove uric acid

describe systemic lupus eryhtematosus (SLE)

systemic inflammatory autoimmune disease that effects skin, skins, serous membranes, renal system, hematologic system, and neurologic system

what are clinical manifestations of SLE

anti-smith antibodies, vascular skin lesions, butterfly rash, oral/nose ulcers, arthritis, polyarthralgia (joint pain), swan neck fingers

what is patient education for SLE

avoid drying soaps/powder/chemicals, limit infection risk, avoid stress

what is involved in acute care for SLE

record severity of symptoms and response to therpy, monitor weight and I/Os, assess neurologic status, provide emotional support, observe for fever/inflammation/fatigue, reduce exposure to precipitating factors

describe fibromyalgia

chronic central pain syndrome marked by widespread, non-articular musculoskeletal pain and fatigue with multiple "tender points"

what physiologic abnormalities can cause fibromyalgia

increased substance P, low thalamus blood flow, dysfunction of HPA axis, low serotoning and tryptophan, cytokine disruption

what are clinical manifestations of fibromyalgia

widespread burning pain, worsens and improves randomly, sleep disturbances, TMJ dysfunction, head or facial pain

what are common "tender points" in fibromyalgia

low cervical area, 2nd rib, AC area, knee, occiput, trapezius, supraspinatus, gluteal, greater trochanter

describe paget's disease

chronic skeletal bone disorder where excessive bone resorption is followed by vascular fibrous connective tissue formation causing new bone to be weak and disorganized

what bones are commonly affected in paget's disease

pelvis, long bones, spine, ribs, sternum, cranium

what medicines can be used for fibromyalgia?

antidepressants, muscle relaxants, analgesics, zolpidem/Ambien