Musculoskeletal

0.0(0)
studied byStudied by 0 people
learnLearn
examPractice Test
spaced repetitionSpaced Repetition
heart puzzleMatch
flashcardsFlashcards
Card Sorting

1/13

flashcard set

Earn XP

Description and Tags

Patho

Study Analytics
Name
Mastery
Learn
Test
Matching
Spaced

No study sessions yet.

14 Terms

1
New cards

Compartment Syndrome:

Is a condition of increased pressure within a limited space (abdominal/limb compartments) that compromises the circulation and function of the tissues in the space.

  • Abdominal alters cardiovascular hemodynamics, respiratory mechanics, and renal function 

  • Duration of pressure, elevation, metabolic rate of tissues, vascular tone, local BP all play a role

  • Less tissue pressure is required to stop circulation when hypotension or vasoconstriction is present 

    Clinical Manifestations:

    • Hallmark symptom of an acute compartment syndrome is severe pain that is out of proportion to the original injury or physical findings 

    • Nerve compression may cause change in sensation, diminished reflexes, and eventually loss of motor function

      Treatment:

      • Cast splitting/removal of restrictive dressings

      • Elevating extremity on pillows to reduce edema

      • Fasciotomy 

2
New cards

6 “P” Signs of COMPARTMENT SYNDROME:

  1. Pain

  2. Paresthesia

  3. Pallor

  4. Pulselessness

  5. Paralysis

  6. Poikilothermia (inability to regulate your own body temp)

3
New cards

Hematogenous Osteomyelitis

Originates with infectious organisms that reach the bone through the bloodstream

  • Acute occurs predominantly in children

  • Chronic skin infections, chronic urinary infections, intravenous drug use (streptococcus pseudomonas) and staph

  • In children the infection usually affects the long bones of appendicular skeleton (metaphyseal to nutrient blood vessels)

  • In adults, vertebrae, sternoclavicular and  sacroiliac joints, the symphysis pubis. Infection typically first involves subchondral bone then spread to joint space 

Bacteremia:

  • Chills / fever / malaise

  • Local bone pain and tenderness 

Treatment:

  • Blood and bone aspiration cultures 

  • Antimicrobial agents are given first parenterally and then orally 

  • IV antibiotics , surgery if needed 

4
New cards

Contiguous Spread Osteomyelitis

Bacteria may be introduced directly into the bone by a penetrating wound, or open fracture, or a surgery.

Complications:

  • Pin tract infection in skeletal traction

  • Sepsis (infected) joints in joint replacement surgery

  • Wound infections after surgery (Staph / Strept)

Differs in that virtually any traumatized bone may be involved. Injury from local inflammation and trauma may devitalize bone and surrounding tissue, providing an inert matrix on which microorganisms introduced during trauma thrive. 

Clinical Manifestations:

  • Persistent / Recurring Fever

  • Increased pain at operative trauma site 

  • Continued wound drainage and wound separation 

  • Joint pain / fever/ cutaneous drainage (prosthetic joint)

Treatment:

  • Surgical debridement of infected and necrotic tissue

  • Empiric IV antibiotics followed by targeted therapy 

  • Address source control

5
New cards

Osteomyelitis with Vascular Insufficiency

Osteomyelitis may develop from a skin lesion; it’s most commonly associated with chronic or ischemic foot ulcers in people with long standing diabetes.  Neuropathy causes a loss of protective reflexes, and impaired arterial circulation and repetitive trauma are the major contributors to skin fissure and ulcer formation.

Manifestations:

  • Often present with seemingly unrelated problems such as in grown toenails, cellulitis, or a perforating foot ulcer 

  • Pain is often muted by peripheral neuropathy 

  • Osteomyelitis is confirmed when bone is exposed in the ulcer bed or after debridement 

  • Radiologic evidence is a late sign

Treatment:

  • Debridement and antibiotic therapy may benefit people who have good oxygen tension

  • Hyperbaric oxygen therapy may be used as an adjunctive treatment  

6
New cards

Osteopenia: Characterized by a reduction in bone mass greater than expected for age, race, or sex that occurs because of a decrease in bone formation, inadequate bone mineralization, or excessive bone deossification.

Risk Factors: 

  • Aging 

  • Sedentary life style

  • Low calcium / Vit D

  • Smoking

  • Excessive Alcohol use

  • Corticosteroid Use

  • Low body weight / eating disorder

  • family history of osteopenia

Prevention: 

  • Weight-bearing exercise 

  • Avoid smoking and limit alcohol

  • Balanced diet

  • Bone density screening 

7
New cards

Osteoporosis: Metabolic bone disease characterized by a loss of mineralized bone mass causing increased porosity of the skeleton and susceptibility to fractures

Risk Factors:

  • Poor nutrition or Age-related decrease in intestinal absorption of calcium because of deficient activation of Vit D

  • Postmenopausal women caused by estrogen deficiency 

  • Long-term corticosteroid use, prolonged use of medications that increase calcium excretion like antacids, corticosteroids, anticonvulsants  

  • Endocrine disorders (hyperthyroidism, hyperparathyroidism)

  • Cushing syndrome or diabetes mellitus   

  • malignancies

  • Alcoholism (inhibit osteoblast) 

Prevention: 

  • Exercise may prevent or delay the onset of osteoporosis by increasing peak bone mineral density (BMD) during periods of growth 

  • Medications for high risk individuals

  • Fall prevention strategies 

  • Bone-strengthening 

8
New cards

Nursing & Medical Interventions for Rhabdo:

1) Immediate Goals:

  • Prevent kidney damage

  • Correct electrolyte imbalances 

2) Hydration:

  • Intravenous (IV) fluids are essential to flush out toxins and support kidney function 

3) Medications:

  • Diuretics (in some cases) to increase urine output 

  • Calcium, insulin / glucose to treat hyperkalemia - (more on this when we get to electrolytes imbalances)

4) Dialysis:

  • May be needed if kidney function severely deteriorates 

5) Address Underlying Cause

Stop offending drugs or treat infections  

9
New cards

Cite the primary features of ankylosing spondylitis (AS)

  • Eyes: Uveitis

  • Kyphosis (forward curvature) and extension of the neck

  • Enthesitis (inflammation and tendency for fibrosis and calcification at sites of muscle insertion) at shoulders, hips, knees, and heels

  • Enthesitis of costovertebral and costosternal junctions with flexion contraction of the diaphragm 

  • Sacroilitis: inflammation in the sacroiliac joint 

  • Progressive spinal fusion 

  • Strongly associated with HLA-B27

  • Loss of lumbar lordosis occurs as disease progresses 

  • Lower back pain (persistent/intermittent), becomes worse when resting 

  • Lumbosacral pain

10
New cards

AS treatment

  • Is directed at controlling pain and maintaining mobility by suppressing inflammation 

  • Therapeutic exercises, muscle-stretching exercises, maintaining ideal weight, quit smoking

  • Pharmacologic treatment includes use of NSAIDs to reduce inflammation, relieve pain, and reduce muscle spasms

  • Current practice is to use anti-TNF-ɑ therapies, including etanercept, infliximab, and adalimumab, which have demonstrated positive effects on disease activity 

11
New cards

Reactive Arthropathies

Defined as sterile inflammatory joint disorders that are distant in time and place from the initial infective process. 

  • May occur due to foreign substance in joint tissue

  • Has been seen in people with acquired immune deficiency

  • When cultured bacteria cannot be isolated even though there has been preceding infection, it’s no longer bacterial arthritis  

Clinical Manifestation

  • Reiter Syndrome: may be accompanied by extra-articular symptoms like uveitis, bowel inflammation, and non-specific urethritis  

  • Often develops in host after bacterial infection 

Treatment:

  • Is largely symptomatic

  • NSAIDs are used in treating arthritic symptoms 

  • Vigorous treatment of possible triggering infections is thought to prevent relapse of reactive arthritis 

12
New cards

Psoriatic Arthritis

Is a seronegative inflammatory arthropathy that occurs in 7% of people with psoriasis. It’s a heterogeneous disease with features of the SpA in some people, RA in others, and features of both coexisting in others.

Etiology/Pathogenesis:

  • Genetic, environmental, and immunologic factors seem to play a role 

  • Environmental factors that play a role in pathogenesis: infectious agents, and physical trauma

  • T-cell-mediated immune responses seem to play an important role in the skin and joint manifestations of the disease 

Clinical Manifestations:

  • Evidence of skin or nail changes typical of psoriasis

5 subgroups of Psoriatic Arthritis:

  • (1) Asymmetric: about 35% of cases, often mild

  • (2) Spondylitis: pain & stiffness in the spine and neck

  • (3) Symmetric: about 50% of cases

  • (4) DIP: inflammation & stiffness near the ends of the fingers

  • (5) Mutilans: most severe, only about 5% of cases 

Some with psoriatic arthritis have elevated serum of uric acid. 

  • The abnormally elevated serum uric acid level is caused by the rapid skin turnover of psoriasis and the subsequent breakdown of nucleic acid followed by its metabolism to uric acid

Treatment:

  • Suppression of the skin disease may be important in controlling the arthritis 

  • Often, affected joints are surprisingly functional and only minimally symptomatic 

  • If there are musculoskeletal symptoms, NSAIDs may be used 

  • DMARDs such as methotrexate, sulfasalazine, and leflunomide should be considered early in those with active disease 

13
New cards

Gout:

Is a group of disorders characterized by increased serum uric acid and urate crystal deposits in the kidneys and joints 

Pathogenesis:

  • Elevation of uric acid and the subsequent development of gout can result from overproduction of purines, decreased salvage of free purine bases, augmented breakdown of nucleic acids because of increased cell turnover, or decreased urinary excretion of uric acid 

Clinical Manifestations:

Gout is characterized into 4 stages:

  1. The asymptomatic hyperuricemia

  • Not symptoms may be present in the beginning  

  1. Acute gout arthritis 

  • Is monoarticular and usually affects the first metatarsophalangeal joint

  • The tarsal joints, insteps, ankles, heels, knees, wrists, fingers, and elbows may also be initial sites of involvement 

  • Often begins at night and may be precipitated by excessive exercise, certain medications or foods, alcohol, or dieting 

  • Onset of pain is abrupt and redness and swelling is observed 

  1. Intercritical gout 

  • In early stages of gout after initial attack has subsided, the person is asymptomatic, and joint abnormalities are not evident 

  1. Chronic tophaceous gout 

  • After first attack, it may be months/years before another attack; because attach recur with increased frequency, joint changes occur and become permanent 

Diagnosis:

  • Definitive diagnosis can only be made when monosodium urate crystals are in the synovial fluid or in tissue section of tophaceous deposits 

  • Measurement of serum uric acid levels and collection of a 24-hour urine sample for determination of urate excretion in the urine is diagnostic (>7mg/dL in men, >6mg/dL in women)

Treatment:

  • Pharmacologic management of acute gout is directed toward reducing joint inflammation 

  • Hyperuricemia and related problems of tophi, joint destruction, and renal problems are treated after the acute inflammatory process has subsided 

  • NSAIDs, particularly indomethacin & ibuprofen are used for treating acute gouty arthritis; alternatives include colchicine and intra-articular deposition of corticosteroids

  • Education about disease and its management are fundamental to treatment

  • Ideal weight, moderation of alcohol consumption, smoking cessation, avoidance of purine-rich foods, 

14
New cards

Describe the pathologic changes that may be found in the joint of a person with rheumatoid arthritis (RA).

  • Can be viewed as an aberrant immune response that leads to synovial inflammation and destruction of the joint architecture 

  • Characteristic of RA is the development of an extensive network of new blood vessels (angiogenesis) in the synovial membrane that contributes to the attachment of rheumatoid synovitis

  • Neutrophils, macrophages, and lymphocytes are attracted to area and phagocytize the immune complexes, and release lysosomal enzymes capable of causing destructive changes in joint cartilage 

  • Pannus is a feature of RA that differentiates it from other forms of inflammatory arthritis 

  • Inflammatory cells found in the pannus have a destructive effect on the adjacent cartilage and bone 

  • Erosion of articular cartilage due to pannus release proteolytic enzymes 

  • Bone erosion (osteoclast activation)

  • Chronic joint changes and ankylosis (joint fusion)

  • Fibrosis and calcification of pannus may occur