• is a continuous, persistent problem or a process of exacerbations and remission.

• fever, night sweats, malaise, and constant bone pain.

Sarcomas

Manifestations of Osteochondroma include

• painless, hard, and immobile mass,
•  one leg or arm longer than other, and
• pressure or irritation with exercise.

No treatment necessary if asymptomatic.

If symptoms, then surgical resection

• is a primary bone tumor that is extremely aggressive and rapidly metastasizes to distant sites.

Osteogenic sarcoma

(osteosarcoma)

·         Preoperative (neoadjuvant) chemotherapy is used to decrease tumor size.

• Metastatic bone lesion is commonly found

• Metastasis to bone may be suspected in patients with local bone pain and past cancer history.   Treatment is: _________

• palliative and consists of radiation and pain management.

______ low back pain is usually associated with activity that causes undue stress (often hyperflexion) on the lower back.

•  
  • weight reduction, analgesics and exercise
  • activity to keep muscles and joints mobilized.
  • Surgery

This symptom generally indicates disk herniation.

·         Radicular pain, which radiates down buttock and below the knee

·         is at least 4 weeks of conservative therapy

 ultrasound and massage,

transcutaneous electrical nerve stimulation,

and

epidural steroid injections

• is a rare condition of adult bone associated with vitamin D deficiency, resulting in decalcification and softening of bone.

• localized bone pain, difficulty rising from a chair, and walking.

• correction of vitamin D deficiency.
• Vitamin D₃ (cholecalciferol) and vitamin D₂ (ergocalciferol) can be supplemented.
• Calcium salts or phosphorus supplements may also be prescribed.
• Exposure to sunlight (and ultraviolet rays) is also valuable, along with weight-bearing exercise.

·         is a chronic, progressive metabolic bone disease characterized by low bone mass and structural deterioration of bone tissue.

·         female sex, increasing age, family history of osteoporosis, white or Asian race, small stature, early menopause, sedentary lifestyle, and insufficient dietary calcium.

·         Dual-energy x-ray absorptiometry (DEXA) studies are used in diagnosis and to assess the treatment effectiveness.

·         affected bone is curved and the cortex is thickened and irregular.

·         Factors linked to OA include these:  

increasing age,

genetics, obesity,

occupations with frequent kneeling,

·         Joint stiffness after periods of inactivity is common with this one: 

Ankylosing spondylitis can effect  Extraarticular inflammation can affect eyes, lungs, heart, kidneys, and peripheral nervous system.

SIGNS OF (AS) include:

Fever

Chills

Headache

SWOLLEN LYMPH NODES

Joint & Muscle Pain

arthritis pain and swelling may occur in large joints

(antibiotics are used to prevent LATE LYME disease)

GOUT

Obesity (men)

HTN

Diuretic Use

Alcohol Consumption

Dusky or Cyanotic joints

Tender joints

Big Toe Inflammation

Chronic gout is characterized by __________ & __________

Multiple Joint Involvment

and

Visible Sodium Urate Crystals

Visible Sodium Urate Crystals

food high in purine are

Butterfly Rash over nose & cheeks

Polyarthralgia with morning stiffness

Tachypnea

Disrhythmias

Seizures

Nephritis

Other signs include anemia, mild leukopenia, and thrombocytopenia

SCLERODERMA

SYSTEMIC SCLEROSIS starts with

1st, collagen is overproduced. 

2nd platelet aggregation and fibrosis

3rd collagen disrupts organs

Visual manifestations are described by CREST

Calcinosis (calcium under skin)

Raynaud's (blue,white to red)

Esophageal (cant swallow)

Sclerodactyly (tight skin under fingers & toes)

Telangiectasia (red spots on hands, face lips)

SYSTEMIC SCLEROSIS cure:

Weight Loss

Fatigue

Muscle Weakness

ADL difficulties

·         DM and PM diagnosis is confirmed by

high-dose corticosteroids

if no effect, immunosuppressive drugs

SJÖGREN’S SYNDROME is GENETIC and ENVIRONMENTALLY caused.   Lymphocytes attack these two glands:

Lacrimal and Salivary glands

(hence dry eyes and dry mouth)

artificial tears

surgical punctual occlusion,

 and increased fluids with meals.

In Myofascial pain syndrome, Regions of pain are often within taut bands and fascia of skeletal muscles.

Its treatment includes:

Chronic fatigue syndrome is similar to Fibromyalgia syndrome

similar symtoms.

There is no cure.  However most patients recover fully

or at least partially.

bunion

(involves a hallus valgus, a lateral  deviation of the great toe)

Quickie Foot Disorder Definitions:

"Painful deformity of the great toe"

Quickie Foot Disorder Definitions:

"Deformity of the 2nd-5th toes"

Quickie Foot Disorder Definitions:

"Neuroma in web space btwn 3rd and 4th toes"

Quickie Foot Disorder Definitions:

"Loss of metatarsal arch"

Quickie Foot Disorder Definitions:

"localize thickening of skin over bony prominences"

Quickie Foot Disorder Definitions:

"Lesion in soft web space from toe-to-toe pressing"

Quickie Foot Disorder Definitions:

"Similar to corn but wider area and on weight-bearing part of foot"

Quickie Foot Disorder Definitions:

"Painful growth caused by virus, usually on pressure points"

OSTEOMALACIA

(aka Ricketts in children)

Causes of Osteomalacia

GI malabsorption

DILANTIN

Kidney disease

lack of sunlight

difficulty walking and rising from a chair

delayed bone healing (3 months vs 10 days)

have them eat eggs, low-fat milk, fish, and veggies

and get some friggin' SUN!!!

Soft Bones are Osteomalacia

Porous bones are:

___________ is known as the "silent thief"

White/Asian

Female

Thin or small framed

LOW Estrogen

Low Testosteron

And all the other typical bad stuff, smoking, etc.

Diseases associated specifically with

Osteoporosis are:

RA, Kidney disease, hyperthyroidism, cirrhosis

and DM

Coritcosteroids, Dilantin and Antiacids interfere also wih bone metabolisms

Minimum sun requirement per day for Osteoporosis is:

Vitamin D supplements should be 400-800IU

for Osteoporosis patients.

Can osteoporosis be reversed?

No, not really... not significantly

Patients should quit smoking and alcohol too.

Key sign in Paget's disease:

Waddling Gait!

Bones get thicker, longer, even the skull. 

Care is supportive only. 

Supportive mainly.....

patients can wear corsets when sitting up. 

NSAIDs manage pain

Calcitonin therapy recommended

Quicky Review on Ch 64:

Indirect entry is

Direct entry is

Indirect:  something like a virus or infection

Direct:  Trauma

BMD (bone mineral density)

Ultrasound

Xray (DEXA)

Neomycin

Keflex

Ancef

Garamycin

And HYPERBARIC CHAMBER

High Spiking Fever

and

Night Sweats

Rolling patients while maintaining body alignment... key in spinal surgery patients. 

Arthritis refers to inflammation of a joint.

Whereas rheumatic disease involves what?

Estrogen (Evista)

Calcitonin

Fosamax

Forteo (hormone stims new bone)

In Osteoarthritis, MORE men are affected BEFORE age 50.   

After age 50, more WOMEN are affected.

OA occurs in two ways:

Idiopathic and Secondary disorders

Secondary is Trauma

Genetic

Estrogen

Obesity

Dull yellow and granular

Soft and elastic too

joint crackles, like my knees

OA is NOT an autoimmune disease

the others are....

Migraines and OA

OA affects joints Symmetrically or Asymmetrically?

In OA, these red swollen tender joints are visible causing patient to feel distressed.  While they dont cause loss of function, osteophytes form and cause loss of joint space. 

The name of these nodes are:

 Free Fact:

Bowleggedness and altered gait are results of

Knee OA. 

 Free Fact:

Hip OA may cause one leg to be shorter

Heat Vs Cold:

Explain

Cold reduces pain and swelling

Heat brings blood to area

for mild to mod pain: 

Acetamenophen 1000mg Q6

Zostrix (hot pepper topical)

Aspercreme

Lets talk MYOFASCIAL pain, Fibromyalgia and Chronic Fatigue Syndrome. 

All three are considered _______ syndromes

Burning

Stinging

Stiffness

Myofascial pain has Trigger points

Fibromyalgia has tender points.

In Fibromyalgia, women/men ratio is

Gebrauers Spray & Stretch

Massage

Trigger point injections

Fibromyalgia is widespread in the body with "tender points". 

Its "NON-degenerative, NON-progressive and

NON-inflammatory. 

It affects this gender moreso: ___________

Women.  

Women often feel the typical signs, including decreased LOC, depression, and insomnia.

NO DEFINITIVE DIAGNOSTIC TESTS EXIST

Increased blood flow to Thalamus

Low Seretonin and Tryptophan

Burning pain

Pain gets better throughout day

 Jaw/Dental dysfunction issues

Fibromyalgia Tender Points on the body are:

Occiptial

Cervial

2nd Rib

Gluteal

Knee & Elbow

Trochanter

Trapezius

Fibromyalgia sign (in the brain) is

 and in the lower GI is:

Memory Fog

IBS, pee alot

Rare fibromyalgia sign: 

Low ANA titer

(not definitive)

1) they have 11-18 tenderpoints

2)History of widespread pain for >3 months on both sides of body.

Cyclobenaprine (sleep disturbances)

NSAIDs or Benzodiaepines for pain and anxiety

Ambien for severe sleep disturbances

Chronic Fatigue Syndrome (CFS) and Fibromyalgia Syndrome (FMS) share similar features.

The most common symptom in CFS is:

CFS Diagnostic Criteria to be termed CFS is:

Persistent Fatigue not alleviated by rest.

Short-term memory impairment, lymph nodes,

joint pain without swelling.

Many CFS paitens have allergies and take decongestants and antihistamines. 

Antidepressants improve their mood and sleep.

List some Nursing implications for CFS patients: 

Diet of Fiber and Dark Fruits and Veggies

Total rest NOT advised

Help them cope with disease

Yes, most recover and improve.  This disease does NOT progress. 

Recovery is more commin in patients with SUDDEN ONSET of CFS.

In OsteoMYElitis, the #1 common infecting organism is:

Staphylococcus aureus

Usually trauma invites it in.

In Osteomyelitis, direct entry example is an open wound or via an implant. 

Once the microorganisms lodge in an area of bone (usually metaphysis), they grow causing increased pressure, leading to________

marrow cavity, causing necrosis

Once you got ischemia, the bone dies

Once you got ischemia, the bone dies, and this dead part forms an area called _________

The living bone area is called ___________

Sequestrum

Involucrum

The Sequestrum is surrounded by pus, so antibiotics and WBCs cant reach it.

Avascular scar tissue protects Sequestrum and provides ideal microorganism growth.

Acute vs Chronic Osteomyelitis:

Describe Acute S&S

Acute is <1 month duration with

fever & night sweats

Pain worsens with activity

Late sign: drainage from sinus tracts

Acute vs Chronic Osteomyelitis:

Describe Chronic S&S

>1 month

Labs frequently positive for microorganisms

High WBC

High ESR (indicates inflammation)

Acute vs Chronic Osteomyelitis:

Typical Treatment:  Meds and Length of time

Cillins, Mycins, Keflex, Ancef

from 4 weeks to 6 months

Osteomyelitis:

can be cured with Hyperaric or muscle flap skin grafting. 

Amputation if necessary. 

Septicemia

Septic Arthritis (fast onset)

Pathologic fractures (falls from bone degradation)

Amyloidosis (protein deposits in muscles)

Osteomyelitis complications:

And what the nurse should ensure post-op...

Prevent Foot Drop

Prevent Contractures (pt may reposition to flexed position to alleviate pain)

Limit activity in affected limb (we want to decrease circulation to site, no exercise & no heat!!!)

Lets talk Lupus

(aka Systemic Lupus Erythematosus)

What is it?

Chronic multi-system inflammatory disease

(includes organs, joints and neurological)

Most lupus occurs in women of childbearing years. 

Whites are least likely to develop it. 

Lupus most commonly affects the skin, lining of lungs & heart, kidneys and nervous tissue.

Butterfly rash

Balding

Oral ulcers

Skin lesions

Polyarthalgia with morning stiffness

SWAN neck fingers

Tachypnea

Pleurisy

Dysrhythmias

CAD

Pericarditis (remember affects linings)

Neuropathy

LOC issues

Anemia & Leukopenia

Thrombocytopenia

Coagulopathy (bleed a lot)

Patient history, exam and lab findings. 

Key findings: 

Rash, oral ulcers, arthritis,and every organ it affects we've just mentioned.

pain and stiffness

(cold is for inflammation)

With Knee OA, use glucosamine for up to 3 years...

however do NOT use it in patients with:

After injecting an OA patient with corticosteroids,

the nurse should inform him:

Joint may feel worse after injection, but treatment lasts for weeks to months.

Tell patient not to overuse joint after injection.

Rheumatoid Arthritis (RA) is chronic AUTOIMMUNE disease w/ inflammation of synovial joints w/ periods of remission. 

Describe the 4 stages of RA

1) No Change, poss. Osteoporosis signs

2)Def. Osteoporosis, atrophy

3)Cartilage & Bone destruction, ulnar deviation

4)Fibrous or bony ankylosis

RA - affects young to 40

OA affects OVER 40

RA- Lose weight

OA - GAIN weight

RA - Systemic

OA - Localized

RA - Small joints

OA - Weight-bearing Joints

RA- Nodules present

OA - Herberdens and Bouchards

Labs:  RA: RF Positive

OA - RF Negative

Nursing Assessment of RA patient: 

Unique things to ask:

Conjunctivitis, nodules, edema

Splenomegaly

Bronchitis hx

RF factor, HIGH ESR, HIGH WBC

Symmetric joint involvment.

Patient teaching for prevent RA joint deformities include: 

1) Neutral joint position

2)press spongues, not wring

3)dont knit for long periods

What is Spondyloarthropathies?

Group of inflammatory diorders that affects the spine.

Axial skeleton and sacral joints, and invertibral disk spaces. 

Affects 25-35yo men usually. 

Spine pain, worse at night & morning, but improves with activity

(kyphosis common)

HEAT and DRUGS

Avoid Flexion during sleep and lifting

Swimming and Raquetball encouraged

Genetic Benign inflammatory skin disorder.

"pencil in a cup" deformity at DIP joints

Reactive Arthritis  (aka Reiter's Syndrome)

Tell me about it?

Mostly in young men.

Occurs after UTI or GI tract infection, usually Chlamydia.

Most recover after 2-16 weeks.

Full system affecting many jointsn via blood, Staph aureus infection being most common. 

Knee & Hip #1 affected

Use heat packs at sites.

Ticks.

See doctor if BULLS-EYE rash develops or flu

Can cause Bells Palsy

Chronic forgetfulness

HIV and Rheumatic disease:

Just remember they can develop Sjorgren's syndrom, or Fibromyalgia.

Increased uric acid production causing acute bouts of arthritis.

Primary Gout:  Hereditary, cant process prurines

Secondary Gout:  r/t another disorder

Obesity,smoking & alcohol increases risk

Tell me more about Gout:

Occurence: 

#1 Sign:

Occurs in less than 4 joints

BIG TOE inflammation (PODAGRA)

Calcium crystals are formed with Septic Arthritis and Psuedogout

Tx: allopurinol & avoidance of red meats

disorder causing fibrous inflammatory changes 

KEY SIGN:  DIFFUSE CUTANEOUS THICKENING  

Affects women more

Onset 30-50yo

Types: limited (more common) and diffuse

Prevent cold hands

Have patient yawn with mouth open! (exercise)

Frequent meals

Sit upright after meals

No stair climbing or cold exposure

Polymyositis and Dermatomyositis affect what?

Striated muscle causing bilateral weakness. 

S&S:  weight loss, cyanotic skin, symmetric rash Grottron's sign (red patches avoiding joint spaces on skin)

Confirmed by electromyography (EMG), Muscle biopsy and serum enzyme levels 

Autoimmune disease targeting moisture producing glands.

(causes dry mouth, dry sinus, dry eyes)

Myofascial pain syndrome is characterized by musculodkeletal pain in ONE region of the body. 

Key distinctive signs:

Regional pain

Trigger points

Can be cured

Fibromyalgia syndrome is characterized by

widespread, non-articular pain with many tender points

6x more frequent in women

Key Sign:  widespread burning pain, and memroy lapses, I.B.S.

Massage

Gentle Stretching

Low-impact aerobics

Relaxation teaching

Chronic Fatigue Syndrome Diagnostic criteria:

and nursing interventions:

Unexplained fatigue

Fatigue NOT due to exertion

Not Alleviated by rest

NI:  Total rest is not advised. 

Fiber and fruits/veggies

GET AN "A" ON THIS TEST!!!!