NURS 3174 ADULT HEALTH|MUSCULOKLETAL DISORDERS STUDY GUIDE REVIEW
EXAM 2022
Arthritis (type of rheumatic disease involving inflammation of joint/joints)
Osteoarthritis (Degeneration Joint Disease)
• Description
o Most common form of arthritis
o Slow progressive deterioration of the articular cartilage; uninflammatory condition
o Causes bone build up and the loss of articular cartilage in peripheral and axial joints (formation of new
joint tissue)
o Affects weight bearing joints and joints that receive the greatest stress (knees, hips, lower vertebral
column and hands)
o Affects women more than men (55 yrs), begins at 20-30, feel it at age 40, symptoms at 50-60
• Risk factors
o Trauma, aging, obesity, genetic changes, smoking
• Clinical manifestations
o Systemic
▪ Fatigue, fever, organ involvement NOT PRESENT IN OA!
o Weight bearing joints (hips, knees, lower vertebral column, hands)
▪ Mild discomfort – significant disability
▪ Early stages: joint pain relieved by rest
▪ Late stages: joint pain even at rest and while sleeping (awakening pain), inclement weather
(barometric pressure drops)
• Crepitation (most common in knee)
o grating sensation caused by loose particles of cartilage in joint cavity
• Assessment
o Joint pain that diminishes after rest and intensifies after activity, notes earlier in the disease process
▪ Joint stiffness occurs after periods of rest or static position
NURS 3174 ADULT HEALTH|MUSCULOKLETAL DISORDERS STUDY GUIDE REVIEW
EXAM 2022
,NURS 3174 ADULT HEALTH|MUSCULOKLETAL DISORDERS STUDY GUIDE REVIEW
EXAM 2022
o As the disease progresses, pain occurs w/ slight motion or even at rest
o S/S are aggravated by temp changes and climate humidity
o Difficulty getting up after prolonged sitting
o Skeletal muscles disuse atrophy
o Inability to perform activities of daily living
o Early morning stiffness is common but resolves w/in 30 mins
o Compression of the spine as manifested by radiating pain, stiffness, and muscle spasms in one or
both extremities
o Deformity ***often red, swollen, tender, ***
▪ Heberden’s nodes: occur on the DIP joints as an indication of osteophyte formation and loss of
joint space, at 40 yrs, hereditary
▪ Bouchard’s nodes: on the PIP joints
▪ Malalignment (knee): bowlegged appearance, altered gate, one leg may shorten due to
decreased joint space
• Diagnostic test
o CT/MRI (early detection, diagnosis)
o XRAY (confirm/stage progression) typically show joint space narrowing, bony sclerosis, and
osteophyte formation
o *changes seen don’t always have pain*
o Synovial fluid analysis (differentiation from OA and other inflammatory arthritis)
▪ In OA the fluid remains clear yellow with little or no sign of inflammation.
• Collaborative care
o **No cure**
o Pain
▪ Admin NSAIDS (Tylenol), muscle relaxants and other meds
▪ Prepare the client for corticosteroids injections into joints
▪ Position joints in function position and avoid flexion of knees and hips
NURS 3174 ADULT HEALTH|MUSCULOKLETAL DISORDERS STUDY GUIDE REVIEW
EXAM 2022
,NURS 3174 ADULT HEALTH|MUSCULOKLETAL DISORDERS STUDY GUIDE REVIEW
EXAM 2022
▪ Immobilize the affected joint w/ a splint or brace until inflammation went subsides
▪ Avoid large pillows under head and knees
▪ Provide a bed or foot cradle to keep linen off of feet
▪ Instruct the client in the importance of moist heat, hot packs or compresses and paraffin dips
▪ Apply cold applications when joints are acutely inflamed
▪ Encourage adequate rest, recommending 10 hours of sleep a night and a 1-2-hour nap in
the afternoon
o Exercise
▪ Tai Chi (low-impact form of exercise), balance of rest and activity (active rather than passive),
stop if pain occurs, limit exercise when joint inflammation is severe
▪ Knee: avoid prolonged standing, kneeling, squatting
o Assistive devices
▪ Cane, walker crutches decrease stress on joints
o Heat/cold therapy
▪ Heat therapy, including hot packs, whirlpool baths, ultrasound, and paraffin wax baths, is
especially helpful for stiffness
▪ Cold not used as much as heat but good for acute inflammation
o Nutritional therapy
▪ Well balanced meals and weight within normal ranges (decreases stress on joints)
▪ If overweight, try to lose weight
• Complimentary/alternative therapy
o Acupuncture, yoga, massage, guided imagery, therapeutic touch
o Nutritional supplements: glucosamine and chondroitin
• Drug therapy
o Mild/moderate joint pain: Acetaminophen (Tylenol),
▪ Adults: 1000 mg q6h = 4000mg/daily dose = ≤4g/day
o NSAIDs
NURS 3174 ADULT HEALTH|MUSCULOKLETAL DISORDERS STUDY GUIDE REVIEW
EXAM 2022
, NURS 3174 ADULT HEALTH|MUSCULOKLETAL DISORDERS STUDY GUIDE REVIEW
EXAM 2022
• Surgical intervention
o Osteotomy
▪ Bone resection to correct joint deformity, promote realignment, reduce joint stress
o Total joint replacement/arthroplasty
▪ When all pain measures have failed
▪ Hip/knee replacement most common
▪ Contraindicated w/ infection, advanced osteoporosis, severe joint inflammation
▪ Interventions
• Relieve pain, abduction of the hip should be maintained, gradually restore muscle
tone, improve function
• Ambulatory/home care
o Safe environment (move rugs, wear fitted shoes, rails, nightlights)
Rheumatoid Arthritis (RA):
• Description
o Chronic systemic autoimmune disease; inflammatory disease of connective tissue in the synovial joints (immune
complex disorder)
o Periods of remission and exacerbation
o Cause is unknown
o Autoimmunity – abnormal IgG; neutrophils are attracted to the site of inflammation, releasing proteolytic
enzymes that can damage articular cartilage
o Genetic factors
o More common in women
• S&S
o Joints – fatigue, anorexia, weight loss, generalized stiffness; specific articular involvement is manifested clinically
by pain, stiffness, limitation of motion, and signs of inflammation; low grade fever; soft/spongy feeling joints
▪ *** Joint symptoms occur symmetrically, small joints of the hands (PIP and MCP)/ feet (MTP) ***
NURS 3174 ADULT HEALTH|MUSCULOKLETAL DISORDERS STUDY GUIDE REVIEW
EXAM 2022
EXAM 2022
Arthritis (type of rheumatic disease involving inflammation of joint/joints)
Osteoarthritis (Degeneration Joint Disease)
• Description
o Most common form of arthritis
o Slow progressive deterioration of the articular cartilage; uninflammatory condition
o Causes bone build up and the loss of articular cartilage in peripheral and axial joints (formation of new
joint tissue)
o Affects weight bearing joints and joints that receive the greatest stress (knees, hips, lower vertebral
column and hands)
o Affects women more than men (55 yrs), begins at 20-30, feel it at age 40, symptoms at 50-60
• Risk factors
o Trauma, aging, obesity, genetic changes, smoking
• Clinical manifestations
o Systemic
▪ Fatigue, fever, organ involvement NOT PRESENT IN OA!
o Weight bearing joints (hips, knees, lower vertebral column, hands)
▪ Mild discomfort – significant disability
▪ Early stages: joint pain relieved by rest
▪ Late stages: joint pain even at rest and while sleeping (awakening pain), inclement weather
(barometric pressure drops)
• Crepitation (most common in knee)
o grating sensation caused by loose particles of cartilage in joint cavity
• Assessment
o Joint pain that diminishes after rest and intensifies after activity, notes earlier in the disease process
▪ Joint stiffness occurs after periods of rest or static position
NURS 3174 ADULT HEALTH|MUSCULOKLETAL DISORDERS STUDY GUIDE REVIEW
EXAM 2022
,NURS 3174 ADULT HEALTH|MUSCULOKLETAL DISORDERS STUDY GUIDE REVIEW
EXAM 2022
o As the disease progresses, pain occurs w/ slight motion or even at rest
o S/S are aggravated by temp changes and climate humidity
o Difficulty getting up after prolonged sitting
o Skeletal muscles disuse atrophy
o Inability to perform activities of daily living
o Early morning stiffness is common but resolves w/in 30 mins
o Compression of the spine as manifested by radiating pain, stiffness, and muscle spasms in one or
both extremities
o Deformity ***often red, swollen, tender, ***
▪ Heberden’s nodes: occur on the DIP joints as an indication of osteophyte formation and loss of
joint space, at 40 yrs, hereditary
▪ Bouchard’s nodes: on the PIP joints
▪ Malalignment (knee): bowlegged appearance, altered gate, one leg may shorten due to
decreased joint space
• Diagnostic test
o CT/MRI (early detection, diagnosis)
o XRAY (confirm/stage progression) typically show joint space narrowing, bony sclerosis, and
osteophyte formation
o *changes seen don’t always have pain*
o Synovial fluid analysis (differentiation from OA and other inflammatory arthritis)
▪ In OA the fluid remains clear yellow with little or no sign of inflammation.
• Collaborative care
o **No cure**
o Pain
▪ Admin NSAIDS (Tylenol), muscle relaxants and other meds
▪ Prepare the client for corticosteroids injections into joints
▪ Position joints in function position and avoid flexion of knees and hips
NURS 3174 ADULT HEALTH|MUSCULOKLETAL DISORDERS STUDY GUIDE REVIEW
EXAM 2022
,NURS 3174 ADULT HEALTH|MUSCULOKLETAL DISORDERS STUDY GUIDE REVIEW
EXAM 2022
▪ Immobilize the affected joint w/ a splint or brace until inflammation went subsides
▪ Avoid large pillows under head and knees
▪ Provide a bed or foot cradle to keep linen off of feet
▪ Instruct the client in the importance of moist heat, hot packs or compresses and paraffin dips
▪ Apply cold applications when joints are acutely inflamed
▪ Encourage adequate rest, recommending 10 hours of sleep a night and a 1-2-hour nap in
the afternoon
o Exercise
▪ Tai Chi (low-impact form of exercise), balance of rest and activity (active rather than passive),
stop if pain occurs, limit exercise when joint inflammation is severe
▪ Knee: avoid prolonged standing, kneeling, squatting
o Assistive devices
▪ Cane, walker crutches decrease stress on joints
o Heat/cold therapy
▪ Heat therapy, including hot packs, whirlpool baths, ultrasound, and paraffin wax baths, is
especially helpful for stiffness
▪ Cold not used as much as heat but good for acute inflammation
o Nutritional therapy
▪ Well balanced meals and weight within normal ranges (decreases stress on joints)
▪ If overweight, try to lose weight
• Complimentary/alternative therapy
o Acupuncture, yoga, massage, guided imagery, therapeutic touch
o Nutritional supplements: glucosamine and chondroitin
• Drug therapy
o Mild/moderate joint pain: Acetaminophen (Tylenol),
▪ Adults: 1000 mg q6h = 4000mg/daily dose = ≤4g/day
o NSAIDs
NURS 3174 ADULT HEALTH|MUSCULOKLETAL DISORDERS STUDY GUIDE REVIEW
EXAM 2022
, NURS 3174 ADULT HEALTH|MUSCULOKLETAL DISORDERS STUDY GUIDE REVIEW
EXAM 2022
• Surgical intervention
o Osteotomy
▪ Bone resection to correct joint deformity, promote realignment, reduce joint stress
o Total joint replacement/arthroplasty
▪ When all pain measures have failed
▪ Hip/knee replacement most common
▪ Contraindicated w/ infection, advanced osteoporosis, severe joint inflammation
▪ Interventions
• Relieve pain, abduction of the hip should be maintained, gradually restore muscle
tone, improve function
• Ambulatory/home care
o Safe environment (move rugs, wear fitted shoes, rails, nightlights)
Rheumatoid Arthritis (RA):
• Description
o Chronic systemic autoimmune disease; inflammatory disease of connective tissue in the synovial joints (immune
complex disorder)
o Periods of remission and exacerbation
o Cause is unknown
o Autoimmunity – abnormal IgG; neutrophils are attracted to the site of inflammation, releasing proteolytic
enzymes that can damage articular cartilage
o Genetic factors
o More common in women
• S&S
o Joints – fatigue, anorexia, weight loss, generalized stiffness; specific articular involvement is manifested clinically
by pain, stiffness, limitation of motion, and signs of inflammation; low grade fever; soft/spongy feeling joints
▪ *** Joint symptoms occur symmetrically, small joints of the hands (PIP and MCP)/ feet (MTP) ***
NURS 3174 ADULT HEALTH|MUSCULOKLETAL DISORDERS STUDY GUIDE REVIEW
EXAM 2022
