1) Diagnostic Procedures
Myelogram Examination
Purpose: Visualize the spinal cord, nerve roots, and intervertebral discs using contrast dye
(often replaced by MRI today, but still covered in some curricula).
Procedure quick note: Contrast is injected into the subarachnoid space via lumbar puncture.
Post-procedure Care:
Keep patient reclined for about 8 hours to minimize risk of spinal headache and CSF leakage.
Monitor for severe or persistent headache, nausea, vomiting, back pain, or signs of
meningitis.
Encourage adequate fluids unless contraindicated.
Nursing considerations:
Assess puncture-site for leakage, redness, swelling.
Check allergies (contrast dye) and kidney function if iodinated contrast used.
Pain control and neurovascular checks in lower extremities as indicated.
Arthrocentesis
Purpose: Remove joint fluid for diagnosis (infection, inflammatory markers) or provide
symptomatic relief (decrease effusion/pain).
Post-procedure Care:
Apply sterile dressing and assess puncture site for bleeding or infection.
Limit excessive joint movement initially; rest the joint as advised.
Monitor for fever, increased pain, swelling, warmth (infection signs) or septic symptoms.
Nursing considerations:
Confirm indication (infection vs. inflammatory vs. aspiration for culture).
Ensure sterile technique; send aspirate for Gram stain/culture, cell count, crystals if
appropriate.
Bone Scan
Purpose: Nuclear imaging to detect bone abnormalities (fractures not seen on X-ray,
infections, tumors, metabolic bone disease).
Procedure: Injection of a small amount of radioactive material (technetium-99m) followed by
imaging after uptake.
Post-procedure/Care:
Hydration to help excrete radiotracer; monitor for any allergic reaction (rare).
Assess renal function and pregnancy status (avoid in pregnancy; use shielding).
Nursing considerations:
Explain that local warmth feeling or flushing can occur at injection site.
Inform that whole-body scan may take 1–3 hours; ask about recent barium or IV contrast use.
Esophagogastroduodenoscopy (EGD)
Purpose: Visualize esophagus, stomach, and duodenum to diagnose upper GI issues (ulcers,
tumors, bleeding, strictures).
Procedure quick note: A flexible endoscope is passed through the mouth; biopsies may be
taken.
Post-procedure Care:
Monitor for complications: bleeding, perforation, infection, and reaction to sedation.
NPO until gag reflex returns; then gradually advance diet as tolerated.
Watch for thoracic or abdominal pain, melena, hematemesis.
, Nursing considerations:
Pre-procedure: consent, NPO, check for anticoagulants, allergies (especially to sedation).
Post-procedure: airway safety due to anesthesia/sedation; document vital signs and pain.
2) Lab Values and Tests
Erythrocyte Sedimentation Rate (ESR)
Purpose: Non-specific marker of inflammation; measures how quickly red blood cells settle in
a tube.
Clinical relevance: Elevated in inflammatory, infectious, autoimmune conditions (e.g.,
rheumatoid arthritis, systemic lupus erythematosus), infections, and some cancers.
Nursing considerations:
Not a diagnostic test on its own; interpret with clinical context and other labs (CRP, CBC).
Factors that affect ESR: age, pregnancy, anemia, kidney disease, medications (e.g., steroids).
3) Medications and Treatments
Disease-Modifying Anti-Rheumatoid Drugs (DMARDs)
Purpose: Slow disease progression in rheumatoid arthritis; improve joint function and prevent
erosions.
Examples: Methotrexate, hydroxychloroquine (and others like sulfasalazine, leflunomide,
biologics such as TNF inhibitors).
Nursing considerations:
Baseline labs: liver function tests, CBC, kidney function; keep monitoring intervals.
Education: take as prescribed; common side effects (nausea, mucosal ulcers, liver toxicity,
bone marrow suppression).
Special notes: Methotrexate requires folic acid supplementation; avoid pregnancy during and
after certain DMARDs due to teratogenicity.
4) Orthopedic and Rheumatological Conditions
Hip Replacement (Total Hip Arthroplasty)
Indication: Severe osteoarthritis with chronic pain and impaired mobility; sometimes
rheumatoid arthritis or fractures.
Postoperative considerations:
Pain control, DVT prophylaxis, infection prevention, and prevention of dislocation.
Early mobilization and physical therapy per surgeon protocol.
Nursing priorities: Neurovascular checks, wound care, Hgb monitoring, patient education on
precautions (e.g., no hip adduction past midline, avoid bending >90 degrees depending on
prosthesis type).
Gout
Nutrition Education: Low-purine diet to reduce urate production; avoid alcohol (especially
beer), high-ppurine foods (red meat, shellfish) during flares.
Commonly Affected Areas: Often the first MTP joint (podagra); fever can accompany severe
attacks.
Nursing considerations: Monitor uric acid levels, renal function, hydration; assess for tophi or
chronic tophaceous gout.
Myelogram Examination
Purpose: Visualize the spinal cord, nerve roots, and intervertebral discs using contrast dye
(often replaced by MRI today, but still covered in some curricula).
Procedure quick note: Contrast is injected into the subarachnoid space via lumbar puncture.
Post-procedure Care:
Keep patient reclined for about 8 hours to minimize risk of spinal headache and CSF leakage.
Monitor for severe or persistent headache, nausea, vomiting, back pain, or signs of
meningitis.
Encourage adequate fluids unless contraindicated.
Nursing considerations:
Assess puncture-site for leakage, redness, swelling.
Check allergies (contrast dye) and kidney function if iodinated contrast used.
Pain control and neurovascular checks in lower extremities as indicated.
Arthrocentesis
Purpose: Remove joint fluid for diagnosis (infection, inflammatory markers) or provide
symptomatic relief (decrease effusion/pain).
Post-procedure Care:
Apply sterile dressing and assess puncture site for bleeding or infection.
Limit excessive joint movement initially; rest the joint as advised.
Monitor for fever, increased pain, swelling, warmth (infection signs) or septic symptoms.
Nursing considerations:
Confirm indication (infection vs. inflammatory vs. aspiration for culture).
Ensure sterile technique; send aspirate for Gram stain/culture, cell count, crystals if
appropriate.
Bone Scan
Purpose: Nuclear imaging to detect bone abnormalities (fractures not seen on X-ray,
infections, tumors, metabolic bone disease).
Procedure: Injection of a small amount of radioactive material (technetium-99m) followed by
imaging after uptake.
Post-procedure/Care:
Hydration to help excrete radiotracer; monitor for any allergic reaction (rare).
Assess renal function and pregnancy status (avoid in pregnancy; use shielding).
Nursing considerations:
Explain that local warmth feeling or flushing can occur at injection site.
Inform that whole-body scan may take 1–3 hours; ask about recent barium or IV contrast use.
Esophagogastroduodenoscopy (EGD)
Purpose: Visualize esophagus, stomach, and duodenum to diagnose upper GI issues (ulcers,
tumors, bleeding, strictures).
Procedure quick note: A flexible endoscope is passed through the mouth; biopsies may be
taken.
Post-procedure Care:
Monitor for complications: bleeding, perforation, infection, and reaction to sedation.
NPO until gag reflex returns; then gradually advance diet as tolerated.
Watch for thoracic or abdominal pain, melena, hematemesis.
, Nursing considerations:
Pre-procedure: consent, NPO, check for anticoagulants, allergies (especially to sedation).
Post-procedure: airway safety due to anesthesia/sedation; document vital signs and pain.
2) Lab Values and Tests
Erythrocyte Sedimentation Rate (ESR)
Purpose: Non-specific marker of inflammation; measures how quickly red blood cells settle in
a tube.
Clinical relevance: Elevated in inflammatory, infectious, autoimmune conditions (e.g.,
rheumatoid arthritis, systemic lupus erythematosus), infections, and some cancers.
Nursing considerations:
Not a diagnostic test on its own; interpret with clinical context and other labs (CRP, CBC).
Factors that affect ESR: age, pregnancy, anemia, kidney disease, medications (e.g., steroids).
3) Medications and Treatments
Disease-Modifying Anti-Rheumatoid Drugs (DMARDs)
Purpose: Slow disease progression in rheumatoid arthritis; improve joint function and prevent
erosions.
Examples: Methotrexate, hydroxychloroquine (and others like sulfasalazine, leflunomide,
biologics such as TNF inhibitors).
Nursing considerations:
Baseline labs: liver function tests, CBC, kidney function; keep monitoring intervals.
Education: take as prescribed; common side effects (nausea, mucosal ulcers, liver toxicity,
bone marrow suppression).
Special notes: Methotrexate requires folic acid supplementation; avoid pregnancy during and
after certain DMARDs due to teratogenicity.
4) Orthopedic and Rheumatological Conditions
Hip Replacement (Total Hip Arthroplasty)
Indication: Severe osteoarthritis with chronic pain and impaired mobility; sometimes
rheumatoid arthritis or fractures.
Postoperative considerations:
Pain control, DVT prophylaxis, infection prevention, and prevention of dislocation.
Early mobilization and physical therapy per surgeon protocol.
Nursing priorities: Neurovascular checks, wound care, Hgb monitoring, patient education on
precautions (e.g., no hip adduction past midline, avoid bending >90 degrees depending on
prosthesis type).
Gout
Nutrition Education: Low-purine diet to reduce urate production; avoid alcohol (especially
beer), high-ppurine foods (red meat, shellfish) during flares.
Commonly Affected Areas: Often the first MTP joint (podagra); fever can accompany severe
attacks.
Nursing considerations: Monitor uric acid levels, renal function, hydration; assess for tophi or
chronic tophaceous gout.
