ORTHOPAEDIC NURSE CERTIFICATION
QUESTIONS AND ANSWERS (GRADED
A)
Dermatomyositis - ANSWER-chronic systemic immunological disease involving
inflammation of the skin, connective tissue, and muscles,
causes widespread skin rash and permanent bumps underneath skin
Polymyositis/Dermatomyositis S/S - ANSWER--Muscle weakness
-Red or purple symmetric rash (heliotrope)
-Scaly, smooth, or raised rash on knuckles and sides of hand (gottron's papules)
-Joint redness, pain, and inflammation and decreased ROM
-Weakened pharyngeal muscles
Polymyositis/Dermatomyositis Care - ANSWER--Biopsy for dx
-Long term corticosteroids
-Immunosuppressive drugs
-IV immunoglobulin (hydrate patient well, may get HA)
Fibromyalgia S/S - ANSWER-*Chronic musculoskeletal syndrome*
-Widespread burning and gnawing, joint and muscle pain, fatigue, "tender points" (↑
sensitivity to touch)
-*Begins with a flu-like viral illness*
-Lower pain threshold
*ABSENCE of inflammation*
-Cognitive difficulties
-RLS
-IBS
Corticosteroids intraarticular injections - ANSWER--Depo-Medrol, Aristospan
-Antiinflammatory, Analgesic
-Joint may feel worse right after injection
-Avoid overusing joint immediately after injection
-Improvement last weeks to months after injection
Systemic Corticosteroids - ANSWER--Hydrocortisone, Methylprednisolone,
dexamethasone, Prednisone, Triamcinolone
-Antiinflammatory, Analgesic
-Use only with severe exacerbation
-Symptoms return with abrupt withdraw
-Monitor BP, weight, CBC, Serum potassium
-Limit sodium intake
,DMARDs - ANSWER--Methotrexate: Monitor CBC and hepatic and renal function and
for anemia. Teratogenic
-Azulfidine: May cause orange-yellow skin or urine. Take with full glass of water.
Continue after symptoms relieved. Monitor CBC
-Arava: Monitor hepatic function. Avoid pregnancy
-Penicillamine: Monitor WBC, platelets, UA. Take 1hr before or 2hrs after eating and an
hour away from any med
Fibromyalgia Diagnosis - ANSWER-Two criteria are met: pain is experienced in 11 of
the 18 tender pints on palpation and a history of widespread pain for at least 3 months
Fibromyalgia treatment - ANSWER--Rest
-Lyrica, Cymbalta, Savella
-Antidepressants
-Benzos
-Massage
-Heat and cold packs
-Stretching
-Limit sugar, caffeine, and alcohol
Osteoarthritis (OA) - ANSWER--Formation of bone spurs and osteophytes
-Inflammation of the joint
-Breakdown of cartilage
Symptoms of OA - ANSWER--Pain & Stiffness: worse in the morning for <30 min,
prolonged inactivity or weather changes
-Locking, cracking, grinding, or feeling of giving out of knees
-Swelling, nodules or stiffness of fingers and difficulty gripping, Herberden's nodes,
Bouchard's nodes, bowlegged, knock-knees
Goals of management of OA - ANSWER--Reduce pain and inflammation
-Maintain joint function
Diagnostics of OA - ANSWER--X-ray
-MRI
-Joint aspiration
-CT
Treatment of OA - ANSWER--Maintain ROM
-Increase muscle strength
-Reduce stress on joints
-Heat and cold
-Glucosamine
-Stretching
-Weight control
, -Topical analgesic-Capsaicin cream, bengay, Icy hot
-Corticosteroid injection: lasts 3-4 weeks
-Viscosupplementation: Lasts 6 months
-Arthroscopy
Salicylate - ANSWER--Aspirin
-Anti-inflammatory, Analgesic, Antipyretic
-Administer with food or full glass of water
-Monitor for bleeding
NSAIDs - ANSWER--Ibuprofen, naproxen, indomethacin, ketorolac, diclofenac,
celecoxib
-Anti-inflammatory, Analgesic, Antipyretic
-Administer with food
-Monitor for signs of bleeding or GI upset
Doxycycline - ANSWER--Decreases action of enzymes on cartilage degradation
Minocycline - ANSWER--Antirheumatic effect
Capsaicin cream - ANSWER--Must be used at regular intervals for maximal effect
-Aloe Vera cream may decrease burning sensation
-Do not use with external heat source
Gold Compund - ANSWER--Rule out pregnancy
-Monitor CBC, UA, hepatic and renal function
-Therapeutic response may take 3-6 months
-Report pruritus, rash, sore mouth, indigestion, metallic taste
C6 Nerve - ANSWER--Neck injury or degeneration
-Pain and decreased sensation that radiates down the arm into the thumb
-Muscle weakness in the biceps and wrist extension
brachioradialis reflex decreased
C7 Nerve - ANSWER--Pain or numbness that travels to the third finger
-Decreased triceps reflex
Cervical Traction - ANSWER--Used at home to decrease pain
-Used in hospital to immobilize pre or postsurgical
Cervical collar - ANSWER--Used to immobilize neck
-OA
-Cervical spondylosis
-Whiplash injuries
QUESTIONS AND ANSWERS (GRADED
A)
Dermatomyositis - ANSWER-chronic systemic immunological disease involving
inflammation of the skin, connective tissue, and muscles,
causes widespread skin rash and permanent bumps underneath skin
Polymyositis/Dermatomyositis S/S - ANSWER--Muscle weakness
-Red or purple symmetric rash (heliotrope)
-Scaly, smooth, or raised rash on knuckles and sides of hand (gottron's papules)
-Joint redness, pain, and inflammation and decreased ROM
-Weakened pharyngeal muscles
Polymyositis/Dermatomyositis Care - ANSWER--Biopsy for dx
-Long term corticosteroids
-Immunosuppressive drugs
-IV immunoglobulin (hydrate patient well, may get HA)
Fibromyalgia S/S - ANSWER-*Chronic musculoskeletal syndrome*
-Widespread burning and gnawing, joint and muscle pain, fatigue, "tender points" (↑
sensitivity to touch)
-*Begins with a flu-like viral illness*
-Lower pain threshold
*ABSENCE of inflammation*
-Cognitive difficulties
-RLS
-IBS
Corticosteroids intraarticular injections - ANSWER--Depo-Medrol, Aristospan
-Antiinflammatory, Analgesic
-Joint may feel worse right after injection
-Avoid overusing joint immediately after injection
-Improvement last weeks to months after injection
Systemic Corticosteroids - ANSWER--Hydrocortisone, Methylprednisolone,
dexamethasone, Prednisone, Triamcinolone
-Antiinflammatory, Analgesic
-Use only with severe exacerbation
-Symptoms return with abrupt withdraw
-Monitor BP, weight, CBC, Serum potassium
-Limit sodium intake
,DMARDs - ANSWER--Methotrexate: Monitor CBC and hepatic and renal function and
for anemia. Teratogenic
-Azulfidine: May cause orange-yellow skin or urine. Take with full glass of water.
Continue after symptoms relieved. Monitor CBC
-Arava: Monitor hepatic function. Avoid pregnancy
-Penicillamine: Monitor WBC, platelets, UA. Take 1hr before or 2hrs after eating and an
hour away from any med
Fibromyalgia Diagnosis - ANSWER-Two criteria are met: pain is experienced in 11 of
the 18 tender pints on palpation and a history of widespread pain for at least 3 months
Fibromyalgia treatment - ANSWER--Rest
-Lyrica, Cymbalta, Savella
-Antidepressants
-Benzos
-Massage
-Heat and cold packs
-Stretching
-Limit sugar, caffeine, and alcohol
Osteoarthritis (OA) - ANSWER--Formation of bone spurs and osteophytes
-Inflammation of the joint
-Breakdown of cartilage
Symptoms of OA - ANSWER--Pain & Stiffness: worse in the morning for <30 min,
prolonged inactivity or weather changes
-Locking, cracking, grinding, or feeling of giving out of knees
-Swelling, nodules or stiffness of fingers and difficulty gripping, Herberden's nodes,
Bouchard's nodes, bowlegged, knock-knees
Goals of management of OA - ANSWER--Reduce pain and inflammation
-Maintain joint function
Diagnostics of OA - ANSWER--X-ray
-MRI
-Joint aspiration
-CT
Treatment of OA - ANSWER--Maintain ROM
-Increase muscle strength
-Reduce stress on joints
-Heat and cold
-Glucosamine
-Stretching
-Weight control
, -Topical analgesic-Capsaicin cream, bengay, Icy hot
-Corticosteroid injection: lasts 3-4 weeks
-Viscosupplementation: Lasts 6 months
-Arthroscopy
Salicylate - ANSWER--Aspirin
-Anti-inflammatory, Analgesic, Antipyretic
-Administer with food or full glass of water
-Monitor for bleeding
NSAIDs - ANSWER--Ibuprofen, naproxen, indomethacin, ketorolac, diclofenac,
celecoxib
-Anti-inflammatory, Analgesic, Antipyretic
-Administer with food
-Monitor for signs of bleeding or GI upset
Doxycycline - ANSWER--Decreases action of enzymes on cartilage degradation
Minocycline - ANSWER--Antirheumatic effect
Capsaicin cream - ANSWER--Must be used at regular intervals for maximal effect
-Aloe Vera cream may decrease burning sensation
-Do not use with external heat source
Gold Compund - ANSWER--Rule out pregnancy
-Monitor CBC, UA, hepatic and renal function
-Therapeutic response may take 3-6 months
-Report pruritus, rash, sore mouth, indigestion, metallic taste
C6 Nerve - ANSWER--Neck injury or degeneration
-Pain and decreased sensation that radiates down the arm into the thumb
-Muscle weakness in the biceps and wrist extension
brachioradialis reflex decreased
C7 Nerve - ANSWER--Pain or numbness that travels to the third finger
-Decreased triceps reflex
Cervical Traction - ANSWER--Used at home to decrease pain
-Used in hospital to immobilize pre or postsurgical
Cervical collar - ANSWER--Used to immobilize neck
-OA
-Cervical spondylosis
-Whiplash injuries
