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Musculoskeletal System. Common Diagnostic Tests. ANA, antinuclear antibodies Detects SLE, a collagen disease Arthritis can result from SLE Normal = negative Client prep. CRP, C-reactive protein inflammation and auto-immune disorders show abnormal protein

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common diagnostic tests
Common Diagnostic Tests
  • ANA, antinuclear antibodies
    • Detects SLE, a collagen disease
    • Arthritis can result from SLE
  • Normal = negative
  • Client prep
CRP, C-reactive protein
    • inflammation and auto-immune disorders show abnormal protein
  • Normal = female 1-20, male 1-13mm/h
    • Can get false negative
  • Client Prep, usually non-fasting blood draw
Uric Acid-Blood
    • Elevated with Gout and arthritis
  • Normal = male 2.1-8.5, female 2.0-6.6 mg/dl
  • Client prep: usually non-fasting blood draw
Uric Acid-Urine (24 hour collection)
  • Normal = 250-750 ml/24hr
  • Client prep
  • Hemoglobin
    • Increase can mean CHF
    • Decrease can mean SLE or sarcoidosis
  • Normal = male 14-18, female 12-16 g/dl
  • Client prep
  • WBC
    • elevated with infection/inflammation
  • Normal + 5,000 – 10,000/mm3
  • Client prep
ESR, Erythrocyte Sedimentation Rate
    • RBC descent in saline in 1 hour
    • Increases with inflammation, infection, necrosis, or cancer
  • Normal = male up to 15, female up to 20 mm/hr
  • Client prep
RF, Rheumatoid Factor (IgM)
    • Elevated with autoimmune disease such as Rheumatoid arthritis and SLE
  • Normal = < 60 U/ml or negative
  • Client prep
Serum Calcium, detects calcium metabolism
    • Increase may indicate: metastatic bone tumor, Paget’s disease, acromegaly
    • Decrease may indicate: rickets, osteomalacia, vitamin D deficiency
  • Normal = 9.0 – 10.5 mg/dl
    • < 6mg/dl may lead to tetany (cramps, convulsions, twitching)
    • > 14mg/dl may lead to coma
  • Client prep
radiologic studies
Radiologic Studies
  • Arthrogram/Arthrography-Xray with contrast dye into joint to visualize soft tissue of joints (meniscus, ligaments, cartilage)
  • Client prep
Arthrogram Procedure:
    • Cleanse & anesthetize area
    • Insert needle into joint space
    • Aspirate fluid to minimize dilution of dye
    • Leave needle in, replace syringe with dye syringe
    • Inject contrast and remove needle
    • ROM to distribute dye
    • X-rays will be taken
    • Takes about 30 minutes
    • May experience some discomfort, pressure, tingling
Following Arthrogram:
    • Assess for swelling
    • Apply ice, if needed
    • Mild analgesic
    • May hear crepitus after test. This is normal and will disappear in 1-2 days.
    • Instruct pt to call MD if pain or swelling occurs
CT Scan
    • X-ray (body scanner) with contrast dye
    • Three-dimensional cross-sectional view of tissues at various angles
    • Can identify small differences: Detects edema, hemorrhage, blood flow, infarcts, tumors, infections, aneurysms, demyelinating disease, muscular disease, skeletal abnormalities, disk problems, causes of spinal cord compression
    • Takes about an hour
    • Findings as with arthrogram, but 3-D view
ct scan
CT Scan
  • Client prep
following ct scan
Following CT Scan
  • Increase fluid intake to flush dye
  • Evaluate patient for delayed reaction to dye (usually occurs within 2-6 hours)
  • Treat with antihistamine and/or steroids, if indicated
ct scan procedure
CT Scan Procedure
  • Patient must lie still
  • Show picture of CT machine and discuss claustrophobia, may need antianxiety med
  • Performed by a radiologist
  • Takes 30-45 minutes
  • Discomfort includes lying still on a hard surface, peripheral venipuncture, mild nausea, salty taste, flushing, and warmth from dye
  • MRI/Magnetic Resonance Imaging
    • Magnetic field and radio waves, noninvasive
    • Can evaluate soft & hard tissue, & blood vessels
    • Unique d/t no exposure to ionizing radiation
    • Advantages over CT
    • Disadvantages
  • Contraindications:
    • > 300 lbs
    • Claustrophobia
    • Metal implants, clips, pacemaker, infusion pumps
    • Pregnancy (long-term effects not known)
    • If on continuous life support
Client prep:
    • Obtain consent
    • Can drive afterwards without assistance
    • Assess for contraindications
    • Show picture of machine, discuss claustrophobia
    • Remove all metal objects from body (create artifacts, can go flying, damages credit cards)
    • Must remain motionless in supine position
    • Will hear thumping sound, ear plugs available
    • Empty bladder prior to test for comfort
    • No food or fluid restrictions prior to test
    • Explain procedure
mri procedure
MRI Procedure
  • Lie flat on hard table that slide into a tube
  • Must lie still
  • Can talk to or listen to staff
  • Magnevist (contrast agent) may be used via IV
  • Performed by radiologist
  • Takes 30 to 90 minutes
  • Discomfort from lying on hard surface, possible venipuncture, possible tingling in teeth (metal fillings)
  • No postprocedural care needed
  • Detects: edema, hemorrhage, blood flow, infarcts, tumors, infections, aneurysms, demyelinating disease, muscular disease, skeletal abnormalities, disk problems, causes of spinal cord compression
x ray
  • X-ray, electromagnetic radiation passes photons (light particles) through the body onto film
    • Bone (very dense) blocks photons, appears white
    • Air appears black
    • Muscle, fat, and fluid appear as various shades of gray
    • Metal and contrast block almost all photons and appear bright white
x ray1
  • Client prep
    • Nonfasting
    • Position determined by area to be x-rayed
    • Patient should be still, usually hold breath
    • Contraindicated if pregnant
    • May need to remove jewelry & don a gown
    • No discomfort except r/t position
  • Detects fractures and some joint abnormalities
  • Myelogram
    • X-ray with contrast dye of spinal subarachnoid space
    • Detects spinal tumors, herniated discs, bone spurs, cervical ankylosing spondylosis, arthritic lumbar stenosis
    • Contraindications: Multiple sclerosis patients (may cause exacerbation), ICP, infection near lumbar puncture sight, allergy to shellfish
  • Client prep
Myelogram Procedure
    • Empty bladder
    • A lumbar puncture is performed
      • 15 ml CSF removed
      • 15 ml of radiopaque dye injected
    • Patient will be tilted up and down to spread dye (prone position)
    • Lights are off, dye followed with fluoroscopy
    • X-ray films taken
    • Needle remains in place until exam concluded
    • Done by radiologist and takes 45 minutes
    • Discomfort varies from mild to severe
following myelogram
Following Myelogram
  • Bed rest for several hours
  • Head position varies per dye used, per MD order
  • Monitor for bleeding, fever, headache, photophobia, seizure, VS, ability to void, reaction to dye
  • Possible med restrictions
  • Push fluids
bone scan
Bone Scan
  • Bone Scan
    • Radioactive isotope intravenous
    • They use a gamma camera to detect “hot spots” of activity where the isotope collects
    • Can detect tumor, arthritis, fracture, necrosis, degenerative changes, osteomyelitis
  • Normal = uniform distribution
  • Abnormal = area of higher concentration
  • Contraindicated in pregnancy, breastfeeding
bone scan1
Bone Scan
  • Advantages:
  • Disadvantages:
bone scan2
Bone Scan
  • Client prep:
    • Explain procedure, is non-fasting, no sedation required
    • Arrive at Nuclear Medicine department 4 hours prior to test
    • Dye given IV, takes 4 hours to travel to bones
    • Push fluid to aid in dye distribution
    • Empty bladder upon return to avoid artifact
    • You may be asked to wear a gown
    • Done in supine, prone, & lateral position, takes an hour
    • Takes 6-24 hours for dye to leave system (push fluids)
    • Discomfort is needle stick for dye infusion, and hard surface
bone mineral density bmd
Bone Mineral Density/BMD
  • BMD
    • Measures bone mass
    • The only test to diagnose osteoporosis
  • Normal is comparative to same age, sex, size. Lower density = higher risk for fractures
    • -1 to –2, Osteopenia
    • < -2.5, Osteoporosis
  • Client prep: Non-fasting, non-invasive, do Q2 yrs
other tests
Other Tests
  • Arthrocentesis
    • Obtain synovial fluid from a joint
    • Needle aspiration
    • Sterile procedure
    • Detects infections, synovitis, crystal-induced arthritis, tumors, joint degeneration
    • Inject anti-inflammatory medications
    • Normal= Clear, straw-colored fluid, no crystals
    • Contraindicated if infection near joint being tested
Arthrocentesis cont’d
    • Informed consent
    • Explain procedure
    • May or may not be fasting
    • Local anesthetic
    • Aseptic procedure
    • Fluid may be removed, Steroid may be injected
    • Apply pressure dressing following procedure
    • May do venipuncture to compare chemical content
    • Doctor office or bedside, by MD, takes 10 minutes
    • Pain may worsen after test
Following Arthrocentesis
    • Assess for pain, fever, swelling
    • Apply ice
    • Apply pressure dressing to decrease reaccumulation of fluid or hematoma
    • Avoid strenuous use of joint for several days
Arthroscopy-used most often for knee
    • Small incision, endoscope
    • Examine the inside of a joint
    • Diagnose disease, meniscus problems, torn cartilage, remove small bodies, do biopsy
    • Advantage: allows direct visualization, can perform surgery, can monitor disease progress, can attach video camera; can examine, biopsy, or do surgery
    • Contraindications:Infection or ankylosis in joint
    • Client prep:
      • Obtain consent
      • NPO at midnight
      • Teach crutch use for post procedure use
      • Shave 6” above and below joint
      • May use local or general anesthesia
      • Pressure wrap or tourniquet
      • Knee at 45 degree angle
      • May have 2-3 small incision sights
      • Sutured with dressing applied
      • Done by orthopedic surgeon, takes 15 to 30 minutes
Arthroscopy Follow-up
    • Asses neurologic status and circulatory status
    • Assess for sxs of infection, for drainage
    • Teach to elevate & ice to decrease swelling
    • May walk with crutches if MD order
    • Suture removal in 7-10 days