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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



CBC

  • Hemoglobin

    • Increase can mean CHF

    • Decrease can mean SLE or sarcoidosis

  • Normal = male 14-18, female 12-16 g/dl

  • Client prep


CBC

  • 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)


Arthrogram
Arthrogram

  • 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

  • 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


MRI

  • 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


MRI

  • 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

  • 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
X-ray

  • 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
Myelogram

  • 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


Myelogram1
Myelogram

  • 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


  • Arthroscopy

    • 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


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