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z S15 HEHI 4 > adult musculoskeletal > Flashcards

adult musculoskeletal Flashcards

1
Q

strain

A

stretching and/or partial tear in a MUSCLE or TENDON

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2
Q

strain cause

A

sudden stretching of contracted muscle

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3
Q

strain assessment findings

A

pain, stiffness, local tenderness, swelling

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4
Q

sprain

A

injury to a LIGAMENT or surrounding CAPSULE

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5
Q

sprain cause

A

abnormal, excessive movement

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6
Q

sprain assessment findings

A

pain, rapid swelling, discoloration, limited function

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7
Q

joint dislocation

A

abnormal displacement of articulating surfaces

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8
Q

subluxation

A

partial dislocation

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9
Q

dislocation/subluxation cause

A

congenital, traumatic, pathologic

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10
Q

dislocation/subluxation assessment findings

A

pain, deformity, limited movement, deviation in length and/or rotation of extremity

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11
Q

fracture

A

disruption in continuity of bone

  • classified according to location, type, direction/pattern of fracture line
  • type further determined by “communication with environment”, degree of break, character of fracture pieces
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12
Q

fracture cause

A

sudden trauma, fatigue stress, pathologic stress

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13
Q

strains/sprains: intervention

A

R est
I ce (put something between it and skin)
C ompress (possible immobilization)
E levante

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14
Q

dislocation/subluxation: intevention

A

closed reduction followed by immobilization and strengthening

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15
Q

fatigue stress

A

excess stress applied to normal bone

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16
Q

pathologic stress

A

normal stress applied to bones weakened by disease

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17
Q

complete fracture

A

involves entire width of bone

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18
Q

incomplete fracture

A

does not extend through the full transverse of a bone

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19
Q

simple fracture

A

often used to describe uncomplicated closed fracture

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20
Q

avulsion

A

fracture occurs when a ligament or tendon pulls away part of the bone

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21
Q

transverse fracture

A

complete, break is at a right angle to the axis

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22
Q

reduction

A

replacing bone fragments to near-normal position

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23
Q

immobilization

A

obtains union of the fracture fragments by preventing movement

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24
Q

CMS aka NV checks: what & when?

A

C irculation + C olor
M ovement
S ensation
N euroVascular

for cast care

q 1-2’ for 48’ then q8

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25
Q

external traction

A

reduction, ALIGNMENT, and immobilization

  • noninvasive
  • decreases spasms
  • stretches adhesions
  • prevents deformity
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26
Q

internal fixation

A

the use of metal pins, screws, rods, plates, prostheses to immobilize fracture during healing; surgeon makes incision (open reduction) to gain access to broken bone then implants one or more devices

  • reduction and immobilization
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27
Q

external fixation

A

system in which pins or wires are passed through skin and bone and connected to rigid external frame to immobilize a fracture during healing

  • reduction and immobilization
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28
Q

ORIF

A

open reduction internal fixation (incision to gain access to broken bone + device implantation)

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29
Q

pin care

A

for external fixation!
- daily inspection

protocol specific:

  • daily cleansing
  • dressings
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30
Q

callus

A

loose, fibrous, vascular tissue that forms at the site of a fracture as the first phase of healing; normally replaced by hard bone as healing continues

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31
Q

fat embolism syndrome

A
  • occurs within 72 hours of LONG BONE or PELVIC fracture

- results from fat droplets in the small blood vessels of lungs or other organs

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32
Q

fat embolism: features

A

respiratory failure, skin petechiae, CNS symptoms

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33
Q

fat embolism: s/s

A
  • substernal chest pain
  • dyspnea
  • tachycardia
  • diaphoresis
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34
Q

acute compartment syndrome

A
  • increased pressure in limited space (muscle compartment) compromising circulation
  • can result in death of nerve, muscle cells
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35
Q

acute compartment syndrome: common causes

A

excessive edema after a crushing injury or bone surgery, vascular injury and bleeding, constrictive dressings/casts, severe burns

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36
Q

acute compartment syndrome: hallmark symptom

A

SEVERE pain that is out of proportion to injury or physical findings

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37
Q

acute compartment syndrome: other s/s

A
  • changes in sensation
  • diminished reflexes
  • eventual loss of motor function
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38
Q

acute compartment syndrome: interventions

A
  • cast splitting
  • limited elevation of extremity
  • if unrelieved: fasciotomy
39
Q

fasciotomy

A

surgical procedure in which an incision is made through the skin and subcutaneous tissues into the fascia of the affected compartment to relieve the pressure in and restore circulation to the affected area

re: ACUTE COMPARTMENT SYNDROME

40
Q

contracture

A

permanent shortening of muscle or joint; elastic tissue is replaced by non-stretchy, fiber-like tissue

41
Q

osteoporosis*

A

primary disorder most often associated with AGING*

secondary disorder often linked to CHRONIC MEDICATION USE

characterized by decreased bone density, strength; data suggests resoprtion exceeds formation, but causation largely unknown

result: minimal stress results in fractures

42
Q

osteoporosis: associated risk factors

A

smoking, high alcohol intake, lack of exercise, estrogen deficiency, deficient calcium intake

43
Q

osteoporosis: s/s

A

sudden onset skeletal fracture, loss of height, kyphosis

44
Q

osteoporosis: prevention

A
  • regular exercise
  • adequate Ca, Vitamin D intake
  • weight bearing exercises
  • early detection
  • meds
45
Q

osteoporosis: pharm interventions (list)

A
  • calcium supplements
  • biphosphates
  • estrogen agonists/antagonists
  • thyroid hormone (calcitonin)
46
Q

calcium supplements for…?

A

osteoporosis

47
Q

biphosphates are/for…?

A

slows resorption; osteoporosis

48
Q

estrogen agonist/antagonist are/for…?

A

stimulates bone formation in post-menopausal women; osteoporosis

CONTROVERSIAL

49
Q

thyroid hormone (calcitonin) is/for…?

A

decreases bone loss; osteoporosis

50
Q

osteomalacia

A

inadequate mineralization of bone resulting in softening

primary cause: vitamin D deficiency

not common in US

51
Q

osteoarthritis

A

AKA degenerative joint disease
- progressive, degenerative disease of the joint surfaces that is characterized by EROSION OF ARTICULAR CARTILAGE, underlying bone density, osteophyte formation

52
Q

osteophyte

A

small, abnormal bony outgrowth

53
Q

articular cartilage

A

smooth, white tissue that covers the end of bones where they come together to form a joint; consists of collagent fiber matrix impregnated with complex ground substance

54
Q

articular cartilage

A

smooth, white tissue that covers the end of bones where they come together to form a joint; consists of collagent fiber matrix impregnated with complex ground substance

55
Q

osteoarthritis: assessment findings

A
  • joint PAINT that improves with rest
  • swelling and joint enlargement
  • joint crepitus
  • decreased range of motion
  • muscular atrophy
56
Q

osteoarthritis: pharm interventions (list)

A
  • NSAIDS
  • steroids
  • adjunctive analgesics
57
Q

osteoarthritis: surgical options (list) + goal

A
  • arthroscopic debridement
  • arthroplasty
  • osteotomy
  • arthrodesis

pain relief, restoration of motion, correction of deformities

58
Q

arthroscopic debridement

A

trim rough edges and remove loose fragments

for osteoarthritis

59
Q

arthroplasty

A

partial or total joint replacement

for osteoarthritis

60
Q

osteotomy

A

wedge of bone removed near damaged joint

for osteoarthritis

61
Q

arthrodesis

A

joint fusion (restores stability and alignment)

for osteoarthritis

62
Q

rheumatoid arthritis

A

chronic, inflammatory autoimmune connective tissue disease

often results in long-term damage to the joints resulting in chronic pain, loss of function, disability

63
Q

rheumatoid arthritis: causes

A

transformed antibodies (rheumatoid factors) attack healthy tissue (especially synovium); it thickens and a pannus forms. this erodes cartilage and destroys bone.

64
Q

pannus

A

vascular granulation tissue

65
Q

rheumatoid arthritis: s/s

A

inflammation of the lining of the joints (synovium) ,bony calcification, secondary osteoporosis

  • ulnar deviation
  • fingers are spindle-like
  • on palpation joints feel soft (effusions with fluid)
  • decreased range of motion
66
Q

rheumatoid arthritis: 3 classes of drugs for treatment

A
  • NSAIDS
  • corticosteroids
  • DMARDS
67
Q

DMARDs

A

Disease Modifying Anti-Rheumatic Drugs

for rheumatoid arthritis

  • slow progression of rheumatoid arthritis by reducing signals to the immune system resulting in less inflammation
  • takes 4 to 6 weeks to begin to decrease inflammatory symptoms

most common: methotrexate (Rheumatrex)

68
Q

methotrexate (Rheumatrex)

A

DMARD for rheumatoid arthritis

69
Q

gout

A

aka “gouty arthritis” - systemic disease in which urate crystals deposit in joints, other body tissues, causing inflammation

primary & secondary gout

easy to treat, diagnose in early phases; chronic gout NOT as common in US (due to treatment availability)

70
Q

gout: interventions

A

drug therapy is KEY!

  • acute v chronic gout drugs DIFFERENT
  • nutrition therapy is controversial
  • avoid aspirin, diuretics (may precipitate attack)
  • excess physical, emotional stress
  • drink lots of water
71
Q

primary gout

A

most common type of gout, results from several inborn errors of purine metabolism.
- uric acid production exceeds excretion capability of kidneys
- sodium urate deposited in synovium and other tissues = inflammation
- can be X-linked trait; middle-aged/older men
+ post-menopausal women

72
Q

uric acid

A

end product of purine metabolism excreted by kidneys; involved in primary gout

73
Q

secondary gout

A

hyperuricemia caused by another disease or factor

    • renal insufficiency, diuretic therapy, crash diets, certain chemo agents - decreased normal excretion of uric acid, other waste products
    • multiple myeloma, certain carcinomas = increased production of uric acid due to greater turnover of cellular nucleic acids
  • affects people of all ages
74
Q

hyperuricemia

A

excess of uric acid in the blood; involved in secondary gout (often seen in older patients with cardiovascular health problems)

75
Q

primary gout: clinical stages of disease

A

1: asymptomatic hyperuricemia
2: acute gouty arthritis
3: chronic or tophaceous gout

76
Q

primary gout: asymptomatic hyperuricemia stage

A

FIRST STAGE
patient usually unaware unless serum uric acid level done (elevated, but no obvious signs of disease present)

  • no treatment needed
77
Q

primary gout: acute gouty arthritis stage

A

SECOND STAGE
first “attack” begins this stage: excruciating pain, inflammation in one or more small joints (usually podagra)
- erythrocyte sedimentation rate usually increased as result of inflammatory process
- months or years may pass before additional attacks occur
- patient asymptomatic, no abnormalities found during examination of joints

78
Q

podagra

A

inflammation of metatarsophalangeal joint of great toe that typically begins acute gouty arthritis stage (2) of primary gout

79
Q

primary gout: chronic tophaceous gout stage

A

THIRD STAGE
follows repeated episodes of acute gout; deposits of urate crystals develop under skin, within major organs (esp. renal system)

  • urate kidney stone formation is more common than renal insufficiency
  • can begin anywhere between 3 and 40 years after initial gout symptoms occur
80
Q

most common finding of acute gout

A

joint inflammation, usually so painful patient seeks medical care immediately; inflamed area usually too painful, swollen to be touched, moved

81
Q

tophi

A

deposits of sodium urate crystals in skin due to chronic gout; hard on palpation, irregular in shape, may discharge yellow, gritty substance if irritated and broken open

commonly appear on the outer ear but can happen anywhere (other common: arms, fingers near joints)

82
Q

chronic gout: s/s

A
  • joint inflammation (most common)
  • renal calculi
  • renal dysfunction (severe pain, changes in UOP)
83
Q

acute gouty attacks

A

inflammation subsides spontaneously within 3 to 5 days, though most patients can’t tolerate pain for that long)

84
Q

acute gout: drug therapy

A

combo of colchicine (Colsalide) + NSAID (like indomethacin, Indocin -or- ibuprofen, Motrin)
- take PO until inflammation subsides (usually 4-7 days)

85
Q

allopurinol, febuxostat

A

xanthine oxidase inhibitors that prevent conversion of xanthine to uric acid
- promote uric acid excretion or to

86
Q

colchicine + indomethacin

A

for acute gout

87
Q

refractory gout: drug therapy

A

pegloticase (IV dose q 2 weeks)

88
Q

refractory gout

A

severe gout that does not respond to drugs

89
Q

pegloticase

A

for refractory gout, given IV, enzyme that works directly on uric acid and converts it to allantoin (can be excreted immediately by kidneys)

is protein that is foreign to the body so monitor for anaphylaxis and other allergic reactions

90
Q

synovium

A

soft tissue between joint capsule and articular cartilage of joint

91
Q

cartilage

A

dense connective tissue

92
Q

tendon

A

connect bone to muscle

93
Q

ligament

A

connect bones or support various organs

z S15 HEHI 4 (7 decks)

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