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Med Surge 3rd exam > Bone disease > Flashcards

Bone disease Flashcards

1
Q

This porous bone disease is a chronic, progressive metabolic bone disease characterized by low bone mass and structural deterioration of bone tissue leading to increased bone fragility is defined as:

A

osteoporosis (silent thief)

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2
Q

The occurrence of bone fxs due to osteoporosis in females and males are:

A

1-2 in women, 1-8 in males

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3
Q

Why are women commonly affected w/osteoporosis:

A

low Ca intake, smaller frame, rapid bone reabsorption during menopause, pregnancy/breastfeeding, longevity

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4
Q

Risk factors for osteoporosis are:

A

Family hx, smoking/drinking, inactive lifestyle, low Ca/D diet, lone term use in corticosteroids

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5
Q

Normally, the rate of bone deposition and reabsorption (both defined as remodeling) are equal to each other. In osteoporosis:

A

bone reabsorption is greater than deposition

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6
Q

Bone mass is determined:

A

70% heredity, nutrition, exercise, hormone function

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7
Q

Where do osteoporosis occur:

A

spine (dowager’s hump), hips, and wrists

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8
Q

What are the clinical manifestations of osteoporosis:

A

Back pain, loss of height, spinal deformities (kyphosis)

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9
Q

When can a x-ray detect osteoporosis:

A

Goes undetected until 25-40 % of Ca is lost

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10
Q

What are the diagnostic studies for osteoporosis:

A

X-ray, bone mineral density (BMD) utilizing quantitative UZ on the knee, heel, shin, or using a dual-energy X-ray absorptiometry (DEXA) on the spine, hips, and forearm

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11
Q

Dual-energy x-ray absorptiometry (sound waves) are read as:

A

T-scores and will read bone density as either: normal, osteopenia, or osteoporosis

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12
Q

How do primary interventions effect osteoporosis:

A

Primary intervention retains bone health by: diet rich in Ca/D, weight-bearing exercises, no smokin, decreased EtOH intake, 20 min exposure to sun for D, bone density testing

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13
Q

Why should Ca supplements be spread out throughout the day and when should they be taken when taking abx:

A

Body won’t absorb more than 500 mg of Ca at one time, and supplements should be taken after 2-4 hrs after abx tx

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14
Q

What is the daily amount of Ca needed for women:

A

1000 mg for premenopausal, 1500 mg post menopause

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15
Q

How do secondary interventions effect osteoporosis and includes what type of medications:

A

Secondary intervention ATTAINS optimal bone health by: HRT-hormone replacement therapy; Calcitonin (decrease reabsorption), Bisphosphonates (reduce reabsorption), Selective estrogen Receptor (SERMs reduces reabsorption), teriparatide (for men w/increased risk of fx, increase action of osteoblasts), Denosumab (for women at increased risk of fx)

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16
Q

What are the types of bisphosphonates and how should they be taken:

A

Fosamax, Boniva, Reclasts (FBR) should be taken w/full glass of water, 30 min before food/meds, remain upright for 30 min

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17
Q

How do secondary intervention effect osteoporosis and includes what type of procedures or braces:

A

Secondary intervention ATTAINS optimal bone health by: thoracic-lumber-sacral-orthosis brace; Vetebroplasty (cement is injected for stabilization); kyphoplasty (bladder bag is inserted/inflated and then cement is injected)

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18
Q

How do tertiary interventions effect osteoporosis:

A

Tertiary interventions MAINTAIN optimal bone health by: incorporating primary/secondary interventions, reporting new pain sites, emphasizing safety to prevent fx: FALLS

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19
Q

A severe infection of the bone, bone marrow, and surrounding soft tissue that’s usually caused by S. aureus is defined as:

A

osteomyelitis

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20
Q

How can S. aureus cause osteomyelitis by indirect entry:

A

indirect entry: affects boys 12 or younger as a result from blunt trauma, adults w/vascular insufficiency (DM) or GU and respiratory infections

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21
Q

How can S. aureus cause osteomyelitis by direct entry:

A

open wound allowing entrance for microorganisms

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22
Q

Osteomyelitis infections occur by:

A

increased pressure (d/t # of organisms), ischemia/vascular compromise (caused by pressure), cortical devascularization (infection moving in deeper to bone), and sequestrum (bone death and medium bed for S.aureus)

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23
Q

Osteomyelitis that’s less than 1 mo and includes local and systemic manifestations is called:

A

Acute osteomyelitis

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24
Q

Systemic manifestations of osteomyelitis include:

A

Fever, night sweats, chills, restlessness, nausea

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25
Local manifestations of osteomyelitis includes:
Bone pain, swelling, tenderness, warmth, decreased movement, drainage during late stages
26
Osteomyelitis that is longer than a 1 mo and has more local manifestation than systemic is called:
chronic osteomyelitis d/t inadequate tx of acute osteomyelitis
27
What are the dx studies for osteomyelitis:
Bone/soft tissue biopsy, blood/wound cultures, increased WBCs and ESRs (erythrocyte sedimentation rate), radiologic signs appear after 10 days via bone scans/MRI/CT
28
What are the types of osteomyelitis txs:
IV/oral abx, surgical interventions (amputation, abx beads, debridement, grafting), wound vac, splinting of extremity
29
The primary interventions for osteomyelitis are:
control infection, teach local and systemic manifestation of infection, involve family in care, have pt report manifestations
30
Secondary interventions for osteomyelitis are:
immobilization, avoid manipulation, pain relief, dressing types, maintain proper alignment, avoid heat/activity to area, teach abx therapy, provide mental support
31
Tertiary interventions for osteomyelitis are:
Physical and mental support, teaching abx and dressing changes/supplies, close follow up
32
A benign bone tumor is defined as:
osteochondroma
33
A primary bone tumor that is extremely aggressive & rapidly metatasizes, occurs in METAPHYSEAL region of bone, is the most common in children/young adults, found in older adults associated w/Paget's disease prior to radiation is defined as:
osteosarcoma
34
What are the clinical manifestations of osteosarcoma:
gradual onset of pain, swelling, decreased ROM
35
What are the dx tests for osteosarcoma:
tissue Bx, X-ray/CT/PET/ MRI (will show up as a starburst appearance)
36
What are the types of Txs for osteosarcoma:
Chemotherapy (pre-op to decrease size of tumor; post-op), surgical interventions (limb salvage procedures or amputation); or adjunct tx (combination of chemo and surgical) increases 5-yr survival rate by 70%
37
Primary intervention for osteosarcoma include:
teaching the public warning signs, importance in health screening/exams
38
Secondary intervention for osteosarcoma include:
prevention of pathologic fx, pain management, rest periods, physical and mental support
39
Tertiary intervention for osteosarcoma include:
educate to avoid falling/fx, mental support, importance in keeping appointments, addressing pt's specific concerns
40
The most common form of joint disease that's a slowly progressive non-inflammatory disorder of the synovial joints where the cartilage becomes worn away causing irregular surfaces to form; affected cartilage becomes softer; irregulr surfaces creates uneven distribution of stress on joints and decreases in motion is defined as:
osteoarthritis
41
Osteoarthritis commonly affects what sites:
fingers, neck, low back, knees, hips
42
What is the prevalence of OA:
21 million americans are affected; not a normal part of aging, affects more women than men, common in the elderly, can be seen in younger adults w/joint injuries
43
What are the risk factors for OA:
aging women, obesity, previous sport injury, occupational physical requirements
44
What are the systemic manifestations of bone disorders and are they found in OA:
Fatigue, fever, and organ involvement are NOT PRESENT in OA
45
What are the clinical manifestations of OA:
LOCAL manifestations include: joint pain, joint stiffness, crepitation, deformity: Heberden's nodes on the distal phalange joint, Bouchard's nodes at mid-joint of phalange
46
What are the dx studies done on OA:
Bone scans, CT, MRI, X-ray, synovial fluid analysis
47
What is important to remember when pt's have Dx done for OA:
Dx may prove signs of OA but pt may not be experiencing any symptoms or pain
48
What are the type of rest and joint protection for OA:
immobilization (braces/splints prn) that doesn't exceed >wk, and assistive devices
49
What is used for pain or stiffness for OA:
heat and cold application
50
What are the nutritional therapy/exercises for OA:
weight reduction, aerobic conditioning, ROM exercises
51
What are some common complimentary/alternative therapy for OA:
acupuncture, yoga/massage/guided imagery, herbs for pain (glucosamine, chondrotin)
52
What is the drug therapy for OA:
Tylenol/NSAIDs, topical ointments (bengay), ASA, corticosteroids, HA (hyaluronic acid inj for knee), vibramycin abx to decrease cartilage loss
53
For OA, what NSAIDs are used:
Advil/motrin blocks COX-1 &-2; celebrex blocks COX-2
54
Pt teaching for OA include:
info about nature/tx of OA, correct body posture and mechanics, pain management, use of assistive devices, manage weight, avoid forceful repetitive motions, seek assistance w/tasks that may cause pain, modification to work and home in the performance of tasks, stress management
55
Approx 80% of adults have back pain causing adults >45 yo to miss work. Where is the common occurrence of back pain:
Occurs at lumbar region d/t: bears most of weight, most flexible region of spine, contains nerve roots, has inherently poor biomechanical structure
56
What are the risk factors of back pain;
lack of muscle tone, weight, poor posture, smoking, stress, heavy lifting, vibration (jack-hammer), prolonged sitting
57
What are the cause of low back pain;
Musculoskeletal issues: acute lumbosacral strain, instability of lumbosacral bony mechanism, OA of lumbosacral vertebrae, degenerative disk disease, herniation of intervertebral disk
58
Back pain that lasts less than 4 weeks, usually associated w/activity caused by undue stress is defined as what type of back pain:
Acute back pain
59
What are the tx for acute back pain:
NSAIDs, muscle relaxants, massage/manipulation, heat/cold, rest
60
Pt teaching of back pain should include:
weight management, no smoking, flat/low heel shoes, sleep on side w/hips/knees bent, sleep on back w/pillow under knees, carry items close to body, use a lumbar roll/pillow for sitting
61
Back pain that is >3 mo, discomfort increases after inactivity and includes spinal stenosis is defined as:
chronic back pain
62
Narrowing of vertebral canal caused by movement of bone into that space d/t trauma or degenerative changes (OA) is defined as:
spinal stenosis where pain starts in the lower back, radiates to buttock or leg, and worsens with standing/walking
63
What are the tx for chronic back pain:
NSAIDs, muscle relaxants, massage/manipulation, heat application, epidural corticosteroids, surgical interventions
64
A progressive degeneration, a normal process of aging that results in the intervertebral disks losing elasticity, flexibility, and shock absorbing capacities is defined as:
Intervertebral Disk Disease (DDD)
65
An acute natural degenerative process of a slipped disk that occurs with age and repeated stress where the nucleus pulposus will first bulge then herniate is called:
Herniated intervertebral disk (slipped disk)
66
What is the clinical manifestations of lumbar disk damage:
pain radiates from low back down to knee along the sciatic nerve
67
What is the clinical manifestation of cervical disk damage:
pain radiates into the arms or the hands
68
What are the clinical manifestations of intervertebral disk disease (Degenerative DD)
Pain (lumbar/cervical pain), positive straight leg test (positive if sciatic pain is present when leg is raised at 30-70 degrees meaning herniated disk) depressed/absent reflexes (spinal nerve damage), cauda equina compression
69
multiple nerve root compression d/t herniated disk or spinal surgery is manifested by:
bowel/bladder incontinence/impotence is known as cauda equina is a MEDICAL EMERGENCY
70
What are the dx studies of DDD:
Myelogram/MRI/CT/epidural/EMG
71
What are the types of surgical therapies for DDD:
Laminectomy, diskectomy, percutaneous diskectomy (sm stab wounds are used), Charite disk (artificial replacement), spinal infusion, outpatient procedures
72
What are the common outpatient procedures:
intradiscal electrothermoplasty (IDET-insertion of heated wire to nerve), radiofrequency discal nucleoplasty (needle is inserted to emit radio waves to break up gel of nucleus), and interspinous process decompression system (X-stop-titanium device used on spinal stenosis pts)
73
This traditional surgical procedure is an excision of the lamina to access the disk and requires minimal HO stay:
laminectomy
74
This surgery is performed to decompressed nerve root, remove damaged portion, helps to maintain spine stability is:
diskectomy
75
This surgery is where a tube is passed through soft tissue and a laser is used on the damaged portion of the disk (out-pt procedure) is:
percutaneous diskectomy
76
What are the types of artificial disks used for DDD
Chartie disk (titanium implantation), PRodise-L, prestige cervical disk system (tx DDD of cervical spine)
77
This type of surgery is performed to stabilize the spine by fusing with a bone graft. This is called what and what's the difference between allograft and autograft:
Spinal fusion; allograft is from someone else whereas autograft is from the pt's body; metal fixation is seen in this case
78
What are the nursing post-op interventions:
post-op positioning, pain management, HA d/t csf drainage, neurochecks, bladder/bowel function, cervical collar or TLSO brace, surgical site/donor site (pressure dressings are utilized/more pain at donor site), level of activity
79
What is a TLSO brace:
Brace used at the thoracic-lumbar-sacral orthosis area and logrolling with pillow between legs is utilized in taking it off)
80
What is the most commonly used donor site for DDD
the posterior iliac crest and cause more pain than the actual infused area
81
A soft tissue injury of the neck that may include the intervertebral joints, ligaments, cervical muscles; most symptoms are reversed and a possible residule HA/pain can occur d/t what type of injury:
whiplash
82
A pt w/osteomyelitis is tx w/ surgical debridement and abx beads. The nurse's response to the pt about the use of the beads are (select all that applies): A) the beads are used to directly deliever abx to the site of infection, B) There are no effective oral/IV abx to treat most cases of bone infection, C) the beads are an adjunct to debridement and oral/IV abx for deep infections, D) the ischemia and bone death that occurs w/osteomyelitis are impentrable to IV antibiotics:
A: direct abx tx, C: adjunct
83
A pt has been dx w/osteosarcoma of the femur. He shows an understanding of his tx when: A) I accept that I have to lose my leg w/surgery, B) the chemotherapy before surgery will shrink the tumor, C) This tumor is r/t the colon cancer i had 3 yr ago?, D) I'm glad they can take out the CA w/a small scar:
B: tumor will shrink
84
Which if the following individuals would be at high risk of low back pain (select all): A) a 65-yr male who is a long-distance driver, B) an aerobic instructor who is 5'6" 120 lb, C) A 25 yo nurse who works in the new-born nursery, D) an 18 yo who's 6'2" football player at 260 lbs
A: truck driver D: overweight kid football player
85
The nurse's primary responsibility for a pt w/a suspected sidk herniation who has severe pain and muscle spasms is: A) teaching exercises such as straight leg raises to decrease pain, B)postioning the pt on abd w/legs extended, C) encouraging spine strengthening exercises and pain management, D) assisting pt to maintain activity restrictions w/gradual increase activity :
D: assistance in activity restriction and gradual increase in activity
86
In carin for a pt w/a spinal infusion, which pt symptom would the nurse report to MD STAT: A) single episode of emesis, B) pt can't move LE, C) pt is nauseated and has not voided in 6 hrs, D) pt complains at bone graft site:
B: pt can't move lower extremities
87
Advise the pt w/early osteoporosis to: A) lose weigh, B)stop smoking, C) eat a high-protein diet, D) start swimming for exercise
B: stop smoking

Med Surge 3rd exam (3 decks)

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