🏥- Bone Test Flashcards
Osteoclasts
Cells that help demineralize and destroy old bone
Osteoblasts
Cells that help form bone
Estrogen
Stimulates osteoblasts activity
Arthrogram
A series of images taken of a joint after contrast medium has been injected
Allows for visualization of soft tissue structures of a joint
Dexa scan
Assess bone density or the amount of calcium and other minerals in the bone
Bones most often used: spine, hip, hand, foot and forearm
Low bone density is an indicator for what
Presence of osteoporosis and increased fracture risk
Osteoporosis
Chronic condition that results in deterioration of bone tissue and density
Bone resorption (osteoclasts) exceeds bone formation (osteoblasts)
Primary risk factors for osteoporosis
Age Gender (female) Race (whites and asians) Family hx Small body frame (less than 58kg) Low Ca and vitamin D intake High K intake Sedentary lifestyle Smoking Excessive alcohol consumption
Secondary risk factors for osteoporosis
- medications (corticosteroids for more than 3 months, antiepileptics, heparin, thyroid hormones)
- disease (hypogonadism or early menopause, malabsorption issues, chronic liver disease, ibs, ra, hyper thyroid and parathyroid, previous fracture)
- other (family hx of hip fracture, recurrent falls, prolonged immobilization)
What is the gold standard for diagnosing and follow up with osteoporosis
Dexa scan
Gives precise measurements that highlights areas for future fracture risks
Treatment of osteoporosis
Prevention
Muscle-strengthening exercise
Healthy lifestyle
Foods high in vitamin d
Vitamin d fortified milk, cereals, egg yolks, saltwater fish and liver
How do bisphosphonates work
Impede bone resorption by inhibiting osteoclasts activity, thereby absorbing Ca phosphate in bone
What is teaching that should be done with all bisphosphonates
Take in the morning on an empty stomach
Can cause: gi disturbances, dysphagia and inflammation of esophagus
Clinical manifestations of osteoporosis
Dowagers hump Loss of height Back pain Restricting movement Previous fractures
Paget’s disease of the bone
Bone metabolism disorder associated with accelerated bone remodeling, resulting in bone that is structurally abnormal
bone excessively broken down and reformed
Type of patient most at risk for developing paget’s
15-40% linked to genetics
Over age 50
White
Males
Clinical manifestations of paget’s
Pain and deformity
Also fractures, bone tumors, neuro diseases, cardiac disease and Ca/Phos imbalance
Types of medications used to treat PDB
Analgesics
Calcitonin
Bisphosphonates (decrease osteoclast activity, which suppresses bone resorption)
What is the most serious complication of PDB
Development of primary bone tumors , osteosarcoma
Surgical treatment of PDB
Joint replacement
Spinal decompression and stabilization
Osteotomy
Varus vs valgus
Varus- bowleg knee
Valgus- knock knee
Surgical spinal decompression/spinal stabilization
Decompression- removal of bony substances that are causing nerve impingement
Stabilization- surgically inserted rods, pins and pedicle screws that maintain spinal column structure
Nursing diagnoses associated with PDB
Risk for trauma
Acute/chronic pain
Impaired mobility
Clinical manifestations of acute osteomyelitis
- fever
- swelling and tenderness at affected site
- erythema and heat
- pain (not relieved by rest)
Clinical manifestations of chronic osteomyelitis
- swelling, tenderness
- constant pain
Which test is the gold standard for diagnosis of osteomyelitis
Bone biopsy
Which test is the test of choice for detecting osteomyelitis
Bone scan
ESR and CRP indicate what
Inflammation
Which lab tests assist in osteomyelitis diagnosis
WBC , ESR, blood cultures, CRP
What medications are used to treat osteomyelitis
Antibiotics, opioids
Fluoroquinolones have been shown to be highly successful because of their bone-penetrating ability
Complications of osteomyelitis
Sepsis
Squamous cell carcinoma
Assessment of osteomyelitis
Fever , pain , tenderness , lethargy , difficulty moving or bearing weight at affected area
What are the 6 P’s of neurovascular assessment
Pain Weak pulses Paresthesia (tingling or prickling) Paralysis Pallor Pressure
What is the leading clinical indication of TJR
Osteoarthritis
Complications of TJR
Hypotension, bleeding and hypovolemia
Infection
Dislocation/subluxation
DVT
PE
Osteosarcoma
Is the most prevalent malignant tumor
There is a link between osteosarcoma and which disease
Paget’s
Clinical manifestations of osteosarcoma
Pain worse with motion
UNRELIEVED by rest
Decreased range of motion
Swelling
Redness
Eating a diet highly in protein helps with what
Tissue and wound healing
Complete fracture
The disruption spans across the width of the bone, causing bone fragments
Incomplete fracture
The disruption occurs through part of the bone cortex; however there is no displacement of bone fragments
Closed (simple)
Fracture is contained within the skin
Open (compound)
Disruption in which pieces of bone protrude through the skin
Avulsion fracture
Caused by overstretching and tearing of a tendon or ligament, separating a small segment of bone at the insertion site
Comminuted fracture
Fracture that has several disruptions producing shattered bone segments within the fracture site
Compression fracture
Fracture caused by excess force along the axis of cancellous (spongy internal layer of bone) bone leading to the bone collapsing on itself; representative in vertebral compression fractures from falls of significant heights
Depressed fracture
Disruptions in which fragments of bone are forced inward; frequently seen in facial or skull fractures involving blunt trauma
Displaced fracture
Malalignment of bone fragments at the fracture site
Greenstick fracture
An incomplete disruption where one side of the bone is bent and the other is fractured; generally seen in children because of the flexibility of their bones
Nondisplaced fracture
Bone fragments are well approximated within the site of the disruption
Oblique fracture
The fracture line occurs usually at a 45-degree angle across the cortex of the bone
Spiral fracture
The fracture wraps around the shaft of the bone
Impacted fracture
Segments of bone are wedged into each other at the fracture line
Nonsurgical management of a fracture
Closed reduction
Fractured bone segments are manually manipulated and realigned while the patient is under general anesthesia
Open reduction
Requires a surgical incision that enables the surgeon to accurately visualize the wound and ensure proper realignment
Skeletal traction
Pins, tongs, screws and wires are surgically secured to the bone and weight is then applied to provide realignment
Skin traction
Utilizes a flexible harness, boot or belt to secure the extremity while 5 yo 10lb of weight is applied to relieve muscle spasms
Antacids
Increase gastric pH
Ex: maalox, mylanta
Histamine receptor antagonist
Decrease gastric acid production
Ex: Zantac , Pepcid
Proton pump inhibitors
Block production of acid
Ex: Prilosec, Prevacid, protonix, nexium
Mucosal barrier fortifier
Ex: sucralfate
Education for antacid administration
- may delay absorption of other meds
- take 1 hour BEFORE or 2 hours AFTER a meal
- avoid taking with milk or foods high in vitamin d
Ex: maalox and mylanta
Education for H2 blockers administration
- administer at bedtime
- reduce dose for elderly (less gastric secretions)
Ex: Zantac , Pepcid
Education for mucosal barrier fortifiers administration
- give 1 hour BEFORE or 2 hours AFTER meals and at bedtime
- wait 30mins AFTER antacids
- no aspirin while on med
- may cause darker stools
Ex: sucralfate
Education for PPI’s administration
- give 30mins BEFORE meals
- do NOT crush capsules
- assess hepatic function
Ex: protonix, nexium, Prilosec, Prevacid
Education for antimicrobial administration
- take with food or immediately after eating
- avoid alcohol
Ex: flagyl, amoxil
