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NURS122 > Bones > Flashcards

Bones Flashcards

1
Q

what’s the reason for kyphosis

A

the vertebrae disks becomes thinner

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2
Q

vitamins that are important for elderly

A

vitamin D 800IU
Ca 1,200mg

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3
Q

osteoarthritis

A

cartilage that protects the end of bones breaks down leading to pain and stiffness

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4
Q

osteomalacia

A

soft bones from not enough vit D, Ca, or P

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5
Q

osteoporosis

A

loss of bone mass and it becomes brittle

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6
Q

osteopenia

A

low bone density can lead to fractures;precursor to osteoporosis

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7
Q

osteomyelitis

A

inflammation or infection of bone tissue
caused by bacteria, fungi, etc.

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8
Q

rheumatoid arthritis

A

inflamed joints

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9
Q

what happens to muscles during gerontological changes

A
  • muscle fibers reduce in number and shrink in size
  • muscle tissue replaced more slowly & are replaced with tough fibrous tissue
  • nervous system: reduced tone and ability to contract
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10
Q

what happens to ligaments during gerontological changes

A

they shorten and loose flexibility

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11
Q

subjective data to collect from pts

A
  • risk factors
  • family hx
  • poss secondary sources of infection from ears, tonsils, teeth, GU, lungs
  • menstrual cycle
  • meds
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12
Q

what can antiseizure meds lead to

A

osteomalacia

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13
Q

what can phenothiazines lead to

A

gait disturbances

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14
Q

what can corticoids lead to

A

decrease in bone and muscle mass

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15
Q

what can potassium sparing diuretics lead to

A

muscle cramps & weakness

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16
Q

important objective data when assessing a pt

A
  • posture & gait, muscle mass & symmetry
  • spinal deformities that can affect breathing & balance
  • joints & muscle: crepitus, deformity, redness, warmth
  • general nutritional status

may appear normal but tender when palpated

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17
Q

what can red joints with boney nodes indicate

A

synovitis

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18
Q

what does a 24hr creatinine lab tell you

A

muscle wasting

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19
Q

what does uric acid lab tell you

A

gout - joint inflamation

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20
Q

what does urine deoxypyridinoline lab tell you

A

bone wasting

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21
Q

what does erythrocyte sedimentation rate tell you

A

increased when inflamed but alone doesn’t diagnose
could indicate rheumatoid arthritis

when RBC are inflammed they tend to clump and settle faster, hence high ESR

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22
Q

normal ESR

A

15 mm/hr for men
20 for women

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23
Q

what does creatinine kinase lab tell you

A

high means muscle destruction

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24
Q

what labs are used to diagnose rheumatoid arthritis

A

rheumatoid factor
anti-cyclic citrullinated peptide (anti-CCP)

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25
Q

what labs measure serum muscle enzymes

A
  • aldolase
  • creatinine phosphokinase (CPK)
  • c-reactive protein (CRP)
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26
Q

what does Le-Prep/Antinuclear antibodies (ANA) lab tell you

A

presence of autoimmune dx such as SLE

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27
Q

what does arthrography test

A

type of x-ray that injects radiopaque dye to see ligaments & cartilage
MRI is preferred over this

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28
Q

how is bone scanning done

A

radioactive dye injected IV to see bone tissue
pt needs to drink lots of fluid to get rid of dye
but dye is harmless as it deteriorate quickly

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29
Q

what does ultrasonography tell you

A

inflammation around joints & tendons

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30
Q

what does arthrocentesis tell you

A

synovial fluid examined under microscope for inflammation
- if there’s uric acid crystals then it’s gout
- if calcium pyrophosphate then it’s pseudogout

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31
Q

what does contusions mean
treatment

A

bruise

RICE

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32
Q

what are sprains
& treatment

A

partial tear to ligament caused by twisting
RICE; sx if complete tear

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33
Q

tendonitis
treatment

A

inflammation of tendons from overuse
RICE if temporary; steroid inj if chronic

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34
Q

bursitis
treatment

A

inflammation of bursa (fluid sac) from overuse
abx if infection

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35
Q

stress injuries

A

small fracture on weight bearing bones from overuse

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36
Q

strains
treatment

A

overuse, force, or stretching of muscle/tendon
tear may require sx

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37
Q

treatment to decrease swelling and pain

A
  • rest
  • ice for first 48hrs
  • splint
  • compression bandage
  • elevation
  • NSAIDS
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38
Q

compound fracture

A

break in skin over bone injury

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39
Q

comminuted fracture

A

several bone fragments

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40
Q

greenstick fracture

A

one side broken, the other side bent/not broken

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41
Q

depressed fracture

A

bone fragments pressed inward

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42
Q

avulsion #

A

fragment of bone pulled away by ligament or tendon

43
Q

impacted #

A

bone fragment pushed into another fragment

44
Q

emergency care for #

A
  • immobilize joint above & below
  • check pulse, color, movement, sensation before splinting
  • sterile dressing for open wounds
  • fracture reduction - closed/open
  • ice 24hrs, elevate above heart first 48hrs
45
Q

5 steps of fracture healing

A
  1. fracture hematoma 72hrs
  2. granulation tissue 3-14days
  3. callus formation 2wks
  4. consolidation up to a yr
  5. remodeling
46
Q

what happens during fracture hematoma

A

bleeding surrounds #
extravasated blood from liquid becomes semisolid clot

47
Q

what happens during granulation tissue formation

A

new blood vessels, fibroblasts, osteoblasts in granulation tissue
hematoma becomes granulation tissue

is base for bone-osteoid base

48
Q

what happens during callus formation

A

minerals & new bone matrix deposited in osteoid
unorganized formation around #
callus forms: cartilage, osteoblasts, Ca, P verified by x-ray

49
Q

what happens during consolidation

A

distance between fragments diminish
ossifications continue 3wks - 6months
radiologic union occurs - x-ray shows reunion up to a yr

50
Q

complications - malunion

A

heals in unsatisfactory position leading to deformity or dysfxn

51
Q

complications - angulation

A

heals in abnormal position
(type of malunion)

52
Q

complications - pseudoarthrosis

A

lack of fusion after attempted spinal arthrodesis (fusion of vertebrae over joint space)
lack of nonunion

53
Q

types of casts

A
  • plaster: takes 24-72hrs to dry
  • fiberglass: can bear weight 30mins after
  • polyester-cotton knit: dries in 7-10mins
54
Q

5 P’s

A

pain
paresthesia
paralysis
pulse
pallor

55
Q

what signs could indicate hemorrhage

A

hypotension
tachycardia
blood stain through plaster

56
Q

what is included in neurovascular checks

A
  • cap refill time
  • warmth
  • color
  • motion checks to see if nerves are compressed
57
Q

cast care

A
  • use palm of hands to handle cast prior to drying
  • don’t cover
  • don’t apply pressure
  • inspect daily for foul odor, cracks
  • don’t place anything inside
58
Q

if it is an open fracture, what is the treatment

A

abx, tetanus shot possibly

59
Q

open vs closed reduction

A

open: requires surgery where screws, pins, etc are used
closed: local anesthesia without incision to put fragments back

60
Q

benefits of closed reduction

A
  • heals quickly and strong; improves chances of looking normal
  • decrease chances for infection
  • decrease tension in skin
  • reduce swelling
  • less pain
61
Q

possible risks for closed reduction:

A
  • nerves, blood vessels, soft tissue may be damaged
  • blood clot may travel to another area
  • new fracture leading to poss surgery intervention
62
Q

risk factors that can lead to further complications after closed reduction

A
  • smoking
  • steroid meds
  • birth control
  • hormones such as insulin
63
Q

where are incisions made with ORIF

A
  • above the break
64
Q

when to call the doctor

A
  • itching that doesn’t go away
  • cracks or soft spots in cast
  • pain that doesn’t improve with meds
  • burning, redness, swelling
  • fever, chills
65
Q

what is used to clean external fixation

A

chlorohexidine

66
Q

to avoid constipation, you would suggest the pt to

A
  • drink 2,500 mls water per day
  • eat high fiber diet
  • encourage regular timing for BM
  • stool softener, laxative, suppository if all above fail
67
Q

what complication can occur with immobilization leading to bone demineralization

A

renal calculi resulting from hypercalcemia
which raises urine pH and forms stones

68
Q

purpose of traction

A

guide body part back in place and hold steady by using ropes, pulleys, and weights

69
Q

effects of traction use

A
  • ## decrease pain before surgery
70
Q

3 types of traction

A
  1. skeletal traction
  2. skin traction
  3. cervical traction
71
Q

what do you do when you need to check or reposition a pt using a traction device

A

have the pt use the trapeze to lift up

72
Q

what needs to be prepared for cervical traction

A
  • metal brace around neck
  • general anesthesia for whole procedure
73
Q

use of cervical traction

A
  • relieve muscle spasms
  • immobilize for injury
74
Q

signs of rib fracture

A
  • contusion
  • difficulty breathing
  • damage to lungs or atelectasis
75
Q

how often to assess traction

A

q4hrs

76
Q

signs of humerus fracture

A
  • shortened extremity
  • abnormal mobility
77
Q

complications of humerus fracture

A
  • radial nerve or brachial artery injury from laceration
  • transection or muscle spasms
78
Q

complications with pelvic fracture

A
  • abdominal injury
  • hemorrhage
  • laceration of urethra, bladder, or colon
  • paralytic ileus
79
Q

intercapsular vs. extracapsular hip fracture

A

intercapsular: acetabulum
extracapsular: intertrochanter & below

80
Q

what not to do with hip fracture

A
  • don’t adduct hip - legs together at knee
  • don’t internally rotate hips - turn toward planted foot on affected
  • put on shoes without adaptive device
  • don’t sit on chairs without support to raise self
  • limit weight bearing 2-3 months
  • no tub bath or driving 1-2months
81
Q

when to call PCP with hip fracture healing

A
  • sudden severe pain
  • lump on buttock
  • limb shortening
  • external rotation

could indicate dislocation

82
Q

signs of vertebral fracture

A
  • pain in spine
  • lump in spine
83
Q

care with vertebral fracture

A
  • teach to keep shoulders and pelvis aligned
  • C-collar, back brace/corset
  • heat & muscle relaxant
84
Q

cause of fat embolism syndrome (FES)

A
  • long bone fracture or hip replacement that leads to increased pressure in bone marrow
  • fat leaves the bone marrow and enters blood stream where it travels to other organs
  • can be caused by stress induced release of catecholamine which leads to mobilization of free fatty acids from fat (adipose)
85
Q

which bone fractures or injury most commonly lead to FES

A

long bones, ribs, tibia, pelvis

total joint replacement, spinal fusion, liposuction, crash injury, bone marrow transplant

86
Q

what age range does FES most commonly affect

A

20-30yrs old young adults

87
Q

how long before FES manifest

A

24-48hrs

88
Q

diagnosis of FES

A
  • fat cells in blood, urine, or sputum
  • decreased platelet count & hct
89
Q

what is the white-out effect in relation to FES

A

CXR shows pulmonary infiltrate or multiple areas of consolidation

90
Q

infection prevention with open fracture surgery

A
  • irrigated with abx solution
  • abx beads placed in site
  • IV abx for 3-7days (cephalosporins - Ancef)
91
Q

what causes compartment syndrome

A

increased tissue swelling from blood or fluid collection that results in decreased blood flow - meaning less nourishment and oxygen reaches tissue

92
Q

decreased compartment size from

A

restrictive dressing, excessive traction, or premature closure of fascia

93
Q

increased compartment size from

A

bleeding, edema, chemical response to snake bite, IV infiltration

94
Q

pathophysiology for muscle spasms

A

involuntary contractions by flexor muscles shortening and causing extreme pain
can be caused by hypoxia of muscles

95
Q

cause of Volkmann’s contracture

A

lack of blood flow to forearm (ischemia) typically from compartment syndrome

96
Q

what is Volkmann’s contracture

A

deformity of hand, wrist, fingers caused from injury to forearm

97
Q

when does obvious shock symptoms occur from hemorrhage from bone fracture

A

when pt loses 1/3 of blood
1500-2000 mL of blood loss
total blood in body typically around 5L

98
Q

common cause of avascular necrosis

A
  • femoral neck fractures increases risk
  • long term use of steroids
99
Q

signs of avascular necrosis

A

pain and reduced ROM in affected joint

100
Q

what diet contraindication for CT scan

A

pts who are allergic to shrimp are also allergic to the dye

101
Q

what is paradoxical breathing

A

“flail chest” where the chest wall contracts with inspiration and expands during expiration often in rib fractures

102
Q

what is halo sign

A

yellow ring surrounding fluid or blood from nose or ear - indicating leakage of CSF in skull fracture

103
Q

what is Battle’s sign

A

bruising behind ears and lower jaw that occurs in skull fracture

NURS122 (28 decks)

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