Bones Flashcards
what’s the reason for kyphosis
the vertebrae disks becomes thinner
vitamins that are important for elderly
vitamin D 800IU
Ca 1,200mg
osteoarthritis
cartilage that protects the end of bones breaks down leading to pain and stiffness
osteomalacia
soft bones from not enough vit D, Ca, or P
osteoporosis
loss of bone mass and it becomes brittle
osteopenia
low bone density can lead to fractures;precursor to osteoporosis
osteomyelitis
inflammation or infection of bone tissue
caused by bacteria, fungi, etc.
rheumatoid arthritis
inflamed joints
what happens to muscles during gerontological changes
- 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
what happens to ligaments during gerontological changes
they shorten and loose flexibility
subjective data to collect from pts
- risk factors
- family hx
- poss secondary sources of infection from ears, tonsils, teeth, GU, lungs
- menstrual cycle
- meds
what can antiseizure meds lead to
osteomalacia
what can phenothiazines lead to
gait disturbances
what can corticoids lead to
decrease in bone and muscle mass
what can potassium sparing diuretics lead to
muscle cramps & weakness
important objective data when assessing a pt
- 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
what can red joints with boney nodes indicate
synovitis
what does a 24hr creatinine lab tell you
muscle wasting
what does uric acid lab tell you
gout - joint inflamation
what does urine deoxypyridinoline lab tell you
bone wasting
what does erythrocyte sedimentation rate tell you
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
normal ESR
15 mm/hr for men
20 for women
what does creatinine kinase lab tell you
high means muscle destruction
what labs are used to diagnose rheumatoid arthritis
rheumatoid factor
anti-cyclic citrullinated peptide (anti-CCP)
what labs measure serum muscle enzymes
- aldolase
- creatinine phosphokinase (CPK)
- c-reactive protein (CRP)
what does Le-Prep/Antinuclear antibodies (ANA) lab tell you
presence of autoimmune dx such as SLE
what does arthrography test
type of x-ray that injects radiopaque dye to see ligaments & cartilage
MRI is preferred over this
how is bone scanning done
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
what does ultrasonography tell you
inflammation around joints & tendons
what does arthrocentesis tell you
synovial fluid examined under microscope for inflammation
- if there’s uric acid crystals then it’s gout
- if calcium pyrophosphate then it’s pseudogout
what does contusions mean
treatment
bruise
RICE
what are sprains
& treatment
partial tear to ligament caused by twisting
RICE; sx if complete tear
tendonitis
treatment
inflammation of tendons from overuse
RICE if temporary; steroid inj if chronic
bursitis
treatment
inflammation of bursa (fluid sac) from overuse
abx if infection
stress injuries
small fracture on weight bearing bones from overuse
strains
treatment
overuse, force, or stretching of muscle/tendon
tear may require sx
treatment to decrease swelling and pain
- rest
- ice for first 48hrs
- splint
- compression bandage
- elevation
- NSAIDS
compound fracture
break in skin over bone injury
comminuted fracture
several bone fragments
greenstick fracture
one side broken, the other side bent/not broken
depressed fracture
bone fragments pressed inward
avulsion #
fragment of bone pulled away by ligament or tendon
impacted #
bone fragment pushed into another fragment
emergency care for #
- 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
5 steps of fracture healing
- fracture hematoma 72hrs
- granulation tissue 3-14days
- callus formation 2wks
- consolidation up to a yr
- remodeling
what happens during fracture hematoma
bleeding surrounds #
extravasated blood from liquid becomes semisolid clot
what happens during granulation tissue formation
new blood vessels, fibroblasts, osteoblasts in granulation tissue
hematoma becomes granulation tissue
is base for bone-osteoid base
what happens during callus formation
minerals & new bone matrix deposited in osteoid
unorganized formation around #
callus forms: cartilage, osteoblasts, Ca, P verified by x-ray
what happens during consolidation
distance between fragments diminish
ossifications continue 3wks - 6months
radiologic union occurs - x-ray shows reunion up to a yr
complications - malunion
heals in unsatisfactory position leading to deformity or dysfxn
complications - angulation
heals in abnormal position
(type of malunion)
complications - pseudoarthrosis
lack of fusion after attempted spinal arthrodesis (fusion of vertebrae over joint space)
lack of nonunion
types of casts
- plaster: takes 24-72hrs to dry
- fiberglass: can bear weight 30mins after
- polyester-cotton knit: dries in 7-10mins
5 P’s
pain
paresthesia
paralysis
pulse
pallor
what signs could indicate hemorrhage
hypotension
tachycardia
blood stain through plaster
what is included in neurovascular checks
- cap refill time
- warmth
- color
- motion checks to see if nerves are compressed
cast care
- 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
if it is an open fracture, what is the treatment
abx, tetanus shot possibly
open vs closed reduction
open: requires surgery where screws, pins, etc are used
closed: local anesthesia without incision to put fragments back
benefits of closed reduction
- heals quickly and strong; improves chances of looking normal
- decrease chances for infection
- decrease tension in skin
- reduce swelling
- less pain
possible risks for closed reduction:
- nerves, blood vessels, soft tissue may be damaged
- blood clot may travel to another area
- new fracture leading to poss surgery intervention
risk factors that can lead to further complications after closed reduction
- smoking
- steroid meds
- birth control
- hormones such as insulin
where are incisions made with ORIF
- above the break
when to call the doctor
- itching that doesn’t go away
- cracks or soft spots in cast
- pain that doesn’t improve with meds
- burning, redness, swelling
- fever, chills
what is used to clean external fixation
chlorohexidine
to avoid constipation, you would suggest the pt to
- drink 2,500 mls water per day
- eat high fiber diet
- encourage regular timing for BM
- stool softener, laxative, suppository if all above fail
what complication can occur with immobilization leading to bone demineralization
renal calculi resulting from hypercalcemia
which raises urine pH and forms stones
purpose of traction
guide body part back in place and hold steady by using ropes, pulleys, and weights
effects of traction use
- ## decrease pain before surgery
3 types of traction
- skeletal traction
- skin traction
- cervical traction
what do you do when you need to check or reposition a pt using a traction device
have the pt use the trapeze to lift up
what needs to be prepared for cervical traction
- metal brace around neck
- general anesthesia for whole procedure
use of cervical traction
- relieve muscle spasms
- immobilize for injury
signs of rib fracture
- contusion
- difficulty breathing
- damage to lungs or atelectasis
how often to assess traction
q4hrs
signs of humerus fracture
- shortened extremity
- abnormal mobility
complications of humerus fracture
- radial nerve or brachial artery injury from laceration
- transection or muscle spasms
complications with pelvic fracture
- abdominal injury
- hemorrhage
- laceration of urethra, bladder, or colon
- paralytic ileus
intercapsular vs. extracapsular hip fracture
intercapsular: acetabulum
extracapsular: intertrochanter & below
what not to do with hip fracture
- 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
when to call PCP with hip fracture healing
- sudden severe pain
- lump on buttock
- limb shortening
- external rotation
could indicate dislocation
signs of vertebral fracture
- pain in spine
- lump in spine
care with vertebral fracture
- teach to keep shoulders and pelvis aligned
- C-collar, back brace/corset
- heat & muscle relaxant
cause of fat embolism syndrome (FES)
- 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)
which bone fractures or injury most commonly lead to FES
long bones, ribs, tibia, pelvis
total joint replacement, spinal fusion, liposuction, crash injury, bone marrow transplant
what age range does FES most commonly affect
20-30yrs old young adults
how long before FES manifest
24-48hrs
diagnosis of FES
- fat cells in blood, urine, or sputum
- decreased platelet count & hct
what is the white-out effect in relation to FES
CXR shows pulmonary infiltrate or multiple areas of consolidation
infection prevention with open fracture surgery
- irrigated with abx solution
- abx beads placed in site
- IV abx for 3-7days (cephalosporins - Ancef)
what causes compartment syndrome
increased tissue swelling from blood or fluid collection that results in decreased blood flow - meaning less nourishment and oxygen reaches tissue
decreased compartment size from
restrictive dressing, excessive traction, or premature closure of fascia
increased compartment size from
bleeding, edema, chemical response to snake bite, IV infiltration
pathophysiology for muscle spasms
involuntary contractions by flexor muscles shortening and causing extreme pain
can be caused by hypoxia of muscles
cause of Volkmann’s contracture
lack of blood flow to forearm (ischemia) typically from compartment syndrome
what is Volkmann’s contracture
deformity of hand, wrist, fingers caused from injury to forearm
when does obvious shock symptoms occur from hemorrhage from bone fracture
when pt loses 1/3 of blood
1500-2000 mL of blood loss
total blood in body typically around 5L
common cause of avascular necrosis
- femoral neck fractures increases risk
- long term use of steroids
signs of avascular necrosis
pain and reduced ROM in affected joint
what diet contraindication for CT scan
pts who are allergic to shrimp are also allergic to the dye
what is paradoxical breathing
“flail chest” where the chest wall contracts with inspiration and expands during expiration often in rib fractures
what is halo sign
yellow ring surrounding fluid or blood from nose or ear - indicating leakage of CSF in skull fracture
what is Battle’s sign
bruising behind ears and lower jaw that occurs in skull fracture
