Chapter 62: Med Surg Flashcards
bone remodeling
removal of old bone by osteoclasts (resorption) and deposition of new bone by osteoblasts (ossifcation)
epiphysis
widened area at the end of a long bone (cancellous bone) location of muscle attachment
diaphysis
main shaft of the bone, structural support and composed of compact bone, marrow is in the center
metaphysis
flared area of cancellous bone between the epiphysis and diaphysis
osteons
also called haversian systems fit closely together in compact bone, creating a dense bone structure (cylinder shaped)
epiphyseal plate
aka growth zone, cartilaginous area between the epiphysis and metaphysis, allows longitudinal growth in children and injury can result in a shorter extremity and significant functional problems
medullary
marrow is the center of the diaphysis and contains red and yellow bone marrow
hinge joint
allows flexion and extension e.g. elbow
ball and socket joint
spheroidal; flexion, extension, abduction, adduction, circumduction e.g. shoulder
pivot
rotary; rotation e.g. atlas-axis, proximal radioulnar joint
condyloid
flexion, extension, abduction, adduction, circumduction e.g. wrist joint
saddle
flexion, extension, abduction, adduction, circumduction, thumb-finger opposition e.g. thumb
gliding
one surface moves over another surface e.g. between tarsal bones and carpal bones
hyaline cartilage
moderate amount of collagen, trachea, nose, epiphyseal plate
elastic cartilage
collagen and elastic fibers, more flexible, ear, epiglottis
fibrous cartilage
collagen fibers, tough, shock absorber, pelvic girdle, knee, shoulder
cardiac muscle
striated, involuntary
smooth muscle
nonstriated, involuntary, found in airways, arteries, GI
skeletal muscle
neuronal stimulation, half a person’s weight, striated, voluntary
muscle contraction
thick and thin filaments slide past each other and cause sacromeres to shorten; acetylcholine activates
skeletal contraction
allows posture maintenance, body movement, and facial expressions
isometric contractions
increase the tension within a muscle but do not produce movement, repeated contractions make muscles grow larger and stronger
isotonic contractions
shorten the muscle and produce movement
what happens to muscles when calcium is low?
tetany occurs (involuntary contractions of skeletal muscle)
tendons
attach muscles to bones
ligaments
connect bones to bones
fascia
layers of connective tissue that can withstand limited stretching, provides strength to muscle tissue
bursae
small sacs of connective tissue that are lined with synovial fluid located at bony prominences or joints to relieve pressure and decrease friction between moving parts
gerontologic changes in musculoskeletal
increased bone resorption and decreased bone formation leading to osteoporosis, tendons and ligaments become less flexible
subjective data needed for muscoloskeletal
s/s pain, weakness, deformity; questions should be focused on past medical problems, surgeries, med use, ask about secondary bacterial infections including the ears, tonsils, lungs etc because these can enter the bones and result in osteomyelitis or joint destruction
objective data needed for musculoskeletal
head to toe assessment, observe skin lesions, palpation, active ROM, passive ROM, assess gait, unequal shoulder and scapula indicates scoliosis
how to assess for scoliosis
ask pt to put hands together as in diving into a pool and slowly bend forward, if the deformity is greater than 45 degrees, lung and cardiac fx is greatly impaired
straight leg raising test
pt lays supine and passively raise leg 60 degrees, if pt complains of pain along the distribution of sciatic nerve, test is confirmed positive
x ray
determines density of bones, bone deformity, joint congruity, and calcification in soft tissue, useful in fracture diagnosis
nursing responsibility of x rays
avoid excess exposure for pt and self, before procedure remove any radiopaque objects, explain procedure, and verify not pregnant
computed tomography (CT) scan
x ray beam used to provide 3D image of soft tissue and bony abnormalities
nursing responsibility of CT scan
inform pt procedure is painless, pt must remain still, pt has no shellfish allergy, and pt cannot be pregnant
magnetic resonance imaging (MRI)
views soft tissue, useful for diagnosis of osteomyelitis
nursing responsibility of MRI
inform pt procedure is painless, pt cannot have on metal, must remain still
dual energy x ray absorptiometry
DEXA; measures bone mass, allows assessment of bone density with minimal radiation, painless
quantitative ultrasound (QUS)
evaluates density, elasticity, and strength of bone using ultrasound rather than radiation, painless
bone scan
involves injection of radioisotope that is taken up by the bone, uniform uptake is normal, but increased uptake is seen with osteomyelitis, osteoporosis, malignant tumors of bone, and certain fractures and decreased uptake is seen with avascular necrosis
nursing responsibility of bone scan
radioisotope is given 2 hours before procedure, bladder must be emptied, procedure requires 1 hr while pt lies supine and no pain or harm will occur, no follow up scans required, increase fluids after examination, pt cannot be pregnant
arthroscopy
involves insertion of arthroscope into joint for visualization of structure and contents, diagnostic for abnormalities of meniscus, ACL, ligaments, or joint capsule
nursing responsibilities of arthroscopy
can be performed in outpatient setting with either local or general anesthesia used, after the procedure cover the wound with sterile dressing
alkaline phosphatase
produced by osteoblasts and elevated levels are found in healing fractures, bone cancers, osteoporosis, osteomalacia, and paget’s disease (38-126 normal)
calcium
decreased found in osteomalacia, renal disease, and hypothyroidism, increased found in hyperparathyroidism and some bone tumors (8.6-10.2 normal)
phosphorus
decreased level found in osteomalacia, increased found in chronic kidney disease, healing fractures, and osteolytic cancer (2.4-4.4 normal)
erythrocyte sedimentation rate (ESR)
nonspecific index of inflammation, measures rapidity with which RBCs settle out of unclotted blood in 1 hr, elevated levels are seen in inflammatory process <30 normal
nursing responsibility for alkaline phosphatase, calcium, phosphorus, and ESR
obtain blood samples by venipuncture, observe site for bleeding or hematoma formation, procedure does not require fasting
arthrocentesis
incision or puncture of join capsule to obtain samples of synovial fluid from joint cavity to remove excess, 18 G or larger usually used, local anesthesia, useful in diagnosis of joint inflammation, infection, meniscal tears, and subtle fractures
nursing responsibility of arthrocentesis
usually done at bedside or in examination room, send samples of synovial fluid to lab, apply compression dressing, observe for leaking of blood or fluid on dressing
what do you observe synovial fluid for?
volume, color, clarity, viscosity, and mucin clot formation, floating fat globules indicate bone injury, uric acid crystals indicate gout
