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Nursing Semester 3 > Cyndi - Week 6 - Exam 3 > Flashcards

Cyndi - Week 6 - Exam 3 Flashcards

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1
Q

what are the parts of the MS system?

A

cartilage, muscles, joints, tendons, ligaments

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2
Q

tendons attach ____ to ____

A

muscle to bone

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3
Q

ligaments attach _____ to ______

A

muscle to muscle

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4
Q

what are osteocytes?

A

mature osteoblasts surround by bone

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5
Q

what are osteoblasts?

A

formation of bone

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6
Q

what are osteoclasts?

A

bone resorption

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7
Q

what are 6 MS changes in the older patient?

A
  • Ineffective bone remodeling (osteoporosis) - ↑ reabsorption of old bone/↓ formation of new bone
  • Vertebral changes
  • Muscle mass changes
  • Functional problems
  • Foot problems
  • Risk for falls
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8
Q

what are the diagnostic tests for orthopedic disorders?

A
  • X‐rays - site broken
  • Bone scan - how much mass
  • MRI - bone pain - cancer
  • CT - bone pain - cancer
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9
Q

what is osteoporosis?

A

Chronic, progressive disease`

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10
Q

what is the disease process of osteoporosis?

A
  • ↑ reabsorption of old bone
  • ↓ formation of new bone
  • Bone resorption exceeds bone deposit
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11
Q

what are the characteristics of bone mass reduction?

A

– Fragility can lead to fracture

– Gender ‐ 80% are women

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12
Q

how can one prevent bone mass reduction?

A
  • diet (mod alcohol/no smoking/sufficient Cal/VD)

- exercise (weight bearing)

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13
Q

what are the risk factors for osteoporosis?

A

• Female Gender – low BMI = increased risk
• Ethnicity (Asian)
• Nutrition – calcium level, Vitamin D (osteomalacia), alcohol
• Medications – steroids, thyroid, antacid, seizure, others
• Smoking
• Hormones – menopause, pregnancy, breastfeeding
• Heredity – 70% of peak bone mass!!
– Parental hx of osteoporosis or fracture
• Rheumatoid arthritis
• Chronic diseases or a previous fracture (Paget’s
• Other factors that reduce bone marrow density
– Nutrition, endocrine disorders, inflammatory bowel disease, etc

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14
Q

what might the first sign of osteoporosis be?

A

First sign might be a fracture!

• Especially spontaneous or from minimal trauma

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15
Q

what are the clinical manifestations of osteoporosis?

A 
Pain
• Back, hips, wrists
• Loss of height due to compression fractures
Deformity:
• Dowager’s hump
– Kyphosis
• Abnormal gait or ROM
Falls
Loss of strength
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16
Q

what is Paget’s disease?

A

read book pleasseee

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17
Q

what are the specific diagnostic tests for osteoporosis?

A
  • Labs
  • Bone density tests
  • Fracture Risk Assessment Tool
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18
Q

what labs are used for osteoporosis?

A

Ca++, Vit D, Phos, Alk Phos, specific bone markers that show biochemical indices of skeletal turnover

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19
Q

what are the characteristics of a bone density test?

A

– DXA scan - fast and precise measurement of bone density - non invasive
• T score, Z score
– Ultrasound

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20
Q

what is a T score? a Z score?

A

T score: avg healthy 30 y/o

Z score: avg density similar age and gender

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21
Q

what are the characteristics of a fracture risk assessment tool?

A

– Algorithm takes into account test results and risk factors
– Computes the 10 year probability of major osteoporotic fx
– Intervention threshold not universally agreed upon

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22
Q

what is treatment for osteoporosis based upon?

A

Treatment is based on the likelihood of future fracture

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23
Q

what is the dietary and lifestyle treatment measures for osteoporosis?

A
  • Sufficient protein levels
  • Calcium and Vitamin D ‐ Table 64‐14 (Lewis)
  • Stop smoking
  • Exercise - weight bearing
  • Fall risk mitigation - clear areas
  • Decrease alcohol
24
Q

T/F it’s important to review pt meds as possible contributing factors for osteoporosis

A

TRUE - steroids

25
Q

what are meds prescribed as tx for osteoporosis?

A
  • Calcium, Vit D supplements
  • Bisphosphonates
  • Calcitonin
  • Selective estrogen receptor modulator
  • Human parathyroid hormone
  • Monoclonal antibody
26
Q

what are the characteristics of calcium vitamin D supplements?

A

dietary intake, supplements

27
Q

what are the characteristics of bisphosphonates?

A

Alendronate (Fosamax) – inhibit bone resorption – can
be taken oral, SQ, or IV – taken with water but not food, need to be upright for at least 30 min after taking, has potential side effects, including jaw necrosi

28
Q

what are the characteristics of calcitonin?

A

Calcimar ‐active form of Vit D – inhibits bone
resorption by acting on osteoclasts. Given IM or intranasal.
Need to take calcium supplements

29
Q

what are the characteristics of selective estrogen receptor modulator?

A

Raloxifene (Evista)‐ reduces bone resorption without stimulating hormonal tissues

30
Q

what are the characteristics of human parathyroid hormone?

A

Teriparatide (Forteo) – anabolic skeletal effects ‐ increases the action of osteoblasts – stimulates bone growth – SQ

31
Q

what are the characteristics of monoclonal antibodies?

A

Denosumab (Prolia) – inhibits activity of osteoclasts by binding to a protein that osteoclasts need to function – SQ admin

32
Q

T/F Hormone Replacement Therapy for osteoporosis prevention not indicated due to risks

A

TRUE

33
Q

what is osteomyelitis?

A

Infection of bone, bone marrow, soft tissue

34
Q

what is the most common organism for osteomyelitis?

A

staph aureus

35
Q

what are the two ways of entry for osteomyelitis?

A

Direct entry ‐ open wound, implant

Indirect entry – blunt trauma, vascular insufficiency, infection beginning elsewhere

36
Q

what are the risk factors for acute and chronic osteomyelitis?

A

Acute – initial infection and < 1 month
Chronic – oqngoing infection > 1 month
• Pressure from infection may prevent
ATBs and WBCs from reaching area

37
Q

what are the clinical manifestations of osteomyelitis?

A

• Persistent, severe, and increasing bone pain
• Wound draining purulent fluid
• Signs and symptoms of systemic infection: temperature, tachycardia, and tachypnea
• Signs of localized infection: edema, pain, warmth, redness, restricted
movement
• Chronic condition (>1 mo) may not have systemic
manifestations as body adapt

38
Q

what are the possible complications of osteomyelitis?

A

sepsis and amputation

39
Q

what are the diagnostic tests for osteomyelitis?

A
  • Labs related to infection, bone marrow health
  • bone or soft tissue biopsy of area
  • wound cultures
40
Q

what are the characteristics of labs for osteomyelitis?

A

– WBC may be normal or elevated, neutrophils may be elevated
– ESR elevated in 90%, CRP may be elevated also
– Blood cultures positive in 50%

41
Q

what are the characteristics of bone or soft tissue biopsy of area for osteomyelitis?

A

– CT guided needle aspiration

42
Q

what are the characteristics of wound cultures for osteomyelitis?

A

– Fail to identify organism in 25% of cases

43
Q

what is the tx for osteomyelitis?

A

Complete rest of limb – non‐weight bearing!!
• IV Antibiotics (4‐6 weeks):
– Culture and Sensitivity from wound culture or biopsy, troughs for some ATBs
– Home health RN and PICC line or skilled nursing facility
• Pain medication
• Excellent nutrition
• Sterile dressings – may have wound vac
• Surgery to debride/remove necrotic bone
• Physical Therapy as needed
• Amputation in worst case scenario

44
Q

what is osteosarcoma?

A

Primary malignant tumor in bone

45
Q

what are the characteristics of osteosarcoma?

A

– Aggressive
– Most common in child or young adult
– More common in males (60%)
– Most often in long bones or pelvis, in metaphyseal area
– Benign tumor (osteochondroma) more common
– Tumor can begin as benign but turn
malignant (Osteoclastoma)
***not the same as a metastatic tumor from another distant primary site

46
Q

what are the clinical manifestations of osteosarcoma?

A

• Gradual onset of pain and swelling
– Especially when weight‐bearing
• May have spontaneous fracture or injury
• Anemia
• Infection
• Edema and discoloration of skin at site

47
Q

what are the specific diagnostic tests for osteosarcoma?

A
  • Radiography - PET scan
  • Labs: ↑ alk phos (ALP) and Ca++/ ↓ blood component levels
  • Biopsy
48
Q

what is the tx for osteosarcoma?

A 
-Surgery
• Amputation
• Rotationplasty  h
• Limb salvage
• Pain management
• May be palliative
- Radiation
• External beam or radioactive drug
- Chemotherapy
- Nursing role ‐ care of ped pt, education
49
Q

what is duchenne muscular dystrophy?

A

One of a group of genetic muscular diseases

– Progressive weakness and wasting of skeletal muscles due to a mutation of dystrophin

50
Q

what are the characteristics of duchenne muscular dystrophy?

A

– Onset at 3 ‐ 7 years old ‐ milestones had been met prior
– May have a learning disorder or cognitive deficit
• Deficiency of dystrophin isoforms in brain
– Death typically late teens/young adult
• With good care can live longer

51
Q

duchenne muscular dystrophy is a congenital disease, what gene is affected

A

• X‐linked recessive trait
– Almost always male (mother as carrier)
• 65% have positive family history
• 1/3 ‐ fresh mutation

52
Q

what are the ways that the body is affected by duchenne muscular dystrophy?

A

• Dystrophin helps muscles attach to surrounding structures
– Calf and arm muscles initially hypertrophy (pseudohypertrophy)
– Progressive generalized weakness in adolescence
– Profound muscular atrophy in later stages
• Nervous system sensation intact
• Bowel and bladder control intact
• Death usually from respiratory or cardiac failure

53
Q

what are the specific diagnostic tests for duchenne muscular dystrophy?

A

Clinical picture a big part of diagnosis:
• Familial history, male, waddling gait, lordosis, Gower’s sign, falls, delay in development
Labs - Creatinine kinase (CK)
Muscle biopsy
Electromyogram testing (EMG)
Electrocardiogram (EKG)
Genetic testing and counseling for family

54
Q

T/F there is a cure for duchenne muscular dystrophy

A

FALSE no cure

55
Q

what is the tx for muscular dystrophy?

A

• Steroids can help to slow disease progression
• Active/independent for as long as possible
– Braces, standing frames, lifts, wheelchairs when needed
• Prevent contractures, pneumonia, ulcers
• Respiratory support when needed
• No special diet
• Help family and patient cope with
progressive incapacity
– Connect with resources – quality of life www.mda.org
– Promote sociability, school

Nursing Semester 3 (29 decks)

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