Cyndi - Week 6 - Exam 3 Flashcards
what are the parts of the MS system?
cartilage, muscles, joints, tendons, ligaments
tendons attach ____ to ____
muscle to bone
ligaments attach _____ to ______
muscle to muscle
what are osteocytes?
mature osteoblasts surround by bone
what are osteoblasts?
formation of bone
what are osteoclasts?
bone resorption
what are 6 MS changes in the older patient?
- Ineffective bone remodeling (osteoporosis) - ↑ reabsorption of old bone/↓ formation of new bone
- Vertebral changes
- Muscle mass changes
- Functional problems
- Foot problems
- Risk for falls
what are the diagnostic tests for orthopedic disorders?
- X‐rays - site broken
- Bone scan - how much mass
- MRI - bone pain - cancer
- CT - bone pain - cancer
what is osteoporosis?
Chronic, progressive disease`
what is the disease process of osteoporosis?
- ↑ reabsorption of old bone
- ↓ formation of new bone
- Bone resorption exceeds bone deposit
what are the characteristics of bone mass reduction?
– Fragility can lead to fracture
– Gender ‐ 80% are women
how can one prevent bone mass reduction?
- diet (mod alcohol/no smoking/sufficient Cal/VD)
- exercise (weight bearing)
what are the risk factors for osteoporosis?
• 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
what might the first sign of osteoporosis be?
First sign might be a fracture!
• Especially spontaneous or from minimal trauma
what are the clinical manifestations of osteoporosis?
Pain • Back, hips, wrists • Loss of height due to compression fractures Deformity: • Dowager’s hump – Kyphosis • Abnormal gait or ROM Falls Loss of strength
what is Paget’s disease?
read book pleasseee
what are the specific diagnostic tests for osteoporosis?
- Labs
- Bone density tests
- Fracture Risk Assessment Tool
what labs are used for osteoporosis?
Ca++, Vit D, Phos, Alk Phos, specific bone markers that show biochemical indices of skeletal turnover
what are the characteristics of a bone density test?
– DXA scan - fast and precise measurement of bone density - non invasive
• T score, Z score
– Ultrasound
what is a T score? a Z score?
T score: avg healthy 30 y/o
Z score: avg density similar age and gender
what are the characteristics of a fracture risk assessment tool?
– Algorithm takes into account test results and risk factors
– Computes the 10 year probability of major osteoporotic fx
– Intervention threshold not universally agreed upon
what is treatment for osteoporosis based upon?
Treatment is based on the likelihood of future fracture
what is the dietary and lifestyle treatment measures for osteoporosis?
- Sufficient protein levels
- Calcium and Vitamin D ‐ Table 64‐14 (Lewis)
- Stop smoking
- Exercise - weight bearing
- Fall risk mitigation - clear areas
- Decrease alcohol
T/F it’s important to review pt meds as possible contributing factors for osteoporosis
TRUE - steroids
what are meds prescribed as tx for osteoporosis?
- Calcium, Vit D supplements
- Bisphosphonates
- Calcitonin
- Selective estrogen receptor modulator
- Human parathyroid hormone
- Monoclonal antibody
what are the characteristics of calcium vitamin D supplements?
dietary intake, supplements
what are the characteristics of bisphosphonates?
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
what are the characteristics of calcitonin?
Calcimar ‐active form of Vit D – inhibits bone
resorption by acting on osteoclasts. Given IM or intranasal.
Need to take calcium supplements
what are the characteristics of selective estrogen receptor modulator?
Raloxifene (Evista)‐ reduces bone resorption without stimulating hormonal tissues
what are the characteristics of human parathyroid hormone?
Teriparatide (Forteo) – anabolic skeletal effects ‐ increases the action of osteoblasts – stimulates bone growth – SQ
what are the characteristics of monoclonal antibodies?
Denosumab (Prolia) – inhibits activity of osteoclasts by binding to a protein that osteoclasts need to function – SQ admin
T/F Hormone Replacement Therapy for osteoporosis prevention not indicated due to risks
TRUE
what is osteomyelitis?
Infection of bone, bone marrow, soft tissue
what is the most common organism for osteomyelitis?
staph aureus
what are the two ways of entry for osteomyelitis?
Direct entry ‐ open wound, implant
Indirect entry – blunt trauma, vascular insufficiency, infection beginning elsewhere
what are the risk factors for acute and chronic osteomyelitis?
Acute – initial infection and < 1 month
Chronic – oqngoing infection > 1 month
• Pressure from infection may prevent
ATBs and WBCs from reaching area
what are the clinical manifestations of osteomyelitis?
• 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
what are the possible complications of osteomyelitis?
sepsis and amputation
what are the diagnostic tests for osteomyelitis?
- Labs related to infection, bone marrow health
- bone or soft tissue biopsy of area
- wound cultures
what are the characteristics of labs for osteomyelitis?
– WBC may be normal or elevated, neutrophils may be elevated
– ESR elevated in 90%, CRP may be elevated also
– Blood cultures positive in 50%
what are the characteristics of bone or soft tissue biopsy of area for osteomyelitis?
– CT guided needle aspiration
what are the characteristics of wound cultures for osteomyelitis?
– Fail to identify organism in 25% of cases
what is the tx for osteomyelitis?
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
what is osteosarcoma?
Primary malignant tumor in bone
what are the characteristics of osteosarcoma?
– 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
what are the clinical manifestations of osteosarcoma?
• 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
what are the specific diagnostic tests for osteosarcoma?
- Radiography - PET scan
- Labs: ↑ alk phos (ALP) and Ca++/ ↓ blood component levels
- Biopsy
what is the tx for osteosarcoma?
-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
what is duchenne muscular dystrophy?
One of a group of genetic muscular diseases
– Progressive weakness and wasting of skeletal muscles due to a mutation of dystrophin
what are the characteristics of duchenne muscular dystrophy?
– 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
duchenne muscular dystrophy is a congenital disease, what gene is affected
• X‐linked recessive trait
– Almost always male (mother as carrier)
• 65% have positive family history
• 1/3 ‐ fresh mutation
what are the ways that the body is affected by duchenne muscular dystrophy?
• 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
what are the specific diagnostic tests for duchenne muscular dystrophy?
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
T/F there is a cure for duchenne muscular dystrophy
FALSE no cure
what is the tx for muscular dystrophy?
• 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
