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N323 > Exam III--Mobility and Clotting > Flashcards

Exam III--Mobility and Clotting Flashcards

1
Q

Describe the function of osteoblasts, osteocytes, and osteoclasts

A

Blasts: bone making
Cytes: mature bone cells
Clasts: break down bone cells

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2
Q

Describe the anatomy of a synovial joint

A

-enclosed by fibrous CT, filled w/ synovial fluids–end of bones covered in hyaline cartilage

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3
Q

Name common causes of MSK issues in older adults

A

-loss of balance/proprioception, flexibility
-decreased bone density (increased osteoclast activity, decreased osteoblast activity)
-30% of muscle mass lost by age 70

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4
Q

______ occurs in 30-65% of hospitalized elders

A

-hospital acquired disability

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5
Q

Describe the process of hemostasis

A

Arrest of bleeding
-platelet “plug” forms around injury
-coagulation cascade –> fibrin clot
-fibrinolysis (remodeling)

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6
Q

Describe the process of hematopoiesis

A

Blood cell production
-In red bone barrow, stem cells are generated
-erythrocytes mature in 48 hours (used for gas transport)
AND
-erythropoiesis is supported by kidneys

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7
Q

Elevated D-dimer and fibrin are signs of

A

hypercoagubility

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8
Q

Garlic and ginko supplements can cause:

A

blood thinning

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9
Q

Name the blood-related changes that occur in pregnancy

A

-40% increase in total blood volume
-physiologic anemia occurs
-white blood cells (granulocytes) increase
-hypercoagulability results from a rise in clotting factors, but decrease in coagulation
-fluid reserve to compensate for post-partum blood loss

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10
Q

PT-INR therapeutic range (on Warfarin)

A

2-3

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11
Q

The _____ stores platelets; the _____ carries fluid to blood and filters pathogens; and the _____ produces pro-coagulants and filters blood

A

-spleen
-lymph
-liver

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12
Q

HCT and HgB normal values

A

HCT: 12-16F, 14-18M
HgB: 37-47F, 42-52M

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13
Q

WBC normal value

A

5,000 - 10,000

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14
Q

RBCs, WBCs, HgB, and HCT is _____ at birth then dramatically ______ in the first month of life

A

-higher
-drops

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15
Q

Three factors of Virchow’s triad:

A

venous stasis, endothelial venous damage, hypercoagulability

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16
Q

Describe the pathophysiology of VTE

A

Platelets aggregate –> clotting factors stimulate fibrin production –> fibrin traps blood cells –> thrombus forms

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17
Q

Clinical manifestations of superficial vein thrombosis

A

Palpable cord-like vein, itching/warmth/redness/pain, leukocytosis, mild fever, “fullness” in leg, paresthesia

18
Q

What complication does this patient have?
S/S: edema, valve damage/reflux, pain, aching, bursting pain w/ exercise, swelling, paresthesia
Patient smokes and has elevated D-dimer

A

Post-thrombotic syndrome (complication of VTE)

19
Q

Name the complication:
A patient presents with a swollen, blue leg. They report this came on suddenly and rapidly.

A

Plhegmasia cerulea dorens, complication of VTE

20
Q

A patient reports sudden shortness of breath and coughing/wheezing. Assessment shows they are tachycardic and extremities are tinged blue.
Name the complication

A

PE, complication of VTE

21
Q

A patient presents w/ suspected VTE. They ask what tests you predict they will undergo. How will you respond?

A

-Labs: CBC, clotting study, D-dimer
-Ultrasound of extremity

22
Q

Warfarin (Coumadin) route, use, MOA, considerations, antidote

A

-route/use: PO long-term anticoagulant
-MOA: inhibits vitamin K-dependent clotting factors
-considerations: monitor INR (2-3), don’t take w/ NSAIDs or other anticoagulants, discourage vit-K rich diet, will need bridging w/ UH/LMWH
-antidote: vit k

23
Q

Heparin [UH] route, use, considerations, antidote

A

-route: SC and IV
-considerations: monitor CBC, aPTT, monitor for thrombocytopenia
-antidote: protamine sulfate

24
Q

Enoxaparin [LMWH] (lovenox) route/use, considerations, antidote

A

-route/use: SC
-considerations: monitor CBC, monitor for thrombocytopenia
-antidote: protamine sulfate

25
Q

Factor Xa inhibitors (“-xabans”) route/use, considerations, antidote

A

-route/use: PO for VTE treatment and prevention
(*except for Fondaparinux–SC), for patients /w a history of HIT
-considerations: monitor for thrombocytopenia, monitor anti-Xa factors
-antidote: andexanet alfa

26
Q

DTIs (direct thrombin inhibitors) route/use, names

A

-route/use: for cardiac pts w/ history of HIT
-Bilvalirudin IV, argatroban IV, dabigatran PO

27
Q

A patient w/ a VTE asks you to adjust their compression stockings. How do you respond?

A

REMOVE! VTE = no compression stockings, preventative measure only

28
Q

Stages of bone healing (HGCOCR)

A

-Hematoma (2 days)
-Granulation (3 days)
-Callous (2-3 weeks)
-Ossification (3 weeks)
-Consolidation (6 months)
-Remodeling (6+ months)

29
Q

Hip fracture do’s and don’t’s

A

DO:
-sleep w/ a pillow btwn legs
-use a device to put on shoes/socks
-use a chair in the shower
-elevate seats
-use chairs w/ arms

DON’T:
-knock knees
-flex hips > 90 degrees

30
Q

Tendons attach _______ to ________
Ligaments attach _________ to _________

A

Tendons attach muscle to bone
Ligaments attach bone to bone (joints)

31
Q

Osteomyelitis patho, S/S, care

A

Patho: bone infection (bone necrosis/sequestration increases pressure)

S/S:
-pain WORSENS w/ activity
-local and systemic infection/inflammation

Care:
-4-6 weeks of IV antibiotics –> oral antibiotics
-keep site immobile and sterile

32
Q

Compartment syndrome patho, S/S, care. What two common MSK treatments to avoid?

A

Patho: crush injury/bite/perfusion issue –> increased pressure in muscle compartment–happens FAST

S/S - 6 Ps: pain, paresthesia, pallor, pulseless, pressure, paralysis

Care: fasciotomy. IMMOBILITY IS KEY FOR PREVENTION
AVOID: ice, elevation

33
Q

Fat embolism patho, S/S, care

A

Patho: long bone fracture –> fat globules in blood

S/S: ARDs, sometimes petechiae

Care: Supportive–fluids, O2/respiratory support
IMMOBILITY IS KEY FOR PREVENTION

34
Q

CMS stands for…

A

circulation, movement, sensation

35
Q

Labs that indicate osteomyelitis

A

high ESR, CRP, WBC

36
Q

Tenants of cast care

A

Ice, elevate, keep dry, maintain ROM, watch for swelling/worsening pain, maintain movement

37
Q

Reductions are the surgical or non-surgical __________ of bone.

A

repositioning

38
Q

Fixations are _________ of bone.

A

immobilization

39
Q

Tractions work to _______ bones.

A

pull

40
Q

The ribs and skull are examples of ______ bones, the tarsals are examples of ______ bones.

A

flat, short

41
Q

Alteplase MOA, considerations–what makes it special

A

MOA: converts plasminogen –> plasmin –> fibrinolysis
-bleeding risk
-don’t use w/ heparin
-alteplase (and other ‘-plase’ drugs–ONLY ANTICOAGULANTS THAT BUST CLOTS)

N323 (9 decks)

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