Exam III--Mobility and Clotting

Question 1

Describe the function of osteoblasts, osteocytes, and osteoclasts

Answer 1

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

Question 2

Describe the anatomy of a synovial joint

Answer 2

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

Question 3

Name common causes of MSK issues in older adults

Answer 3

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

Question 4

______ occurs in 30-65% of hospitalized elders

Answer 4

-hospital acquired disability

Question 5

Describe the process of hemostasis

Answer 5

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

Question 6

Describe the process of hematopoiesis

Answer 6

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

Question 7

Elevated D-dimer and fibrin are signs of

Answer 7

hypercoagubility

Question 8

Garlic and ginko supplements can cause:

Answer 8

blood thinning

Question 9

Name the blood-related changes that occur in pregnancy

Answer 9

-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

Question 10

PT-INR therapeutic range (on Warfarin)

Answer 10

2-3

Question 11

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

Answer 11

-spleen
-lymph
-liver

Question 12

HCT and HgB normal values

Answer 12

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

Question 13

WBC normal value

Answer 13

5,000 - 10,000

Question 14

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

Answer 14

-higher
-drops

Question 15

Three factors of Virchow’s triad:

Answer 15

venous stasis, endothelial venous damage, hypercoagulability

Question 16

Describe the pathophysiology of VTE

Answer 16

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

Question 17

Clinical manifestations of superficial vein thrombosis

Answer 17

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

Question 18

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

Answer 18

Post-thrombotic syndrome (complication of VTE)

Question 19

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

Answer 19

Plhegmasia cerulea dorens, complication of VTE

Question 20

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

Answer 20

PE, complication of VTE

Question 21

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

Answer 21

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

Question 22

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

Answer 22

-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

Question 23

Heparin [UH] route, use, considerations, antidote

Answer 23

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

Question 24

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

Answer 24

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

Question 25

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

Answer 25

-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

Question 26

DTIs (direct thrombin inhibitors) route/use, names

Answer 26

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

Question 27

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

Answer 27

REMOVE! VTE = no compression stockings, preventative measure only

Question 28

Stages of bone healing (HGCOCR)

Answer 28

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

Question 29

Hip fracture do's and don't's

Answer 29

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

Question 30

Tendons attach _______ to ________ Ligaments attach _________ to _________

Answer 30

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

Question 31

Osteomyelitis patho, S/S, care

Answer 31

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

Question 32

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

Answer 32

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

Question 33

Fat embolism patho, S/S, care

Answer 33

Patho: long bone fracture --> fat globules in blood S/S: ARDs, sometimes petechiae Care: Supportive--fluids, O2/respiratory support IMMOBILITY IS KEY FOR PREVENTION

Question 34

CMS stands for...

Answer 34

circulation, movement, sensation

Question 35

Labs that indicate osteomyelitis

Answer 35

high ESR, CRP, WBC

Question 36

Tenants of cast care

Answer 36

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

Question 37

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

Answer 37

repositioning

Question 38

Fixations are _________ of bone.

Answer 38

immobilization

Question 39

Tractions work to _______ bones.

Answer 39

pull

Question 40

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

Answer 40

flat, short

Question 41

Alteplase MOA, considerations--what makes it special

Answer 41

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