Exam III--Mobility and Clotting Flashcards
Describe the function of osteoblasts, osteocytes, and osteoclasts
Blasts: bone making
Cytes: mature bone cells
Clasts: break down bone cells
Describe the anatomy of a synovial joint
-enclosed by fibrous CT, filled w/ synovial fluids–end of bones covered in hyaline cartilage
Name common causes of MSK issues in older adults
-loss of balance/proprioception, flexibility
-decreased bone density (increased osteoclast activity, decreased osteoblast activity)
-30% of muscle mass lost by age 70
______ occurs in 30-65% of hospitalized elders
-hospital acquired disability
Describe the process of hemostasis
Arrest of bleeding
-platelet “plug” forms around injury
-coagulation cascade –> fibrin clot
-fibrinolysis (remodeling)
Describe the process of hematopoiesis
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
Elevated D-dimer and fibrin are signs of
hypercoagubility
Garlic and ginko supplements can cause:
blood thinning
Name the blood-related changes that occur in pregnancy
-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
PT-INR therapeutic range (on Warfarin)
2-3
The _____ stores platelets; the _____ carries fluid to blood and filters pathogens; and the _____ produces pro-coagulants and filters blood
-spleen
-lymph
-liver
HCT and HgB normal values
HCT: 12-16F, 14-18M
HgB: 37-47F, 42-52M
WBC normal value
5,000 - 10,000
RBCs, WBCs, HgB, and HCT is _____ at birth then dramatically ______ in the first month of life
-higher
-drops
Three factors of Virchow’s triad:
venous stasis, endothelial venous damage, hypercoagulability
Describe the pathophysiology of VTE
Platelets aggregate –> clotting factors stimulate fibrin production –> fibrin traps blood cells –> thrombus forms
Clinical manifestations of superficial vein thrombosis
Palpable cord-like vein, itching/warmth/redness/pain, leukocytosis, mild fever, “fullness” in leg, paresthesia
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
Post-thrombotic syndrome (complication of VTE)
Name the complication:
A patient presents with a swollen, blue leg. They report this came on suddenly and rapidly.
Plhegmasia cerulea dorens, complication of VTE
A patient reports sudden shortness of breath and coughing/wheezing. Assessment shows they are tachycardic and extremities are tinged blue.
Name the complication
PE, complication of VTE
A patient presents w/ suspected VTE. They ask what tests you predict they will undergo. How will you respond?
-Labs: CBC, clotting study, D-dimer
-Ultrasound of extremity
Warfarin (Coumadin) route, use, MOA, considerations, antidote
-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
Heparin [UH] route, use, considerations, antidote
-route: SC and IV
-considerations: monitor CBC, aPTT, monitor for thrombocytopenia
-antidote: protamine sulfate
Enoxaparin [LMWH] (lovenox) route/use, considerations, antidote
-route/use: SC
-considerations: monitor CBC, monitor for thrombocytopenia
-antidote: protamine sulfate
Factor Xa inhibitors (“-xabans”) route/use, considerations, antidote
-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
DTIs (direct thrombin inhibitors) route/use, names
-route/use: for cardiac pts w/ history of HIT
-Bilvalirudin IV, argatroban IV, dabigatran PO
A patient w/ a VTE asks you to adjust their compression stockings. How do you respond?
REMOVE! VTE = no compression stockings, preventative measure only
Stages of bone healing (HGCOCR)
-Hematoma (2 days)
-Granulation (3 days)
-Callous (2-3 weeks)
-Ossification (3 weeks)
-Consolidation (6 months)
-Remodeling (6+ months)
Hip fracture do’s and don’t’s
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
Tendons attach _______ to ________
Ligaments attach _________ to _________
Tendons attach muscle to bone
Ligaments attach bone to bone (joints)
Osteomyelitis patho, S/S, care
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
Compartment syndrome patho, S/S, care. What two common MSK treatments to avoid?
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
Fat embolism patho, S/S, care
Patho: long bone fracture –> fat globules in blood
S/S: ARDs, sometimes petechiae
Care: Supportive–fluids, O2/respiratory support
IMMOBILITY IS KEY FOR PREVENTION
CMS stands for…
circulation, movement, sensation
Labs that indicate osteomyelitis
high ESR, CRP, WBC
Tenants of cast care
Ice, elevate, keep dry, maintain ROM, watch for swelling/worsening pain, maintain movement
Reductions are the surgical or non-surgical __________ of bone.
repositioning
Fixations are _________ of bone.
immobilization
Tractions work to _______ bones.
pull
The ribs and skull are examples of ______ bones, the tarsals are examples of ______ bones.
flat, short
Alteplase MOA, considerations–what makes it special
MOA: converts plasminogen –> plasmin –> fibrinolysis
-bleeding risk
-don’t use w/ heparin
-alteplase (and other ‘-plase’ drugs–ONLY ANTICOAGULANTS THAT BUST CLOTS)
