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ADULT Health > FINALS Musculoskeletal > Flashcards

FINALS Musculoskeletal Flashcards

1
Q

How do we promote bone health????

A
  1. Regular WEIGHT BEARING exercise
  2. Diet: Calcium, Vit. D, Vit. K, & Magnesium
  3. Potential supplementation with Vit. D
  4. NO Smoking, No ETOH, plenty of sunshine
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2
Q

What is osteoporosis???

A

Bone loss causing a decrease in bone mineral density. OSTEOCLASTIC > osteoblastic!!

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3
Q

What are the factors that influence peak mass and bone maintainance for Osteoporosis?

A

“PIGS - Nah”
1. Genetics
2. Nutrition: Calcium, vit D, K, mag
3. Physical activity
4. Inter-current illness
5. Socioeconomic status

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4
Q

What are the factors that INCREASE bone loss with aging (osteoporosis)?????

A
  1. Weight Loss
  2. Smoking
  3. Alcohol
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5
Q

Who is most susceptible to Osteoporosis?????!!!!!

A

FEMALE, CAUCASIAN/ASIAN, PETITE!!!!!!

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6
Q

What are MEDICATIONS that CAUSE Osteoporosis???

A

“CATS, LongPus 🍆 “
1. Corticosteroids
2. AntiConvulsants
3. Thyroid Hormones
4. SSRIs
—–
5. Loop diuretics
6. Proton Pump Inhibitors (PPIs)

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7
Q

What are DISEASES that CAUSE Osteoporosis???

A

“CCC, DD, HH”
1. Chronic Kidney Disease
2. Chronic LIVER disease
3. CUSHING SYNDROME!!!
—-
3. Diabetes
4. Diseases that impact nutrient uptake
—-
5. HyperTHYROIDISM
6. HyperPARATHYROIDISM

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8
Q

With aging and osteoporosis, what would happen to their: Calcitonin, Estrogen, PTH??

A
  1. Decreased Calcitonin
  2. Decreased Estrogen
  3. Increased PTH
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9
Q

What are the MANIFESTATIONS of Osteoporosis????

A
  1. Fractures
  2. Kyphosis/ “Dowager Hump”
  3. ## Loss of Height
  4. Back pain and restriction of movement
  5. DEXA Scan!!!
  6. Lab Evaluation:
    - Calcium & Vit. D
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10
Q

What are the patient care and teaching for Osteoporosis????

A
  1. Nutrition: Protein, Calcium, vit. D, K, and Magnesium
  2. Avoid Alcohol
  3. Avoid Caffeine
  4. Avoid CARBONATED DRINKS !!!!
  5. NO SMOKING
  6. Safety issues: falls and fracture risk
  7. EXERCISE:
    - Strengthen back and core,
    - Posture, balance, tone
    - Weight bearing (walking)
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11
Q

What are the assessment of the patient with fracture????

A
  1. VITAL SIGN (Shock potential with trauma)
  2. Signs of bleeding:
    1) H & H
    2) VS changes (Decrease BP, increased HR, decreased UOP, mental status change)
    —–
  3. Neurovascular assessment!!!
  4. Change in bone alignment/ deformity
  5. SHARP, Piercing pain with movement!!!!
  6. CREPITUS (“grating” sound)
  7. ## Edema & bruising
  8. MUSCLE SPASM
  9. Soft tissue damage / organ damage!!!
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12
Q

What is the purpose of Tractions????

A
  1. Reduce & align FRACTURES
  2. DECREASE SPASMS
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13
Q

What are the patient care for Tractions????????

A
  1. Patient pulled up in bed & Weights OFF the floor. ROPE MOVES IN PULLEY
  2. FOOTPLATE = prevent foot drop
  3. TRAPEZE = ADL ASSISTANCE!
  4. Skin care and break down prevention
  5. ## NV Assessment
  6. FOR Skeletal, PIN SITE SHOULD NOT MOVE IN & OUT!!! THERE’S INFECTION RISK TOO WITH SKELETAL
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14
Q

What are the risk factors for FAT EMBOLISM???

A
  1. Happens 12-48 hours AFTER the injury (EARLY)
  2. HIGHEST RISK WITH HIP FRACTURE!!!!!!!
  3. May be confused with pulmonary embolus from a DVT! (but remember, fat embolism happens earlier than a DVT)
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15
Q

What are ASSESSMENT FINDINGS with Fat Embolism??????
1. Respiratory alterations?
2. Neurological Alterations?
3. **Rash??

A
  1. Respiratory Alterations??
    - Dyspnea, Tachypnea, Hypoxemia & signs of low perfusion (low level of oxygen in the blood).
  2. Neurologic Alterations??
    - Acute confusion, Change in LOC, Focal DEFICITS, AND SEIZURES!!!
  3. **PETECHIAL RASH ==> LATER FINDING!!!
    - (This helps distinguish btwn a fat embolus or a blood clot embolus)
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16
Q

What are the Patient Care with Fat Embolism???

A
  1. BEDREST, fracture immobilization
  2. *RESPIRATORY SUPPORT:
    - Oxygen
    - HOB Elevated
  3. *PULMONARY ASSESSMENT:
    - CRACKLES & WHEEZES
    - ABG: *Respiratory Acidosis (↓pH, ↑CO2, ↓HCO3)
17
Q

Would someone with compartment syndrome has a swollen extremity???

A

IT CAN, BUT NOT ALWAYS!!!!!

18
Q

What are the risk factors of Compartment syndrome???? or What causes compartment syndrome???

A
  1. Fractures
  2. BURNS
  3. Dislocations
  4. DVT (bc of swelling)
  5. RHABDOMYLOSIS!!!
19
Q

What are the EARLY VS LATE assessment alterations with Compartment Syndrome?????

A

*EARLY assessments:
1. PAIN not proportion to the injury!!!!
2. PAIN that’s not RELIEVED by Narcotics!!
3. PAIN with PASSIVE movement
4. PARASTHESIA
—–
*LATE:
1. Pallor
2. Pulseless
3. Paralysis
4. POLAR (latest finding)

20
Q

WHAT WOULD YOU DO AS A NURSE WHEN A PATIENT HAS COMPARTMENT SYNDROME??

A
  1. NOTIFY HCP!!!!!*****
  2. ## Monitor signs of Rhabdo
  3. Loosens splint (remove jewelry & clothing)
  4. DON’T ELEVATE EXTREMITY!!!! Neutral position ONLY
  5. Infection prevention and wound care if the patient has a FASCIOTOMY
  6. Pain management and ABX
21
Q

DO YOU ELEVATE EXTREMITY WHEN SOMEONE HAS COMPARTMENT SYNDROME????

A

NOOOO!!! NEVER ELEVATE WITH COMPARTMENT SYNDROME!!!!

22
Q

How would you recognize if a patient has developed Rhabdomyolysis?????

A
  1. ## Change in URINE COLOR: TEA COLORED (REDDISH-BROWN)!!!!
  2. Muscle PAIN
  3. ## WEAKNESS
  4. Also possible:
    - Flank pain,
    - Muscle swelling
    - Decreased Blood pressure
23
Q

What labs would you ANTICIPATE in someone who has Rhabdomyolysis????

A
  1. CREATININE KINASE (CK): ELEVATE
  2. ## Urine MYOGLOBIN: POSITIVE
  3. Electrolytes:
    1) Potassium: UP (bc of cell dying/lysis, causing potassium and phosphorus to shift out of the cell!! ALSO bc the tissue isn’t getting oxygen, causing in metabolic acidosis = potassium goes outside of cell)
    2) Phosphorus: UP
    3) CALCIUM: DOWN (Increased phosphorus=more calcium is excreted)
    ——
  4. ## BUN & CREATININE: UP
  5. ABGs: METABOLIC ACIDOSIS ( ↓pH, ↓Hco3, ↓CO2)
24
Q

WHAT ARE THE PATIENT CARE WITH RHABDO????

A

1: FLUID VOLUME IS PRIORITY!!!:

1) IV fluids
2) possible Alkalization:
—> 1. Bicarbonate in D5W
—> 2. NOT if Hypocalcemic or Alkalotic (pH >7.5, HCO3 >30) WHY? because calcium binds to bicarbonate and becomes non ionized (ionized: the ones that actually functions to make ur heart pumps well, muscles work, etc). Now, if you give bicarb in someone who already has a LOW calcium level, it’ll make calcium even lower!!!
——–
2. Monitor for Phosphorus:
- WILL CORRECT WITH IV FLUIDS
- HEMIDIALYSIS
3. Calcium:
- NOT

25
Q

CAN YOU GIVE BICARBONATE WHEN SOMEONE IS HYPOCALCEMIC???

A

NOOOO!!! NEVER!!! Calcium binds with BICARBONATE!! When they bind they are NO longer IONIZED (the ones that actually function to help heart, muscles, etc).
SO, When they already have low calcium levels, you shouldn’t give them bicarbonate!!

26
Q

DO YOU REPLACE CALCIUM (for rhabdo patient care)???

A

NOPE!! YOU DONT ROUTINELY REPLACE UNLESS SEVERE SYMPTOMS OR NEED FOR ADMINISTRATION WITH HYPERKALEMIA!!!!!

27
Q

What are the 2 types of Casts??

A
  1. Fiberglass: DRIES FAST & can get WATERPROOF!
  2. Plaster:
    - Hours to dry!
    - Produces HEAT while drying!
    - HANDLE WITH PALMS!!!!
28
Q

What are the complications of Casts????

A
  1. SKIN BREAKDOWN and Infection:
    1) HOT SPOTS
    2) ODORS
    3) FEVER
    4) Increased PAIN
  2. Contractures!!!!!!!
  3. MUSCLE ATROPHY!!!!!!
29
Q

what are the patient teaching for Cast???

A
  1. Keep it DRY!
  2. NOTHING in the cast!
  3. Report a cast that’s TOO TIGHT or TOO LOSE!
  4. **COOL DRYER FOR ITCHING!! (not hot please!!)
30
Q

What are the POSITIONS for someone who just had Amputation????**

A
  1. NO OVER Soft mattress
  2. NO HOB Elevation
  3. Range of motion
  4. NO PILLOW BETWEEN LEGS
  5. ## AVOID PROLONGED KNEE FLEXION
  6. Avoid STATIC POSITIONING
  7. PRONE (15 mins, 3x a day)

AND ALSOOOOO:
1. NO pillow UNDER stump!!!!
2. FOOT of BED elevation
3. PRONE!!!!!!

31
Q

What are the 3 USES of Heparin??

A
  1. PREVENTION of clot development, extension, and formation in some IV lines
32
Q

What is the Antidote for HEPARIN???

A

PROTAMINE SULFATE!!!!
Often it’s not necessary to give this because Heparin has a short half-life. So, better to just wait until Heparin no longer active in the body!!!

33
Q

WHICH LAB DO YOU USE FOR HEPARIN???

A

PTT!!!!!!

34
Q
A

ADULT Health (24 decks)

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