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MedSurg > Lecture 7 - MSK > Flashcards

Lecture 7 - MSK Flashcards

1
Q

What is a pathological fracture?

A

Spontaneous fracture at site of bone disease (cancerous tumour, osteoporosis, poor bone density)

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2
Q

What is a comminuted fracture?

A

More than two fragments
–> Smaller fragments appear to float in X-Ray

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3
Q

What is an oblique vs a transverse fracture?

A

Oblique
–> diagonal

Transverse
–> Straight through bone

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4
Q

What is a greenstick fracture?

A

When a portion of the bone breaks and the rest bends (incomplete)
–> Common in children who have undeveloped bones.
–> Recovery is much better than other breaks

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5
Q

What is a stress fracture?

A

Bone that is subject to repeated stress such as jogging or running.

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6
Q

What are some common causes of non-spontaneous fractures?

A

Cancer and osteoporosis

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7
Q

What is a compression fracture?

A

One caused by decreased bone mass and stress on the bones (non-traumatic)

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8
Q

What kind of bone fracture requires the most immediate attention?

A

Femur
–> Highest amount of bleeding (should go into surgery w/in 6 hrs of break)

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9
Q

What are the manifestation of a bone fracture?

A

–> Immediate and localized pain
–> Decreased function distal to break
–> Inability to bear weight or use affected limb
–> Guarding
–> Swelling (can be difficult to see w adipose tissue) (the longer it is broken without treatment the more swelling)
–> Ecchymoses
–> Crepitus
–> Bleeding in open fractures

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10
Q

What are the nursing priorities in a person with a fracture?

A

–> ABCs
–> Control bleeding (pressure w tensor, elevation)
–> Monitor neurovascular status distal to injury
–> Ice
–> X-ray
–> Tetanus/diphtheria prophylaxis
Mark location of pulses to facilitate repeat assessment

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10
Q

What prophylaxis should be given to someone with an open fracture?

A

Tetanus and diptheria vaccine.

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11
Q

What is the primary priority in a patient with a new fracture (less than 1 week)?

A

Monitor neurovascular status
–> Colour, sensation, movement

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12
Q

What is the RICE pneumonic for a broken limb?

A

Rest
Ice
Compression
Elevation

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13
Q

How often and long should ice be used to alleviate swelling?

A

No more than 20 minutes and no more than once an hour

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14
Q

What is compartment syndrome? What kind of bones are most common with it? What are the S/S? Does it occur initially or a few days after injury?

A

When the pressure within a compartment increases and cuts of circulation (neurovascular interruption)
–> More common in long bones where there is a not a lot of space for swelling
–> 6Ps w pain often unrelieved by meds and out of proportion to the level of injury

Can occur initially (cell death in 4-8 hours) or delayed for several days

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15
Q

What are the 6Ps and compartment syndrome?

A

Pain, pallor, paresthesia, paralysis, pulselessness, pressure

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16
Q

How long does it take for ischemia resulting in cell death to occur after onset of injury with compartment syndrome?

A

4-8 hours

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17
Q

In compartment syndrome how high should we elevate the limb? Why?

What about icing?

A

No higher than the heart
–> May rise venous pressure

Ice results in vasoconstriction that may exacerbate compartment syndrome

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18
Q

What are some decompression techniques for compartment syndrome?

A

–> Loosen or remove bandage or cast
–> Reduce traction weight to reduce external circumferential pressure
–> Surgical decompression might be necessary

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19
Q

What medications should we know about a person’s hx with a fracture?

A

Use of:
Corticosteroids, analgesics, hormone therapy, calcium supplementation

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20
Q

What is osteopenia?

A

Decreased bone density (not bad enough to be considered osteoporosis yet)

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21
Q

Why do we want to know is someone takes corticosteroids with a bone fracture?

A

Steroids decrease bone density and can result in fractures

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22
Q

How long does the bone remodel after an injury? What about initial healing?

A

Initial healing does not occur at an expected timeline and depends on age, nutritional status, bone density, and the kind of fracture.

Remodeling can continue occurring up to a year after the injury.

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23
Q

How to perform a closed reduction?

A

Administer conscious sedation –> Propofol/Ketamine/Medazepam

Then perform non-surgical manual realignment
Traction may be used to restore position or alignment

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23
Q

Why would you administer ketamine over propofol?

A

Ketamine does not drop BP as much as propofol does

Propofol is used for cardioverting and is more shorter acting (less alters loc afterwards)

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24
Q

What is an open reduction?

A

Surgical correction of bone out of alignment through wires, screws, pins, plates, intramedullary rods, nails, etc.

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25
Q

What antispasmodic can we give someone to ensure alignment remains during fracture?

A

Oxybutin

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26
Q

what is the purpose of traction in fractures?

A

Prevent muscle spasm, promote immobilization and expand the joint.

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27
Q

What is skin traction? How long is it used for?

A

Boots, tape, or pressure applied direction to the skin
–> 48-72 hours

28
Q

What is skeletal traction and what should you be aware of when using it?

A

Pins applied directly into the bones
–> Too much weight can delay or prevent closure of bones

29
Q

What should the nurse be aware of when using traction?

A

–> Inspect exposed skin regularly
–> Observe skeletal traction pins for infection
–> External rotation of the hip can occur when traction is used on the lower extremities

30
Q

What is a trochanter roll?

A

Rolling sheet to either side of the trochanter to present rolling and external rotation

31
Q

Casts are applied following a closed reduction. What are different kinds of cast materials?

A

–> Fiberglass
–> Polymer
–> Hybrid materials like gorex (water proof)

32
Q

How long should we elevate a limb with a cast?

A

Elevated above the heart for first 24 hours
–> After 24 hours this position could increase the possibility of excessive edema.

33
Q

What medications are we going to give someone with fracture?

A

Analgesia
–> NSAIDS (Celebrex/ibuprofen), Acetaminophen, Opioid
–> Muscle relaxants: Oxybutin

Antibiotics if indicated, such as cefazolin.

34
Q

What nutritional therapy should be given to someone with a fracture?

A

Protein - 1g/kg body weight
Vitamins - B, C, D
Minerals - Calcium, phosphorus, magnesium

Fluid - 2-3L a day
High fiber diet w fruit and veggies

Six small meals a day to avoid overeating and abdominal pressure/cramping

35
Q

What is arthritis? Which demographics are most often affected by it

A

Inflammation of a joint
–> Most forms affect women fore frequently than men

36
Q

What is osteoarthritis? When does it start developing and when do symptoms begin presenting?

A

Slowly progressing noninflammatory disorder where cartilage destruction can begin between 20-30 but few experience symptoms until after 50-60.

37
Q

What are some risk factors for osteoarthritis?

A

–> Estrogen reduction
–> Obesity
–> Age
–> Female

Genetic, metabolic, local factors also apply.

38
Q

How will the pain on osteoarthritis be described?

A

Localized pain, stiffness, and crepitation

39
Q

What kind of deformity are seen with osteoarthritis? When does it appear?

A

Herberden’s Nodes
–> Lumps that develop on the distal joints of the phalanges

Can appear as early as 40 years old.

40
Q

How can we diagnose osteoarthritis?

A

–> Bone scan
–> CT
–> MRI
–> X-ray
–> BW
–> Synovial fluid analysis

41
Q

What are the goals in managing osteoarthritis?

A

–> Managing pain and inflammation
–> Maintaining and improving joint function through rest and activity
–> Joint protection measures to improve activity tolerance
–> Preventing disability and promote independence

42
Q

How can we manage osteoarthritis?

A

Foundation is nonpharmaceutical and medication serves only as an adjunct.

–> H&C
–> Rest and joint protection
–> Nutritional therapy and exercise
–> Complementary and alternative therapies
–> Surgical if necessary

43
Q

What is rheumatoid arthritis? when is onset?

A

Chronic, systemic, autoimmune disease
–> Usually 30-50, can occur in children

44
Q

What biomarker can identity rheumatoid arthritis?

A

Rheumatoid factor

45
Q

What are the three most common types of rheumatoid arthritis?

A

Rheumatoid nodules
–> Firm lumps that develop under the skin

Sjogren Syndrome
–> Dry mucous membranes and joint pain and swelling

Felty Syndrome
–> Splenomegaly, Anemia, neutropenia, rheumatoid arthritis

46
Q

How soon after disease onset does joint destruction occur with rheumatoid arthritis? How does it progress?

A

Joint destruction as early as first year without treatment
–> Flexion and contractions develop
–> Nodular myositis and muscle fiber degeneration
–> Cataracts and loss of vision

Later stages have been linked with cardiopulmonary problems
Depression

47
Q

50% of all inflammatory disorders are linked with _____

A

Depression

48
Q

What Hx will we collect with rheumatoid arthritis?

A

–> Recent infection
–> Pattern of remission and exacerbations
–> Family Hx
–> Use of ASA, NSAIDS, corticosteroids, Disease modifying antirheumatic drugs (DMARDS)

49
Q

What are the S/S of rheumatoid arthritis?

A

Systemic: Anorexia & weight loss, fatigue, malaise, dry mucous membranes

Joints: stiffness, muscle weakness numbness or loss of sensation

50
Q

What physical assessment findings are indicative of rheumatoid arthritis?

A

Lymphadenopathy, fever

Skin that is shiny and taut over joints, peripheral edema. SC rheumatoid nodules visible of forearms and elbows.
Symmetrical involvement of joint swelling, erythema, heat
Enlargement of proximal phalangeal joints
Raynaud’s syndrome present.

Splenomegaly

Chronic bronchitis and tuberculosis d/t rheumatoid nodules

51
Q

What is Felty’s syndrome?

A

Splenomegaly
–> Associated w rheumatoid arthritis

52
Q

What diagnostic studied are used for rheumatoid arthritis?

A

Positive RF
Antinuclear antibody titres
Erythrocyte sedimentation rate
Anticirullinated protein antibody
Synovial analysis

Imaging: Xray, MRI, CT, Ultrasound.

53
Q

What is the cornerstone of rheumatoid arthritis treatment?

A

Medication
–> Methotrexate
–> Sulfasalazine (Azulfidine)
–> Hydroxytoluene (Plaquenil)
–> Adalimumab (Humira)

Immunosuppressants + Corticosteroids
Gold preparations - experimental

High dose salicylates and NSAIDS

54
Q

What is a complication of methotrexate? What is it used for?

A

Cirrhosis, leukopenia, anemia, renal impairment.

Used for rheumatoid arthirits

Liver damage tests
–> Bilirubin, AST, ALT, alcfos, amylase

55
Q

What are some complication of corticosteroid therapy?

A

Bone mass loss + hyperglycemia

56
Q

What are nursing priorities with rheumatoid arthritis?

A
  1. Chronic pain
  2. Reduced physical mobility
  3. Disrupted body image
57
Q

What nutritional therapy can be used for rheumatoid arthritis?

A

Balanced nutrition, weight control (exercise can be a challenge with chronic joint pain)

Foods that lower inflammation and boost immune function
–> Fish, berries, leafy greens

58
Q

What foods that lower inflammation and boost immune function?

A

Fish, berries, leafy greens

59
Q

What are some risk factors for osteoporosis?

A

Small-boned postmenopausal females
–> Caucasian and Asian
–> Pregnancy, breastfeeding
–> Family HX

Diet low in calcium
Excess alcohol, tobacco, and caffeine
Sedentary lifestyle
Low testosterone in men

Diabetes, cirrhosis, corticosteroids, loop diuretics

60
Q

What assessment findings indicate osteoporosis?

A

–> Dowager’s hump
–> Kyphosis
–> Loss of height
–> Pathological fractures
–> Compression fracture of spine can occur

61
Q

What are some adverse effects of loop diuretic like furosemide (Lasix)?

A

Loss of bone density and hearing loss

62
Q

What diet and lifestyle changes are recommend for people with osteoporosis?

A

Implement fall prevention strategies + exercise programs

Encourage diet high in vit D, protein, Ca

20 mins UV daily

63
Q

What primary prevention strategies are used to detect osteoporosis?

A

Routine DEXA screening begin at 60yrs.

64
Q

What is lupus?

A

Chronic, multisystem inflammatory autoimmune disease that results from interactions among
–> Genetic
–> Hormonal
–> Environmental
–> Immunological factors

65
Q

What systems are affected by systemic lupus erythematosus?

A

–> Skin
–> Joints
–> Serous membranes
–> Lungs
–> Heart
–> Kidneys
–> Neuro system

66
Q

What medications are used for osteoporosis?

A

Bisphosphonates
–> Alendronate

Selective Estrogen Receptor Modulators

Recombinant Parathyroid Hormone

67
Q

What is the number one cause of Lupus?

A

Tick bites

68
Q

What are some assessment findings of Lupus?

A

Scaly rash on bridge of nose
Photosensitivity (Avoid UV)
Fever

Join pain

Pericarditis

Nephritis & AKI

69
Q

Which demographic is most affected by lupus?

A

Women

70
Q

What should be use for joint inflammation in Lupus?

A

Steroids.

MedSurg (11 decks)

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