Med Surg 2- Musculoskeletal Exam Flashcards
Ibandronate (Boniva)- Biophosphonates
For osteoporosis, osteoarthritis
Take on empty stomach 1st thing in morning, sit up 30 min after taking, take on same day weekly/monthly
Estrogen (hormone therapy)
Osteoporosis, osteoarthritis
At risk for blood clots
Ibuprofen
Naproxen
NSAIDs for RA pain
At risk for Gi distress, bleeding, strokes
Prednisone (corticosteroid)
Immunosuppresion- avoid large crowds and sick people
Methotrexate (DMARD)
Used for RA
Use contraception- can cause birth defects, abortion, death; avoid alcohol
Leukopenia, thrombocytopenia; will have increased creatinine and LFT
Hydroxychloroquine (DMARD)
retinal and corneal damage- must have regular eye exams every 6months
BRM’s (Biologic Response Modifiers)
Decreased immune response- avoid large crowds and sick people
Alloprurinol
CHRONIC antigout drug
Colchicine
ACUTE gout pain
Gabapentin
Used for phantom limb pain
Monoclonal Antibodies- Belimumab
Management of SLE (lupus)
Assess/check the CBC values (lower)
Heparin
Blood thinner used to prevent DVT and PE
Check PTT
Arthrogram
xray with contrast dye to visualize joint (knee)
Arthoscopy
diagnostic surgical procedure in which firbo-optic tube inserted for direct visualization
AFTER SURGERY- elevate extremity 12-24 hrs, apply ice
Osteoporosis
A condition in which the body’s bones become weak and break easily.
genetically linked
gentle in handling, give pt time
osteomalacia
softening of the bone due to vit. D deficiency
Ca and P relationship
when calcium rises, phosphorus drops
When collecting HH, ask about these drugs
Prednisone- fragile bones
Statins- achilles tendon rupture
What puts stress on joints
Weight
Gout has a genetic link with
osteoporosis
ALP level
30-120
Normal platelet count
150,000-400,000
Normal WBC
5,000-10,000
Normal ESR
anything above 20 means inflammation, 0-20
MRI
allergy to shellfish/iodine
remove metals and jewelry
Increases fluids to flush out contrast after procedure
CMS
circulation, motion, sensation
One cause of osteoporosis
Phosphorus in carbonated drinks
What to get on admission
Height, weight
What is best exercise?
Walking
Osteomyelitis
infection of the bone
Increased WBC, ESR, positive blood cultures (B4 antibiotics)
Bone tumors/cancer
usually metastasized from another area, leads to amputation and usually fatal
Most common type is osteosarcoa- focus on pain mainagement
RICE
rest, ice, compression, elevate
Gout
a type of arthritis characterized by deposits of uric acid crystals in the joints
elevated ESR and CRP (c-reactive protein)
can happen in other parts of body not only feet
Gout treatment
Encourage fluids, decrease alc and purines in diet
tylenol, NSAIDs
Post-Op Hip Replacement
Pillow between legs, prevents Adduction & dislocation
Encourage fluid intake, prevents DVT
prevent 90 degree flexion, legs always straight, HOB 30 degrees
prehab for exercises
check circulation every hour!
Post-op, what to watch for
Delirium in elderly
Assistive devices for hip surgery
Walker, cane goes on stronger/unaffected side
RA factor testing
unusual antibodies in IGG- indicates connective tissue disease
no single test confirms
What elevates blood sugar
steroids
fatty embolism syndrome
life-threatening!
bone breaks and fat from inside bone can become a clot and travel through bloodstream
early s/s- hypoxemia, dyspnea, tachypnea
Acute compartment syndrome
Swelling in a confined space that produces dangerous pressure; may cut off blood flow or damage sensitive tissue- serious edema!
S/S- 6 P’s
Post- Op nursing interventions
ABCs
Assess patient CMS
Neuro checks q1hr
Treating phantom limb pain
gabapentin
What to do if pt has traction on post-op
if weights are messed up, call ortho tech or provider
S/S Lupus
fever, fatigue, pain, butterfly rash, vasculitis, alopecia in women
What to do with open bone fracture
cover with clean/sterile gauze
possibly splint, cover, ice, remove jewelry
Emergent managing fracture
remove clothing (NOT SHOES), jewelry, CMS, control bleeding, cover
Biphosphonates
slows bone resorption and may cause GI upset
Fat embolism s/s
tachycardia, dyspnea
Neurovascular assessment
CMS hourly
Increased fracture healing diet
healthy diet (vit. B/C, iron, high protein/calories)
BMRIs
decreased immunity- increased infections
rheumatoid arthritis s/s
pain, limited ROM, swelling, fatigue, low grade fever (body attacks itself)
Calcium foods
dark leafy green veggies, dairy
RA determining labs
RA factor (IGG), ANA
sign of osteoporosis
Kyphosis (change in height with humpback)
Signs of fracture
serous drainage, weeping, edema
What foods cause increased calcium excretion
high protein, caffeine, carbonation
Dietary supplements for aid in treatment for osteoarthritis
Glucosamine and chrondoitin (bioflex) (OTC)
Whats linked to Alkaline phosphate (ALD)
metabolic bone disease, bone cancer, problems with liver
When is osteoporosis diagnosed
T-score is at or lower than -2.5
S/S of osteomyelitis
Pain
Pallor
Puslelessness
Paresthesia
Paralysis
Poikilothermia
Bone healing stages
Stage 1-Hematoma formation within 48 to 72 hr. after injury
Stage 2-Hematoma to granulation tissue (3 days to 2 weeks)
Stage 3- Callus formation (3-6 weeks)-the beginning of a non-bony union (bump on fracture)
Stage 4- Callus is resorbed and transformed into bone.
Stage 5- Consolidation & remodeling of bone.(4-6 weeks /1 year)
Closed reduction
manipulation of the bone fragments without surgical exposure of the fragments
Open reduction
surgical realignment of broken bone ends
Bandages, splints, and boots/shoes
Assess CMS
Plaster cast- will feel burning sensation due to chemical hardening, normal reaction
Traction
CMS checks
Buck’s traction- velcro boot being pulled
Skeletal traction
Screws inserted into surgical site
Pin care q8hr to prevent infection
carpal tunnel syndrome
caused by repetitive hand movements
can wear wrist brace
Rotator cuff injury s/s
limited ROM, shoulder pain, weakness, loss of function, muscle atrophy
Who is at increased risk for osteoporosis
Chinese american woman
*Older caucasian woman more at risk for injury (bone mass decreases)
Dupuytren’s contracture
Thickening and shrinking of the fascia of the palm with fingers being drawn into a flexed position
