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Exam 4 > Mobility part 2 > Flashcards

Mobility part 2 Flashcards

1
Q

The most prevalent bone disease in the world?

A

osteoporosis

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2
Q

means porous bone, is a disease in which the density and quality of bone are reduced.

A

osteoporosis

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3
Q

a disease of the bones that happens when you lose too much bone, make too little bone or both.

A

osteoporosis

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4
Q

low bone density, middle ground, not enough bone density lost to be diagnosed as osteoporosis

A

osteopenia

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5
Q

break down bone

A

ostoeclasts

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6
Q

rebuild bone

A

osteoblasts

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7
Q

What medication risk factors are there for osteoporosis?

A
  • steroids
  • anti-seizure
  • antacids
  • chemotherapy drugs
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8
Q

What disease risk factors are there for osteoporosis?

A

–Anorexia
–Malabsorption syndrome
–Chronic Kidney failure

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9
Q

– Measures bone mineral density (BMD)
– Recommended for ALL women >65yrs
– Post-Menopausal women >50yrs w/risk factors

A

Dual-energy x-ray absorptiometry (DEXA)

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10
Q

10 year probability of getting a fracture based on assessment

A

Fracture Risk Assessment Tool (FRAX)

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11
Q

What are osteoporosis medication treatment?

A
  • Calcium and Vitamin D supplements
  • Raloxifene Hydrochloride (Evista)
  • Calcitonin
  • Bisphosphonates
  • Teriparatide (Forteo)
  • Denosumab (Prolia)
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12
Q

– Inhibits bone breakdown (osteoclast activity)
– Available as a daily, weekly, monthly or yearly
dose
– Potential side effects: GI symptoms –dyspepsia,
nausea, flatulence, diarrhea and constipation
• Take on an empty stomach
• Take with a full glass of water
• Stay upright for 30-60 minutes after ingestion
– Do NOT take at the same time as Calcium

A

Bisphosphonates

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13
Q 
–Selective Estrogen Receptor Modulator
(SERM) – mimics natural estrogen without
increasing cancer effects from estrogen
–Inhibits bone breakdown (osteoclast
activity)
–Side Effects: Increase risk of blood clots, hot
flashes
A

• Raloxifene Hydrochloride (Evista)

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14
Q

–Inhibits bone breakdown (osteoclast activity) and
stimulates bone formation (osteoblasts)
–Available as an injection or nasal spray
–No major side effects
*good option

A

Calcitonin

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15
Q

– Synthetic Parathyroid Hormone – stimulates
formation of bone (osteoblast activity)
– For use with:
• Men and postmenopausal women with
osteoporosis at high risk for fractures
• Men and women with chronic steroid use
• Those unable to take other osteoporosis
medications
– Can’t take for more than 2 years in a lifetime
– Side effect: orthostatic hypotension, joint and
muscle pain and weakness, nausea
– Daily Subcutaneous Injection

A

Teriparatide (Forteo)

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16
Q 
– Inhibits bone breakdown (osteoclasts)
– For osteoporosis with a high risk of fractures
OR can’t use other osteoporosis medications
OR other medications were not effective
– Contraindicated with low blood calcium
levels
– Side effects: jaw bone necrosis, thigh
fractures, serious infections
A

Denosumab (Prolia)

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17
Q

Which types of treatment medications are there available for osteoporosis?

A
  • Denosumab (Prolia)

* Teriparatide (Forteo)

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18
Q

What are fractures?

A
  • Break in the continuity of a bone

* Can happen to any bone in the body

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19
Q

– Break is across entire width of the bone

A

complete fracture

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20
Q

– Break is through only part of the bone, and the other side is bent

A

incomplete fracture (greenstick)

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21
Q

– Produces bone fragments

A

Comminuted Fracture

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22
Q

– No break in the skin

A

Closed Fracture aka Simple Fracture

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23
Q

– Bone breaks through the skin or mucus

membranes

A

Open Fracture aka Compound Fracture

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24
Q

How are gustilo open (compound) fractures classified?

A
  • Grade I
  • Grade II
  • Grade III
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25
Q

– Least severe
– Wound < 1 cm
– Wound is clean

A

Grade I

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26
Q

– Wound >1 cm and < 10 cm

– Without extensive soft tissue damage

A

Grade II

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27
Q 
– Most severe injury and mostly > 10cm
– Extensive soft tissue damage
– Highly Contaminated Wound
– May also have nerve or vascular damage or
associated with a traumatic amputation
A

Grade III

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28
Q

a fracture that remains contained, with no disruption of the skin integrity

A

simple fracture

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29
Q

a fracture in which damage also involves the skin or mucous membranes, also called a compound fracture

A

open fracture

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30
Q

a fracture occurring at an angle across the bone (less stable than a transverse fracture)

A

oblique fracture

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31
Q

a fracture that is straight across the bone shaft

A

transverse fracture

32
Q

a fracture that twists around the shaft of the bone

A

spiral fracture

33
Q

a fracture in which a bone fragment is driven into another bone fragment

A

impacted fracture

34
Q

a fracture in which bone has been compressed (seen in vertebral fractures ONLY)

A

compression fracture

35
Q

a fracture in which fragments are driven inward (seen frequently in fractures of skull and facial bone)

A

depressed fracture

36
Q

a fracture in which a fragment of bone has been pulled away by a tendon and its attachment

A

avulsion

37
Q

What are risk factors for fractures?

A
  • elderly
  • vitamin deficiency
  • sedentary lifestyle
  • sensory perception problems
  • cancer of the bone
38
Q

What are some clinical manifestations?

A
  • Deformity (Shortening)
  • Pain
  • Loss of function
  • Crepitus
  • Edema and Ecchymosis
39
Q

What should be done for emergency management for a fracture?

A 
• DON’T MOVE
• Stop any bleeding
• Immobilize (Splint) DO NOT
realign the bones !!!
• Apply ice
• Cover for Open Wound
40
Q

What should be done for medical management for a fracture?

A

• Immobilization
– A means of preventing movement to keep bone
alignment
– Internal Fixation vs. External Fixation
• Fracture Reduction
– Restoring the bones to their original positions
– Closed Reduction vs. Open Reduction
• Treatment of Symptoms

41
Q

What should be done first in immobilization?

A

Reduction if needed

42
Q

What are methods of reduction?

A
  • internal fixation

* external fixation

43
Q

includes pins, screws, wires, plates, nails, rods

A

internal fixation

44
Q

includes bandages, splints, casts, traction, external fixators

A

external fixation

45
Q 
–Immobilizes the body part while allowing
for movement of the rest of the body
–Materials:
• Plaster
• Fiberglass
A

External Fixation: CAST

46
Q

Used for temporary immobilization

A

External Fixation: SPLINTS and BRACES

47
Q

Maintains alignment and can reduce muscle spasms

and pain

A

External Fixation: TRACTION

– 2 Types: Skin Traction vs. Skeletal Traction

48
Q

What other concerns do you have with a patient in traction?

A
  • pneumonia
  • incontinence
  • skin breakdown
  • blood clots
49
Q

– Bones are realigned and then mobilized for

healing using an external fixation device

A

closed reduction

50
Q

– Surgical Procedure
– Bones are realigned and held in place using
nails, screws, wires, plates and rods

A

open reduction

51
Q

What are the 5 P’s of the neurovascular assessment?

A 
– Pain
– Pulse
– Pallor
– Paresthesia
– Paralysis
52
Q

What factors affect the healing of fractures?

A 
• Immobilization and reduction
(realignment) of bone and bone fragments
• Blood supply
• Nutrition
• Exercise
• Hormones (Parathyroid, Growth Hormone, Thyroid,
Calcitonin, Steroids)
• Medications
• Diseases
53
Q

What are the EARLY complications of fractures?

A 
Early
• Compartment Syndrome
• Hypovolemic Shock
• Fat Embolism Syndrome*
• Blood Clot (DVT or Emboli)*
54
Q

occurs when excessive pressure builds up inside an enclosed space in the body. This syndrome usually results from bleeding or swelling after an injury. The
dangerously high pressure in compartment
syndrome impedes the flow of blood to and from
the affected tissues. It can be an emergency,
requiring surgery to prevent permanent injury

A

compartment syndrome

55
Q 
occurs during massive blood loss from hemorrhage
Treatment
• Stop the bleeding
• Restore blood volume
• Oxygen therapy
A

hypovolemic shock

56
Q

DEFINITION: Fat emboli become lodged in the
blood vessels causing clinical symptoms similar to
a blood clot (embolus)
• ONSET OF SYMPTOMS: 12 to 72 hours after injury
– may occur up to a week after injury

A

fat embolism syndrome (FES)

57
Q

• CLASSIC TRIAD of SYMPTOMS:
– Hypoxemia (Respiratory Distress)
– Neurological Compromise
– Petechial Rash (later – 48-72 hours)

A

fat embolism syndrome (FES)

58
Q

can become lodged in a

vessel obstructing blood flow

A

blood clot

59
Q

blood clot develops in the lower extremities.

A

Distal Venous Thrombosis (DVT)

60
Q

can become lodged in any part of the body
– Heart Vessels – chest pain, heart attack
– Brain – neurological symptoms, stroke
– Lungs – hypoxia, dyspnea
Coughing up blood

A

emboli

61
Q

How to prevent blot clot (DVT or emboli)

A

Prevention
– Blood Thinners
– Movement

62
Q

How to treat blood clots (DVT or emboli)?

A

Treatment
– Respiratory Support – oxygen including mechanical
ventilation if needed
– Heparin therapy – blood thinners to prevent
further blood clotting
– Fluid Replacement – to prevent dehydration
– Thrombolytic – in some cases to break up the clots
– Surgical Interventions – insertion of a filter in the
vena cava

63
Q

What are the late complications for fractures?

A

Late
• Delayed Union & Non-Union
• AvascularNecrosis
• Infection; Osteomyelitis

64
Q

When bone does not heal at a normal rate
Treatments
• Eventually fracture heals

A

delayed union

65
Q 
Failure of the ends of the bone to unite or to heal in a
misaligned position
Treatments
• Internal Fixation
• Bone grafting
• Electrical stimulation
• Combination of therapies
A

non-union/malunion

66
Q 
Bone loses it blood supply and dies
• Symptoms: pain and limited movement
• Risk Factors: steroid use, excessive alcohol intake,
trauma, medical conditions
• Diagnosis:
– X-Rays
– MRI or CT Scan
– Bone Scans
A

Avascular Necrosis

67
Q 
• DEFINITION: Infection in the Bone
• SYMPTOMS:
– Bone Pain
– Fever
– Edema, Erythema, Warmth and Tenderness at
the site of infection
– Chronic Osteomyelitis – non-healing ulcerated
wound over the site of the infected bone
– Purulent Drainage
A

Osteomyelitis

68
Q

A chronic degeneration of the cartilage of the joints
Also called:
-wear and tear
-degenerative

A

Osteoarthritis

69
Q

What are risk factors for osteoarthritis?

A
  • age
  • gender
  • genetic deformities
  • joint injury or overuse
  • obesity
  • diseases
70
Q

What are some clinical manifestations you would find in your patient?

A
  • pain
  • stiffness
  • functional impairment
  • crepitus(pieces of bone from joint possible fracture)/grating sensation
71
Q

A chronic (long-term) disease. There is no cure, but treatments are available to manage symptoms.

A

Osteoarthritis

72
Q

Long-term management of the disease will include several factors:

A
  • managing symptoms pair, stiffness swelling
  • improving joint mobility and flexibility
  • lifestyle modifications
73
Q

Surgical management for osteoarthritis includes

A
  • osteotomy
  • arthroscopy
  • arthrodesis( joint fusion)
  • arthroplasty (joint replacement)
74
Q 
Begins with the decision to have surgery 
Includes where and how long?
*informed decision making 
*written list of patients needs
*written instructions
*medication review 
*safety issues
A

Preoperative phase

75
Q

What is the floor nurse requirements during the preparation phase?

A
  • pre-op teaching
  • pre-op checklist
  • planning

Exam 4 (7 decks)

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