MSK Flashcards
osteoblasts
form bone, mature and turn into osteocytes
osteocytes
maintain bone, respond to parathyroid hormone
osteoclasts
break down bone
neurovascular assessment
5 P’s - pain, pulse, pallor, paresthesia, paralysis, poikilothermia
antiarthritic drugs
NSAIDs, glucocorticoids, disease modifying antirheumatic drugs (DMARDs) such as methotrexate
Methotrexate
DMARD, rheumatoid arthritis, slows down destruction of joint by slowing down immune and inflammatory response
Antigout drugs
NSAIDs, glucocorticoids, anti uric acid agents (allopurinol)
allopurinol
antiuricemic acid, reduce gout, prevents uric acid from forming, avoid foods high in purine (beer, wine, cheese, beans), side effects of leukopenia, fever, rash
drugs for bone health
calcium, vitamin D, calcitonin, biphosphonates
calcium and vitamin D help to
increase calcium
calcitonin and biphosphonates help
to
decrease amount of calcium
alendronate
biphosphonate, used for osteoporosis, decreases bone resorption of osteoclasts, remain upright for 30 min after taking and take with full glass of water, side effect of esophagitis
baclofen
muscle relaxer, acts within spinal cord to suppress hyperactive reflexes, monitor for CNS depression, do not discontinue abruptly (can cause seizure), need to taper over 1-2 weeks
dislocation
complete loss of contact between surfaces of two bones
subluxation
partial loss of contact between two bones
sprain
ligament tears
avulsion
complete separation of tendon or ligament from its attachment
types of fractures
open, closed, stress, fatigue, insufficiency, direction (transverse, spiral, green stick, comminuted, oblique)
Traction nursing considerations
temperature of extremity, ropes should be hanging freely, alignment, circulation 5 P’s! , tension (should be none on skin), I&Os, overhead trapeze to assist with ROM, no weights on floor (if they are proper alignment will
not occur as there is no weight on extremity)
Bucks traction
weight used on extremity (femur or pelvis) to align bone
Halo device
used for spinal cord injury to cervical spine, can be mobile while maintaining alignment, pain at pin sites may indicate infection, pin site cleaning done regularly
external fixators
keep together broken bone, pins inserted through skim to connect to bone, pin sites require frequent cleaning to prevent infection
pin site care
hand hygiene and assess appearance of pin site, sterile gauze soaked in NS, remove any drainage or pus that has formed, dry with new sterile gauze, cleanse length of pin moving upwards from the site
osteoporosis
metabolic disease where bones demineralize; loss of calcium and phosphorus lead to fragile bone and increase risk for fractures, may be asymptomatic until bones get to weak or fragile and injury occurs
osteoporosis risk factors
women, early menopause, smoking, family hx, ETOH excessive use, sedentary lifestyle, thin small frame, older age
osteoporosis interventions
assess risk for injury and prevent, gentle movement, assist with ambulating, gentle ROM, exercises to strengthen, high calcium and vitamin D, increase iron and protein, avoid alcohol
rheumatoid arthritis
chronic systemic inflammatory disease, destruction of connective tissue and synovial membrane within joints, weakens joints leading to dislocations and deformity, pannus forms at junction of joint causing necrosis, occurs in flare ups
Rheumatoid arthritis specific S&S
pain early in morning (more than 30 min), spongy soft boggy feeling joints, redness to joints, joint deformities, elevated ESR and positive rheumatoid factor, xray shows deterioration, synovial fluid shows inflammation
rheumatoid arthritis tx
NSAIDs, DMARDs, glucocorticoids, heat or cold as prescribed, consistent exercise, avoid weight bearing on inflamed joints, surgery for when affecting ADLs
osteoarthritis
age related as cartilage in bones decreases and bones become sclerosed leading to bone spurs (osteophytes), most common in hands, knees, hips, spine
OA S&S
outgrowths, morning stiffness (less than 30 min), tenderness (hard bony tender joints), exacerbated by exercise (pain goes away with rest), only in joints (no autoimmune so labs normal, no inflammation)
Herberden’s node
bone spur close to fingernail
Bouchard’s node
bone spur on middle finger joint
OA tx
low impact exercise, encourage weight loss (if needed, less pressure on joints), corticosteroids, analgesics, NSAIDs
Gout
body cannot control uric acid production or exertion, it crystallizes and deposits in connective tissues, causes inflammation and destruction of joints, common location is great toe, can cause gouty arthritis
gout S&S
pain gets worse as day goes on, inflammation, redness, decreased mobility, tophi, high uric acid level
tophi
large clumps of uric acid crystals and that have accumulated over time, white or yellow, can permanently damage joints
gout tx
rest, NSAIDs, corticosteroids, allopurinol, low purine diet
foods high in purine
organ meats, red meats, anchovies, sardines, scallops, alcohol
strain
tendon tears
contractures
permanent muscle shortening caused by muscle spasticity
foot drop
plantar flexi on contractor, prevent with boots and promoting mobility
myopathy
muscle disorder causing weakness and atrophy, deceased muscle strength and tone, caused by drugs, alcohol abuse, or can be idiopathic
rhabdomyolysis
damage to muscle (burn, trauma, compartment syndrome), muscle releases contents into blood (myoglobin, creatinine kinase, lots of potassium and phosphorus), these substance are toxic in circulation, major kidney damage as they have to filter these toxins out
rhabdomyolysis S&S
weak, tired, n/v, bruising, dark cola colored urine
rhabdomyolysis tx
fluids (flush kidneys), diuretics (decrease swelling, increase UOP, flush out toxins), dialysis (if K to high kidneys unable to clear on own), bed rest, monitor electrolytes and CK
compartment syndrome
increased pressure within confined space, compromises circulation, distal tissue becomes ischemic, tissue and nerve damage occur
compartment syndrome assessment
extremely painful, limb feels tight, swelling, numbness, tingling, paralysis, diminished or absent pulses, decreased sensation
compartment syndrome tx
fasciotomy to relieve pressure
avascular necrosis
tissue does not get oxygen and dies, can happen in any bone and joint can collapse, permanent damage
fat embolism and S&S
fat gets released into blood stream and releases into circulation, fatty tissue in bone marrow gets released; hypoxia, dyspnea, tachypnea, confusion, altered LOC, petechial rash (sometimes), associated with long bone and pelvic fractures (symptoms depend on where clot goes)
osteomyelitis
infection of bone, usually staph, spreads through bone shaft or bone marrow, treatment: abx
