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Adult Health I > Muscleskeletal > Flashcards

Muscleskeletal Flashcards

1
Q

What is Osteoarthritis?

A

Degenerative joint disease

**most common among joint disorders

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2
Q

What are the two different classifications of OA?

A

Primary or Idiopathic - no prior event or disease related to it

Secondary - results from previous injury or inflammatory disease

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3
Q

What are causes of OA?

A
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4
Q

What are S/S of OA?

A

Pain
Stiffness
Functional impairment
Usually worse in AM

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5
Q

What is Rheumatoid Arthritis

A

Autoimmune inflammatory disease

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6
Q

Differences between OA and RA PT history

A

OA:
-C/O palpable bony joint
-morning stiffness
-pain

RA:
-pain duration > 6 weeks
-morning stiffness
-Systemic symptoms (fatigue, anorexia, etc)

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7
Q

Differences between OA and RA: physical exam

A

OA:
-Reduced ROM
-Joint malalignment
-Crepitus

RA:
-Synovitis
-joint involvement, symmetrical
-joint destruction
-extra-articular manifestation

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8
Q

Differences between OA and RA Tests:

A

OA:
-Osteophytes
-joint space narrowing
-lab: clear synovial fluid

RA:
-Erosion on X-ray / MRI
-synovitis noted by ultrasound
-ESR or C-reactive protein
-Anti-CCP
-Reheumatoid factors

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9
Q

Differences between OA and RA Tests:

A
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10
Q

Ways to prevent OA

A

Weight reduction
prevention of injuries
perinatal screening for congenital hip disease

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11
Q

What are some medical managements options for OA

A

-Heat
-Weight reduction
-joint rest
-Orthotic devices
-Pharm
*NSAID
*APAP (Tylenol)
*Cox-2 inhibitors (Celebrex)
*Corticosteroids

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12
Q

What are surgical options for OA

A

-Osteotomy
-Arthroplasty (replacement)

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13
Q

Nursing interventions for OA:

A

-weight loss
-assistive devices
-Exercise
-Analgesic
-Physical therapy

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14
Q

What is lower backpain

A

leading cause of occupational disability in the world!

-most common cause of missing work days

-50-80% cause of ppl who miss work is bc of this

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15
Q

What are some caused of lower back pain

A

80-90% = mechanical
5-15% = neurogenic
1-2% = non-mechanical spinal condition
1-2% referred visceral pain
1-4% = other

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16
Q

What are mechanical causes

A

-unknown
-degenerative disc or joint disease
-vertebral fracture
-Congenital deformity
-Spondylolysis
-Instability

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17
Q

What are neurogenic causes?

A

-Herniated disc
-Spinal Stenosis
-Osteophytic nerve root composition
-Ammular fissure with chemical irritation to nerve root
-Failed back surgery
-Infection (Herpes Zoster)

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18
Q

What are non-mechanical spinal conditions?

A

-Neoplastic (primary or secondary) *cancer / tumor
-infection (osteomyelitis, deicitis, or abscess)
-Inflammatory arthritis
-Paget’s disease (type of cancer)

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19
Q

Red Flag Syndroms

A

These must be ruled out before diagnosis:

-onset at age <20 or >50
-non-mechanical pain (aka unrelated to a specific activity)
-Thoracic pain
-Prev history of carcinoma, steroids or HIV infections
-Fever, night sweats, unexplained weight loss (fear of cancer
-widespread neurological symptoms especially sphincter disturbance (loss of bowel or bladder control)
-Structural spinal deformity

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20
Q

Red Flags for spinal fractures

A

-Very sudden onset of severe central pain in the spine which is releived by lying down

-major trauma

-minor trauma

-structural deformity of spine

-pint tenderness over vertebral body

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21
Q

Red Flag for malignancy or infection

A

-pain that remains when lying down, aching at night, disturbed sleep

-onset age 50+

-history of cancer

-S/S of infection

-Recent bacterial infection

–Immune suppression

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22
Q

What are pharmacological treatment options for back pain

A

-simple analgesia
-NSAID
-Opiates *try not to go here due to dependence
-Steroids
-Muscle relaxant

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23
Q

What are other therapy options for lower back pain?

A

-Physical therapy
-regular activities
-group exercise
-Massage / manipulation
-Acupuncture, electrotherapies & spinal injections
-Epidural Injections
-Radiofrequency Denervation

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24
Q

What are surgery options for lower back pain?

A

-Vertebroplasty and kyphoplasty
-spinal laminectomy / spinal decompression
-discectomy
-foraminotomy
-nucleoplasty, also called plama disk decompression
-spinal fusion
-artificial disc replacement

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25
What is Arthroplasty?
Joint replacement
26
Whi is arthroplasty indicated for?
-irreversibly damaged joints with loss of function and unremitting pain -selected fractures -joint instability -congenital hip disorders
27
What is Osteoporosis?
Weak bone density -new bone does not keep up with removal of old bone -bones become weak and brittle leaving the pt with an increased risk for Fx (fractures)
28
What is Osteopenia?
29
What is Primary osteoperosis?
30
What is secondary osteoporosis?
31
What are T-scores and Z-scores?
T-score = compares your results to healthy YOUNG ADULT 20-35 Z-score = compares your results to a person of same gender and age as self
32
What do Z-scores mean
Z-score between 1 and -2.5 = Osteopenia Z-score < -2.5 = Osteoperosis
33
What are causes of osteoporosis
-Genetics -Age -Nutrition (low calcium intake, low vitamin D, high phosphate intake) -lack of physical activity -lifestyle choices -medications (corticosteroids, anti seizure medications, heparin, thyroid hormone)
34
What are manifestations of Osteoporosis?
-Fractures -Kyphosis -Decreased calcitonin -decreased estrogen -increased parathyroid hormone
35
How can we help prevent Osteoperosis?
-Identifying it early -diet -activities -lifestyles
36
What are medical management options for osteoperosis?
-diet -exercise -fracture management
37
What is pharmacologic therapy for osteoperosis?
Calcium supplements with vitamin D -Bisphosphonates -calcitonin -Selective estrogen receptor modulators (SERMS)
38
What are surgical management options for osteoperosis?
-joint replacement -closed or open reduction with internal fixation -open reduction, internal fixation
39
What are fractures??
complete or incomplete disruption in the continuity of the bone structure -defined according to type and extent
40
What adjacent structures are affected during a fracture?
soft tissue edema hemorrhage joint dislocation ruptured tendons severed nerves damaged blood vessels
41
What is a complete fracture?
break across the entire cross-section of the bone and is frequently displaced
42
What is an incomplete fracture
involved a breakthrough only part of the cross section of the bone
43
what is a comminuted fracture
one that produces several bone fractures
44
what is a closed fracture
one that does not cause a break in skin
45
what is an open fracture
one wehre there is a break in skin
46
what is a pathological fracture
caused by weaking of the bone as a result of a disease
47
What are causes of fractures?
direct blows crushing forces sudden twisting motions extreme muscle contractions
48
What are manifestations of a fracture
-pain -loss of function -displacement -shortening of extremity -crepitus -localized edema and ecchymosis
49
What are complications of fractures
-hypovolemic shock (due to bleeding) -fat embolism syndrome (higher risk with long bone and pelvic fat) -compartment syndrome (usually in extremities)
50
What is compartment syndrome?
All bones are in their own compartments - so everything starts to swell really big and it runs out of room and needs to be cut open to relieve pressure
51
What are medical management options for fractures
-immediate immobilization -splinting -sterile dressing -fracture reduction (closed or open *open is surgical)
52
What needs to be completed during a nursing assessment for fractures
-Neurovascular checks (if no pulse, nurse can make minor adjustments) -open or closed -S/S of infection -S/S of hemorrhage or shock -S/S of compartment syndrome
53
What are the different materials a cast can be made out of?
Nonplaster (fiberglass) plaster of paris
54
What position should a bone be in before casting it?
in its position of function
55
What are the types of splints?
-Stirrup - foot -Volar cock-up splint - wrist -Sugar-tong splint - more complex forearm and wrist fractures (some elbow) -double sugar tone - elbow fractures -Ulnar Gutter splint - 4th & 5th metacarpal fractures (boxers fractures) -Thumb spica - for a thumb break -HARE Traction splint - if we have a displaced fracture of femur -Sager Traction splint - both legs -SAM splint (great for travel bags)
56
What is a cast
Rigid external immobilizing devise molded to contours of body part
57
How do we care for a patient with a brace, splint, or cast
58
What are the 6 Ps for assessing neurovascular changes in a pt with a brace, splint, or cast?
-pain -poikilothermic -paresthesia -paralysis -pulses -pallor
59
What are potential problems from having a cast?
60
What causes pressure ulcers with casts?
Inappropriately applied casts -creating a hotspot or tightness
61
What is disuse syndrome?
muscle atrophy and loss of strength
62
What should a pt report when they have a cast
-persistent pain or swelling -changes in sensation, movement, color, temp -s/s of infection -pressure areas
63
What is a reduction of fractures?
putting fraction back Non-surgical: closed reduction Surgical: ORIF / OREF *uses pins O:Open R:Reduction I:internal / external F:fixation
64
What is traction?
(pulling force to a part of the body) When you have something attached to your body that has weights and pulls limb to give "traction" to bone to get back to normal Skin -buck extension traction *boot with weight -Cervical head halter *create traction -Pelvic traction *pin in through bone, attach weight to Skeletal -pin through bone, and weight pulls on that
65
Why use traction?
-reduce muscle spasm -reduce, align and immobilize fracture -reduce deformity -increase space between opposing forces *short term intervention until other modalities are possible
66
Traction principles
-Must have counterforce -must be continuous -never interrupt skeletal traction -weights are not removed unless intermittent traction has been ordered -weights must hang freely -knots or footplate must not touch the food of bed -skeletal traction - all traction needs to be applied in two directions "vectors of force"
67
What are nursing management for patients in traction
-assessing anxiety -assisting with self-care -monitor and manage complications *pressure ulcer *atelectasis (alveoli collapse) *pneumonia *constipation *anorexia *Urinary stasis *infection *DVT
68
What do pts with a hip replacement need
-preventing dislocation of hip prosthesis -mobility and ambulation -drain use postoperatively -Prevent infection -prevent DVT -Pt education and rehab
69
What do pts with a knee repalcement need?
Postoperatively -compression on knee -assess neurovascular **every 2-4 hours -monitor for complications (infection, bleeding, VTE) Wound suction drain -removed in 24-48 hours -antibiotics prophylactically -autotransfusion of extensive bleeding
70
Needs of pts with knee replacement
-CPM (continuous passive motion) -PT -Acute rehab (1-2 weeks) Total recovery time: 6 weeks
71
Things that need to be assessed during preoperative bone surgery
-routine preop assessment -hydration -medication history -possible infection -knowledge -support and coping
72
Things that need to be assessed during postoperative bone surgery
-pain -VS, breath sounds -LOC -neurovascular tissue -S/S of bleeding -wound drainage -mobility and understanding of mobility restritctions -bowel sounds and elimination -flatulence -urinary output -s/s DVT
73
Potential complications - postoperative
-hypovolemic shock -atelectasis -pneumonia -urinary retention -infection -thromboembolism: DVT or PE -constipation or fecal impaction
74
Nursing interventions post surgery
-Give meds -alternative method of pain relief (reposition, distraction, guided imagery) -pain control -Muscle setting (exercises) -nutrition -skin care measures -follow up PT -set realistic goals
75
What is an amputation
total or partial surgical removal of an extremity or digit
76
What are the types of amputations
BKA - below the knee AKA - above the knee Upper extremity
77
What are reasons for BKA
-peripheral vascular disease -facilitates successful adaptation to prosthesis bc of retained knee function
78
what are reasons for AKA
necessitated by trauma or extensive disease
79
What are reasons for upper extremity amputation
severe trauma malignant tumors congenital malformation
80
What needs to be assessed after amputation
-neurovascular -history of health problems -clients understanding of extent of surgery -coping status -support system
81
What re nursing interventions for amputation?
82
What is Kyphosis
an outward curvature of the spine "hunch back"
83
What is lordosis?
an inward curvature of the spine *lumbar spine
84
What is scoliosis
lateral curvature of spine

Adult Health I (10 decks)

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