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MedSurg 1 > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

hormonal disturbances that alter bone function: calcitonin, estrogen, parathyroid, vitamin D

A

calcitonin- inhib osteoclasts (bone-crushing) (prevent bone breakdown) (inc calcitonin= stronger bones)
estrogen- stim osteoblast (bone building0
parathy- cause bones release Ca (can be weakened if overactive)
vitamin D- enhance Ca absorb

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2
Q

weight-bearing exercises

A

promote bone density (not incl swimming)

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3
Q

adl v iadl

A

adl- grooming, toileting, bathing, dressing and eating

iadl- instumental (phone, meds, shopping, transpor, meal prep and housework)

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4
Q

physical assessment

A 
CMS
posture, gait, joint mobility/abnormal
pulse assessment
sensation
muscle tone/ strength
curvature of spine
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5
Q

cms assessment

A

circulation- pulses, cap refil, temp and color
movement- paralysis?
sensation- inc pain, assess for paresthesia

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6
Q

lab- Ca

A

8.5-10.5 mg/dl
source- bones
indicates bone integrity or density

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7
Q

lab- phosphorus and vitamin d

A

2.5-5 mg/dl
d- 35-40 ng/ml

assess bone health, rely on renal system
kidney failure- dec Ca absorb (kidneys activate vitam D)
sources phos- nuts and meat (anything high in protein)
diary/ leafy greens

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8
Q

lab- estrogen

A

dec estrogen after menop inc risk fx

assessed through urine

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9
Q

xray

A

bone density, degen dis, joint irreg, spurs

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10
Q

CT

A

muscle and bone disorders (tumors and fx)

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11
Q

MRI

A

disk dis
osteomyelitis and ligamentous tears
soft tissue dis (musc, tendon, nerves, fat)

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12
Q

use of contrast dye

A

see vascularity of areas (ex tumor)

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13
Q

DEXA

A 
bone mineral density study
for id of osteopenia/ osteoporosis
monitors trtmnt
T score
> -1 = normal
< -2.5=OA
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14
Q

bone scan

A

find bone damage, dis or infection
radioactive IV
cold spots- cancer
hot- infection

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15
Q

role of aging on bones

A

dec bone mass and mineralization around age 30
dec ca avaliable
joint cartil dec (inc fx)
CT ligaments/tendons lose water content become more rigid

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16
Q

sarcopenia

A

dec muscle mass and strength

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17
Q

factors for fall risk

A

eyesight, dec coord, balance, polypharm, mentation, sensation, home environment

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18
Q

Osteoporosis- def

A

deterioration of bone tissue and density

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19
Q

Osteoporosis- risk factors

A

genetics- female, sm frame, white, asian
age- post meno females, low testosterone
low Ca, vitam D and phosp
low physical, non-weight bearing exercise
caffine, alcoh, smoking (nicotine impairs absorb zca, dec osteob fun and dec blood supply bones)
meds- corticosteroids, anti-seizure, heparin and thyroid
malabsorption (bariatric surgery), renal failure and hyperthyroidism

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20
Q

recommended Ca and vitamin D

A

Ca 1200mg

D- 800-1,000 (sunlight, supplements)

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21
Q

osteopor- patho

A

osteoclastic act> osteoblastic act
calcitonin (protective)dec
estrogen lvls dec (dec bone formation)
inc parathyroid (inc osteoclastic activity)

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22
Q

osteop- clincial manif

A 
silent dis
fx occur in spine (compression)= change height, posture
progressive curvature of spine
kyphosis- rounding in cervial
lordosis- inward curving of lumbar spine
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23
Q

osteopor- prevention

A

prevention
FRAX- fracture risk assessment
labs- serum ca, phos, vit D, tesosterone (men)
if Ca abn then PTH

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24
Q

osteop- management

A

weight b exercise
vit d and ca supplements (post meno higher dose than pre)
meds slow bone absorption (bisphosphonates)
estrogen replacement
serms (selective estrogen receptor modulators)
calcitonin (dec bone resorption, not taken chronically)

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25
Q

bisphosphonates

A

inhib bone breakdown (stop osteoc)

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26
Q

serms

A

mimic estrogen effects
*better than direct estrogen (risk MI, stroke, breast ca, dvt)
selective estrogen recep modulators

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27
Q

low back pain- patho

A 
lumbar region
inc P from poor body mechanics
most flexible portion of spine
l4-5 and l5-s-1 
common w/ age as discs degen
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28
Q

LBP- risk

A

occupations, obesity, age

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29
Q

radiculopathy

A

pain radiating down extremities form area of back affected

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30
Q

disc abnormal

A

degen- genetic, metab change assoc w/ aging, repeated stress or trauma (shrinks in size)
bulge- swelling
herniated- tears or cracks of disc (inc P on nerve root)
thinning- dec h2o and protein w/ aging

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31
Q

disc abnorm- s/s

A

radiculopathy, paresthesias (numbness and tingling)

32
Q

LBP- management

A

35+ age= inc change of spine seen on MRI
(typically try o/ trtmnts before this)
lasts longer 6-12 wks use diagnostic imaging
analgesics and inflamm reduction (nsaids, ice, transcutaneous electrical nerve stim (TENS))
encourage mvmnt- sitting makes worse

33
Q

LBP- prevention

A

good body mech, proper shoes, good diet

34
Q

LBP- manif

A

dull pain lower back area

muscl spasms, paid radiating down leg or into butt

35
Q

LBP- immediate care

A

sudden loss function bowel/bladder
loss of feeling saddle area (inner thighs)= spinal infection or cancer
traumatic injury

36
Q

OA- patho

A

*most common degen joint dis

loss of cartilage (collage), causes surface ulcerations and deep fissures in joint

37
Q

OA- management

A

analgesics- acetamin, cox-2 inhib, topical nsaids, corticosteroid injections
exercise
surgery (last resort)
NSAIDS- contraindicated for active peptic ulcer dis, gi bleed, impaired renal func, or hx hypersen rxn

38
Q

RA- def/

A

autoimmune, inflamm dis (systemic)
affects CT
genetic componenet
wmn>men

39
Q

RA-patho

A

wbc release toxins

synovitis of joints (inflamm)

40
Q

RA- s/s

A

aching, edema, tenderness, bilat joint inflamm (swam neck/nodules), limited ROM
fatigue, weight loss, skeletal muscl atrophy, cardiac inflamm, spenomegaly
can progress from bones to muscl (vasc system lungs)

41
Q

RA v OA

A

RA- systemic, autoimm
periods remission and exacerb
swan neck defom (hyperextension of joints)
bilat joints

42
Q

RA management

A

balance btw exercise and rest
encourage indep adls
suppression inflamm process
nsaids, mild analgesics, corticosteroids, dmards (dis. modifying anti-rheumatic drugs)
surgery- replace joints but moves to diff parts of body

43
Q

fx- s/s

A

localized edema, shortening

44
Q

fx- patho/ epidem

A

young and eldelry

patho- excess force applied on bones

45
Q

fx- types

A

avulsion- from overstretching
compression- bone collapses on itself
obliquie- 45 degree angle

46
Q

fx pattern importance

A

need make sure pattern matches injury

47
Q

fx-management

A 
immob/splint distal and proximal joints
physical assessment
confirmation by imaging
narcotics, anti-inflamm meds
neurovasc assessment b4 and after immobilization (CMS)
tetanus (if open fx)
48
Q

open v closed fx

A

open- can incl plates, screws

closed- realign w/o surgery

49
Q

fx- post-op care

A

assess surgical site for s acute bleeding (daily) and infection
infection happens 5-7 days later
bleeding -1-3 days

amnt, color drainage every shift
pain severity, and if expected
neurovasc assessment (CMS)
analgesia (transition to po asap), acetomin, muscle relaxants
early ambulation
IS
50
Q

factors that inhibit healing

A

bone loss, smoking, fm, RA/OA (d/t immunosupp meds), malalignment fx, inaccurate immob

51
Q

cast considerations

A 
monitor for compartment syndrome
keep limb elevated
apply ice
check pulses, sensation
keep clean and dry
isometric exercises (circulation (improve skin integ) and musc strength)
52
Q

stages of healing-1

A

hematoma formation 1-2 days
inflamm, vasodil, hemorrhaging
localized necorisi, inc inflamm
fibroblasts, lymphocytes, macrophages migrate to site

53
Q

stages of healing-2

A

fibrocartil callus formation 48h
base for bone growth
tissue granulation replaces hematoma

54
Q

stages of healing-3

A

bony callus
3-4wks
gradual mineralization of matrix

55
Q

stages of healing- 4

A

remodeling
removal excess callus (replaced by mature bone cells)
compact bone replaces spongy
can take cast off at beginning of this stage*

56
Q

fx- complications

A 
compartment synd
neurovasc compromise
dvt
fat emboli
hemorrage
avascular necrosis
infection
57
Q

compartment syndrome def

A

dec blood flow
edema and hemorrh occur
fascia envelopes muscle- nerves and blood compressed

58
Q

compartm syndrome- s/s

A

inc pain and p
dec pulses, pallor
paresthesia, paralysis (dev later on, can incl permanent damage)
cyanotic nails beds, cool skin, rhabdomyolysis (proteinuria)

59
Q

compart synd- trtmnt

A

fasciotomy, alleviate p, emergent cast removal

60
Q

fat embolism syndrome- def

A

fatty acids released from fx bone (pelvis and femur)

clog vessels and attract platelets

61
Q

fat embol- greatest risk (time)

A

from long bone/ multi-trauma

24/72 h after is peak

62
Q

fat embo- s/s

A 
respir distress, irreg pulse
fever, thrombocytopenia
fatty globules in urine
petechiae arms/chest (dysfunction of microcirc)
fever, change in cns (drowsy)
63
Q

fat embol- trtmnt

A

supportive only
oxygen, hydration (dec platelet aggreg), dvt prophylaxis, gi prophyla, cortiosteroids (dec inflamm),
high fowlers position

64
Q

reasons for joint replacement

A

joint destruction, dysfun and deformity

immobility, pain, inflamm RA/OA

65
Q

care for pt w/ joint replacement

A 
prophylactic antib 30 prior to surgery
analgesics
blood transfusion
neurovasc checks (CMS)
compression stockings
is
early ambulation
aseptic dressing chnge
66
Q

need for blood transfusion

A

s/s- dec bp, inc hr
h/h hemoglobin <7
lethargic, dizzy, syncope, SOB

67
Q

total hip precautions

A

risk for dislocation
watch for popping, groin pain and shortening of leg
no flexion past 90 degrees
no crossing legs, avoid abduction and adduction

68
Q

osteomyelitis- patho

A

bone inflamm from infection
*complication of joint replacement

inc vasculrity it affected area= edema
thrombus of vessels -ischemia, and necrosis of bone and tissue

69
Q

osteomy- time frame

A

dev w/in 3 mon of surgery

70
Q

ostemyeli- s/s

A

edema, inc wbc, fever, abnormal inc pain
highest risk pt w/ dm
fever, nausea, chills, sepsis

71
Q

osteomy- diagnosis

A

hard bc labs are nonspecific
wbc
crp (c reactive protein, general inflamm)
esr (erthrthrocyte segmentation rate) elevated if infected
blood culture
xray- bone deformities after 14 days
bone biopsy, ct/mri

72
Q

osteomyl- management

A 
infection meds - iv antib 4-6 wks
surgical debridement
pain control
nutrition (vit a,c, zinc and protein)
if trtment fails can result in sepsis and amputation
73
Q

amputation- need for (elective)

A

periph vasc dis (assoc w/ dm and atherosclerosis)
malignant neoplasm
infections

74
Q

amputation- complications

A

hemorrh/bleeding
infection (inc risk w. dm and vasc dis (dec blood supply)
contracture- dont put pillow under leg, stretch regularly, change positions
phantom limb pain- sharp, burning (severed nerves), trt/ w/ lyrica/gabapentin

75
Q

prosthetic considerations

A

training- inc compression gradually
caution w/ elevation (inc risk contracture)
work distal to proximal
ROM

MedSurg 1 (9 decks)

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