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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
bisphosphonates
inhib bone breakdown (stop osteoc)
26
serms
mimic estrogen effects *better than direct estrogen (risk MI, stroke, breast ca, dvt) selective estrogen recep modulators
27
low back pain- patho
``` 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 ```
28
LBP- risk
occupations, obesity, age
29
radiculopathy
pain radiating down extremities form area of back affected
30
disc abnormal
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
31
disc abnorm- s/s
radiculopathy, paresthesias (numbness and tingling)
32
LBP- management
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
LBP- prevention
good body mech, proper shoes, good diet
34
LBP- manif
dull pain lower back area | muscl spasms, paid radiating down leg or into butt
35
LBP- immediate care
sudden loss function bowel/bladder loss of feeling saddle area (inner thighs)= spinal infection or cancer traumatic injury
36
OA- patho
*most common degen joint dis | loss of cartilage (collage), causes surface ulcerations and deep fissures in joint
37
OA- management
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
RA- def/
autoimmune, inflamm dis (systemic) affects CT genetic componenet wmn>men
39
RA-patho
wbc release toxins | synovitis of joints (inflamm)
40
RA- s/s
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
RA v OA
RA- systemic, autoimm periods remission and exacerb swan neck defom (hyperextension of joints) bilat joints
42
RA management
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
fx- s/s
localized edema, shortening
44
fx- patho/ epidem
young and eldelry | patho- excess force applied on bones
45
fx- types
avulsion- from overstretching compression- bone collapses on itself obliquie- 45 degree angle
46
fx pattern importance
need make sure pattern matches injury
47
fx-management
``` 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
open v closed fx
open- can incl plates, screws | closed- realign w/o surgery
49
fx- post-op care
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
factors that inhibit healing
bone loss, smoking, fm, RA/OA (d/t immunosupp meds), malalignment fx, inaccurate immob
51
cast considerations
``` 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
stages of healing-1
hematoma formation 1-2 days inflamm, vasodil, hemorrhaging localized necorisi, inc inflamm fibroblasts, lymphocytes, macrophages migrate to site
53
stages of healing-2
fibrocartil callus formation 48h base for bone growth tissue granulation replaces hematoma
54
stages of healing-3
bony callus 3-4wks gradual mineralization of matrix
55
stages of healing- 4
remodeling removal excess callus (replaced by mature bone cells) compact bone replaces spongy can take cast off at beginning of this stage*
56
fx- complications
``` compartment synd neurovasc compromise dvt fat emboli hemorrage avascular necrosis infection ```
57
compartment syndrome def
dec blood flow edema and hemorrh occur fascia envelopes muscle- nerves and blood compressed
58
compartm syndrome- s/s
inc pain and p dec pulses, pallor paresthesia, paralysis (dev later on, can incl permanent damage) cyanotic nails beds, cool skin, rhabdomyolysis (proteinuria)
59
compart synd- trtmnt
fasciotomy, alleviate p, emergent cast removal
60
fat embolism syndrome- def
fatty acids released from fx bone (pelvis and femur) | clog vessels and attract platelets
61
fat embol- greatest risk (time)
from long bone/ multi-trauma | 24/72 h after is peak
62
fat embo- s/s
``` respir distress, irreg pulse fever, thrombocytopenia fatty globules in urine petechiae arms/chest (dysfunction of microcirc) fever, change in cns (drowsy) ```
63
fat embol- trtmnt
supportive only oxygen, hydration (dec platelet aggreg), dvt prophylaxis, gi prophyla, cortiosteroids (dec inflamm), high fowlers position
64
reasons for joint replacement
joint destruction, dysfun and deformity | immobility, pain, inflamm RA/OA
65
care for pt w/ joint replacement
``` prophylactic antib 30 prior to surgery analgesics blood transfusion neurovasc checks (CMS) compression stockings is early ambulation aseptic dressing chnge ```
66
need for blood transfusion
s/s- dec bp, inc hr h/h hemoglobin <7 lethargic, dizzy, syncope, SOB
67
total hip precautions
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
osteomyelitis- patho
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
osteomy- time frame
dev w/in 3 mon of surgery
70
ostemyeli- s/s
edema, inc wbc, fever, abnormal inc pain highest risk pt w/ dm fever, nausea, chills, sepsis
71
osteomy- diagnosis
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
osteomyl- management
``` 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
amputation- need for (elective)
periph vasc dis (assoc w/ dm and atherosclerosis) malignant neoplasm infections
74
amputation- complications
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
prosthetic considerations
training- inc compression gradually caution w/ elevation (inc risk contracture) work distal to proximal ROM

MedSurg 1 (9 decks)

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