Musculoskeletal Flashcards
what is a determinate of bone mass later in life
peak bone mass
who experiences greater bone loss
women, especially during their postmenopausal years
who reaches the fracture threshold first
women, the have lower peak density and experience post menopausal decline
what happens to bone around age 30
the bone reabsorbed by osteoclasts in greater than the bone formed by osteoblasts
what is a t score? what value is a normal t score
a value created that compares current bone to bone at peak levels (around 30 yo)
- -1 or greater is normal
what is osteopenia
low bone mass
between -1 and -2.5
what is osteoporosis
porous bone
less than or equal to -2.5
what is severe osteoporosis
porous bone with a hx of fragility fracture
less than or equal -2.5
what is the definition of osteopenia
thinning of trabecular matrix of the bone before osteoporosis
what is osteoporosis measured with
DEXA scan which is a type of x ray
what are the characteristics of osteoporosis
low bone mass
micro-architectural deterioration
in in bone fragility
susceptibility to fracture
what are the major risk factors for osteoporosis
aging
female
caucasian
hx of fracture as an adult
fam hx
low body wt (below 127), thin and small frame
smoking, alc
corticosteroid therapy and immune suppressive drugs
lack of Ca and vitamin D
eating disorders, gastric bypass
lack of estrogen/testosterone
excess caffeine
what is a FRAX
prediction tool for assessing ind’s risk of fracture
- used to provide treatment guidelines
- calculates a 10 yr risk score to help dictate when to start treatment
- > 3% hip fracture, >20% osteoporotic hip fracture
what is the patho of osteoporosis
either
- failure to make new bone
- inc reabsorption
- both
what are osteoblasts and osteoclasts
osteoclasts: production of enzymes that dissolve bone
- bone reabsorption
osteoblasts: build up protein matrix
- bone formation
early clinical manifestation of osteoporosis
none
late clinical manifestations of osteoporosis
fractures
pain
loss of ht
stooped posture –> kyphosis, compression fractures
what are the three most fractures of osteoporosis
hip: upper end of femor
wrist
vertebrae: compression fracture
trabecular bones
what are hip fracture complications
death –> dec mobility that leads to things like pneumonia
dec independent living
what are the risk factor for hip fractures
over 65
female
medical hx of frequent falls or osteoporosis
what fracture location is the most common
femoral neck
what are hip fracture clinical presentations
sudden onset of hip pain before or after fall
inability to walk
severe groin pain
tenderness
affected leg is externally rotated
affected extremity is shortened
what are complication of a hip fracture
infection
venous thromboembolism
what is the goal of treatment for osteoporosis
reduce fractures
what is the primary prevention of osteoporosis
calcium (1200-2000 mg/day)
vitamin D (800-1000 IU/day)
exercise at lest 30 mins 3x/wk
what is the treatment for osteoporosis
promote bone formation
dec bone resorption with drugs
- biophosphonates
- selective estrogen receptor modulators
- hormone therapy
what class is alendronate
biophosphonates
what is the moa of alendronate
binds permanently to surface of bones
inhibits osteoclasts
- reduces fractures by ~50% , approved for prevention and treatment
what are the adverse effects of alendronate
GI: N, discomfort, D
some risk of esophageal ulcerations
what are nursing considerations for alendronate
take with water –> makes most bioavailable
dont lie down after taking
no food, drink, Ca, vitamins w/in 2 hours
drug holiday ~5 years to dec risk of jaw necrosis and esophageal cancer
admin daily or weekly
what class is raloxifene
selective estrogen receptor modulators
what is the moa of raloxifene
mimics estrogen
inhibits bone resorption
what is the indication of raloxifene
prevention and treatment of osteoporosis
- specifically dec spinal fractures by ~ 50%
what are the side effects of raloxifene
hot flashes
leg cramps
what are nursing considerations for raloxifene
need adequate Ca and vitamin D with it
discontinue use at least 72 hours before immobilization like surgery, drug will inc risk of DVT
no tobacco, alc
black box: stroke in some
what class is calcitonin salmon
hormone, bone resorption inhibitor
what is the moa of calcitonin salmon
inhibits bone removal by osteoclasts
what are the side effects of calcitonin salmon
can cause nasal irritation
strong safety profile
what are nursing considerations for calcitonin salmon
treatment only no prevention
reduces spinal fractures by 30%
have to wait 5 years to see benefits
what is the definition of a fracture
any break in continuity that occurs when more stress is placed on bone than it is able to absorb
what are the causes of a fracture
traumatic (direct/indirect)
fatigue: when bone subjected to repeated, prolonged stress
pathologic: weakened bone may spontaneously, highest risk population is elderly
how do you describe a fracture
name of bone
location of bone
orientation of fracture
alignment of fracture
condition of overlying tissue
what is an open fracture
fractured bone penetrates skin
what is a closed fracture
fracture that doesnt break the skin
what are the various types of fractures
transverse
spiral
longitudinal
oblique
comminuted
impacted
greenstick
stress
what are the clinical manifestations of a fracture
at site of bone disruption
P: pain
E: edema
D: deformity
- loss of function
- abnormal mobility
what are complications of fractures
delayed healing
bone growth impairments
compartment syndrome
fat embolism syndrome
what happens during delayed healing
delayed union: bone pain and tenderness inc, smoking, malnutrition, infection dec circulation
malunion: improper alignment
nonunion: non healing, 4-6 month post fracture caused by poor blood supply, repetitive stress
what is compartment syndrome
pressure build up from internal bleeding or swelling within limited anatomical space
- seen w crush injuries, casts, severe burns, animal bites
what is the tourniquet effect
edema at the fracture site puts intense pressure on soft tissue
can lead to tissue hypoxia of muscles and nerves
what are the manifestations of compartment syndrome
the 5 p’s
- pain, pulselessness, paraesthesia, pallor, paralysis
what is the cycle of compartment syndrome
injury –>
tissue swelling–> inc compartment pressure –> dec perfusion pressure –> local hypoxia –> cell membrane damage –> tissue swelling
what is fat embolism syndrome
fat molecules in the lungs from
- long bone fracture
- major trauma
typically 24-48 hours after injury
how do fat embolisms occur
from bone marrow or traumatized tissue
released into blood stream –> lungs
what are the manifestations of a fat embolism
triad
- hypoxia
- altered LOC
- petechiae
what is osteomyelitis
an acute or chronic pyogenic infection of the bone (marrow cavity)
- pus producing
what is the usual cause of osteomyelitis
bacteria - staph a
what are the risk factors of osteomyelitis
recent trauma
diabetes
hemodialysis
IV drug use
splenectomy
peripheral vascular disease
what is the route of contamination–> direct
direct:
open wound –> open fracture, gunshot, puncture, surgery
insertion of metal plates or screws
what is the route of contamination –> hematogenous
bloodstream –>most common
- bacteremia
- usual location is in long bone
- highest risk is under 16
what is the patho of hematogenous patho
- arterial blood flow brings bacteria into bone
- infection results in inflammation, bone destruction, pus and edema
- pressure inc
- ischemia/necrosis
- osteoblasts lay new bone around old, infected bone
- infection is isolated
what is the problem of inc pressure
causes local arterial collapse bc there is no supply of O2, nutrition, immune cells
- abx can’t penetrate
results in impaired healing
what are the clinical manifestations of local osteomyelitis
local tenderness, warmth, redness
wound drainage
restricted movement
spontaneous fractures
what are the clinical manifestations of systemic osteomyelitis
spiking fever
positive blood culture
leukocytes
what pharm do we use to treat osteomyelitis
obtain culture for specific abx
- use broad treatment until results –> nafcillin, cefazolin, vancomycin
what are complications of osteomyelitis
chronic osteomyelitis
local spread of infection
reduced limb or joint function