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NUR 326 > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

what is a determinate of bone mass later in life

A

peak bone mass

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2
Q

who experiences greater bone loss

A

women, especially during their postmenopausal years

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3
Q

who reaches the fracture threshold first

A

women, the have lower peak density and experience post menopausal decline

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4
Q

what happens to bone around age 30

A

the bone reabsorbed by osteoclasts in greater than the bone formed by osteoblasts

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5
Q

what is a t score? what value is a normal t score

A

a value created that compares current bone to bone at peak levels (around 30 yo)
- -1 or greater is normal

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6
Q

what is osteopenia

A

low bone mass
between -1 and -2.5

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7
Q

what is osteoporosis

A

porous bone
less than or equal to -2.5

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8
Q

what is severe osteoporosis

A

porous bone with a hx of fragility fracture
less than or equal -2.5

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9
Q

what is the definition of osteopenia

A

thinning of trabecular matrix of the bone before osteoporosis

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10
Q

what is osteoporosis measured with

A

DEXA scan which is a type of x ray

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11
Q

what are the characteristics of osteoporosis

A

low bone mass
micro-architectural deterioration
in in bone fragility
susceptibility to fracture

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12
Q

what are the major risk factors for osteoporosis

A

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

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13
Q

what is a FRAX

A

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

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14
Q

what is the patho of osteoporosis

A

either
- failure to make new bone
- inc reabsorption
- both

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15
Q

what are osteoblasts and osteoclasts

A

osteoclasts: production of enzymes that dissolve bone
- bone reabsorption
osteoblasts: build up protein matrix
- bone formation

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16
Q

early clinical manifestation of osteoporosis

A

none

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17
Q

late clinical manifestations of osteoporosis

A

fractures
pain
loss of ht
stooped posture –> kyphosis, compression fractures

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18
Q

what are the three most fractures of osteoporosis

A

hip: upper end of femor
wrist
vertebrae: compression fracture
trabecular bones

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19
Q

what are hip fracture complications

A

death –> dec mobility that leads to things like pneumonia
dec independent living

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20
Q

what are the risk factor for hip fractures

A

over 65
female
medical hx of frequent falls or osteoporosis

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21
Q

what fracture location is the most common

A

femoral neck

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22
Q

what are hip fracture clinical presentations

A

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

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23
Q

what are complication of a hip fracture

A

infection
venous thromboembolism

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24
Q

what is the goal of treatment for osteoporosis

A

reduce fractures

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25
Q

what is the primary prevention of osteoporosis

A

calcium (1200-2000 mg/day)
vitamin D (800-1000 IU/day)
exercise at lest 30 mins 3x/wk

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26
Q

what is the treatment for osteoporosis

A

promote bone formation
dec bone resorption with drugs
- biophosphonates
- selective estrogen receptor modulators
- hormone therapy

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27
Q

what class is alendronate

A

biophosphonates

28
Q

what is the moa of alendronate

A

binds permanently to surface of bones
inhibits osteoclasts
- reduces fractures by ~50% , approved for prevention and treatment

29
Q

what are the adverse effects of alendronate

A

GI: N, discomfort, D
some risk of esophageal ulcerations

30
Q

what are nursing considerations for alendronate

A

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

31
Q

what class is raloxifene

A

selective estrogen receptor modulators

32
Q

what is the moa of raloxifene

A

mimics estrogen
inhibits bone resorption

33
Q

what is the indication of raloxifene

A

prevention and treatment of osteoporosis
- specifically dec spinal fractures by ~ 50%

34
Q

what are the side effects of raloxifene

A

hot flashes
leg cramps

35
Q

what are nursing considerations for raloxifene

A

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

36
Q

what class is calcitonin salmon

A

hormone, bone resorption inhibitor

37
Q

what is the moa of calcitonin salmon

A

inhibits bone removal by osteoclasts

38
Q

what are the side effects of calcitonin salmon

A

can cause nasal irritation
strong safety profile

39
Q

what are nursing considerations for calcitonin salmon

A

treatment only no prevention
reduces spinal fractures by 30%
have to wait 5 years to see benefits

40
Q

what is the definition of a fracture

A

any break in continuity that occurs when more stress is placed on bone than it is able to absorb

41
Q

what are the causes of a fracture

A

traumatic (direct/indirect)
fatigue: when bone subjected to repeated, prolonged stress
pathologic: weakened bone may spontaneously, highest risk population is elderly

42
Q

how do you describe a fracture

A

name of bone
location of bone
orientation of fracture
alignment of fracture
condition of overlying tissue

43
Q

what is an open fracture

A

fractured bone penetrates skin

44
Q

what is a closed fracture

A

fracture that doesnt break the skin

45
Q

what are the various types of fractures

A

transverse
spiral
longitudinal
oblique
comminuted
impacted
greenstick
stress

46
Q

what are the clinical manifestations of a fracture

A

at site of bone disruption
P: pain
E: edema
D: deformity
- loss of function
- abnormal mobility

47
Q

what are complications of fractures

A

delayed healing
bone growth impairments
compartment syndrome
fat embolism syndrome

48
Q

what happens during delayed healing

A

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

49
Q

what is compartment syndrome

A

pressure build up from internal bleeding or swelling within limited anatomical space
- seen w crush injuries, casts, severe burns, animal bites

50
Q

what is the tourniquet effect

A

edema at the fracture site puts intense pressure on soft tissue
can lead to tissue hypoxia of muscles and nerves

51
Q

what are the manifestations of compartment syndrome

A

the 5 p’s
- pain, pulselessness, paraesthesia, pallor, paralysis

52
Q

what is the cycle of compartment syndrome

A

injury –>
tissue swelling–> inc compartment pressure –> dec perfusion pressure –> local hypoxia –> cell membrane damage –> tissue swelling

53
Q

what is fat embolism syndrome

A

fat molecules in the lungs from
- long bone fracture
- major trauma
typically 24-48 hours after injury

54
Q

how do fat embolisms occur

A

from bone marrow or traumatized tissue
released into blood stream –> lungs

55
Q

what are the manifestations of a fat embolism

A

triad
- hypoxia
- altered LOC
- petechiae

56
Q

what is osteomyelitis

A

an acute or chronic pyogenic infection of the bone (marrow cavity)
- pus producing

57
Q

what is the usual cause of osteomyelitis

A

bacteria - staph a

58
Q

what are the risk factors of osteomyelitis

A

recent trauma
diabetes
hemodialysis
IV drug use
splenectomy
peripheral vascular disease

59
Q

what is the route of contamination–> direct

A

direct:
open wound –> open fracture, gunshot, puncture, surgery
insertion of metal plates or screws

60
Q

what is the route of contamination –> hematogenous

A

bloodstream –>most common
- bacteremia
- usual location is in long bone
- highest risk is under 16

61
Q

what is the patho of hematogenous patho

A
  • 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
62
Q

what is the problem of inc pressure

A

causes local arterial collapse bc there is no supply of O2, nutrition, immune cells
- abx can’t penetrate
results in impaired healing

63
Q

what are the clinical manifestations of local osteomyelitis

A

local tenderness, warmth, redness
wound drainage
restricted movement
spontaneous fractures

64
Q

what are the clinical manifestations of systemic osteomyelitis

A

spiking fever
positive blood culture
leukocytes

65
Q

what pharm do we use to treat osteomyelitis

A

obtain culture for specific abx
- use broad treatment until results –> nafcillin, cefazolin, vancomycin

66
Q

what are complications of osteomyelitis

A

chronic osteomyelitis
local spread of infection
reduced limb or joint function

NUR 326 (20 decks)

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