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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
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
26
what is the treatment for osteoporosis
promote bone formation dec bone resorption with drugs - biophosphonates - selective estrogen receptor modulators - hormone therapy
27
what class is alendronate
biophosphonates
28
what is the moa of alendronate
binds permanently to surface of bones inhibits osteoclasts - reduces fractures by ~50% , approved for prevention and treatment
29
what are the adverse effects of alendronate
GI: N, discomfort, D some risk of esophageal ulcerations
30
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
31
what class is raloxifene
selective estrogen receptor modulators
32
what is the moa of raloxifene
mimics estrogen inhibits bone resorption
33
what is the indication of raloxifene
prevention and treatment of osteoporosis - specifically dec spinal fractures by ~ 50%
34
what are the side effects of raloxifene
hot flashes leg cramps
35
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
36
what class is calcitonin salmon
hormone, bone resorption inhibitor
37
what is the moa of calcitonin salmon
inhibits bone removal by osteoclasts
38
what are the side effects of calcitonin salmon
can cause nasal irritation strong safety profile
39
what are nursing considerations for calcitonin salmon
treatment only no prevention reduces spinal fractures by 30% have to wait 5 years to see benefits
40
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
41
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
42
how do you describe a fracture
name of bone location of bone orientation of fracture alignment of fracture condition of overlying tissue
43
what is an open fracture
fractured bone penetrates skin
44
what is a closed fracture
fracture that doesnt break the skin
45
what are the various types of fractures
transverse spiral longitudinal oblique comminuted impacted greenstick stress
46
what are the clinical manifestations of a fracture
*at site of bone disruption* P: pain E: edema D: deformity - loss of function - abnormal mobility
47
what are complications of fractures
delayed healing bone growth impairments compartment syndrome fat embolism syndrome
48
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
49
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
50
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
51
what are the manifestations of compartment syndrome
the 5 p's - pain, pulselessness, paraesthesia, pallor, paralysis
52
what is the cycle of compartment syndrome
injury --> tissue swelling--> inc compartment pressure --> dec perfusion pressure --> local hypoxia --> cell membrane damage --> tissue swelling
53
what is fat embolism syndrome
fat molecules in the lungs from - long bone fracture - major trauma *typically 24-48 hours after injury*
54
how do fat embolisms occur
from bone marrow or traumatized tissue released into blood stream --> lungs
55
what are the manifestations of a fat embolism
triad - hypoxia - altered LOC - petechiae
56
what is osteomyelitis
an acute or chronic pyogenic infection of the bone (marrow cavity) - pus producing
57
what is the usual cause of osteomyelitis
bacteria - staph a
58
what are the risk factors of osteomyelitis
recent trauma diabetes hemodialysis IV drug use splenectomy peripheral vascular disease
59
what is the route of contamination--> direct
direct: open wound --> open fracture, gunshot, puncture, surgery insertion of metal plates or screws
60
what is the route of contamination --> hematogenous
bloodstream -->most common - bacteremia - usual location is in long bone - highest risk is under 16
61
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
62
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*
63
what are the clinical manifestations of local osteomyelitis
local tenderness, warmth, redness wound drainage restricted movement spontaneous fractures
64
what are the clinical manifestations of systemic osteomyelitis
spiking fever positive blood culture leukocytes
65
what pharm do we use to treat osteomyelitis
obtain culture for specific abx - use broad treatment until results --> nafcillin, cefazolin, vancomycin
66
what are complications of osteomyelitis
chronic osteomyelitis local spread of infection reduced limb or joint function

NUR 326 (20 decks)

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