MusculoSkeletal Flashcards
1
Q
Long Bones
A
Femur, Arm
2
Q
Short Bones
A
Fingers and Toes
3
Q
Ends of long bones
A
Epiphysis
4
Q
Diaphesis
A
Middle part of the bone made of compact bone
5
Q
Epiphiseal Plate
A
Separates the ends from the shaft
6
Q
Articular Carteladge
A
Covering after a bone grows
7
Q
Irregular Bones
A
Odd shape: jaw and vertebrate
8
Q
Flat bones
A
Protect underlying structures
9
Q
Composition of Bones
A
Cells, protein, and membrane
10
Q
Periostium
A
Fiberous membrane that nourishes the bone itself
11
Q
Endostium
A
Vascular membrane that covers the marrow
12
Q
Red Bone Marrow
A
Sternum, Ilieus, ribs, and vertebrate
13
Q
Bone Marrow
A
Highly vascular, located in the shaft of bones
14
Q
Resorption
A
Removal or destruction of bone influenced by dietary intake, hormones, physical activity, thyroid hormone
15
Q
Important nutrients for bone health
A
Calcium and Vitamin D
16
Q
How much Vit D
A
20-30 minutes of sun exposure 3x a week
Young Adults: 600 units
50+: 800-1000 units
17
Q
PTH
A
Regulates calcium in the blood. Pulls from the bone to the blood when calcium in the blood is low. This promotes demineralization of the bone
18
Q
Calcitonin
A
Stops bone resorption and causes calcium in the bone
19
Q
Calcitriol
A
Increases serum calcium by promoting absorption in the GUT
20
Q
Increased Cortisol
A
Breaks down the bones
21
Q
Increased TH4
A
Too much bone absorption and breakdown
22
Q
Estrogen
A
Stimulates osteoBLASTS and inhibits osteoPLASTS. This is needed to build bone.
23
Q
Testosterone
A
Helps to grow bones. Greater muscle mass=greater weight bearing for the bones=stronger bones
Testosterone converts to estrogen in older males and preserves their bones
24
Q
Articulation
A
The junction of two or more bones
25
Synovial Fluid
Fluid between the joints
26
Flaccid
Without tone
27
Spastic
Greater than normal tone
28
Atonic
Flabby
29
Hypertrophy
Increased size and of muscle fibers generally from working out
30
atrophy
Decrease in the size of the muscle from lack of use
31
Osteoporosis
Excessive bone loss
32
Kyphosis
Forward curvature of the spine
33
Lordosis
Exaggerated curve of lumbar (swayback)
34
Scoliosis
Lateral curvature of the spine
35
Arthography
Identifies cause of pain in a joint
Determines progression of joint disease
Contrast agent into joint cavity
Joint ROM through study
36
Arthroscopy
visualize joint with endoscope
dx of joint disorders
can biopsy
can treat tears, defects, and disease processes
General anesthesia and sterile procedure
Check for s/sx of infection
37
Arthrocentesis
Obtain sample of synovial fluid and see if there is something causing inflammation
Receive pain from effusion
look for hemarthrosis
38
Synovial Fluid Characteristics
Straw colored, clear, pale
39
Nursing Considerations for Tests
Pt. must lie still (sometimes we need to give a sedative)
allergies or contraindications (COPD, Pregnancy)
KIDNEY FUNCTION (contrast agent is excreted by the kidney)
Extend extremity to reduce swellings
40
High Calcium
Could indicate bone destruction
Osteoporosis
Parathyroid disfunction
41
Alkeline Phosphatase (ALP)
Found throughout body
Concentrated in liver, GI, bones, and kidneys
High levels can indicate bone disorders
42
CK and AST
Elevated with muscle damage
43
Urine Calcium
increased with bone destruction
44
Indications for Casting
o Immobilize fracture
o Correct and prevent deformity
o And to support weakened joints
45
Complications of Casting
o Pressure Ulcers
o Compartment Syndrome
46
Nursing Priority for Casting
N/V assessment
47
6 Ps
Pain
Pallor
Paralysis
Paresthesia
Pulses
Temperature
48
Compartment Syndrome
Every muscle compartment has facia. It is intended to keep the muscle in its compartment and does not allow for much expansion. When we have bleeding or trauma, there is bleeding in the compartment, but the facia is not letting things expand so it all stays in the compartment and this constricts the blood vessels. This can lead to limb death because the blood has stopped perfusing
49
Sx of Compartment Syndrome
**Pain disproportionate to injury is a huge indicator that this is occurring
o Numbness
o Nothing helps pain
o Skin will be tight
50
Stryker
Tests for compartment syndrome by sticking a needle into your muscle to determine the pressure
51
Interventions of Compartment Syndrome
Remove the cast so swelling can occur
Removing the facia (Fasciotomy)
52
Faciotomy Care
Negative pressure wound therapy with instillation has been used effectively to assist in granulation in acute wounds
53
External Fixation Indications
Holding a fracture in place until surgery is able to happen
54
External Fixation Process
Inserting pins through skin and bone to hold proper alignment
55
External Fixation Complications
External Fixation
Pin loosening
Osteomyelitis or infection
56
External Fixation Considerations
Clean pins
N/V checks
Cover sharp edges
57
Skeletal Traction Indications
Short term fx management
Decrease muscle spasms
Maintain alignement before surgery
Prevent deformities
58
Skeletal Traction MOA
Uses pt. weight as a counterbalance to create traction which reduces muscle spasms
59
Nursing Considerations Muscle Traction
Check Skin
Check NV
Pain control
Pin Care
ROM + PROM
60
Skeletal traction Complications
Pneumonia
Constipation
Anorexia
Infection
CAUTI
61
Complications of Orthopedic Surgery
Blood loss (1500ml)
Post op bleeding
Post op anemia
infection
62
Arthroplasty
Replacing an old joint with a new one
63
Nursing Considerations for Arthroplasty
Give antibiotic 60 minutes before incision
WATCH FOR COMPLICATIONS OF IMMOBILITY
assess N/V
pain management
Promote ambulation
64
Meds for Lower Back Pain
TCAs (Amitriptyline)
SSRIs (duloxetine)
Atypical Anticonvulsants (Gabapentin)
NSAIDS (Ibuprofen / Motrin / Naproxen / ASA / Aleve)
65
Complications of Lower Back Pain
loss of bowel or bladder
66
Percocet
Acetaminophen + Oxy
67
Vicodin
Hydrocodone + Acetaminophen
68
Foods high in Calcium
Cheese, Dairy products, Broccoli, Canned
Salmon
Dark green leafy veggies
Soy products
Ca fortified cereals & OJ
69
Causes of Osteoporosis
Smaller frame
* Postmenopausal
* Malnutrition
* Bariatric surgery
* GI malabsorption disorders
* Immobilization
* Corticosteroids
* Medications
* Tobacco / Alcohol use
* Sedentary lifestyle
* Reduced Calcitonin
* Reduced Estrogen
* Increased PTh
70
Osteoporosis Presentation
back pain
Shortened frame
Stooped posture
bones fracture easily
71
Pharm for Osteoposis
Biphosphates (Alendronate, risedronate, ibandronate, zolidronic acid)
Estrogens (raloxifene)
Antineoplastics (denosumab)
72
Osteomalacia
Soft and weak skeletal bones
73
Causes for Osteomalacia
Lack of Vitamin D
Renal failure
GI disorders
Hyperparathyroidism
Medications
Malnutrition
74
Osteomalacia presentation
pain and tenderness to bones that is worse when ambulating
bowing of bones
possible pathologic fx
waddling gait
possible Steatorrhea
Pain not relieved by rest
75
Which organs activate vitamin D
Liver then kidneys
76
Osteomyelitis
Infection of the bone
77
Causes of osteomyelitis
bloodstream (like staph)
Complicated DM
nearby tissue infection
open fractures
poor circulation
78
Symptoms of osteomyelitis
fever
tachycardia
swelling over infected joint
fatigue
pain
79
Labs to test for osteomyelitis
CBC/Blood cultures
CT/MRI
ESR
80
Meds for osteomyelitis
Strong oral or IV antibiotics
Longer term: three-six weeks for both
81
Interventions for osteomyelitis
Surgery
ORIF
82
Nursing considerations for Osteomyelitis
quit smoking
monitor worsening infection
prolong elective orthopedic surgery
remove urinary catheters ASAP
Aseptic wound care
Management of soft tissue infections
Inspect feet of DM pts
83
Subluxation
Partial dislocation
84
Complications of joint dislocation
avascular necrosis
85
Fracture s/sx
pain with movement and less when not
muscle spasm
deformity
Ecchymosis and swelling
86
Open Fracture Treatment
cover and prepare for surgery
87
open reduction
Opening the wound and fixing it in on the inside with screws
88
Avascular necrosis
death of a joint
89
Complications from Complicated Fracture
Hemorrhage, Fat embolus, osteomyelitis, avascular necrosis
90
disseminated intravascular coagulation
You bleed so much that you use up all your clotting factors. Happens with hemorrhage. This is treated with heparin
91
Malunion
Not healing exactly like it should
92
Nonunion
does not heal at all
93
Hematoma block
reducing the amount of people getting sedated. Taking lidocaine and putting a needle it right into the fracture and then put the lidocaine in it to numb it so that they can maneuver it all they can
94
#1 priority for pelvic fractures
HEMORRHAGE
get CT and CBC to monitor blood
95
Complications for pelvic fracture
severe back pain because all the blood is going to the back
Hemorrhage
Fat Emboli
Unstable pelvis upon rocking
96
Nursing considerations with pelvic fractures
Monitor with bed rest and assess for complications of immobility
Painful to poop and sit!
early mobilization (weight bearing in 3 months)
97
Paralytic Ileus
you will hear no bowel sounds due to a pelvic fracture where the muscles do not let food pass through resulting in a blocked intestine. Tell doc right away
98
Hip Fracture Manifestations
Affected leg will be shorter
Pain in hip, groin, and knee upon slightest movement
99
Nursing considerations for a hip fracture
Standard post-op care
Complications of immobility
Abductor pillow; less than 90 degrees
Elevated toilet seat
Ambulate first day post-op (in most cases)
100
Femur Fracture Presentation
Edema, deformity, and pain to thigh/knee
101
Femur Fracture Considerations
Immobilize
Assess NV function to extremity
Skeletal Traction
takes longest time to walk after! 6 months
102
Fat Embolism
Fat emboli enter the microcirculation
Induce Systemic Inflammatory Response Syndrome: this is the body’s reaction to a fat emboli
103
Presentations of a Fat Embolism
Confusion
Petechial rash
Tachypnea
Tachycardia
Fever
Respiratory depression (75%) mild to ARDS to mechanical ventilation
104
Treatment of Fat Emboli
Largely supportive. We cannot do anything about this
Fix long bone fractures early=decreased likelihood of developing FES
Corticosteroids? Studies show that these are minimally effective
105
Nursing considerations for Fat Emboli
watch for change in LOC
Watch for Petechial rash
watch for ARDS
106
Causes of Amputations
DM
Osteomyelitis
Injuries
Surgery to remove tumor
107
Levels of Amputation
Try to keep the distal joint because there is better prosthetic
BKA
AKA
108
Complications from Amputations
Hemorrhage
Infections
Joint contractures
Phantom limb pain
109
Rigid Cast dressing
uniform compression to shape the residual limb for a prosthetic
110
Pharm for Amputation
Beta blockers: manage pain
Anticonvulsant: Gaba: used to help nerve pain
TCA: helps with mood and anxiety and depression
111
Position to avoid contractures
prone
112
Rheumatoid Arthritis
Chronic Inflammatory Disorder
Auto immune disorder
Immune system attacks synovial linings of joints
Begins in distal joints (fingers and toes)
Lose movement of the joints
113
RA Presentation
worse when you are NOT MOVING
Tender, warm, swollen and erythemic joints
Fatigue, fever, and loss of appetite.
Also attacks other places besides the hands and feet
114
RA Labs
o Arthrocentesis: removal of fluid to do a test on it
o CT
o CBC, ESR elevation (indicating inflammation), CRP, Rheumatoid Factor positive
115
Pharm for RA
NOT opioids
DMARDS: Disease modifying antirhematic drug
NSAIDS: cannot be on for a while
COX-2: Celecoxib
Corticosteroids: prednisone
116
Nonbiological DMARD
methotrexate (horrible drug and you need blood tests done annually)
117
Biological DMARD
adalimumab (injected, better, but only insurance will pay for it only if you fail non-biologic)
118
RA Complimentary alternative medicine
Fish oils/plant oils
119
RA Complications
Medication toxicity
Damage to skin, eyes, lungs, heart, blood vessels, kidneys, nerve tissue, salivary glands and bone marrow
CV disease
120
Osteoarthritis
Not autoimmune and noninflammatory joint destruction. RA destroys the joint and will LEAD to this, but is not REQUIRED for this
121
Osteoarthritis Presentation
o Pain, stiffness and functional impairment
o Joint pain aggravated by movement and exercise
RELIEVED BY REST
o Morning stiffness
o Decreased ROM in affected joint
o Crepitus (air under the skin) over knee or grating sensation. Can happen anywhere
122
Diagnostic Tests for OA
o X-ray/MRI
o Blood test to rule out RA
123
Meds for OA
o NSAIDS (cannot be on these forever)
o COX-2 celecoxib
o Intra-articular corticosteroids
o Acetaminophen
o Diclofenac
o Glucosamine and Chondroitin
124
Gout
high levels of uric acid in the blood (can also have uric acid stones)
125
Gout Causes
o Alcohol consumption
o Fructose-rich beverages
o Age/BMI
o HTN meds
o Thiazide Diuretics
126
Gout Pathophysiology
o Kidney cannot get rid of uric acid so it makes a bunch of deposits
o Hyperuricemia
o Uric acid loves to go into your joints
o Macrophages in joint space end up becoming crystalized into the joint. Eat the uric acid which turns them into crystals
127
Gout Labs
o Joint fluid analysis (uric acid will show up)
o X-ray (see if there is a deformity in the joint space)
128
Gout Meds
Acute Attacks:
Colchicine
NSAIDS
Corticosteroids
Management:
Xanthine (Allopurinol)
Uricosurics (probenecid)
129
Gout Prevention
Low Urine Diet
Weight loss
Lifestyle changes
130
Fibromyalgia
Pain that we do not know where it is coming from. We rule out EVERYTHING else and then we diagnose this.
131
Fibromyalgia Presentation
widespread pain
Fatigue
Cognitive difficulties
Other conditions usually co-exist
