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Module 4 (MedSurg 2) > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

The musculoskeletal system is composed of what

A

bone
CT
Voluntary muscles

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2
Q

Connective tissue consists of

A

ligaments, tendons, versa, fascia

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3
Q

Ligaments connect

A

bone to bone

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4
Q

Tendons connect

A

bone to muscle

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5
Q

Fascia ________ bone

A

encloses

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6
Q

Bursa is what is compared to bone

A

fluid-filled sack for cushioning

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7
Q

Functions of the Musculoskeletal System

A

protect organs
provide support and stability
store Ca
coordinated mvmt

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8
Q

Osteoblasts

A

bone forming

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9
Q

Osteocytes

A

mature bone cells

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10
Q

Osteoclasts

A

clean up/breakdown bones

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11
Q

BOne remodeling

A

removal of old bone by osteoclasts
deposit new bone by osteoblasts

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12
Q

Risk Factors associated with Musculoskeletal disorders

A

Autoimmune disorders
Calcium deficiency
Falls
Hyperuricemia
Metabolic disorders (diabetes)
Neoplastic disorders (tumor growths)
Obesity
Post-menopausal states (low estrogen)
Trauma and injury

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13
Q

Diagnostic Tests for Musculoskeletal

A

Radiography
MRI
Xrays
Arthrocentesis
Arthroscopy
Bone scan (CT)
Bone or muscle biopsy
Electromyography (least common)

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14
Q

Radiography and MRI
WARNINGS

A

Handle injured areas carefully
Stabilize/support above and below injured joint
Pain meds
Remove any radiopaque and metallic objects (jewelry)
Ask the client if pregnant** - may be contraindicated
Shield testes, ovaries, and pregnant abdomen
Notify patient they must lie still during the scan
HCP must wear a lead apron if in the room

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15
Q

Arthrocentesis

A

needle aspiration
diagnose joint inflammation or infection
aspirate fluid, blood, or pus
inject corticosteroid to lower inflamed

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16
Q

Arthrocentesis Interventions

A

informed consent
pain meds
Rest 8-24 hrs post-op
notify if fever/swelling occurs

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17
Q

Arthroscopy

A

**diagnose and treat acute and chronic disorders of joint w/ scope
endoscopic exam
- assess or trim cartilage abnormal, loose body removal
biopsy performed
ACL tear

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18
Q

Arthroscopy Interventions

A

NPO 8-12 hours prior
consent
pain meds
Neurovascular assessments per policy
Elastic compression 2-4 days post-op
Elevate and ice PRN 12-24 hours post-op-Help with swelling
Weight-bearing activity but should be limited to 1-4 days (per provider orders)
Notify physician of fever, swelling or increased pain >3 days post-op (infection)

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19
Q

Subjective Data

A

Past health hx = if something is new
Meds = long term corticosteroids lead to osteoporosis or arthritis, taking Ca
Surgery =
Perception = what do they consider healthy, exercise after?
Nutrition = diabetes
Exercise = willing to work on activity
Sleep-rest = healing
coping-stress tolerance

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20
Q

What is needed when a patient had a hip surgery?

A

abduction pillows
- hips don’t cross

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21
Q

Objective Data

A

General overview with focused exam
Physical examination
Inspection - spine
Palpation
Motion
Measurement
Other
Use of assistive devices
Posture and gait
Straight-leg-raising

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22
Q

Kyphosis

A

hunchback

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23
Q

Lordosis

A

swayback

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24
Q

Scoliosis

A

side to side (C or S)

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25
Q

Gerontologic considerations for muscles and skeletal

A

Decreased bone density
Decreased muscle mass and strength (less than 30%)
Decreased flexibility
Functional problems
-ADL is main goal

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26
Q

Soft Tissue Injuries

A

-from trauma mostly (sports)
sprains
strains
subluxation
dislocation

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27
Q

Sprain is

A

an injury to ligaments around a joint
wrenching or twist

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28
Q

Sprain Grades 1 through 3

A

Grade I: few fiber tears; mild tenderness and swelling - functional
Grade II: partial disruption of tissue - little more swelling and pain, tenderness
-depends on the function
Grade III: complete tear with moderate to severe swelling and pain (result in loss of function) - can not walk

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29
Q

Do what type of ROM 1st?

A

active
then if they can not do it themselves passive

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30
Q

Strain Grades 1-3

A

Grade 1: mild or slightly pulled
Grade II: moderately torn muscle
Grade III: severely torn or ruptured muscle

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31
Q

Strain is

A

excessive stretching of muscle and fascia; may involve tendon

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32
Q

Sprains and Strains S/S

A

Pain
Edema
Decreased function
Bruising

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33
Q

Dx Sprains and Strains

A

hx and physical (mechanism of injury makes a difference)
X-ray
MRI
CT

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34
Q

Avulsion fx

A

breaks away a piece of bone
- necrosis could occur due to a lack of blood supply
- hips and 5th metatarsal

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35
Q

Subluxation

A

partial dislocation

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36
Q

Dislocation

A

complete displacement or separation of the joints

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37
Q

Hemarthrosis

A

articular bleeding in joint area

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38
Q

What are the 6 Ps for Peripheral Neurovascular Exams

A

Pallor
Pulse
Poikilothermia
Pain
Paralysis
Paresthesia

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39
Q

Health Prevention of Sprains and Strains

A

Warm-up exercises and stretching
strength, balance, and endurance exercises
start gradually

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40
Q

What stretching should be done before static?

A

functional
(sit up pt to move before walking)

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41
Q

RICE and self-limiting

A

Rest: Stop activity and limit movement
Ice: 24 to 48 hours; 20 to 30 minutes at a time (barrier)
Compression: elastic bandage; apply distal to proximal- have the swelling move the blood flow back to the heart
Elevate: above the heart
Analgesia

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42
Q

Compression elastic should be put in what way

A

distal to proximal
- swelling moves blood back to the heart

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43
Q

How long do you keep ice on an injury
DAYS?
AT A TIME?

A

24-48 hours
30-30 mins

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44
Q

S/S of dislocation and subluxation

A

deformity
pain
tenderness
loss of function
swelling

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45
Q

Complications of dislocation and subluxation

A

intraarticular fx and avascular necrosis

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46
Q

Fractures

A

disruption or break in the bone continuity
- from traumatic injuries
-secondary to the disease process (pathologic)
= cancer osteoporosis

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47
Q

Case Study
L.G., a 23-year-old man, is brought to ED following an injury to his right arm during a rugby game. A bone in his forearm is protruding through his skin. EMS immobilized the arm at the scene. L.G. rates his pain as a 9 on a scale of 0 to 10.
-How would you classify this fracture? Explain
- Other s/s associated w/ fx in L.G.?

A

Open fx = protruding through the skin
- worry about infection (antibiotics), bleeding, 6Ps
- pain, emotional state, clots functionality

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48
Q

Open fx

A

skin broken; bone exposed

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49
Q

Closed Fx

A

skin intact

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50
Q

Linear fx

A

break along the bone’s long axis

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51
Q

Longitudinal fx

A

irregular in shape and chip long

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52
Q

Displaced

A

two ends separated from one another
Often comminuted or oblique

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53
Q

Nondisplaced

A

the periosteum is intact, and the bone is aligned.
Usually transverse, spiral, or greenstick

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54
Q

Transverse

A

straight acoss

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55
Q

Spiral

A

twisted across

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56
Q

Greenstick

A

chip not attached but rest of bone is

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57
Q

Comminuted

A

shattered into little pieces

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58
Q

Oblique

A

in the middle and not straight

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59
Q

Pathologic

A

due to disease

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60
Q

A broken bone that causes damage to

A

surrounding
periosteum
blood vessels in cortex/marrow

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61
Q

s/s of broken bone

A

Edema/swelling
Pain and tenderness
Muscle spasm (may need muscle relaxer)
Deformity
Contusion
Loss of function
Crepitation (grating sound or feeling)
Guarding

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62
Q

Possible Objective Data of Broken Bone

A

Apprehension
Guarding
Skin lacerations (infection), color changes
Hematoma, edema
↓ or absent pulse, ↓ skin temperature
Delayed capillary refill
Paresthesia
Absent, ↓ or ↑ sensation
Restricted or lost function
Deformities; abnormal angulation
Shortening, rotation, or crepitation
Muscle weakness
Imaging findings

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63
Q

6 STages of Bone Healing

A

1.Bleeding at fractured ends of the bone - hematoma formation.
2.Hematoma organized into fibrous network - hematoma converts to granulation tissue
3.Callus formation: new bone is built up as osteoclasts destroy dead bone
4.Ossification of the callus occurs (3 weeks to 6 months)
5. Consolidation: callus continues to develop, closing the distance between bone fragments **(up to 1 year after injury) **
6.Remodeling is accomplished as excess callus is resorbed and trabecular bone is laid down

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64
Q

Normal Bone Remodeling

A

osteoblasts form new
osteoclasts clean up old

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65
Q

Traction Purpose

A

Prevent or decrease pain and muscle spasm
Immobilize joint or part of body
Reduce fracture or dislocation
Treat a pathologic joint condition – tumors or
*counter traction (relieve pressure) pulls in opposite direction

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66
Q

Buck’s Traction

A

used for the patient with a hip, knee, or femur fracture
- 24-48 hours to relieve painful muscle spasms
w/ weights

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67
Q

Skeletal Traction

A

Long-term pull to maintain alignment
Pin or wire inserted into bone
Weights 5 to 45 pounds
Risk for infection
Complications of *immobility
Elevate end of bed
Maintain continuous countertraction
Keep weights off the floor** DO NOT TOUCH WEIGHTS!!!!!

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68
Q

With traction, weights should never be placed where

A

on the floor

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69
Q

Casts

A

Temporary
Allows patient to perform many normal activities of daily living
Typically incorporates joints above and below the fracture

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70
Q

Lower extremity Immobilization

A

Elevate extremity above heart (24-48 hours)
Do not place in a dependent position
Observe for signs of compartment syndrome and increased pressure
Prevent getting wet

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71
Q

External Fixation

A

Metal pins and rods - possible loosening (clean and teaching)
Applies traction
Compresses fx fragments
Immobilizes and holds fracture fragments in place
Mostly used for long-bones

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72
Q

Internal Fixation

A
  • surgically inserted to realign and position bony fragments
    -biology and bone healing by xrays
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73
Q

Nutritional Therapy

A

Essential in optimal soft tissue and bone healing
Promotes muscle strength and tone
Builds endurance
Provides energy

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74
Q

Diets with fx

A

Protein 1g/kg
Vitamins B,C, and D
Ca
Mg - relax muscles
Fluid intake 2-3L/day
HIgh fiber as constipation precaution

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75
Q

Peripheral Neurological

A

sensation
motor function
pain

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76
Q

Health Promotions for fx

A

safety
advocate for decreased injuries
moderate exercise
safe environment
Ca and Vit D

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77
Q

Pre-Op Management

A

immobilization
assistive devices
expected activity limits
needs met
pain is subjective and trust pt on schedule
start discharge planning now

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78
Q

Post-op Management

A

V/S
frequent neurovascular assessments
minimize pain and discomfort
monitor for bleeding or drainage
-asepsis
-blood salvage and reinfusion

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79
Q

How to prevent immobility complications?

A

constipation
kidney stones
cardiopulmonary deconditioning (pneumonia)
- TCDB and ICS
DVT/pulmonary emboli
- SCD, TED Hose, Anticoagulants

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80
Q

Non-weight bearing

A

NOT allowed to put any weight through the operated or injured limb to allow it to heal

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81
Q

TDTT weight bearing

A

touch down = entire foot touches the floor but not all the weight
toe touch = toes touch the floor and rest of weight on an assistive device

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82
Q

Partial weight bearing

A

a small amount on the affected extremity

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83
Q

Weight-bearing as tolerated

A

all weight they can

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84
Q

Full weight-bearing ambulation

A

normal

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85
Q

Cast CARE Dos

A

frequent neurovascular assessments
Apply ice for 1st 24 hours
elevate above the heart for 1st 48 hours
exercise above and below
Hair dryer on cool for itching thoroughly
report pain, swelling with movement
Report burning or tingling under a cast or foul odors

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86
Q

Cast CARE Don’ts

A

Do not get plaster cast wet
Discourage pulling out cast padding
Do not place foreign objects inside cast
Do not bear weight on the new cast for 48hrs
Do not cover the cast with plastic for prolonged periods of time

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87
Q

Psychosocial Problems with Home Care

A

Dependence* in performing ADLs
Family separation
Finances
Inability to work
Potential disability

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88
Q

Walker
Dos
Don ‘ts
Measure
Sitting and Stairs

A

15-30 degree elbow flex
Push off armrests of the chair and stand before grabbing walker
-stand up straight don’t hunch
- only one step ahead of you
-affected leg should go 1st**
-put the walker together and next to you when going upstairs

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89
Q

Cane
Dos
Don ‘ts
Measure
Sitting and Stairs

A
  • Cane on Strong SIDE - NOT WEAK SIDE
  • 15-30 DEGREES flex of elbow
    like a hand in pocket
  • 8-12 inches ahead to walk
  • Good does to heaven, bad go to hell Good side going upstairs 1st - bad side going downstairs 1st
  • different types of bottoms
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90
Q

Crutches
Dos
Don ‘ts
Measure
Sitting and Stairs

A

-good going upstairs, bad going downstairs
-2 to 3 fingers width below armpits (cut off blood flow and damage nerve)
-8 to 12 inches out to walk
-15 to 30-degree elbow flex
the bar at wrist height
don’t rush

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91
Q

Slings
Dos
Don ‘ts
Measure

A

the arm needs to be 90 degrees
dress with affected arm 1st
the hand should be supported on both sides possibly stress ball
Measure from elbow to pinkie
- don’t let your arms dangle or pressure
6 Ps

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92
Q

Gait Belt
Dos
Don’ts
Measure
Walking

A

Hand under the belt when walking
mid sternum with tag inside
square base in front to stand them with counting
Ambulation
skin breakdown and protect yourself
don’t use if chemo or radiation

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93
Q

Hip fx are _________ in hospital settings

A

prevalent

94
Q

Hip Fx is a fx in what part of the bone?

A

any in the upper 1/3 part of the femur

95
Q

Hip fx S/S

A

external rotation (turns out an up
muscle spasms (contractions - Buck’s traction)
shortening of affected
severe pain and tenderness

96
Q

Hip fractures use what type of traction

A

Buck’s (skin) traction
- muscle spasms

97
Q

Hip Fractures Tx Options

A
  • immediate surgery
  • Buck’s traction immobilization if delay
  • Pre Post-Op Care
  • Ambulatory and Home Care
98
Q

In hip fractures, when should you have surgery after it happens?

A

immediately
- longer the wait less likely of recovery

99
Q

Preoperative Care

A

Discharge Planning
- chronic health problems
- analgesics or muscle relaxants
- comfortable positioning
- traction

100
Q

Postoperative Care

A

Abductor pillow and no crossing of legs
V/S BP (anestesia)
I&Os (kidney function for nephrotoxic drugs)
Respirations (pneumonia)
-TCDB and IS (pneumonia)
Pain management (regimen)
6Ps
Observe dressing and bleeding
-Dr 1st dressing unless with an order

101
Q

Post Hip Replacement
-For ADLs

A

elevated toilet seat
shower chair (remain seated while washing)
Pillow btw legs for 1st 6wks when supine
neutral straight

102
Q

After a hip replacement, when should you notify the doctor?

A

severe pain
deformity
loss of function
bc infection

103
Q

What should someone with a hip replacement get from their doctor when going in for dental work?

A

prophylactic antibiotics in advance

104
Q

What are some major NEVER DO for Post Hip Replacements?

A

Flex hip greater than 90
adduct (only abduct)
internally rotate hip
cross legs or ankles
sit on chairs w/o arms

105
Q

What should you use to put shoes and socks on after surgery?

A

adaptive device for 4-6 weeks

106
Q

Average hospitalization for hip replacement
and schedule after

A

3-4 days post-op
then attend a subacute rehab or skilled nursing home health
-follow up appointments

107
Q

What are some possible complications for post-op hip replacement?

A

DVT
Compartment syndrome
Pneumonia
INFECTION
pain mgmt (intervals and before PT)
bleeding risk due to anticoagulant and other sites except for an incision
fall risk - pick up trash/clutter
Brittle bones need supplements

108
Q

S/S of DVT

A

swollen
local red
local warmth

109
Q

The easiest way to educate patients on dressing changes to prevent infection

A

wash hands
wear gloves

110
Q

You should always assess peripheral neurovascularly

A

bilaterally

111
Q

What percentage of muscle mass is lost every day the pt is in bed?

A

1-5%

112
Q

What are some diseases that can cause an amputation?

A

DM
peripheral vascular disease
osteomyelitis

113
Q

Amputation

A

removal of a body extremity by trauma, disease, or surgery
-physically and mentally complicated

114
Q

What word should be associated with amputation?

A

GRIEF - emotion drainage

115
Q

Amputation Assessment

A

the appearance of soft tissue (before and after
no necrosis
preexisting illness
skin temperature
sensory function
quality of the peripheral pulse

116
Q

Amputation dx studies

A

underlying reason
H&P
WBC (infection or gangrene)
Vascular tests
- arteriography, doppler, venography

117
Q

Closed amputation

A

performed to create a weight-bearing residual limb or stump
-prostetics
ensure proper healing, and closure w/o infection
Emotional support

118
Q

Post-op mgmt
Phantom limb sensation

A

brain representation does not know it does not have a limb
-causes a feeling of their limb to still be there
-ambulation for a prosthetic and home care
-teachings for pt and caregiver

119
Q

Phantom-limb sensation tx

A

Mirror therapy

120
Q

Direct Complication of Fractures

A

infection
incorrect union
necrosis

121
Q

Indirect Complication of Fractures

A

compartment syndrome
venous thromboembolism (VTE)
fat embolism
rhabdomyolysis
hypovolemic shock

122
Q

Infection

A

wound closed or open
risk increase with dirty environment
-soft tissue injuries

123
Q

Open fractures should be treated with

A

prophylactic antibiotics

124
Q

Surgical I&D

A

Wound cleaned with saline lavage in the operating room
Contaminants are irrigated and mechanically removed
LEAVE ANTIBIOTIC BEADS
Muscle, sub Q fat, skin, and bone fragments are surgically excised if contaminated
–Under anesthesia–

125
Q

Infection Tx

A

skin grafting (good if the same color as skin with blood supply attached)
antibiotics = irrigation, beads, and IV

126
Q

Compartment Syndrome

A

too much swelling (increases contents)
nowhere for it to go (lowers compartment size)

127
Q

Compartment syndrome affects what blood supply

A

Arterial flow becomes compromised
ischemia
cell death
loss of function

128
Q

How many total compartments does the human body have?

A

38

129
Q

6 Ps of Compartment Syndrome

A

#1 Pain unrelieved by meds or elevation (out of proportion)
pressure
paresthesia
pallor
paralysis
pulselessness

130
Q

Should the patient be told they can take off their own casts?

A

no, need to see a doctor to remove them

131
Q

What is the best time to catch compartment syndrome?
Also, what needs to be assessed for kidney function?

A

early recognition via regular neurovascular assessment
- notify HCP unrelieved by meds or elevation
Urine output for kidney function

132
Q

Should the compartment be elevated above the heart?

A

NEVER

133
Q

Should you put ice on a patient with compartment syndrome? Why?

A

no, need vasodilation and blood supply

134
Q

What should be done 1st for a patient with compartment syndrome?

A

Loosen bandage and splint
reduce traction wt
fasciotomy to relieve pressure

135
Q

Venous Thromboembolism

A

High susceptibility aggravated by muscle inactivity
Prophylactic anticoagulant drugs – always
Unless low platelet count
Antiembolism stockings
SCD
ROM exercises – encourage regularly

136
Q

Anticoagulant Therapy

A

monitor for bleeding anywhere
reinforce with pressure and dressing if bleeding
safe self-injection
keep lab appointments (low platelet count don’t give)

137
Q

Fat embolism originated in the

A

bone marrow
- fat globule released into bloodstream

138
Q

Fat embolism occurs after

A

fracture

139
Q

What fx causes fat embolism?

A

crushing injury to a long bone or pelvis

140
Q

S/S of fat embolism

A

restlessness
Hypoxemia and peticual rash on chest - O2 sat
mental status change - confused
dyspnea/tachypnea
tachycardia
hypotension

141
Q

T/F: Raloxifene is contraindicated in pts with hx of venous thrombotic events.

A

True

142
Q

Osteoarthritis PATHO

A

gradual loss of joint cartilage
osteophytes form at joints
not normal
Destruction of cartilage
not reversible

143
Q

Osteoarthritis turns cartilage into

A

dull, yellow, and granular
soft and less elastic
not able to resist wear and tear
-cracks and osteophytes form

144
Q

Inflammation (local) and thickening odf capsules cause

A

earrly stage pain and stiffness

145
Q

Central cartilage is thinner; edges become thicker, and osteophytes are formed resulting in

A

uneven weight distribution

146
Q

W/ uneven weight distribution of the bones in osteoarthritis, bones tend to do what leads to increasing pain in later stages

A

bones rub together

147
Q

Osteoarthritis Risk Factors

A

over 65
females
- menopause (decrease estrogen)
obesity (more weight)
ACL injury
frequent kneeling (occupation)
smoking (vasoconstriction)
genetic? maybe

148
Q

Osteoarthritis aka

A

Degenerative Joint Disease

149
Q

Osteoarthritis is

A

progressive noninflammatory disorder of the synovial joints

150
Q

What is the basic progression of osteoarthritis?

A

initial injury
attempts cartilage repair
stimulates cartilage degradation - osteophytes
outgrowth and hyperplasia

151
Q

S/S Osteoarthritis

A

joint pain
morning stiffness
crepitation
deformity
tenderness
limited mvmt
Bilaterally compared

152
Q

A nurse is assessing an Osteoarthritis pt, what would be normal findings?

A

joint pain and stiffness
impact on ADLs
pain mgmt
compare bilateral joints
-swelling
-limitation of mvmt
-crepitation (grating sound)

153
Q

Osteoarthritis Tests

A

Bone scan, CT scan, MRI
X-rays
No specific lab tests or biomarkers
Synovial fluid analysis
arthroscopy - trim cartilage
NO specific markers

154
Q

Is there a cure for osteoarthritis?

A

no
-manage pain
prevent disability
maintain functioning

155
Q

What are the type of tx starting from least to most invasive for osteoarthritis?

A

rest and joint protection (balance, avoid prolonged, use assistive devices)
heat in the morning and cold with activity
nutrition and exercise
Drug Therapy - Tylenol, topical, OTC creams
Surgical (arthroscopic, replacement, PT assist, anticoag, edema, pain mgmt

156
Q

When should you use ice or heat with osteoarthritis?

A

heat in the morning and cold with activity and acute inflammation

157
Q

What exercise is good for OA pts?

A

aerobic
ROM
muscle strength

158
Q

For Moderate to severe joint pain use what drug therapies for OA?

A

Nonsteroidal antiinflammatory drug (NSAID); start low dose, increase if needed
Ibuprofen 200 mg up to four times per day
Misoprostol to decrease GI side effects
Arthrotec (combination of misoprostol and NSAID diclofenac)
Diclofenac gel
Avoid both oral and topical NSAIDs together
Celebrex

159
Q

Intraarticular **corticosteroid injections

A

4 or more injections without relief suggest need for additional intervention
Corticosteroids should not be given systemically
Only given 3-4 times a year

160
Q

Why is Hyaluronic acid injection—knee OA not used for OA anymore?

A

allergic reaction stiffness

161
Q

Arthroscopic surgery OA

A

For patients with loss of function, unmanaged pain, and decreased independence
Common for patients with knee OA
May provide no additional benefit over PT and medical treatment

162
Q

Overall goals of OA

A

maintain or improve function - with braces
joint protection
independence in self-care
satisfactory pain mgmt

163
Q

Health promotion of OA

A

LOSE wt
reduce hazards
athletic instruction of warming up
and physical fitness programs to increase activity
tx traumatic joint injuries

164
Q

Physical therapy for exercise program such as ______ to warm up to prevent injury

A

Tai-Chi

165
Q

Ambulatory Care for

A

adjusting home management goals
- no scatter rugs, railing, night light, fitting shoes, assistive devices
sex counseling
w/ pt, caregiver, family members, significant others

166
Q

If they have OA, should they be exercising?

A

yes, but not insane marathons

167
Q

CPM machine is used to

A

keep joints moving after a total knee arthroscopy not hip

168
Q

Osteomyelitis is the

A

severe infection of bone, bone marrow, and surrounding soft tissue

169
Q

Most common organism to cause osteomyelitis

A

staphylococcus aureus

170
Q

Risk factors for Osteomyelitis

A

open wound
young boys
blunt trauma, vascular insufficiency, infections, foreign body presence

171
Q

S/S of osteomyelitis

A

fever high
Pain unrelieved by rest and worsens with activity-restricted
night sweats
chills
restlessness
nausea
malaise
drainage(late)
increase WBC, ESR, and positive cultures
spontaneous fx

172
Q

What differentiates the same symptoms but different diseases?

A

hx and physical

173
Q

Acute osteomyelitis is an infection that occurs with

A

one month

174
Q

Dx for osteomyelitis

A

bone and sift tissue biopsy
cultures
WBC count
ESR (erythrocyte sedimentation rate)
x-ray
bone scan
MRI/CT scan

175
Q

Nursing Interventions for Osteomyelitis

A

Cultures before giving aggressive, prolonged, IV antibiotics
Irrigation and debridement
surgery - amputation
control infection in the body
pain control
wound/dressing care

176
Q

What drugs are used to tx osteomyelitis?

A

Cephalosporins
Vancomycin

177
Q

When on antibiotics for so long, what could possibly happen as a result?

A

C diff

178
Q

If you suspect an infection, what should you give after cultures?

A

aggressive antibiotics

179
Q

Pt Teaching for osteomyelitis

A

prevent infections (UTI, resp, deep pressure wounds)
**encourage IS, TCDB, and up in a chair
activity = circulation
limit stress to affected
support
lead to amputation

180
Q

What type of precaution is on an osteomyelitis pt?

A

fracture precaution

181
Q

Osteoporosis is a

A

chronic, progressive metabolic bone disease
-porous, brittle, prone to fx

182
Q

Osteoporosis is terms of cells

A

increase of osteoclasts (reabsorption)
decrease osteoblasts (deposition)

183
Q

Osteomyelitis results in

A

low bone mass
deterioration of bone
high fragility

184
Q

Most common bone to have osteoporosis

A

hips, pelvis, wrists, vertebrae

185
Q

How do you prevent osteoporosis

A

reg exercise
fluride
Calcium
vItamin D

186
Q

Osteoporosis Risk Factors

A

> 65
long term corticosteroids
Females - menopause decreases estrogen
hyperthyroidism
Chronic alcoholism - more than 2 drinks a day
cirrhosis
intestinal malabsorption
low activity (sedentary)
low calcium and vit D
low body weight
white or Asian
family hx
smoking

187
Q

What drug puts you at risk of osteoporosis?

A

long term corticosteroids
-decrease Ca absorption

188
Q

S/S of Osteoporosis

A

back pain
spontaneous fx
gradual loss of ht
kyphosis

189
Q

Peak bone mass is at what age

A

20

190
Q

Bone loss happens at what age

A

35-40

191
Q

Bone loss is rapid in females after

A

menopause

192
Q

Dx of osteoporosis

A

H-P
bone mineral density
initial - women over 65, earlier if high risk
ultrasound
DXA
not xray or labs for dx

193
Q

Nursing Interventions of Osteoporosis

A

nutrition
ca supplementation
exercise
prevent fx
brace if needed (Turtle shells= TLSO)
Anitresporative (estrogen, raloxifene, bisphosphonates, calcitonin, densumabs)

194
Q

How much exercise should be done in a week for osteoporosis pts

A

3 times for 30 mins doing weight-bearing activity

195
Q

Should a patient with osteoporosis increase alcohol use?

A

no, decrease

196
Q

Adequate Ca intake a day
Premenopause
Postmenopause

A

Pre-1000 mg
Post- 1500
-supplemental with food in divided doses

197
Q

Calcium Foods

A

Milk
Yogurt
Turnip greens
Cottage cheese
Ice cream
Sardines
Spinach

198
Q

Weight-bearing exercise includes

A

Walking, hiking, weight training, stair climbing, tennis, dancing
- Build up and maintain bone mass
Increase strength, coordination, balance

199
Q

Drugs Tx of Osteoporosis - goal

A
  • decrease bone reabsorption
  • promote bone formation
200
Q

What drugs treat osteoporosis?

A

Antiresportive drugs

201
Q

Antiresorptive drugs

A

estrogen
raloxifene
biphosponates
calcitonin
denosumab

202
Q

Raloxifene (Evists)

A

hormone drug therapy
- tx breast CA
-decrease cardiac events
similar to estrogen and bind with receptors
**reduces bone reabsorption

203
Q

Major HIgh risk for Raloxifene is it

A

potential DVT
fetal harm
hot flashes

204
Q

Raloxifene should be ______ before surgery because

A

Discontinued for 72 hours
prolonged immbolization and don’t resume until fully mobile

205
Q

Alendronate (Fosamax

A

Biphosphonate
inhibit bone reabsoption

206
Q

Side effects for alendronate

A

anorexia
weight loss
gastritis
take with water and 30 mins before lunch while maintaining upright for 30 mins

207
Q

Rare but serious reaction of alendronate

A

jaw osteo necrosis

208
Q

Calcitonin should be given

A

IM at night
-nasal

209
Q

Calcitonin does what for osteoprorsis

A

inhibits bone resorption
-get out of blood stream for hypercalcemia

210
Q

What must be given along with calcitonin

A

calcium supplementation

211
Q

Denosumab (Prolia) used for

A

-used in post menopausal women and men at risk for fx

212
Q

Denosumab (Prolia) administered

A

subQ every 6 months

213
Q

Denosumab (Prolia) is a management of

A

pts receiving corticosteroids

214
Q

Teriparatide (Forteo)

A

form of PTH
only drug that increases bone formation and osteoclasts as well

215
Q

Teriparatide (Forteo) side effects with BLACK BOX WARNINGS

A

Nausea
Headache
Back pain
Leg cramps
increased risk of bone cancer

216
Q

Cephalosporins

A

most widely used antibiotics
similar to PCN
IM or IV
Toxicity is low

217
Q

Cephalosporins cause

A

cause cell lysis

218
Q

Cephalosporins are most effective against

A

cells undergoing active growth and division**

219
Q

The higher the generation of antibiotics the more

A

resistance

220
Q

Cephalosporins generations with the name attached

A

First-generation
Cefazolin (Ancef) - prophylactic

Second-generation
Cefaclor (Ceclor)

Third-generation
Cefoperazone (Cefobid)

Fourth-generation
Cefepime (Maxipime)

221
Q

cephalosprins drug interactions

A

Probenecid (Benemid)
Alcohol**
Drugs that promote bleeding**
Calcium**
Ceftriaxone (Rocephin)**

222
Q

Cephalosporins adverse reactions

A

allergic
bleeding
thrombophletis

223
Q

First- and second-generation Cephalosporins

A

used for prophylactic surgery

224
Q

The third and Fourth generations of Cephalosporins are used for

A

broad spectrum - more aggressive
agianist active infections
highly active against gram negative
penetrate CSF

225
Q

Vancomycin uses

A

Severe active infections only
Methicillin-resistant Staphylococcus aureus or Staphylococcus epidermidis

226
Q

Vancomycin uses what type of levels for toxicity measurements

A

peak and trough

227
Q

Vancomycin adverse effects

A

Ototoxicity (reversible or permanent)
*Red man syndrome – raised red rash throughout body**
Just need to slow the rate down
Thrombophlebitis (common)
Thrombocytopenia (rare) – low platelet count

228
Q

Aminoglycosides IV

A

Narrow-spectrum antibiotics/Bactericidal
aerobic gram-negative bacilli

229
Q

Aminoglycosides adverse effects

A

**Nephrotoxicity
**Ototoxicity (total cumulative and trough levels)
Hypersensitivity reactions
**Neuromuscular blockade
Blood dyscrasias – blood disorders

230
Q

Aminoglycosides drug interaction with

A

PCN

Module 4 (MedSurg 2) (36 decks)

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