Musculoskeletal Flashcards
MVA, fractures, what blood tests need to be ordered
CBC - baseline, Hgb, Hct, electrolytes, coagulation, type and cross
what diagnostic tests are order after MVA/fractures
Xray, CT, MRI, EEG
KVO is how many mL per hour
25
NPO IV rate?
125 mL/hr
the 5 P’s (NV) post surgery
Pain, Pallor, Paralysis, Paresthesia, Pulselessness
how often do you assess NV/5 P’s post surgery
q 2-4 hrs and PRN
moderate to severe pain, can give with PC pump, oral, rectal, intranasal, or IV, monitor respirations
hydromorphone (Diluadid)
SE of hydromorphone (Diluadid)
lowered respirations, increased HR, orthostatic hypertension, drowsy, constipation, urinary retention
hydromorphone (Dilaudid) antidote
naloxone (Narcan)
what is normal dosage of morphine?
1-2 mg max dose q 4-6 hours otherwise question order
treats bacterial infections and MRSA. Monitor trough (30m before next dose) and peak (usually about an hour after taken)
vancomycin (Vancocin)
what should you monitor for with vancomycin
thomocytopenia, nephrotoxicity, ototoxicity (CN VII), and red man syndrome
how should you infuse vancomycin
slowly
hormones you need for bone development
thyroid, growth hormone (mainly kids), calcitonin, and VD
fat globules released from hello bone marrow form emboli in blood stream
shock/fat embolism
symptoms occur 12-72 hrs after injury (or surgery), lowered platelets, lower Hgb, and raised ESR. HR at about 110. Altered mental status, O2 down and SOB (chest pain) ,petechiae vest
fat embolism
how does compartment syndrome heal after being opened
secondary intention
what is the most important thing to avoid with compartment syndrome
tissue death
hip fracture that involves head or neck of femur
intracapsular
hip fracture involving trochanter below head/neck of femur
extracapsular
bone infection
osteomyelitis
discectomy
removal of herniated disk
laminectomy
removed of disk portion and bone between spinal process and junction
“wear and tear” joint stiffness, decreased ROM, worse with activity throughout the day, most affects middle age and older people,
osteo-arthritis
autoimmune, join issue, symmetrical, worse in the AM, can occur at any age
rheumatoid arthritis
with RA the problem is with?
synovium
which test shows RA
rheumatoid factor
no tears or saliva
sjogren’s syndrome
nodules, vasculitis, respiratory and cardiac complications, sjogren’s syndrome, raynaud’s synrome
RA
lowers inflammatory process and pain, may need help with GI system due to irritation
NSAID. ibuprofen (Motrin, Advil)
what do you have to patients taking NSIAD’s
PPI’s and H2 blockers
an anti rheumatic drug that has also been used for chemo
methotrexate
breakdown of cartilage. No systemic symptoms, onset is gradual, previous joint injury
osteoarthritis
anesthetic. can cause redness, swelling, and blisters at site. Used for osteoarthritis
lidocaine patch (Xylocaine)
due to overproduction of uric acid
gout
medication that blocks formation of uric acid and treated in gout.
allopurinol (Zyloprim)
Medication that blocks reabsorption of uric acid and promotes excretion. Used with gout. MANY DRUG INTERACTIONS
probenecid (Benemid)
NSAID. Decreases joint pain. DO NOT USE WITH COUMADIN or ASTHMA. Can cause fatal liver disease
indomethacin (Indocin)
if you see ESR (erythrocyte sedimentation rate) or CRP (c reactive protein) being ordered think?
inflammation
is a type of blood test that measures how quickly erythrocytes (red blood cells) settle at the bottom of a test tube that contains a blood sample. Normally, red blood cells settle relatively slowly. A faster-than-normal rate may indicate inflammation in the body.
erythrocyte sedimentation rate (ESR)
is a substance produced by the liver in response to inflammation. … A high level of CRP in the blood is a marker of inflammation
c reactive protein
fracture with skin intact
closed
bone pierces skin
Open/Compound
fracture common in children
Greenstick – incomplete fracture
multiple pieces of bone
Comminuted
Emergent intervention required to prevent loss of limb
Fasciotomy required to relieve pressure
Once pressure goes down, can be closed or covered with skin graft
compartment syndrome
therapeutic management of gout
Avoid purines (Organ meat, Wine, Aged Cheese, Meats, especially seafood) Adequate fluid intake Bed rest during exacerbations
Affects weight-bearing joints and joints that receive a lot of stress
osteoarthritis
nodes that affect the medial joints
Bouchard (B, closer to the body)
nodes that affect the Distal joints
Heberden’s (HE - pointing)
side effects of methotrexate
rash, toxic to liver and bone marrow, birth defects, photosensitivity. MONITOR FOR HEMODYNAMIC CHANGES
alternative therapies for OA
acupuncture, tai chi, magnets, lidocaine patch, TENS unit, copper bracelets
what gout med do you not stop abrubtly
prednisone
what gout med can weaken the immune system
prednisone (because corticosteroid)
long term SE of prednisone (corticosteroid)
osteoporosis, cushings syndrome
short term SE of prednisone
insomnia, mood swings, wt. gain, bruising, slow wound healing
