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Med-Surg Final exam > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

Which nerve is affected in Carpal Tunnel Syndrome

A

Median

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2
Q

What’s Phalen’s maneuver?

A

Produces paresthesia in the median nerve distribution within 60 seconds. Upside down prayer with nails facing each other.

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3
Q

What is Tinel’s sign?

A

Tap lightly over median nerve in wrist and inflate a blood pressure cuff in upper arm to patient’s systolic pressure. If there’s pain and tingling, it’s a positive sign

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4
Q

What is an electromyography

A

Recording of the electrical activity of peripheral nerves by testing muscle activity

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5
Q

Pharmacological therapy for CTS

A

NSAIDS and corticosteroid injections

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6
Q

Open carpal tunnel release surgery for CTS

A

Transverse carpal tunnel ligament is cut to provide nerve decompression

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7
Q

Endoscopic carpal tunnel releases surgery for CTS

A

Free trapped median nerve through an endoscope inserted

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8
Q

Priority nursing interventions for post-op carpal tunnel release

A

n/v, elevate hand, VS, monitor dressing, pain management

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9
Q

How long should you restrict hand movements and heavy lifting for carpal tunnel?

A

4-6 weeks

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10
Q

What is gouty arthritis

A

Systemic disease that involves deposits of urate crystals in the joints & other body tissues leading to inflammation. It is the most common inflammatory arthritis.

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11
Q

Primary gout characteristics

A

Problem with purine metabolism Too much uric acid for the kidneys to excrete Sodium urate deposits in synovium and other tissues leading to inflammation Middle-age men and post-menopausal woman. More stages

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12
Q

Secondary gout characteristics

A

Hyperuricemia secondary to disease Renal insufficiency, diuretic therapy, and chemo agents used to decrease uric acid excretion Treating underlying problem Prolonged pain Affects persons of all ages

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13
Q

Clinical stages of gout

A

Asymptomatic - no obvious signs Acute gouty arthritis - inflammation and excruciating pain in one or more small joints. Increased ESR and usually occurs in the great toe Inter-critical stage - symptom free period Tophacerous gout (chronic) - Urate crystals develop under the skin and within major organs after repeated acute attacks. Kidney stones may form

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14
Q

Acute gout

A

Joint inflammation Elevated serum uric acid level >6.5 Urinary uric acid levels may or may not be increased Increased BUN/Cr Arthrocentesis - synovial fluid aspiration to detect the uric crystals on the affected joints

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15
Q

Chronic gout

A

Presence of tophi-sodium urate crystal deposits (irregular shape, may break if skin is irritated, improperly managed gout). Outer ear, arms, and fingers near the joints Renal calculi/dysfunction

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16
Q

What is colchicine (colsalide)

A

Used in acute gout to decrease inflammation by preventing the migraines of leukocytes to the inflamed site. Take with food.

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17
Q

Name meds for acute gout

A

Colchicine (colsalide)

Indomethacin (indocin)

Ibuprofen (motrin)

Corticosteroids

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18
Q

Meds for chronic gout

A

Xanthine oxidase inhibitors (allopurino (zyloprim), Febuxostat (uloric))

Uricosuric (probenecid (benemid))

combination drugs (colbenemid).

19
Q

Nutrition therapy for gout

A

Avoid excessive alcohol, avoid fad diets, low purine diets (avoid shellfish, fish), limit protein foods, increase fluid intake, avoid aspirin & diuretics, avoid excessive stress (can cause exacerbations).

20
Q

What are isometric exercises

A

Building muscle strength, but not lengthening the muscle. Leaning against a wall and pressing against it or pressing the right hand against the side of the face with resistance.

21
Q

How to decrease kyphotic pressure

A

Use arm support on chairs and encourage proper body mechanics

22
Q

What is ALP

A

Alkaline phosphatase - Musculoskeletal damage causes a rise in it. As a part of the aging process, older generation has a higher ALP

23
Q

Which tests do you require to stabilize the joint for 12 hours?

A

Arthrogram (picks up tears in the joint capsule by injecting air or radiopaque contrast into the joint which allows visualization)

24
Q

calcitonin vs pth

A

calcitonin decreases calcium, pth increases it (inverse)

25
Q

PTH action on body

A

reduces renal excretion of calcium and facilitates absorption from the intestines

26
Q

Calcitonin action on body

A

Inhibits bone resorption by stopping the break down of bone calcium that would increase serum calcium levels.

27
Q

Why are steroids bad for bones

A

They have a negative affect on calcium metabolism. It promotes bone loss

28
Q

What are glucosamine and chondroitin?

A

medications that treat arthritis

29
Q

Hypocalcemia effects

A

More excitable membranes (increased skeletal and smooth muscle contraction) - cramps, seizures, paresthesia, trousseau’s and chvoslek’s signs - CV: arrhythmia, irregular heartbeats, MI

30
Q

IV calcium should be administered how fast?

A

SLOWLY - it’s a severe tissue irritant.

31
Q

How do you move a client with fragile bones

A

With a lifting sheet and not pulling on their extremities

32
Q

Thiazide diuretics relationship with calcium

A

increases the absorption

33
Q

Hypercalcemia s/s

A

Decreased excitability and decreased depolarization

CV: cardiac arrest, faster clotting, cardiac depression, dysrhythmias,

NM: loss of consciousness, confusion, coma

GI: constipation, n/v, anorexia, decreased motility

34
Q

How often do you perform n/v checks with fractures

A

q1h

35
Q

How big are the weights for skin traction? skeletal?

A

skin: 5-10, skeletal: 15-30

36
Q

In regards to complications in fractures, are sensory changes an early sign or late? how about motor?

A

changes in sensory is an early sign of complication, motor is a late sign.

Also: paint out of proportion to the injury is a later sign of complication

37
Q

Teachings to prevent hip dislocation

A

Do not sit or stand for prolonged periods

Do not cross legs beyond the midline of the body, do not cross them at all.

Do not bend at your hips more than 90 degrees

Use an ambulatory aid

No BLTs (bending, lifting, turning)

Sit in a 90 degree chair rather than a slouched chari

38
Q

Pelvic fracture #1 concern

A

Hemorrhage

39
Q

Management of osteomyelitis

A

Nonsurgical:

IV antibiotics

Wound irrigation

pain mangaement

Hyperbaric oxygen therapy

Standard vs contact precautions (depends on the drainage)

Surgical:

Sequestrectomy - allowing revascularization of necrotic tissue and promoting healing to the bone

Bone grafting - using bone material to fill the gap

Muscle flap - using cadavers or even using other small bones from other locations to fill in the bone from amother area

40
Q

FES early detection (Fat embolism syndrome)

Other symptoms?

A

AMS (decreased LOC, anxiety, restlessness, drowsiness) is #1

SOB, chest pain, dyspnea, increased pulse, RR, tachycardia, Decreased O2

Latest sign- petechiae

41
Q

Diagnosing FES

A

CXR (snowstorm infiltrate)

increased ESR

Decreased serum calcium, RBCs, and platelets

Increased serum lipase

Free fat in urine

42
Q

Treating FES

A

Immobilize and give oxygen

43
Q

What is compartment syndrome?

What are the risk factors?

What are the interventions?

A

Increased pressure within one or more compartments (where muscle, nerve, etc reside) causing reduced circulation to the area. It is a medical emergency. Risk factors include fractures, severe burns, insect bites, severe IV infiltration, tight dressings and cast dressings. Interventions include lowering the extremity to get tissue perfusion and blood flow.

44
Q

What is rhabdomyolysis

How do you treat it?

A

Results from a large injury to skeletal muscles causing a release of myoglobin into the circulation

Caused by burns, compression/crush injury, seizures, cocaine abuse, infections.

Treatment: massive IV infusion to prevent myoglobins from creating renal damage, correct hyperkalemia, mannitol to enhance renal prefusion, dialysis, and BM

Med-Surg Final exam (7 decks)

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