Musculoskeletal Flashcards
Osteoblast
Function in bone formation, and it contains collagen and living cells
Osteocytes
Mature bone cells that function in bone maintenance
Located in the lacunae
Osteoclast
Function in destroying, demineralizing, and remodeling bone
Located in Howship lacunae (In bone, osteoclasts found in pits in the bone surface which are called resorption bays, or Howship’s lacunae).
List the Primary risks on Osteoporosis
1. Genetics: • Age (older than 50 and postmenopausal) • Gender (females greater than males) • Race (Caucasian or Asian) • Family history • Smaller body frame (< 58 kg) 2. Nutrition (Modifiable) • Low calcium intake • Low vitamin D intake • High potassium intake • Inadequate calories 3. Lifestyle (Modifiable) • Sedentary lifestyle • Cigarette smoking • Excessive alcohol consumption (more than three glasses per day)
List the Secondary Risk factors on Osteoporosis
1. Medications • Corticosteroid therapy for more than 3 months • Anticonvulsants • Heparin therapy • Thyroid hormones 2. Disease pathology • Cushing’s disease • Hypogonadism or premature menopause • Malabsorptive issues (Crohn’s, celiac disease, gastric surgery, etc.) • Chronic liver disease • Inflammatory bowel disease • Rheumatoid arthritis • Hyperthyroidism • Hyperparathyroidism • Previous fracture 3. Other • Parental history of hip fracture • Recurrent falls • Prolonged immobilization
Sesamoid bones
patella or “knee cap”
Joints
Non-synovial joints and Synovial joints
What is bone resorption?
Same thing as Osteoclastic activity
Osteogenesis
Process of short and long bone formation. Cartilage is present during process.
- Bone in constant state of turnover.
- Bone remodeling throughout lifespan.
- Role of menopause, loss of estrogen and race.
Ossification
Process of formation of bone matrix/mineral deposition.
Hormonal influences in bone formation and maintenance.
- )Estrogen.
- )Thyroid-stimulating hormone and calcitonin.
- )Parathyroid hormone.
- )Growth hormones.
- )Calcium
What are the changes in aging bones and Muscles ?
- Changes in bone density, posture & gait occur over time.
- After age 30, bone density diminishes.
- Menopause accelerates bone density loss in women.
- With age, joints become stiffer.
- Joint calcification occurs.
- Dowager’s hump.
- Sarcopenia – Loss of skeletal muscle.
What is Osteopenia?
Bone Loss
What is the normal Standard Deviation on a BMD measurement?
Normal: 1 SD
Osteoporosis: 2.5 SD
Osteopenia: 1-2.5 SD
How can a patient prevent Osteoporosis?
- Balanced diet high in calcium and vitamin D throughout life
- Use of calcium supplements
- Regular weight-bearing
- Weight training stimulates bone mineral density (BMD)
- Healthy lifestyle includes avoidance of smoking/excessive alcohol intake
List the pharmacological Interventions to treat osteoporosis.
- Calcium 1,200mg/day and vitamin D 800-1,000 IU
- Bisphosphonates (Prevent Loss of bone density): Must be taken on empty stomach and sit upright for at least 30 mins and never give in conjunction with calcium
- Calcitonin: To decrease osteoclastic activity
- Estrogen agonist/anatgonist
- Parathyroid hormone
- Teriparatide
What are some complications of Osteoporosis?
Risk for falls, which incurs a greater risk for fractures, specifically vertebral compression fractures and hip fractures.
List the findings you will see while doing an assessment on a patient with Osteoporosis.
- “Dowager’s hump” (kyphosis of the dorsal spine)
- Loss of height (loss as great as 2 to 3 in. [5–7.5 cm])
- Back pain (sharp or acute)
- Pain increased with activity and relieved with rest
- Restriction of movement, especially in the thoracic and lumbar regions
- Fear of falling (known as “fallophobia”) and/or history of previous falls
- Previous fractures
- constipation, abdominal distention, and reflux esophagitis
- potential respiratory complications are due to curvature of the spinal column and decreased chest excursion.
What would you assess for a patient with Osteoporosis?
- Fall Risk
- Pain: pain decreases mobility and optimal functioning.
- Nutritional status : Adequate ingestion of protein, magnesium, vitamin K, calcium, vitamin D, and trace elements essential for bone formation/remodeling
- Assess level of activity/exercise
- Body image disturbance
As a nurse, what would you do/implement to treat someone with Osteoporosis?
- Administer Meds (Bisphosphonates & Vitamins), Give Calcitonin, Estrogen therapy, Parathyroid hormone.
- Dual-Acting bone agent: Decreases osteoclastic activity
- Monoclonal activity - Inhibits osteoclastic function
- Support exercise program/Implement
- Provide training for safe movement with activities of daily living
- Contact home health agency for a home environmental safety
What is osteocytes ?
Mature bone cells that function in bone maintenance
Located in the lacunae
What is osteoclast ?
Function in destroying, demineralizing, and remodeling bone
Located in Howship lacunae (In bone, osteoclasts found in pits in the bone surface which are called resorption bays, or Howship’s lacunae).
Flat bones
protective bones of the chest and sternum.
Irregular bones
vertebral body
sesamoid bones
patella or “knee cap”
joints
Non-synovial joints and Synovial joints
Type of muscles
Three types of muscles (skeletal muscle, smooth muscle, and cardiac muscle)
Osteogenesis
Process of bone formation
Ossification
Process of formation of bone matrix/mineral deposition.
- Bone in constant state of turnover.
- Bone remodeling throughout lifespan.
- Role of menopause, loss of estrogen and race.
Aging bones and Muscles
Changes in bone density, posture & gait occur over time
After age 30, bone density diminishes
Menopause accelerates bone density loss in women
With age, joints become stiffer
Joint calcification occurs
Dowager’s hump
Sarcopenia – Loss of skeletal muscle
Sarcopenia
Gradual muscle loss after the 4th decade of life (>30 years old).
- Loss through inactivity comprises 1 % per year,in males after the age of 50.
- Loss of muscle mass is permanent affecting ADls and bone mass later in life.
- Loss of muscle protein will affect the immune system as well as affect insulin absorption; increasing the risk for type 2 diabetes.
- Metabolic syndrome may be ameliorated (improved) through the maintenance of muscle mass through life.
Physical assessment for the musculoskeletal function includes assessment of which of the following ?
A-) ROM, posture and symmetry.
A client arrives to the emergency room with a suspected orthopedic injury. Which question should the nurse ask?
B-) Describe the location and quality of the pain.
Musculoskeletal overview.
Musculoskeletal conditions and injuries are not conditions of older age but relevant across life span.
- 60% and 77% of unintentional injuries reported United States due to musculoskeletal trauma.
- About 27 million musculoskeletal injuries occur annually in the United States withstrains,sprains, and most prevalent isfractures.
- These injuries effects patients’ mobility, sensation etc.
Bone fractures
- Incidence of fractures are on the rise in the U. S. with about six million fractures annually and occur in young/older population with porous and weakness.
- Fragility fractures in older adults result of progressive decrease in bone density/strength, frequently suffer chronic bone disorders that increase risk of pathologic fractures.
Examples of Chronic bone disorders.
- Cushing’s syndrome.
- Osteoporosis.
- Osteogenesis imperfecta.
- Neoplasms.
- Anorexia. 6.Paget’sdisease.
* These diseases significantly weaken bones, decrease load-carrying capacity and tolerance to force, increase the patient’s susceptibility to fractures, and further prolong the healing process.
High-energy trauma
Fractures in young people between the ages of 12 and 21 are typically the result of high-energy trauma.
Fractures in people 65 years or older are usually caused by low-energy trauma, for example, fractures from falling
Examples of high-energy trauma include:
.Motor vehicle collisions
.Contact sports.
.Bicycle accidents.
Bone
Classified as dense, irregular connective tissue made up of osteoblasts and osteocytes.
Provide support/structure, assist body in movement, and protect vital organs.
Fracture
A disruption, or break in the continuity of a bone.
There are numerous classifications of fractures that can occur throughout the body.
What is a Complete fracture?
The disruption spans across the width of the bone, causing bone fragments.
- Types:
1. Transverse ( In-place fragments after closed reduction).
2. Oblique(the fracture line occurs usually at 45-degree angle across cortex of the bone
3. Spiral (fracture wraps around shaft of the bone).
4. Impacted (Jammed fragments with indistinct line,Segments of bone are wedged into each other at the fracture line).
5. Comminuted (Fracture has several disruptions producing shattered bone fragments within fracture site, >2 fragments).
What is an Incomplete fracture ?
The disruption occurs through part of the bone cortex; however, there is no displacement of bone fragments.
Types:
1.Greenstick
( Buckled/bent bone, happens in children)
2.Compression( Crumpled cancellous bone, happens in adults).
What is a Closed (simple) fracture ?
Fracture that is contained within the skin
What is an Open (compound) fracture ?
Disruption in which pieces of bone protrude through the skin, creating an external wound that exposes the fracture site. Open fractures are graded on the basis of their severity.
Open wounds Grade I
Presence of a puncture wound, minimal injury to the soft tissues, and vasculature remains intact
Open wound Grade II
Puncture wound, fragments of broken bone, moderate skin and muscle contusions, and significant wound contamination
Open wound Grade III
Severe damage to soft tissues, nerves, muscles, and blood vessels. The open fracture site is considered extremely contaminated and contains numerous comminuted fractures.
What is an Avulsion fracture?
Caused by overstretching/tearing of tendon/ligament, separating small segment of bone at insertion site
What is a Compression fracture?
Fracture caused by excessive force along axis of cancellous (spongy internal layer of bone) bone, leads to bone collapsing on itself, in vertebral compression fractures from falls of significant heights
What is a depressed fracture ?
Disruptions in which bone fragments are forced inward; in facial/skull fractures of blunt trauma
What is a Displaced fracture ?
Malalignment of bone fragments at the fracture site.
Clinical Manifestations
- )Pain:
- Continuous pain and increases in severity until bone fragments are immobilized.
- After a fracture, injured area becomes numb and surrounding muscles flaccid.
- Muscle spasms occur within few to 30 minutes, and result more intense pain than at time of injury.
- Muscle spasms minimize movement and results in further bony fragmentation or malalignment.
2.) Loss of function: After fracture, extremity cannot function due to normal function of muscles depends on integrity of bones they are attached. Pain contributes to loss of function. Abnormal movement (false motion) may be present.
- ) Deformity:
- Displacement, angulation, or rotation of fragments fracture of the arm or leg causes deformity that is detectable when the limb is compared with the uninjured extremity.
4.) 5Ps: Pain Pallor Pulseless Paresthesia Paralysis
- ) Edema
- ) Ecchymosis ( swelling, purple-blue color.)
- ) Point tenderness over fracture site.
- ) Crepitus
- ) Shortening of extremity.
Diagnostic Findings
Diagnosis of fractures based on thorough history of how the injury occurred, a physical assessment, and confirmed by radiography or computed tomography (CT).
During patient’s history is obtained, important to note specific mechanism of force that caused injury.
Other imperative information includes patient’s medical history and any chronic illnesses, medications, and potential substance abuse.
Medications and substance abuse can impair mental judgment and function and contribute to motor vehicle accidents and falls, thus producing bone fractures and other traumatic injuries.
Chronic illness suspected as having major role in injury, a bone scan and MRI may be needed to confirm the diagnosis.
Medical Treatment
-Definitive treatment highly dependent on their type and location and may require either surgical or nonsurgical intervention.
Table 54.1 describes various fractures and their treatment.
-Open fractures with contaminated wounds, antibiotics are implemented to prevent osteomyelitis and other wound infections.
-Effective pain management is an important aspect in treating fractures.
-Narcotics and anti-inflammatory medications are effective in controlling pain and inflammation.
-Medications allow patient to gradually regain movement and function of the injured area.
-After definitive treatment, movement and function are key in preventing muscle atrophy and contractures.
Emergency Management.
-Immediately after injury, body part is immobilized before patient is moved.
Adequate splinting is essential.
-Joints proximal/distal to fracture must be immobilized to prevent movement of fracture fragments.
-*Immobilization of the long bones of the lower extremities accomplished by bandaging the legs together, with the unaffected extremity serving as a splint for the injured one.
-Upper extremity injury, arm may be bandaged to chest, or an injured forearm may be placed in a sling.
*Assess neurovascular status distal to injury before/after splinting to determine adequacy of peripheral tissue perfusion/nerve function.
*Open fracture wound is covered with sterile dressing to prevent contamination of deeper tissues.
No attempt made to reduce fracture, even if one of the bone fragments is protruding through the wound.
Splints are applied for immobilization.
Clothes are gently removed from uninjured side of body and then from the injured side.
Fractured extremity is moved as little as possible to avoid more damage.
Open fractures with contaminated wounds, antibiotics are implemented to prevent osteomyelitis and other wound infections.
Pain management in important aspect in treating fractures.
Narcotics and anti-inflammatory medications are effective in controlling pain and inflammation.
Medical Managment
Reduction:
*Nonsurgical treatment of a fracture or aclosed reduction.
Refers to restoration of fracture fragments to anatomic alignment/positioning.
Physician reduces fracture as soon as possible to prevent loss of elasticity from the tissues through infiltration by edema or hemorrhage.
Fracture reduction becomes more difficult as injury begins to heal.
Before fracture reduction/immobilization, patient is prepared for procedure; consent for procedure is obtained, and an analgesic agent is given as prescribed.
Anesthesia may be given.
*Surgical repair of fractures includes: Open reductionwithInternal fixationorExternal fixation.
*Open Reduction
Surgical repair of fractures includes: Open reductionwithInternal fixationorExternal fixation.
*Internal Fixation (surgery)
Requires use of plates, screws, rods, and other hardware to realign fractured bone segments.
Irrigation and debridement might be needed for open fractures contaminated with dirt/foreign matter.
*External Fixation (casts)
Application of series of rods/pins to area surrounding fracture,creating an external frame to stabilize/align displaced fragments.
External fixators are frequently used when there is significant soft-tissue damage at fracture site.
Nursing Management Preoperative.
Nurse should inform patients of:
.Immobilization
.Assistive devices
.Expected activity limitations after surgery.
