Musculoskeletal and Cardiac Alterations Flashcards
1
Q
Two systems
A
- skeleton bones and joints
- skeletal muscles – soft tissue, tendon, ligaments
2
Q
functions of the skeletal system
A
- forms the body
- supports tissue
- permits movement
- protects vital organs
- blood cell formation
- mineral storage
3
Q
Elements of bone tissue
A
- rigid connective
- constituents
- cells
- fibers
- ground substances
- calcium
4
Q
osteoblasts
A
- bone forming cells
- from stem cells
- type I collagen
- responds to PTH
- produces osteocalcin stimulated by vitamin D
- active on outer layer of bone
- bone is shaped by function
5
Q
osteoclasts
A
- resorptive cells
- clears out damaged cells
- ruffled border increases surface area to bind to bone surface
- when resorption is complete, retract and loosen through action of calcitonin
6
Q
osteocytes
A
- osteoblast that is surrounded in osteoid as it hardens from deposited minerals
- function is not known, but they are abundant, concentrate nutrients in bone matrix, obtain nutrients from capillaries, determine bone structures
7
Q
collagen fibers
A
- proteoglycans = strengthens bones, plays a role in calcium deposition and calcification
- glycoproteins = control collagen interactions that lead to fibril formation
- bone minerals = formation of initial mineral deposit, proliferation of mineral crystals on initial mineral deposits (calcium and phosphate)
8
Q
Bone types
A
- compact bone (hard bone) = highly organized, solid strong, structural unit is Haversian system
- spongy bone (soft bone) = less complex, lacks Haversian system
1. lamellae = where bone marrow lies
2. periosteum = attaches ligament - these bones have the same structure, just different organization
9
Q
Bone remodeling
A
- activation = hormone, drug, vitamin, or stressor activates basic multicellular units
- resorption = osteoclasts leaves behind resorption cavity
- formation = new bone formed by osteoblasts lining the walls of the resorption cavity, termed secondary bone
10
Q
Complete fracture
A
break is across entire width of bone, bone divided sections
11
Q
Incomplete fracture
A
bone is damaged, but remains in one piece, break is through only one part of the bone
12
Q
closed (simple) fracture
A
fracture does not extend through the skin
13
Q
open (compound) fracture
A
fracture does result in a break of the skin – external wound
14
Q
oblique fracture
A
diagonal to shaft to bone
15
Q
spiral fracture
A
encircles bone
16
Q
transverse fracture
A
across the bone
17
Q
causes of fracture
A
at pre-existing abnormality or stress
18
Q
pathophysiology of fracture
A
force applied to bone, disruption of periosteum, marrow and surrounding tissue, bleeding occurs, bone necrosis, inflammatory response
19
Q
manifestations of fracture
A
deformity, numbness, flaccidity or spasm, pain, ecchymosis, swelling, loss of function, crepitus or crackling, visible bleeding
20
Q
stages of bone healing
A
- hematoma
- procallus formation
- callus formation
- callus replacement
- bone remodeling
21
Q
osteoporosis
A
- porous bone, bone mass decreased
- spongy bone becomes less thick and viscous, compact bone more porous
- decreased quantity and quality of bone
- fractures = vertebrae, distal radius, ribs, long bones, neck of femur
- clinical manifestations = pain, deformity, hunch, shortened height, psychosocial effect
21
Q
osteoporosis
A
- porous bone, bone mass decreased
- spongy bone becomes less thick and viscous, compact bone more porous
- decreased quantity and quality of bone
- fractures = vertebrae, distal radius, ribs, long bones, neck of femur
- clinical manifestations = pain, deformity, hunch, shortened height, psychosocial effect
22
Q
pathophysiology of osteoporosis
A
- bone remodeling cycle is altered
- decreased osteoblasts, increased osteoclasts
- bone remodeling is prolonged
- decreased bone density and quality
23
Q
Osteomyelitis
A
- infectious bone disease
- caused by bacteria
- exogenous = entered from outside the body and spreads from soft tissue to bone
- endogenous = occurs from within body, blood to infected area, bone to soft tissue
- acute = fever, swelling, tenderness, redness, bone pain
- chronic = low grade fever, malaise, anorexia, weight loss, localized pain, skin ulceration, drainage
24
pathophysiology of osteomyelitis
- initial infection
- inflammatory response
- abscess formation
- ischemia
- necrosis
- sequestrum
- involucrum
- systemic infection
25
osteoarthritis
- degeneration of joint cartilage and hypertrophy of bone, wear and tear
- primary effects = hips, knees, vertebral column, hands
- primary (idiopathic) or secondary (stress, congenital musculoskeletal abnormalities, damage)
- manifestations = pain, stiffness, joint enlargement and deformity, limited ROM, crepitus with movement
26
pathophysiology of osteoarthritis
- erosion of the articular cartilage
- formation of bone spurs
- sclerosis of bone beneath cartilage
27
arthritis
inflammatory damage or destruction in the synovial membrane or articular cartilage
28
rheumatoid arthritis
- systemic inflammatory autoimmune disease associated with swelling and pain in multiple joints
- primarily affects synovial joints
- causes is unknown, most likely a combination of genetics interacting with inflammatory mediators
29
Gout
- caused by defects in uric acid metabolism which disrupts the body's control of uric acid production or excretion
- uric acid crystallizes and deposits in connective tissue
- gouty arthritis when crystals occur in synovial fluid
30
Fibromyalgia
- chronic syndrome with diffuse pain, fatigue, and tender point
- often vague symptoms
31
Rhabdomyolysis
- breakdown of muscle tissue releasing myoglobin, which damages the kidneys
- can be life threatening complication of severe muscle trauma or secondary to malignant hyperthermia
- crush syndrome -- most severe
- compartment syndrome -- less severe forms which are localized
32
varicose veins
- blood has pooled in the vein
- distended, tortuous and palpable veins
- caused by trauma, valve damage, gradual vein distention
- risk factors = age, family history, gender, obesity, injury, standing, crossing legs, restrictive clothing
33
chronic venous insufficiency
- dark brown color in lower extremities
- inadequate venous return
- results in fibrosclerotic remodeling of skin and possible ulceration -- venous stasis ulcers
34
Deep vein thrombosis
- thrombus = blood clot attached to vessel wall
- thrombus embolus = blood clots becomes unattached from vessel wall
- virchow's triad = venous stasis, venous endothelial damage, hypercoagulable states
35
Superior vena cava syndrome
- progressive occlusion of the superior vena cava that leads to distention of upper extremities and head
- causes = cancer, pacemaker implantation, pleural effusion, CVC
36
Classifications of HTN
- normal = 120/80
- pre-hypertension = 120-129/<80
- stage 1 = 130-139/80-89
- stage 2 = <140/90 `
37
Blood Pressure
Cardiac output x stroke volume
38
cardiac output
stroke volume x heart rate
39
Factors for cardiac
- SNS
- RAAS
- Baroreceptors
- Natriuretic peptides
- inflammation, endothelial damage
- insulin resistance
40
angiotensin II
- promote vascular remodeling
- promotes accelerates atherosclerosis -- stimulates smooth muscle proliferation
- results in permanent increase in peripheral resistance
41
ADH
- released from hypothalamus in response to decreased BP and increased plasma osmolality
- vasoconstricting effect
- prevents excretion of water by kidneys
42
natriuretic peptides
- from atrium
- released in response to increased volume
- decreased BP and increases urine output
43
Aneurysms
- local dilation or outpouching of a vessel wall or cardiac chamber
- aorta is the most common location
- true aneurysms = involve three layers of arterial wall
- false aneurysms = dissecting saccular aneurysms
44
Causes of Aneurysms
- trauma/stress
- atherosclerosis
- infection
- congenital defects
- smoking
- age
45
Manifestations of aneurysms
- asymptomatic until they rupture
- dysphagia
- breathlessness
- fullness
- chest or back pain
- aortic regurgitation
- shortness of breath
- heart failure
46
Thromboangitis Obliterans
- in young men who smoke
- inflammatory disease of peripheral arteries resulting in the formation of nonatherosclerotic lesions
- symptoms = slow, sluggish blood flow, pain, tenderness, hair loss, gangrenous lesions
47
Raynaud's disease
- episodic vasospasm in arteries and arterioles of the fingers, less commonly on the toes
- secondary to other systemic diseases
48
Arteriosclerosis
- chronic disease of the arterial system
- abnormal thickening and hardening of the vessel walls
- smooth muscle cells and collagen fibers migrate to the tunica intima causing stiffness and thickening of arterial lumen
49
Atherosclerosis
- fat filled macrophages with the arterial wall harden over time
- plaque development
- risk factors = HTN, smoking, diabetes, hyperlipidemia, decreased HDL, hyperhomocysteinemia
50
Peripheral artery disease
- arteriosclerotic disease of arteries that perfuse limbs -- lower extremities
- ischemia can be acute or gradual
- intermittent claudication -- occlusion
- loss of blood flow -- emergency
51
Coronary artery disease
- any vascular disorder that narrows or occludes the coronary arteries
- atherosclerosis is the most common cause
- risk factors = dyslipidemia, HTN, smoking, diabetes, obesity, sedentary lifestyle
52
myocardial ischemia
- local, temporary deprivation of the coronary blood supply
- stable angina
- prinzmetal angina
- silent ischemia
53
stable angina
- pain caused by intermittent myocardial ischemia -- lack of oxygen to heart muscle
- resolved with rest
- no cellular death if blood flow is resolved
- pain d/t decreased O2 and increased lactic acid or abnormal stretching of myocardium that irritates myocardial nerve fibers
- patient has heaviness, pressure, pallor, diaphoresis, dyspnea
54
Unstable angina
- attacks increase in frequency and duration
- still reversible
- pain can differ, unpredictable
- reversible myocardial ischemia -- plaque has become complicated, transient episode of thrombolytic vessel occlusion and vasoconstriction
55
Prinzmetal's Angina
- unpredictable
- angina attributable ischemia of entire thickness of myocardium
- pain caused by vasospasm
- hyperactivity of SNS
- pain usually occurs at rest
- woken up with pain
56
Infective endocardium
- inflammation of endocardium
- agents = bacteria, virus, fungi, parasites
- pathogenesis = damaged endocardium, blood borne microorganism adherence, proliferation of the microorganism
- manifestations = fever, new or changed cardiac murmur, petechial lesions of skin, conjunctiva, oral mucosa
