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Med surg exam 2 > Musculoskeletal part 2 > Flashcards

Musculoskeletal part 2 Flashcards

1
Q

Stages of fracture healing

A
  1. Fracture Hematoma
  2. Granulation tissue
  3. Callus formation
  4. Ossification
  5. Consolidation
  6. Remodeling
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2
Q

Cast care

A

Nothing down cast

Ice for 24 hours after cast applied

Elevate position

Neurovascular checks

Check for skin breakdown (hot spots, drainage, odor)

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3
Q

Buck’s traction

A

No lower leg support

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4
Q

Russel’s traction

A

Support through entire leg

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5
Q

Balanced suspension

A

leg in air supported by cables

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6
Q

Traction care (TRACTION)

A

Temperature

Ropes hang freely

Alignment

Circulation (6 Ps)

Type and location of fracture

Increase fluid intake

Overhead trapeze

No weights on bed or floor

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7
Q

Compartment syndrome

A

Don’t elevate- keep at level of heart

No ice (vasoconstriction)

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8
Q

Amputation types

A

Open: stump prepared for prosthesis

Open: usually with infection

Disarticulation: amputation through a joint

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9
Q

Amputation nursing care key points

A

Impaired skin integrity: pressure areas and wrapping stump properly’

Pain r/t phantom sensation: may need analgesics

Impaired physical mobility:

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10
Q

Joint replacement pre-op nursing care

A

Splint

NWB (non-weight bearing) techniques

UE strengthening

Pulmonary function

N/V assessment

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11
Q

Joint replacement post-op nursing care

A

Positioning/turning

Peroneal nerve

Hip flexion/ambulation

Pain

Hemovac

Anticoags/antibiotics

I&O

TED/SCD

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12
Q

Osteomyelitis

A

Infection of bone marrow/surrounding tissue

Indirect: 1 organism, often under 17 y.o.

Risks for adults include debilitation, age, hemodialysis, sickle cell, IV drug abuse.

DIrect: multiorganism, open wound, implant

Complication: septicemia

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13
Q

Osteomyelitis diagnosis

A

Labs: high WBC, high ESR (erythrocyte sedimentation rate), high CRP (C-reactive protein)

CT, MRI

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14
Q

Osteomyelitis management

A

Surgery
Long term antibiotics
Acrylic bead chains
Hyperbaric O2

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15
Q

Osteochondroma

A

Benign bone tumor: overgrowth of cartilage and bone near end of bone

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16
Q

Osteosarcoma

A

Malignant bone tumor

Aggressive, gradual pain onset, bone swelling, surgical removal, chemo

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17
Q

Acute vs chronic back pain

A

Acute: under 4 weeks duration, symptoms come after injury

Chronic: More than 3 months or repeated incapacitating episode

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18
Q

Herniated intervertebral disk treatments

A

Treatments:

Laminectomy: enlarges and decompresses- to gain access to disk and remove it. (removing bone)

Discectomy: decompress nerve root (removing bulging part of disc)

Spinal fusion: welding two vertebrae together- trading stability for mobility.

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19
Q

Herniated disk post op

A

Compare circulation to baseline: Look for numbness and tingling

DON’T TWIST; LOG ROLL INSTEAD

can be on PCA, normally PO meds

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20
Q

Oteomalacia/Rickets

A

Softening of bones from vitamin D deficiency

21
Q

Osteoporosis risk factors

ACCESS

A 
Alcohol use
Corticosteroid use
Calcium Low
Estrogen Low
Smoking
Sedentary
22
Q

Osteoporosis fracture sites

A

T-8 and below

23
Q

Kyphosis

A

Hunch back

24
Q

Lordosis

A

Spine collapses in

25
Q

Osteoporosis testing

A

H&P

Bone Mineral Density every 15 yr for women:

GOLD STANDARD is Dual energy x-ray on spine, hips, forearms

26
Q

BMD: Bone Mineral Density test

A

Start at age 40

Every 15 years for women

-1 to 1 is normal
1- to -2.5 osteopenia
Under 2.5= osteoporosis

27
Q

Osteoporosis medications

A

Estrogen after menopause

Calcitonin

Biphosphonates: TAKE W/ GLASS OF WATER IN MORNING AND SIT/STAND FOR 30 MINS AFTER

SERMS

28
Q

Calcium supplements

A

Can neutralize gastric acid

Will decrease efficacy of tetracyclines

Thiazide diuretics can cause increase in serum Ca

Watch for hypercalcemia

29
Q

Calcitonin

A

Bone resorption inhibitor

Decrease osteoclast activity
Increase calcium excretion

Only for women 5 years past menopause

Can be Subq, IM or nasal spray

Watch for nausea after injections

30
Q

Biphosphonates

A

Prevent osteoclasts from breaking down bone

Fosamax
Actonel
Boniva
Reclast

31
Q

Osteoarthritis (OA)

A 
Non inflammatory
Asymmetric
Progressive
Weight bearing joints and metatarsals
Pain worse w/ activity
Limited ROM in affected joints
Stiffness w/inactivity
Joint space narrows
Bone on bone (crepitus)
Heberden's and Bouchard's nodules
32
Q

OA treatments

A

Manage pain/inflammation:

  • Acetaminophen/NSAIDS
  • Steroids
  • Rest
  • Immobilize Joint
  • Arthroplasty
33
Q

Second gen COX-2 inhibitor

A

Celebrex

High risk for cardiovascular disorders
Does not promote bleeding

Watch for dyspepsia, diarrhea, Renal impairment

34
Q

Rheumatoid Arthritis (RA)

A

Autoimmune

Starts at YOUNGER AGE

Chronic and systemic inflammation

Affects CT and synovial joints

Teaching: prevent loss of ROM: remain active, stretch joints

Labs: ESR, CRP, Antinuclear Antibody Assay, Arthrocentesis (milky/cloudy)

35
Q

RA treatment

A

Corticosteroids
DMARDS (disease modifying antirheumatic drugs): methotrexate

Biologics

36
Q

Nonbiologic DMARDS

A 
Plaquenil
Minocin
Leflunomide
Azathioprine
Gold Salts
Sulfasalazine
37
Q

Biologic DMARDS

A 
Humira
Cimzia
Orencia
Embrel
Inflixmab
Glimumab
38
Q

Stuff to monitor during DMARDS

A

Monitor CBC and Liver function tests

Teach pt to report S&S of infection, bleeding, SOB, dysuria

Avoid alcohol on Minocin

Avoid sunlight

Store Minocin at room temp

39
Q

OA vs RA

A 
OA: 
After 40
Gradually develops
One side of body first (overuse)
Usually no redness, warmth, swelling, malaise
30 min morning stiffness then improve
No erosion
RA:
between 25-50
Autoimmune
Can develop suddenly
Joints on both sides of body
Redness, warmth, swelling of joints
More than 30 min morning stiffness
Inflammation causes erosion
40
Q

Gout

A

Caused by high uric acid/purine

Treated w/ Colchicine (immediate)
Allopurinol (Long term)

41
Q

Septic arthritis

A

Infected Joint cavity

42
Q

Anklyosing Spondylitis

A

Chronic inflammation in axial skeleton, onset in 30s

43
Q

Psoriatic arthritis

A

From psoriasis

med example: Otezla

44
Q

Reactive Joint inflammation

A

From GI or GU infections (chlamydia, salmonella)

treated w/ antibiotics and rest

45
Q

Synovectomy

A

Removal of inflamed tissue

46
Q

Osteotomy

A

Removal of bone wedge to restore alignment

47
Q

Arthrodesis

A

Surgical fusion of joint

48
Q

Arthroplasty

A

reconstruction/replacement of joint

Med surg exam 2 (7 decks)

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