Musculoskeletal System Flashcards
name two specific examples of long bones
femur in leg & humorous in arm
Diaphysis
- what is it?
- what is it made up of?
middle part of the long bone (made up of compact bone)
Epiphysis
- what is it?
ends of long bones
Epiphyseal plate
- what is it?
- what does it do & promote?
separates the epiphysis from the diaphysis (separates ends from shaft) so bone growth will occur!
once bone growth is finished, each of the long bones are covered at the joints by ____
articular cartilage
what type of bone marrow do long bones contain?
fatty yellow marrow
give 2 examples of articular joints
femur has the knee & humorous has the elbow
short bones (tarsals)
- where are they found?
- list 4 examples
- found in ankles & hands
- carpals, metacarpals, tarsals, metatarsals
irregular bones
- give example
- what type of shape?
- bones of the ___ & ____
- EX: jaw
- odd shape
- bones of the vertebrae & jaw
flat bones
- give 2 examples
- function
- EXs: sternum & skill
- Function: protect underlying structures
what are bones made up of? (composition) (3)
cells, proteins, & minerals
periosteum
- what is it?
- what attaches to it?
fibrous membrane that nourished the bone itself; tendons & ligaments attach to this
endosteum
- what is it?
vascular membrane that covers the marrow cavity of long bones
the bone marrow is highly ____
vascular
bone marrow
- what is it?
shaft of the long & flat bones
red bone marrow
- found in which locations?
- what is made here?
- found mainly in sternum, ileum, vertebrae, & ribs
- RBCs, WBCs, & platelets are made
Remodeling of bones
Old bones removed, new ones added (new bones added faster when young)
Resorption of bones
removal / destruction
list things that influence bone resorption
physical activity (specifically weight bearing), dietary intake (esp Ca), hormones
which types of patients have increased bone resorption & why?
bed bound patients from Ca loss = bone weakening = increased risk of fractures
how much calcium & vitamin D is needed to maintain adult bone mass?
1,000 - 1,200 mg
what is needed to absorb calcium?
Vitamin D!!!
how many units of vitamin D should young adults have?
600
how many units of Vitamin D should older adults have?
800 - 1,000
role of PTH
maintains serum calcium level in the blood by promoting movement of Calcium from the bone to the blood
*“PULLS” from the bone to the BLOOD
what does the PTH promote?
demineralization of the bone to increase calcium in the blood
role of calcitonin
maintains serum calcium level
***stops bone resorption & deposits calcium into the BONE
what is calcitonin secreted by when serum calcium levels are too high?
thyroid gland
role of calcitriol
increases serum Ca in BLOOD by promoting absorption of calcium in the GI TRACT
role of thyroid hormone
breaks down bone (do not want too much)
role of cortisol
corticosteroid that breaks down bone (do not want too much)
role of growth hormone
direct effect on bone growth & remodeling
role of testosterone
has both direct & indirect effect on skeletal growth throughout lifespan; greater muscle mass & increased bone formation
in aging men, what does testosterone convert to in the adipose tissue to help preserve bones?
estrogen
role of estrogen
stimulates osteoblasts & inhibits osteoclasts; needed to enhance bone formation
role of ligaments & tendons
bind articulating bones together
ligaments
bone to bone
tendons
muscle to bone
flaccid
without tone
spastic
greater-than-normal tone
atonic
soft & flabby
hypertrophy
increase in size of muscle fibers; exercise & weightlifting
atrophy
decrease in size of muscle; immobility & bed rest
kyphosis
forward curvature of the spine
lordosis
exaggerated curvature of the lumbar spine (swayback)
scoliosis
lateral curving deviation of the spine
arthyrography
- what does it identify & determine?
- describe the procedure
- identifies cause of pain in joint & determines progression of joint disease
- contrast agent into joint cavity to visualize joint
- joint ROM while x-ray series obtained
arthroscopy
- what does it visualize?
- what dose it diagnose?
- what can it treat?
- describe the procedure
- Visualize joint w fiber optic endoscope
- Diagnose joint disorders
- Can biopsy
- Can treat ulcers, defects & disease processes
- Sterile procedure until local or general anesthesia
- Wound closed w steri strips or sometimes sutures & covered w a dressing
arthrocentesis
- describe what procedure does
- what can it diagnose?
- what does it relieve pain from?
- what to monitor for?
- what should the synovial fluid look like?
- what type of technique is this procedure?
- Obtains sample of synovial fluid from joint
- Can dx inflammatory arthropathies
- Relieves pain from effusion (fluid in joint)
- Look for hemarthrosis (bleeding in joint cavity)
- Synovial fluid (should be clear, pale, straw colored, & small in volume)
- Aseptic technique
X-ray / CT / MRI
- what does it show & reveal?
- Bone density, texture, erosion, bone changes
- Reveals fluid, irregularity, spur formation, narrowing / changes of joint
CT
- what can it visualize?
- With or w out contrast
- Visualize tumors, soft tissue injury, ligaments & tendons, trauma
MRI
- what does it visualize?
- what dose it assess & diagnose?
- Visualize & assess torn muscles, ligaments & cartilage
- Assess & dx herniated disc, hip, & pelvic conditions
electromyography
- what does it assess & evaluate?
- describe the procedure
- post op interventions
- Assesses electrical potential of muscles / nerves & evaluates weakness, pain, & disability & Evaluates weakness, pain & disability
- Needle electrodes into muscles
- Warm compresses post procedure
bone densitometry
- what does it test?
tests BMD through x-rays & US
bone scan
- what does it detect?
- describe procedure
- Used to detect tumors (metastatic & primary), Osteomyelitis & DDD
- Radioisotope through IV, scan 2-3 hours after
- Areas of abnormal bone will appear brighter
list some nursing considerations & contraindications for diagnostic tests (7) (indicate ones specifically for MRI)
Nursing:
1. patient must lie still (MRI) - sedative or Ativan sometimes given before
2. discuss MRI
Contraindications:
1. COPD or disorder where patient cannot lay flat
2. pregnant patient
3. patient w metal implants
4. always check urinalysis on women at child-bearing age!!
Allergies / contraindications to contrast agents:
1. check kidney function
2. be sure creatinine level is below 1.3
post diagnostic care (3)
- rest joint for 12 hours
- enjoy strenuous activity until approved
- provide ice 20 min on & 20 min off
post diagnostic care for an arthrography
- patient may hear a clicking or crackling joint for 24-48 hours (dye is causing sound)
- drink plenty of fluids to flush out contrast dye
post diagnostic care for an arthroscopy
- check for s/sx of infection due to incisions
- keep joint extended & elevated to reduce swelling
- avoid strenuous activity until cleared by the PCP
- ice 20 mins on & 20 mins off
list reasons of why a calcium lab would be drawn
Altered in osteomalacia (softening of the bone), parathyroid dyfx, prolonged immobilization
list reasons why an alkaline phosphatase (ALP) would be drawn
can indicate liver disease or bone disorders
Found throughout the body (concentrated in liver, bones, kidneys & GI)
list reasons why parathyroid labs (PTH), calcitonin, vitamin D labs would be drawn
Evaluate bone metabolism
list reasons why CK (creatine kinase) & asparate aminotransferase (AST) levels would be drawn
Elevated w muscle damage
list reasons why urine calcium levels would be drawn
Increased w bone destruction
indications for casting (3)
Immobilize fracture, Correct / prevent deformity, Support weakened joints
how is a cast applied?
Fiberglass or plaster of paris (joints proximal & distal)
what are some complications of casts? (2)
- pressure ulcers
- compartment syndrome (occurs due to casting too soon)
nursing focus / education for casting (5)
- *Neurovascular checks 6P’s (pain, pulselessness, pallor, paresthesia, paralysis, polythermal)
- cold therapy
- do not scratch; infection
- keep clean, dry, & elevate!
- discuss potential complications
what is a benefit of a waterproof cast?
does not smell!
how do you perform a neurovascular assessment?
6 Ps: pain, pallor, paralysis (can they move it?), paresthesia (numbness / tingling), pulse, polycythemia
list causes of compartment syndrome (5)
- trauma
- fracture
- severely bruised muscle
- severe sprain
- cast / bandage
what is compartment syndrome? describe what happens
- Fascia (fibrous material) covers muscles; DOES NOT expand
- Swelling occurs = nowhere to go
- Increased pressure in compartment
- Blood flow compromised
what could compartment syndrome lead to? (worse case)
ischemia & limb death
how will a client w compartment syndrome present? (3)
- *pain disproportionate to injury
- N/t to extremity; paleness
- NO pain relief despite analgestics
list & describe the diagnostic test used for compartment syndrome
Stryker: tests pressure; looks like a meat thermometer
list acute interventions for compartment syndrome (2)
- remove cast
- Fasciotomy: removing fascia
how can nurses help w compartment syndrome? education! (5)
- immobilized fx should not hurt
- N/T to extremity / warmth
- pain out of proportion
- keep clean & dry
- report fever or S & S of infection
status post fasciotomy care
Negative pressure wound therapy w installation has been used effectively to assist in granulation in acute, subacute, & chronic wounds
indications of external fixation (2)
- fractures w soft tissue damage or wounds
- complicated fractures
describe an external fixation - what is happening? (3)
- surgical pins inserted through skin to bone
- metal external frame attached to pins
- holds proper alignment (until healed or surgery)
benefits of external fixation (5)
- immediate fx stabilization
- minimize blood loss (ORIF)
- increased comfort
- improved wound care
- early mobilization
complications of external fixation (3)
- pin loosening
- infection / osteomyelitis
- compartment syndrome
how can nurses help / educate for external fixations (8)
- pin cleaning - be able to educate patients when they get discharged
- altered body image
- may need to alter clothing
- elevate
- cover sharp edges
- discuss complications (what to look for)
- monitor NV status (24 hours)
- may need casting / splint after removal