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NCLEX: Med Surg > Musculoskeletal System > Flashcards

Musculoskeletal System Flashcards

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1
Q

A _____ is where two or more bones come together to allow for movement

A

Joint

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2
Q

Examples of synovial joints

A

Shoulder, knee

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3
Q

__________ attach muscles to bones

A

Tendons

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4
Q

_________ attach bones to bones

A

Ligaments

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5
Q

Minerals and hormones essential for bone growth/health

A

Calcium, vitamin D, phosphorous, PTH, calcitonin, growth hormone

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6
Q

Parathyroid hormone (PTH) pulls calcium out of the bones and into the bloodstream which _________ calcium levels

A

Increases

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7
Q

_________ is a hormone that counteracts the activity of PTH by inhibiting osteoclast activity and decreases reabsorption of calcium at the kidneys which decreases blood calcium levels

A

Calcitonin

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8
Q

Aspiration of synovial fluid from joint cavity

A

Arthrocentesis

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9
Q

Insertion of narrow tube with camera to visualize internal structure of joint and allows for collection of biopsies

A

Arthroscopy

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10
Q

Knee arthroscopy nursing consideration

A

Patient needs to be able to bend their knee at least 40 degrees and there cannot be an active infection in that knee

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11
Q

Procedure that uses low levels of X-rays to measure a patients bone mass for the diagnosis of osteoporosis

A

Dual x-ray absorptiometry (DXA)

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12
Q

Diagnostic used to identify fractures, bone cancer, and bone infections

A

Nuclear scans

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13
Q

Describe nuclear scan process

A

Administration of radioactive substance or isotope is administered 4-6 hrs before the procedure; nuclear scan will show a hot spot of where radiation has gathered revealing affected site; nuclear scans can be repeated at 24, 48, and 72 hours

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14
Q

Diagnostic used to evaluate muscle weakness by which needles are inserted into muscles and muscle activity is recorded

A

Electromyograpy (EMG)

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15
Q

Progressive degeneration of the articulate cartilage in a joint causing inflammation, development of bone spurs, and decreased mobility

A

Osteoarthritis

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16
Q

Osteoarthritis risk factors

A

Older age, female gender, smoking, obesity, repetitive stress on joints

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17
Q

S/S of osteoarthritis

A

Joint pain and stiffness, enlarged joints, crepitus, heberden’s nodes (higher up on finger) and bouchard’s nodes (lower on finger closer to body)

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18
Q

Osteoarthritis treatment

A

NSAIDs, topical medications such as voltaren gel (topical nsaid), topical capsaicin, glucosamine supplement (decreases inflammation and further degeneration of articulation cartilage), injections into synovial joint (corticosteroids, hyaluronic acid)

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19
Q

Osteoarthritis patient education

A

Balance rest with activity, weight loss if applicable, encourage strength training and physical therapy, yoga and tai chi are good exercises for osteoarthritis, apply ice for ACUTE exacerbations and heat for stiffness, use of splinting and assistive devices

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20
Q

Autoimmune disorder in which antibodies attack synovium leading to swelling, inflammation, and destruction of articulated cartilage and bone

A

Rheumatoid arthritis (RA)

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21
Q

T or F: rheumatoid arthritis is characterized by periods of exacerbation and remission

A

True

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22
Q

RA risk factors

A

Females, ages 20-50, family hx

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23
Q

S/S of RA

A

Bilateral and symmetrical joint pain and swelling, morning stiffness, ankylosis (joint fixation and deformity), swan neck and boutinniere deformities; swan neck is characterized by flexion of the distal interphalangeal joint and hyperextension of the proximal interphalangeal joint. The boutinniere deformity causes hyperextension of the distal joint and flexion of the proximal joint. Ulnar shift is occurs when all fingers start to bend towards pinky finger; subcutaneous nodules; fever, red sclera, lymphadenopathy (swelling of lymph nodes)

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24
Q

Abnormal labs with RA

A

Positive rheumatoid factor, positive ANA titer, elevated WBCs, CRP, and ESR

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25
Q

RA treatment

A

Immunosuppressants (prednisone, methotrexate), NSAIDs, hydroxychloroquine, Plasmapharesis, PT and OT

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26
Q

RA nursing care

A

Monitor for complications such as Sjögren’s syndrome

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27
Q

S/S of Sjögren’s syndrome

A

Excessively dry eyes and dry mouth

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28
Q

RA patient education

A

Take warm shower in morning to relieve morning stiffness, engage in physical activity to preserve ROM, use assistive devices as needed for safety

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29
Q

Osteoarthritis vs RA: pain

A

Osteoarthritis: end of day pain; patient will have more pain with activity that is relieved with rest. After sleeping all night, patient will feel better in the morning
RA: patients will have morning stiffness and pain that is relieved through activity

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30
Q

The replacement of a diseased joint with a prosthetic joint

A

Arthroplasty (most common include knee, hip, and shoulder)

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31
Q

Contraindications for arthroplasty

A

Active infection, advanced osteoporosis

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32
Q

Arthroplasty pre-op care

A

Administration of epoetin Alfa or autologous blood donation several weeks before procedure, remind patient to shower with antiseptic soap to decrease risk for infection

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33
Q

Arthroplasty post-op care

A

Monitor for DVT or PE, prevent thromboembolism through (SCDs, stockings, anticoagulants, start exercise and activity soon after surgery), monitor for infection, bleeding, and neurovascular compromise (pulses, color, temp, etc)

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34
Q

Arthroplasty patient education

A

Take antibiotics prior to any dental or invasive procedure (for the rest of life)

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35
Q

Hip replacement post-op care

A

Abduction device in place, ensure heels are elevated off bed to prevent injuries, provide trapeze device for repositioning, monitor for signs of joint dislocation (increased hip pain, affected leg appears shorter or internally rotated)

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36
Q

Hip replacement patient education

A

Use elevated toilet seat, avoid low chairs (avoid hip flexion over 90 degrees), do not cross ankles or legs (can cause joint dislocation)

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37
Q

Knee replacement post-op care

A

Continuous passive motion if ordered, do NOT place pillow or knee gatch beneath the knee (can result in flexion contractures), educate patient to avoid kneeling or deep knee bends following procedure

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38
Q

Metabolic bone disorder causing a decrease in bone mass leading to fragile bones and increased risk for bone fractures

A

Osteoporosis

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39
Q

What is the precursor to osteoporosis?

A

Osteopenia

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40
Q

Osteoporosis risk factors

A

Older age, low body weight, vitamin D or calcium deficiency, smoking, immobility, corticosteroids use, hyperparathyroidism, white and Asian

41
Q

S/S of osteoporosis

A

Back pain, height that decreases over time, kyphosis, balance issues

42
Q

Osteoporosis treatment

A

Medications: calcitonin, estrogen, Alendronate, Raloxifene (these meds decrease bone resorption)

43
Q

Osteoporosis patient education

A

Ensure adequate intake of calcium and vitamin D, engage in weight-bearing exercise (strength training, walking), implement home safety precautions

44
Q

Bone loss due to vitamin D deficiency (adult equivalent to rickets in children)

A

Osteomalacia

45
Q

Osteomalacia risk factors

A

Insufficient sunlight exposure or insufficient vitamin D intake, disease or disorder that impairs vitamin D absorption such as crohns or celiac disease

46
Q

Osteomalacia S/S

A

Bone pain and weakness, waddling gait, increased falls (d/t soft bones)

47
Q

Osteomalacia labs

A

Decreased serum calcium and phosphorus, elevated PTH

48
Q

Osteomalacia treatment

A

Vitamin D supplementation

49
Q

Metabolic disorder that causes bones to become soft, structurally disorganized, and weak placing patients at high risk for fractures

A

Paget’s disease

50
Q

Paget’s disease risk factors

A

Older age, European descent, male gender

51
Q

S/S of Paget’s disease

A

Bone pain and stiffness, abnormal spinal curvature, fractures, bowing of long bones

52
Q

Paget’s disease patient education

A

Engage in gentle exercises to help maintain mobility, implement safety precautions to prevent falls

53
Q

Infection of the bone

A

Osteomyelitis

54
Q

Osteomyelitis risk factors

A

Deep wounds, recent trauma such as open fracture, orthopedic surgery, diseases such as diabetes

55
Q

Osteomyelitis S/S

A

Bone pain, redness, swelling, fever, increased WBCs

56
Q

Osteomyelitis treatment

A

Long-term IV antibiotics (often via PICC line), surgical debridement of bone

57
Q

Metabolic disorder that causes hyperuricemia (elevated uric acid levels) causing formation of uric acid crystals that become deposited in the joints causing joint pain, redness, swelling, and tophi (red, enlarged area on joints)

A

Gout

58
Q

Gout most often affects

A

The great toe

59
Q

Gout labs

A

Elevated uric acid levels, synovial fluid from joint via arthrocentesis will show urate crystals

60
Q

Gout treatment

A

NSAIDs and ice packs for pain control; colchicine for acute gout attack, allopurinol and probenecid for chronic gout

61
Q

gout patient education

A

Avoid alcohol, avoid purine-rich foods (red meat, organ meat, shellfish, fructose drinks), avoid starvation dieting, increase fluid intake, reduce stress

62
Q

A _________ fracture does not break through the skin

A

Closed

63
Q

_________ fractures break through the skin and carry a high risk for infection

A

Open

64
Q

What kind of fracture occurs perpendicular to the long axis of the bone?

A

Transverse

65
Q

What kind of fracture occurs when two or more bones are crushed together due to a loading force?

A

Impacted/compression

66
Q

A _________ fracture is when the fracture results in two or more pieces

A

Comminuted

67
Q

What kind of fracture occurs at an angle?

A

Oblique

68
Q

What kind of fracture occurs from a twisting motion and is a definite sign of abuse?

A

Spiral

69
Q

Fracture in which only one side of the bone is broken and is most common in children

A

Greenstick

70
Q

S/S of fracture

A

Pain, swelling, ecchymosis, deformity, muscle spasms

71
Q

Procedure for treatment of fractures in which bones are placed back into normal position without cutting the skin open

A

Closed reduction

72
Q

Fracture treatment involving the insertion of screws and pins into the bone and are attached to an external frame

A

External fixation

73
Q

Fracture treatment involving cutting open of skin, placement of screws, pins, and rods to correct fracture, followed by closure of skin

A

Open reduction and internal fixation (ORIF)

74
Q

Fracture complication in which fat globule that comes out of the bone marrow and travels to the lungs

A

Fat embolism

75
Q

Fat embolism is more common with what type of fractures?

A

Long bone and hip

76
Q

S/S of fat embolism

A

Dyspnea, confusion, tachypnea, tachycardia, petechiae, decrease O2 saturation

77
Q

Fat embolism treatment

A

Supportive: bed rest, IV fluids, oxygen

78
Q

Fracture complication resulting in increased pressure in the muscle compartment that impairs circulation to that extremity

A

Compartment syndrome

79
Q

S/S of compartment syndrome (hint: 5 P’s)

A

Intense Pain (even with passive movement and unrelieved with meds), Paresthesia, Paralysis, Pallor, Pulselessness. Additionally, affected extremity will be hard and swollen

80
Q

Compartment syndrome nursing care/considerations

A

DO NOT apply cold to area, DO NOT elevate extremity, notify provider

81
Q

Compartment syndrome treatment

A

Fasciotomy (deep incision into muscle compartment to relieve pressure), amputation may be necessary

82
Q

Handling a plaster cast

A

With palms of hand until dry

83
Q

Cast nursing care

A

Elevate cast above level of heart for first 48 hours

84
Q

Cast patient education

A

Do not stick anything in cast, if itching use a blow dryer on cool setting, notify provider of increased pain, hot spots, matador, or increased drainage

85
Q

Application of weights to patients skin in order to immobilize affected area a decrease muscle spasm

A

Skin traction

86
Q

Bryants traction and bucks traction are examples of

A

Skin traction

87
Q

_________ traction is typically used in children for hip dysplasia

A

Bryants

88
Q

_________ traction is used in adults for hip fractures

A

Bucks

89
Q

Insertion of screws or pins into bones for long bone fractures

A

Skeletal traction

90
Q

Traction device used for cervical bone fractures

A

Halo traction

91
Q

Traction nursing care

A

Weights should hang freely (do not pick them up; should not be resting on floor), provide analgesic and muscle relaxants

92
Q

Cervical traction nursing care

A

Move patient as unit, never apply pressure to rods, ensure wrench or screwdriver is attached to vest for emergency removal

93
Q

Prevention of hip flexion contractures

A

Perform ROM exercises, avoid elevating stump, avoid chair-sitting, lay in prone position for 20-30 min q3-4h

94
Q

Life-threatening complication that occurs due to certain drugs used in general anesthesia

A

Malignant hyperthermia

95
Q

Example of drug that can trigger malignant hyperthermia

A

Succinylcholine

96
Q

S/S of malignant hyperthermia

A

Muscle rigidity, fever, tachycardia, tachypnea, dysrhythmias, hypotension, cyanosis

97
Q

Altered labs that may be present with malignant hyperthermia

A

Metabolic acidosis and myoglobin present in urine

98
Q

Treatment of malignant hyperthermia

A

Discontinue surgery if possible, administer antidote dantrolene, 100% oxygen, implement cooling measures such as cold IV fluids and ice packs, sodium bicarbonate

NCLEX: Med Surg (5 decks)

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