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NU318 Exam 4 > Musculoskeletal System > Flashcards

Musculoskeletal System Flashcards

1
Q

osteoblasts

A

functional unit of bone; bone-forming cells (make new bone)

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2
Q

osteocytes

A

mature bone cell

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3
Q

osteoclasts

A

bone that is breaking down

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4
Q

diaphysis

A

middle of bone; more compact (stronger); shaft

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5
Q

epiphysis

A

end of long bone; lattice-like (lacy); one end of a long bone

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6
Q

metaphysis

A

growth plate region

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7
Q

articular cartilage over joint surfaces

A

reduces friction and acts as a shock absorber (cushions joint; rubber soles)

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8
Q

medullary cavity

A

marrow cavity

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9
Q

endosteum

A

lining of marrow cavity

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10
Q

periosteum

A

tough membrane covering bone but not the cartilage

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11
Q

joints/articulation

A

junction where 2 or more bones come together

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12
Q

Diarthrodial/Synovial

A

freely movable

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13
Q

types of synovial joints

A

Ball-and-socket, hinge, saddle joint, pivot joint, gliding joint

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14
Q

non-synovial joint

A

cartilaginous; not freely movable

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15
Q

types of non-synovial joints

A

Sutures in skull and vertebrae

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16
Q

Dislocation

A

separation of joint surfaces; no longer in alignment

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17
Q

traumatic dislocation is considered

A

orthopedic emergency

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18
Q

symptoms of dislocation

A

Loss of movement

Pain

Deformity

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19
Q

subluxation

A

Partial or incomplete displacement of the joint surface

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20
Q

fracture

A

A complete or incomplete disruption in the continuity of bone structure and is defined according to its type and extent. Fractures occur when the bone is subjected to stress greater than it can absorb.

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21
Q

causes of fractures

A

direct blows, crushing forces, sudden twisting motions, and extreme muscle contractions

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22
Q

types of fractures

A 
complete
incomplete
comminuted
closed
open
spiral
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23
Q

complete fracture

A

involves a break across the entire cross-section of the bone and is frequently displaced (removed from its normal position)

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24
Q

incomplete fracture

A

greenstick fracture

involves a break through only part of the cross-section of the bone; these more commonly occur in children

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25
Q

comminuted fracture

A

produces several bone fragments

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26
Q

closed fracture

A

simple fracture; does not cause a break in the skin

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27
Q

open fracture

A

compound fracture; the skin or mucous membrane wound extends to the fractured bone

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28
Q

osteomyelitis

A

infection of the bone

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29
Q

manifestations of fractures

A 
pain
loss of function
deformity
shortening
crepitus
edema and ecchymosis
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30
Q

neurovascular assessment

A 
Pain 
Pallor 
Pulse
Paresthesia
Paralysis
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31
Q

xray

A

Determines bone density, texture, erosion, changes in bone relationships

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32
Q

CT scan

A

Identified soft tissue and bony abnormalities and evaluates musculoskeletal trauma

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33
Q

MRI

A

Uses radio waves and magnetic fields to provide an image of soft tissue. Efficient in evaluating soft tissues, such as vertebral disk, tumor, ligaments and cartilage

34
Q

arthrography

A

Visualization of a joint by injecting radiopaque substances into the joint cavity (common on knee, and shoulders)

35
Q

bone scan

A

Evaluates the uptake of radionuclide material, the uptake is relate to the metabolism of the bone

36
Q

bone mineral density

A

used to determine the core mineral content and the density of bone – helpful in dx of osteoporosis

37
Q

myelogram

A

radiographic study of the spinal cord and nerve root using a contrast dye. Useful in evaluating patients with back pain

38
Q

what is the first thing to do when someone sustains an injury?

A

immobolize them

39
Q

The neurovascular status _____ to the injury should be assessed both before and after splinting to determine the adequacy of peripheral tissue perfusion and nerve function.

A

distal

40
Q

treatment of open fractures

A

wound is covered with a sterile dressing to prevent contamination of deeper tissues

41
Q

reduction

A

Fracture reduction refers to restoration of the fracture fragments to anatomic alignment and positioning

42
Q

Methods of external fixation

A

bandages, casts, splints, continuous traction, and external fixators

43
Q

closed reduction

A

In most instances, closed reduction is accomplished by bringing the bone fragments into anatomic alignment through manipulation and manual traction.

Traction (skin or skeletal) may be used until the patient is physiologically stable to undergo surgical fixation.

44
Q

open reduction

A

Through a surgical approach, the fracture fragments are anatomically aligned. Internal fixation devices (metallic pins, wires, screws, plates, nails, or rods) may be used to hold the bone fragments in position until solid bone healing occurs.

45
Q

potential complications of fractures

A

shock

fat embolism

compartment syndrome

venous thromboembolism

delayed union vs. non-union

avascular necrosis

complex regional pain syndrome

46
Q

shock

A

resulting from hemorrhage and more frequently noted in trauma patients with pelvic fractures and in patients with a displaced or open femoral fracture in which the femoral artery is torn by bone fragments.

47
Q

treatment of shock

A

stabilizing the fracture to prevent further hemorrhage, restoring blood volume and circulation, relieving the patient’s pain, providing proper immobilization, and protecting the patient from further injury

48
Q

fat embolism

A

presence of systemic fat globules from fractures that are distributed into tissues and organs after a traumatic skeletal injury

49
Q

FES is also more common in patients with ______ __________

A

multiple fractures

50
Q

The onset of symptoms in FES is rapid, typically within ___ to ___ hours of injury

A

12, 72

51
Q

clinical manifestations of FES

A

hypoxemia, neurologic compromise, and a petechial rash (often on the chest or hand)

52
Q

compartment syndrome

A

a sudden and severe decrease in blood flow to the tissues distal to an area of injury that results in ischemic necrosis if prompt, decisive intervention does not occur.

53
Q

hallmark sign of compartment syndrome

A

pain that occurs or intensifies with passive ROM

54
Q

management of compartment syndrome

A

maintaining the extremity at the heart level and opening and bivalving the cast or opening the splint, if one or the other is present.

55
Q

fasciotomy

A

surgical decompression with excision of the fascia

56
Q

Complications that may occur after fasciotomy

A

AVN and infection

57
Q

venous thromboembolism

A

associated with reduced skeletal muscle contractions and bed rest; common after total hip or knee replacements

58
Q

delayed union

A

occurs when healing does not occur within the expected time frame for the location and type of fracture; the healing time is prolonged, but the fracture eventually heals

59
Q

nonunion

A

results from failure of the ends of a fractured bone to unite

60
Q

avascular necrosis

A

bone loses its blood supply and dies; patient develops pain and experiences limited movement

61
Q

treatment of AVN

A

surgical decompression, bone grafts, prosthetic replacement, or osteotomy

62
Q

clinical manifestations of clinical regional pain syndrome

A

severe burning pain, local edema, hyperesthesia, stiffness, discoloration, vasomotor skin changes, and trophic changes that may include glossy, shiny skin and increased hair and nail growth.

63
Q

Volkmann’s contracture

A

permanent flexion contracture of the hand at the wrist, resulting in a claw-like deformity of the hand and fingers - especially associated with fracture of the humerus

64
Q

nursing management for closed fractures

A

educates the patient regarding the proper methods to control edema and pain

assistive devices and safety of home setting

fracture healing and restoration of strength and mobility may take an average maximum of 6 to 8 weeks

65
Q

nursing management for open fractures

A

risk for osteomyelitis, tetanus, and gas gangrene

prevent infection of the wound, soft tissue, and bone and to promote healing of bone and soft tissue

wound irrigation and débridement are initiated in the operating room as soon as possible

extremity is elevated to minimize edema. Neurovascular status must be assessed frequently

66
Q

The patient with a hip fracture/replacement is at risk for

A

osteoporosis

67
Q

osteoporosis

A

porous bone or fragile bone disease, characterized by low bone mass and structural deterioration of bone tissue

68
Q

prevention of osteoporosis

A 
Increase calcium and vitamin D
Weight bearing exercise
Don’t smoke
Don’t drink a lot of caffeine
Don’t drink a lot of carbonated beverages
69
Q

Hip fracture manifestations

A

External rotation
Muscle spasm
Shortening of affected extremity
Severe pain and tenderness

ONCE MANIFESTATIONS ARE PRESENT: IMMOBILIZE

70
Q

nursing priorities for hip fractures

A 
hydration
respiratory support
circulation checks
pain control
prevention of immobility complications
history of chronic conditions and medications
71
Q

goals for fracture treatment

A

reduction

immobilize to maintain alignment

restoration of normal or near normal function of injury

manual re-alignment:

72
Q

traction

A

Application of pulling force to an injured extremity while counter traction pulls in opposite direction

73
Q

purpose of tractions

A 
Prevent/decrease pain
Decrease muscle spasm
Immobilize joint
Reduce fracture
Maintain alignment
74
Q

skin traction

A

Force applied is transmitted from skin to the bones via superficial fascia, deep fascia and intramuscular septa

Used for short term treatment

Traction used weighs about 4-8 lbs

75
Q

skeletal traction

A

used for longer periods of time

physician inserts pin or wire into bone surgically (infected area)

traction weighs from 5-40 pounds

76
Q

management of skin traction

A

Always inspect skin beneath tape, boots, splints

Check pressure over bony prominence

Check peripheral vascular assessments

Check skin integrity – every 8 hours

Check for skin breakdown, redness, blisters, nerve damage, circulatory impairment

77
Q

management for skeletal traction

A

Always inspect skin at each pin or screw insertion site

Proper positioning; internal and external rotation; watch for foot drop

Increased risk for infection (osteomyelitis)

Check for skin breakdown (especially on elbows and heels), redness, blisters, neurovascular, cap refill, color, temperature, pulses, sensation (higher risk for fat embolism due to immobility)

Sterile dressing for first 48 hours

78
Q

treat the fracture within ___ to ___ hours upon admission

A

24, 48

79
Q

post-op hip fracture management (ORIF)

A

monitor VS

I&Os

monitor respirations

coughing and deep breathing

pain management

assess dressing and incision

80
Q

post-op management

A

Avoid hyperextension

Place a pillow or abductor splint between legs (first 6 weeks)

Avoid extreme hip flexion – don’t bend hip at 90 degrees

Avoid turning patient on affected side until approved by surgeon

Use elevated toilet seat, assistive devices to avoid bending

Inform surgeon of severe pain, fever, loss of function

NU318 Exam 4 (7 decks)

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