Musculoskeletal System Flashcards
1
Q
osteoblasts
A
functional unit of bone; bone-forming cells (make new bone)
2
Q
osteocytes
A
mature bone cell
3
Q
osteoclasts
A
bone that is breaking down
4
Q
diaphysis
A
middle of bone; more compact (stronger); shaft
5
Q
epiphysis
A
end of long bone; lattice-like (lacy); one end of a long bone
6
Q
metaphysis
A
growth plate region
7
Q
articular cartilage over joint surfaces
A
reduces friction and acts as a shock absorber (cushions joint; rubber soles)
8
Q
medullary cavity
A
marrow cavity
9
Q
endosteum
A
lining of marrow cavity
10
Q
periosteum
A
tough membrane covering bone but not the cartilage
11
Q
joints/articulation
A
junction where 2 or more bones come together
12
Q
Diarthrodial/Synovial
A
freely movable
13
Q
types of synovial joints
A
Ball-and-socket, hinge, saddle joint, pivot joint, gliding joint
14
Q
non-synovial joint
A
cartilaginous; not freely movable
15
Q
types of non-synovial joints
A
Sutures in skull and vertebrae
16
Q
Dislocation
A
separation of joint surfaces; no longer in alignment
17
Q
traumatic dislocation is considered
A
orthopedic emergency
18
Q
symptoms of dislocation
A
Loss of movement
Pain
Deformity
19
Q
subluxation
A
Partial or incomplete displacement of the joint surface
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.
21
Q
causes of fractures
A
direct blows, crushing forces, sudden twisting motions, and extreme muscle contractions
22
Q
types of fractures
A
complete incomplete comminuted closed open spiral
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)
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
25
comminuted fracture
produces several bone fragments
26
closed fracture
simple fracture; does not cause a break in the skin
27
open fracture
compound fracture; the skin or mucous membrane wound extends to the fractured bone
28
osteomyelitis
infection of the bone
29
manifestations of fractures
```
pain
loss of function
deformity
shortening
crepitus
edema and ecchymosis
```
30
neurovascular assessment
```
Pain
Pallor
Pulse
Paresthesia
Paralysis
```
31
xray
Determines bone density, texture, erosion, changes in bone relationships
32
CT scan
Identified soft tissue and bony abnormalities and evaluates musculoskeletal trauma
33
MRI
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
arthrography
Visualization of a joint by injecting radiopaque substances into the joint cavity (common on knee, and shoulders)
35
bone scan
Evaluates the uptake of radionuclide material, the uptake is relate to the metabolism of the bone
36
bone mineral density
used to determine the core mineral content and the density of bone – helpful in dx of osteoporosis
37
myelogram
radiographic study of the spinal cord and nerve root using a contrast dye. Useful in evaluating patients with back pain
38
what is the first thing to do when someone sustains an injury?
immobolize them
39
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.
distal
40
treatment of open fractures
wound is covered with a sterile dressing to prevent contamination of deeper tissues
41
reduction
Fracture reduction refers to restoration of the fracture fragments to anatomic alignment and positioning
42
Methods of external fixation
bandages, casts, splints, continuous traction, and external fixators
43
closed reduction
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
open reduction
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
potential complications of fractures
shock
fat embolism
compartment syndrome
venous thromboembolism
delayed union vs. non-union
avascular necrosis
complex regional pain syndrome
46
shock
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
treatment of shock
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
fat embolism
presence of systemic fat globules from fractures that are distributed into tissues and organs after a traumatic skeletal injury
49
FES is also more common in patients with ______ __________
multiple fractures
50
The onset of symptoms in FES is rapid, typically within ___ to ___ hours of injury
12, 72
51
clinical manifestations of FES
hypoxemia, neurologic compromise, and a petechial rash (often on the chest or hand)
52
compartment syndrome
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
hallmark sign of compartment syndrome
pain that occurs or intensifies with passive ROM
54
management of compartment syndrome
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
fasciotomy
surgical decompression with excision of the fascia
56
Complications that may occur after fasciotomy
AVN and infection
57
venous thromboembolism
associated with reduced skeletal muscle contractions and bed rest; common after total hip or knee replacements
58
delayed union
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
nonunion
results from failure of the ends of a fractured bone to unite
60
avascular necrosis
bone loses its blood supply and dies; patient develops pain and experiences limited movement
61
treatment of AVN
surgical decompression, bone grafts, prosthetic replacement, or osteotomy
62
clinical manifestations of clinical regional pain syndrome
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
Volkmann's contracture
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
nursing management for closed fractures
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
nursing management for open fractures
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
The patient with a hip fracture/replacement is at risk for
osteoporosis
67
osteoporosis
porous bone or fragile bone disease, characterized by low bone mass and structural deterioration of bone tissue
68
prevention of osteoporosis
```
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
Hip fracture manifestations
External rotation
Muscle spasm
Shortening of affected extremity
Severe pain and tenderness
ONCE MANIFESTATIONS ARE PRESENT: IMMOBILIZE
70
nursing priorities for hip fractures
```
hydration
respiratory support
circulation checks
pain control
prevention of immobility complications
history of chronic conditions and medications
```
71
goals for fracture treatment
reduction
immobilize to maintain alignment
restoration of normal or near normal function of injury
manual re-alignment:
72
traction
Application of pulling force to an injured extremity while counter traction pulls in opposite direction
73
purpose of tractions
```
Prevent/decrease pain
Decrease muscle spasm
Immobilize joint
Reduce fracture
Maintain alignment
```
74
skin traction
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
skeletal traction
used for longer periods of time
physician inserts pin or wire into bone surgically (infected area)
traction weighs from 5-40 pounds
76
management of skin traction
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
management for skeletal traction
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
treat the fracture within ___ to ___ hours upon admission
24, 48
79
post-op hip fracture management (ORIF)
monitor VS
I&Os
monitor respirations
coughing and deep breathing
pain management
assess dressing and incision
80
post-op management
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
