Musculoskeletal System (Exam One) Flashcards
1
Q
What are the functions of the skeleton?
A
- Provides structural support
- Protects organs
- Provides attachment
- Blood cell production
- Stores minerals
2
Q
What is hemopoiesis? Where does this occur?
A
- Production of blood cells and platelets
- Occurs in red bone marrow
3
Q
What are the functions of the muscle?
A
- Stabilize the skeleton
- Produce heat
- Aids in the return of blood from the legs
4
Q
A fracture in the epiphyseal plate, or long bones, can affect what?
A
Growth
5
Q
If a child is under the age of 16, a bone fracture will most likely do what? If the bone does not realign itself appropriately what might be necessary?
A
- Repair itself
- Rebreaking of the bone in order to realign the bone
6
Q
Bone fractures in adults require what in regards to repair?
A
- Extensive repair
- Perfect realignment
7
Q
What are the three types of bone cells?
A
- Osteoblasts
- Osteoclasts
- Osteocytes
8
Q
What are osteoblasts responsible for?
HINT: Building Blocks
A
- Producing new bone
- Rebuilding existing bones when they are broken
9
Q
Osteoclasts are responsible for what?
HINT: Clean up
A
- Reabsorb existing bone when more calcium is needed in the blood
- Removes excess bone
- Breakdown existing bone
10
Q
Osteocytes are responsible for what?
A
- Maintaining bone tissue
- Cycle of bone
11
Q
Give examples of long bones.
A
- Femur
- Humerus
- Tibia
12
Q
Give examples of short bones.
A
- Carpals in the hand
- Tarsals in the foot
13
Q
Give examples of flat bones.
A
- Ribs
- Skull
- Scapula
- Sternum
14
Q
Give examples of irregular bones.
A
- Sacrum
- Mandible
- Ear ossicles
15
Q
The axial skeleton is composed of what?
A
- Skull
- Hyoid
- Vertebral Column
- Rib Cage
16
Q
The appendicular skeleton is composed of what?
A
- Arms/Legs
- Shoulder
- Pelvic Girdles
- Synovial Joints
17
Q
What are the characteristics of an immature skeleton in children?
A
- Increased resilience to stress
- Thicker periosteum
- Shorter healing times
- Apophysis
18
Q
What is a disadvantage for children regarding the immature skeleton?
A
- Misaligned fragments become solid sooner
- Bones may heal themselves in an improper position
19
Q
What is the purpose of the thoracic cage?
A
- Protects the heart, lungs, liver, and spleen
- Expands chest cavity for inhalation
20
Q
List the vertebrae of the vertebral column in order.
HINT: Cereal, Turkey, Lasagna, Snack, Chocolate
A
- Cervical
- Thoracic
- Lumbar
- Sacrum
- Coccyx
21
Q
Synovial fluid is responsible for what?
A
- Lubrication of joints
- Nourishes cartilage
- Contain phagocytes to removes debris
22
Q
What are bursae?
A
Small sacs of synovial fluid between joints and other structures
23
Q
Tendons attach _____ to _____.
A
Muscle to bones
24
Q
Ligaments connect _____ to _____.
A
Bones to bones
25
Do antagonistic muscles work with or against each other?
Work against each other
26
Synergistic muscles aid in what functions of the body?
- Fine motor control
| - Maintain balance
27
Describe cardiac muscle.
- Involuntary
| - Contracts spontaneously
28
Describe smooth muscle.
- Involuntary
- Found in the walls of hollow structures
- Contracts based on neuronal and hormonal influences
29
Describe skeletal muscle.
- Voluntary
| - Contracts based on neuronal stimulation
30
Contractions of the skeletal muscle allow for what?
- Posture maintenance
- Body movement
- Heat production
- Facial expressions
31
Muscular atrophy is the result of what?
Immobility of muscular activity
32
Muscular hypertrophy is the result of what?
Increased muscular activity
33
The point of origin ____ move during contraction.
Does not
34
The point of insertion ____ move during contraction.
Does
35
Skeletal muscles require what in order to contract?
Electrolytes
36
Which electrolytes are necessary for muscle contraction?
- Calcium
- Sodium
- Potassium
37
Which electrolytes enter the muscle fibers?
- Calcium
| - Sodium
38
Which electrolyte exits the muscle fibers?
Potassium
39
Are osteoarthritis and osteoporosis a normal part of the aging process?
No
40
What is joint crepitation?
Grating or crackling sound with joint movement
41
What six components should be assessed during a neurovascular assessment?
HINT: 6 P's
- Pain
- Pallor
- Pulse
- Paresthesia
- Paralysis
- Pressure
42
What is a cause for concern when performing a muscle strength test? What might this indicate?
- Only one side of the body is presenting with weakness
| - Might be indicative of an underlying neurological issue
43
What is the purpose of the muscle strength test?
Assesses for weakness and localizes a likely problem area
44
The muscle strength test should be performed _____.
Bilaterally
45
What is the normal range for calcium?
9.0 - 10.5
46
What is the normal range for phosphorus?
2.6 - 4.5
47
If the patients calcium level is elevated, the nurse knows that what other laboratory value will be elevated?
Phosphorus
48
An increase in ALP may be indicative of what?
- Bone abnormalities
| - Formation of new bone
49
Too much of what lab value can damage the muscle?
Creatine Kinase
50
Where can oxygen molecules be stored?
Muscle tissue
51
Muscle breakdown causes what to be released into the bloodstream?
Myoglobin
52
The nurse knows these muscles are at risk if a patient presents with an elevated creatine kinase and myoglobin?
Cardiac muscle
53
Potassium aids in muscle _____.
Contraction
54
What electrolyte allows the heart to send electrical impulses?
Potassium
55
Which laboratory value is nonspecific?
ESR
56
X-rays are used to identify what?
- Soft tissue abnormalities
- Bony abnormalities
- Various trauma
57
What education should the nurse provide to the patient if they require an x-ray?
- Painless
| - Importance of remaining still
58
If contrast dye is utilized, the nurse must verify what?
- Shellfish allergy
| - Liver function
59
What is an arthroscopy?
- Surgical intervention used to visualize the inside of a joint
- Usually performed in the knee
60
What is an arthrocentesis?
- Collects synovial fluid from a joint capsule using a syringe
- Also known as joint aspiration
61
What is the preferred method of treatment for many musculoskeletal injuries?
R - Rest for 2-3 days
I - Ice inflammation 15-20 minutes every 2-3 hours
C - Compression with elastic bandages (do not leave on while sleeping)
E - Elevate above level of the heart
62
Ask the ____ if they are satisfied with the level of pain control.
Patient
63
Which hours are critical for soft-tissue injuries?
The first 12 to 24 hours
64
What are soft-tissue injuries?
Injury to a muscle, tendon, or ligament
65
What is a sprain?
Excessive stretching of a ligament
66
What is a sTrain?
Excessive stretching of a Tendon or muscle
67
What are the clinical manifestations of soft-tissue injuries?
- Decreased ROM
- Pain
- Edema
- Decreased function
- Contusion (bruising)
68
Soft-tissue injuries are ____ _____.
Self limiting
69
What is dislocation?
When the ends of bones are forced from their normal position
70
Where do dislocations occur?
Joints
71
What should immediately follow a dislocation? Why?
- Immobilization or splinting
| - To preserve function of extremity
72
What must be performed before treatment of the dislocation? Why?
- X-rays
| - Determine the extent of the injury
73
A patient with a dislocated joint will lose range of motion in which direction of the joint?
Distally
74
What education should the nurse provide to a patient who has a dislocation?
A patient with a dislocated joint is at a greater risk for dislocations in the future
75
What is bursitis?
Inflammation of the bursa itself
76
What is the cause of bursitis?
Repetitive joint action or motion
77
What makes up the rotator cuff?
Muscles and tendons
78
How is a rotator cuff injury diagnosed?
MRI
79
What is carpel tunnel syndrome?
- Median nerve compression
| - Swelling within the tunnel
80
What might a patient with carpel tunnel syndrome complain of?
- Pain
- Numbness
- Paresthesia
- Muscle weakness
- Possible fine motor deficits
81
What tests are used to diagnose carpel tunnel syndrome?
- Phalen's sign
| - Tinel's sign
82
Explain Phalen's sign?
- Forced flexion of patients hands for 30-60 seconds compressing the nerve
- Patient will experience burning, tingling, numbness
83
Explain Tinel's sign.
- Light tapping over the nerve
| - Patient will experience a tingling sensation
84
Who is at an increased risk for developing carpel tunnel syndrome? What can they do to mitigate this development?
- Secretaries
- Individuals who type
- Use wrist elevation pads
- Wrist splint
85
What is a fracture?
A break in the bone
86
What is the FIRST priority if a fracture is suspected?
- Immobilize the extremity!
- Splint the extremity
- RICE
87
Which types of fractures may result in limb shortening?
- Complete
| - Complex
88
Should the nurse be concerned about bleeding with a broken bone/fracture?
Yes
89
What labs would the nurse want to assess in a patient with a fracture?
- Hemoglobin
- Hematocrit
- ESR
- Calcium
90
How are fractures diagnosed?
X-ray
91
The inability to locate a pulse in an extremity that is distal to an injury is considered what?
EMERGENCY!
92
If a patients capillary refill is 7 seconds, the nurse should do what?
Notify the health care provider
93
What is the most common treatment for simple fractures?
Reduction
94
_____ is key after a fracture has been successfully reduced.
Immobilization
95
A closed reduction immobilization will include which joints?
Joints above and below the fracture
96
What is bucks traction?
Temporary medical device which applies a pulling force on a fractured extremity using weight which causes immobility of that extremity
97
What is the primary purpose of Bucks Traction? What is the weight limit for Bucks Traction?
- Immobilization until surgery can be done
- Pain relief for the patient
-10 pounds
98
What should never be touched by the nurse regarding Bucks Traction?
Weights
99
If the weights are not in the correct position for Bucks Traction, what should the nurse do?
-Notify the RN or health care provider
100
What is Skeletal Traction used to treat? What is the weight limit for Skeletal Traction?
- Fractures of the femur
| - 20 to 40 pounds
101
When is Skeletal Traction used?
- When Bucks Traction will not work
| - Fractures that require longer duration than Bucks Traction
102
What should the nurse expect with Skeletal Traction?
Pain medication will be administered regularly
103
The nurse knows she should do what if the patient expresses their pain is unrelieved or severe while in skeletal traction?
Notify the health care provider
104
Open reduction with internal fixation (ORIF) is commonly performed on patients who have a fracture in which joint?
Hip fracture
105
When will external fixation be utilized?
Severe bone damage (i.e. crush injury, splintered fractures, numerous breaks)
106
What is osteomyelitis?
Infection of the bone caused by invasion of bacteria into bone and soft tissue
107
The nurse knows the healing process may be delayed for which patients?
- Diabetic patients
| - Older adults
108
What are concerning findings of the neurovascular assessment that indicate neurologic complications?
- Numbness and tingling
- Decreased sensations
- Decreased mobility
109
What are concerning findings of the neurovascular assessment that indicate circulation complications?
- Decreased pulses
- Absent pulses
- Cool skin temperature
- Dusky skin
110
What should the nurse do if concerning findings are present during the neurovascular assessment?
Notify the health care provider
111
Which fracture poses the biggest risk for bleeding or hemorrhage and infection?
Open fracture
112
Open fractures require what?
Aggressive surgical debridement
113
Common infections with fractures stem from which sites?
- Wound
- Pin-site
- Surgical incision
- Bone (osteomyelitis)
114
All post-op fracture patients should be on what type of medication?
Prophylactic anticoagulant
115
What is the priority nursing intervention with venous thrombosis?
Prevention
116
What is compartment syndrome?
- Swelling and increased pressure occur within a limited space
- Pressure compromises function of blood vessels, nerves, and tendons
- Reduction of blood circulation and capillary refill
- Impaired tissue perfusion
- Life-threatening, EMERGENCY!
117
What are the causes of compartment syndrome?
- Decreased compartment size due to restrictive dressings, splints, casts
- Increased compartment size due to bleeding, edema, tissue swelling, IV infiltration
118
How is compartment syndrome prevented?
- Extremity elevation
| - Ice
119
What is the earliest symptom of compartment syndrome?
Patient reports severe increasing pain that is unrelieved by opioids
120
A fasciotomy may be necessary regarding what syndrome?
Compartment Syndrome
121
The patient is most at risk for what with a fasciotomy?
Infection
122
What may occur if compartment syndrome is not treated in a timely manner?
- Tissue necrosis
- Infection
- Rhabdomyolysis
- Renal failure
123
What is rhabdomyolysis?
- Death of muscle fibers
- Muscle fibers release protein into the bloodstream
- Excessive protein in renal system causes renal failure
124
What is fat embolism syndrome?
- Occurs in patients with long bone fracture
| - Small fat particles are dislodged from broken bone and distributed into tissues and organs
125
When will fat embolism syndrome occur?
72 hours after initial injury
126
What are the signs and symptoms of fat embolism syndrome in the skin?
- Petechiae
| - Red rash on chest, neck, axilla, and conjunctiva
127
What is the priority nursing management regarding fat embolism syndrome?
-Continuous immobilization of long bone fractures
128
What nursing interventions should be done for a patient with fat embolism syndrome?
- Notify the health care provider
- Apply oxygen
- High-fowlers
- Immobilization
- Corticosteroids
129
Fat embolism is most common in what type of fracture?
Long bone fracture
130
Infant hip dysplasia has a significant relationship with what?
Tight swaddling
131
What are the signs and symptoms of hip dysplasia?
-Limited hip abduction
-Asymmetrical skinfolds
-Uneven knee heights
-
132
What are the treatment options for hip dysplasia?
- Pavlik Harness
- Spica cast
- Surgery
133
What is the cause of scoliosis?
Unknown
134
What is scoliosis?
Curvature of the spine
135
What is clubfoot? Where is clubfoot is easily identified ?
- Complex deformity of the ankle and foot
| - Easily identified in utero
136
_____ __ _______ is a priority with clubfoot.
Correction of deformity
137
What is the common treatment approach for clubfoot?
Ponseti method
138
How long does acute osteomyelitis last?
< 4 weeks
139
How long does chronic osteomyelitis last?
> 4 weeks
140
What tests are used to diagnose osteomyelitis?
- CBC
- Bone biopsy
- Blood culture
- Imaging
141
The nurse would expect what labs to be elevated in a patient with osteomyelitis?
- WBC
| - ESR
142
How is osteomyelitis treated?
- Vigorous and prolonged antibiotic therapy
- Hyperbaric Oxygen Therapy
- Surgery
- Amputation
143
What is the most effective way to prevent osteomyelitis?
- Handwashing!
| - Sterile dressing changes
144
What is hyperbaric oxygen therapy?
Enhances bodies natural healing process by inhalation of 100% oxygen
145
What is osteoporosis?
- Chronic, progressive metabolic bone disease
- Causes weak and fragile bones that are prone to fracture
- Loss of bone density and structural deterioration
146
What are the risk factors for osteoporosis?
- Female
- Poor nutrition
- Smoking/Alcohol
- Caffeine
- Low calcium levels
- Family history
147
What is the single most effective prevention method for osteoporosis?
Low-impact exercise (i.e. walking)
148
Calcium supplements become more effective if paired with what other supplement?
Vitamin D
149
What is a DEXA scan?
Assesses the mineral density
150
What laboratory values should the nurse assess in a patient with osteoporosis?
- Calcium
- Vitamin D
- Phosphorus
151
How are falls and fractures prevented in patients with osteoporosis?
- Promote hazard free environment
- Decrease clutter
- Clear walkways
- Use of gait aide (i.e. walker, cane)
152
What is Paget's disease? What bones are most commonly affected?
- Skeletal bone disorder characterized by bone destruction
- Spine
- Femur
- Skull
- Pelvis
153
Paget's disease can result in what?
Osteoarthritis
154
What are the signs and symptoms of Paget's disease?
- Bone pain
- Limping/waddling gait
- Joint stiffness
- Pinched nerves
155
How is Paget's disease diagnosed?
X-ray
156
What is osteosarcoma? Where is it most commonly found?
- Most common and most fatal malignant bone tumor
- Tumor located inside of the bone
- Found in long bones
157
Who is most at risk for osteosarcoma?
- Younger people (ages 10 to 25)
| - Males
158
What are the signs and symptoms of osteosarcoma?
- Localized pain and swelling
| - Possible tender, palpable mass
159
Which bone cancer has a high rate of being cured?
Ewing's Sarcoma
160
What is Ewing's sarcoma?
-Malignant bone tumor
-Tumor located on outside of
the bone
161
Metastatic bone disease are commonly known as what? Why?
- Referred to as bone-seeking cancers
| - Tumors first present in tissue and then migrate to bone
162
What is primary gout?
Occurs when uric acid production is greater than the kidneys ability to excrete the uric acid
163
What medication can cause secondary gout?
-Diuretics
164
Gout usually occurs in which joint?
Big toe
165
What is a normal serum uric acid level?
2.4 - 7.0
166
What medication is commonly prescribed for patients with gout? What does this medication do?
- Allopurinol
| - Blocks the formation of uric acid
167
List foods high in purine.
- Seafood
- Red meat
- Organ meat
- Wild game
168
What should a patient with alcohol avoid?
- Diuretics
- Aspirin
- Alcohol
169
What is osteoarthritis?
-Slow deterioration of articular cartilage and bone ends of joints
170
What is the most common form of joint disease in North America?
Osteoarthritis
171
The cause of osteoarthritis is _____.
Unknown
172
Osteoarthritis most commonly affects which joints?
Weight bearing joints (i.e. hips, knees, hands, vertebral column)
173
What are the signs and symptoms of osteoarthritis?
- Increased pain with activity
- Decreased pain with rest
- Crepitus
- Heberden's nodes
- Bouchard's nodes
174
What are Heberden's nodes?
Pain and redness that is distal to the joint
175
What are Bouchard's nodes?
Pain and redness that is proximal to the joint
176
What is the key difference between osteoarthritis and rheumatoid arthritis?
Osteoarthritis has no system manifestations -- it is localized
177
Why is a patient with osteoarthritis educated to not take excessive amounts of NSAIDs?
NSAIDs can affect other organs
178
The synovial fluid removed from a joint should be what color?
Clear
179
Synovial fluid of this color would be concerning to the nurse. What would this indicate?
- Cloudy
- Milky
- Dark yellow with inflammatory cells
- Indicates rheumatoid arthritis
180
What is rheumatoid arthritis?
A chronic, progressive, systemic autoimmune disease
181
What is rheumatoid arthritis?
- A chronic, progressive, systemic autoimmune disease
| - Destroys synovial joints and other connective tissues
182
Rheumatoid arthritis is more prevalent in individuals with a _____ ____ of the disease. It can occur at ___ ____.
- Family history
| - Any age
183
An increase in lymphocytes and plasma cells, synovitis, and articular destruction is common in what disease?
Rheumatoid arthritis
184
Joint deformity is considered a late manifestation in what disease?
Rheumatoid arthritis
185
Rheumatoid arthritis generally begins in which extremities?
Upper extremities
186
Which joints are affected in rheumatoid arthritis?
Large peripheral joints (i.e wrist, elbows, shoulders, hips, jaw)
187
Rheumatoid arthritis can lead to what extracellular manifestations?
- Raynaud's phenomenon
- Carpel tunnel syndrome
- Felty syndrome
- Spleenomegaly
188
Patients with rheumatoid arthritis may be prescribed what?
- DMARD's
- Corticosteroids
- NSAIDs
189
Who should be involved in care for patients with rheumatoid arthritis?
Family
190
What is an arthroplasty?
Total joint replacement
191
If a patient undergoes a total hip or total knee replacement, what should be done if CPM is not ordered?
Pillow should be placed under the postoperative joint
192
Patients who have a joint replacement will be given what medication prior to surgery?
Prophylactic antibiotics
193
What should the nurse ensure for a post-op total hip replacement patient?
Proper positioning!
194
Patients who have had a hip replacement cannot be in what positions?
- Adduction
- Hyperflexion
- Bending over
- Crossing body and twisting
195
What is the most common post-op complication of a total hip replacement? The nurse should do what if this occurs?
- Hip dislocation
- Notify the surgeon immediately
- Administer pain medication
196
What is the correction positioning of a post-op total hip replacement patient?
- Supine, head slightly elevated
| - Abductor pillow in place
197
If placing a post-op hip replacement patient on a bed pan, how should the nurse rotate the patient?
Turn the hip and leg simultaneously
198
Regarding post-op hip replacement patients, what should be kept off of the bed to avoid skin breakdown?
Heels
199
If a hip replacement post-op patient presents with confusion, the nurse should be concerned about what?
Infection
200
Late infection can occur ____ after a total hip replacement.
One or more years
201
How should the nurse monitor dressings?
- Draw a line around the drainage to monitor hourly progression
- Report large of unexpected amounts
202
What lab values should be monitor post-op in a hip replacement or knee replacement patient?
- Hemoglobin
| - Hematocrit
203
Neurovascular assessments should be performed _____ to the surgical site.
Distal
204
Which patients are at the greatest risk for a DVT or PE?
Total hip replacement patients
205
Traumatic amputation are considered what?
Accidents
206
When transporting limbs or body parts, they should be what?
- In a bag
- Clean
- Cold
207
What is the most common amputation site?
Lower extremities
208
What occurs if the great toe is amputated?
Balance and gait are affected
209
What would be an appropriate nursing diagnosis for a pre-operative elective amputation patient?
Increased anxiety
210
Why are residual limbs wrapped in compression bandages during post-op care?
Ensures molding of the residual limb
211
What is phantom pain? What nursing management is provided with phantom pain?
- Patient feels as if the limb is still there
- Manage with prescribed pain medication
- This is REAL pain!
212
Is phantom sensation painful?
No
213
How is phantom pain assessed?
Just like normal pain
214
What is the nursing priority for amputee patients?
Empathetic nursing care
215
What must reduce prior to using prosthetics?
Swelling
216
Describe that bandaging technique for post-operative above the knee amputation patients?
- Elevate the foot of the bed for 24 hours after surgery
- Then keep bed flat to prevent contractures
- No pillows!
217
Explain the neuromuscular junction.
1) Neuron releases acetylcholine
2) Action potential travels down motor neuron to the synaptic end bulb
3) Acetylcholine crosses into the synaptic cleft and bonds with receptors on motor end plate
4) Action potential travels into the transverse tubules to the sarcoplasmic reticulum
5) Calcium from the sarcoplasmic reticulum bonds to myosin heads
6) Myosin shortens the sarcomeres and pulls the muscle fiber
218
Describe 0 on the Muscle Strength Testing Scale.
No detection of muscular contraction
219
Describe 1 on the Muscle Strength Testing Scale.
A barely detectable flicker or trace of. contraction with observation or palpation
220
Describe 2 on the Muscle Strength Testing Scale.
Active movement of body part with elimination of gravity
221
Describe 3 on the Muscle Strength Testing Scale.
Active movement against gravity only and not against resistance
222
Describe 4 on the Muscle Strength Testing Scale.
Active movement against gravity and some resistance
223
Describe 5 on the Muscle Strength Testing Scale.
Active movement against full resistance without evident fatigue (normal strength)
