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Advanced Lifespan > Orthopedics and Osteoporosis > Flashcards

Orthopedics and Osteoporosis Flashcards

1
Q

Excessive stretching of a muscle it’s facial sheath, or a tendon

A

Strain

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2
Q

Injury to the ligamentous structures surrounding a joint

A

Sprain

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3
Q

Etiology of strains and sprains

A

Abnormal stretching or twisting forces that may occur during vigorous activities

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4
Q

Avulsion fractures may occur with…

A

Severe sprains

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5
Q

Hemarthrosis

A

Bleeding into a joint space or cavity

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6
Q

How can you prevent strains and sprains?

A

Warm up muscles before exercise/vigorous activity. Follow with stretching.

Build up muscle strength and bone density with strength, balance, and endurance exercises.

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7
Q

Acute intervention for sprains and strains

A 
RICE:
Rest, limit movement 
Ice injured area, 20-30 min applications
Compress injury, 30 min on, 15 min off 
Elevate above level of heart

Provide analgesia as needed

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8
Q

Do you apply heat or cold to strains/sprains in the post-acute phase?

A

Heat— reduces swelling and provides comfort

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9
Q

Severe injury of the ligamentous structures that surround a joint, displacing or separating the articulate surfaces of a joint

A

Dislocation

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10
Q

Partial or incomplete displacement of the joint surface

A

Subluxation

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11
Q

Etiology of dislocation and subluxation

A

Results from forces transmitted to the joint that disrupt the soft tissue support structures surrounding it

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12
Q

Clinical manifestations of dislocation and subluxation

A
  1. Deformity
  2. Local pain
  3. Tenderness
  4. Loss of function
  5. Swelling of soft tissues
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13
Q

Complications of dislocations

A
  1. Open joint injuries
  2. Intraarticular fractures
  3. Compartment syndrome
  4. Avascular necrosis
  5. Damage to adjacent neurovascular tissue
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14
Q

Why are dislocations often considered orthopedic emergencies?

A

Risk of significant vascular injury

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15
Q

Bursitis

A

Inflammation of the bursae (closed sacs located at sites of friction that are lined with synovial membrane and contain small amounts of synovial fluid)

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16
Q

Etiology of bursitis

A

Improper body mechanics, repetitive kneeling, jogging in worn-out shoes, and prolonged sitting with crossed legs

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17
Q

Clinical manifestations of bursitis

A
  1. Warmth
  2. Pain
  3. Swelling
  4. Limited range of motion
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18
Q

What are the steps in the process of fracture healing?

A
  1. Fracture hematoma
  2. Granulation tissue
  3. Callus formation
  4. Ossification of callus
  5. Consolidation
  6. Remodeling
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19
Q

When do fracture hematomas occur?

A

Within the first 72 hours after injury

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20
Q

When does granulation tissue form after a fracture?

A

3 to 14 days post-injury

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21
Q

Granulation tissue produces the basis for…

A

New bone substance (osteoid)

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22
Q

What is callus made of?

A

Cartilage, osteoblasts, calcium, phosphorus

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23
Q

An unorganized network of bone forms and is woven around the fracture parts in which stage of healing?

A

Callus formation

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24
Q

When does callus formation occur

A

By the end of the 2nd week post-injury (can be visualized with X-ray)

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25
Q

When does ossification of callus occur?

A

From 3 weeks to 6 months after the fracture occurs, continues until it’s healed

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26
Q

“Clinical union” occurs during which stage of fracture healing?

A

Ossification of callus

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27
Q

“Radiologic union” occurs during which stage of fracture healing?

A

Consolidation

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28
Q

When does consolidation occur?

A

Can occur up to 1 year after injury

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29
Q

Closed (simple) fracture

A

Fracture that doesn’t break through the skin’s surface

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30
Q

Open (compound) fracture

A

Fracture that disrupts the skin integrity, causing an open wound and tissue injury with risk of infection

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31
Q

Complete fracture

A

Fracture that goes through the entire bone, dividing it into two parts

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32
Q

Incomplete fracture

A

Fracture that goes through only part of the bone

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33
Q

Comminuted fracture

A

Fracture that has multiple fracture lines splitting the bone into multiple pieces

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34
Q

Displaced fracture

A

Fracture that has bone fragments that aren’t in alignment

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35
Q

Nondisplaced fracture

A

Fracture that has bone fragments that remain in alignment

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36
Q

Fatigue (stress) fracture

A

Fracture that results when excess strain occurs from recreational and athletic activities

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37
Q

Pathologic (spontaneous) fracture

A

Fracture that occurs to bone that is weak from a disease process, such as bone cancer or osteoporosis

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38
Q

Compression fracture

A

Fracture that occurs from a loading force pressing on callus bone

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39
Q

Oblique fracture

A

Fracture that occurs from an oblique angle and across bone

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40
Q

Spiral fracture

A

Fracture that occurs from twisting motions (commonly physical abuse)

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41
Q

Impacted fracture

A

Fractured bone is wedged inside opposite fractured fragment

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42
Q

Greenstick fracture

A

Fracture that occurs on one side (cortex) but doesn’t extend completely through the bone

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43
Q

Transverse fracture

A

Line of the fracture extends across the bone shaft at a right angle to the longitudinal axis

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44
Q

What can happen if you cover a fresh plaster cast?

A

Air can’t circulate, so heat builds up and causes burns and delays drying time

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45
Q

How often do you need to perform neurovascular assessments after applying a cast?

A

Every hour for the first 24 hours

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46
Q

Elevate fresh casts above the level of the heart for the first ____ to ____ hours to prevent edema

A

24 to 48 hours

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47
Q

What should patients with a new cast report?

A
  1. Painful areas under the cast
  2. Hot spots
  3. Increased drainage
  4. Areas warm to the touch
  5. Odors
48
Q

Internal fixation

A

Surgical insertion of pins, plates, rods, or screws to realign and maintain bone fragments

49
Q

External fixation

A

Use of percutaneous pins and wires attached to an external frame to immobilize a fracture

50
Q

Indications for external fixation

A
  • Simple fractures
  • Complex fractures with extensive soft tissue damage
  • Correction of congenital bony defects
  • Nonunion or malunion
  • Limb lengthening
51
Q

How often should neurovascular assessments be perfomred?

A

Every hour for the first 24 hours after musculoskeletal injury, then every 1 to 4 hours thereafter

52
Q

What should be included in a neurovascular assessment?

A 
Peripheral vascular assessment
- Color, temperature
- Capillary refill
- Pulses bilaterally 
- Peripheral edema 
Peripheral neurologic assessment
- Sensory and motor innervation bilaterally
- Motor function
- Sensation
- Pain
53
Q

What are common complications that can occur with fracture injuries?

A
  • Edema and swelling
  • Pain and tenderness
  • Muscle spasm
  • Deformity
  • Ecchymosis/contusion
  • Loss of function
  • Crepitation
54
Q

What are common complications that can occur during fracture healing?

A
  • Delayed union
  • Nonunion
  • Malunion
  • Angulation
  • Pseudoarthrosis
  • Refracture
  • Myositis ossificans
55
Q

Crepitation

A

Grating or crunching together of bony fragments producing palpable or audible crunching or popping sensations.
- Can increase the chance of union if bone moves excessively

56
Q

Delayed union

A

Fracture healing progresses more slowly than expected. Healing eventually occurs.

57
Q

Nonunion

A

Fracture fails to heal despite treatment. No x-ray evidence of callus formation.

58
Q

Malunion

A

Fracture heals in expected time but in an unsatisfactory position. Can cause deformity or dysfunction.

59
Q

Angulation

A

Fracture heals in an abnormal position in relation to midline of structure– a type of malunion

60
Q

Pseudoarthrosis

A

Type of nonunion occurring at the fracture site in which a false joint is formed with abnormal movement at the site

61
Q

Refracture

A

New fracture occurring at the original fracture site

62
Q

Myositis ossificans

A

Deposition of calcium in muscle tissue at site of significant blunt muscle trauma or repeated muscle injury

63
Q

Traction

A

Application of a pulling force to an injured or diseased part of the body or an extremity

64
Q

Uses for traction

A
  1. Prevent or reduce pain and muscle spasm
  2. Immobilizes a joint/body part to prevent soft tissue damage
  3. Reduce a fracture or dislocation
  4. Treat pathologic joint condition
  5. Expend a joint space
  6. Promote passive and active exercise
65
Q

When is skin traction used?

A

SHORT TERM
Used to decrease muscle spasms and immobilize an extremity prior to surgery or until skeletal traction is possible
Pulling force is applied by weights attached by rope to the client’s skin with tape, straps, boots, or cuffs.

66
Q

What needs to be assessed with skin traction?

A
  • Skin assessment

- Pressure points (every 2 to 4 hr.)

67
Q

When is skeletal traction used?

A

LONGER TERM
Used to align injured bones/joints or to treat joint contractures and congenital hip dysplasia.
Pins or wires are inserted into the bone, either partially or completely, to align and immobilize the injured part.

68
Q

What needs to be assessed with skeletal traction?

A
  • Signs of infection (drainage, redness, loosening of pins, tenting of skin at pin site)
69
Q

Indications for amputation

A
  1. Peripheral vascular disease
  2. Atherosclerosis
  3. Diabetes mellitus → peripheral neuropathy → trophic ulcers → gangrene
  4. Traumatic injury
  5. Thermal injury
  6. Tumors
  7. Osteomyelitis
  8. Congenital limb disorders
70
Q

What do you need to assess for in patients receiving an amputation?

A
  • Preexisting illness

- Vascular and neurologic status

71
Q

What mental health condition should you assess for in patients receiving amputations because of a traumatic injury?

A

PTSD– patient may not have had time to prepare or even participate in decision to remove limb

72
Q

What complications should you monitor for in patients with an amputation?

A
  • Hypovolemia (watch for bleeding)
  • Infection (watch for warmth, odor, drainage)
  • Flexion contractures
73
Q

How is incisional pain treated with amputationns?

A

Analgesics

74
Q

What medications can be given for phantom limb pain?

A
  • Calcitonin (1st week post-op)
  • Beta blockers
  • Antiepileptics
  • Antispasmodics
  • Antidepressants
75
Q

If immediate postoperative prosthesis is applied, what do you need to have available for emergency use?

A

Surgical tourniquets

76
Q

Arthroplasty

A

Reconstruction or replacement of a joint to relieve pain, improve or maintain ROM, and correct deformity

77
Q

Autologous blood donation

A

Patient donates blood prior to a procedure which can be used during or after the procedure

78
Q

Hemoglobin and hematocrit levels can continue to drop for ___ hours after surgery.

A

48

79
Q

What complications of arthroplasty should you assess for?

A
  • DVT (swelling, redness, pain in calf)

- Pulmonary embolism (shortness of breath, chest pain)

80
Q

Osteoporosis

A

Chronic, progressive metabolic bone disease characterized by low bone mass and structural deterioration of bone tissue, leading to increased bone fragility

81
Q

What diseases are associated with osteoporosis?

A
  • Inflammatory bowel disease
  • Intestinal malabsorption
  • Kidney disease
  • Rheumatoid arthritis
  • Hyperthyroidism
  • Chronic alcoholism
  • Liver cirrhosis
  • Hypogonadism
  • Diabetes
82
Q

What medications are associated with developing osteoporosis?

A
  • Anti seizure drugs
  • Aluminum-containing antacids
  • Heparin
  • Certain cancer treatments
  • Excessive thyroid hormones
83
Q

Why is osteoporosis more common in women than men?

A
  • Lower calcium intake
  • Less bone mass d/t smaller frame
  • Bone resorption begins at an earlier age and is accelerated in menopause
  • Depleted skeletal reserves of calcium during pregnancy/breastfeeding
  • Longer lifespan
84
Q

Pathophysiology of osteoporosis

A

Bone resorption exceeds bone deposition

85
Q

Clinical manifestations of osteoporosis

A
  • Back pain
  • Spontaneous fractures
  • Gradual loss of height
  • Hunched back (kyphosis)
86
Q

Osteoporosis is defined as a bone mineral density of ____ or lower

A

-2.5

87
Q

Postmenopausal women should receive treatment for osteoporosis when…

A
  1. T score less than -2.5
  2. T score between -1 and -2/3 with additional risk factors
  3. Prior history of a hip or vertebral fracture
88
Q

How much calcium do premenopausal women need each day? Postmenopausal women?

A

1000 mg/day PRE

1500 mg/day POST

89
Q

Foods high in calcium?

A
  • Whole/skim milk
  • Yogurt
  • Turnip greens
  • Cottage cheese
  • Ice cream
  • Sardines
  • Spinach
90
Q

Why is it important to take calcium supplements in divided doses?

A

Doses higher than 500 mg are harder to absorb, so splitting the dose is more effective

91
Q

What vitamin is important for calcium absorption and bone formation?

A

Vitamin D

92
Q

How much supplemental vitamin D is recommended for patients at risk of osteoporosis?

A

800-1000 IU

93
Q

Mechanism of action for bisphosphonates

A

Inhibits osteoclast-mediated bone resorption to increase total bone mass and bone mineral density

94
Q

Bisphosphonates prototype medications

A

AlendRONATE

Zoledronic acid

95
Q

Bisphosphaonates are pregnancy risk category __

A

C

96
Q

Patients shouldn’t take bisphosphonates with these conditions..

A
  • Dysphagia
  • Esophageal stricture
  • Esophageal disorders
  • Serious kidney impairment
  • Hypocalcemia
97
Q

Side effects of bisphosphonates

A
  • Anorexia
  • Weight loss
  • Gastritis
  • Esophagitis, esophageal ulcerations
  • Musculoskeletal pain
  • Jaw osteonecrosis
98
Q

What should a patient do after taking a bisphosphonate?

A

Sit/stand upright for at least 30 minutes

99
Q

What reduces bisphosphonate absorption?

A
  • Antacids
  • Orange juice
  • Caffeine
  • Calcium
  • Iron
  • Magnesium
100
Q

What should you monitor in patients taking bisphosphonates?

A
  • Serum calcium levels

- Kidney function and hydration

101
Q

If _________ occurs while taking a bisphosphonate, discontinue the medication

A

Visual disturbances

102
Q

Mechanism of action of calcitonin

A

Decreases bone resorption by inhibiting osteoclast activity and increasing renal calcium excretion

103
Q

Contraindications with calcitonin

A
  • Pregnancy risk category C

- Hypersensitivity to fish protein

104
Q

Side effects of calcitonin

A
  • Nausea
  • Nasal dryness/irritation with nasal spray
  • Facial flushing
105
Q

Calcium supplements should be given with calcitonin to prevent…

A

secondary hyperparathyroidism

106
Q

What should you monitor in patients taking calcitonin?

A
  • Serum lithium levels (may decrease)

- Serum calcium levels (hypocalcemia)

107
Q

Selective estrogen receptor modulator prototype medication

A

Raloxifene

108
Q

Mechanism of action of raloxifene

A

Decreases bone resorption which slows bone loss and preserves bone mineral density

109
Q

Contraindications of raloxifene

A
  • Pregnancy risk category X

- History of DVT

110
Q

Sid effects of raloxifene

A
  • Pulmonary embolism
  • DVT
  • Hot flashes
  • Leg cramps
111
Q

Raloxifene should be discontinued before…

A

schedule immobilization, such as surgery, to prevent DVTs. Resume medication when mobile.

112
Q

What should you monitor in patients taking raloxifene?

A
  • Serum calcium levels

- Liver function tests (raloxifene levels can increase with hepatic impairment)

113
Q

Recombinant DNA parathyroid hormone prototype medication

A

Teriparatide

114
Q

Teriparatide mechanism of action

A

Increases the action of osteoblasts to stimulate new bone formation

115
Q

Contraindications for teriparatide

A
  • Pregnancy risk category C
  • Increased baseline risk of osteosarcoma
  • Bone metastases
  • History of skeletal malignancies
  • Preexisting hypercalcemia
116
Q

Side effects of teriparatide

A
  • Leg cramps
  • Dizziness
  • Osteosarcoma (rare)
117
Q

What should you monitor for in patients taking teriparatide?

A
  • Serum calcium levels (hypercalcemia– nausea, vomiting, constipation, lethargy, muscle weakness)

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