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MUSCULOSKELETAL > Test#2 Study Guide (Dz/Disorder, Tx, Meds) > Flashcards

Test#2 Study Guide (Dz/Disorder, Tx, Meds) Flashcards

1
Q

What does a Greenstick Fracture look like and who is prone to getting them?

A
  • FX occurs on one side, other side of bone is BENT

- common in CHILDREN

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2
Q

What does a Spiral Fracture look like and who is prone to getting them?

A
  • FX that occurs from a TWISTING motion

- commonly ASSOCIATED WITH ABUSE

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3
Q

What does a Comminuted Fracture look like and what is a probable cause?

A

-the bone is in FRAGMENTS/multiple pieces.

  • commonly associated with HIGH IMPACT INJURIES
    • MVA -FALLS -TRAUMA
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4
Q

What is an open/compound fracture? What is a possible complication?

A

-bone protrudes through the skin DISRUPTING SKIN INTEGRITY, causing an OPEN WOUND, and tissue injury.

RISK FOR INFECTION!!!

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5
Q

What bones are at greater risk for emboli?

A

LONG BONES (femur, etc.), pelvis, and ribs are at highest risk for having FAT EMBOLISM.

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6
Q

Describe pallor

A

Pallor - paleness; lack of normal skintone.

one of the 7 P’s to assess for neurovascularity

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7
Q

What is a priority assessment post-op cast placement?

A
  • CMST
  • 7 P’s (Pallor, Pain, Pulselessness, Polar Temp., Paralysis, Paresthesia, Pufffiness)
  • Drainage (s/s infection)
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8
Q

What foods help promote healing in pts with fractured bones?

A

PROTEIN
+
VITAMIN C

(increase fiber and fluids

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9
Q

OSTEOPOROSIS

  • cause
  • signs/symptoms
  • affected areas
  • diagnostics/labs
A

OSTEOPOROSIS: bone breakdown faster than building
AFFECTS–> *
-CAUSE
-advanced AGE -long-term corticosteroid use
-low calcium -sedentary
-S/S
-progressive deformities (spinal, etc.)
-pain worse with activity
-PATHOLOGICAL FXs
-brittle bones/limited movement
-DIAGNOSTICS
-DEXA SCAN: scans for bone mass
-CT SCAN: scans for spinal bone loss
-LABS –> Serum Ca+, Phos, Parathyroid, Parathyroid

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10
Q

OSTEOARTHRITIS

  • cause
  • signs/symptoms
  • affected areas
  • diagnostics/labs
A 
OSTEOARTHRITIS: degenerative joint dz (DJD) - progressive deterioration
*NON-INFLAMMATORY* *NON-SYSTEMIC*
AFFECTS --> * WEIGHT BEARING *
-CAUSE
    -Age (women)    -Obesity      -Smoker
    -Genetics           -Hx stress on joints
-S/S
    -Pain WORSE WITH ACTIVITY, resolving with rest
    -DECREASE ROM and CREPITUS
    -Joint enlargement/stiffness
    -HEBERDEN NODES
    -BOUCHARD NODES
-DIAGNOSTICS
    -XRAY    -MRI     -Arthroscopy
    -ESR      -Bone Scan
    -Synovial Fluid Exam
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11
Q

GOUTY ARTHRITIS

  • cause
  • signs/symptoms
  • affected areas
  • diagnostics/labs
A

GOUT: accumulation of URIC ACID deposits in the joints.

  • INEFFECTIVE METABOLISM OF PURINES *
  • CAUSES
    • ALCOHOL
    • Surgery/Infection/Injury
    • Genetics
    • Obesity/HTN
  • S/S
    • SEVERE pain
    • Inflammation
    • TOPHI - bog toe, ankle, pinna
    • FEVER/Chills
    • High BP/High HR
  • DIAGNOSTICS
    • Serum URIC ACID LEVELS - blood and urine
    • CBC, ESR
    • XRAY
    • Aspiration of synovial fluid
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12
Q

RHEUMATOID ARTHRITIS

  • cause
  • signs/symptoms
  • affected areas
  • diagnostics/labs
A 
RHEUMATOID ARTHRITIS: a CHRONIC, SYSTEMIC, inflammatory AUTOIMMUNE dz characterized by SYMMETRICAL synovial membrane inflammation.
 * NON - WEIGH BEARING *   * HANDS/FEET *
-CAUSES
    -WOMEN at risk 3:1
      (onset 20-30 y/o)
-S/S
    -FATIGUE!!!!!
    -RED, SWOLLEN, WARM joints
    -Joint PAIN/STIFF IN AM
    -weight loss/anorexia/FEVER
    -DEFORMITIES
        * SWAN NECK
        * BOUTONNIERE
        * ULNAR DRIFT
-DIAGNOSTICS
    -ESR
    - +RF    +ANA
    -XRAY
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13
Q

FIBROMYALGIA

  • cause
  • signs/symptoms
  • affected areas
  • diagnostics/labs
A 
FIBROMYALGIA: * CHRONIC PAIN SYNDROME * characterized by body wide pain
-CAUSES
    -GENETICS (runs in fam)
    -INFECTION (some trigger/aggravate fibromylagia)
    -TRAUMA (ptsd)
-S/S
    -FATIGUE!!!!!!
    -SLEEP DISTURBANCE
    -DEPRESSION
    -Pain worse AT NIGHT and when COLD
    - +11/18 tenderpoints
-DIAGNOSTICS
    1. Widespread pain lasting >3 months
   2. At least 11/18 tenderpoints
    LABS - CBC, ESR, Thyroid fxn
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14
Q

GANGRENE

  • cause
  • signs/symptoms
  • affected areas
  • diagnostics/labs
A 
GANGRENE: necrosis of tissue caused by insufficient/lack of blood supply.
-CAUSES
    -INFECTION
    -frostbite
    -PERIPHERAL VASCULAR DZ (PVD)
    -Neurovascular Compromise
-S/S
    -Dark-red/BLACK TISSUE
    -no feeling
-DIAGNOSTICS
    -
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15
Q

What is a sprain? and interventions?

A

SPRAIN: injury to LIGAMENT involving tearing/TWISTING of a joint BEYOND NORMAL ROM.

  • Most Common –> ANKLE
  • S/S –> swelling, pain, inflammation
  • INTERVENTIONS
    • RICE
    • Intermittent ICE - 12-48hrs
    • Immobilize/splint
    • Analgesics
    • Surgery
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16
Q

What is a strain? and interventions?

A

STRAIN: injury to MUSCLE / TENDON caused by OVERSTRETCHING of the muscle which can result in a muscle tear.

*Common Causes –> Falls, Sprinting, Inadequate exercise warm-ups

  • INTERVENTIONS
    • RICE
    • ICE - 48hrs, THEN HEAT
    • Immobilize/Splint
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17
Q

What does RICE mean?

A

Rest
Ice
Compression
Elevate

Tx for strains/sprains

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18
Q

CALCITONIN SALMON (MIACALCIN)

  • Classification
  • Nursing/Patient Education
  • Side effects to report
A

CALCITONIN SALMON (MIACALCIN)

** TX for OSTEOPOROSIS **

CLASS: bone re-absorption inhibitor
( * PULLS CALCIUM FROM BLOOD –> BONE * )

NURSING

- assess nasal cavities
- monitor for hypocalcemia
- ALLERGY TESTING

S/E TO REPORT

- Hypocalcemia
- Allergic rxn
- decreased therapeutic effectiveness
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19
Q

GLUCOSAMINE

  • Classification
  • Nursing/Patient Education
  • Side effects to report
A

GLUCOSAMINE

** TX for ARTHRITIS **

CLASS: Supplement
( * REBUILDS CARTILAGE * )

NURSING

- monitor for BLEEDING
- contraindicated with preg/breastfeed.

S/E TO REPORT

- BLEEDING
- Allergic rxn
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20
Q

HYALURONIC ACID (SYNVISC)

  • Classification
  • Nursing/Patient Education
  • Side effects to report
A

HYALURONIC ACID (SYNVISC)

** TX for OSTEOARTHRITIS (of the KNEE) **

CLASS: anti-inflammatory - replaces body’s natural hyaluronic acid that is destroyed by joint inflammation.
( * INTRA-ARTICULAR INJECTION * )

NURSING

- ALLERGIES: BIRDS/FEATHERS/EGGS   * ****Made from COMBS OF THE CHICKEN******
- Monitor for infection

S/E TO REPORT

- Allergic rxn
- s/s of infection
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21
Q

ALENDRONATE (FOSAMAX)

  • Classification
  • Nursing/Patient Education
  • Side effects to report
A

ALENDRONATE (FOSAMAX)

** TX for OSTEOPOROSIS **

CLASS: Amniobiphosphate –> INHIBITS AUTOCLASTS –> gradually increases bone mass.
( * BONE RE-ABSORPTION INHIBITOR * )

NURSING

- REMAIN UPRIGHT 30 MINS AFTER TAKING MED
- Take with  8oz water

S/E TO REPORT

- JAW PAIN/chest pain
- DIFFICULTY SWALLOWING
- bloody emesis
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22
Q

ZYLOPRIM (ALLOPURINOL)

  • Classification
  • Nursing/Patient Education
  • Side effects to report
A

ZYLOPRIM (ALLOPURINOL)

** PREVENTATIVE TX for GOUT **

CLASS: xanthine oxidase inhibitor/ anti-gout
( * INHIBITS URIC ACID PRODUCTION * )

NURSING

- INCREASE FLUIDS: promotes excretion of uric acid
- ASPIRIN COUNTERACTS THIS MED

S/E TO REPORT

- HEAMTURIA / DYSURIA
- S/S of infection
- Allergic rxn
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23
Q

METHOTREXATE (RHEUMATREX)

  • Classification
  • Nursing/Patient Education
  • Side effects to report
A

METHOTREXATE (RHEUMATREX)

** TX for RA **

CLASS: antirheumatic
( * IMMUNOSUPPRESSIVE effective at suppressing T & B lymphocytes * )

NURSING

- CYTOTOXIC!!
- TERATOGENIC
- INCREASE FLUIDS: prevents adverse GU effects
- monitor for INFECTION (this med is an immunosuppresant)

S/E TO REPORT

- S/S of INFECTION
- kidney damage
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24
Q

CELECOXIB (CELEBREX)

  • Classification
  • Nursing/Patient Education
  • Side effects to report
A

CELECOXIB (CELEBREX)

** TX for OSTEOARTHRITIS **

CLASS: blocks COX-2 enzyme which activates inflammation.
( * NSAID * )

NURSING

- have pt report s/s bleeding (BLACK TARRY STOOL)
- Monitor BUN/Creatinine/LFT

S/E TO REPORT

- BLEEDING ( * BLACK TARRY STOOL * )
- Indigestion
- SOB
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25
ASPIRIN - Classification - Nursing/Patient Education - Side effects to report
ASPIRIN CLASS: salicylate, BLOOD THINNER, antiinflammatory, analgesic, antipyretic NURSING - monitor for BLEEDING - CONTRAINDICATED WITH ALLOPURINOL S/E TO REPORT -BLEEDING (GI, HEMATURIA) -Allergic reaction
26
CYCLOBENZAPRINE (FLEXERIL) - Classification - Nursing/Patient Education - Side effects to report
CYCLOBENZAPRINE (FLEXERIL) CLASS: * SKELETAL MUSCLE RELAXANT * (acts on brain to reduce/abolish tonic muscle hyperactivity) NURSING - may cause DROWSINESS - FALL SAFETY - Avoid alcohol and other CNS depressants S/E TO REPORT - SEIZURES - Cardiac disturbance --> MI, CVA, arrhythmia - heat stroke
27
DEMEROL (MEPERIDINE) - Classification - Nursing/Patient Education - Side effects to report
DEMEROL (MEPERIDINE) CLASS: * OPIOID ANALGESIC * (binds with opioid receptors in spinal cord causing higher levels) NURSING - monitor: BOWELS, RESPIRATIONS - INCREASE FLUIDS - Have pt be aware of withdrawal sx S/E TO REPORT - CONSTIPATION - SOB (<12rpm) - Severe nausea - Allergic reaction
28
GABAPENTIN (NEURONTIN) - Classification - Nursing/Patient Education - Side effects to report
GABAPENTIN (NEURONTIN) *** TX of PHANTOM LIMB PAIN and NEUROPATHY *** CLASS: * ANTI-CONVULSANT * NURSING - capsules can be crushed in juice of soft foods - avoid hazardous activities until response known * **ALSO GIVEN TO TRAUMA PTS TO LOWER OPIOID USE*** S/E TO REPORT - Suicidality - Allergic reaction - Seizures
29
CORTISONE - Classification - Nursing/Patient Education - Side effects to report
CORTISONE ** TX for OSTEOARTHRITIS ** CLASS: * GLUCOCORTICOID * ( ANTI-INFLAMMATORY / IMMUNOSUPPRESANT ) NURSING - LONG TERM use can cause: OSTEOPOROSIS, and rise in blood glucose in patients with diabetes. - Monitor for S/S OF INFECTION S/E TO REPORT - S/S OF INFECTION - symptoms of electrolyte imbalance
30
Tophi deposits are a clinical sign of what disorder?
Gout.
31
Proper stump care is done to prepare the amputee for prosthesis use how soon after surgery and why?
Pt is fitted for prosthesis ASAP AFTER SURGERY (usually a few days, after swelling goes down)
32
Describe what could be the cause of compartment syndrome, s/s, and interventions.
COMPARTMENT SYNDROME: results from inadequate/obstructed blood flow to muscles, nerves, and tissues. CAUSES - EDEMA - SOFT TISSUE INJURY - Tight dressing - BURNS - Hemorrhage INTERVENTIONS -REMOVE CONSTRICTING ITEM (cast, bandage, etc..) -FASCIOTOMY
33
Describe what acute osteomyelitis is, possible causes, s/s, and tx.
OSTEOMYELITIS: a serious BONE INFECTION CAUSES -compound fx causing bone exposure S/S - FEVER -ELEVATED ESR - PAIN -ELEVATED WBC - limited mobility - erythema, edema TREATMENT - MULTIPLE ABX - Surgical debridement - AMPUTATION
34
What is the rationale on why a pt who has had a hip replacement, NOT supposed to sit and cross legs, but can do straight-leg exercises?
CROSSING LEGS, and SITTING LOW could cause DISLOCATION. Straight-leg exercises help STRENGTHEN (quad) MUSCLES. ( * The patient has been favoring their injury and has muscle weakness and atrophy * )
35
What are the signs & symptoms of gout?
GOUT -INEFFECTIVE METABOLISM OF PURINES --> accumulation of URIC ACID in blood --> deposits in joints ``` S/S -Severe PAIN -SWOLLEN GLANDS -DECREASE MOBILITY -TOPHI (common in big toe) -EDEMA in effected joint (usually in PM) -fever/chills ```
36
What can cause gout?
GOUT -INEFFECTIVE METABOLISM OF PURINES --> accumulation of URIC ACID in blood --> deposits in joints. Gout can be caused by: - ORGAN MEATS - SHELLFISH - CARBONATED DRINKS - ALCOHOL - fatty foods - surgeries - stress - fasting diet
37
What are lab tests to confirm gout?
- URIC ACID --> blood and urine - CBC - ESR
38
What would be symptoms you'd expect to see on your assessment on a patient getting ready to have a lower leg amputated?
- DIMINISHED PEDAL PULSES - COOL TEMP - DUSKY COLORED - NECROSIS - LACK OF HAIR GROWTH
39
Describe BUCKS TRACTION, what it is commonly used for, and nursing care.
BUCKS TRACTION: (**SKIN**) - provides straight-pull on extended extremities in hip fractures. USES: **PRE-OP** for HIP FX for IMMOBILIZATION of adult pt. NURSING - Make sure the WEIGHT NOT ON FLOOR - PT NOT AT FOOT OF BED - monitor CMST/NEUROVASCULAR STATUS
40
Describe BRYANT'S TRACTION, what it is commonly used for, and nursing care.
BRYANT'S TRACTION: (**SKIN**) - legs suspended in air at 90deg from hips, knees slightly flexed, butt off bed. USES: **CHILDREN** with unstable HIP/FEMUR FXs NURSING -Monitor CMST/NEUROVAS. STATUS (7 p's)
41
If a bone is protruding out of the skin, why do we cover it with a sterile dressing prior to surgery?
open wound = RISK OF INFECTION Covering with sterile dressing * REDUCES RISK FOR INFECTION. *
42
Why do patients with open fractures need a tetanus injection or booster?
open wound = RISK OF INFECTION Tetanus ---> * REDUCES RISK FOR INFECTION. *
43
Name types of food high in purines? calcium?
FOODS HIGH IN PURINES - Fish (SARDINES) - ORGAN MEATS - SWEETBREAD - BEER - GRAVY FOODS HIGH IN CALDIUM - DAIRY - DARK GREEN LEAFY VEGGIES - WHITE BEANS
44
What is phantom limb pain?
PHANTOM LIMB PAIN: the*VERY REAL* sensation of PAIN, pressure, or ithing that occurs in the location of the extremity AFTER THE AMPUTATION. - PT will describe pain as: BURNING, SHOOTING, CRAMPING, ACHING - Tell patient to "MOVE LIMB" as much as possible --> activates damaged nerves --> helps decrease pain GABAPENTIN --> can tx pain of phantom limb pain since nerves in brain still sending pain signals.
45
Why is Gabapentin (Neurontin), an antiepileptic, prescribed for phantom limp pain?
GABAPENTIN --> can tx pain of phantom limb pain since nerves in brain still sending pain signals. - works on NEUROTRANSMITTERS
46
If pain is not relieved after giving medication to pt with a cast or a pt with a fx bone, what do you expect is the problem?
COMPARTMENT SYNDROME
47
What assessment finding (in pt with unrelieved pain suspected of compartment syndrome) would warrant a call to the PCP?
Excruciating/SHARP PAIN
48
What is a dx of ineffective tissue perfusion in relation to assessing distal pulses in post-op hip replacement pt?
- COMPARTMENT SYNDROME | - DVT
49
What is your discharge teaching for your hip replacement pt?
- *PREVENT DISLOCATIONS* * ** PT CANNOT SIT IN LOW CHAIRS * ** PT CANNOT CROSS LEGS - LOG ROLL to move pt - Use ABDUCTOR PILLOW - Suggest a TOILET SEAT MODIFIER - Observe for S/S OF INFECTION
50
What are the 7 P's in relation to neurovascular checks on patients?
1. PARASTHESIA (unrelieved numbness, pins/needles) 2. PAIN 3. PALLOR (slow cap. refill, pale looking skin) 4. PARAYLSIS 5. PUFFINESS (edems/swelling) 6. PULSELESSNESS (decreased/absent distal pulses) 7. POLAR TEMP (cool extremities)
51
Describe care and interventions you'd implement for post-BEA pt.
- Encourage DEPENDENT POSITION DOCUMENT! - Wrap in FIGURE 8 - Encourage pt to TALK ABOUT FEELINGS * (altered body image)*
52
Why is it important to have wire cutters and suction at the bedside of a pt who has facial fractures?
EMERGENCY (swelling, edema, emesis) - Pts with facial fx's usually have JAWS WIRED * Cutters to cut wires * Suction to suction out emesis
53
Why do we have post-op BKA pts in the prone position several times per day?
This PREVENTS HIP CONTRACTURES * To reduce edema --> ELEVATE F.O.B, *not stump*
54
Describe ORIF
Open Reduction Internal Fixation (ORIF): visualization of fx thru an INCISION IN SKIN, and internal fixation with PINS, SCREWS, RODS, and prosthesis as needed. ***WITHOUT TRACTION*** NURSING - Monitor NEUROVASCULAR STATUS (**7 P's**) - Assess DRAINAGE - Monitor S/S INFECTION - Observe for S/S of PE and FE
55
How would you care for your pt with ORIF?
NURSING - Monitor NEUROVASCULAR STATUS (**7 P's**) - Assess DRAINAGE - Monitor S/S INFECTION - Observe for S/S of PE and FE *Dressing changes with pins are STERILE*
56
What compartment syndrome symptoms would you see in a patient with ORIF?
- Increased PAIN UNRELIEVED BY MEDS - Increased PAIN WITH P.R.O.M - 7 P's *if untreated--> necrosis --> amputation.*
57
What are Heberden's Nodes?
DISTAL joint enlargement that occurs with OSTEOARTHRITIS
58
What is unique about where hyaluronic acid is made from?
Made from COMBS OF THE CHICKEN *assess for ALLERGIES--> egg, feathers, bird
59
Can ptts who are wearing a cast use a hair dryer on the cool setting to blow air into their cast if they are itching?
YES Cool air acts as a VASOCONSTRICTOR
60
What are s/s of compromised circulation in your cast pt your assessing?
- 7 P's * *PALLOR first sign of compromise** - FOUL ODOR could be sign of INFECTION
61
Why is sleep so important to pts with autoimmune conditions like fibromylagia?
FATIGUE is #1 S/S of autoimmune disorders. | * Finding a ROUTINE SLEEPING PATTERN is an important part of their care.
62
What is an intra-articular injection? What medications are used?
INTRA-ARTICULAR INJECTION: *injections* administered directly into the joints. TX FOR OSTEOARTHRITIS * GLUCOCORTICOIDS * HYALURONIC ACID GOAL: decrease inflammation and pain.
63
What types of pts get intra-articular injections?, how does it work, and what is the goal?
INTRA-ARTICULAR INJECTION: *injections* administered directly into the joints. TX FOR OSTEOARTHRITIS * GLUCOCORTICOIDS * HYALURONIC ACID GOAL: decrease inflammation and pain.
64
What is a "hot spot" when a pt is wearing a cast?
"HOT SPOT" --> when there is a specific area of warmth felt on the cast. -- SIGN OF INFECTION!
65
What is each lab, and what can it confirm? - WBC - ANA - RF - ESR - H&H
WBC: white blood cell count - CONFIRMS INFECTION - HIGH ---> infection - LOW ----> immunocompromised ANA: antinuclear antibody -can help DX AUTOIMMUNE DISORDER RF: rheumatoid factor -CONFIRMS R.A ESR: erythrocyte sedimentation rate - DETECTS INFLAMMATION - not location specific H&H: hemoglobin & hematocrit -assesses BLOOD LOSS --> (indicator of o2)
66
Describe each term: - Atrophy - Hemiparesis - Apraxia - Hypertrophy
ATROPHY - deterioration in size/fxn of muscle and tissue HEMIPARESIS - weakness to ONE SIDE of the body APRAXIA - inability to perform purposeful movements or to use objects properly. HYPERTROPHY - enlargement of muscles/tissues
67
Describe the following diagnosic tests for carpal tunnel syndrome: - PHALEN'S TEST - TINEL'S SIGN
PHALEN'S TEST * hands in FORCED FLEXION for 60 secs --> if there is a production of pins/needles along thumbside half of hand.... +CARPAL TUNNEL TINEL'S SIGN * TAPPING medial nerve in wrist --> if pins/needles, or electric shock sensation... +CARPAL TUNNEL
68
Normal adult VS ranges
``` HR: 60-100 RR: 12-20 BP: 90/60 - 138/89 TEMPERATURE Aux.: 96.8 - 101.3 Rect.: 97.7 - 100.4 Temp.: 95.5 - 99.5 PAIN: 0-10; medicate at or above 3. ```
69
What assessment finding would you expect to see with a fx femoral neck in your hip trauma pt?
- PAIN, reduced mobility - INABILITY TO BEAR WEIGHT - SHORTENED EXTREMITY (one leg usually shorter than the other) - Bruising, swelling
70
What are long term effects on bones in pts taking glucocorticoids?
BONELOSS! | decreased mineral density
71
Pitting edema post-amputation warrants a call to the PCP if pt was wearing an ace bandage.... why??
This indicates COMPROMISED CIRCULATION and is serious.

MUSCULOSKELETAL (2 decks)

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