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Fundamentals SEM2 > WEEK 7 > Flashcards

WEEK 7 Flashcards

alterations in mobility ATI + notes from class

1
Q

mobility

A

ability for free movement

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2
Q

immobility

A

not able to move or motionless

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3
Q

what does the musculoskeletal system include

A

bones
connective tissue
muscles
joints

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4
Q

The functions of the musculoskeletal system include the following. (6 things)

A

Maintaining body form and shape
Providing support and mobility
Protecting soft organs
Maintaining hemostasis of calcium, phosphate, and magnesium levels within the body
Formation of blood cells through stem cells in the red or yellow bone marrow
Reserving energy through triglyceride storage in the yellow marrow

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5
Q

how many bones are in the adult human skeleton

A

206

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6
Q

what is the adult human skeleton system divided into

A

axial section and appendicular section

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7
Q

what is the axial section of the skeleton composed of

A

bones along the axis of the body

skull
sternum
ribs
spine

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8
Q

what is the appendicular section of the skeleton composed of

A

bones of the appendages

clavicle
scapula
humerus
ulna
radius
pelvis
carpals
metacarpals
phalanges
femur
patella
tibia
fibula
tarsals
metatarsals
phalanges

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9
Q

bones are classified based off what

A

according to their shape

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10
Q

long bones

A

Long bones, such as the humerus, radius, tibia, and femur, are in the appendicular skeleton. Functionally, the long bones function as levers in mobility

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11
Q

what are long bones usually composed of

A

diaphysis and epiphysis

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12
Q

diaphysis

A

Long, cylinder shaped shaft of a bone.

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13
Q

epiphysis

A

Irregularly shaped ends of the bone.

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13
Q

what is within the shaft of the diaphysis

A

the medullary cavity, which contains red and yellow bone marrow

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14
Q

The bone marrow in infants is primarily

A

red

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15
Q

Located at each end of the long bones are the

A

epiphyses

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16
Q

proximal

A

closest to center (for mobility that would be torso)

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17
Q

distal

A

Furthest away from the center; for mobility, this would be away from the torso.

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18
Q

hard part of bone that covers bone structure

A

periosteum

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19
Q

Short bones include

A

the carpal bones in the hands, as well as the tarsal bones located in the feet

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20
Q

Short bones are small with a shape like

A

a cube

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21
Q

Flat bones

A

bones of the skill, ribs, and scapula (found in the axial skeleton)

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22
Q

Functionally, the flat bones provide

A

protection for the soft organs

think: skull (brain)
ribs (lungs)
etc

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23
Q

tendons

A

​​​​​​​Connective tissue that connects muscles to bones.

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24
Q

Bone tissue is classified as either

A

cortical bone or cancellous bone

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25
Q

Cortical bone

A

compact tissue that is dense and hard

Cortical bone provides strength, protects bones, and gives bones their smooth, white appearance. It also provides sites for muscles and tendons to attach firmly.

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26
Q

cancellous bone

A

soft and spongy tissue located on the inside of the bone

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27
Q

bone marrow

A

Marrow is a soft, connective tissue that produces red blood cells

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28
Q

where is red marrow located in adults

A

skull, ribs, sternum, upper parts of the humerus, the pelvis, and upper parts of the femur

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29
Q

what do other long bones have if they don’t have red marrow

A

yellow marrow

which does not contribute to hematopoiesis

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30
Q

Yellow marrow is composed primarily of

A

adipose tissue and stores triglycerides

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31
Q

hematopoiesis

A

The development of blood cells.

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32
Q

Bones maintain both their strength and flexibility through

A

collagen fibers

this flexibility is needed to prevent bones from easily breaking due to the forces applied on them through day-to-day activities

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33
Q

what does each bone have its own of

A

neurovascular supply

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34
Q

Bones contain several types of cells, including

A

osteoblasts
osteocytes
osteoclasts

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35
Q

osteoblasts

A

Single-nucleus cells that promote bone formation and remodeling through synthesis and mineralization.

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36
Q

The osteoblasts have several functions, including

A

forming a collagen compound to create the matrix and releasing calcium and phosphate into the matrix

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37
Q

what does the matrix allow

A

bones to be hard and not brittle

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38
Q

what hormones do osteoblasts produce

A

parathyroid hormone and estrogen

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39
Q

osteocytes

A

Highly specific bone cells that are responsible for the maintenance of the bony matrix, maintain biomineral content.

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40
Q

Osteocytes are derived from

A

osteoblasts

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41
Q

what do osteocytes help with

A

bone tissue formation, regulation, and breakdown

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42
Q

osteoclasts

A

Multi-nucleated cells that resorb bone.

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43
Q

The osteoclasts’ functions include

A

resorption of bone tissue, breakdown of bone, dissolution of minerals, and release of minerals into the blood stream

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44
Q

Each bone is completely remodeled every

A

10 yrs

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45
Q

Calcium is an essential mineral required for many activities, including

A

muscle contraction and blood clotting

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46
Q

The parathyroid hormone responds to

A

low serum calcium levels by causing the release of calcium from the bone, which raises serum calcium levels

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47
Q

Calcitonin, a thyroid hormone, responds to

A

high serum calcium levels by causing the deposit of excess calcium into the bones

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48
Q

Human growth hormone (HGH) is the primary hormone

A

that stimulates bone growth in children

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49
Q

what are the most common joint

A

synovial

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50
Q

abduction

A

Movement of limb away from the midpoint.

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51
Q

adduction

A

Movement of limb towards the midline.

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52
Q

circumduction

A

Circular movement.

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53
Q

Functions of the muscles include

A

maintaining posture and balance, preventing skeletal deformation, and keeping joints stable

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54
Q

All muscle tissues have the characteristics of

A

excitability

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55
Q

excitability

A

Ability for the muscle to contract through the use of action potential.

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56
Q

There are other characteristics of muscles including

A

elasticity, extensibility, and contractility

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57
Q

elasticity

A

Ability for muscle to return to original shape.

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58
Q

extensibility

A

​​​​​​​Ability for muscle to stretch.

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59
Q

contractility

A

​​​​​​​Ability for muscle to tighten.

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60
Q

Sequence of Muscle Contraction

A

signal
ACh release
Enters tubules
Filament interaction
Fibers shorten

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61
Q

Impaired muscle tone is due to

A

a loss of control in the nervous system and may be attributed to hypertonia or hypotonia

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62
Q

hypertonia

A

Excesses muscle tone, usually caused by a loss of neuromuscular control.

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63
Q

hypotonia

A

Lack of muscle tone, usually caused by a loss of neuromuscular control.

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64
Q

musculoskeletal alterations include

A

sprains
strains
fractures
as well as disease of the bones, joints, and muscles

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65
Q

conditions effecting the bones

A

osteoporosis
osteopenia

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66
Q

an example of a condition that would affect the muscles is

A

sarcopenia

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67
Q

sarcopenia

A

Loss of muscle mass, usually due to aging.

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68
Q

Movement disorders such as

A

Huntington’s disease and Wilson’s disease may be connected to an inherited or genetic cause

can cause excessive or limited movement

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69
Q

neuro conditions that can lead to immobility

A

Huntington’s disease
Wilson’s disease
Parkinson’s disease
ataxia
MSA
dyskinesia

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70
Q

physical and psychosocial issues contributing to alterations in mobility

A

pain
critically ill
worry about being a burden
depression
anger
low confidence

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71
Q

A client undergoing a surgical procedure, regardless of the cause, is at risk for developing problems with

A

mobility

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72
Q

Chronic neurologic problems such as

A

Parkinson’s disease may lead to immobility

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73
Q

Immobility can lead to

A

an increased risk of comorbidities such as cardiovascular disease, venous thromboembolism, respiratory complications, and respiratory conditions

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74
Q

venous thromboembolism

A

Blood clot formation in a vein that can migrate to become lodged in the pulmonary vessels.

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75
Q

Effects of Immobility: nervous system

A

confusion
depression
loss of confidence
loss of cognitive function

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76
Q

Effects of Immobility: cardiovascular system

A

decreased cardiac output
venous statis
ortho hypotension
DVT

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77
Q

venous stasis

A

Pooling of blood in the veins due to immobility. This reduces venous blood returning to the heart.

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78
Q

deep vein thrombosis (DVT)

A

A blood clot in the veins, generally of the legs.

can go to lungs and THAT is a pulmonary embolism !

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79
Q

Effects of Immobility: pulmonary system

A

Pneumonia
Decreased cough reflex
Pulmonary secretion pooling
Hypoventilation
Atelectasis
Decreased lung expansion

80
Q

Effects of Immobility: GI sytem

A

Swallowing difficulties
Incontinence
Constipation
Fecal impaction
Bowel dysfunction
Anorexia
Increased intestinal gas
Heartburn
Aspiration
Malnutrition

81
Q

Effects of Immobility: GU system

A

Incontinence
Urinary tract infections (UTIs)
Urinary retention

82
Q

Effects of Immobility: integumentary system

A

Skin breakdown
Pressure injuries
Infections
Abrasions
Tissue damage
Inflammation over bony prominences
Friction and shear

83
Q

what age does bone density begin to decrease

A

age 30

84
Q

Clients experiencing menopause may have

A

accelerated loss of bone mass, making their bones more fragile

85
Q

Loss of muscle mass can be overcome or delayed with

A

regular physical activity

86
Q

Ways to prevent falls at home include

A

repairing broken or uneven steps, removing throw rugs, and clearing other clutter

87
Q

define synovitis

A

Inflammation of the synovial membrane.

88
Q

Synovitis may be caused by a

A

by a contusion or sprain, repetitive motion, or disease processes such as rheumatologic diseases or infection

89
Q

manifestations of synovitis

A

painful joints that worsen with movement and !swelling at night!

full extension of the limb is not possible without pain

90
Q

diagnostics for synovitis

A

ultrasound, possible MRI, and aspiration of synovial fluid

91
Q

treatment and management of synovitis

A

managed symptomatically
uses heat or ice to reduce pain
may need anti-inflamm agents

92
Q

arthritis definition

A

inflammatory condition in the joints

93
Q

manifestations of arthritis

A

joint pain and stiffness, swelling, and decreased mobility

94
Q

causes of arthritis

A

aging, autoimmune disorders, viral and bacterial infections, or damage to the articular cartilage

and sometimes cause can be unknown

95
Q

joint effusion

A

Fluid accumulation in the intra-articular space.

96
Q

In larger joints, such as the knee joint, the effusion may be caused by

A

overuse, trauma, changes in osteoarthritis, and infections

97
Q

gout

A

Presence of uric acid crystals in a joint, usually in the toe. A form of arthritis.

Allopurinol- RASH notify PCP (prevent gout)
Colchicine- acute gout reaction

98
Q

manifestations of joint effusion

A

swelling of the affected joint, restricted movement, and pain

99
Q

Management of arthritis includes

A
100
Q

If the client who has mobility problems develops a raised temperature, it may be an indication of a

A

septic joint from septic arthritis

101
Q

Management of arthritis includes

A

immobilization of the joint with a brace, anti-inflammatory agents or acetaminophen, and cold packs

102
Q

diagnostics for arthritis

A

radiographic imaging (x-rays) of the affected joint, looking at both the anterior-posterior and lateral views

103
Q

arthrocentesis

A

A procedure to remove synovial fluid for testing.

104
Q

muscle atrophy define

A

loss of muscle tissue from disuse

105
Q

Causes of muscle atrophy include

A

prolonged bedrest, aging, or medical conditions, such as multiple sclerosis or stroke.
and prolongs immbolization of a limb

106
Q

osteoporosis define

A

softening of the bones often associated with aging, specifically with post-menopausal clients

107
Q

Osteoporosis is generally

A

asymptomatic disorder and is not often diagnosed until a fracture occurs

108
Q

kyphosis

A

hunchback

109
Q

When osteoporosis causes thoracic compression, it can lead to

A

kyphosis, cervical lordosis, and shortness of breath and compression on the abdominal cavity

110
Q

labs and diagnostics for osteoporosis

A

DXA, plain X-ray

Other evaluations will include serum levels of calcium, magnesium, phosphorous, liver enzymes, PTH levels, thyroid levels, and tests to rule out cancer

111
Q

osteoarthritis

A

most common disease of the joints. It is a chronic degenerative disease typified by loss of joint cartilage

112
Q

Osteoarthritis in the cervical or lumbar vertebrae may lead to

A

back or leg pain, aggravated by walking

113
Q

Many of the complications result from the stasis of the blood. Complications such as

A

pressure injuries, atelectasis, alterations in elimination, and venous thromboembolism are all are results of the stasis of blood

114
Q

atelectasis

A

Collapse of alveoli in the lungs often caused by effects of anesthesia or as a complication of immobility.

115
Q

Older clients are at the greatest risk for development of

A

pneumonia due to anatomical changes associated with aging

116
Q

Injuries to soft tissues are often described as

A

strains, sprains, and contusions

117
Q

Etiology and Risk Factors: soft tissue injuries

A

exercise or sports activities
sudden fall
overuse injury

118
Q

contusions

A

A bruise caused by a direct blow.

119
Q

most frequently affected joints with soft tissue injuries

A

ankles
knees
wrists

120
Q

Older adults are at risk for a soft tissue injuries due to

A

proprioception issues, impaired reflexes, and osteoporosis

121
Q

how to avoid soft tissue injuries

A

yoga
cardio (jogging)
strength training
warm up before
plenty of water
cool down period

122
Q

why are older adults at risk for soft tissue injuries

A

decrease in protective reflexes, vision losses, and changes in equilibrium

123
Q

Clinical Presentation: soft tissue injuries

A

pain
tenderness
swelling of the injured area

124
Q

ice therapy (4 important things to remember!)

A

10-20 min intervals
cause vasoconstriction, decrease swelling
wrapped with a compression wrap (elastic bandage)
elevate injured limb, above the heart ideally

PRICE acronym

protect
rest
ice
compress
elevate

125
Q

open vs closed fracture

A

open: creates a break in the skin (at risk for infection)
closed: leaves the skin intact

126
Q

medical conditions that put client at risk for fractures

A

osteomyelitis
osteomalacia
osteoporosis
cancer
infection

127
Q

osteomyelitis

A

Infection or inflammation of bone tissue.

128
Q

osteomalacia

A

A softening of the bones that leads to brittleness.

129
Q

what condition is the big one leading to fractures

A

osteoporosis

130
Q

manifestations of hip fracture

A

inability to bear weight, hip and groin pain, or the affected leg is outwardly rotated and is visibly shorter than the unaffected leg

131
Q

Clinical Presentation: fractures

A

pain at the site of the fracture
swelling
tenderness
shortening of the limb
deformity of the extremity

132
Q

what are the two types of bones fractures only seen in children

A

torus
greenstick

133
Q

most common cause of hip fractures

A

falls

134
Q

A client with an open fracture should

A

receive antibiotics ASAP and may need irrigation surgery

135
Q

A client in a cast is at risk for development

A

pressure injuries if swelling occurs

136
Q

what to eval for if client with fracture is in PERSISTENT pain?

A

compartment syndrome

137
Q

how to prevent atelectasis and pneumonia

A

TDBC
incentive spirometer

138
Q

complications for fractures

A

infection
bleeding
neurovascular compromise
compartment syndrome
embolism

139
Q

If the blood supply to the injury is disrupted

A

the limb will not be perfused and there is risk for loss of limb

140
Q

Complex Regional Pain Syndrome

A

caused by prolonged inflammation and pain. CRPS can be acute or chronic

141
Q

Manifestations of Complex Regional Pain Syndrome

A

pain that is spontaneous and extreme, pallor in the affected limb with the limb cool to touch, and the limb may have swelling below the site of injury.

142
Q

One of the more serious complications of a fractured bone and treatment is

A

compartment syndrome

143
Q

define compartment syndrome

A

increase in pressure within the fascia
pressure builds and compresses the nerves and vascular supply of muscle

144
Q

what fractures are of the greatest risk for compartment syndrome

A

forearm

145
Q

6 p’s with compartment syndrome

A

pain
paresthesia
paralysis
pallor
pulselessness
poilkothermia

146
Q

Embolism

A

serious comp of fractures
pelvic or hip are at the highest risk for pulmonary embolism

A pulmonary embolism is a clot that travels from the site of the injury through the venous system and lodges in the pulmonary vasculature

147
Q

manifestations of an embolism

A

acute SOB
chest pain
tachycardia
tachypnea
cough
hemoptysis

148
Q

The USPSTF recommends screening for osteoporosis for clients over

A

the age of 65 years who were assigned female at birth

149
Q

Neurovascular Checks: CMST

A

Color of the limb
Motion or movement
Sensation
Temperature

150
Q

initial mang of pain in fractures

A

PRICE

151
Q

care of casts

A

keeping the cast dry

152
Q

is osteomalacia expected in older adults

A

no

153
Q

do you cover boot/splint in the shower or take it off?

A

take off splint/boot
cover cast with plastic to shower

154
Q

back pain

A

pain experienced along the spinal column

155
Q

The most common causes of back pain

A

are disorders of the spinal structures such as…

herniated disks, nerve root pain, compression fractures, osteoarthritis, muscle or tendon strain, and spinal stenosis, cancer, infection, and inflammation, Bacterial infections due to a penetrating trauma, or recent surgery may also contribute to back pain

156
Q

mechanical causes of back pain

A

herniated disc
nerve root pain
compression fractures
osteoarthritis
muscle or tendon strain
spinal stenosis

157
Q

spinal stenosis

A

A narrowing of the spinal canal, which results in spinal nerve compression.

158
Q

Serious, non-mechanical causes of back pain

A

abdominal aortic aneurysm, aortic dissection, angina, and meningitis

159
Q

what if back pain if caused by non-mechanical causes

A

immediate interventions

160
Q

Clients at risk for back pain

A

obese and older clients

161
Q

Clinical Presentation : back pain

A

alterations in gait and balance
stiffness
numbness
weakness in back and legs
tender spine and muscles
constipation
difficulty urination

162
Q

what meds may be used to treat back pain

A

opioids

163
Q

client education for lower back pain

A

good posture
core strengthening exercises

164
Q

potential Pharmacologic pain management for back pain

A

non-opioid analgesics
NSAIDs
opioids
corticosteroids
muscle relaxers

165
Q

back pain: When managing pain, begin with non-pharmacologic treatments.

A

rest
massage
PT
stretching
spinal manipulation
immobilization
acupuncture
use of TENS unit

166
Q

Medications for Back Pain: non-opioid analgesics

A

Indomethacin
Naproxen
Ketorolac

action: reduce sensation of pain and cools the body

nursing considerations: GI effects (indomethacin); Naproxen has a long half-life

167
Q

Medications for Back Pain: opioid analgesics

A

PO: Codeine
Hydromorphone
Morphine
Oxycodone

Transdermal: Fentanyl

Actions: Bind to receptors in the brain, which allows for the sensation of pain to be blocked

Nursing considerations: may cause drowsiness and impaired judgement, respiratory depression, addiction, AVOID ALC

168
Q

Medications for Back Pain: muscle relaxants

A

Diazepam
Methocarbamol
Cyclobenzaprine

Actions: Relieves manifestations causing back pain and muscle spasms

Nursing Considerations: may cause drowsiness, confusion, dizziness, habit-forming, AVOID ALC

169
Q

Medications for Back Pain: antidepressants

A

Amitriptyline
Desipramine
Imipramine

Actions: Alters the way the brain senses or notices pain

Nursing considerations: may cause dry mouth, constipation, blurred vision, daytime sleepiness, sexual dysfunction, DON’T STOP TAKING ABRUPTLY

170
Q

Medications for Back Pain: Anti-Epileptics

A

Gabapentin
Pregabalin
Carbamazepine

Actions: Change electrical signals in the brain, usually for those with nerve damage

Nursing considerations: weight gain or loss, anorexia, skin rash, confusion, depression, drowsiness, DON’T STOP TAKING ABRUPTLY

171
Q

most common surgery for back pain

A

laminectomy

a type of back surgery in which the vertebral posterior arch is accessed to remove either a lesion or a herniated disk or to relieve pressure and provide a fusion of the vertebrae

172
Q

most common cause of limb amputation

A

Peripheral vascular disease

173
Q

Risk factors for amputation include

A

traumatic injuries
uncontrolled diabetes
smoking

174
Q

amputation with diabetes

A

lower extremities because of diabetic foot ulcers

175
Q

Peripheral artery disease can lead to limb loss due to

A

narrowing or occlusion of the blood vessels, reducing blood flow to the limb

176
Q

medications for phantom pain

A

anti-epileptic (Gabapentin)
anti-depressants

177
Q

Clinical Presentation: decrease perfusion to limb

A

pale or necrotic limb
absent pulse
area may not be blanche
presence of foul odor (infection or gangrene)

178
Q

what med class reduces neuropathic pain

A

anti-epileptic

179
Q

Client Teaching: care for the amputation site

A

massaging residual limb
assess the amputation site (including use of mirror to see all areas of the site)

180
Q

what med can help with perfusion

A

Aspirin

181
Q

what med can help with antiplatelet for someone with immobility

A

Plavix (can cause bruises)

182
Q

signs of embolism with vital signs

A

decreases O2
increased HR
increased RR

183
Q

Sx of pneumonia

A

fever
tachycardia
cough
crackles in the lungs
decreased lung sounds
sputum in cough

184
Q

what is the ONLY thing to do to Tx VTE

A

medications

DO NOT massage, compression stockings, hot/cold as it can lead to pulmonary embolism

185
Q

things to check with a brace

A

follow directions for how tight
cap refill (less than 3 seconds)
check surrounding pulses

186
Q

what labs to assess for with someone who has osteoporosis

A

calcium
PTH levels
mag

187
Q

neuropathy pain medications

A

Gabapentin (Neurontin)

can cause drowsiness and can amplify narcotics (addictive!)

188
Q

what is something to NOT do when moving a patient who is immobile up in the bed

A

DO NOT use a trash bag

189
Q

what condition is at risk for osteomyelitis

A

diabetes
open foot ulcers lead to bones open therefore lead to an infection/inflammation of the bone tissue

WEAR DIABETIC SHOES

190
Q

fasciotomy helps with what

A

compartment syndrome

takes out some of the fascia to decrease pressure

191
Q

what to give with gas pain with some with alterations in mobility?

A

Simethicone

192
Q

mang of sprain and strain (acronym)

A

RICE

rest
ice
compress
elevate

193
Q

types of immobilization for fractures

A

immobilizer
splint
cast
traction
surgical interventions

194
Q

what are hip fractures usually treated with

A

surg interventions

open reduction internal fixation
total hip replacement

195
Q

why is compartment syndrome a medical emergency

A

When pressure builds up in a muscle compartment, it can block blood flow and prevent muscles and nerves from getting oxygen and nutrients

can lead to necrosis of the muscles and ischemia of the muscles

can lead to amputation if left untreated

196
Q

what might people with osteomyelitis have

A

PICC line because of long-term antibiotics

197
Q
A

Fundamentals SEM2 (7 decks)

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