wk5 Flashcards
what are osteoblasts
Produce collagen (support and strength) and proteoglycans (polysaccharide and protein substances that transport minerals): stimulate osteoclast resorptive activity
what are osteoclasts
Maintain bone matrix, Resorb bone; assist with mineral homeostasis
what are the disease processes of musculoskeletal system
- Joint disorders
- Fractures
- Osteomyelitis
- Osteoporosis
- Paget’s disease
- Rheumatoid arthritis
- Osteoarthritis
- Gout
joint disorders
- Strains and sprains
strain vs sprain
o Strain- stretching or a partial tear in a muscle or muscle and tendon unit (a complete tear is a rupture)
o Sprain- involve damage to the supporting ligaments of a joint, or the joint capsule
whats a dislocation
the loss of articulation of the joint
o Caused by displacement of the bone ends
o Usually the result of severe trauma that disrupts the ligaments holding the bones in position
o May be traumatic, congenital or pathologic
o Signs and symptoms include pain, deformity, limited movement
o Treatment usually reduction, with assistance of pain relief or anaesthesia, and x-ray
o Joint will require immobilisation for several weeks to allow injured joining tissues to heal
o May be complicated by fractures
a herniated disk
- Discs are pads that serve as “cushions” between vertebral bodies
oHarder outer layer surrounds soft inner centre
- Outer layer split or rupture, inner layer centre squeezed outwards
oCommon in L4 & L5 lower back
- Disc tissue can press on the adjacent spinal nerves
whats a fracture
- Occurs when a greater stress is placed on a bone than it can withstand
- Causes include
o Sudden injury
o Fatigue or stress fractures
o Pathologic fractures
types of fractures
o Greenstick- a bend or partial break, common in children as they have more resilient bones
o Impacted- fractured fragments are wedged together
o Compression- two bones crushed together
o Comminuted- more than two pieces of fractured bone
TX of fractures
o First aid- ABCDE then splint the fracture- prevent movement and further injury
o Reduction of the fracture
o Immobilisation- to hold in place while healing occurs
o Preservation and restoration of function of the injured part
- Nursing Interventions o ABCDE o Pain relief o Postoperative elevation of the limb o Neurovascular observations of limb- colour, warmth, movement, sensation in extremities, pulse distal to fracture, capillary refill o Check for complications- DVT, compartment syndrome o Drains o Document o Nutrition o Physiotherapy o Social
four stages of bone healing
haemotoma formation: blood at fracture site forms a clot. this is the framework of bone repair
fibrocartilaginous callus formation: fibroblasts and osteoblasts migrate to site and begin reconstruction
Ossification: 3rd to 4th week callus is replaced with mature bone, can begin WBAT
Remodelling: reabsorption of callus from marrow space and around fracture site
complications with fractures
hypovolemic shock
- DVT
- Compartment syndrome
- Fracture blisters
- Fat embolism syndrome
- Osteomyelitis
what is compartment syndrome
- Increased pressure within a confined space
- Muscles and nerves of a limb are enclosed by a firm layer of tissue called fascia (muscle compartment)
- If there is much bleeding and/or oedema, increase in the volume of the muscle compartment
o Fascia does not stretch
o Pressure will increase inside the muscle compartment
o Pressure will cause permanent damage to muscles and nerves if not relieved
Tx of compartment syndrome
- Reduce the pressure
- If limb has a tight cast or dressing- slit these as pressure may be due to this
- Elevate limb
- Prepare for surgery- fasciotomy may be necessary to relieve pressure and save the muscles and nerves
what is osteoarthritis
- Surface crack appear in the cartilage surface
- Cracks widen down to subchondral bone
o Synovial fluid forms cysts within the bone - Articular cartilage becomes eroded, exposed bone becomes polished, thickened and hardened
- Abnormal bony outgrowths occur at the joint margins – spurs
- Joint loses its resilience and its structural integrity
S&S of osteoarthritis
o Pain- aching; early in disease, relieved by rest
o Joint swelling
o Joint stiffness after periods of immobility
o Crepitus and grinding may be heard/felt in affected joint
- Joints commonly affected include; hip, knee, lumbar and cervical vertebrae, hands, fingers, and toes
o One joint may be affected initially, then may spread to other joints as they take on extra stress in protecting injured joint
o Joint becomes limited in movement and unstable
what is rheumatoid arthritis
- Systemic autoimmune disease
- Joint cartilage is destroyed
- Synovial tissues become inflamed
- Abnormal healing process occurs- vascular tissue grows into synovial membrane and bone pannus
- Pannus growth leads to reduced joint motion and eventually ankylosis (joint fixation, often deformed), subluxation (dislocation of the joint) and joint instability
nursing management of rheumatoid arthritis
o Reduce pain, stiffness, swelling and maintain mobility of joints o Education o Rest o Physiotherapy o Medication- analgesia, anti-inflammatories, DMARDS o Heat and cold o Support services o Assistance with daily living
what is acute osteomyelitis
Acute infection of the bone (up to 6 weeks)
can be due to:
• Open fracture
• Infection due to surgery
what is chronic osteomyelitis
Becomes chronic if it persists after 6-8 weeks
- Sequestrum formation- dead bone
- Requires long term antibiotic therapy
what is osteoporosis
- Long bone mass, and deterioration in the structure of bone
- Diagnosis- bone mineral density measurement
- Treatment- drugs to block bone resorption and to stimulate bone formation
- Prevention- diet, lifestyle changes- increase in weight bearing exercise, stop smoking, calcium and vitamin D supplementation
- Screening of susceptible people
what is paget disease
- Localised increase in bone formation and reabsorption
- Bone replacement is rapid and chaotic, producing poor quality bone
treated with NSAIDS, anti-inflammatory, calcitonin
what is gout
- Due to an elevation in serum uric acid levels
o End-product of purine metabolism - Over production of purine, and decreased ability to excrete uric acid (as in chronic renal failure)
- Uric acid crystals precipitate in the joint causing inflammation
o Tophi- large hard nodules containing uric acid crystals (late stage disease)
