Musculoskeletal Disorders Flashcards

Question

what is osteomalacia

Answer 1

is loss of bone related to a vitamin D deficiency; causing softening of the bone resulting from inadequate deposits of calcium and phosphorus in the bone matrix Osteomalacia is the adult equivalent of rickets, or vitamin D deficiency, in children

Answer 2

Muscle and bone weakness Spinal kyphosis and bowed legs Waddling and unsteady gait Bone pain/tenderness

Answer 3

Low serum calcium Low phosphorus Low urine excretion of calcium X-rays

Answer 4

Prevention For all at-risk patients, teach them about which high calcium and vitamin D foods to eat and the importance of adequate daily sunlight Pharmacological: Active vitamin D (calcitriol) Adequate daily sunlight Pain management

Answer 5

also called degenerative joint disease (DJD); is a noninflammatory, localized progressive deterioration and loss of cartilage and bone in one or more joints It is not systemic and it is not an autoimmune disease As cartilage and the bone beneath the cartilage begin to erode, the joint space narrows and osteophytes (bone spurs) form Secondary joint inflammation can occur when joint involvement is severe

Answer 6

Joint stiffness/pain Pain that diminishes after rest and worsens with activity Functional impairment Possible tenderness Crepitus Heberden’s nodes Bouchard’s nodes Joint effusions

Answer 7

Supportive care Pain management Acetaminophen, NSAIDs or COX2 inhibitors, opioids Cortisone injections Q3 months ? Topical analgesic agents such as diclofenac sodium gel, capsaicin and methylsalicylate PT / OT (exercise!) Surgery / joint arthroplasty

Answer 8

refers to the surgical removal of an unhealthy joint and the replacement of joint surfaces with metal or synthetic materials. Total joint arthroplasty, also known as total joint replacement, involves the replacement of all components of an articulating joint

Answer 9

pain relief, return of joint motion, and improved functional status and quality of life. The scope of these improvements depends in part on patients’ preoperative soft tissue condition and general muscle strength

Answer 10

Use an abduction pillow or splint to prevent adduction after surgery if the patient is very restless or is confused Keep the patient’s heels off the bed to prevent pressure ulcers Do not rely on fever as a sign of infection; decreased mental status is a better indicator in the elderly Move the patient slowly to prevent orthostatic hypotension Encourage the patient to cough and deep breathe and use the incentive spirometry As soon as permitted, get the patient up and out of bed Anticipate the patient’s need for pain relief Expect a temporary change in mental state immediately after surgery as a result of the anesthetic and unfamiliar sensory stimuli - reorient the patient frequently

Answer 11

Apply the continuous passive motion (CPM) machine as soon as it is ordered Manage the patient’s pain to provide comfort, increase participation in activity, and improve joint mobility Maintain the knee in a neutral position and not rotate internally or externally Teach the patients that they can partially weight bear unless their prosthesis is not cemented

Answer 12

Dislocation Venous thromboembolism (VTE) Infection Anemia Neurovascular compromise

Answer 13

an infection in the bone; caused by bacteria, viruses, or fungi; that can be severe and difficult to treat

Answer 14

Vascular insufficiency: seen most commonly with diabetes, PVD, most commonly affecting the feet Hematogenous: in which organisms are carried by the bloodstream from other areas of infection in the body Contiguous: in which bone infection results from contamination from surgery, open fracture, or traumatic injury

Answer 15

Fever (usually above 38.3), tachycardia, general malaise, swelling around the affected area, erythema of the affected area, increased heat in that area, tenderness of the affected area, bone pain that is constant, localized, and pulsating that intensifies with movement

Answer 16

Foot ulcer(s), sinus tract infection, localized pain, drainage from the affected area

Answer 17

labs: Leukocytosis Elevated ESR Blood cultures/wound cultures tests: nuclide scans MRI

Answer 18

Prevention General supportive measures (hydration, diet high in vitamins and protein, etc.) Improve physical mobility with avoidance of stress on that bone Pharmacological: Antibiotics Pain management Wound care Surgery / debridement

Answer 19

a soft tissue injury produced by blunt force, such as a blow, kick, or fall, causing small blood vessels to rupture and bleed into soft tissues (ecchymosis or bruising) A hematoma develops from bleeding at the site of impact, leaving a characteristic “black and blue” appearance

Answer 20

Local symptoms include pain, swelling, and possible discoloration

Answer 21

are managed with PRICE therapy, an acronym that refers to protection, rest, ice, compression, and elevation

Answer 22

excessive stretching of a muscle or tendon when it is weak or unstable. Strains are sometimes referred to as muscle pulls

Answer 23

First-degree (mild) strain causes mild inflammation but little bleeding. Swelling, ecchymosis (bruising), and tenderness are usually present Second-degree (moderate) strain involves tearing of the muscle or tendon fibers without complete disruption. Muscle function may be impaired Third-degree (severe) strain involves a ruptured muscle or tendon with separation of muscle from muscle, tendon from muscle, or tendon from bone. Severe pain and disability result from severe strains and surgery may be needed

Answer 24

Cold and heat applications, exercise, activity limitations, NSAIDs and/or muscle relaxants

Answer 25

excessive stretching of a ligament; caused by a twisting motion or hyperextension (forcible) of a joint They are also classified according to severity similar to strains

Answer 26

First degree: PRICE therapy Second degree: immobilization, such as elastic bandage and an air stirrup ankle brace or splint, and partial weight bearing while the tear heals Third degree: immobilization for 4 to 6 weeks is necessary; and arthroscopic surgery may be done

Answer 27

when the ends of two or more bones are moved away from each other and no longer in anatomic alignment Subluxed: when the joint is only partially dislocated

Answer 28

Usually, there is pain, decreased mobility, deformity, and deviation in length and rotation of the extremity

Answer 29

Immobilization Closed reduction of the joint Pain management

Answer 30

a break or disruption in the continuity of a bone that often affects mobility and sensory perception

Answer 31

the break is through the bone in such a way that the bone is divided into two distinct sections

Answer 32

the fracture is through only part of the bone

Answer 33

the skin surface over the broken bone is disrupted; so there is an external wound

Answer 34

does not extend through the skin and therefore has no visible wound

Answer 35

occurs after minimal trauma to a bone that has been weakened b disease

Answer 36

results from excessive strain and stress on the bone

Answer 37

produced by a loading force applied to the long axis of cancellous bone

Answer 38

Moderate to severe pain Muscle spasm, paresthesias Loss of function Ecchymosis, edema Deformity, shortening of the extremity Subcutaneous emphysema, crepitus

Answer 39

Assess ABC’s, and perform a quick head-to-toe assessment Immobilize the extremity by splinting, including joints above and below injury Remove the clothing to inspect the affected area Remove jewelry on the affected extremity in case of swelling Apply direct pressure if there is bleeding Keep the patient warm and in a supine position Assess neurovascular status (check 6 P’s) Cover any open wounds with a sterile dressing

Answer 40

Reduce and immobilize Traction Splints or casts Assess neurovascular and neuromuscular system frequently PRICE therapy Pain management Non-opioid and opioid analgesics with anti-inflammatory drugs and muscle relaxants Surgery

Answer 41

Compartment syndrome Pressure ulcers Infection Disuse syndrome Immobility Anxiety

Answer 42

Acute compartment syndrome Crush syndrome Hypovolemic shock Fat embolism syndrome Venous thromboembolism Infection Chronic complications such as ischemic necrosis or delayed union

Answer 43

increased pressure within one or more compartments encased by bone or fascia, which reduces circulation to the area

Answer 44

Sensory perception deficits or paresthesia (usually 1st sign) Pallor, pulses weaken Affected area is palpably tense Pain with movement Then cyanosis, numbness, paresis, paralysis and necrosis

Answer 45

fasciotomy

Answer 46

systemic manifestation of muscle cell damage resulting from pressure or crushing Systemic manifestations are caused by a traumatic rhabdomyolysis due to muscle reperfusion injury when compressive forces on the tissues are released This can cause local tissue injury, organ dysfunction, and metabolic abnormalities, including acidosis, hyperkalemia, and hypocalcemia Prevention of renal failure is important Alkaline diuresis and mannitol therapy is recommended. Hemodialysis is also recommended for acute renal failure

Answer 47

from a loss of blood The bone is very vascular, and bleeding is a risk In addition, trauma can cut nearby arteries and cause hemorrhage

Answer 48

Stabilize the fracture to prevent further bleeding Restore blood volume and circulation Provide proper immobilization and protect from further injury Pain relief

Answer 49

fat globules are released from the yellow bone marrow into the bloodstream causing clots

Answer 50

Hypoxemia, dyspnea with tachypnea Decreased LOC, agitation, confusion Petechial rash (late sign)

Answer 51

Reduce the risk with immobilization and maintenance of fluid and electrolytes Supportive care with mechanical ventilation, vasopressors and corticosteroids

Answer 52

includes deep vein thrombosis (DVT) and pulmonary embolism (PE) and its major complications It is the most common complication of lower extremity surgery or trauma and the most often fatal complication of musculoskeletal surgery

Answer 53

Cancer or chemotherapy, surgical procedures > 30 minutes, smoking, obesity, heart disease, prolonged immobility, oral contraceptives, history of VTE, older adults

Answer 54

Osteomyelitis: is most common with open fractures in which skin integrity is lost and after surgical repair of a fracture Wound infections are the most common type of infection resulting from orthopedic trauma They range from superficial skin infections to deep wound abscesses Infection can also be caused by implanted hardware used to repair a fracture surgically, such as pins, plates, or rods

Answer 55

blood supply to the bone is disrupted causing decreased perfusion and death of bone tissue This problem is most often a complication of hip fractures or any fracture in which there is displacement of bone. Surgical repair of fractures also can cause necrosis because the hardware can interfere with circulation

Answer 56

is a fracture that has not healed within 6 months of injury Some fractures never achieve union; that is, they never completely heal Malunion: when the bone heals incorrectly

Answer 57

is the removal of a part of the body Amputation is considered only after other interventions have not restored circulation, sometimes referred to as limb salvage procedures The circulatory status of the limb is evaluated through physical examination and diagnostic studies. Muscle and skin perfusion is important for healing

Answer 58

Poor circulation (6 Ps!) Discolored skin Edema Ulcers Necrosis Hair distribution

Answer 59

Ankle-brachial index (ABI) Doppler ultrasonography Laser doppler flowmetry Transcutaneous oxygen pressure (TcPO2)

Answer 60

Monitor for signs of sufficient tissue perfusion Monitor and control for bleeding and infection Control edema though compression dressings Prevent joint contractures Pain management Analgesics + beta blockers, antiepileptic drugs, antispasmodics, antidepressants Collaborate with rehab to improve ambulation and self-care Psychological and behavioral health

Answer 61

Hemorrhage Infection Phantom limb pain Flexion contractures Skin breakdown

Answer 62

when sensation is felt in the amputated part and it persists and is unpleasant or painful Often described as intense burning, crushing, cramping, or that the part is in a distorted or uncomfortable position For most patients, the pain is triggered by touching the residual limb or by temperature or barometric pressure changes, concurrent illness, fatigue, anxiety, or stress

Answer 63

IV infusions of calcitonin (Miacalcin, Calcimar) during the week after amputation can reduce phantom limb pain

Answer 64

occur usually in the hip or knee in patients with amputations of the lower extremity This complication must be avoided so that the patient can ambulate with a prosthetic device Proper positioning and active range-of-motion exercises help prevent this complication

Musculoskeletal Disorders Flashcards

(89 cards)