mobility Flashcards
(97 cards)
1
Q
helps blood calcium levels to promote calcium absorption from GI tract.
A
Calcitriol
2
Q
major hormone regulation for calcium
A
parathyroid and calcitonin hormone
3
Q
are the bones widening, narrowing, irregular, is there a fracture?
A
X-ray
4
Q
usually assess for soft tissue in the bones, the ligaments, the tendons, tumors, extent of fractures
A
CT
5
Q
assess for any torn muscles, ligaments, cartilage, herniated discs, as well as any pelvic conditions
A
MRI
6
Q
IV contrast injected into joint cavity to visualize the joint structure. if tear is present contrast leaks out of joint
A
arthrography
7
Q
if any fluid in joint they’ll aspirate it
A
arthrocentesis
8
Q
: bone mineralization. For women and men that have osteoporosis
predicts fracture risk
A
bone densitometry (DEXA)
9
Q
contraindicated for patients taking anticoagulants and skin infections. tests for muscles and nerves
A
electromyography
10
Q
increased if fracture is present. increased with osetomalacia or paget disease
A
alkaline phosphatase (ALP)
11
Q
which 3 lab studies used for bone metabolism
A
calcitonin, vit d, PTH
12
Q
increased in muscle damage from trauma. cross fit. being in hospital too long
A
Creatine kinase (CK)
13
Q
increased in muscle damage
A
Aspartate aminotransferase (AST)
14
Q
rate of bone turnover lab
A
serum osteocalcin
15
Q
increased with bone destruction (parathyroid dysfunction, metastatic bone tumors, multiple myeloma)
A
urine calcium
16
Q
usually aggravated by activity
A
low back pain
17
Q
what are some meds used for lower back pain?
A
NSAIDS, muscle relaxants
18
Q
inhibits prostaglandin synthesis by blocking COX 1 and COX-2 receptor sites
-example: ibuprofen
-anti-inflammatory
A
NSAIDS
19
Q
NSAIDS SE
A
headache, dizziness, somnolence, fatigue, rash, nausea, dyspepsia, bleeding, constipation, bone marrow suppression, MI, CVA
20
Q
Helps CNS to interfere with the reflexes causing muscle spasms
-baclofen
A
Skeletal muscle relaxants
21
Q
skeletal muscle relaxants SE
A
transient drowsiness, dizziness, weakness, fatigue, constipation, headache, insomnia, hypotension, nausea, urinary retention
22
Q
non-inflammatory, degenerative joint disease
-cartilage in the joints starts to break down and become narrow
-can get osteophytes which are bone spurs
A
OSTEOARTHRITIS (OA)
23
Q
Primary OA
A
idiopathic, it just happens
24
Q
SECONDARY OA
A
there was a previous injury or inflammatory disease or joint destruction like rheumatoid arthritis.
25
most modifiable risk factor for OA
obesity
26
manifestations of OA
joint pain
stiffness
functional impairment
enlarged joints (bouchard's and Heberden's node)
decreased ROM
Crepitus
Joint effusion
27
how is OA usually diagnosed
X-ray
28
initial analgesic for OA
Acetaminophen
29
treatment for moderate to severe OA
Arthroplasty where they do surgery to replace a damaged joint with an artificial one
30
-inhibits the synthesis of prostaglandins
-Tylenol
-SE: rash and liver toxicity, dont exceed 4g/day
Acetaminophen
31
metabolic bone disease characterized by decrease in bone density and strength
-increased risk of bone fractures
-becomes porous, brittle, fragile
osteoporosis
32
primary osteoporosis
affects women after menopause bcs of decrease in estrogen
33
secondary osteoporosis
is from either meds or disease that affect bone metabolism like if a patient is taking corticosteroids for a long time
34
risk factors of osteoporosis
-osteopenia (start having low bone mineral density) (precursor)
-small framed female
-meds like corticosteroids
-hormonal imbalances
-nutritional factors
-malabsorption disorders
-autoimmune disorders
-immobility
-alcohol and tobacco
35
what is the first sign of osteoporosis
fractures like compression fractures, hip, and wrist
36
diagnosis for osteoporosis
DEXA which measures bone density
37
management of osteoporosis
-diet rich in calcium and vitamin D
-exercise
-stop alcohol and tobacco
-meds
38
-used for osteoporosis
-slows the normal and abnormal bone resorption w/o inhibiting bone formation and mineralization
-alendronate (fosamax)
-po daily or monthly
-taken on empty stomach with full glass of water and remain upright for 30 min
Biphosphonates
39
Biphosphonates SE
abdominal pain, constipation, nausea, diarrhea, increased or recurrent bone pain, esophageal erosion
40
-for osteoporosis
-increases bone mineral density and modulates effects of estrogen at specific receptor sites
-raloxifene (evista)
-PO once a day
estrogen agonist/ antagonist
41
estrogen agonist/antagonist SE
VTE, hot flashes, skin rash, n/v, vaginal bleeding, depression, lightheadedness, stroke, PE, high triglycerides, hepatic impairment
42
-for osteoporosis
-monoclonal antibody that increases bone mineral density and reduces porosity of cortical bone
-denosumab (prolia)
-SQ every 6 months
-DONT JUST STOP
rankl inhibitors
43
-metabolic bone disease characterized by inadequate mineralization of the bone
-due to deficiency in vitamin D
-pain, tenderness, bowing of legs, pathologic fractures
-Causes: GI disorders, liver and kidney disease, hyperparathyroidism, malnutrition
osteomalacia
44
diagnosis for osteomalacia
h and p
x-ray
labs: low calcium phosphorus levels, high alkaline phosphate
bone biospy
45
-for osteomalacia
-a vit d compound that regulates the absorption of calcium and phosphate from the small intestine
-po daily
-se: weakness, headache, nausea, vomiting, dry mouth, constipation, muscle pain, bone pain
-adverse effect: metallic taste
calcitriol (rocaltrol)
46
medical management for osteomalacia
calcitriol, vitamin D and calcium supplementation, sunlight
47
-osteitis deformans: chronic bone disorder. rapid bone turnover leading to pathological fractures.
-proliferation of osteoclasts followed by bone replacement
-usually affects ppl greater than 50, commonly men
-cause is unknown but can be genetic
paget disease
48
clinical manifestations of pagets
-skeletal deformity. skull may be thickened, hats may not fit.
-legs may be bowed
-misalignment of hips, knees, ankle, and spine is usually bent forward and rigid
-tenderness and warmth due to increased vascularity
49
labs for pagets would show
elevated alkaline phosphate
50
x rays for pagets would show
demineralization and bone overgrowth
51
bone scans for pagets would show
the extent of disease
52
medical management for pagets
-NSAIDS for pain
-Biphosphates to stabilize the rapid bone turnover
-walking aids
-show lifts for gait instability or misalignment
-obese patients should lose weight
-increase vit D and calcium
53
-infection of the bone
-usually caused by MRSA
-results in inflammation, necrosis, and formation of a new bone
osteomyelitis
54
hematogenous osteomyelitis
bloodborne spread from another site of infection. So they could have an infection in the kidneys and then it goes to the bone.
55
contiguous-focus osteomyelitis
direct bone contamination. so from like a trauma or a joint replacement
56
osteomyelitis with vascular insufficiency
diabetes, PVD
57
risk factors for osteomyelitis
-older adults
-poor nutrition
-obesity
-chronic illness (diabetes, RA)
-impaired immune systems
-long term corticosteroid or immunosuppressive therapy
-IV drug users
58
hematogenous osteomyelitis clinical manifestations
-sudden onset of s/s of sepsis
-fever, chills, tachycardia, malaise
-pain, swelling, tenderness
59
contiguous focus osteomyelitis clinical manifestations
-no s/s of sepsis
-area swollen, warm, painful and tender to touch
60
vascular insufficiency osteomyelitis clinical manifestations
non healing ulcer over infected bone
61
how can a fracture lead to organ damage?
rib fracture can puncture a lung. skull fracture can lead to brain damage
62
complete fracture
all the way through
63
partial fracture
only a portion of the bone is fractured and the other side sometimes bends, use that in a green stick fracture which is very common in children because their bone is still developing.
64
comminuted
more than 2 bone fragments
65
bone fragment that pulls away from the tendon
evulsion
66
closed or simple fracture
doesn't cause disruption in skin
67
open or compound fracture
bone comes through the skin. at risk for infection. seen in vehicle accidents
68
intra-articular fracture
fracture that extends into the joint
69
nondisplaced fracture
when the bone breaks but remains in alignment
70
displaced fracture
when the bone breaks into separate pieces and they no longer align
71
pathological fracture
occurs in an area of diseased bone. example is someone with osteoporosis
72
spiral fracture
occurs during twisting. sports injuries. seen in child abuse
73
what does reduction mean for management of fractures?
to place the bone back in alignment
74
closed reduction (external)
if we have a break thats nondisplaced and properly aligned we could put a cast on it, a splint, or put them in traction
75
open reduction
would be a surgery where they place pins or screws or plates to realign the fracture like ORIF surgery
76
fat embolism syndrome (complication of fractures)
usually at the time of the fracture there’s fat globules that can get released into circulation and they kind of act as a thrombus so they can lead to the occlusion fo some small blood vessels.
77
delayed union
fracture that doesn’t heal in the normal anticipated time frame.
78
nonunion
incomplete healing so the ends of that fracture don’t line up correctly and doesn’t heal properly because those ends don’t unite
79
malunion
fracture that heals in a malaligned or deformed position. Sometimes u can see a bump where that fracture hasn’t properly aligned but its healed so its partially healed but theyre not aligned.
80
heterotopic ossification
benign bone growth. Growth that happens in the soft tissue which is an area we wouldn’t expect.
81
a fracture that is open so the bone breaks and pokes through the skin.
compound fracture
82
initial treatment for compound fracture
make sure its not bleeding and then cover it with a sterile dressing to prevent infection.
83
treatment for compound fracture
tetanus vaccine, IV antibiotics, bone grafting, vacuum assisted closure, wound irrigation and debridement
84
potential complications of compound fracture
-osteomyelitis
-tetanus
-gas gangrene very lethal infection
85
complications of casts, splints, braces
acute compartment syndrom: increased pressure in a confined space which confines blood flow.
-pressure injuries
-disuse syndrome: deterioration of a body system as a result of musculoskeletal inactivity. Educate on isometric and ROM exercises.
86
-painful, results from increased pressure in those compartments. Can be due to bleeding. Can lead to a decrease on the compartment size which is cutting off circulation. Can lead to permanent muscle and nerve damage
-manifestations: the five Ps
-deep throbbing pain, not relived by meds, intensifies with ROM. Pain that Is disproportionate to the injury.
compartment syndrome
87
treatment for compartment syndrome
univalve or bivalve cast, fasciotomy
88
5 Ps
-pain
-pallor
-pulselessness
-paresthesias
-paralysis
89
stable pelvic fracture
usually only one break in pelvic ring and the alignment of pelvis is maintained
90
unstable pelvic fracture
2 or more breaks in pelvic ring and bones are displaced and misaligned which can lead to rotational instability
91
95% are due to fall
hip fracture
92
extracapsular hip fracture
trochanteric, intertrochanteric, subtrochanteric
93
intracapsular hip fracture
femoral head and neck
94
extracapsular manifestations
extremity will be shortened, externally rotated, muscle spasms, ecchymosis
95
intracapsular manifestations
-may or may not be shortened, adducted, may or may not be externally rotated
96
intial treatment for hip fracture
traction and then orif
97
