Musculoskeletal Flashcards
(230 cards)
1
Q
The musculoskeletal system is composed of what
A
bone
CT
Voluntary muscles
2
Q
Connective tissue consists of
A
ligaments, tendons, versa, fascia
3
Q
Ligaments connect
A
bone to bone
4
Q
Tendons connect
A
bone to muscle
5
Q
Fascia ________ bone
A
encloses
6
Q
Bursa is what is compared to bone
A
fluid-filled sack for cushioning
7
Q
Functions of the Musculoskeletal System
A
protect organs
provide support and stability
store Ca
coordinated mvmt
8
Q
Osteoblasts
A
bone forming
9
Q
Osteocytes
A
mature bone cells
10
Q
Osteoclasts
A
clean up/breakdown bones
11
Q
BOne remodeling
A
removal of old bone by osteoclasts
deposit new bone by osteoblasts
12
Q
Risk Factors associated with Musculoskeletal disorders
A
Autoimmune disorders
Calcium deficiency
Falls
Hyperuricemia
Metabolic disorders (diabetes)
Neoplastic disorders (tumor growths)
Obesity
Post-menopausal states (low estrogen)
Trauma and injury
13
Q
Diagnostic Tests for Musculoskeletal
A
Radiography
MRI
Xrays
Arthrocentesis
Arthroscopy
Bone scan (CT)
Bone or muscle biopsy
Electromyography (least common)
14
Q
Radiography and MRI
WARNINGS
A
Handle injured areas carefully
Stabilize/support above and below injured joint
Pain meds
Remove any radiopaque and metallic objects (jewelry)
Ask the client if pregnant** - may be contraindicated
Shield testes, ovaries, and pregnant abdomen
Notify patient they must lie still during the scan
HCP must wear a lead apron if in the room
15
Q
Arthrocentesis
A
needle aspiration
diagnose joint inflammation or infection
aspirate fluid, blood, or pus
inject corticosteroid to lower inflamed
16
Q
Arthrocentesis Interventions
A
informed consent
pain meds
Rest 8-24 hrs post-op
notify if fever/swelling occurs
17
Q
Arthroscopy
A
**diagnose and treat acute and chronic disorders of joint w/ scope
endoscopic exam
- assess or trim cartilage abnormal, loose body removal
biopsy performed
ACL tear
18
Q
Arthroscopy Interventions
A
NPO 8-12 hours prior
consent
pain meds
Neurovascular assessments per policy
Elastic compression 2-4 days post-op
Elevate and ice PRN 12-24 hours post-op-Help with swelling
Weight-bearing activity but should be limited to 1-4 days (per provider orders)
Notify physician of fever, swelling or increased pain >3 days post-op (infection)
19
Q
Subjective Data
A
Past health hx = if something is new
Meds = long term corticosteroids lead to osteoporosis or arthritis, taking Ca
Surgery =
Perception = what do they consider healthy, exercise after?
Nutrition = diabetes
Exercise = willing to work on activity
Sleep-rest = healing
coping-stress tolerance
20
Q
What is needed when a patient had a hip surgery?
A
abduction pillows
- hips don’t cross
21
Q
Objective Data
A
General overview with focused exam
Physical examination
Inspection - spine
Palpation
Motion
Measurement
Other
Use of assistive devices
Posture and gait
Straight-leg-raising
22
Q
Kyphosis
A
hunchback
23
Q
Lordosis
A
swayback
24
Q
Scoliosis
A
side to side (C or S)
25
Gerontologic considerations for muscles and skeletal
Decreased bone density
Decreased muscle mass and strength (less than 30%)
Decreased flexibility
Functional problems
-ADL is main goal
26
Soft Tissue Injuries
-from trauma mostly (sports)
sprains
strains
subluxation
dislocation
27
Sprain is
an injury to **ligaments** around a joint
**wrenching or twist**
28
Sprain Grades 1 through 3
Grade I: few fiber tears; mild tenderness and swelling - **functional**
Grade II: **partial** disruption of tissue - little more swelling and pain, tenderness
-depends on the function
Grade III: **complete** tear with moderate to severe swelling and pain **(result in loss of function)** - can not walk
29
Do what type of ROM 1st?
active
then if they can not do it themselves passive
30
Strain Grades 1-3
Grade 1: mild or **slightly pulled**
Grade II: **moderately torn** muscle
Grade III: severely torn or **ruptured muscle**
31
Strain is
excessive stretching of muscle and fascia; may involve tendon
32
Sprains and Strains S/S
Pain
Edema
Decreased function
Bruising
33
Dx Sprains and Strains
hx and physical (mechanism of injury makes a difference)
X-ray
MRI
CT
34
Avulsion fx
breaks away a piece of bone
- necrosis could occur due to a lack of blood supply
- hips and 5th metatarsal
35
Subluxation
partial dislocation
36
Dislocation
**complete displacement or separation** of the joints
37
Hemarthrosis
articular bleeding in joint area
38
What are the 6 Ps for Peripheral Neurovascular Exams
Pallor
Pulse
Poikilothermia
Pain
Paralysis
Paresthesia
39
Health Prevention of Sprains and Strains
**Warm-up exercises and stretching**
strength, balance, and endurance exercises
start gradually
40
What stretching should be done before static?
functional
(sit up pt to move before walking)
41
RICE and self-limiting
Rest: Stop activity and limit movement
Ice: **24 to 48 hours; 20 to 30 minutes at a time (barrier)**
Compression: elastic bandage; apply **distal to proximal**- have the swelling move the blood flow back to the heart
Elevate: above the heart
Analgesia
42
Compression elastic should be put in what way
distal to proximal
- swelling moves blood back to the heart
43
How long do you keep ice on an injury
DAYS?
AT A TIME?
24-48 hours
30-30 mins
44
S/S of dislocation and subluxation
deformity
pain
tenderness
loss of function
swelling
45
Complications of dislocation and subluxation
intraarticular fx and avascular necrosis
46
Fractures
disruption or break in the bone continuity
- from traumatic injuries
-secondary to the disease process (pathologic)
= cancer osteoporosis
47
Case Study
L.G., a 23-year-old man, is brought to ED following an injury to his right arm during a rugby game. A bone in his forearm is protruding through his skin. EMS immobilized the arm at the scene. L.G. rates his pain as a 9 on a scale of 0 to 10.
-How would you classify this fracture? Explain
- Other s/s associated w/ fx in L.G.?
Open fx = protruding through the skin
- worry about infection (antibiotics), bleeding, 6Ps
- pain, emotional state, clots **functionality**
48
Open fx
skin broken; bone exposed
49
Closed Fx
skin intact
50
Linear fx
break along the bone's long axis
51
Longitudinal fx
irregular in shape and chip long
52
Displaced
two ends separated from one another
Often comminuted or oblique
53
Nondisplaced
the periosteum is intact, and the bone is aligned.
Usually transverse, spiral, or greenstick
54
Transverse
straight acoss
55
Spiral
twisted across
56
Greenstick
chip not attached but rest of bone is
57
Comminuted
shattered into little pieces
58
Oblique
in the middle and not straight
59
Pathologic
due to disease
60
A broken bone that causes damage to
surrounding
periosteum
blood vessels in cortex/marrow
61
s/s of broken bone
Edema/swelling
Pain and tenderness
Muscle spasm (may need muscle relaxer)
Deformity
Contusion
Loss of function
Crepitation (grating sound or feeling)
Guarding
62
Possible Objective Data of Broken Bone
Apprehension
Guarding
Skin lacerations (infection), color changes
Hematoma, edema
↓ or absent pulse, ↓ skin temperature
Delayed capillary refill
Paresthesia
Absent, ↓ or ↑ sensation
Restricted or lost function
Deformities; abnormal angulation
Shortening, rotation, or crepitation
Muscle weakness
Imaging findings
63
6 STages of Bone Healing
1. Bleeding at fractured ends of the bone - **hematoma formation**.
2. Hematoma organized into fibrous network - hematoma **converts to granulation tissue**
3. **Callus formation**: new bone is built up as osteoclasts destroy dead bone
4. **Ossification** of the callus occurs (3 weeks to 6 months)
5. **Consolidation**: callus continues to develop, closing the distance between bone fragments **(up to 1 year after injury) **
6. Remodeling is accomplished as **excess callus is resorbed and trabecular bone is laid down**
64
Normal Bone Remodeling
osteoblasts form new
osteoclasts clean up old
65
Traction Purpose
**Prevent or decrease pain and muscle spasm**
**Immobilize joint or part of body**
Reduce fracture or dislocation
**Treat a pathologic** joint condition – tumors or
*counter traction (relieve pressure) pulls in opposite direction
66
Buck's Traction
used for the patient with a hip, knee, or femur fracture
- 24-48 hours to relieve painful muscle spasms
w/ weights
67
Skeletal Traction
Long-term pull to maintain alignment
**Pin or wire inserted into bone**
Weights 5 to 45 pounds
**Risk for infection**
Complications of *immobility
**Elevate end of bed**
Maintain continuous countertraction
Keep weights off the floor** DO NOT TOUCH WEIGHTS!!!!!
68
With traction, weights should never be placed where
on the floor
69
Casts
Temporary
Allows patient to perform many normal activities of daily living
Typically incorporates joints above and below the fracture
70
Lower extremity Immobilization
**Elevate** extremity above heart (**24-48 hours**)
Do **not** place in a **dependent position**
Observe for signs of **compartment syndrome and increased pressure**
Prevent getting wet
71
External Fixation
**Metal pins and rods** - possible loosening (clean and teaching)
Applies traction
**Compresses fx fragments**
**Immobilizes** and holds fracture fragments in place
Mostly used for **long-bones**
72
Internal Fixation
- surgically inserted to realign and position bony fragments
-biology and bone healing by xrays
73
Nutritional Therapy
Essential in optimal soft tissue and bone healing
Promotes muscle strength and tone
Builds endurance
Provides energy
74
Diets with fx
Protein 1g/kg
Vitamins B,C, and D
Ca
Mg - relax muscles
Fluid intake 2-3L/day
HIgh fiber as constipation precaution
75
Peripheral Neurological
sensation
motor function
pain
76
Health Promotions for fx
safety
advocate for decreased injuries
moderate exercise
safe environment
Ca and Vit D
77
Pre-Op Management
immobilization
assistive devices
expected activity limits
needs met
pain is subjective and trust pt on schedule
start discharge planning now
78
Post-op Management
V/S
frequent neurovascular assessments
minimize pain and discomfort
monitor for bleeding or drainage
-asepsis
-blood salvage and reinfusion
79
How to prevent immobility complications?
constipation
kidney stones
cardiopulmonary deconditioning (pneumonia)
- TCDB and ICS
DVT/pulmonary emboli
- SCD, TED Hose, Anticoagulants
80
Non-weight bearing
NOT allowed to put any weight through the operated or injured limb to allow it to heal
81
TDTT weight bearing
touch down = entire foot touches the floor but not all the weight
toe touch = toes touch the floor and rest of weight on an assistive device
82
Partial weight bearing
a small amount on the affected extremity
83
Weight-bearing as tolerated
all weight they can
84
Full weight-bearing ambulation
normal
85
Cast CARE Dos
frequent neurovascular assessments
Apply ice for 1st 24 hours
elevate above the heart for 1st 48 hours
exercise above and below
**Hair dryer on cool for itching thoroughly**
**report pain, swelling with movement**
**Report burning or tingling under a cast or foul odors**
86
Cast CARE Don'ts
Do not get plaster cast wet
**Discourage pulling out cast padding**
Do **not place foreign objects inside** cast
**Do not bear weight on the new cast for 48hrs**
Do not cover the cast with plastic for prolonged periods of time
87
Psychosocial Problems with Home Care
Dependence* in performing ADLs
Family separation
Finances
Inability to work
Potential disability
88
Walker
Dos
Don 'ts
Measure
Sitting and Stairs
**15-30 degree elbow flex
**Push off armrests of the chair and stand before grabbing walker**
-stand up straight don't hunch
- only one step ahead of you
-**affected leg should go 1st**
-put the walker together and next to you when going upstairs
89
Cane
Dos
Don 'ts
Measure
Sitting and Stairs
- Cane on **Strong SIDE** - NOT WEAK SIDE
- **15-30 DEGREES** flex of elbow
like a hand in pocket
- **8-12 inches ahead to walk**
- Good does to heaven, bad go to hell **Good side going upstairs 1st - bad side going downstairs 1st**
- different types of bottoms
90
Crutches
Dos
Don 'ts
Measure
Sitting and Stairs
-good going upstairs, bad going downstairs
-2 to 3 fingers width below armpits (cut off blood flow and damage nerve)
-8 to 12 inches out to walk
-15 to 30-degree elbow flex
the bar at wrist height
**don't rush**
91
Slings
Dos
Don 'ts
Measure
the arm needs to be **90 degrees**
dress with affected arm 1st
the hand should be supported on both sides possibly stress ball
**Measure from elbow to pinkie**
- don't let your arms dangle or pressure
6 Ps
92
Gait Belt
Dos
Don'ts
Measure
Walking
Hand under the belt when walking
mid sternum with tag inside
square base in front to stand them with counting
Ambulation
skin breakdown and protect yourself
don't use if chemo or radiation
93
Hip fx are _________ in hospital settings
prevalent
94
Hip Fx is a fx in what part of the bone?
any in the upper 1/3 part of the femur
95
Hip fx S/S
**external rotation (turns out an up**
muscle spasms (contractions - Buck's traction)
**shortening of affected**
severe pain and tenderness
96
Hip fractures use what type of traction
Buck's (skin) traction
- muscle spasms
97
Hip Fractures Tx Options
- immediate surgery
- **Buck's traction** immobilization if delay
- Pre Post-Op Care
- Ambulatory and Home Care
98
In hip fractures, when should you have surgery after it happens?
immediately
- longer the wait less likely of recovery
99
Preoperative Care
**Discharge Planning**
- chronic health problems
- analgesics or muscle relaxants
- comfortable positioning
- traction
100
Postoperative Care
**Abductor pillow and no crossing of legs**
V/S **BP** (anestesia)
I&Os (kidney function for nephrotoxic drugs)
Respirations (pneumonia)
-TCDB and IS (pneumonia)
Pain management (regimen)
**6Ps**
Observe dressing and bleeding
-**Dr 1st dressing unless with an order**
101
Post Hip Replacement
-For ADLs
**elevated toilet seat**
shower chair (remain seated while washing)
**Pillow btw legs for 1st 6wks when supine**
neutral straight
102
After a hip replacement, when should you notify the doctor?
severe pain
deformity
loss of function
bc infection
103
What should someone with a hip replacement get from their doctor when going in for dental work?
prophylactic antibiotics in advance
104
What are some major **NEVER DO** for Post Hip Replacements?
**Flex hip greater than 90**
adduct (only abduct)
internally rotate hip
cross legs or ankles
sit on chairs w/o arms
105
What should you use to put shoes and socks on after surgery?
adaptive device for 4-6 weeks
106
Average hospitalization for hip replacement
and schedule after
3-4 days post-op
then attend a subacute rehab or skilled nursing **home health**
-follow up appointments
107
What are some possible complications for post-op hip replacement?
DVT
Compartment syndrome
Pneumonia
INFECTION
pain mgmt (intervals and before PT)
bleeding risk due to anticoagulant and other sites except for an incision
fall risk - pick up trash/clutter
**Brittle bones need supplements**
108
S/S of DVT
swollen
local red
local warmth
109
The easiest way to educate patients on dressing changes to prevent infection
wash hands
wear gloves
110
You should always assess peripheral neurovascularly
bilaterally
111
What percentage of muscle mass is lost every day the pt is in bed?
1-5%
112
What are some diseases that can cause an amputation?
DM
peripheral vascular disease
osteomyelitis
113
Amputation
removal of a body extremity by trauma, disease, or surgery
-physically and mentally complicated
114
What word should be associated with amputation?
GRIEF - emotion drainage
115
Amputation Assessment
the appearance of soft tissue (before and after
**no necrosis**
preexisting illness
skin temperature
sensory function
quality of the peripheral pulse
116
Amputation dx studies
underlying reason
**H&P**
WBC (infection or gangrene)
Vascular tests
- arteriography, doppler, venography
117
Closed amputation
performed to create a weight-bearing residual **limb or stump**
-prostetics
**ensure proper healing, and closure w/o infection**
Emotional support
118
Post-op mgmt
Phantom limb sensation
brain representation does not know it does not have a limb
-causes a feeling of their limb to still be there
-ambulation for a prosthetic and home care
-teachings for pt and caregiver
119
Phantom-limb sensation tx
Mirror therapy
120
Direct Complication of Fractures
*infection*
incorrect union
necrosis
121
Indirect Complication of Fractures
**compartment syndrome
venous thromboembolism (VTE)
fat embolism**
rhabdomyolysis
hypovolemic shock
122
Infection
wound closed or open
risk increase with **dirty environment**
-soft tissue injuries
123
Open fractures should be treated with
prophylactic antibiotics
124
Surgical I&D
*Wound cleaned with saline lavage* in the operating room
Contaminants are irrigated and **mechanically removed**
**LEAVE ANTIBIOTIC BEADS**
Muscle, sub Q fat, skin, and bone fragments are surgically excised if contaminated
--Under anesthesia--
125
Infection Tx
skin grafting (good if the same color as skin with blood supply attached)
antibiotics = irrigation, beads, and IV
126
Compartment Syndrome
too much swelling (increases contents)
nowhere for it to go (lowers compartment size)
127
Compartment syndrome affects what blood supply
Arterial flow becomes compromised
ischemia
cell death
loss of function
128
How many total compartments does the human body have?
38
129
6 Ps of Compartment Syndrome
**#1 Pain unrelieved by meds or elevation (out of proportion)**
pressure
paresthesia
pallor
paralysis
pulselessness
130
Should the patient be told they can take off their own casts?
no, need to see a doctor to remove them
131
What is the best time to catch compartment syndrome?
Also, what needs to be assessed for kidney function?
early recognition via regular neurovascular assessment
- notify HCP unrelieved by meds or elevation
**Urine output for kidney function**
132
Should the compartment be elevated above the heart?
NEVER
133
Should you put ice on a patient with compartment syndrome? Why?
no, need vasodilation and blood supply
134
What should be done 1st for a patient with compartment syndrome?
**Loosen bandage and splint**
reduce traction wt
fasciotomy to relieve pressure
135
Venous Thromboembolism
**High susceptibility aggravated by muscle inactivity**
Prophylactic **anticoagulant** drugs – always
Unless low **platelet count**
**Antiembolism stockings**
SCD
ROM exercises – encourage regularly
136
Anticoagulant Therapy
monitor for bleeding anywhere
reinforce with pressure and dressing if bleeding
safe self-injection
keep lab appointments (low platelet count don't give)
137
Fat embolism originated in the
bone marrow
- fat globule released into bloodstream
138
Fat embolism occurs after
fracture
139
What fx causes fat embolism?
crushing injury to a long bone or pelvis
140
S/S of fat embolism
restlessness
**Hypoxemia and peticual rash on chest - O2 sat
mental status change - confused
dyspnea/tachypnea**
tachycardia
hypotension
141
T/F: Raloxifene is contraindicated in pts with hx of venous thrombotic events.
True
142
Osteoarthritis PATHO
**gradual loss of joint cartilage**
osteophytes form at joints
*not normal*
Destruction of cartilage
**not reversible**
143
Osteoarthritis turns cartilage into
dull, yellow, and granular
**soft and less elastic**
not able to resist wear and tear
-cracks and osteophytes form
144
Inflammation (local) and thickening odf capsules cause
earrly stage pain and stiffness
145
Central cartilage is thinner; edges become thicker, and osteophytes are formed resulting in
uneven weight distribution
146
W/ uneven weight distribution of the bones in osteoarthritis, bones tend to do what leads to increasing pain in later stages
bones rub together
147
Osteoarthritis Risk Factors
**over 65**
females
- **menopause (decrease estrogen)**
**obesity** (more weight)
ACL injury
frequent kneeling (occupation)
smoking (vasoconstriction)
genetic? maybe
148
Osteoarthritis aka
Degenerative Joint Disease
149
Osteoarthritis is
**progressive noninflammatory** disorder of the synovial joints
150
What is the basic progression of osteoarthritis?
initial injury
attempts cartilage repair
stimulates cartilage degradation - osteophytes
outgrowth and hyperplasia
151
S/S Osteoarthritis
**joint pain**
**morning stiffness**
**crepitation**
deformity
tenderness
limited mvmt
**Bilaterally compared**
152
A nurse is assessing an Osteoarthritis pt, what would be normal findings?
**joint pain and stiffness
impact on ADLs**
pain mgmt
compare bilateral joints
-swelling
-limitation of mvmt
-crepitation (grating sound)
153
Osteoarthritis Tests
Bone scan, CT scan, MRI
X-rays
No specific lab tests or biomarkers
Synovial fluid analysis
**arthroscopy - trim cartilage**
**NO specific markers**
154
Is there a cure for osteoarthritis?
no
-manage pain
prevent disability
maintain functioning
155
What are the type of tx starting from least to most invasive for osteoarthritis?
rest and joint protection (balance, avoid prolonged, use assistive devices)
heat in the morning and cold with activity
nutrition and exercise
Drug Therapy - Tylenol, topical, OTC creams
Surgical (arthroscopic, replacement, PT assist, anticoag, edema, pain mgmt
156
When should you use ice or heat with osteoarthritis?
heat in the morning and cold with activity and acute inflammation
157
What exercise is good for OA pts?
aerobic
ROM
muscle strength
158
For Moderate to severe joint pain use what drug therapies for OA?
Nonsteroidal antiinflammatory drug **(NSAID)**; start low dose, increase if needed
Ibuprofen 200 mg up to four times per day
Misoprostol to decrease GI side effects
Arthrotec (combination of misoprostol and NSAID diclofenac)
Diclofenac gel
**Avoid both oral and topical NSAIDs together**
Celebrex
159
Intraarticular **corticosteroid injections
4 or more injections without relief suggest need for additional intervention
Corticosteroids should not be given systemically
**Only given 3-4 times a year**
160
Why is Hyaluronic acid injection—knee OA not used for OA anymore?
allergic reaction stiffness
161
Arthroscopic surgery OA
For patients with **loss of function, unmanaged pain, and decreased independence**
Common for patients with knee OA
May provide no additional benefit over PT and medical treatment
162
Overall goals of OA
maintain or improve function - with braces
joint protection
independence in self-care
satisfactory pain mgmt
163
Health promotion of OA
LOSE wt
reduce hazards
athletic instruction of warming up
and physical fitness programs to increase activity
tx traumatic joint injuries
164
Physical therapy for exercise program such as ______ to warm up to prevent injury
Tai-Chi
165
Ambulatory Care for
adjusting home management goals
- no scatter rugs, railing, night light, fitting shoes, assistive devices
sex counseling
w/ pt, caregiver, family members, significant others
166
If they have OA, should they be exercising?
yes, but not insane marathons
167
CPM machine is used to
keep joints moving after a total knee arthroscopy not hip
168
Osteomyelitis is the
severe infection of bone, bone marrow, and surrounding soft tissue
169
Most common organism to cause osteomyelitis
staphylococcus aureus
170
Risk factors for Osteomyelitis
**open wound
young boys**
blunt trauma, vascular insufficiency, infections, foreign body presence
171
S/S of osteomyelitis
fever high
**Pain unrelieved by rest and worsens with activity-restricted**
night sweats
chills
restlessness
nausea
malaise
**drainage(late)**
**increase WBC, ESR, and positive cultures**
**spontaneous fx**
172
What differentiates the same symptoms but different diseases?
hx and physical
173
Acute osteomyelitis is an infection that occurs with
one month
174
Dx for osteomyelitis
**bone and sift tissue biopsy**
cultures
WBC count
ESR (erythrocyte sedimentation rate)
x-ray
bone scan
MRI/CT scan
175
Nursing Interventions for Osteomyelitis
**Cultures before giving aggressive, prolonged, IV antibiotics**
**Irrigation and debridement**
surgery - amputation
control infection in the body
pain control
wound/dressing care
176
What drugs are used to tx osteomyelitis?
Cephalosporins
Vancomycin
177
When on antibiotics for so long, what could possibly happen as a result?
C diff
178
If you suspect an infection, what should you give after cultures?
aggressive antibiotics
179
Pt Teaching for osteomyelitis
prevent infections (UTI, resp, deep pressure wounds)
**encourage IS, TCDB, and up in a chair
**activity = circulation**
limit stress to affected
support
**lead to amputation**
180
What type of precaution is on an osteomyelitis pt?
fracture precaution
181
Osteoporosis is a
**chronic, progressive** metabolic bone disease
-porous, brittle, prone to fx
182
Osteoporosis is terms of cells
increase of osteoclasts (reabsorption)
decrease osteoblasts (deposition)
183
Osteomyelitis results in
low bone mass
deterioration of bone
high fragility
184
Most common bone to have osteoporosis
hips, pelvis, wrists, vertebrae
185
How do you prevent osteoporosis
reg exercise
fluride
Calcium
vItamin D
186
Osteoporosis Risk Factors
>65
**long term corticosteroids**
**Females - menopause** decreases estrogen
**hyperthyroidism**
**Chronic alcoholism** - more than 2 drinks a day
cirrhosis
**intestinal malabsorption**
low activity (sedentary)
low calcium and vit D
low body weight
white or Asian
family hx
smoking
187
What drug puts you at risk of osteoporosis?
long term corticosteroids
-decrease Ca absorption
188
S/S of Osteoporosis
back pain
**spontaneous fx**
gradual loss of ht
kyphosis
189
Peak bone mass is at what age
20
190
Bone loss happens at what age
35-40
191
Bone loss is rapid in females after
menopause
192
Dx of osteoporosis
**H-P
bone mineral density**
initial - women over 65, earlier if high risk
ultrasound
DXA
**not xray or labs for dx**
193
Nursing Interventions of Osteoporosis
**nutrition
ca supplementation
exercise**
prevent fx
brace if needed (Turtle shells= TLSO)
**Anitresporative (estrogen, raloxifene, bisphosphonates, calcitonin, densumabs)**
194
How much exercise should be done in a week for osteoporosis pts
3 times for 30 mins doing weight-bearing activity
195
Should a patient with osteoporosis increase alcohol use?
no, decrease
196
Adequate Ca intake a day
Premenopause
Postmenopause
Pre-1000 mg
Post- 1500
-supplemental with food in divided doses
197
Calcium Foods
Milk
Yogurt
Turnip greens
Cottage cheese
Ice cream
Sardines
Spinach
198
Weight-bearing exercise includes
Walking, hiking, weight training, stair climbing, tennis, dancing
- Build up and maintain bone mass
Increase strength, coordination, balance
199
Drugs Tx of Osteoporosis - goal
- decrease bone reabsorption
- promote bone formation
200
What drugs treat osteoporosis?
Antiresportive drugs
201
Antiresorptive drugs
estrogen
raloxifene
biphosponates
calcitonin
denosumab
202
Raloxifene (Evists)
**hormone** drug therapy
- tx breast CA
-decrease cardiac events
similar to estrogen and bind with receptors
**reduces bone reabsorption
203
Major HIgh risk for Raloxifene is it
potential DVT
fetal harm
hot flashes
204
Raloxifene should be ______ before surgery because
Discontinued for 72 hours
prolonged immbolization and don't resume until fully mobile
205
Alendronate (Fosamax
Biphosphonate
inhibit bone reabsoption
206
Side effects for alendronate
anorexia
weight loss
gastritis
**take with water and 30 mins before lunch while maintaining upright for 30 mins**
207
Rare but serious reaction of alendronate
jaw osteo necrosis
208
Calcitonin should be given
IM at night
-nasal
209
Calcitonin does what for osteoprorsis
inhibits bone resorption
-get out of blood stream for hypercalcemia
210
What must be given along with calcitonin
calcium supplementation
211
Denosumab (Prolia) used for
-used in post menopausal women and men at risk for fx
212
Denosumab (Prolia) administered
subQ every 6 months
213
Denosumab (Prolia) is a management of
pts receiving corticosteroids
214
Teriparatide (Forteo)
form of PTH
**only drug that increases bone formation and osteoclasts as well**
215
Teriparatide (Forteo) side effects with **BLACK BOX WARNINGS**
Nausea
Headache
Back pain
Leg cramps
**increased risk of bone cancer**
216
Cephalosporins
most widely used antibiotics
similar to PCN
**IM or IV**
**Toxicity is low**
217
Cephalosporins cause
cause **cell lysis**
218
Cephalosporins are most effective against
cells undergoing active growth and division**
219
The higher the generation of antibiotics the more
resistance
220
Cephalosporins generations with the name attached
First-generation
Cefazolin (Ancef) - prophylactic
Second-generation
Cefaclor (Ceclor)
Third-generation
Cefoperazone (Cefobid)
Fourth-generation
Cefepime (Maxipime)
221
cephalosprins drug interactions
Probenecid (Benemid)
Alcohol**
Drugs that promote bleeding**
Calcium**
Ceftriaxone (Rocephin)**
222
Cephalosporins adverse reactions
allergic
bleeding
thrombophletis
223
First- and second-generation Cephalosporins
used for prophylactic surgery
224
The third and Fourth generations of Cephalosporins are used for
broad spectrum - more aggressive
**agianist active infections**
highly active against gram negative
penetrate CSF
225
Vancomycin uses
**Severe active infections only**
**Methicillin-resistant Staphylococcus aureus or Staphylococcus epidermidis**
226
Vancomycin uses what type of levels for toxicity measurements
peak and trough
227
Vancomycin adverse effects
**Ototoxicity (reversible or permanent)**
*Red man syndrome – raised red rash throughout body**
Just need to slow the rate down
Thrombophlebitis (common)
Thrombocytopenia (rare) – low platelet count
228
Aminoglycosides IV
**Narrow-spectrum** antibiotics/Bactericidal
aerobic gram-negative bacilli
229
Aminoglycosides adverse effects
**Nephrotoxicity
**Ototoxicity (total cumulative and trough levels)
Hypersensitivity reactions
**Neuromuscular blockade
Blood dyscrasias – blood disorders
230
Aminoglycosides drug interaction with
PCN
