Musculoskeletal

Question 1

MVA, fractures, what blood tests need to be ordered

Answer 1

CBC - baseline, Hgb, Hct, electrolytes, coagulation, type and cross

Question 2

what diagnostic tests are order after MVA/fractures

Answer 2

Xray, CT, MRI, EEG

Question 3

KVO is how many mL per hour

Answer 3

25

Question 4

NPO IV rate?

Answer 4

125 mL/hr

Question 5

the 5 P’s (NV) post surgery

Answer 5

Pain, Pallor, Paralysis, Paresthesia, Pulselessness

Question 6

how often do you assess NV/5 P’s post surgery

Answer 6

q 2-4 hrs and PRN

Question 7

moderate to severe pain, can give with PC pump, oral, rectal, intranasal, or IV, monitor respirations

Answer 7

hydromorphone (Diluadid)

Question 8

SE of hydromorphone (Diluadid)

Answer 8

lowered respirations, increased HR, orthostatic hypertension, drowsy, constipation, urinary retention

Question 9

hydromorphone (Dilaudid) antidote

Answer 9

naloxone (Narcan)

Question 10

what is normal dosage of morphine?

Answer 10

1-2 mg max dose q 4-6 hours otherwise question order

Question 11

treats bacterial infections and MRSA. Monitor trough (30m before next dose) and peak (usually about an hour after taken)

Answer 11

vancomycin (Vancocin)

Question 12

what should you monitor for with vancomycin

Answer 12

thomocytopenia, nephrotoxicity, ototoxicity (CN VII), and red man syndrome

Question 13

how should you infuse vancomycin

Answer 13

slowly

Question 14

hormones you need for bone development

Answer 14

thyroid, growth hormone (mainly kids), calcitonin, and VD

Question 15

fat globules released from hello bone marrow form emboli in blood stream

Answer 15

shock/fat embolism

Question 16

symptoms occur 12-72 hrs after injury (or surgery), lowered platelets, lower Hgb, and raised ESR. HR at about 110. Altered mental status, O2 down and SOB (chest pain) ,petechiae vest

Answer 16

fat embolism

Question 17

how does compartment syndrome heal after being opened

Answer 17

secondary intention

Question 18

what is the most important thing to avoid with compartment syndrome

Answer 18

tissue death

Question 19

hip fracture that involves head or neck of femur

Answer 19

intracapsular

Question 20

hip fracture involving trochanter below head/neck of femur

Answer 20

extracapsular

Question 21

bone infection

Answer 21

osteomyelitis

Question 22

discectomy

Answer 22

removal of herniated disk

Question 23

laminectomy

Answer 23

removed of disk portion and bone between spinal process and junction

Question 24

“wear and tear” joint stiffness, decreased ROM, worse with activity throughout the day, most affects middle age and older people,

Answer 24

osteo-arthritis

Question 25

autoimmune, join issue, symmetrical, worse in the AM, can occur at any age

Answer 25

rheumatoid arthritis

Question 26

with RA the problem is with?

Answer 26

synovium

Question 27

which test shows RA

Answer 27

rheumatoid factor

Question 28

no tears or saliva

Answer 28

sjogren's syndrome

Question 29

nodules, vasculitis, respiratory and cardiac complications, sjogren's syndrome, raynaud's synrome

Answer 29

RA

Question 30

lowers inflammatory process and pain, may need help with GI system due to irritation

Answer 30

NSAID. ibuprofen (Motrin, Advil)

Question 31

what do you have to patients taking NSIAD's

Answer 31

PPI's and H2 blockers

Question 32

an anti rheumatic drug that has also been used for chemo

Answer 32

methotrexate

Question 33

breakdown of cartilage. No systemic symptoms, onset is gradual, previous joint injury

Answer 33

osteoarthritis

Question 34

anesthetic. can cause redness, swelling, and blisters at site. Used for osteoarthritis

Answer 34

lidocaine patch (Xylocaine)

Question 35

due to overproduction of uric acid

Answer 35

gout

Question 36

medication that blocks formation of uric acid and treated in gout.

Answer 36

allopurinol (Zyloprim)

Question 37

Medication that blocks reabsorption of uric acid and promotes excretion. Used with gout. MANY DRUG INTERACTIONS

Answer 37

probenecid (Benemid)

Question 38

NSAID. Decreases joint pain. DO NOT USE WITH COUMADIN or ASTHMA. Can cause fatal liver disease

Answer 38

indomethacin (Indocin)

Question 39

if you see ESR (erythrocyte sedimentation rate) or CRP (c reactive protein) being ordered think?

Answer 39

inflammation

Question 40

is a type of blood test that measures how quickly erythrocytes (red blood cells) settle at the bottom of a test tube that contains a blood sample. Normally, red blood cells settle relatively slowly. A faster-than-normal rate may indicate inflammation in the body.

Answer 40

erythrocyte sedimentation rate (ESR)

Question 41

is a substance produced by the liver in response to inflammation. ... A high level of CRP in the blood is a marker of inflammation

Answer 41

c reactive protein

Question 42

fracture with skin intact

Answer 42

closed

Question 43

bone pierces skin

Answer 43

Open/Compound

Question 44

fracture common in children

Answer 44

Greenstick – incomplete fracture

Question 45

multiple pieces of bone

Answer 45

Comminuted

Question 46

Emergent intervention required to prevent loss of limb Fasciotomy required to relieve pressure Once pressure goes down, can be closed or covered with skin graft

Answer 46

compartment syndrome

Question 47

therapeutic management of gout

Answer 47

``` Avoid purines (Organ meat, Wine, Aged Cheese, Meats, especially seafood) Adequate fluid intake Bed rest during exacerbations ```

Question 48

Affects weight-bearing joints and joints that receive a lot of stress

Answer 48

osteoarthritis

Question 49

nodes that affect the medial joints

Answer 49

Bouchard (B, closer to the body)

Question 50

nodes that affect the Distal joints

Answer 50

Heberden’s (HE - pointing)

Question 51

side effects of methotrexate

Answer 51

rash, toxic to liver and bone marrow, birth defects, photosensitivity. MONITOR FOR HEMODYNAMIC CHANGES

Question 52

alternative therapies for OA

Answer 52

acupuncture, tai chi, magnets, lidocaine patch, TENS unit, copper bracelets

Question 53

what gout med do you not stop abrubtly

Answer 53

prednisone

Question 54

what gout med can weaken the immune system

Answer 54

prednisone (because corticosteroid)

Question 55

long term SE of prednisone (corticosteroid)

Answer 55

osteoporosis, cushings syndrome

Question 56

short term SE of prednisone

Answer 56

insomnia, mood swings, wt. gain, bruising, slow wound healing