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Med surg exam 2 > Musculoskeletal part 2 > Flashcards

Musculoskeletal part 2 Flashcards

(48 cards)

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1
Q

Stages of fracture healing

A
  1. Fracture Hematoma
  2. Granulation tissue
  3. Callus formation
  4. Ossification
  5. Consolidation
  6. Remodeling
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2
Q

Cast care

A

Nothing down cast

Ice for 24 hours after cast applied

Elevate position

Neurovascular checks

Check for skin breakdown (hot spots, drainage, odor)

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3
Q

Buck’s traction

A

No lower leg support

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4
Q

Russel’s traction

A

Support through entire leg

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5
Q

Balanced suspension

A

leg in air supported by cables

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6
Q

Traction care (TRACTION)

A

Temperature

Ropes hang freely

Alignment

Circulation (6 Ps)

Type and location of fracture

Increase fluid intake

Overhead trapeze

No weights on bed or floor

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7
Q

Compartment syndrome

A

Don’t elevate- keep at level of heart

No ice (vasoconstriction)

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8
Q

Amputation types

A

Open: stump prepared for prosthesis

Open: usually with infection

Disarticulation: amputation through a joint

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9
Q

Amputation nursing care key points

A

Impaired skin integrity: pressure areas and wrapping stump properly’

Pain r/t phantom sensation: may need analgesics

Impaired physical mobility:

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10
Q

Joint replacement pre-op nursing care

A

Splint

NWB (non-weight bearing) techniques

UE strengthening

Pulmonary function

N/V assessment

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11
Q

Joint replacement post-op nursing care

A

Positioning/turning

Peroneal nerve

Hip flexion/ambulation

Pain

Hemovac

Anticoags/antibiotics

I&O

TED/SCD

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12
Q

Osteomyelitis

A

Infection of bone marrow/surrounding tissue

Indirect: 1 organism, often under 17 y.o.

Risks for adults include debilitation, age, hemodialysis, sickle cell, IV drug abuse.

DIrect: multiorganism, open wound, implant

Complication: septicemia

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13
Q

Osteomyelitis diagnosis

A

Labs: high WBC, high ESR (erythrocyte sedimentation rate), high CRP (C-reactive protein)

CT, MRI

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14
Q

Osteomyelitis management

A

Surgery
Long term antibiotics
Acrylic bead chains
Hyperbaric O2

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15
Q

Osteochondroma

A

Benign bone tumor: overgrowth of cartilage and bone near end of bone

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16
Q

Osteosarcoma

A

Malignant bone tumor

Aggressive, gradual pain onset, bone swelling, surgical removal, chemo

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17
Q

Acute vs chronic back pain

A

Acute: under 4 weeks duration, symptoms come after injury

Chronic: More than 3 months or repeated incapacitating episode

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18
Q

Herniated intervertebral disk treatments

A

Treatments:

Laminectomy: enlarges and decompresses- to gain access to disk and remove it. (removing bone)

Discectomy: decompress nerve root (removing bulging part of disc)

Spinal fusion: welding two vertebrae together- trading stability for mobility.

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19
Q

Herniated disk post op

A

Compare circulation to baseline: Look for numbness and tingling

DON’T TWIST; LOG ROLL INSTEAD

can be on PCA, normally PO meds

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20
Q

Oteomalacia/Rickets

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A

Softening of bones from vitamin D deficiency

21
Q

Osteoporosis risk factors

ACCESS

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A 
Alcohol use
Corticosteroid use
Calcium Low
Estrogen Low
Smoking
Sedentary
22
Q

Osteoporosis fracture sites

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A

T-8 and below

23
Q

Kyphosis

24
Q

Lordosis

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A

Spine collapses in

25
Osteoporosis testing
H&P Bone Mineral Density every 15 yr for women: GOLD STANDARD is Dual energy x-ray on spine, hips, forearms
26
BMD: Bone Mineral Density test
Start at age 40 Every 15 years for women -1 to 1 is normal 1- to -2.5 osteopenia Under 2.5= osteoporosis
27
Osteoporosis medications
Estrogen after menopause Calcitonin Biphosphonates: TAKE W/ GLASS OF WATER IN MORNING AND SIT/STAND FOR 30 MINS AFTER SERMS
28
Calcium supplements
Can neutralize gastric acid Will decrease efficacy of tetracyclines Thiazide diuretics can cause increase in serum Ca Watch for hypercalcemia
29
Calcitonin
Bone resorption inhibitor Decrease osteoclast activity Increase calcium excretion Only for women 5 years past menopause Can be Subq, IM or nasal spray Watch for nausea after injections
30
Biphosphonates
Prevent osteoclasts from breaking down bone Fosamax Actonel Boniva Reclast
31
Osteoarthritis (OA)
``` Non inflammatory Asymmetric Progressive Weight bearing joints and metatarsals Pain worse w/ activity Limited ROM in affected joints Stiffness w/inactivity Joint space narrows Bone on bone (crepitus) Heberden's and Bouchard's nodules ```
32
OA treatments
Manage pain/inflammation: - Acetaminophen/NSAIDS - Steroids - Rest - Immobilize Joint - Arthroplasty
33
Second gen COX-2 inhibitor
Celebrex High risk for cardiovascular disorders Does not promote bleeding Watch for dyspepsia, diarrhea, Renal impairment
34
Rheumatoid Arthritis (RA)
Autoimmune Starts at YOUNGER AGE Chronic and systemic inflammation Affects CT and synovial joints Teaching: prevent loss of ROM: remain active, stretch joints Labs: ESR, CRP, Antinuclear Antibody Assay, Arthrocentesis (milky/cloudy)
35
RA treatment
Corticosteroids DMARDS (disease modifying antirheumatic drugs): methotrexate Biologics
36
Nonbiologic DMARDS
``` Plaquenil Minocin Leflunomide Azathioprine Gold Salts Sulfasalazine ```
37
Biologic DMARDS
``` Humira Cimzia Orencia Embrel Inflixmab Glimumab ```
38
Stuff to monitor during DMARDS
Monitor CBC and Liver function tests Teach pt to report S&S of infection, bleeding, SOB, dysuria Avoid alcohol on Minocin Avoid sunlight Store Minocin at room temp
39
OA vs RA
``` OA: After 40 Gradually develops One side of body first (overuse) Usually no redness, warmth, swelling, malaise 30 min morning stiffness then improve No erosion ``` ``` RA: between 25-50 Autoimmune Can develop suddenly Joints on both sides of body Redness, warmth, swelling of joints More than 30 min morning stiffness Inflammation causes erosion ```
40
Gout
Caused by high uric acid/purine Treated w/ Colchicine (immediate) Allopurinol (Long term)
41
Septic arthritis
Infected Joint cavity
42
Anklyosing Spondylitis
Chronic inflammation in axial skeleton, onset in 30s
43
Psoriatic arthritis
From psoriasis med example: Otezla
44
Reactive Joint inflammation
From GI or GU infections (chlamydia, salmonella) treated w/ antibiotics and rest
45
Synovectomy
Removal of inflamed tissue
46
Osteotomy
Removal of bone wedge to restore alignment
47
Arthrodesis
Surgical fusion of joint
48
Arthroplasty
reconstruction/replacement of joint

Med surg exam 2 (7 decks)

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