Musculoskeletal System Flashcards
(208 cards)
1
Q
name two specific examples of long bones
A
femur in leg & humorous in arm
2
Q
Diaphysis
- what is it?
- what is it made up of?
A
middle part of the long bone (made up of compact bone)
3
Q
Epiphysis
- what is it?
A
ends of long bones
4
Q
Epiphyseal plate
- what is it?
- what does it do & promote?
A
separates the epiphysis from the diaphysis (separates ends from shaft) so bone growth will occur!
5
Q
once bone growth is finished, each of the long bones are covered at the joints by ____
A
articular cartilage
6
Q
what type of bone marrow do long bones contain?
A
fatty yellow marrow
7
Q
give 2 examples of articular joints
A
femur has the knee & humorous has the elbow
8
Q
short bones (tarsals)
- where are they found?
- list 4 examples
A
- found in ankles & hands
- carpals, metacarpals, tarsals, metatarsals
9
Q
irregular bones
- give example
- what type of shape?
- bones of the ___ & ____
A
- EX: jaw
- odd shape
- bones of the vertebrae & jaw
10
Q
flat bones
- give 2 examples
- function
A
- EXs: sternum & skill
- Function: protect underlying structures
11
Q
what are bones made up of? (composition) (3)
A
cells, proteins, & minerals
12
Q
periosteum
- what is it?
- what attaches to it?
A
fibrous membrane that nourished the bone itself; tendons & ligaments attach to this
13
Q
endosteum
- what is it?
A
vascular membrane that covers the marrow cavity of long bones
14
Q
the bone marrow is highly ____
A
vascular
15
Q
bone marrow
- what is it?
A
shaft of the long & flat bones
16
Q
red bone marrow
- found in which locations?
- what is made here?
A
- found mainly in sternum, ileum, vertebrae, & ribs
- RBCs, WBCs, & platelets are made
17
Q
Remodeling of bones
A
Old bones removed, new ones added (new bones added faster when young)
18
Q
Resorption of bones
A
removal / destruction
19
Q
list things that influence bone resorption
A
physical activity (specifically weight bearing), dietary intake (esp Ca), hormones
20
Q
which types of patients have increased bone resorption & why?
A
bed bound patients from Ca loss = bone weakening = increased risk of fractures
21
Q
how much calcium & vitamin D is needed to maintain adult bone mass?
A
1,000 - 1,200 mg
22
Q
what is needed to absorb calcium?
A
Vitamin D!!!
23
Q
how many units of vitamin D should young adults have?
A
600
24
Q
how many units of Vitamin D should older adults have?
A
800 - 1,000
25
role of PTH
maintains serum calcium level in the blood by promoting movement of Calcium from the bone to the blood
***"PULLS" from the bone to the BLOOD**
26
what does the PTH promote?
demineralization of the bone to increase calcium in the blood
27
role of calcitonin
maintains serum calcium level
***stops bone resorption & deposits calcium into the BONE
28
what is calcitonin secreted by when serum calcium levels are too high?
thyroid gland
29
role of calcitriol
increases serum Ca in BLOOD by promoting absorption of calcium in the GI TRACT
30
role of thyroid hormone
breaks down bone (do not want too much)
31
role of cortisol
corticosteroid that breaks down bone (do not want too much)
32
role of growth hormone
direct effect on bone growth & remodeling
33
role of testosterone
has both direct & indirect effect on skeletal growth throughout lifespan; greater muscle mass & increased bone formation
34
in aging men, what does testosterone convert to in the adipose tissue to help preserve bones?
estrogen
35
role of estrogen
stimulates osteoblasts & inhibits osteoclasts; needed to enhance bone formation
36
role of ligaments & tendons
bind articulating bones together
37
ligaments
bone to bone
38
tendons
muscle to bone
39
flaccid
without tone
40
spastic
greater-than-normal tone
41
atonic
soft & flabby
42
hypertrophy
increase in size of muscle fibers; exercise & weightlifting
43
atrophy
decrease in size of muscle; immobility & bed rest
44
kyphosis
forward curvature of the spine
45
lordosis
exaggerated curvature of the lumbar spine (swayback)
46
scoliosis
lateral curving deviation of the spine
47
arthyrography
- what does it identify & determine?
- describe the procedure
- identifies cause of pain in joint & determines progression of joint disease
- contrast agent into joint cavity to visualize joint
- joint ROM while x-ray series obtained
48
arthroscopy
- what does it visualize?
- what dose it diagnose?
- what can it treat?
- describe the procedure
- Visualize joint w fiber optic endoscope
- Diagnose joint disorders
- Can biopsy
- Can treat ulcers, defects & disease processes
- Sterile procedure until local or general anesthesia
- Wound closed w steri strips or sometimes sutures & covered w a dressing
49
arthrocentesis
- describe what procedure does
- what can it diagnose?
- what does it relieve pain from?
- what to monitor for?
- what should the synovial fluid look like?
- what type of technique is this procedure?
- Obtains sample of synovial fluid from joint
- Can dx inflammatory arthropathies
- Relieves pain from effusion (fluid in joint)
- Look for hemarthrosis (bleeding in joint cavity)
- Synovial fluid (should be clear, pale, straw colored, & small in volume)
- Aseptic technique
50
X-ray / CT / MRI
- what does it show & reveal?
- Bone density, texture, erosion, bone changes
- Reveals fluid, irregularity, spur formation, narrowing / changes of joint
51
CT
- what can it visualize?
- With or w out contrast
- Visualize tumors, soft tissue injury, ligaments & tendons, trauma
52
MRI
- what does it visualize?
- what dose it assess & diagnose?
- Visualize & assess torn muscles, ligaments & cartilage
- Assess & dx herniated disc, hip, & pelvic conditions
53
electromyography
- what does it assess & evaluate?
- describe the procedure
- post op interventions
- Assesses electrical potential of muscles / nerves & evaluates weakness, pain, & disability & Evaluates weakness, pain & disability
- Needle electrodes into muscles
- Warm compresses post procedure
54
bone densitometry
- what does it test?
tests BMD through x-rays & US
55
bone scan
- what does it detect?
- describe procedure
- Used to detect tumors (metastatic & primary), Osteomyelitis & DDD
- Radioisotope through IV, scan 2-3 hours after
- Areas of abnormal bone will appear brighter
56
list some nursing considerations & contraindications for diagnostic tests (7) (indicate ones specifically for MRI)
Nursing:
1. patient must lie still (MRI) - sedative or Ativan sometimes given before
2. discuss MRI
Contraindications:
1. COPD or disorder where patient cannot lay flat
2. pregnant patient
3. patient w metal implants
4. always check urinalysis on women at child-bearing age!!
Allergies / contraindications to contrast agents:
1. check kidney function
2. be sure creatinine level is below 1.3
57
post diagnostic care (3)
1. rest joint for 12 hours
2. enjoy strenuous activity until approved
3. provide ice 20 min on & 20 min off
58
post diagnostic care for an arthrography
- patient may hear a clicking or crackling joint for 24-48 hours (dye is causing sound)
- drink plenty of fluids to flush out contrast dye
59
post diagnostic care for an arthroscopy
- check for s/sx of infection due to incisions
- keep joint extended & elevated to reduce swelling
- avoid strenuous activity until cleared by the PCP
- ice 20 mins on & 20 mins off
60
list reasons of why a calcium lab would be drawn
Altered in osteomalacia (softening of the bone), parathyroid dyfx, prolonged immobilization
61
list reasons why an alkaline phosphatase (ALP) would be drawn
can indicate liver disease or bone disorders
Found throughout the body (concentrated in liver, bones, kidneys & GI)
62
list reasons why parathyroid labs (PTH), calcitonin, vitamin D labs would be drawn
Evaluate bone metabolism
63
list reasons why CK (creatine kinase) & asparate aminotransferase (AST) levels would be drawn
Elevated w muscle damage
64
list reasons why urine calcium levels would be drawn
Increased w bone destruction
65
indications for casting (3)
Immobilize fracture, Correct / prevent deformity, Support weakened joints
66
how is a cast applied?
Fiberglass or plaster of paris (joints proximal & distal)
67
what are some complications of casts? (2)
1. pressure ulcers
2. compartment syndrome (occurs due to casting too soon)
68
nursing focus / education for casting (5)
1. ***Neurovascular checks** 6P's (pain, pulselessness, pallor, paresthesia, paralysis, polythermal)
2. cold therapy
3. do not scratch; infection
4. keep clean, dry, & elevate!
5. discuss potential complications
69
what is a benefit of a waterproof cast?
does not smell!
70
how do you perform a neurovascular assessment?
6 Ps: pain, pallor, paralysis (can they move it?), paresthesia (numbness / tingling), pulse, polycythemia
71
list causes of compartment syndrome (5)
1. trauma
2. fracture
3. severely bruised muscle
4. severe sprain
5. cast / bandage
72
what is compartment syndrome? describe what happens
- Fascia (fibrous material) covers muscles; DOES NOT expand
- Swelling occurs = nowhere to go
- Increased pressure in compartment
- Blood flow compromised
73
what could compartment syndrome lead to? (worse case)
ischemia & limb death
74
how will a client w compartment syndrome present? (3)
1. ***pain disproportionate to injury**
2. N/t to extremity; paleness
3. NO pain relief despite analgestics
75
list & describe the diagnostic test used for compartment syndrome
Stryker: tests pressure; looks like a meat thermometer
76
list acute interventions for compartment syndrome (2)
1. remove cast
2. Fasciotomy: removing fascia
77
how can nurses help w compartment syndrome? education! (5)
1. immobilized fx should not hurt
2. N/T to extremity / warmth
3. pain out of proportion
4. keep clean & dry
5. report fever or S & S of infection
78
status post fasciotomy care
Negative pressure wound therapy w installation has been used effectively to assist in granulation in acute, subacute, & chronic wounds
79
indications of external fixation (2)
1. fractures w soft tissue damage or wounds
2. complicated fractures
80
describe an external fixation - what is happening? (3)
1. surgical pins inserted through skin to bone
2. metal external frame attached to pins
3. holds proper alignment (until healed or surgery)
81
benefits of external fixation (5)
1. immediate fx stabilization
2. minimize blood loss (ORIF)
3. increased comfort
4. improved wound care
5. early mobilization
82
complications of external fixation (3)
1. pin loosening
2. infection / osteomyelitis
3. compartment syndrome
83
how can nurses help / educate for external fixations (8)
1. ***pin cleaning - be able to educate patients when they get discharged***
2. altered body image
3. may need to alter clothing
4. elevate
5. cover sharp edges
6. discuss complications (what to look for)
7. monitor NV status (24 hours)
8. may need casting / splint after removal
84
indications of skeletal traction (5)
1. short term fx management
2. decrease muscle spasms / pain
3. fracture w soft tissue damage / wounds
4. maintain alignment while waiting for surgery
5. correct / prevent deformities
85
mechanism of action of skeletal traction (3)
1. local anesthesia
2. traction / countertraction (patients body weight / weight on pullies)
3. pulling reduces painful muscles spasms
86
what can a client expect during a skeletal traction?
1. pressure / pain during insertion
2. weights attached to pins / wires
3. complete bed rest during therapy (trapeze provided (triangle))
4. adjustment of weights as muscles relax
87
nursing considerations for skeletal traction (7)
1. check through shift & Q8 (NV status / VTE)
2. pain control
3. prevent skin breakdown
4. prevent shearing injuries
5. PT consult for AROM & PROM
6. pin care
7. anxiety reduction
88
complications of skeletal traction (7)
***immobility**:
- atelectasis / pneumonia
- constipation
- anorexia
- infection
- VTE
- CAUTI (if unable to use trapeze)
89
describe skin traction (bucks) (how & why they are used) (4)
used less frequently:
- bucks (lower leg) used most frequently
- short term stabilization w out pins / wires
- weights attached by velcro, tape, straps, boots, or cuffs
- be cautious not to exceed tolerance of skin! (4.5 lb - 8lb per extremity)
90
nursing considerations for skin traction (bucks) (6)
1. inspect area under traction
2. assess N/V status
3. encourage AROM
4. same considerations as skeletal
5. complications of immobility
6. ***simple traction***
91
list main differences between skeletal & external fixation (4 for each)
skeletal:
- short term fx management
- ***pt immobile - weights placed to pins**
- weights cannot be removed
- keeps in anatomical alignment until surgery an option
external:
- short term or longer term fx management
- **pt mobile - use of crutches & non-weight bearing on affected extremity**
- no weights!
- maintains anatomical alignment until surgery an option
92
indications for orthopedic surgery (5)
1. unstable fx
2. deformity
3. joint disease (arthroplasty)
4. necrotic or infected tissue & tumors
5. amputation
93
goals for orthopedic surgery (5)
1. improve function
2. restore motion
3. relieve pain & disability
4. improve quality of life
5. safer than most surgeries w rare complications
94
complications of orthopedic surgery (4)
1. blood loss (up to 1,500 ml anticipated)
2. acute post-op bleeding common
3. post op anemia
4. infection
95
arthroplasty indications (3)
1. hip & knee most common
2. OA, RA, trauma, deformity
3. avascular necrosis (traumatic injury, steroid usage, alcohol)
96
arthroplasty mechanism of action
remove bad & replace w new
97
arthroplasty complications (5)
1. blood loss
2. infection
3. **robotic surgery**
4. **post op knee**
5. **post op hip**
98
nursing considerations for arthroplasty (4)
1. IV antibiotics 60 mins prior to incision
2. complications of immobility (VTE prophylaxis, pressure ulcers, pneumonia / atelectasis)
3. hip: abductor pillow; <90 degrees
4. knee: knee immobilizer (assess N/V status, pain management, promotion ambulation, home care)
99
what are causes of low back pain associated w musculoskeletal disorders? (5)
1. "awkward movement"
2. trauma / fall
3. OA of spine
4. osteoporosis of vertebrae
5. scoliosis
100
how will a client w low back pain associated w a musculoskeletal disorder present? (5)
1. acute vs chronic
2. radiculopathy
3. sciatica
4. sharp / stabbing pain
5. *most common: sacral & lumbar*
101
diagnostic tests used for musculoskeletal disorders (2)
1. X-ray
2. CT / MRI
102
meds that can help w chronic musculoskeletal disorders (3)
1. TCA's (amitriptyline)
2. SSRIs (duloxetine)
3. atypical anticonvulsants (gabapentin)
103
what is a complication of a musculoskeletal disorder?
loss of bowel or bladder function
104
how can nurses help / educate patients w musculoskeletal disorders? (10)
1. self-limiting w rest
2. avoid strain
3. take prescribed medications for acute (short term opioids, muscle relaxants, & possible steroids)
4. daily pains = NSAIDS
5. hot / cold
6. chiropractic care
7. orthopedic shoes / lumbar support
8. limit sitting
9. condition exercises
10. good posture & body mechanics
105
list NSAIDS used to treat back pain (7)
- Ibuprofen / motrin / naproxen / ASA / aleve
- Ketorolac
- tramadol
106
list muscle relaxants used to treat back pain (1)
cyclobenzaprine
107
list tricyclic antidepressants / atypical anticonvulsants used to treat back pain (3)
1. amitripyline
2. duloxetine
3. Gabapentin
108
list opioids used to treat back pain (2)
1. hydrocodone / acetaminophen (Vicodin or Norco)
2. oxycodone / acetaminophen (Percocet)
109
what two things work together to protect your bones? describe their specific roles
calcium & vitamin D
calcium: helps build & maintain bones
vitamin D: helps body effectively absorb calcium
110
causes of osteoporosis (12)
1. smaller frame
2. postmenopausal
3. malnutrition
4. bariatric surgery
5. GI malabsorption disorders
6. immobilization
7. corticosteroids
8. medications
9. tobacco / alcohol use
9. sedentary lifestyle
10. reduced calcitonin
11. reduced estrogen
12. increased PTH
111
describe osteoporosis (what is happening?)
reduced bone mass, deterioration of bone matrix, diminished architectural strength, fracture easily under stress
112
how will a client w osteoporosis present? (5)
1. early = no symptoms
2. back pain (collapsed vertebra)
3. loss of height
4. stooped posture
5. bones fracturing easily
113
lab & diagnostic tests for osteoporosis (8)
diagnostic tests: **dexa scan**, FRAXX, x-ray
labs: Sertum P & Ca, ALP, urine Ca excretion, hematocrit, ESR
114
list some foods that can help w osteoporosis (5)
1. foods high in Ca
2. cheese, dairy products, broccoli, canned salmon
3. dark green leafy veggies
4. soy products
5. Ca fortified cereals & OJ
115
complications of osteoporosis (1)
fracture management
116
how can nurses help / educate for osteoporosis (7)
1. diet rich in Ca & Vitamin D
2. peak bone mass "bank it!"
3. weight bearing exercises
4. supplements (citrate, vitamin D)
5. medication therapy
6. reduce use of caffeine, tobacco, alcohol, & carbonated soft drinks
7. educate on secondary osteoporosis
117
what main class of drugs is used to treat osteoporosis? list the specific examples
Biphosphonates!
- ***Alendronate: weekly pill***
- Risedronate: weekly / monthly pill
- Ibandronate: monthly pill or quarterly IV infusion
- Zoledronic acid: annual infusion
118
which antinoplastic is used to treat osteoporosis?
Denosumab
119
which estrogen is used to treat osteoporosis?
Raloxifene
120
how long can patients w osteoporosis have opioids?
72 hours & follow up w PCP
121
describe osteomalacia - what is happening?
Soft & weak skeletal bones (Lower back, pelvis, hips, legs, & ribs)
122
causes of osteomalacia (6)
1. Lack of Vitamin D (sunlight & dietary)
2. Renal failure
3. GI disorders (Celiac)
4. Hyperparathyroidism
5. Medications
6. Malnutrition
123
how will a client w osteomalacia present? (6)
1. pain & tenderness to bones (worse when ambulating)
2. bowing of bones (kyphosis / legs)
3. waddling gait
4. possible pathologic fractures
5. possible steatorrhea (fatty stools)
6. pain not relieved by rest (as progresses)
124
lab & diagnostic tests for osteomalacia
- X-ray (demineralization)
- serum Ca / P levels & ALP in the bones
- urine Ca & creatinine
125
foods that can help w osteomalcia
- same as osteoporosis (rich in vitamin D & Ca)
- may need vitamin supplements
126
complications of osteomalcia (1)
fractures
127
how can nurses help / educate for osteomalacia (6)
1. discuss dietary changes (foods w D & Ca)
2. supplements for liver / kidney issues
3. sunlight therapy
4. braces may help w pain / deformity
5. educate on S & S of fracture
6. safety to prevent fractures
128
the process of activation of vitamin D occurs in which two organs?
the liver & kidney
129
describe osteomyelitis
bone infection
130
causes of osteomyelitis (5)
1. bloodstream (often staph)
2. nearby tissue infection
3. open fractures / ORIF (open reduction internal fixation)
4. complicated DM
5. immunocompromised / poor circulation
131
how will a client present w osteomyelitis? (5)
1. may be asymptomatic
2. VS changes (fever, tachycardia)
3. swelling, warmth, & redness over area
4. pain to affected area
5. fatigue
132
lab & diagnostic tests for osteomyelitis
labs: CBC & blood cultures to identify pathogen causing infection
- CT / MRI
- ESR (elevated sedimentation rate) - marker of inflammation
133
meds that can help treat osteomyelitis (2)
how long should a patient be on these meds?
1. strong IV antibiotics
2. oral antibiotics
**longer term (3-6 weeks) for both**
134
acute interventions for osteomyelitis (3)
1. surgery (remove areas of dead bone)
2. ORIF reversal or treatment
3. strong IV antibiotics
135
complications of osteomyelitis (3)
1. avascular necrosis (osteonecrosis) - death of bone due to lack of blood supply
2. amputation
3. sepsis = death
136
how can nurses help / educate for osteomyelitis? (9)
1. smoking cessation
2. safety
3. monitor for worsening infection (discuss S & S)
4. prolong elective orthopedic surgery if needed
5. remove urinary catheters ASAP
6. aseptic postop wound care
7. prompt management of soft tissue infections like cellulitis
8. at home wound care
9. clients w DM - inspect feet daily
137
joint dislocation - describe
- joint not longer in anatomic alignment
138
sublazation
partial joint dislocation
139
when is a joint dislocation considered an orthopedic emergency?
trauma dislocations
140
complications of joint dislocations (2)
- avascular necrosis = without blood supply
- check NV status immediately
141
acute interventions for joint dislocations (2)
- X-ray
- immobilize joint & reduce joint (may need sedation or heavy pain meds (fentanyl); INFORMED CONSENT
142
nursing considerations & education for joint dislocations (2)
1. NV assessment
2. Discuss exercises; PRICE (protection, rest, ice, compress, elevate)
143
causes of fractures (3)
1. direct blows
2. crushing forces
3. sudden twisting motion
144
how will the client present w a fracture? (4)
1. pain w movement (lessened when immobilized)
2. muscle spasm
3. deformity (often)
4. possible ecchymosis & edema at site
145
diagnostic tests for fractures (2)
1. X-ray
2. CT (extensive soft tissue damage)
146
acute interventions for fractures (1) describe difference between interventions for open vs. closed fractures
1. ***NV assessment!! priority***
2. open: cover w saline gauge; prepare for surgery
closed: reduction & immobilization (conscious sedation; informed consent)
147
complications of fractures (9)
1. complicated fracture (ORIF / external fixation or skeletal traction (for hips & femurs))
2. avascular necrosis - death of joint
3. Osteomyelitis - worried esp w open fractures!
4. hemorrhage - commonly seen w pelvic fractures
5. fat embolus (femur)
6. compartment syndrome
7. VTE
8. DIC (disseminated intravascular coagulation; bled too much & body used up all clotting factors)
9. nonunion: cannot get back into anatomical alignment
malunion: not healing exactly like it should
148
how can nurses help / educate for fractures (8)
1. discuss conscious sedation for reduction
2. aid in immobilization
3. discuss splitting & casting
4. PRICE - protect, rest, ice, compress, elevate
5. NV assessment
6. pain control
7. monitor for complications
8. discuss home care & follow up
149
describe a hematoma block procedure
lidocaine needle is placed directly into the fracture to block it & make it go numb in order to splint it
**aspirate before injecting lidocaine**
150
causes of pelvic fractures (2)
1. falls from great height; crush injuries
2. MVA; vehicle vs pedestrian
151
how will the client present w a pelvic fracture? (5)
1. ecchymosis & tenderness to A & P pelvis
2. bruising will happening immediately due to bleeding
3. ***number 1 priority is hemorrhage due to many arteries & veins being disrupted in that area!****
4. edema & N/T to pubis, genitals, & thighs
5. pain when weight bearing
152
lab & diagnostic tests for pelvic fractures (2)
1. CT
2. CBC
153
acute interventions for pelvic fractures (2)
1. Immobilize = surgery
2. blood transfusion if severe enough
154
complications of pelvic fractures (4)
1. severe back pain (retroperitoneal bleed) - behind kidneys
2. hemorrhage (open book; rock pelvis)
3. fat emboli
4. NV compromise to lower extremities
155
nursing considerations for pelvic fractures (5)
1. stable vs unstable
2. monitor w best rest & assess for complications of immobility
3. painful to sit / defecate = sitz baths, stool softener
4. early mobilization; rehab for full weight bearing in 3 months
5. monitor for paralytic ileus (will not hear bowel sounds!!)
156
causes of hip fractures
***falls***!
157
how will the client present w a hip fracture? (2)
1. affected leg shortened w external or internal rotation of foot
2. pain in hip / groin / knee (upon slightest movement)
158
diagnostic tests for hip fractures (2)
***X-ray (CT if worried about more damage)***
159
acute interventions for hip fractures (2)
1. Immobilize
2. surgery (within 24 hours)
160
complications of hip fractures
avascular necrosis
161
nursing considerations for hip fractures (6)
1. standard post op care
2. complications of immobility
3. abductor pillow; less than 90 degrees; elevated toilet seat
4. ambulate first day post-op (in most cases)
5. LTCF / rehab on floor / rehab at home w PT consult
6. **delirium in older adults due to pain & blood loss**
162
causes of femur fractures
***MVA (motor vehicle accident)***
163
how will the client present w a femur fracture?
edema, deformity, & pain to the thigh / knee
164
lab & diagnostic tests used for femur fractures (2)
1. doppler US & X-ray
2. CBC
165
acute interventions for femur fractures (3)
1. immobilize!
2. assess NV function to extremity
3. skeletal traction = surgery
166
complications of femur fractures (3)
1. hemorrhagic shock
2. compartment syndrome
3. ** fat emboli - most common cause is a femur fracture**
167
what is the most common cause of fat emboli?
a femur fracture
168
nursing considerations for femur fractures (2)
1. same as general post op
2. may take up to 6 months to walk (intensive PT)
169
causes of fat embolism syndrome (2)
1. ***orthopedic trauma***
2. rare: bone marrow transplant, osteomyelitis
170
fat embolism syndrome - what is happening?
- Fat embolic enter into the microcirculation
- Induce SIRS (systemic inflammatory response syndrome) = pulmonary, cutaneous, neurological, retinal symptoms
171
how will a client present w fat embolism syndrome? (5)
1. altered mental status (early)
2. ***tachypnea, tachycardia, & fever***
3. petechial rash (round spots that occur on the skin as a result of bleeding)
4. respiratory depression (75%) - mild to ARDS to mechanical ventilation
5. common systemic: respiratory distress, altered mental status, & rash
172
treatment of fat embolism syndrome (3)
1. largely supportive
2. fix long bone fractures early = decreases likelihood of developing FES (0.9% - 11%)
3. corticosteroids? not used as much
173
nursing considerations for fat embolism syndrome (5)
1. can occur when manipulating fractures
2. monitor for hypoxemia
3. GCS to assess for LOC (should be 15!) - eye opening, verbal response, motor response
4. petechial rash is transient (up to 24 hours)
5. supportive care - monitor for ARDS (respiratory distress)
174
causes of amputations (3)
1. diseases (vascular, DM, osteomyelitis) - destroys blood supply to visceral extremities
2. injuries
3. surgery to remove tumors
175
levels of amputations (4)
- performed at most ___ post to allow for healing
- based on ____ _______ of limb
- goal?
- preservation of ____
1. performed at most distal point to allow for healing
2. based on circulatory status of limb
3. Goal = achieve good prosthetic fit
4. preservation of joints desirable (knee / elbow)
176
complications of amputations (4)
1. hemorrhage
2. infection
3. joint contracture
4. phantom limb pain (body does not realize that the limb is gone)
177
nursing focus & education of amputations (7)
1. rigid cast dressing = uniform compression & residual limb shaping
2. Rehab team = nurse, social worker, doctor, PT / OT, psychologist, & prosthetist
3. pain
- surgical = opioids
- changing positions / sandbag to residual limb for painful muscle spasms
- phantom limb therapies: mirror, massage, acpunture, VR
- beta blockers (metoprolol): may relieve burning dull discomfort
- anticonvulsants (gabapentin)
- TCAs (amitriptyline) - helps w mood as well
4. promotion of wound healing
5. enhancing body image
6. coping / grief
7. helping patient achieve mobility & independent care
- prone positioning to prevent hip / knee joint contracture
- prone 20-30 minutes TID to avoid contractures (helps to stretch flexor muscle to reduce pain)
178
causes of rheumatoid arthritis (3)
- what is it?
- risk factors
1. chronic inflammatory disorder
2. autoimmune w unknown etiology
3. risk factors = smoking, genetics, viral or bacterial illness
179
what is happening in rheumatoid arthritis? (5)
- **immune system attacks synovial lining of joints**
- begins in distal joints (fingers & toes)
- inflammation thickens synovium destroying or eroding joint (Pannus formation) - destroyed joints that become deformed
- tendons & ligaments weaken & stretch
- lose joint mobility & use of joints
180
which meds are used to treat amputations? (3)
1. beta blockers (metoprolol): may relieve burning dull discomfort
2. anticonvulsants (gabapentin)
3. TCAs (amitriptyline) - helps w mood as well
181
Pannus formation
- describe & when it commonly occurs
destroyed joints become deformed (often occurs in Rheumatoid arthritis)
182
how will a client w rheumatoid arthritis present? (3)
- tender, warm, swollen, & erythemic joints (bilateral & symmetric)
- joint stiffness worse in mornings & after inactivity
- fatigue, fever, & loss of appetite
183
lab & diagnostic tests used for rheumatoid arthritis (3)
- arthrocentesis - removal of fluid in joint (aspirated w needle)
- CT
- CBC, ESR (elevated sedimentation rate or inflammatory markers), CRP, rheumatoid factor
184
meds that can help w rheumatoid arthritis (4)
1. ***DMARDS - disease modifying antirheumatic drug
nonbiologic (methotrexate): bad side effects (liver & kidney diseases), need blood tests done annually
biologic (adalimumab): have to fail the nonbiologic treatment first in order for insurance to pay for the biologic
2. NSAIDS (ibuprofen, naproxyn)
3. Cox-2 (celecoxib)
4. corticosteroids (prednisone) - acute flare ups & pain
185
which meds should be avoided for rheumatoid arthritis? why?
opioids - only used for acute conditions!!
186
complications of rheumatoid arthritis (4)
1. CVD
2. medication toxicity (methotrexate)
3. damage to skin, eyes, lungs, heart, blood vessels, kidneys, nerve tissue, salivary glands & bone marrow
4. deformity of hands & feet
187
how can nurses help / educate patients w rheumatoid arthritis? (7)
1. aggressive treatment early!
2. goals = decrease joint pain & swelling, prevent joint damage & minimize disability
3. exercise (discuss complications of immobility on joints)
4. non pharm methods (relaxation, heat / cold)
5. Tai Chi / yoga (improves mood & quality of life, gentle stretching, keeps mobility for as long as possible)
6. complementary alternative medicine (CAM) - fish oils / plant oils
7. weight management (less pressure being put on joints = decreases pain & increases mobility)
188
causes of osteoarthritis (5)
1. ***noninflammatory joint destruction**
2. end result of autoimmune disorder
3. obesity
4. laborious occupations & sports
5. genetic predisposition
189
describe osteoarthritis - what is happening? (6)
- Breakdown of articular cartilage
- Progressive damage to underlying bone
- Narrowing of joint space
- Joint movement limited
- Pain & damage
- Progressive joint degeneration
190
how will a client w osteoarthritis present? (5)
1. Pain, stiffness, & functional impairment
2. Joint pain aggravated by movement / exercise (Relieved by rest)
3. Morning stiffness
4. Decreased ROM in affected joint
5. Crepitus over knee or grating sensation (may feel like bubbles under their skin)
191
lab & diagnostic tests for osteoarthritis (2)
1. X-ray or MRI
2. blood test to rule out RA
192
meds that can help osteoarthritis (6)
1. NSAIDS (ibuprofen, naproxen)
2. Cox-2 (celecoxib)
3. intra-articular corticosteroids
4. acetaminophen
5. Diclofenac
6. Glucosamine & chondroitin
193
complications of osteoarthritis (3)
1. depression & sleep disturbances
2. difficulty w ADL's
3. need for arthroplasty (joint replacement)
194
how can nurses help / educate for osteoarthritis? (6)
1. exercise & lower extremity strength training
2. weight loss
3. OT / PT
4. splints / braces or walking aids
5. CAM therapies
6. heat / cold
195
causes of gout (4)
1. high levels of uric acid in blood (fructose-rich beverages like pop, alcohol consumption - esp beer)
2. age, BMI
3. HTN meds (beta blocker, ACEIS, ARBs except losartan)
4. thiazide diuretics
196
describe gout - what is happening? (4)
1. hyperuricemia
2. macrophages in joint space phagocyte urate
3. macrophages become crystalized (crystals are sharp & needle-like)
4. deposits in peripheral areas (great toe, hands & ear)
197
how will a client w gout present? (4)
1. arthritis
2. sudden & severe attacks of pain
3. pain, swelling, & tenderness (great toe, knee or ankle)
4. limited ROM
198
labs & diagnostic tests for gout (2)
1. joint fluid analysis (uric acid will show up)
2. x-ray / dual energy CT scan
199
meds that can help gout (list ones for both acute attacks & management)
acute attacks: Colchicine, NSAIDs, corticosteroids
management: Xanthines (allopurinol) & uricosurines (probenecid)
200
complications of gout (2)
1. Tophi - deformity in joint due to huge deposits of hardened crystals
2. kidney stones
201
Tophi - describe
what is this a complication of?
deformity in joint due to huge deposits of hardened crystals (complication of gout)
202
how can nurses help / educate for gout? (8)
1. Eat foods low in purines / avoid high purine diet
2. Coffee, vitamin C, & cherries (reduce uric acid levels)
3. Lifestyle changes
4. Weight loss
5. Decrease alcohol intake
6. Avoid certain meds (thiazides)
7. Medication compliance
8. Avoid trauma / stress
203
causes of fibromyalgia (2)
triggers?
1. unknown
2. triggers: genetics, anxiety, depression, physical / emotional trauma, infection
204
what is happening in fibromyalgia?
Amplified pain d/t CNS abnormally amplifying pain signals
- considered more of a psychological disorder
205
how will a client w fibromyalgia present? (4)
1. Bil widespread pain (dull ache x 3 months)
2. Fatigue (restless leg / sleep apnea)
3. Cognitive difficulties (fibro fog)
4. Other conditions usually co-exist
206
lab & diagnostic tests used for fibromyalgia
no diagnostic / labs (may rule out other conditions)!
207
meds that can help w fibromyalgia (5) which meds cannot be given?
1. NSAIDS / acetaminophen
2. TCA's
3. muscle relaxants
4. SNRIs / SSRIs
5. anticonvulsants
**no opioids!!**
208
how can nurses help patients w fibromyalgia? (6)
1. CAM / exercise therapy (yoga / tai chi)
2. CBT (cognitive behavioral therapy)
3. sleep hygiene
4. support groups
5. stress reduction
6. provide education on pharm / non pharm methods
