Test #7 - Musculoskeletal Flashcards Preview

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Flashcards in Test #7 - Musculoskeletal Deck (54):
1

What are 3 types of muscles?

Cardiac
(Heart)

Skeletal

Smooth
(Inside of muscles)

2

How is bone formed?

By the gradual addition of calcium and phosphorus salts to cartilage or fibrous connective tissue

3

What is it when two bones meet and articulate?

Joints

4

What is a living tissue with a complex system of canals thru which blood, lymph, nerves and vessels pass?

Bones

5

What are small sacs of connective tissue located wherever pressure is exerted over moving parts?

Bursae

6

What is a material composed of fibers embedded in a firm gel?

Cartilage

7

What does alcohol do to the bones?

 

Hip Deterioration & increased incidence of fractures and other injuries

8

What is a metabolic disease in which bone demineralization results in decreases density and subsequent fractures?

 

Osteoporosis

9

What is an inflammation of bone tissue caused by pathogenic micro-organisms: produces an increase in vacularity and edema often involving the surrounding soft tissue (infection of the bone)?

Osteomyelitis

Can occur from something out side of the body or inside of the body.

(IE: outside: fracture, inside: UTI)

10

Environmental conditions can effect a pt bone, what are they?

Age

Sex

 Nutrition

Underlying Diseases

Any altered cognitive function

11

What are some assessments for Osteomyelitis?

Pulsating

Pain worsens when moves

Temp higher than 101

Redness, swelling, heat

(LONG term antibiotics)

12

What is a disease second to osteoporosis, risk increases with age, Have bone pain usually in hip or pelvis, occurs at night, and is chronic?

Paget's Disease

13

What are some assessments of Paget's disease?

Abnormal Shaped bones

Weak bones (often break)

They don't always have symptoms until a fracture occurs

Confined to single bone usually

Can effect bones of hear and cause hearing loss

Pain is usually deep achy pain and can't localize

Worsens with pressure

Effects skull (Softer/Thicker) and enlarges

S/S of stroke due to enlarged skull

14

What is a metabolic bone disorder characterized by thining, less dense or porous bone mass, "Silent Disease?

Osteoporosis

15

What are some risk factors for Osteoporosis?

Occurs in women after 40 (Menopause)
- Due to decreased estrogen

Men (Due to dec testosterone)

Body build and weight

Older and lean built women

Excessive Caffeine

Diet low in calcium and Vit D

Excess Alcohol

Low-Protein

Anorexia/bulimia

Cigarettes

Laxatives

Antacid Use

Caucasian

Asian

Weight-Loss diets lacking nutrients

Lack of physical activity

 

16

What is the patho for Osteoporosis?

Bone reabsorption exceeds bone formation

17

Bone Mineral Density is a test to diagnose osteoporosis?

X-Ray

Spine & hip most often assessed sites

18

Interventions for Osteoporosis?

Nutritional Therapy
High in Protein, Mag, Vit K, Calcium, Vit D

Exercise:
Walking 30 min 3-5 times/week is the single most effective exercise for osteoporosis prevention

Lifestyle:
Avoid tobacco, prevent falls

Drug Chart: 1126 53-2

19

Labs to look at for Osteoporosis?

Labs: CBC and Blood Chemistry

Serum Calcium

Serum Phosphorous

Alkaline Phosphatase : Monitor liver/bone

Erythrocyte Sedimentation Rate: Detect chronic and acute inflammation

Urinalysis: Can tell you if they have an infection or has gone septic

Arthrocentesis: Putting a needle into joint and getting synovial fluid, sent for analysis, Can diagnose infection, gout, arthritis

Electromyography (EMG): done by nuerologist, check nerve impulse in the muscles

 

20

Radiological tests for Osteoporosis?

X-Ray: Bone spurs, tumors, cogenital abnormality

Bone Scan-CA-Mets: Low radioactivity injected in vein, inspects to detect where CA is deposited.  To see if cancer has metastisized to bone.

Computed Tomographic Scan (CT): Commonly to have slices of body parts to check. Can see stuff in the bones.

Arthrogram: X-Ray where they shoot dye into the joint and can see soft tissue, ligaments, tendons and cartilage

Myelogram: Dye is placed in spinal canal and that visualizes spine.  Post-Op: bedrest, HOB raised 30-50 degrees to keep dye in spine. Seizures is a side effect.

21

Pharmacology for Osteoporosis?

Calcitonin (osteo, pagets, hypercalcemia)
Thyroid hormone that inhibits bone break down
SE: Effects dec after 2 years, 
Teach: Switch nares

Alendronate (Fosamax)
Slows bone reabsorbtion
Teach: Take on empty stomach in am w/ full glass of water, Sit upright or stand for 30 min after to decrease GI esophagitis

Adrogens (Testosterone)
Replacement of testosterone for males

Estrogens
Replacement in women, prevents bones loss and increases bone density.
Teach: Inc chance of veinous thrombus in legs
 

22

Muscle relaxers for osteoporosis?

Carisoprodal (Soma)
SE: Asthma, anaphylactic, shock, N/V, Drowsiness, Take with food, If rash DC

Cyclobenzaprine Hydrochloride (Flexeril)
SE: Edema of tongue, syncope, drowsiness, Short term use, don't give with MAOI

Diazepam (Valium)
SE: Drowsiness, ataxia, dizziness, Monitor  for suicidal tend, resp depression, max effect may take 1-2 weeks

23

Assessments Osteoporosis?

Back pain

Dowager's Hump (Kyphosis)

Teeth

Weight

24

Teachings for osteoporosis?

Adequate Ca, Vit D intake

Use of supplements

Less caffeine and alcohol intake

Encourage regular hysical activity; and potential hazards to avoid injury

25

Interventions for Osteoporosis?

Admin medication as ordered

Assist with ADL's as necessary

Teach/Assist with assistive devices

Complications: Fractures

Documentation: All care and teaching done, any variations from normal

26

What is a soft tissue injury?

Sprain is a tear of the capsule or ligament surrounding a joint.

It is always the result of a twisting injury

Usually ankle or knee

27

What to do for strain?

Muscles

Teach to modify ADL's 

Rest involved muscle

Immobilizing device

28

What to do for sprain?

Joints

Initially immobile with increasing mobility

29

What are fractures?

Due to a blow, fall or accident

During normal activity or with minimal injury

30

A closed complete fracture is what?

Bone is broken with no external injury

31

What is an open complete fracture?

Bone has penetrated the skin

32

What is a comminuted fracture?

Pieces splintered apart

33

What are some incomplete fractures?

Greenstick: Bone bends and breaks but not all the way through

Torus

Bowing

Stress : From repetitive movements

Transchondral: in a joint

34

Nursing care for fracture?

Splinting

Maintain body alignment

Elevate body part

Apply cold for 1st 24 hours

Observe for changes in color, sensation temperature

Observe for shock: Low BP, Inc P, Cool, Clammy skin, Urinary Output <30 ml/hr

35

Closed fracture assess, interventions, teachings?

Assess: Pain, Neurovascular compromise, skin breakdown, coping

Interventions: Pain meds, ice, splint, ROM & isometric exercises, keep elevation, assist with ADL's

Teach: S/S of NV compromise, S/S of skin breakdown, use of aids

36

What to do when cast is drying?

 

Sleep on firm mattress, fan support cast on pillows, reposition every 2-4 hours, Make sure you use palms of hand when moving cast

37

Call the PC after you have cast if what happens?

Warm, burning pain, not relieved by changing of position

38

What is an arthroscopy and what do you  need to do and watch for post-op?

Exam of interior joint with an arthroscope (Fiberoptic tube)

Post Op: ace pressure wrap, avoid strenuous use

Watch for pain, fever, swelling in excess

Hx of arterial peripheral vascular disease - DO NOT elevate extremity

Avoid high Elevation

39

What are some risk factors for hip fractures?

Osteoporosis 

Advanced age

Low Estrogen levels

sedentary

Inadequate Ca+ and Vit D

Decreased Protein

Caffeine

Smoking

Alcohol

Psychotropic Drug

40

What do you want to do for Buck's Traction?

Proper Body Alignment

Assess leg but do not take boot completely off

Make sure nothing is touching the rope 

Don't let weights touch floor

Foot does not touch the end of bed

41

What do you want to do for skeletal traction?

Look for infection at all of the insertion site: drainage, redness, heat

42

Assessments Post-Surgical?

Pain

Comfort

Orientation

Auditory and visual deficits

Mental responses to meds

affected extremity for color and temp

cap refil

edema

deep throbing pain

passive flexion of foot

sensations of numbness

ability to move foot & toes

Pulses

Lung status

Skin

I&O

Home environment for expected discharge

43

What are some nursing interventions post op?

Trapeze for Bed

Bedpan insertion - Flex unoperated knee, have client pull on trapeze to lift pelvis

Apply Ice for the 1st 24 hours

 

44

What is some safety items post op?

Avoid Hip flexion as ordered; Usually not >90 degrees

No internal rotation

May have abduction of legs

Document these normal findings when found

Avoid adduction of legs for about 2 months

Most common complication is DVT so apply sequential compression stockings

Maintain partial weight bearing for about 2 months

Monitor for complications: Fat embolism syndrome, compartment syndrome, and deep vein thrombosis

45

What is a fat embolism (Complication of surgery)?

Occurs 12-48 hours after Injury

Once fat droplets enter the circulation, the fat is too large to pass through pumonary circulation

They lodge in the capillaries and break down into fatty acids

Relatively uncommon but potentially life threatening

Total hip/total knee have higher risk

 

46

What are some assessments and interventions for fat embolism?

Dyspnea

Restlessness

Confused

Inc RespRate

Inc HR

Rash 

Chest Pain

Lung crackles

Alert mental status

INTERVENTIONS:
O2

Fluid Replacement

Mech Ventilation

Corticosteroids

47

Pulmonary embolism is a complication of bone surgery, what is it?

An occlusion of a portion of the pulmonary blood vessels by an embolus

An embolus is defined as a detached intravascular solid, liquid or gaseous mass that is carried by the blood stream from it's point of origin to distant site

Acute and potentially lethal disorder

48

What are some assessments and interventions for PE?

Altered Mental Status

Increased respirations, pulse and temp

Chest pain

Dyspnea

Crackles

Dec Pulse Ox

INTERVENTIONS: 
Anticoagulation

Surgical intervention-Bedrest

O2

Gentle Handling

Hydration

Fracture immobilization

49

What is compartment syndrome?

Increased pressure within a confined space that leads to micro-vascular comp-romise and ultimately cell death

Increased pressure leads to cutting off circulation and cell death:  Inc pulse, numb, pain, swelling

50

What are the 6 P's of compartment syndrome?

Pain

Pressure

Paralysis

Paresthesia

Pallor

Pulselessness

51

What are some assessments for compartment syndrome?

A dramatic increase in pain (Even w/passive motion) that is no longer controlled by medication

Loss of movement, sensation, pulse

Tight, shiny, pale skin

Diminished distal pulses

INTERVENTIONS:
Elevate, Ice, CALL PCP!

52

What is the treatment for Compartment Syndrome?

Fasciotomy

Fascia is a very dense, relatively inelastic tissue that surrounds individual compartments in the body.  

The fascia is divided along the length of the compartment to release pressure within

The skin is also left open for several days to weeks because some post-ischemic swelling occurs after surgical decompression

53

Osteo

Risk

54