What are 3 types of muscles?
(Inside of muscles)
How is bone formed?
By the gradual addition of calcium and phosphorus salts to cartilage or fibrous connective tissue
What is it when two bones meet and articulate?
What is a living tissue with a complex system of canals thru which blood, lymph, nerves and vessels pass?
What are small sacs of connective tissue located wherever pressure is exerted over moving parts?
What is a material composed of fibers embedded in a firm gel?
What does alcohol do to the bones?
Hip Deterioration & increased incidence of fractures and other injuries
What is a metabolic disease in which bone demineralization results in decreases density and subsequent fractures?
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)?
Can occur from something out side of the body or inside of the body.
(IE: outside: fracture, inside: UTI)
Environmental conditions can effect a pt bone, what are they?
Any altered cognitive function
What are some assessments for Osteomyelitis?
Pain worsens when moves
Temp higher than 101
Redness, swelling, heat
(LONG term antibiotics)
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?
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
What is a metabolic bone disorder characterized by thining, less dense or porous bone mass, "Silent Disease?
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
Diet low in calcium and Vit D
Weight-Loss diets lacking nutrients
Lack of physical activity
What is the patho for Osteoporosis?
Bone reabsorption exceeds bone formation
Bone Mineral Density is a test to diagnose osteoporosis?
Spine & hip most often assessed sites
Interventions for Osteoporosis?
High in Protein, Mag, Vit K, Calcium, Vit D
Walking 30 min 3-5 times/week is the single most effective exercise for osteoporosis prevention
Avoid tobacco, prevent falls
Drug Chart: 1126 53-2
Labs to look at for Osteoporosis?
Labs: CBC and Blood Chemistry
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
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.
Pharmacology for Osteoporosis?
Calcitonin (osteo, pagets, hypercalcemia)
Thyroid hormone that inhibits bone break down
SE: Effects dec after 2 years,
Teach: Switch nares
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
Replacement of testosterone for males
Replacement in women, prevents bones loss and increases bone density.
Teach: Inc chance of veinous thrombus in legs
Muscle relaxers for osteoporosis?
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
SE: Drowsiness, ataxia, dizziness, Monitor for suicidal tend, resp depression, max effect may take 1-2 weeks
Dowager's Hump (Kyphosis)
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
Interventions for Osteoporosis?
Admin medication as ordered
Assist with ADL's as necessary
Teach/Assist with assistive devices
Documentation: All care and teaching done, any variations from normal
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
What to do for strain?
Teach to modify ADL's
Rest involved muscle
What to do for sprain?
Initially immobile with increasing mobility
What are fractures?
Due to a blow, fall or accident
During normal activity or with minimal injury
A closed complete fracture is what?
Bone is broken with no external injury
What is an open complete fracture?
Bone has penetrated the skin
What is a comminuted fracture?
Pieces splintered apart
What are some incomplete fractures?
Greenstick: Bone bends and breaks but not all the way through
Stress : From repetitive movements
Transchondral: in a joint
Nursing care for fracture?
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
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
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
Call the PC after you have cast if what happens?
Warm, burning pain, not relieved by changing of position
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
What are some risk factors for hip fractures?
Low Estrogen levels
Inadequate Ca+ and Vit D
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
What do you want to do for skeletal traction?
Look for infection at all of the insertion site: drainage, redness, heat
Auditory and visual deficits
Mental responses to meds
affected extremity for color and temp
deep throbing pain
passive flexion of foot
sensations of numbness
ability to move foot & toes
Home environment for expected discharge
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
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
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
What are some assessments and interventions for fat embolism?
Alert mental status
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
What are some assessments and interventions for PE?
Altered Mental Status
Increased respirations, pulse and temp
Dec Pulse Ox
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
What are the 6 P's of compartment syndrome?
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
Elevate, Ice, CALL PCP!
What is the treatment for Compartment Syndrome?
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