Week 13 Flashcards
(118 cards)
1
Q
What is the purpose of the musculoskeletal system?
A
Support and movement
2
Q
What are the structures of the musculoskeletal system?
A
- Bone
- Joint
- Cartilage
- Muscle
- Ligaments
- Tendons
3
Q
What are the primary functions of the musculoskeletal system?
A
Support, movement, protection of organs, and storage of minerals
4
Q
What should be considered regarding intersectionality in the musculoskeletal system?
A
Individual differences and experiences related to health and treatment
5
Q
What are the subjective assessment questions for the musculoskeletal system?
A
- Where are you having pain?
- Aching? Cramping? Onset?
- What do you do, or did you do for your occupation?
6
Q
What are the objective assessment components of the musculoskeletal system?
A
- Range of motion (ROM)
- Visual deformities
- Palpation (superficial vs. deep)
- Free flexion/extension
- General body shape/appearance
7
Q
What lab tests are associated with the musculoskeletal system?
A
- CBC
- Creatine Kinase (CK)
- Rheumatoid Factor
- Erythrocyte Sedimentation Rate (ESR)
- C-reactive Protein (CRP)
- Calcium
- Uric Acid
- Phosphate
8
Q
What is the role of C-reactive Protein (CRP) in diagnostics?
A
A marker of inflammation, useful for flagging infections
9
Q
What is the purpose of a bone scan?
A
Nuclear imaging exam using radioactive dye to assess bone conditions
10
Q
What is arthrocentesis?
A
An invasive study where a needle is inserted in a joint to aspirate fluid or administer medication
11
Q
What are the clinical manifestations of a hip fracture?
A
Severe pain, inability to bear weight, and visible deformity
12
Q
What are the risks associated with hip fractures in the elderly?
A
- Slips
- Trips
- Falls
- Dizziness
- Isolation
13
Q
What is osteoporosis?
A
A chronic progressive metabolic disorder where loss of bone exceeds formation
14
Q
What are common fractures associated with osteoporosis?
A
- Vertebral
- Hip
- Wrist
- Humerus
- Pelvis
15
Q
What are the clinical manifestations of osteoporosis?
A
Bone fragility leading to fractures, kyphosis, and potential pain
16
Q
What are common risk factors for osteoporosis?
A
- Advanced age
- Inadequate caloric intake
- Sedentary lifestyle
- Menopause
17
Q
What is the significance of a DEXA scan?
A
Most commonly used to measure bone mineral density (BMD)
18
Q
What are the therapeutic classifications of alendronate (Fosamax)?
A
Bone resorption inhibitor, classified as bisphosphonates
19
Q
Fill in the blank: The term used to describe a stretched or torn ligament is _______.
A
Sprain
20
Q
True or False: Osteoporosis is often called a silent disease.
A
True
21
Q
What is the purpose of hormone replacement therapy (HRT) in osteoporosis?
A
To decrease bone resorption and prevent fractures
22
Q
What are osteoblasts
A
Bone forming cells
23
Q
What do osteoclasts do
A
Resorb or break down bone
24
Q
Osteocytes
A
Are mature bones
25
What do joints do
- allow the movement between bones
- formed where two bones join
- surfaces are covered with cartilage
- enclosed in a capsule
- support and movement (flexion/extension)
26
What is cartilage
- rigid connective tissue
- should be smooth, white and translucent
27
What is connective tissue
- blood
- bone
- cartilage
- fat
- lymphatic tissue
28
Flexion
Bending towards centre of body
29
Extension
Movement away from the center of the body
30
Abduction
Limbs are moved away from your bodies midline
31
Adduction
Limbs moving closer to the midline of body
32
Labs for MSK- CBC
- elevated WBC count for osteomyelitis
- hemoglobin for internal bleeding Rheumatoid
33
Labs for MSK- Rheumatoid factor
Assess presence of antibody in serum
34
Labs for MSK- C-reactive protein (CRP)
- a marker of inflammation
- useful for flagging infections
- a protein your liver makes, generally have low levels of C-reactive protein in your blood
35
Labs for MSk- creating kinase (CK)
- enzyme primarily found in muscle tissues, and its relapse into the bloodstream can indicate muscle damage
- r/t muscle breakdown/wasting
- rhabdomyolsis
36
Erythrocytes sedimentation rate (ESR)
- a measure of inflammation
- can help detect rheumatoid arthritis, osteomyelitis
37
What is an open fracture
Also called compound fracture
- the bone pokes through the skin and can be seen
- or a deep wound exposes the bone through the skin and can
38
what is a closed fracture
Also called a simple fracture
- bone is broken, but the skin is intact
39
Labs for MSk- Uric acid
- end product of purine metabolism
- help diagnose gout
40
Labs for MSK- calcium
- levels can predict risk of bone disease/injury
- can also detect renal insufficiency or parathyroid disease
41
Labs for MSK- phosphate
- detects the ability to grow bone
- high levels may be a sign of renal dysfunction
42
Diagnostics for MSK- X-ray
- rapid determination of deformity or injury
- must correlate clinically
- may not identify all pathology
43
Diagnostics - CT or MRI
- included for soft tissue studies
- MRI essential for blood flow, tumors and osteomyelitis
44
Diagnostics for MSK- Arthography
- radiographic study: invasive
- contrast or air injected to visualize the joint cavity
- joint movement is assessed with a series of radiographic images
45
Diagnostics for MSK- Arthrocentesis
- invasive study
- needle inserted in joint to aspirate synovial fluid sample, blood, pus, or administer medication
- useful to detect joint inflammation or infection
46
Diagnostics for MSK- synovial fluid analysis
- fluid sample analyzed for colour, clarity, characteristics, presence of WBC
47
What is a green stick fracture
- incomplete fracture
- part of the bone is broken, causing the other side to bend
48
What is a transverse
A break is in a straight line across the bone
49
What is a spiral fracture
- the break spirals around the bone, common in a twisting injury
50
What is an oblique fracture
- the break is diagonal across the bone
51
What is a compression fracture
The bone is crushed
- this causes the broken bone to be wider or flatter in appearance
52
What is a comminuted fracture
- the bone has broken into three or more places and fragments are presented at the fracture site
53
What is a segmental fracture
- the same bone is fractured in two places, so there is a floating piece of bone
54
What is an avulsion fracture
- when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone
- hips, elbows and ankle are most common locations for avulsion fractures in the youn adult
55
Bone scan
- nuclear imaging exam
- uses radioactive dye (contrast)
- helps diagnose and track several types of bone disease
- assess bone density AND looks for areas of increased bone metabolism
56
Clinical manifestations of fractures of the hip
- external rotation
- muscle spasm
- shortening of the affected leg
- severe pain
- blood supply could affect to femoral head
- restricted ability or inability to move leg
- reported popping sensation in the hip
57
What is the frequency of hip fractures in Canada
1 in 4 in women
1 in 5 in men
Aged 65+
58
Types of hip fractures
Intertrochanteric and femoral neck fractures are the most common type of hip fracture
- femoral head fractures are extremely rare and are usually the result of a high velocity event
- most hip fractures occur in the femoral neck or interochanteric area
59
Nursing management for hip fractures
- pain control
- CSM assessment
- muscle relaxants
- post-op education
- general health assessment/integration into orthopaedic care
- DVT prophylaxis and identification
60
Nursing role Pre-op for hip fracture
- consider comorbidities
- general health assessment
- analgesia
- muscle relaxants
- pre-op education if possible
- physiotherapy consultation and treatment
61
What doe NOF stand for
Neck of femur
- most common site for hip fractures
62
Post-op rehab and care of hip fractures
- cardiac, respiratory and neuromuscular status of the leg and CSM
- ROM exercises - physio
- Continuous passive motion (CPM)
- weight bearing - depending upon X-ray findings 6-12 weeks
-ongoing pain management
- prevention of infection
- prevention of DVT
63
What is an ORIF
Open reduction and internal fixation
- realigning broken bones and stabilizing them with internal hardware like screws, plates or rods
64
What is a partial hip replacement (hemiarthroplasty)
- replaces ONLY the femoral head (ball)
65
What is a total hip arthroplasty
Replacement of both the femoral head and the acetabulum (socket)
66
Post-op rehab and care of hip fractures
- proper hip alignment
- use of abductor pillows
- hips never bend >90 degree angle
- do not cross your operated leg
- never elevated the head of the bed more than 60 degrees
- dont sleep on affected side without constuling the surgeon
- avoid internal and external rotation, hyperextension, and acute flexion
67
What is osteoporosis
A chronic progressive metabolic disorder
- a disease in which loss of bone exceeds the rate of bone formation
- bones become porous, brittle and fragile
- increased risk of fractures (fragility fractures and low trauma)
- common fractures, vertebral hip, wrist, humerus, pelvis
- a common disease characterized by low bone mass with micro architecture distribution
68
Risk factors for osteoporosis
Genetics
- Asian, female, family hx, small frame
Age
- advanced age >80, post menopause, low testosterone, decreased calcitonin
Nutrition
- low Ca, vit D, high phosphate, inadequate calories
Lifestyle
- sedentary lifestyle
-lack of weight bearing exercise
- low weight and BMI
- caffeine, alcohol, smoking
69
Prevention of osteoporosis
- starts at very young age
- calcium
- vitamin d
- weight bearing exercise
70
Clinical manifestations of osteoporosis
- bone pain, decreases movement
- often result in compression fractures
- thoracic and lumbar spine (kyphosis) (dowagers hump)
- neck, hip, wrists
-develops slowly without symptoms, first signs are often fractures or back pain r/t collapsed vertebra
71
Osteoporosis is associated with:
Calcium absorption and metabolism
- anorexia nervosa
- hypothyroidism (not a direct cause, overtreatment with T4 can lead to bone loss)
- malabsorption syndrome
- renal failure
- drugs: long term corticosteroids
72
Hormonal considerations
- hormone replacement therapy (HRT)
- estrogen replacement (inhibits osteoclasts)
- aim to decrease bone resorption and prevent fractures
73
Alendronate (fosamax)
- therapeutic:bone resorption inhibitor
- pharmacological: biphosponates
- caution in liver and renal impairment
Can cause ulceration if it has prolonged contact to mouth or throat
- ensure to drink a full glass of water w the med
- sit up for 30 min
- take on an EMPTY stomach
74
What is the purpose of the musculoskeletal system?
Provides structure, support, and movement to the body
## Footnote
The musculoskeletal system is essential for physical stability and mobility.
75
What are the main structures of the musculoskeletal system?
* Bone
* Joint
* Cartilage
* Muscle
* Ligaments
* Tendons
## Footnote
Each structure plays a unique role in supporting and enabling movement.
76
What are the primary functions of the musculoskeletal system?
* Support
* Movement
* Protection of internal organs
* Mineral storage
* Blood cell production
## Footnote
These functions are crucial for overall health and physical activity.
77
What intersectionality considerations relate to the musculoskeletal system?
Includes factors such as age, gender, socioeconomic status, and cultural influences
## Footnote
These factors can impact access to care and disease prevalence.
78
What is involved in the assessment of the musculoskeletal system?
Includes physical examination, patient history, and diagnostic tests
## Footnote
Assessment helps identify issues like pain, mobility limitations, and structural abnormalities.
79
What is the purpose of common diagnostics related to the musculoskeletal system?
To identify and evaluate musculoskeletal disorders
## Footnote
Common diagnostics include X-rays, MRIs, and blood tests.
80
What are key characteristics of hip fractures?
* Clinical manifestations: pain, inability to move
* Complications: infection, blood clots
* Diagnostics: X-ray, CT scan
* Treatment: surgery, physical therapy
## Footnote
Effective management is crucial for recovery and mobility.
81
What is osteoporosis?
* A condition characterized by decreased bone density
* Clinical manifestations: fractures, back pain
* Complications: increased fracture risk
* Diagnostics: bone density scan
* Treatment: medications, lifestyle changes
## Footnote
Osteoporosis is often asymptomatic until a fracture occurs.
82
What are key features of osteoarthritis?
* Progressive, degenerative disorder
* Symptoms: pain, stiffness, swelling
* Diagnostics: X-ray, MRI
* Treatment: pain control, physical therapy
## Footnote
Osteoarthritis is common among older adults and is not a normal part of aging.
83
What are the clinical manifestations of rheumatoid arthritis?
-joint laxity, subluxation (dislocation)
Joint swelling
* Pain and stiffness
* Fatigue
* Deformities (boutonnière thumb)
- pannus formation (scar tissue)
Systemic complications (cardiomyopathy, pericarditis, interstitial fibrosis, spleen omega lay)
## Footnote
Rheumatoid arthritis is an autoimmune disease affecting joints bilaterally.
84
What is gout?
* A type of arthritis caused by uric acid crystal accumulation
* Clinical manifestations: joint pain, swelling, redness
* Treatment: medications, lifestyle changes
## Footnote
Gout commonly affects the big toe and can lead to chronic joint issues.
85
Fill in the blank: Osteoarthritis is characterized by the loss of _______.
Articular cartilage
## Footnote
This loss leads to joint pain and decreased mobility.
86
True or False: Osteoarthritis typically affects joints symmetrically.
False
## Footnote
Osteoarthritis generally affects joints asymmetrically.
87
What are potential nursing diagnoses for patients with osteoarthritis?
* Chronic pain
* Impaired physical mobility
* Activity intolerance
## Footnote
These diagnoses guide nursing interventions and patient care plans.
88
What pharmacological treatments are commonly used for osteoarthritis?
* Ibuprofen
* Acetylsalicylic acid (Aspirin)
* Diclofenac
## Footnote
These medications help manage pain and inflammation.
89
What are the characteristics of rheumatoid arthritis pathology?
* Chronic inflammation
* Synovial membrane thickening
* Pannus formation
* Joint destruction
## Footnote
These changes contribute to the progressive nature of the disease.
90
What diagnostic studies are used for gout?
* Serum uric acid levels
* 24-hour urine collection
* Joint aspiration
## Footnote
These tests help confirm the diagnosis and guide treatment.
91
What is the hallmark manifestation of osteoporosis?
Increased fracture risk
## Footnote
Osteoporosis often leads to fractures with minimal trauma.
92
What lifestyle changes can help manage gout?
* Avoidance of alcohol
* Limiting high-purine foods
* Staying hydrated
## Footnote
These changes can help reduce flare-ups and improve quality of life.
93
Risk factors for osteoarthritis
- obesity
- increased age
- female sex
- family history
- drugs
- occupational overuse
- skeletal deformities
- trauma to joint
94
Etiology and pathophysiology of osteoarthritis
- progressive, degenerative disorder of the joint
- not a normal part of the aging process
- destruction of articulation cartilage between joints with osteophyte formation (bone spurs)
- wear and tear on the joints
- normally smooth articulating surfaces become dull, yellow and granular
95
Apoptosis
Planned Cell death
96
Synovitis
Inflammation at the synovial joint
97
Collaborative care for osteoarthritis
- pain and inflammatory control
- maintain ADLs
- improve joint function
- slow progression of disease
- risk vs benefits of surgery
98
Clinical manifestations of osteoarthritis
- local, not systemic effects
- generally affects joints asymmetrically
- mild discomfort to severe pain (exacerbated by activity)
- stiffness, commonly in the morning or end of day
- some associated increased pain with a drop in environment pressure
- crepitus
- typically no swelling at joints
99
Potential nursing diagnoses: osteoarthritis
- acute and chronic pain r/t physical activity
- disturbed sleep in pattern
- impaired physical mobility ‘
- self care deficits r/t joint deformity and pain
- imbalanced nutrition
- chronic low self esteem r/t changing physical appearance
100
Surgical interventions: joint replacement
- surgical candidate
- often greater improvement in pain rather than function
- recovery can be strenuous and lengthy
- infection rate high
- complications include thromboembolic events
101
Pharmacological treatments: osteoarthritis PO
Acetaminophen
- initial treatment
NSAIDS
- avoid long term use
- rash and hypersensitivity rxns
- abd pain or GI bleeding
- impairment of renal, hepatic, and bone marrow function and platelet aggregation
- central nervous system in the elderly
102
Pharmacological treatment: osteoarthritis other
Topical analgesics
Corticosteroid
- intra articulate injections
Hyaluronic
- injection of knees
- short term lubricant
- analgesic effect by buffering synovial nerve endings
- possible anti-inflammatory effects
- stimulate synovial lining scells to produce hyaluuronic acid
103
Non-pharmacological treatment
Weight loss
- decrease load on the joint
- fundamental part of OA management
Rest
- short period of time, typically 12-24 hours if severe joint inflammation
- prolonged rest can lead to muscle atrophy and decreased joint mobility
-rest the joint hen acute phase
- joint protective devices like knee braces
- acupuncture
- excessive- focus on low load
- heat and cold
104
105
Etiology and pathophysiology of RA
- chronic, systemic, autoimmune disease
- antibodies attack joints
- inflammation of synovial joints, typically bilateral
- periods of remission and relapse
- exact cause of immune response is unknown
106
Labs for RA
- CBC (wbc elevation or anemia)
- ESR
-CRP
- rheumatoid factor
- anti-nuclear antibodies (ANA)
- synovial biopsy or arthrocentesis
107
Potential Nursing Dx: RA
- chronic pain r/t joint inflammation
- impaired physical mobility
- disturbed body image r/t chronic disease
- ineffective therapy regimen management r/t complexity of chronic health problems
- self care defeicit r/t disease progression
108
RA collaborative management goals
- control pain and inflammation
- minimize disability
- improve joint function
- prevent progression
- education
- chronic condition and management
109
Dexamethasone (decadron)
Therapeutic: anti-inflammatory, immune suppression
Pharmacological: corticosteroids
Indications
- anti-inflammatory and immunosuppressive effects make it useful in a variety of conditions
- dosage and administration widely based on the indication, severity of the condition and patient factors
Common side effects
- increased appetite
- weight gain
- fluid retention
- mood changes
- increased risk for infection
-hyperglycaemia
- osteoporosis
-GI irritation (ulcers)
- Hypertension
110
Etiology and pathophysiology of Gout
- accumulation of uric acid crytstals in joints
- acute flareups
Primary
- hereditary disorder
- purine metabolism error
- retention or overproduction of uric acid
Secondary
- renal disease
- most menopausal
- medication related
111
Diagnostic studies for Gout
- serum uric acid and levels
—> 24 hour urine (uric acid)
- joint aspiration
- diagnostic imagine r/t other pathology
112
Collaborative care
- avoidance of alcohol
- joint immobilization
- application of heat or cold
- nursing: BE GENTLE
- bed rest for painful episodes
- avoid many meats and shellfish if prone to gout
113
Acute phase of gout
- gouty arthritis in one or more joints but usually fewer than 4
- cyanotic, tender
- low grade fever
- inflammation of great toe is common
- subsides in 2-10 days
114
115
Sub-acute phase
- multiple joint involvements
- visible deposits of sodium irate crystals called tophi
- joint deformity cartilage destruction
- large tophaceous deposits may perforate overlaying skin, producing draining sinuses that often become infected
116
Nursing management
- acute episode of gout - supportive care for the inflamed joints
-Nurse must avoid causing pain to an inflamed joint
-Bed rest may be appropriate
-Teach about nutrition
117
Foods to avoid with gout
-salmon
- red meat
- tuna
- poultry
- seafood
- liver
- alcohol
118
