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Med Surg Exam 2 > Week 6 > Flashcards

Week 6 Flashcards

1
Q

What are bones composed of?

A

collagen fibers (Ca++, phos)
Cells: Osteoblasts (build bone) and Osteoclasts (break bone)

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2
Q

Functions of bones:

A

Provide support for body
Protect internal organs
Provide for movement in conjunction with muscles
Store calcium, phosphorus, other minerals
Produce red and white blood cells (long bone)

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3
Q

Guidelines for Musculoskeletal Assessment

A

Inspect for deformities
Inspect and palpate any swelling
Any visible deformities, swelling, or asymmetry can indicate trauma or underlying conditions.
Feel for increased temperature
- Observe for redness
- Palpate for tenderness around joint: location, intensity, and nature of the pain (sharp, dull, constant, intermittent). Use pain scale
- Assess ROM

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4
Q

Osteoporosis patho review

A

Chronic disease of cellular regulation
More osteoclast activity than osteoblast
Causes significant decreased density and possible fracture
Fragility fracture – caused by osteoporosis
Osteopenia to osteoporosis

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5
Q

Osteoporosis etiology and genetic risk

A

-Genetic, lifestyle, and environmental factors
Primary– Post menopause; low Ca++ or Vit D intake
Secondary – CKD, myeloma, endocrine, malabsorption disorders

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6
Q

What is osteoporosis lifestyle risk factor

A

Sedentary lifestyle like lack of weight-bearing and resistance exercises can weaken bones and decrease bone density
Excessive alcohol consumption, and smoking can contribute

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7
Q

What secondary etiology and genetic risk of osteoporosis

A

CKD, myeloma, endocrine, malabsorption disorders, malnutrition, immobility, alcoholism

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8
Q

What environmental factors example of osteoporosis?

A

poor living condition like easy to fall
Exposure to heavy metals like lead and cadmium can negatively impact bone health
Certain chemicals in the environment may disrupt hormone function and bone metabolism

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9
Q

Examples of endocrine in osteoporosis?

A

Hyperthyroidism: The condition leads to increased metabolism and can cause a loss of bone density over time. Excess thyroid hormone can interfere with the balance of bone remodeling, leading to bone resorption outpacing bone formation. This makes bones weaker and more susceptible to fractures

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10
Q

Lab assessment of osteoporosis

A

low or normal Ca, low or normal phosphate, high or normal PTH, high or normal ALP (alkaline phosphatase), low or normal magnesium

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11
Q

why osteoporosis is silent disease or silent theft?

A

because the first sign of
osteoporosis in most people follows some kind of a fracture.

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12
Q

Who majority can have most chance of having a fragility fracture?

A

Euro-American postmenopausal women have a 50% chance of having a
fragility fracture (fracture caused by osteoporosis; sometimes referred to
as a “bone aack”) in their lifetime. A woman who experiences a hip fracture has a greater risk
for a second fracture.

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13
Q

Non-modifiable risk factors

A

Assess for these nonmodifiable risk factors:
* Older age (over 50 years of age)
* Menopause or history of total hysterectomy, including removal of ovaries (bc these decrease in estrogen)
* Parental history of osteoporosis, especially mother
* Euro-Caucasian or Asian ethnicity
* Eating disorders, such as anorexia nervosa
* Rheumatoid arthritis
* History of low-trauma fracture after age 50 years

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14
Q

Modifiable risk factors are

A
  • Low body weight, thin build or obese women (bc their body store estrogen in their tissues to maintain normal level of serum calcium better than thinner women)
  • Chronic low calcium and/or vitamin D intake
  • Estrogen or androgen deficiency
  • Current smoking (active or passive)
  • High alcohol intake (two or more drinks a day)
  • Drug therapy, such as chronic steroid therapy (also see Table 45.2)
  • Poor nutrition
  • Lack of physical exercise or prolonged decreased mobility
    -High protein diet or carbonated beverages drinker
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15
Q

what do we do first in nursing assessment?

A

Assess for pt’s risk factors = important for early detection and prevention, pt’s fall risk scale

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16
Q

Signs and symptoms of osteoporosis

A

Fractures after minor falls
Pathologic fractures (spine, femur)
Kyphosis
Height loss (2 to 3 inches/ 5 to 7.5 cm within 20 years)
Pain (common back pain after bending, stooping or lifting; worse with activity and relieved with rest)
Vertebral collapse

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17
Q

Imaging assessment for osteoporosis

A

X-rays of spine and long bones
DXA

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18
Q

what medications is for osteoporosis?

A

Bone resorption inhibitor
Hormone replacement therapy (HRT)
Calcium supplements with Vitamin D

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19
Q

serum calcium should be between for osteoporosis

A

9.0 and
10.5 mg/dL (2.10 and 2.50 mmol/L)

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20
Q

what is health promotion and wellness of osteoporosis?

A

Stop smoking
Lose weight
Fall prevention
Limit alcohol and carbonated beverages
Weight bearing exercises
Complementary and alternative: biofeedback, yoga, massage, reflexology

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21
Q

Patients
who have osteopenia usually have follow-up DXA scans every ____ years

A

2

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22
Q

The priority problem for patients with osteoporosis or osteopenia is

A

Potential for fractures due to weak, porous bone tissue (pathological/fragility fracture)

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23
Q

expected outcome for osteoporosis pt

A

The expected outcome is that the patient will avoid fractures by
preventing falls, managing risk factors, and adhering to preventive or treatment measures for bone loss.

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24
Q

Interventions of pt with osteoporosis

A

nutrition therapy, lifestyle
changes, and drug therapy are used to slow bone resorption and form new
bone tissue. Self-management education (SME) can help prevent
osteoporosis or slow the progress.

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25
what is nutrition therapy
Avoid alcohol and caffeine. Drink milk, lactose free, soy, rice, bread, cereal
26
Which lifestyle changes is important?
Exercise is important in the prevention and management of osteoporosis. It also plays a vital role in pain management, cardiovascular function, and an improved sense of well-being. Teach patients that walking for 30 minutes three to five times a week is the single most effective exercise for osteoporosis prevention.
27
Home care management?
Patients with osteoporosis are usually managed at home unless they have major fragility fractures. Some patients do not know that they have osteoporosis until they experience a fall and have one or more fractures. Remind patients to have follow up DXA scans as prescribed to determine the effectiveness of drug therapy
28
Non inflammatory arthritis
Osteoarthritis: Related to overuse/ wear and tear Unilateral and not systemic.
29
Inflammatory arthritis:
Connective tissue disease caused by inflammation Systemic Often autoimmune *Rheumatoid arthritis* *Systemic lupus erythematosus* Defect in immunologic mechanism Possible genetic component Characterized by hypersensitivity Tend to be systemic and chronic Medications control or reduce immune system response
30
What is osteoarthriris/Degenerative joint disease (DJD)?
Osteoarthritis, also known as degenerative joint disease (DJD), is the most common type of arthritis affecting individuals over the age of 60. This condition is characterized by joint pain and a gradual loss of function, resulting from the progressive deterioration of cartilage within the joints. As collagen synthesis decreases and breakdown increases, the structural integrity of the joints is compromised. The formation of osteophytes—bony growths on the edges of the joints—can further exacerbate discomfort and limit mobility. In some cases, synovitis, or inflammation of the joint lining, may occur, leading to subluxation, where joints become partially dislocated. While the erythrocyte sedimentation rate (ESR) may remain normal or only slightly elevated, the impact of osteoarthritis on daily life can be profound, highlighting the importance of early intervention and management strategies.
31
What happens in osteoarthritis inside the synovial joint?
The sodium hyaluronate in synovial fluid does not stay there for a whole lifetime, but is continuously broken down and replaced. Normally, there is an exact balance between the breakdown of old sodium hyaluronate and the production of new sodium hyaluronate. In osteoarthritis, however, this balance is disturbed and breakdown happens faster than production. As a result, the synovial fluid becomes more watery and stops working properly. Due to the change in the synovial fluid - and for other, more complex reasons - the cartilage in the joint gradually wears away. In some places, in fact, the cartilage may eventually disappear altogether. The thinning of the synovial fluid and wearing away of the cartilage lead to the symptoms of osteoarthritis, which include pain, stiffness and swelling. The sodium hyaluronate in the joint space becomes depolymerised and fragmented. The synovial fluid becomes less viscous and its lubricating, shock-absorbing and filtering abilites are reduced. The coating over the surface of the joint breaks down, leaving the cartilage exposed to mechanical and inflammatory damage. The synovial membrane becomes inflamed. The cartilage is gradually destroyed.
32
Osteoarthritis etiology
Primary: Aging, Genetic factors Secondary Joint injury (Heavy manual occupations (e.g., carpet laying, construction, farming) cause high-intensity or repetitive stress to the joints. The risk for hip and knee OA is increased in professional and amateur athletes, especially football players, runners, and gymnasts) Obesity Repetitive stress to joints
33
Clinical manifestations (cues) for osteoarthritis?
Persistent joint pain and stiffness Crepitus Joint deformity Muscle atrophy Joint tenderness Morning stiffness, better with movement Pain with overuse of joint
34
Osteoarthritis nursing management
Highest priority: pain relief (NSAIDs (short-term use); Acetaminophen; Other analgesics) Heat and cold applications Complementary and alternative therapies Exercise, firm mattress, splints Fall protocol in hospital and at home Promotion of independence Mobility aids Fall prevention Weight loss Psychosocial support Patient education
35
what is rheumatoid arthritis
Chronic, progressive, systemic inflammatory autoimmune disease affecting primarily the synovial joints Autoantibodies (rheumatoid factors) formed that attack healthy tissue, especially synovium, causing inflammation; development of a pannus Cartilage becomes fibrous and calcified Affects connective tissue of any organ or body system
36
Rheumatoid arthritis clinical manifestations
Remissions and exacerbations Physical and emotional stresses are linked to exacerbations Early disease manifestations—joint stiffness, swelling, pain, fatigue, and generalized weakness Systemic Manifestations -- Swollen glands, dry mouth, pleuritis, anemia, decreased WBCs, vasculitis Late disease manifestations—as the disease worsens, the joints become progressively inflamed and quite painful Ex: ulnar deviation, swan neck deformity
37
RA more examples of systemic complications
Weight loss, fever, and extreme fatigue Exacerbations Subcutaneous nodules Pulmonary complications Vasculitis Periungual lesions Paresthesias Cardiac complications Respiratory complications Correlations: *Heart disease *Blood clots *Sleep apnea
38
RA Laboratory and Diagnostic Procedures Radiologic imaging Blood tests include:
Rheumatoid factor Antinuclear antibodies Erythrocyte sedimentation rate (ESR) C-reactive protein (CRP)
39
interventions for RA
Pharmacologic interventions: Disease-modifying antirheumatic drugs NSAIDs Biologic response modifiers Other drugs: Glucocorticoids Immunosuppressive agents Gold therapy Analgesic drugs Surgical interventions Synovectomy, arthrodesis, and/or reconstructive surgery Adequate rest Proper positioning Ice and heat applications Plasmapheresis Gene therapy Complementary and alternative therapies Joint mobility, preventing contractures Rest during flare-ups, safeguarding joints Heat/ cold application Promotion of self-care Support, referral
40
what is SLE?
Chronic, progressive, inflammatory connective tissue disorder that can cause major body organs and systems to fail. Characterized by spontaneous remissions and exacerbations. Autoimmune complexes tend to be attracted to the glomeruli of the kidneys. Most patients with SLE have some degree of kidney involvement.
41
SLE clinical manifestations
Lupus is a chronic autoimmune disease characterized by a range of symptoms that can affect multiple body systems. A common sign is the “butterfly rash,” a red, macular facial rash that appears across the cheeks and nose. Many people also develop discoid rashes on sun-exposed areas like the face and scalp, often triggered by sunlight. Other symptoms include joint pain from nonerosive arthritis and inflammation of serosal membranes, which can affect organs. Patients may experience chronic lesions on mucous membranes, neurological issues, and hematological problems. Additionally, lupus can have significant psychosocial effects, impacting emotional well-being and daily life. Understanding these symptoms is crucial for effective management and support.
42
SLE lab assessment
Laboratory assessment ESR Serum complement levels for C3 and C4 ANAs, and other antibodies to nuclear membrane phospholipids Other diagnostic assessment Blood and urine tests (kidney involvement)
43
SLE focus of care
Focus of Care Pain Fatigue Tissue integrity Self-esteem/role performance
44
SLE patient teaching
Disease process and interventions Therapeutic regimen Minimizing triggers Preventing complications
45
Psychosocial of OA
Persistent pain that affect daily lives activities And how person deal with changes
46
Lab assessment of OA
The primary health care provider uses the history and physical examination to make the diagnosis of OA instead; however The erythrocyte sedimentation rate (ESR) and high-sensitivity C-reactive protein (hsCRP) may be slightly elevated when secondary synovitis occurs. The ESR also tends to rise with age and infection. Routine X-ray, MRI
47
Priority problem of OA
The priority collaborative problems for patients with osteoarthritis (OA) include: 1. Persistent pain due to joint swelling, cartilage deterioration, and/or secondary joint inflammation 2. Potential for decreased mobility due to joint pain and muscle atrophy
48
Desire outcome of OA
The patient with OA is expected to have a pain level that is acceptable to the patient (e.g., at a 3 or less on a pain intensity scale of 0 to 10).
49
surgical management of fractues
TJA (Total joint replacement) is a procedure used most often to manage the pain of fractures and improve mobility, although other conditions causing cartilage and bone destruction may require the surgery Total hip arthroplasty
50
pre-op for patient who need total hip arthroplasty
nutrition assessment Pain assessment and management VTE Infection prevention
51
THA precautions
* Do not sit or stand for prolonged periods. * Do not cross your legs beyond the midline of your body. * For posterolateral or direct lateral surgical approach patients: Do not bend your hips more than 90 degrees. * For anterior surgical approach patients: Do not hyperextend your operative leg behind you. * Do not twist your body when standing. * Use the prescribed ambulatory aid such as a walker when walking. * Use assistive/adaptive devices as needed (e.g., sock aids, shoehorns, dressing sticks, extenders [also see Chapter 7]). * Do not put more weight on your affected leg than allowed and instructed. * Call 911 if you experience any signs and symptoms of hip dislocation, including sudden difficulty bearing weight on the surgical leg, leg shortening or rotation, or a feeling that the hip has “popped” with immediate intense pain. * Resume sexual intercourse as usual on the advice of your surgeon
52
Fractures
Break or disruption in continuity of a bone that affects mobility and causes pain Classification Complete or incomplete Open (compound) or closed (simple) Fragility (pathologic or spontaneous) Fatigue or stress Compression
53
Open vs closed fractures
Open fracture: Tear in soft tissue, bone exposed to outside Potential for contamination Higher morbidity and mortality Closed fracture: no opening
54
Clinical manifestations of fractures
Pain at fracture site Swelling Tenderness Bruising Shortening of a limb Deformity Displacement
55
Lab assessment of fractures
Hemoglobin &Hematocrit ESR WBC Serum calcium, and phosphorus
56
Image assessment
X-rays CT MRI
57
Fractures nursing care
Managing acute pain Increasing mobility Preventing and monitoring for neurovascular compromise Preventing infection
58
Fractures medical treatment
Fixation and/or union must occur within 6–8 hours Cast (watch for swelling, no access to soft tissues) Fixtures Splint or brace Traction External fixation Open reduction internal fixation Intramedullary rod
59
Neurovascular assessment
(6 Ps and cap refill): pain, poikilothermia, paresthesia, paralysis, pulselessness, and pallor.  Color of limb Movement Temperature Sensation
60
Complications of fractures include
VTE (DVT and PE) Bone or soft tissue infection Neurovascular compromise *Acute compartment syndrome* Fat embolism syndrome Complex regional pain syndrome (CRPS) Avascular necrosis (chronic)
61
Patients with ACS may need a _____
surgical procedure known as a fasciotomy. In this procedure, the surgeon cuts through the fascia to relieve pressure and tension on vital blood vessels and nerves. The wound remains open and requires care to begin to heal from the inside out. The surgeon usually closes the wound with a skin graft in several days
62
Fat embolism?
Fat globules fro long-bone fracture enter the circulatory system Can produce multi-system organ failure Symptoms Respiratory failure Neurological dysfunction Petechial rash
63
What to do for fat embolism and treatment
On the medical-surgical floor Close monitoring for the first 4 to 12 hours Incentive spirometer Early ambulation Treatment Intubation, mechanical ventilation with PEEP Supportive care
64
Hip fractures Clinical Manifestations
Joint surfaces become rough Pain, swelling, deformity Discomfort to groin, buttock, thigh Stiffness in morning Increasing pain with activity Inability to rotate, flex, extend hip
65
Total hip arthroplasty
Removal of femoral head Creation of post-hole in femur for implant Repair and placement of head and stem Artificial joint may need replacing in 15 to 20 yrs
66
Nursing care post THA
DVT Prevention Early ambulation Pain management Incisional care Traditional post-op care
67
Hip Precautions after THA
Do not bend the hip more than 90 degrees. Do not cross legs or feet. Do not roll or lie on your unoperated side for the first 6 weeks. Do not twist the upper body when standing. Sleep on the back for the first 6 weeks.
68
Total knee replacement?
Patients with progressive arthritis, trauma, rare diseases that damage joint Most common in United States: severe osteoarthritis Progressively increasing pain and stiffness Diagnostic test: MRI
69
Total knee replacement nursing management
Early obilization Continuous passive motion (CPM) device Pain controlled with medication Hospital stay 3 to 7 days Discharge goals: bend knee 90 degrees, walk with crutches or walker Mobility Assistive devices: Crutches Wheelchairs Walkers Canes Reachers
70
Traction
Application of a pulling force to the body to provide reduction, alignment, and rest at that site Types of traction: skin, skeletal
71
Traction care:
Maintain correct balance between traction pull and countertraction force Care of weights Skin inspection Pin care Assessment of neurovascular status
72
External fixations systems:
Unilateral fixators Taylor spatial frame fixator
73
The earliest signs and symptoms of FES are
a low arterial oxygen level (hypoxemia), dyspnea, and tachypnea (increased respirations). Headache, lethargy, agitation, confusion, decreased level of consciousness, seizures, and vision changes may follow Nonpalpable, red-brown petechiae—a macular, measles-like rash—may appear over the neck, upper arms, and/or chest. This rash is a classic manifestation but is usually the last sign to develop (

Med Surg Exam 2 (2 decks)

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