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96 Cards in this Set

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your pt has a leg in a cast. how do we prevent muscle weakness?
R O M with the non affected limbs
so, we could so:
isometric exercises
what if flexion?
flexion is flexing the muscle, bending a joint like the elbow
what is extension?
unflexing the muscle, straightening the joint
what is abduction?
abduct means to take away so
abduction is to move away from midline
what is adduction?
move toward the midline
what is rotation?
turning around an axis like your head side to side
what is circumduction?
arm in a big circle at shoulder
what is pronation?
palms, down
what is supination?
palms up, like for a bowel of soup
what is inversion?
turning inward, the feet pointing inward
what is eversion?
turning outward, like my feet turn out, eversion
what is protration?
pushing out
what is retraction?
pulling in
what is an ex of isometric?
no joint movement
immovable motion...Isometrics are done in static positions, rather than being dynamic through a range of motion. The joint and muscle are either worked against an immovable force or are held in a static position while opposed by resistance.
how is isotonic different from isometric?
isotonic is muscle tension is unchanged BUT muscle is shortened
what is tone?
tone means ready to go
a state of readiness
what is flaccid?
loose muscle, limp, no tone
what is spastic?
short jerky motion
having greater than muscle tone
what is crepitus?
like my knee
bad cartliadge
popping sound
what is contracture?
abnormal shortening of muscle or joint or both
not allowing for full range of motion
Atonic is ...
like flaccid soft and flabby

w/o tone a = no tonic = tone right?
what is hypertrophy?
increased in size like weight lifters
what is atropy?
decreased muscle size opposite of hypoertopy
atrophy, don't use it, you lose it
what is clonus?

(Clonus is a sign of certain neurological conditions, and is particularly associated with so-called upper motor neuron lesions such as stroke, multiple sclerosis or spinal cord damage.)
dorsiflex & then push down (dorsiflex is the foot) but it tremors and jerks
from electolyte imbalance. Clonus is most common in the ankles, where it is tested by rapidly flexing back (dorsiflexing) the relaxed ankle. It can also be tested in the knees by rapidly pushing the patella towards the toes.
what is Kyphosis?
increase in curvature of the spine like in the back, stooping over
what is Lordosis?
butt sticks out
what is Scoliosis?
lateral curving of the spine
Now concerning bone formation, the microscopic functioning unit of mature bone is ...
the osteon
what is the center for longitudianal growth?
the epiphesisial plate. sp
what is the process by which bone is formed?
osification. a dynamic tissue in constant state of reabsorption and pronation.
what helps long bones not loose their calcification?
stress on the bones ie not being a couch potato
you have to move to keep calcium in your bones
what vitamin promotes calcion reabsorption from the GI tract promotes good strong bones?
vitamin D
what gland increases and decreases calcium?
the parathyriod gland increases and decreases calcium in the body
what does calcitonin do?
inhibits bone resorption and increase the desposit of Calcium in bone...Specifically, calcitonin reduces blood Ca2+ levels in three ways:

Decreasing Ca2+ absorption by the intestines
Decreasing osteoclast activity in bones
Decreasing Ca2+ and phosphate reabsorption by the kidney tubules
Its actions, broadly, are:

Bone mineral metabolism
Prevent postprandial hypercalcemia resulting from absorption of Ca2+ from foods during a meal
Promote mineralization of skeletal bone
Protect against Ca2+ loss from skeleton during periods of Ca2+ stress such as pregnancy and lactation
Vitamin D regulation
A satiety hormone
Inhibit food intake in rats and monkeys
May have CNS action involving the regulation of feeding and appetite
does bone need blood supply?
yes blood allows o2 and nutrients to bone
does a women grow much more after she starts menses?
what is the process by which the bone matrix is formed

a dynamic tissue in constant state of reabsorption and formation
bone formation and maintenance has to do w/ stress on the long bones. stress like weight lifting and action of the tendons and muscle around it what?
you not as apt to loose the calcification of those bones as compared to a couch potato.
remember Vit d and parathyoid both provide what?
Vit D promotes calcium reabsorption from GI tract

Para thyroid hormone is going to decrease or increase calcuim
what is calcitonin do?
inhibit bone reabsorption and increase deposit of calcuim in bone
what are the 3 types of bone cells again?
osteoblasts-bone formation. Think: its a blast to build.
osteocyts-involved in bone maintenance. Think: going onsite to do a PM.
osteoclasts-involved in destroying resorbing, remolding bone. Clasts cave it in.
where is and what is the hard fiberous membrane known as the peri...
periosteum...The periosteum is a thin layer of dense, irregular connective tissue that covers the outer surface of a bone in all places except at joints
what is osterogenisis?
bone formation
what are 2 examples of a hinged joint?
saddle joint allows mov. in 2 planes at right angles to each other. give an ex.
the joint at the base of the thumb is a saddle joint.
rotating a door knob is like what joint in the body?
a pivot joint
like the articulation b/t the radius and ulna in the arm
what kind of joint is the elbow or knee?
a hinge joint, permits bending in one direction only
what are 2 examples of a ball and socket joint?
permit full freedom of movement but are not strong
what kind of joints are in our wrists?
gliding joints
allow movement in all directions think carpal bones in the wrist.
now the assessment of this bone patient. what does it start with?
the interview
interview is the first part of the assessment. get social history,
do they have copd, cardiac issues, diabetes, what else?
determine their learning abilities
what they do for a living and if this will impact their healing
how do they deal with pain at their house?
We will be ask them about pain. a dull deep ache is probably related to ...
bone pain
how is muscle pain different from bone pain?
bone pain is deep boring drilling deep deep ache
musclelar pain is an aching or sore pain
fracture pain is sharp and petircing and releived with ...
whats the diff b/t bone pain and fracture pain?
bone is a deep boring pain
a fracture pain is sharp
what is osteromylitis?
bone infection and its pain is very sharp too like fracture pain is sharp. a progressive pain too...Osteomyelitis is an infection of bone or bone marrow, usually caused by pyogenic bacteria or mycobacteria
what does radiating pain have to do with usually?
radiating pain has to do with pressure excerted on a nerve root.
we will look at color, cap refill, movement, pulse, edema, does changing position help. ask about altered sensations like burning, tingling, and numbness. what is this kind of pain called?
altered sensations like tingling or numbness. caused by pressure on nerve or by circulatory impairment!
usually has to do with direct trauma to nerves and circulation
people may change posture to guard b/c of pain! slumpin over to that side or limb so they don't put pressure on that sore hip. one limb shorter than the other would make gait shuffle or fast forward gait so they don't fall down. But what are we trying to do?
establish a baseline
what is pain in the knees shoulders and elbows usually related to?
because gout and rhumitoid arthitus are in the same family, what questions would we ask?
if they have gout problems along with arthitis
what is clonis. why are intrested in this?
Clonus is most common in the ankles, where it is tested by rapidly flexing back (dorsiflexing) the relaxed ankle. It can also be tested in the knees by rapidly pushing the patella towards the toes.
when we assess, what do we look at for a point of reference to compare a problem?
the uneffected side! use it to compare with the affected side! We are looking for symmetry
the arms hang the same length and also the legs, stuff like that
why would we measure the length around the uneffected side of a limb?
to assess for edema when we compare the measurements to both sides! edema and muscle size. Also muscle size for someone who will be in bed for a long time.
whats the difference b/t a hematoma and a bruise?
a hematoma is raised! a pocket of blood. a bruise is not raised, a result of bumped capillaries and a little leakage but a hematoma is a large leakage like a blood blister.
so we do a head to toe assessment for this guy with a broken bone looking at that person's skin and ...
neuro vascular status
this is really really important meaning circulation, motion, and sensation.
color cap refill, temp.
is area cynotic, pale, cool, whats the timing of CRT refill, is there unrenting pain, decreased feeling, reduced feeling.
what does an X ray show?
density, change of bones and joints
what does a CT do?
CT scan will give detail on a specific plane for things like a tumor, ligaments, tendons
what is an MRI good for?
bone and soft tissue
what is Arthrography good for?
radio opaque study
what is Arthrocentesis for?
removal of synovial fluid, should be clear, pale, straw colored, and not too much of it...Definition
Puncture of a joint space with a sterile needle to do either of the following:

Withdraw fluid for diagnosis and/or treatment of a condition
Inject medications into the joint space
what is a electromyography?
electrodes to determine muscle and nerve damage.
what does a biopsy good for?
bone marrow and muscle
its very painful
what is a CBC?
H$H for bleeding
infection is WBC
Necrosis will show increase in WBC
what is an arthroscopy?

hint: I had one
Arthroscopy is a surgical procedure in which a small fiberoptic telescope (arthroscope) is inserted into a joint. Fluid is then inserted into the joint to distend the joint and to allow for the visualization of the structures within that joint. Usually the surgery is viewed on a moniter so that the whole operating team is aware of the type of surgical procedure that is being performed
when would you not catherize someone
blood on the meatus.
whats the best way to keep your pt from pain other than using meds?
keep them immobile. don't use what is hurting so much
whqts a contusion? (you treat it with cold)
tissue injury from blunt force, a huge bruise. a blow, a kick from a cow, fall down and hit your head.
whats a strain? a muscle pull or a ligement injury?
a strain is a pulled muscle, micrscopic tears.
from overstretching with some bleeding in the tissue
what is a sprain?
an injury to a ligaments surrounding a joint. Ligaments stabilize a joint.
with a sprain, a peice of bone MIGHT have come loose with the sprain so there is severe pain, and what procedure does it need?
an X-ray to see if there is a bone loose, this is Avulsion fracture.******************
a bone on the torn ligament
we used ICE on this sprain and rest. After it goes down, then we add heat to ...
increase absoprtion and healing. ice to decrease inflammatory and elevation to help decrease swelling. after 48 hours, heat is applied, to decrease swelling the decrease the pain AND risk for nerve & spasm
what is avascular neucrosis?
no blood + death = avascular neucrosis...Avascular necrosis is a disease resulting from the temporary or permanent loss of the blood supply to the bones. Without blood, the bone tissue dies and causes the bone to collapse
you get pinned between 2 cars you get a ...
get a communicated fracture which the bone is in tiny peices.
then there is a greenstick fracture?
jagged, it gets flexed and pops back, so it will look like the bone is intake but its shattered inside but looks ok!
so R I C E has to do with a sprain what does rice stand for? (remember, a sprain is a torn ligament)
long distance runners will get what kind of fracture?
a green stick or stress fracture
green stick can be a stress facture too.
so what is a stress fracture?
(a fracture from repeated loading w/o muscle or bone recovery)
a fracture from repeated loading w/out bone or muscle recovery. long distance runners and stress fractures.
but most likely it is a stress fracture ... The BEST ANSWER STRESS FRACTURE
angiogenesis =
angio = vessals
genesis = beginnings
so new blood vessels are forming. influenced by chemicals released inside out body to say something needs to heal and so ...
cell proliferation occurs, and overlays cartlidge and the fracture and the cartlidge is calcified.
potential complications:
compartment - muscles or group of muscles w/ nerve & blood supply, enclosed w/ in tough fibrous fascia. when you falay a deer and see a whole slab of comparmtnet meat, thats what this means. so, compartment syndrome =
so increased pressure in this compartment causes irreversible damage w/in 6 hours and paralysis and sensory loss in 24-48 hours.
what happens when a bone breaks? tiny microscopic peices of fat fly everywhere. so what things are we going to see in an assessment?
swelling!!!respiratory status!!! WE ARE GOING TO HAVE PULMONARY EMBOLYEE. instead of blood clots it will be fat clots. fat emboly that cause strokes and occlude and respiratory failure, heart attack, strokes, CVA damage and brain. will happen w/in 72 of surgery.
Kedney failure b/c of occulsion to kidneys, so this will show up like a stroke, confusion, iscemic st.roke associated w/ fat emboli. thick cough, sputum, hypoxia! no o2 stats, crackles, pulmonary edema, respirtatory failure! may start coughing up blood too b/c may have hemorrage in the aveloli. most common cause of death w/ fat emboli is respiratory failure. ********************
fat embolyi will look like an Xray snow storm. look for Petietia. what is petitecia?
small purple dots spread across the chest. this is always associated with fat emboli. AND have a temp of 103 and urinary output will drop. I&O. fat in the urine too! Tachycarida and pectecia in the chest.***********
whats the first thing we as nurses do if we suspect a fat embolii might be coming up? to prevent it?
make sure that fracture is supported properly

all the way from wreck to hospital there is minimal manipulation of that fracture.
so this guy w/ the broken leg, we make sure we move it as little as possible, we see that its supported properlye and what else?
we check his electrolytes and see to it this pt is ...
well hydrated. IF they are in respiratory distress, they will get anxious! SO, what drugs will be morphine to drop pain and anxiety, we want to minimize hypoxia (causes pressure in the brain area) etc
where would they put a harley accident patient with dirt in his wound?
a hyperbaric chamber to kill anaorobic bacteria PLUS any gas gangerine too. and severly painful and will happen in the next 14 days.
harley accident guy will be in intense pain, dillirium, gas bubbles under the skin, and crackles like celophane