Bms Exam 4: Mobility

Front 1

What are the 5 functions of bones?

Back 1

Support, storage, movement, protection, hematopoiesis.

Front 2

_________ attach bone to bone while ________ attach muscle to bone.

Back 2

Ligaments/Tendons.

Front 3

What should a nurse assess in a muscular assessment?*

Back 3

Hx of muscular problems,onset/duration of any pain, medication taken, ADLs, occupation, lifestyle, ambulation ability, posture, and gait, neuromusclar integrity, sensory impairment.

Front 4

What are some age-related changes in the bones?

Back 4

Women: Peak at age 30. Men: Peak at age 50

Front 5

Changes in the bones are related to _____________ decrease.

Back 5

Hormone.

Front 6

Which labs help to diagnose osteoporosis?

Back 6

Serum Calcium (9.0-10.5), serum phosphorus (3-4.5), ESR, and muscle enzymes (CK, CK-MM, AST, LDH).

Front 7

How do you diagnose osteoporosis via imaging assessments?

Back 7

MRI, X-ray, tomography, radioisotope bone scan.

Front 8

What are the peripheral nerve studies done to diagnose osteoporosis?

Back 8

Electromyography and nerve conduction studies.

Front 9

What are the invasive studies done to diagnose osteoporosis?

Back 9

Biopsy and arthroscopy.

Front 10

Define osteoporosis:

Back 10

A degenerative bone disease that decreases bone mass and increases the risk for a fracture.

Front 11

What are the risk factors for osteoporosis?

Back 11

Family history, low body weight, not exercising, excessive alcohol ingestion, smoking, menopause, and poor nutrition.

Front 12

What can be done to help prevent osteoporosis?

Back 12

Weight bearing exercises, improve diet (increased calcium,vitamin D ,protein, leafy greens), increase sun exposure, AVOID caffeine, alcohol, and smoking.

Front 13

How do you diagnose osteoporosis?

Back 13

DXA scan.

Front 14

What drugs are used with osteoporosis?

Back 14

Biphosphonates, calcium, and vitamin D.

Front 15

What is osteomyelitis?

Back 15

An inflammation of the bone and/or bone marrow usually r/t infection.

Front 16

Clinical manifestations of osteomyelitis include:

Back 16

Fever, pain, edema, erythema, leukocytosis, vascular compromise, and possible ulceration.

Front 17

What's the non-surgical treatment of osteomyelitis?

Back 17

Pain control, hyperbaric treatment, IV antibiotics, possible isolation.

Front 18

What's the surgical treatment of osteomyelitis?

Back 18

Debridement, bone grafting, amputation.

Front 19

What does post-op care include with osteomyelitis?

Back 19

IV antibiotics, hyperbaric therapy, wound care.

Front 20

What is hyperbaric therapy?

Back 20

Used with retractable diseases; high concentration/pressure of O2 stimlate healing.

Front 21

What are the clinical manifestations of a fracture?

Back 21

PAIN, loss of function, visibly deformed: free motion @ the site, internal/external rotation, grating sound with movement, edema, ecchymosis (bruising), paresthesia (numbness).

Front 22

How do you confirm a fracture?

Back 22

X-Ray.

Front 23

How would you treat a patient with a fracture?

Back 23

Assess their ABCs, x-ray (to confirm it is actually a fracture), splint (to immobilize the extremity), elevation, neurovascular assessment, pain management (meds).

Front 24

What are the 5 P's of pain ?

Back 24

Pain, pulse, pallor, paresthesia, paralysis.

Front 25

What are the complications of a fracture?

Back 25

Acute compartment syndrome, crush syndrome, rhabdomyolosis, hypovolemic shock, fat embolism, venous thromboembolism, infection, chronicity.

Front 26

How should you care for a client in a cast?

Back 26

Perform neuroassessments hourly, note odor/drainage if any, monitor for infection, watch out for hot spots, report any changes, turn, cough, deep breathe.

Front 27

What should be avoided with all cast care?

Back 27

Foreign objects underneath the cast, wetness/dirt, pulling out padding, pulling the cast off, scratching undreneath the cast.

Front 28

What is the consequence of not performing an hourly neurovascular exam?

Back 28

The patient could lose a limb.

Front 29

To maintain skin integrity, a nurse should:

Back 29

Prevent skin break down and promote healing: turning client every 2 hours, providing a specialty bed, good hygiene, and increasing the protein and vitamins C/D in their diet.

Front 30

What is a fat embolism?

Back 30

A fat clot that breaks off from the bone marrow of the fracture site.

Front 31

95% of all fat emboli come from ________________.

Back 31

Long bone fracutres (ex: femur).

Front 32

Clinical manifestations of fat emboli are:

Back 32

Altered mentality, petechiae, fever, tachypnea, tachycardia, hypoxemia.

Front 33

How do you diagnose a fat embolism via diagnostic tests?

Back 33

Increased ESR, lipase, Ca+, RBC, platelets in the blood. Lipuria and lipidemia presence. ABG levels: O2 stat decreased.

Front 34

How do you diagnose fat emboli via radiology?

Back 34

Chest x-ray and lung scans.

Front 35

Treatment of a patient with a fat embolism includes:

Back 35

Being put on a ventilator, steroids, fluid replacement, bed rest, O2.

Front 36

What would a nurse want to monitor in a patient with a fat embolism?

Back 36

Turning Q 2h, pain, respiratory status, and you must make sure the fracture stays immobile!

Front 37

What is compartment syndrome?

Back 37

When the nerves and muscles compress and causes a vascular compromise, can turn necrotic.

Front 38

What are the 6 P's of compartment syndrome?

Back 38

Pain, pressure, paralysis (motor deficit, muscular weakness), paresthesia, pallor, pulse-lesness.

Front 39

How would you treat someone with compartment syndrome?

Back 39

Call the Dr. ASAP! Loosen dressings, possible diuresis, possible fasciotomy, restore circulation, preserve limb function, keep limb at heart level.

Front 40

What should you never use in patients with compartment syndrome?

Back 40

ICE!

Front 41

What are some complications of amputations?

Back 41

Phantom limb, hemorrhage, infection, flexion contracture, neuroma (tumor on the nerve).

Front 42

Physical assessments for amputations include?

Back 42

NV checks, skin integrity, prolonged rehab, physical/occupational therapy.

Front 43

Psychosocial assessments for amputations include?

Back 43

Grieving, body image, self-esteem, employment, adapting at home...Some patients may want to bury their limb.

Front 44

Health promotion for amputations includes?

Back 44

Education, encouraging ambulatory devices, teach contracture-preventing exercises, provide community resources.

Front 45

Three types of amputations are ________, ________, and __________.

Back 45

Below the knee, above the knee, upper extremity.

Front 46

Which type of amputation is the best for prosthesis?

Back 46

Below the knee.

Front 47

What is the purpose of traction?

Back 47

To immobilize the extremity so it can heal.

Front 48

What precautions should we take with traction weights?

Back 48

Weights should not be removed without prescription, they shouldn't be lifted manually or resting on the floor-- weights should hang free at all times.

Front 49

Skin traction vs skeletal traction.

Back 49

Skin-- sling, not invasive, external immobilizes, holds 5-10 lbs.

Skeletal-- Invasive, lasts longer, attaches to the bone, holds 15-30 lbs.

Front 50

Nursing care of traction includes?

Back 50

Manage pain, position Q 2h, heels off the bed, VTE prophylaxis, falls prevention.

Front 51

External vs. ORIF:

Back 51

External: used for comminuted fractures, facilitate alignment of bone and provide early mobilization, risk for infection at pin sites.

ORIF: FASTER mobilization, open visualization of injury.

Front 52

Nursing care for traction includes?

Back 52

Checking temperature and alignment of the extremity, performing circulation checks, increase fluid intake, good bowel care, and provide a trapeze to assist with client movement.

Front 53

Biphosphonates are used for _______________.

Back 53

Osteoporosis.

Front 54

The first week after a fracture, a ____________ shows up.

Back 54

Hematoma (inflammation).

Front 55

A _____________ _____________ is formed 2-3 weeks after a fracture.

Back 55

Soft callus.

Front 56

A ___________ _____________ is formed 4-16 weeks after a fracture.

Back 56

Hard callus.

Front 57

When does remodeling occur after a fracture?

Back 57

17 weeks.

Front 58

What does calcium do?

Back 58

Maintains functional integrity of bones, muscle, nerves, myocardium. MUST take with meals and drink lots of water!

Front 59

What does vitamin D do?

Back 59

Regulates Ca+ and phosphorus, increases absorption of Ca+ and phosphorus.

Front 60

What's the main side effect of biphosphonates?

Back 60

GI upset-- must take on an empty stomach with 8 oz H20 and sit up for 30-60 minutes before meal.

Front 61

What are the ADRs associated with biphosphonates?

Back 61

Gastric and esophageal ulcers, osteonecrosis of the jaw, dysphagia.

Front 62

With biphosphnates, you must report any __________________.

Back 62

Chest pain.

Front 63

The suffix for the generic brand of biphosphonates is?

Back 63

-dronate.

Front 64

What are the signs and symptoms of hypercalcemia?

Back 64

N/V, weakness, fatigue, constipation.