Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
109 Cards in this Set
- Front
- Back
|
leading cause of disability in the USA
|
arthritis
|
|
|
functions of the system
|
-protection
-framework -mobility -produces heat -blood return via vascular massage -stores immature RBCs -Ca, phos, Mag, Fluoride storage *most of body's Ca is in BONE |
|
|
how many bones in our body
|
206
|
|
|
4 classifications of bones (by shape)
|
-long
-short -flat -irregular *the shape depends on F and forces it must support |
|
|
types of bone tissue
|
cancellous (trabecular)
-lacunae layered in irregular lattice work -like most epiphyses cortical (compact) -like in most diaphysis |
|
|
epiphyseal plate
|
allows for longitudinal growth
-calcified in adults |
|
|
articular cartilage
|
tough, elastic, nonvascular tissue
|
|
|
long bones
|
-made for weight bearing/movement
cancellous (trabecular) -like most epiphyses cortical (compact) -like in most diaphysis |
|
|
short bones
|
cancellous bone covered by a layer of compact bone
|
|
|
Flat bones
|
cancellous layer between compact
|
|
|
osteoblasts
|
BUILD
bone formation by secreting matrix |
|
|
matrix
|
collagen and ground substance that make a framework where minerals (phosphorus and calcium) are deposited
|
|
|
osteocyte
|
mature bone cells
involved in bone maintenance located in lacunae(bone matrix unit) |
|
|
osteoclasts
|
dissolve and resorb bone
located in Howship's lacunae (sm pits in the bone) |
|
|
periosteum
|
dense,fibrous membrane covering bone
-nourishes bone/facilitates growth -attachment of tendons/ligaments |
|
|
endosteum
|
thin vascular membrane lining the marrow cavity of long bones and spaces in cancelous bone
|
|
|
Red bone marrow
|
located in long bones b4 puberty
sternum/ ilium/ vertebrae/ ribs after puberty site of RBC production AKA hematopoiesis |
|
|
osteogenesis
|
bone formation
|
|
|
ossification
|
process by which bone matrix is formed and hard mineral crystals (STRENGTH) are bound to collagen fibers (RESILIENCE)
|
|
|
bone is a dynamic tissue -explain
|
constant state of turnover
|
|
|
modeling
|
bone growth during childhood continues until early 20's
|
|
|
remodeling
|
simultaneous bone resorption and osteogenesis that maintains structure and function
starts in early 20's |
|
|
factors that influence bone formation and resorption
|
-physical activity
-calcitriol (activated vit D) -PTH -calcitonin -thyriod hormone -growth hormone -estrogen -testosterone -blood supply |
|
|
calcitriol
|
-activated vitamin D
-increases amount of Ca absorbed by GI -helps mineralization of osteoid tissue -absorbed in duodenum (bypass) -fortified milk is the best source |
|
|
osteon
|
microscopic functional bone unit
-center is Haversian canal (capillary) -encircled by lamellae (matrix) |
|
|
paresthesia
|
abnormal sensation
(like burning,numbness,tingling) |
|
|
isometric contraction
|
-increased muscle tension w/out change in length or joint movement
-almost all of energy is released as heat (like shivering) |
|
|
isotonic contraction
|
muscle tension unchanged, muscle shortened, joint moved
-some energy is used for movement |
|
|
major hormonal regulators of Ca homeostasis
|
PTH and calcitonin
|
|
|
calcitonin
|
secreted by the thyriod gland when serum Ca is HIGH
-inhibits bone resorption -increases Ca deposits in bone -tells kidneys not to keep Ca??? -decreases w/age Miacalcin -nasal spray/ IM/ SQ -not given if SEAFOOD ALLERGY |
|
|
PTH
|
-released when serum Ca is LOW
-causes bone deminieralization -tells kidneys to keep Ca ??? -increases w/age |
|
|
thyriod hormone
|
-increased bone resorption and decreased bone formation
-CORTISOL has the same effect -and since cortisol is a steriod then corticosteriods will also have the same effect |
|
|
growth hormone
|
-stimulates LIVER and bone to make insulinlike growth factor-1
AKA IGF-1 -accelerated bone modeling in kids/adolescents -also stimulates skeletal muscle growth in this age group |
|
|
estrogen
|
-stimulates osteoblasts and inhibits osteoclasts= increased bone formation and reduced resorption
|
|
|
testosterone
|
-skeletal growth in adolescents
-continued effect on skeletal muscle growth Remember increased muscle mass = greater weight bearing stress on bones=increased bone formation -also it converts to estrogen in adipose tissue |
|
|
RANKL
|
receptor for activated nuclear factor-kappa B ligand =binds to RANK on osteoclast precursurs causing them to mature into ostoeclasts
1) produced by osteoblasts 2)produced by T cells during inflammatory response |
|
|
OPG
|
osteoprogerin =blocks the effects on RANKL, turning off bone resorption
-also made by osteoblasts |
|
|
synarthrosis jionts
|
immovable -like the skull after maturity
|
|
|
amphiarthrosis joints
|
-allow limited motion,joined by cartilage
like the vertebra, symphysis pubis |
|
|
diarthrosis joints
|
freely movable
include: -ball and socket (full freedom) -hinge (bending in 1 direction) -saddle aka biavial (movement in two planes at right angles to each other as in the thumb) -pivot (permit rotation) as in radius and ulna -gliding (limited movement in all directions) as in the carpal bones |
|
|
joint capsule
|
-surrounds articulating bones
-lined w/synovium=synovial fluid so bones DO NOT touch each other |
|
|
tendons
|
attach muscle to bone
|
|
|
ligaments
|
attach bone to bone
|
|
|
bursa
|
fluid filled sac of sinovial fluid that cushions movement of tendons,ligaments, and bones at point of friction
elbow,shoulder,hip,knee |
|
|
stages of fracture healing
|
1) REACTIVE PHASE
-bleeding and hematoma formation -cytokines released cause fibroblasts to come -fobroblasts cause angiogenesis -granulation tissue forms from clot 2) REPARATIVE PHASE -granulation tissue replaced w/procallus -fibroblasts invade procallus forming a denser callus of fibrocartilage -this is replaced by bony callus in 3-4 weeks -lamellar bone forms as it calcifies 3) REMODELING -new bone reformed to former structure -can take months or years |
|
|
skeletal muscle contraction
|
-each muscle cell/fiber is made of sarcomeres
-sarcomeres are the contractile unit of skeletal muscle -sarcomeres contain thick myosin and thin actin filaments -contract in response to electrical stimulation =cell depolarization and action potential -action potential=release of Ca ions that are stored in sarcoplamic reticula -Ca ions cause actin and myosin to cross each other -the Ca ions are then reabsorbed into the sarcoplasmic reticulum Ca needed for muscle contaction |
|
|
energy for muscle contraction
|
primary source is ATP
1)low levels of activity -ATP made from oxidation of glucose to H2O and CO2 2) strenuous activity -glucose metabolized into lactic acid and stored glycogen -this is not as effective muscle fatigue d/t depletion of glycogen and accumulation of lactic acid |
|
|
myoglobin
|
hemoglobin like protein pigment found in striated (skeletal) muscle that transports O2
RED muscles-have lots of this -contract slow but w/force -like respiratory/postural muscles WHITE muscle-have less of this -contract quickly -like EOM most muscle have both |
|
|
muscle tone
|
relaxed muscles in a state of readiness to respond
AKA tonus -produced by some muscle fibers remaining in a contracted state -reduced in sleep/increased w/anxiety -muscle spindles =are sense organs that monitor tone |
|
|
flaccid
|
limp without tone
|
|
|
spastic
|
greater than normal tone
|
|
|
atonic
|
denervated muscle that will atrophy
|
|
|
prime mover
synergists antagonists |
-muscle that causes the movement
-assist the prime mover -must relax to allow prime mover to contract |
|
|
hypertrophy
|
increase in muscle fiber SIZE not number
atrophy is the opposite isometric exercise helps if immobile |
|
|
pain assessment
|
bone=dull,deep ache, "boring"
muscle=sore,ache, cramping fracture=sharp relieved w/immobilization increases w/activity= sprain, strain, compartment steady increase= progression of infetious process/tumor/etc |
|
|
kyphosis
|
increased forward curve of thoracic spine
-ab muscles relax -breathing may be impaired -often seen in elderly associated w/OP |
|
|
lordosis
|
AKA swayback
increased curve of lumbar spine -often seen during pregnancy |
|
|
scoliosis
|
lateral curve to spine
-may be idiopathic or d/t muscle damage |
|
|
effusion
|
excessive fluid within capsule
-suspect if joint is swollen and normal bony landmarks are obscured may use balloon sign or ballottement of knee |
|
|
fasiculation
|
involuntary twitching of muscle fiber groups
|
|
|
when measuring muscle size
|
-measure at greatest width at rest
-document distance from bony landmark -change greater than 1cm is significant |
|
|
arthrography
|
-used to ID tears in capsule,ligaments
-dye or air injected into joint -passive ROM performed -X-rays taken -compression bandage and rest for 12h after -clicking or crackling normal for next 2-3 days |
|
|
bone densitometry
|
-tests for bone density
-uses X-rays or ultrasound -DXA (dual energy X-ray absorptiometry) is best for predicting hip fracture risk r/t OP so it is the most commonly used -uses T-scores or standard deviation |
|
|
bone scan
|
-radioisotope given IV 2-3h before
-isotopes taken up my metabolicaly active bone tissue -encourage fluids to clear isotopes -empty bladder if scanning pelvis |
|
|
arthroscopy
|
-direct visualization of joint
-compression wrap, ice, extended and elevated joint |
|
|
arthrocentesis
|
-joint aspiration
|
|
|
electromyography
|
-needle electrodes used to stimulate muscle to differentiate muscle issues from nerve issues
-may use warm compress after |
|
|
bone GLA protein
|
AKA serum osteocalcin
-indicates the rate of bone turnover |
|
|
lab values for increased osteoclast activity
|
-urinary N-telopeptide of type 1 collagen (N-Tx)
-urinary deoxypyridinoline (Dpd) |
|
|
lab values for increased osteoblast activity
|
-serum bone-specific alkaline phosphatase (ALP)
-osteocalcin -intact N-terminal propeptide of type 1 collagen (P1NP) |
|
|
casts
|
1)plaster
-used more in adults -get cool water for DR -longer dry time -wet is dull, sounds "thud" -dry is shiny,sounds hallow -CANNOT GET WET 2)fiberglass -used more in kids -can get wet but must dry -get warm water for DR BOTH -handle with palms -leave open to air, avoiding plastic -will feel warm while drying -burning over bony prominence may be d/t to pressure ulcer -exercise any joint not immobilized hourly when awake -compartment syn,ulcers,disuse -bivalving=or splitting of cast |
|
|
neurovascular assessment
|
Pain
Pallor Pulse Paresthesia Paralysis q2-4h w/any musculoskelatal injury |
|
|
nursing pt w/immobilized upper extremity
|
-when lying down position arm so wrist is higher then elbow, is higher than shoulder
-Volkmann's contracture = type of compartment syndrome will see contracture of the fingers and wrists, unable to/painful to extend fingers, loss of circulation |
|
|
nursing pt w/immobilized lower extremity
|
-elevated to heart level and ice packs for 1-2 days
-then elevated when sitting -should assume a recumbent position several times a day -Peroneal nerve injury can cause footdrop= can't keep foot in flexed position |
|
|
nursing pt w/immobilized body or spica cast
|
-impaired mobility is huge
-turn to uninjured side q2h -use at LEAST 3 people to turn -may require a trapeze -turn to prone position x2/d to provide postural drainage (a sm pillow under belly may help) -line w/plastic sheets during elimination if not Gore-Tex -monitor bowel sounds and for cast syndrome q4-8h -cast syndrome= psychologically-claustrophobic physically- GI dysfunction |
|
|
External Fixator
|
-used when there is soft tissue damage
-may be replaced by cast after healing -disuse/immobility less of an issue -pt may be freaked out by appearance -PIN CARE is very important -encourage mobility AS ORDERED -DO NOT ADJUST THE PINS Ilizarov=used to lengthen bones and correct other deformities it IS ADJUSTED daily as ORDERED |
|
|
Traction
|
-pulling force to a body part
-body/part is countertraction -straight/running= pulling force in straight line of part like Buck's -balanced suspension=part is elevated off of bed -skin traction=no pins -skeletal traction=PINS -manual traction=hands |
|
|
Skin traction
|
-muscle spasms and immobility b4 sx
-max 4.5-8lbs an extremity -assess circulation in 10-15min then q1-2h -encourage exercise q1h WA |
|
|
Buck's traction
|
-straight/running skin traction
-leg pulled straight out -do not turn side to side -use manual traction to remove boot x3/day to inspect skin -palpate areas of traction tape -provide back care q2h |
|
|
Skeletal traction
pins |
-allows more mobility
-uses more wt (15-25 lb) -inspect weight and pulley system -NEVER REMOVE WEIGHTS -DVT is huge risk do calf pump 10xh -REPORT/ASSESS ANY PAIN ASAP -pins will be covered 1st 48 hrs -some redness drainage WNL 1st 72h -assess q8h |
|
|
Immobilty complications
|
-anxiety
-self care -atelectasis/pneumonia -constipation/anorexia -urinary stasis/infection -DVT |
|
|
Hip precautions (sx)
|
-maintain abduction, neutral rotation, and flexion LESS than 90
-no crossing the legs -hips higher than knee when sitting -fracture pan -keep leg extended and pivot w/ transfer -avoid sitting more than 45min -followed for about 4 months |
|
|
continuous passive motion device
|
basically moves a part for you
-used w/knee replacements/etc |
|
|
s/s DVT
|
-unilateral calf swelling
-tenderness/warmth/redness |
|
|
s/s hypovolemic shock
|
-increased pulse (100+)
-low B/P (90/60) -increased pulse pressure (20+) -decreased Hct/Hgb -decreased urine output (30/h) -change in LOC/thirst |
|
|
Low back pain
herniated nucleus pulposus |
-most often L4-L5 and L5-S1
-most will end in 4 weeks -acute=less than 3 months -take it easy -assess pt prone d/t relaxation of paraspinal muscles -head up w/knees flexed or side w/pillows -avoid sleeping prone -avoid high heels,bad posture,lifting -loose weight AKA herniated disc =pressure on nerve root -radiculopathy/sciatica=radiating pain -postive straight leg test=pain w/raise -depressed/absent Achilles reflex |
|
|
carpal tunnel syndrome
|
-entrapment neuropathy syndrome
-median nerve compressed -most often d/t repeated movement -pain,numbness,paresthesia, weakness along median nerve (thumb, index, and middle fingers) -Tinel's sign=tap on inner aspect of wrist to illicit s/s -splints |
|
|
cane usage
|
COAL
C-ane O-pposite A-ffected L-eg bad leg and cane move together |
|
|
cane/crutches and stairs
|
"Up with the good (foot), Down with the bad"
|
|
|
Ostoeporosis
|
-primary
-secondary d/t dz or meds -osteoclasts more than osteoblasts -bone becomes porous/brittle -1st s/s may be fracture -compression fracture most common -age r/t loss begins after peak(40) -sm white women at highest risk -may not see in X-ray until advanced -DX w/ DXA |
|
|
daily Ca intake
daily Vit D intake |
1000-1200
-split doses in 2 800-1000 NEITHER taken w/bisphosphonates |
|
|
Osteomalacia
|
-metabolic bone dz
-bone is not being mineralized -soft weak bones=fracture/deformity -may see waddling or limping gait -primary deficit is lack of calcitriol -but also renal/liver/vit D/etc issue -X-ray shows demineralization -biopsy of osteoid AKA prebone -handle pt gently support w/pillows |
|
|
Paget's Disease
|
AKA osteitis deformans
-localized rapid bone turnover -skull/long bones/pelvis/spine most -primary proliferation of osteoclasts -compensatory increase in osteoblasts -classic mosiac pattern of growth -areas of reduced and overgrowth -insidious -skull may thicken=hats/loss of hearing/ sm triangular face -legs bow=waddling gait -spine bent forward with chin to chest -thorax compressed=breathing hard -arms bent out and forward=look long -pain,tenderness,warmth over bone -pain with weight bearing -vascular lesions=cardiac failure -normal serum Ca levels -fractures and arthritis common |
|
|
Osteomyelitis
|
-infection of bone
-causes inflammation,necrosis,bone growth -post sx w/in 30 days or 1y after implant -bone avascular =hard to tx -50% caused by staph.aureus -bone abscess forms if not tx -sequestrum=the abscess -involucrum=bone around abscess -s/s of sepsis if blood born -constant, pulsating pain, worse w/move -chronic=non healing ulcer that drains 3 types: -hematogenous=from blood -contiguos-focus=contamination -w/vascular insufficiency (DM) |
|
|
strain
sprain |
-pulled muscle or tendon
-pulled ligament/tendon around joint BOTH -graded in stages 1) stretching 2) some tear 3)major or complete tear -avulsion fracture possible |
|
|
contusion
|
-soft tissue injury d/t blunt force
-causes rupture of vessels -takes 1-2 weeks to heal |
|
|
tx for sprains, strains,contusions
|
RICE
then heat after 1st 24-48 hrs |
|
|
dislocation
subluxation |
-articular surfaces no linger aligned
-partial dislocation BOTH -considered an ER if traumatic -may result in avascular necrosis |
|
|
rotator cuff tears
Impingement syndrome= general term to describe ALL lesions that involve the rotator cuff |
-rotator cuff is made of 4 muscle and there tendons and stabilizes the humeral head
-supraspinatous -infraspinatous -teres minor -subscapularis s/s -night pain unable to sleep on side -cannot do over-the-head stuff |
|
|
epicondylitis
|
-chronic painful condition
-caused by moving forearms too much -results in tendonitis -lateral epicondylitis AKA tennis elbow -medial epicondylitis AKA golfers or pitchers elbow=d/t repeated wrist flexion |
|
|
lateral and medial collateral ligament injury
|
foot planted on floor..........
-lateral ligament if struck medially -medial ligament if struck laterally |
|
|
ACL and PCL injury
|
foot planted on floor............
ACL -anterior cruciate ligament if struck forward PCL-posterior cruciate is struck from behind s/s -may feel/hear a "pop" -suspect if severe swelling in 2h |
|
|
meniscal injury
|
may cause leg to "give out"
or "lock up" |
|
|
Achilles tendon rupture
|
-attaches soleus and gastrocnemius muscles to the os calcis (the heel)
-suddden contraction of calf muscle w/foot planted may cause it -will not be able to plantar flex foot |
|
|
types of fractures (basics)
S/S |
-complete=across entire bone
-incomplete=does not go all the way -comminuted=several fragments -closed/simple=does not break skin -open/compund/complex=breaks skin -intraarticualr=ends of bones and hard to see w/X-ray -pain=will get worse -muscle spasms=possible -loss of function -deformity -shortening=esp w/long bones -crepitus=assessing may cause injury so keep it minimal -edema and ecchymosis =hrs after |
|
|
Dupuytren's disease
|
-slow progression of contracture of palmar fascia
-results in flexion of 4th/5th and sometimes 3rd finger -looks like making a GUN w/hand -inherited autosomal dominant -also arthritis,cigs, alcoholism,DM |
|
|
Benign bone tumors
|
-more common than malignant
-symetric controlled growth pattern -primary tumors=bone destruction -osteochondroma most common= starts as projection on end of long bone -echondroma=tumor of hyaline cartilage -giant cell tumors(osteoclastoma)= may become malignant |
|
|
Malignant bone tumors
|
-primary are RARE
-metastatic is more common=NO TX -osteosarcoma is most common and most fatal -chondrosarcomas=from hyaline |
|
|
complications of bone fractures
|
EARLY
-shock (often hypovolemic)= -fat embolism syndrome (FES)= hypoxia, tachypnea, tachycardia, dyspnea, crackles, wheezes, thick WHITE SPUTUM, edema, PaO2 below 60, x-ray shows SNOW STORM infiltrate, change in LOC, petechia, fever over 103, fat in urine -compartment syndrome= pain that increases w/passive ROM not relieved by narcotics or seems way to extreme for injury -DVT --------------------------------------- DELAYED -delayed union=takes longer to heal -nonunion=ends do not unite -malunion=do not unite right -avascular necrosis of bone= loses blood supply and dies -reaction to internal devices -complex regional pain syndrome= sympathetic nervous system goes nuts and skin temp and look changes frequently -hetorotopic ossification= bone forms where it should not including soft tissue/muscle/etc |
