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108 Cards in this Set
- Front
- Back
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What are the endocrine effects on bone? |
Increase and decrease resorption and formation. Estrogen promotes bone growth. |
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What two minerals do bones store? |
Calcium and phosphorus, which is why bone disorders often mess with calcium and phosphorus. |
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What are the two nutritional building blocks of positive bone health? |
Calcium and Vitamin D |
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What does abnormal posture and gait tell us? |
There is something wrong with the musculoskeletal system. |
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What two pieces of family/genetic history would indicate that someone is at risk for a musculoskeletal disorder? |
Family history of osteoporosis or autosomal dominant musculoskeletal disorder. |
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What is one of the best ways to promote a healthy musculoskeletal system? |
Weight bearing exercise |
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How does smoking influence musculoskeletal system? |
Smoking damages vasculature due to decreased oxygenation. |
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How does nerve impulse compromise influence musculoskeletal system? |
You can strain something without realizing it when your nerve impulses don't work correctly - you might end up stretching or pulling something beyond its limits. |
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What is osteoporosis? |
Excessive resorption by osteoclasts and a deficit of new formation by osteoblasts that causes decreased bone density and risk for fracture. This is a silent disorder that wreaks havoc on your bones before you start to see symptoms. |
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What is the DEXA score that indicates to us that someone has osteoporosis? |
T-score of less than or equal to 2.5 |
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Who is at highest risk for osteoporosis? What factors increase risk for osteoporosis? |
Postmenopausal women are at higher risk than men or premenopausal women. Age, smoking, immobility, Vitamin D deficiency, low-impact fracture after 50, estrogen deficiency and hyperparathyroidism all put people at higher risk for osteoporosis. |
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What are five clinical manifestations of osteoporosis? |
Kyphosis Height loss Low impact fracture Voluntary mobility restriction: spine Spinal tenderness |
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What is a low impact fracture? |
Falling from standing height or below and fracturing part of the body. |
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What is the confirming assessment for osteoporosis? |
Bone density assessment. |
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What are four non-pharm management techniques for osteoporosis? |
-Bracing -Heat -Massage -Surgical intervention (only would happen if there is an injury, like hip fracture) |
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What are four pharmacologic interventions for osteoporosis? |
-Calcium & Vitamin D supplements -Biphosphonates -Estrogen in post-menopausal women -Thyroid hormone |
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What is the best way to prevent osteoporosis? |
Build strong bones as a young adult! |
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What is osteomalacia? |
Decreased mineralization of turnover sites - bone tissue is softer. Higher rates in populations with suboptimal nutrition, not as common in US. |
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What is the diagnostic method for osteomalacia? |
Bone biopsy after identified through clinical features, lab and radiology. |
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Why is osteomalacia commonly misdiagnosed in America? |
Because it is not as common and it often looks similar to osteoporosis. |
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What are three risk factors for developing osteomalacia? |
-Prolonged & severe Vitamin D deficiency leading to hypocalcemia -Hereditary hypophosphatemia -In conjunction with rickets syndromes |
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What are four manifestations of osteomalacia and how does it present in labs? |
-Bone pain (but people often call it "muscle pain" because they don't know what bone pain feels like) -Fracture -Muscle weakness/cramps -Waddling gait or difficulty ambulating - classically the bowing of long bones, especially the legs Labs = decreased serum Vitamin D, calcium, phosphate and elevated parathyroid hormone |
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What are three non-pharm interventions for osteomalacia? What does the method of treatment depend on? |
-Increased sun exposure and nutrition
-Bracing -Surgical intervention Treatment depends on the underlying etiology. |
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What are five pharmacological interventions for osteomalacia? |
-Vitamin D supplement -Calcium intake of more than 1000 mg per day -Phosphate supplement -Estrogen in post-menopausal women -Thyroid hormone |
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Which is more likely to affect the elderly population: osteoporosis or osteomalacia? |
Osteoporosis is more likely to affect the elderly population. Osteomalacia can happen to anyone - all ethnicities. |
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What races are more likely to be impacted by osteoporosis? |
White women and Chinese American women. African Americans have more dense bones than Caucasians and Asians. |
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What is Paget disease? |
A disorder of bone metabolism that results in accelerated remodeling, overgrowth and impaired bone integrity. It is a mismatch between bone building and resorption that results in deformity, or pain in joint prior to deformity. |
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How is Paget disease diagnosed? |
Diagnosed with radiography lab analysis |
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What are risk factors for Paget disease? |
-Genetic -Environmental -Viral |
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What are four clinical manifestations of Paget disease? What lab manifestations would we see? |
-Arthritis -Chronic back pain -Bone deformity (enlarged skull, abnormal spine curve) Alkaline phosphatase would be elevated. |
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What is the goal of treatment in Paget disease? |
Goal of treatment is to ease pain and modify hormonal balance to get bone building and destroying to line up correctly. |
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What is the non-pharmacologic management of Paget disease? 5 |
-Nutrition -Fall prevention -Physical therapy -Non-impact exercise -Surgical intervention |
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What are two pharmacologic interventions of Paget disease? |
Anti-pagetic medication - nitrogen-containing biphosphonates and Calcium Analgesics |
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What is osteomyelitis? |
Infection of the bone that is classified by duration (acute vs. chronic) and is Staged 1-4 in severity. |
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Who is more likely to get osteomyelitis? |
Children |
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What is the most common location for osteomyelitis in the adult? |
The vertebrae |
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Who is most likely to develop chronic osteomyelitis? |
Diabetics |
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Who is most likely to develop acute osteomyelitis in terms of adults? |
Those who have an open injury or who develop a pressure injury on their coxyx. |
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What kind of disorder are most connective tissue diseases classified as? |
Most classified as autoimmune disorders. |
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What are the manifestations of connective tissue diseases? |
-Chronic pain -Progressive joint deterioration (this is key term in connective tissue disease) -Impaired function/mobility |
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What is the best approach to care of connective tissue disease? |
Interdisciplinary |
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What types of arthritis are non-inflammatory (localized, non-autoimmune)? |
Osteoarthritis |
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What types of arthritis are inflammatory (systemic)? |
Rheumatoid and Lupus |
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What can be the ultimate outcome of osteomyelitis? |
Blood flow can become blocked by pus and buildup, which would then cause bone to become necrotic. |
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What is osteoarthritis? |
Progressive deterioration/loss of cartilage and bone. One or more joints often accompanied by secondary inflammation. Typically a repetitive-use injury. |
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What is the difference between primary and secondary osteoarthritis? |
Primary happens due to normal aging - when you're older than 60 and genetics. Secondary happens due to joint injury or obesity. |
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What are four clinical manifestations of osteoarthritis? |
-Chronic joint stiffness and pain that is worse with activity and better with rest. -Tenderness/crepitus on palpation -Bone hypertrophy and nodules -Inflammation (synovitis) |
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Why is it important to educate patients regarding the importance of rest vs. exercise in osteoarthritis?
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Need rest in early osteoarthritis, but in late osteoarthritis, rest contributes to the settling of fluids/inflammation. |
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What is functional joint positioning? |
This is the most optimally balanced position for a joint to be in. |
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Why is nutrition important in the management of osteoarthritis? |
It is important for weight control. |
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What is CAM therapy? What is it used for? |
Capsaicin, glucosamine and chondroitin - important for management of osteoarthritis. |
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What is the surgical management of osteoarthritis? |
Total joint arthroplasty. |
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What are three pharm interventions for management of osteoarthritis? What is our first choice management? |
-Topical and oral analgesics/NSADS - these are our first choice. -Cortisone -Hyalgan injection (similar to fluid that surrounds joints - can act to lubricate and as a shock absorber) |
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What is rheumatoid arthritis? |
A chronic, progressive, systemic inflammatory autoimmune process that affects the synovial joints. |
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How can patients tell the difference between osteoarthritis and rheumatoid arthritis? |
In osteoarthritis, if you recognize there is a problem, you stop doing the aggravating activity and the problem stops. In rheumatoid arthritis, the problem will continue to get worse unless you use medicaitons. |
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What is the etiology of rheumatoid arthritis? |
The etiology is unclear. It seems there are some environmental and genetic factors involved. Female reproductive hormones can also put someone at risk. |
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What can cause the rate of degeneration to speed up in rheumatoid arthritis? |
Flares contribute to more rapid degradation in rheumatoid arthritis. |
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What is the onset of rheumatoid arthritis? |
Onset can be acute or severe and it can be slow or progressive. |
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What are four clinical manifestations of rheumatoid arthritis? |
-Joint inflammation (can be symmetrical... or not) -Fatigue -Generalized weakness -Persistent, low-grade fever |
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What are three late signs of rheumatoid arthritis? |
-Frequent morning stiffness -Decreased ROM -Joint deformity |
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What are three systemic manifestations of rheumatoid arthritis? |
-Vasculitis -Respiratory complications -Cardiac complications |
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How do heat and cold help in arthritis? |
Heat can help ease pain - including heating pads and warm showers. Cold can help reduce inflammation - should not ice for more than 15 minutes at a time. |
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How does plasmaphoresis help in rheumatoid arthritis? |
It is a method of removing blood plasma from the body by withdrawing blood, separating it into plasma and cells, and transfusing the cells back into the bloodstream. It is performed especially to remove antibodies in treating autoimmune conditions. |
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What CAM therapies can we use to treat rheumatoid arthritis? |
-Acupuncture -Hypnosis -Imagery -Music therapy |
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What three drugs can we use to treat rheumatoid arthritis? |
-Disease-modifying antirheumatic drugs (DMARDs) -NSAIDs -Biological response modifiers (BRMs) |
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What is gout? |
Systemic disease of urate crystal deposits in joints and other tissues, causing inflammation. |
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How do you diagnose gout? |
Arthrocentesis, synovial fluid cell counts and examination for crystals. |
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What is the difference between primary and secondary gout? |
Primary is an error of purine metabolism. Secondary is due to excessive uric acid related to renal insufficiency, diuretic therapy, crash diets, and chemotherapy agents. |
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What is lupus? |
Lupus is a chronic inflammatory disease that occurs when your body's immune system attacks your own tissues and organs. Inflammation caused by lupus can affect joints, skin, kidneys, blood cells, brain, heart and lungs. Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive sign of lupus — a facial rash that resembles the wings of a butterfly unfolding across both cheeks — occurs in many but not all cases of lupus. |
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What is fibromyalgia? |
A chronic pain condition that has lots of somatic symptoms and often manifests as a chronic musculoskeletal disorder. |
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What is Lyme disease? |
A bacterial infection that mimics many other musculoskeletal disorders. Spread by ticks. Symptoms of early Lyme disease may present as a flu-like illness (fever, chills, sweats, muscle aches, fatigue, nausea and joint pain). Some patients have a rash or Bell’s palsy (facial drooping). However, although a rash shaped like a bull’s-eye is considered characteristic of Lyme disease, many people develop a different kind of Lyme rash or none at all. |
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What is the difference between a sprain and a strain? |
A sprain is a stretching or tearing of ligaments — the tough bands of fibrous tissue that connect two bones together in your joints. The most common location for a sprain is in your ankle. A strain is a stretching or tearing of muscle or tendon. A tendon is a fibrous cord of tissue that connects muscles to bones. Strains often occur in the lower back and in the hamstring muscle in the back of your thigh. |
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What is a compound fracture? |
When a bone breaks through the skin. Also called an open fracture. |
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What is a comminuted fracture? |
A comminuted fracture is a break or splinter of the bone into more than two fragments. Since considerable force and energy is required to fragment bone, fractures of this degree occur after high-impact trauma such as in vehicular accidents. |
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What is a displaced fracture? |
In a displaced fracture, the bone snaps into two or more parts and moves so that the two ends are not lined up straight. If the bone is in many pieces, it is called a comminuted fracture. |
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What is an oblique fracture? |
An oblique fracture is a relatively common fracture in which the bone breaks diagonally. |
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What is a spiral fracture? |
A spiral fracture (a.k.a. torsion fracture) is a bone fractureoccurring when torque (a rotating force) is applied along the axis of a bone. Spiral fractures often occur when the body is in motion while one extremity is planted. |
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What is an impacted fracture? |
An impacted fracture is a bone fracture in which the parts of the broken bone are driven toward or into each other by force. This type of fracture often occurs as a result of a fall or an impact. |
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What is a greenstick fracture? |
A greenstick fracture is a fracture in a young, soft bone in which the bone bends and breaks. Greenstick fractures usually occur most often during infancy and childhood when bones are soft. |
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What are seven clinical manifestations of a fracture? |
-Pain -Loss of function -Deformity -Crepitus -Edema -Erythema -Ecchymosis (bruising) -Impaired sensation |
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What is the priority problem in a bone fracture, and what is the key to fixing it? |
The priority problem is pain, and the key to fixing it is stabilization. |
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How do we confirm fracture? |
Confirmed by X-ray |
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What two things do we need to worry about if someone has a comminuted fracture? |
Infection and Tetanus vaccination |
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What is the difference between an internal and external fixation? |
Internal - surgical repair with rods, plates and prosthetics plus an immobilization device like a splint or cast. External - placement of rods/pins through skin and bone and attached to rigid external frame - see on pelvis, neck and upper/lower extremities. |
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What is a pathological fracture? |
Due to weakened bone structure, like osteogenesis imperfecta, rickets, hyperparathyroidism and cancer. |
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Why is hyperparathyroidism a risk factor for pathological fracture? |
When one (or more) of the parathyroid glands are overactive (hyperparathyroidism), our bones release calcium constantly into the blood stream. It is the excess parathyroid hormone that is causing this! The result of too much parathyroid hormone is that bones lose their density and hardness. |
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What are the five steps in the healing process of a fracture? |
-Hematoma formation -Granulation tissue formation -Soft callus formation -Hard callus formation -Remodeling |
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How long does it take for a fracture to heal? |
4-6 weeks when you're younger - slower healing time as you get older. Need to consider the health of your musculoskeletal system overall. |
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What is the difference between an intracapsular and extracapsular hip fracture? |
Intracapsular involves the femoral neck. Extracapsular is below the femoral neck. |
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What musculoskeletal injury has the highest morbidity and mortality rate of any musculoskeletal injury and why? |
Hip fracture - can lead to most rapid decline in an older adult. One injury impacts EVERY single system. Also - the head of the femur is very vascular, so necrosis can happen more often in the intracapsular fracture (more risk for vasculature being impeded). |
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In what musculoskeletal condition would we see neurovascular compromise? How do we prevent it? |
Would see this in a patient with a stabilizing device - either a splint or a cast or external fixator. Would prevent this by assessment - repeated ongoing assessment to recognize change. |
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What is compartment syndrome? What does it result in? |
This is an orthopedic emergency that is characterized by pressure within soft tissues in a fixed body compartment. It increases pressure to a level that exceeds venous pressure, resulting in compromised venous blood flow and limited capillary perfusion. Causes muscle ischemia and necrosis. |
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What injuries are at highest risk for compartment syndrome? |
Long bone fractures and crush injuries are at the highest risk. |
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What are early signs of compartment syndrome? |
Pain out of proportion to the injury, impaired sensation (tingling/numbness) and perhaps discoloration. |
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What is a late sign of compartment syndrome? |
Pulselessness. Tends to be lasting damage because of this. |
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What is the repair for compartment syndrome? |
The only repair is a fasciotomy in which you open the compartment and wait until the swelling goes down before you close it. |
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What is a fat embolism? |
A fat embolism occurs when fat globules are released into the bloodstream. It’s most commonly associated with a trauma, such as a bone fracture. Symptoms, if present, typically occur 24 to 72 hours after the trauma. They include shortness of breath, confusion, and a rash. RESPIRATORY DISTRESS! |
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What type of fracture has higher risk for fat embolism? |
Closed and traumatic fractures have higher risk than open and non-traumatic. |
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What is the classic triad of a fat embolism? |
-Hypoxia -Neurological abnormalities -Petechial rash |
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What is the clinical manifestation of a DVT? |
-Swelling/edema -Erythema -Calf pain |
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How do you manage DVT? |
-Rest -Lovonox or Heparin are medication administration, but tough to balance with someone who just had a hip replacement |
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What are the clinical manifestations of pulmonary embolism? |
-Sharp pain -Shortness of breath -Rapid onset -Hypoxia -Impending doom |
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What is the nursing management of pulmonary embolism? |
Support respiratory function with oxygen, positioning, etc. |
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What is carpal tunnel syndrome? |
Focal mononeuropathy of the hand (i.e. usually unilateral, though can be bilateral) due to overuse of the wrist and compression of the median nerve. |
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How do you diagnose carpal tunnel syndrome? |
Diagnosed with symptom presence and nerve conduction studies. |
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What demographics put people at higher risk for developing carpal tunnel syndrome? |
-Female -Obese -Diabetes -RA -Genetic predisposition -Workplace factors |
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What is the clinical manifestation of carpal tunnel syndrome? |
Pain or paresthesia in first three digits and radial half on fourth digit. Symptoms are worse at night - can awaken patient from sleep. |
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What is the treatment for carpal tunnel syndrome? |
-Splinting -Glucocorticoid injections or oral medication -Surgery is the treatment of choice for ongoing symptoms without a reversible etiology |
