Med-Surg II Exam II Part I
Isotonic contraction
'shortening of the muscle without an increase in tension within the muscle;
Pharmacologic Therapy for Osteoarthritis
(NSAIDs): ibuprofen, naproxen., diclofenac., celecoxib., mefenamic acid., etoricoxib. Acetaminophen COX-2 enzyme blockers Opioids intra-articular corticosteroids Topical analgesics (capsaicin and methyl salicylate)
Clinical Manifestations of Osteoarthritis.
1. Pain, lasts less than 30 minutes and decreases with movement. 2. stiffness, most common in the morning after awakening 3. functional impairment due to pain on movement and limited joint motion
7 Ps of neurovascular compromise that could indicate compartment syndrome:
1. Paresthesia 2. Pulses 3. Poikilothermy 4. Pain or pressure 5. Pallor 7. Paralysis
What care should a nurse provide a patient with a hip fracture and placed in Buck traction?
1. Perform frequent neurovascular checks 2. Monitor the client for skin breakdown 3. Keep the affected extremity in neutral position 4. Ensure that the client receives adequate pain relief 5. Maintain patient in a supine position
What interventions will a nurse implement for a patient with an Immobilized lower extremity?
1. Support the patient's leg on a pillow to the level of the heart to control swelling. 2. Apply cold therapy or ice packs as prescribed over the fracture site for 1 to 2 days. 3. Teach the patient to elevate the immobilized leg when seated. 4. Teach the patient to assume a recumbent position several times a day with the immobilized leg elevated to promote venous return and control swelling 5. Teach patient to increase venous return and diminish edema by gently exercising toes and ankles for isometric contraction of muscles beneath the cast
What are the signs and symptoms of cachexia?
1. Weight loss 2. muscle loss 3. a lack of appetite fatigue 4. decreased strength
What are early complications of a fracture?
1. acute pain 2. loss of function 3. deformity 4. shortening of the extremity 5. crepitus 6. localized edema 7. ecchymosis 8. Early complications include shock 9. fat embolism 10. compartment syndrome 11. venous thromboemboli (deep vein thrombosis [DVT] 12 pulmonary embolism [PE]).
What are interventions carried out in caring for patients with a fracture?
1. administering analgesics 2. providing comfort measures 3. assisting with ADLs 4. preventing constipation 5. promoting physical mobility 6. preventing infection 7. maintaining skin integrity 8. preparing client for self-care.
What are delayed complications of a fracture?
1. delayed union 2. malunion 3. nonunion 4. avascular necrosis (AVN) of bone, 5. reaction to internal fixation devices 6. complex regional pain syndrome 7. heterotopic ossification.
How can edema from a fall be reduced?
1. elevating the extremity on a pillow above the heart level 2. Move body part
Characteristics of gout:
1. metatarsophalangeal (MTP) joint of the big toe is most commonly affected; the tarsal area, ankle, or knee may also be affected 2. triggered by trauma, alcohol ingestion, dieting, medication, surgical stress, or illness 3. Abrupt onset occurs at night, causing severe pain, redness, swelling, and warmth over the affected joint 4. Early attacks tend to subside spontaneously over 3 to 10 days without treatment 5. Next attack may not come for months or years; in time, attacks tend to occur more frequently, involve more joints, and last longer. 6. Tophi are generally associated with frequent and severe inflammatory episodes.
A technician usually administers a calculated dose of a radioisotope how many hours before a bone scan?
2 hours
The baseline goal for the reduction of pain is
30 %
How many IU of vitamin D do young adults need daily?
600 IU,
How many IU of Vitamin D do adults 50 years and older require?
800 to 1000 IU
What is a bursa?
A bursa is a closed, fluid-filled sac that works as a cushion and gliding surface to reduce friction between tissues of the body.
What is the Homan sign?
A clinical finding of pain behind the knee upon forced dorsiflexion of the foot.
Diseminated Intravascular Coagulation (DIC)
A condition in which small blood clots develop throughout the bloodstream, blocking small blood
Intra-articular fracture
A fracture extends into the joint surface of a bone.
An impacted fracture
A fracture in which a bone fragment is driven into another bone fragment.
A compression fracture
A fracture in which bone has been compressed (seen in vertebral fractures).
Open fracture
A fracture in which the skin or mucous membrane wound extends to the fractured bone. An oblique fracture runs across the bone at a diagonal angle of 45 to 60 degrees.
Incomplete fracture (greenstick)
A fracture involves a breakthrough only part of the cross-section of the bone.
The presence of bruising, older age, and prolonged use of corticosteroid medications increases the risk of?
A fracture posttraumatic injury
Oblique fracture
A fracture that runs across the bone at a diagonal angle of 45 to 60 degrees.
Movement away from the midline.
Abduction
What does acute compartment syndrome produce?
Acute compartment syndrome may produce deep, throbbing, intense pain not controlled by opioids (can be due to a tight cast or constrictive dressing or an increase in muscle compartment contents because of edema or hemorrhage). Cyanotic (blue-tinged) nail beds and pale or dusky and cold fingers or toes are present; nail bed capillary refill times are prolonged (greater than 3 seconds); pulse may be diminished (Doppler) or absent; and motor weakness, paralysis, and paresthesia may occur.
Movement toward the midline.
Adduction.
Risk factors for osteoarthritis are
Age, congenital and developmental disorders of the hip, obesity, previous joint damage, repetitive use (occupational or recreational), anatomic deformity, and genetic susceptibility
The nurse is caring for a client with a hip fracture. The physician orders the client to start taking a bisphosphonate. Which medication would the nurse document as given?
Alendronate
The nurse is caring for patient with a hip fracture. The physician orders the patient to start on a bisphosphonate. Which medication would the nurse document as given?
Alendronate (Fosamax)
Isometric or muscle setting
Alternately contracting and relaxing a muscle while keeping the part in a fixed position; this exercise is performed by the patient.
Tricyclic Antidepressants (TCAs)
Amitriptyline
What is a hematoma?
An accumulation of blood outside of the blood vessels is generally formed by a rupture in the blood vessel wall.
Calcitonin and PTH are referred to as ________hormones because of their opposing actions.
Antagonistic
What is an example of a pivot joint?
Articulation between the radius and the ulna.
The junction of two or more bones is identified as?
Articulation, also known as joint.
Surgical immobilization of the jaw with metal wiring prevents the mouth from opening, this increases the risk for what emergencies?
Aspiration and airway obsetruction
How does the nurse assess the circulation of a patient with an immobilized lower extremity?
Assesses circulation by observing the color, temperature, and capillary refill of the exposed toes. Assess nerve function by observing the patient's ability to move the toes and by asking about the sensations in the foot.
The nurse is caring for a client with osteoporosis. Which information will the nurse include when teaching actions to manage the condition?
Avoid excessive alcohol intake Stop smoking Engage in regular weight-bearing exercise
The hip and shoulder are examples of what type of joint?
Ball-and-socket joints
Which type of joint permits full freedom of movement.?
Ball-and-socket joints
What is an example of a saddle joint (biaxial joint)?
Base of the thumb
Why do people with Paget's disease often develop kidney stones and/or calcium deposits in blood vessels and heart valves?
Because of the increased calcium in the body from the accelerated breakdown of bone tissue.
During bone healing, where are new osteons formed?
Bone cortex
Where does fracture healing occur?
Bone marrow
What is the outcome of vitamin D deficiency?
Bone mineralization deficit, deformity, and fractures.
Which bones are likely to consist of cortisol bones and why?
Bones that are designed for weight-bearing and movement such as long bones
What hormone does the thyroid gland produce and release to help regulate calcium levels in the blood?
Calcitonin
Which medication can prevent hypercalcemia?
Calcitonin
Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing bone mass density (BMD)?
Calcitonin
How does calcitonin react to the elevation of blood calcium levels?
Calcitonin, secreted by the thyroid gland in response to elevated blood calcium levels, inhibits bone resorption and increases the deposit of calcium in bone.
Which electrolyte triggers a contraction within the muscle cell?
Calcium
What part of the body consists of short bones?
Carpal and tarsal
What are amphiarthrosis?
Cartilaginous joints with limited motion
What syndrome is associated with the cause of low back pain from compression of the cauda equina?
Cauda equina syndrome
A nurse is caring for a client with eczema. Which medication would be prescribed when an allergy is a factor causing the skin disorder?
Chlorpheniramine
When might osteomyelitis occur after postoperative period?
Chronic osteomyelitis may occur after persistent infection in the late postoperative period.
Why are fractures common among seniors?
Collagen structures are less able to absorb energy. Increased inactivity, diminished neuron stimulation, musculoskeletal disorders, and nutritional deficiencies contribute to the loss of muscle strength.
A distal radius fracture?
Colles' fracture
A fracture most common in women age grater than 50 and is related to osteopenia or osteoporosis?
Collures' Fracture
What are indicators of peripheral circulation dysfunction?
Color: Pale, cyanotic, or mottled Temperature: Cool Capillary refill: More than 3 s
A nurse is assessing a patient with a hip and femur fracture and notes pallor and paresthesia, and the patient reports increasing pain despite pain medications or elevation. The nurse is concerned about which possible complication?
Compartment syndrome
What action is taken during the isometric exercise?
Contract or tighten the muscle as much as possible without moving the joint, hold for several seconds, then let go and relax; breathe deeply.
What type of bone develops during the healing process?
Cortical bone remodeling Immature bone develops from the endosteum. intensive regeneration of new osteons
Tophi can lead to
Crystalline deposits accumulating in articular tissue, osseous tissue, soft tissue, and cartilage) gouty nephropathy (renal impairment) uric acid urinary calculi
Muscle relaxant
Cyclobenzaprine
How many mg daily of calcium is essential to maintain adult bone mass?
Daily intake of approximately 1000 to 1200 mg of calcium
What are some dietary sources of vitamin D?
Dietary sources of vitamin D include vitamin D-fortified milk and cereals, egg yolks, saltwater fish, and liver.
During an outpatient visit a nurse is assessing a patient's understanding about the signs and symptoms associated with osteoporosis.
Dowager's Hump Some patients are asymptomatic Fractures most commonly in the hips, wrist, and spine
Serotonin-norepinephrine reuptake inhibitors
Duloxetine
How is walking an example of both isometric and isotonic muscle contractions?
During walking, isotonic contraction results in the shortening of the leg, and isometric contraction causes the stiff leg to push against the floor.
Clinical manifestation of compartment syndrome.
Early sign:paresthesia Pain Pressure Pallor Pulselessness Poikilothermy Late sign: Paralysis
List examples of hinge joints.
Elbows and knees
How do thiazide diuretics affect uric acid?
Elevates serum uric acid (SUA) levels.
You're developing a nursing care plan for a patient with gout present on the right foot. What specific nursing interventions will you include in this patient's plan of care?
Encourage fluid intake of 2-3 liters per day. Use a footboard while the patient is in bed. Apply alternating cold and warm compresses to foot as tolerated by the patient daily.
Where is cancellous bone located within the body?
Ends of long bones, pelvic bones, ribs, skull, and the vertebrae in the spinal column
Longitudinal growth is nurtured and facilitated by which section of the long bone?
Epiphyseal plate
What layer of cartilage separates the epiphysis and diaphysis?
Epiphyseal plate, also known as the growth plate
What section of the long bone consists of spongy cancellous bone?
Epiphysis
What role does estrogen play in bone formation?
Estrogen stimulates osteoblasts and inhibits osteoclasts; therefore, bone formation is enhanced and resorption is inhibited.
Turning outward
Eversion
How often does complete bone turnover occur?
Every 10 years
Straightening at a joint.
Extension
Bending at a joint.
Flexion
When has fracture strength been achieved?
Fracture strength is obtained when the new osteons have become established
Comminuted fracture
Fracture that produces several bone fragments
What are diarthrosis joints?
Free-moving synovial joints.
Recovery path to low back pain is
Frequent change in position Limiting sitting to 20 to 50 minutes Avoid absolute bed rest Resume ADLs ASAP Low-stress aerobic exercises Conditioning exercising after 2 weeks
Anticonvulsant medications
Gabapentin
Which joint allows for limited movement in all directions ?
Gliding joint
Which joint is represented by the joints of the carpal bones in the wrist?
Gliding joint
What are potential complication in the immediate postoperative period?
Hematoma, hemorrhage, and infection are potential complications in the immediate postoperative period.
Red bone marrow, located mainly in the sternum, ilium, vertebrae, and ribs in adults, is responsible for producing red blood cells, white blood cells, and platelets through a process called___.
Hematopoiesis
Which joint permits bending in only flexion or extension?
Hinge joints
A patient is taking Calcitonin for osteoporosis. The patient should be monitored for?
Hypocalcemia
What is the role of insulin-like growth factor 1 (IGF-1)?
IGF-I stimulates bone formation and resorption. The result is an increase in the overall rate of bone remodeling, with a net effect of bone accumulation.
How does vitamin D deficiency affect the bones of children?
In children, it can cause rickets. Rickets is a rare disease that causes the bones to become soft and bend
How does PTH react to low calcium levels in the blood?
In response to low calcium levels in the blood, increased levels of PTH prompt the mobilization of calcium, the demineralization of bone, and the formation of bone cysts.
When is joint pain from RA worse?
In the morning, worse on awakening, with prolonged morning stiffness lasting >1 hour that usually improves with activity.
How does calcitonin reduce calcium?
Increase diuresis and decrease reabsorption of calcium
Radiculopathy
Injury or damage to nerve roots in the area where they leave the spine
Turning inward
Inversion
During a biceps curl, holding the dumbbell in a constant/static position rather than actively raising or lowering it is an example of what type of muscle contraction?
Isometric
Pushing against an immovable object is an example of what type of muscle contraction?
Isometric
Which muscle contraction involves increasing tension in the muscle, but the muscle does not change length, nor does the angle of the joint change?
Isometric muscle contraction
How does testosterone affect bone growth and formation?
It directly causes skeletal growth in adolescence and has continued effects on skeletal muscle growth throughout the lifespan.
How might growth hormone and IGF-I affect the aging process?
It is believed that the low levels of both growth hormone and IGF-I that occur with aging may be partly responsible for decreased bone formation and resultant osteopenia.
How does growth hormone effect skeletal growth and remodeling?
It stimulates the liver to produce insulin-like growth factor 1 (IGF-I), which accelerates bone modeling in children and adolescents.
What type of fibrous sheath surrounds the articulating bone?
Joint capsule
Where is the bursa located within the body?
Joints of the elbow, shoulder, hip, and knee.
Physical findings for which tissue?
Ligaments
Structural Findings for which tissue? Lax ligaments (less-than-normal strength; weakness)
Ligaments
What bundles of collagen connect the articulating bones together?
Ligaments
Epicondylitis (tennis elbow)
Manifested by pain that usually radiates down the extensor surface of the forearm and generally is relieved with rest and avoidance of the aggravating activity.
X-ray of the spine:
May demonstrate a fracture, dislocation, infection, osteoarthritis, or scoliosis
Bone scan and blood studies:
May disclose infections, tumors, and bone marrow abnormalities
What vessels supply blood to cancellous tissue?
Metaphyseal and epiphyseal vessels
How can RA patients reduce joint stiffness and pain?
Moist heat and range of motion exercises
How do muscles react to low levels of calcium?
Muscle cramps
What medications are used for lower back pain?
NSAIDs Tricyclic antidepressants Serotonin-norepinephrine reuptake inhibitors Anticonvulsant Opioids (short-term)
Uric acid is
Natural waste product that is formed when the body breaks down purines.
What are the signs and symptoms of cauda equina syndrome?
Neurologic deficit, recent bowel or bladder dysfunction, and paresthesias in perineal, inner thigh, or buttock region
Are blood test valuable for osteoarthritis?
No
Is there a treatment to stop osteoarthritis?
No
What is tophi?
Nodules that develop in people with uncontrolled chronic gout.
What are the signs and symptoms of peroneal nerve injury?
Numbness, tingling, and burning may indicate peroneal nerve injury resulting from pressure at the head of the fibula.
What are the signs of peroneal injury?
Numbness, tingling, and burning may indicate peroneal nerve injury resulting from pressure at the head of the fibula.
When does compartment syndrome occur?
Occurs when perfusion pressure falls below tissue pressure within a closed anatomic compartment
Opioid medications are contraindicated for
Older adults, those with kidney disease, or those who must avoid chronic NSAID exposure because of its adverse gastric effects. Systemic corticosteroids and acetaminophen are not effective in fully alleviating acute low back pain
A patient is prescribed Alendronate (Fosamax) at 0800 for the treatment of osteoporosis. As the nurse you know you must administer this medication:
On an empty stomach with a full glass of water and keep the patient upright for 30 minutes.
Where the peroneal nerve located?
On the outside of the fibula just below the knee.
How can a fat embolus be distinguished from a pulmonary embolism?
One sign of fat embolism is a petechial rash that appears on the neck, chest, and axilla due to microvascular occlusion.
How longer are opioid used for osteoarthritis?
One to two weeks for moderate to severe cases of low back pain (pain level: 8 to 10)
What procedure is the correction and alignment of the fracture after surgical dissection and exposure of the fracture?
Open reduction
During bone healing, endothelial cells are transformed into what type of cells within the bone marrow?
Osteoblasts
What bone cells form new bones and grow and heal existing bones?
Osteoblasts are the cells that form new bones and grow and heal existing bones.
Which bone cells are responsible for bone maintenance and regulation of osteoblasts and osteoclasts?
Osteocytes
How does osteogenesis differ from ossification?
Osteogenesis refers to the broader picture of bone formation. Ossification refers to the formation and hardening process of the bone matrix through the crystallization of calcium and phosphorus and the bounding of collagen fibers.
Which of the following is the most common and most fatal primary malignant bone tumor?
Osteogenic sarcoma (osteosarcoma)
If unattended, an infected bones can lead to what bone disorder?
Osteomyelitis
What is the microscopic functioning unit of mature cortical bones?
Osteon
Surgical Management used when pain is severe and function is lost:
Osteotomy • Joint arthroplasty (replacement)
What are the major hormonal regulators of calcium homeostasis?
PTH and calcitonin are the major hormonal regulators of calcium homeostasis.
How does PTH regulate the concentration of calcium in the blood?
PTH regulates the concentration of calcium in the blood, in part by promoting the movement of calcium from the bone
What hormones are vital in ensuring that calcium is available for bone mineralization and matrix formation?
PTH, calcitonin, calcitriol
What hormones are vital in ensuring that calcium is properly absorbed?
PTH, calcitonin, calcitriol
Radiculopathy
Pain radiating from a diseased spinal nerve root
What are the signs and symptoms of acute gout arthritis?
Pain, stiffness, swelling, red, fatigue
Which substance stimulates osteoclast activity?
Parathyroid hormone
What are indicators of peripheral sensation dysfunction?
Paresthesia, Unrelenting pain, Pain on passive stretch, Absence of feeling
How does long-term use of corticosteroids affect bones?
Patients receiving long-term synthetic cortisol or corticosteroids (e.g., prednisone) are at increased risk for steroid-induced osteopenia and fractures.
Fat embolism is mostly associated with fractures of what bones?
Pelvic and long bones
What vessel supplies blood to compact bone?
Periosteal vessel
During bone healing, where is a hard callus formed?
Periosteum
Which layer of the bone provides for attachment of the tendons and ligaments?
Periosteum
Which membranous structure consist of nerves, blood vessels, and lymphatics?
Periosteum
Which membranous structure of the bone provides nourishment and facilitates grow?
Periosteum
Magnetic resonance imaging (MRI) scan:
Permits visualization of the nature and location of spinal pathology
Peroneal nerve injury
Peroneal nerve injury may result in numbness, tingling, and burning in the feet. Cyanosis, pallor, and decreased capillary refill are signs of inadequate circulation.
Which type of joint allows one bone to move around a central azis without displacement?
Pivot joint
Turning downward with palm facing the floor.
Pronation
Mandible facing forward.
Protraction.
What are some quality sources of calcium?
Quality sources of calcium include low-fat milk, yogurt, and cheese. Foods with added calcium such as orange juice, cereals, and bread are also beneficial.
Red bone marrow is responsible for producing what blood products?
RBC, WBC, platelets
What is a joint arthroplasty?
Replacement of joint surfaces with metal or synthetic materials.
How is the bone structure and function maintained?
Resorption and osteogenesis
What are the clinical manifestations of fat embolism?
Respiratory distress, neurologic impairment, petechiae.
Mandible facing upward and head pulling backwards.
Retraction
Which joint allows movement in two planes at right angles to each other?
Saddle joint
What are the contractile units of skeletal muscle?
Sarcomeres
What is osteoblasts function in bone formation?
Secrete bone matrix
What type of x-rays are used to monitor the progress of bone healing?
Serial x-rays
What is an example of a synarthrosis joint?
Skull (cranium)
Treatment for osteoarthritis is focused on
Slowing and treating symptoms
A muscle with greater-than-normal tone is described as ______.
Spastic
Bleeding into the injured tissue and local vasoconstriction occur, and a hematoma forms at the site of the fracture. Which stage?
Stage I
Cytokines are released, initiating the fracture healing processes by causing replicating cells known as fibroblasts to proliferate, which in turn causes angiogenesis to occur. WHich stage?
Stage I
Degranulated platelets and inflammatory cells release growth factor, which stimulates the generation of osteoclasts and osteoblasts. Which stage?
Stage I
Granulation tissue begins to form within the clot and becomes dense. Which stage?
Stage I
Fibroblasts and osteoblasts migrate into the fractured site and begin the reconstruction of bone.
Stage II
Fibroblasts and osteoblasts migrate into the fractured site and begin the reconstruction of bone. Which stage?
Stage II
Inflammatory phase occurs with the formation of granulation tissue. Which stage?
Stage II
Maximum girth by the end of the second or third week occurs. However, in iit is still not strong enough for weight bearing. Which stage?
Stage II
The fibroblasts produce a fibrocartilaginous soft callus bridge that connects the bone fragments. Which stage?
Stage II
At this time, it is usually safe to remove a cast, if one is present. Which stage?
Stage III
During this stage, mature bone gradually replaces the fibrocartilaginous callus and the excess callus is gradually reabsorbed by the osteoclasts. Which stage?
Stage III
During this stage, the fracture site feels immovable and appears aligned on x-ray. At this time, it is usually safe to remove a cast, if one is present. Which stage?
Stage III
Reparative phase usually begins during the third or fourth week of fracture healing and continues until a firm bony union is formed. Which stage?
Stage III
Compact bone replaces spongy bone around the periphery of the fracture. Which stage?
Stage IV
Remodeling occurs as necrotic bone is removed by the osteoclasts. Which stage?
Stage IV
What part of the body consists of flat bones?
Sternum, ribs, cranium, scapula,
Turning upward, with palm facing the ceiling.
Suprination
Immovable joints are known as?
Synarthrosis joint
Joints with fibrous tissue banding are known as _____?
Synarthrosis joints
The joint capsule is lined with what type of membrane?
Synovium
What membrane secretes synovial fluid into the joint capsule?
Synovium
What membrane secretes synovial fluid?
Synovium
How should RA patients take NSAIDs?
Taken with food to avoid GI upset. Taken in the evening since symptoms worsen during the night.
How does testosterone help preserve men's bones?
Testosterone converts to estrogen in adipose tissue, providing an additional source of bone-preserving estrogen for aging men.
What is cauda equina?
The bundle of spinal nerves that arise from the lower portion of the spinal cord.
What must the patient not do after an open reduction with internal fixation?
The client should not cross the legs and should keep them abducted. Passive or active ROM exercises shouldn't be performed on the affected leg during the postoperative period, because this could damage the operative site and cause hip dislocation. Most clients should be turned to the unaffected side, not from side to side. After open reduction with internal fixation, the client must avoid acute flexion of the affected hip to prevent possible hip dislocation; therefore, semi-Fowler's position should be avoided.
Chronic Tophaceous Gout
The deformities of long-standing chronic tophaceous gout can mimic rheumatoid arthritis and osteoarthritis. Joint involvement is usually not as symmetric as in rheumatoid arthritis. Acute inflammation may be present
What is urate?
The end product of purine metabolism in humans.
During bone healing, when does hematoma formation occur?
The first 1 to 2 days of the fracture.
In order for an immobile patient to regain pre-injured strength and functional ability, they need what type of exercising?
The healed muscle needs progressive exercising to resume its pre-injury strength and functional ability.
What is the bone matrix?
The intercellular substance of the bone that forms most of the mass of the bone.
What is the bone matrix made of?
The matrix consists of collagen and ground substances (glycoproteins and proteoglycans) that provide a framework for the deposits of inorganic mineral salt deposits like calcium, phosphorus, and hydroxyapatite.
How does the patient control swelling after the cast is removed from the affected leg?
The nurse should instruct the patient to control swelling by elevating the formerly immobilized body part, no higher than the heart, until normal muscle tone and use are reestablished.
How should the nurse care for the patient after open reduction with internal fixation?
The patient should be turned to the unaffected side, not from side to side. After open reduction with internal fixation, the client must avoid acute flexion of the affected hip to prevent possible hip dislocation; therefore, semi-Fowler's position should be avoided.
What is a total joint arthroplasty?
The replacement of both the articular surfaces within a joint with metal or synthetic materials.
A decrease in the size of a muscle is caused by what?
The replacement of inactive contractile muscle tissue with fibrotic tissue.
What muscle contraction describes isotonic contraction?
The shortening of the muscle without an increase in tension within the muscle.
What is rickets?
The softening and weakening of bones in children.
Intercritical gout
The time between gout flares is known as an "intercritical" period.
What factors influence the rate of fracture healing?
The type of bone fractured, the adequacy of blood supply, the condition of the fracture fragments, the immobility of the fracture site, and the age and general health of the person
Nonpharmacologic interventions for chronic low back pain
Thermal applications (hot or cold) Spinal manipulation (chiropractic therapy) Lumbar support belts Cognitive-behavioral therapy (biofeedback) Exercise regimens Spinal manipulation Physical therapy Acupuncture Massage Yoga
How does a lack of physical activity affect the bone formation of people on bed rest or who have physical disabilities?
Those on prolonged bed rest or those with some physical disabilities have increased bone resorption from calcium loss, and their bones become osteopenic (reduced in terms of mass) and weak. Their weakened bones may fracture easily.
What is the purpose of isometric exercises?
To maintain strength when a joint is immobilized.
What is the treatment for cachexia?
Treatment includes nutritional counseling, medications to stimulate appetite and weight gain, and treating the underlying disease.
Adequate immobilization is essential until there is x-ray evidence of bone formation with ossification True or False
True
Alcoholics have a high urate level? True or false
True
Applying a heating pad for 30 minutes in not appropriate. The patient may alternate heat and cold therapy, but heat should not be applied for greater than 20 minutes to prevent injury to the skin.
True
Arteries and nerves are typically compressed from edema after trauma, medical device placement.
True
Cauda equina syndrome is a medical emergency requiring immediate referral to an emergency department so that the patient may receive expeditious treatment to relieve the underlying cause before nerve damage occurs. True or False
True
Clients with rib fractures often take frequent, shallow breaths as they experience intense pain with inspiration. Adequate pain control allows for deep breathing, which prevents buildup of secretions, atelectasis, and pneumonia.
True
Compartment syndrome is a limb-threatening condition characterized by ischemia and impaired nerve function that occurs when the arteries and nerves in a tissue compartment are compressed.
True
Despite a multitude of age-related musculoskeletal changes, the many effects of aging can be slowed if the body is kept healthy and active through positive lifestyle behaviors. True or False
True
For a patient with a mandibular fracture whose jaw is wired together the priority is to maintain a clear airway. If choking occurs, the nurse should suction the mouth along the gum line to clear secretions.
True
RA is associated with progressive fibrosis of joint membranes which results in joint pain and deformity.
True
Remodeling may take months to years, depending on the extent of bone modification needed, the function of the bone, and the functional stresses on the bone. True or false
True
Systemic corticosteroids and acetaminophen are not effective in fully alleviating acute low back pain. True or false
True
The weights hanging from a Buck traction should be free-hanging at all times and should never touch the floor or be placed on the bed.
True
When caring for clients with jaw fixation, nurses must keep wire cutters near the head of the bed to free the jaw by cutting the wires in case of a medical emergency. This is a priority action.
True
finger joints are also involved. • Bony nodes may be present (painless unless inflamed). True or False
True
How does a patient connected to a skin traction meet their elimination needs?
Use a fracture pan
Electromyogram (EMG) and nerve conduction studies:
Used to evaluate spinal nerve root disorders (radiculopathies)
Ultrasound
Useful in detecting tears in ligaments, muscles, tendons, and soft tissues in the back
Computed tomography (CT) scan:
Useful in identifying underlying problems, such as obscure soft tissue lesions adjacent to the vertebral column and problems of vertebral discs
What are examples of amphiarthrosis?
Vertebral joints and symphysis pubis
How does vitamin D deficiency affect adult bones?
Vitamin D deficiency can lead to a loss of bone density, osteoporosis, and fractures.
A sign of disease such as cancer, AIDS, heart failure, or advanced chronic obstructive pulmonary disease (COPD) that is associated with
Wasting syndrome
What are indicators of peripheral motion dysfunction?
Weakness, Paralysis
What physical activities support osteogenesis?
Weight-bearing activity acts to stimulate bone formation and remodeling
Where does osteoarthritis occur most often?
Weight-bearing joints (hips, knees, cervical and lumbar spine);
When does a malunion occur?
When a fractured bone heals in an abnormal position, which can lead to impaired function of the bone or limb and make it look like it is 'bent'.
When is fat embolism syndrome likely to occur?
Within 12 to 48 hours but may occur up to 10 days after injury
How does an X-ray reveal osteoarthritis?
X-ray study shows narrowing of joint space and osteophytes (spurs) at the joint margins and on the subchondral bone.
Rheumatoid arthritis is
a chronic autoimmune -mediated disorder characterized by inflammation and damage to synovial joints.
Purine is
a compound that occurs naturally in our tissue and high levels in some foods, including alcoholic beverages, shellfish, and some meats, including bacon, turkey, liver, boar, hares, goats, and antelopes.
Osteoarthritis is
a degenerative joint disease, in which the tissues in the joint break down over time.
Acute compartment syndrome involves
a sudden and severe decrease in blood flow to the tissues distal to an area of injury that results in ischemic necrosis if prompt, decisive intervention does not occur.
skeletal traction
a treatment method for broken bones in which long bone fractures are immobilized through a system where a combination of pulleys, pins, and weights are used to promote the healing of fractured bones.
Colles' fracture
a type of wrist fracture that causes a characteristic dinner fork deformity of the wrist.
asymptomatic hyperuricemia
accumulation of uric acid in the blood.
Rotator cuff tear key assessment findings:
acromioclavicular joint pain, limited range of motion, and muscle weakness.
Fat embolism travels to the brain leading to neurologic changes such as
altered mental status, confusion, and restlessness.
Chronic tophaceous gout can occur in unusual locations such as
aortic walls, heart valves, nasal and ear cartilage, eyelids, cornea, and sclera. Joint enlargement may cause a loss of joint motion.
Tophi with chronic gout
are large, hard, painless visible bumps (nodules) made of urate crystals. "They can form in joints, bone, or cartilage."
Four stages of gout can be identified as
asymptomatic hyperuricemia acute gouty arthritis intercritical gout chronic tophaceous gout
Age and disuse cause loss of muscular function as fibrotic tissue replaces the contractile muscle tissue. The decrease in the size of a muscle is called _____.
atrophy.
cachexia
complicated metabolic syndrome related to underlying illness and characterized by muscle mass loss with or without fat mass loss that is often associated with anorexia, an inflammatory process, insulin resistance, and increased protein turnover.
Gout is characterized by
deposits of uric acid in various joints
Types of joints
diarthroses, amphiarthroses, synarthroses
Damaged peroneal nerve is observed during ambulation when the patient
drags the foot.
What frequently forms after fracture of long bones, pelvic bones, or crushed injuries?
fat emboli
A client with a musculoskeletal injury is instructed to make dietary alterations to facilitate calcium absorption. Which food item(s) should the nurse encourage the client to include in the diet?
fatty fish vitamin D-fortified milk eggs
A muscle that is limp and without tone is described as _____.
flaccid
Which bones are important sites of hematopoiesis and frequently protect vital organs?
flat bones,
Injury to the peroneal nerve as a result of pressure is a cause of
footdrop (the inability to maintain the foot in a normally flexed position).
Chronic tophaceous gout
frequent and severe inflammatory episodes. Most commonly occur in the synovium, olecranon bursa, subchondral bone (bony plate that supports the articular cartilage), infrapatellar and Achilles tendons, and subcutaneous tissue on the extensor surface of the forearms and overlying joints.
In secondary hyperuricemia
gout is a clinical feature secondary to any of a number of genetic or acquired processes, including conditions with an increase in cell turnover (leukemias, multiple myeloma, psoriasis, some anemias) and an increase in cell breakdown
The classic triad of FES is
hypoxemia, neurologic compromise, and a petechial rash. The typical first manifestations are pulmonary and include hypoxia and tachypnea.
A pulse oximetry can detect
hypoxemia.
If fat embolism syndrome occurs, with blockage of the small blood vessels that supply the brain, lungs, kidneys, and other organs, what may be noted?
hypoxia, tachypnea, tachycardia, and pyrexia; dyspnea, crackles, wheezes, precordial chest pain, cough, large amounts of thick white sputum; hypoxia and blood gas values with PaO2 below 60 mm Hg, with an early respiratory alkalosis and later respiratory acidosis; mental status changes varying from headache and mild agitation to delirium and coma.
What type of bones contain red bone marrow?
ilium, sternum, scapula, vertebrae, and ribs,, clavicle, skull, and spine.
Buck traction is a type of skin traction used to
immobilize hip fractures and reduce pain and spasms until the client can have the hip repaired.
Fat embolism travels through the pulmonary circulation and lodges in a pulmonary capillary. This leads to
impaired gas exchange and respiratory failure.
Cyanosis, pallor, and decreased capillary refill are signs of
inadequate circulation.
Osteomyelitis
inflammation or swelling that occurs in the bone.
Gout is a
inflammatory conditions related to a genetic defect of purine metabolism and resulting in hyperuricemia.
Fat Embolism Syndrome
is an acute respiratory disorder caused by an inflammatory response to embolized fat globules that may enter the bloodstream as a result of acute long bone fractures
In gout, there is an oversecretion of uric acid (hyperuricemia) or a renal defect resulting in decreased excretion of uric acid, or a combination of both.
is an oversecretion of uric acid or a renal defect resulting in decreased excretion of uric acid, or a combination of both
Acromioclavicular joint pain i
is when the joint between the clavicle (collar bone) and the acromion (part of the shoulder blade) becomes inflamed.
How can an immobile patient decrease the effects of immobility?
isometric exercise of the muscles of the immobilized part.
What muscle contraction involves no change in muscle tension, but the muscle length and joint angle both change?
isotonic contraction
Untreated compartment syndrome can lead to
loss of limb function or tissue necrosis
Acute gouty arthritis
most common early sign.
What is sciatica pain?
pain radiating from an inflamed sciatic nerve; presence of this symptom suggests nerve root involvement.
Subluxation
partial dislocation
Myelogram:
permits visualization of segments of the spinal cord that may have herniated or may be compressed (infrequently performed; indicated when MRI scan is contraindicated)
What factors help to balance resorption and osteogenesis?
physical activity, dietary intake of certain nutrients, especially calcium; and several hormones, including calcitriol (i.e., activated vitamin D), parathyroid hormone (PTH), calcitonin, thyroid hormone, cortisol, growth hormone, and the sex hormones estrogen and testosterone
Primary hyperuricemia may be due to
severe dieting or starvation, excessive intake of foods high in purines (shellfish, organ meats), or heredity
Heterotopic ossification is
the abnormal formation of bone, near bones or in muscle, in response to soft tissue trauma after blunt trauma, fracture, or total joint replacement.
Signs and symptoms of systemic embolization:
the patient appears pale. Petechiae appear in the buccal membranes and conjunctival sacs, on the hard palate, and over the chest and anterior axillary folds. Fever (temperature above 39.5C [103F]) develops. Free fat may be found in the urine when emboli reach the kidneys. Acute tubular necrosis and renal failure may develop.
Acquired immunodeficiency syndrome is a viral disease: caused by the human immunodeficiency virus (HIV): which destroys T cells
thereby increasing susceptibility to infection and malignancy. The client with AIDS who has nausea and vomiting: needs to avoid fatty products such as dairy products and red meat. Meals would be small and frequent: to lessen the chance of vomiting. HIV client needs to avoid: spices and odorous foods because they aggravate nausea. HIV tolerates foods: cold or at room temperature
fibrosis
thickening or scarring of the tissue
Chronic Tophaceous Gout may lead
to joint enlargement causing a loss of joint motion.
Gout is a type of arthritis that occurs due to the accumulation of ____________ in the blood that causes needle-like crystals to form around the joints.
uric acid
Bone marrow: is a spongy substance found in the center of the bones. Bone marrow manufactures: bone marrow stem cells and other substances
which in turn produce blood cells.
