MSK med-surg ch 60 PN 2, BRTC
Nutrition notes (60-1, p 1044)
*Calcium:* under 50 = 1,000 mg over 50 = 1,200 mg 4 servings of milk group or green leafy vegetables, caned sardines/salmon with bones, broccoli, Ca fortified OJ *Vitamin D:* helps absorb the calcium *Vitamin K, magnesium and potassium also all important*
gout
*Inflammation of joints due to elevated uric acid levels.* High uric acid levels cause crystals to form in joints and kidneys. Most commonly affected the great toe, knees, and ankles. Patients with gout are at an increased risk for kidney stones. Signs and symptoms include severe pain, joint inflammation, swelling, redness, heat, and high uric acid level in blood. Treatment includes relief of pain and inflammation and prevention of future attacks. Low purine diet (avoid red meats, soda, high fructose corn syrup, organ meats, and alcohol), weight loss, increase fluid intake. Meds to treat acute attack and prevent future attacks. NSAIDs for inflammation and pain. Cherry juice as a homeopathic treatment.
Nursing guidelines (60-1, p 1047)
*Need consent* Do not bend the joint afterward Keep the extremity elevated Use ice for pain Instruct pt to report unusual pain, bleeding, drainage, or swelling at the arthroscopic site
What is the treatment for musculoskeletal injuries?
*R*est *I*ce *C*ompression *E*levation *S*tablization
How do you properly remove a tick?
*refer to diagram*
What are some important nursing considerations for casts?
1. A cast is applied from the joint above the break to the joint below the break (functional position) 2. Plaster casts require longer drying time and mold better to patient (patient will be placed in a temporary cast/splint until swelling goes down) 3. The most commonly used cast is a fiberglass cast 4. Montior neurovascular status! 5. It takes approximately on year for the bone to regain its former strength
What is the difference between a splint and a cast?
1. A splint is used for a body part that *does not* need rigid immobilization 2. A splint is used to immobilize and support 3. A splint is used if there is a lot of swelling in the area (can be temporary until a cast can be applied)
What are some important patient teaching points regarding stump care?
1. A stump shrinker or ACE wraps offer compression to reduce and control swelling, protect the area, and help shape the stump for a prosthesis 2. ROM exercises prevent contractures 3. *See stump care on page 1069 Box 61-5* 4. *See patient home care instructions on page 1070*
What are ways the nurse can help a patient deal with anger and depression following an amputation?
1. Acknowledge the patient's feelings as this reaction is normal 2. Be objective and non-judgemental 3. Provide comfort measures
What nutrition is important to help maintain musculoskeletal health?
1. An adequate calcium intake BEFORE age 35 to help maximize peak bone mass 2. Calcium intake recommendations are set at 1,000 mg/day for adults younger than age 50, and 1,200 mg/day for adults over the age of 50 3. Non-dairy sources of calcium include dark green leafy vegetables, sardines, canned salmon with bones, broccoli, and calcium fortified orange juice 4. Vitamin K, magnesium, and potassium help maintain bone density *refer to table 60-1 on page 1044 of the textbook*
What are some important nursing considerations for traction?
1. Apply prescribed weight 2. Weights *should not* touch the floor 3. Ensure straight body alignment of the affected extremity 4. Perform proper pin care
What are the expected age-related musculoskeletal changes?
1. Bones - gradual progressive bone loss after age 35 and vertebral collapse 2. Muscles - decreased muscle mass (atrophy) and wasting, and decreased tendon elasticity 3. Joints - cartilage progressively deteriorates and intervertebral discs thin 4. Ligaments - relaxed ligaments results in decreased strength and weakness *refer to table 60-3 on page 1046 of the textbook*
What are the signs and symptoms of avascular necrosis?
1. Decreased function of the affected extremity 2. Increased pain
What are some important nursing considerations for orthopedic surgery?
1. Early ambulation is important 2. Risk for DVT and PE 3. Risk for pneumonia 4. Aspirin and anticoagulants need to be held prior to surgery to decrease bleeding risk 5. Assess patient's home environment and potential problems prior to discharge
What are some important patient teaching points for a total knee arthroplasty?
1. Elevate the affected extremity when seated 2. Bending the knee and use of the joint is very important 3. Don't walk with the knee straight! 4. Use CPM device as ordered 5. Use a walker when ambulating
What is the treatment for carpal tunnel syndrome?
1. Heat/ice 2. NSAIDs 3. Splint 4. Corticosteroids 5. Surgery
What are some post-operative complications of an amputation?
1. Hemorrhage 2. Hematoma (monitor for formation) 3. Infection 4. Monitor for signs of sepsis if the patient has gangrene 5. Severe pain including phantom limb pain 6. Disturbed emotions including anger and depression
What should the nurse include in the physical assessment and patient history?
1. Is the problem acute or chronic? 2. Has the patient had a recent injury? 3. Assess pain (onset, duration, location, radiation) 4. Does the patient have any numbness or paresthesias? 5. Have the patient describe the pain (burning, aching, stabbing) 6. Does anything make the pain better or worse? 7. Obtain medical history, drug history, and any allergies *refer to page 1043-1045 of the textbook to review physical assessment*
What are some reasons that an amputation may be necessary?
1. Malignant tumor 2. Chronic infection of bone and tissue 3. Trauma 4. Necrosis from vascular insufficiency 5. Thermal injury 6. Deformity of the limb 7. life threatening disorder such as arterial thrombosis
What is the treatment for phantom limb pain?
1. Mirror therapy 2. Medications to treat nerve pain 3. Surgical removal of the nerve endings at the stump
What are some important patient teaching points for a total hip arthroplasty?
1. No subluxation 2. Sit on elevated chair/toilet seat in a slightly slouched position 3. Keep hip flexion < 90 degrees 4. Use a grabber to pick up items 5. NO bending at the waist! 6. Keep the head of the bed < 45 degrees 7. Keep legs abducted with pillow or wedge 8. Kick affected leg out when sitting 9. Use a walker when ambulating *refer to box 61-5 on page 1062 of the textbook*
What are the assessment signs and symptoms of a fracture?
1. Pain - one of the most consistent symptoms of a fracture is pain 2. Loss of function - skeletal muscular function depends on intact bone 3. Deformity - a break may cause an extremity to bend backward or assume another unusual position 4. Crepitus - the grating sound of bone ends moving over one another may be audible 5. Edema - swelling usually is greatest directly over the fracture 6. Spasm - muscles near the fracture involuntarily contract *refer to page 1076 in the textbook*
What are the signs and symptoms of carpal tunnel syndrome?
1. Pain and inflammation of the wrist, numbness, and tingling 2. Pain may be relieved by shaking the hands 3. Loss of sensation to fingers 4. Flexion of the wrist causes immediate pain and numbness
When is it important for the nurse to assess the neurovascular status of an extremity?
1. Patients with a cast 2. Patients with traction related to injury/fracture 3. Patients with a musculoskeletal injury 4. Post-operatively after musculoskeletal surgery *refer to table 60-2 on page 1044 of the textbook for neurovascular assessment*
What are some important patient teaching points for orthopedic surgery prior to being discharged?
1. Proper diet and nutrition 2. Use assistive device for ambulation 3. Eliminate safety hazards such as rugs and cords 4. Notify doctor if any incision drainage, fever, chills, sudden onset or worsening of pain, redness, or swelling
What are the complications of a fracture?
1. Shock 2. Fat embolism 3. Pulmonary embolism 4. Compartment syndrome 5. Delayed bone healing 6. Infection 7. Avascular necrosis *refer to Box 62-1 on page 1077 in the textbook*
What is compartment syndrome and how is it treated?
1. Tendon or nerve is compressed in a confined space due to swelling 2. It is very painful 3. Circulation becomes compromised and nerve damage can occur 4. Can occur as the result of a cast being too tight or due to generalized swelling after an injury 5. If it is due to a cast, it must be removed 6. If it is due to swelling, surgical intervention is necessary (fasciotomy)
What are some important patient teaching points for casts?
1. The patient may feel a warm sensation during the application of the cast 2. Keep the cast dry and watch for any soft spots or cracks 3. NEVER stick anything inside the cast 4. Elevate the extremity to decrease swelling 5. It is normal for the skin to be yellow and crusty after cast removal; warm soaks and lotion will help remove it 6. The muscles will be weak and stiff after cast removal
What are some important nursing considerations for ORIF?
1. There is a risk for infection 2. Perform proper pin care using applicator only once per site *refer to table 61-3 of page 1057 of the textbook for pin care*
The human body has _____ bones
206
Bones
206 in the body Short- fingers Long- femur Flat- sternum Irregular- vertebrae
What type of urine test can determine levels of Uris acid and calcium excretion
24 hour urine analysis
After ______ years, people generally experience loss of bone mass and height and chances in the structure of the spine and joints
35
Bursa
A small sac filled with synovial fluid
Bursae
A small sac filled with synovial fluid
Bone densitometry
AKA bone density Done on women after menopause to look see bone density
A nurse is assessing a client who is experiencing peripheral neurovascular dysfunction. What assessment findings are most consistent with this diagnosis?
Absence of feeling, capillary refill of 4 to 5 seconds, and cool skin
Bone density scanning or dual energy X-ray absorptiometry (DXA/DEXA)
Advance radiographoc technology to measure bone mineral density
The primary functions of cartilage are to reduce friction between articular surfaces, absorb shocks, and reduce stress on joint surfaces. Where in the human body is cartilage found?
All options are correct.
SLE
An autoimmune disorder with an unknown trigger. More common in women and has a strong familial tendency. Affects multiple body systems. Antibodies destroy connective tissues in the body. Has episodes of remission and exacerbation. Signs and symptoms include butterfly rash on the face, fever, anorexia, weight loss, arthritis, atrophy, avascular necrosis, and skin lesions. Lab tests helps diagnose. Treatment is managed by a rheumatologist. The goal is to produce remission and prevent exacerbation. Treatment depends on the body system affected. Medications can include NSAIDs, immunosuppresants, antineoplastics, and analgesics. Avoid exposure to UV light and rest periods with activity.
Neurovascular Sensation Assessment
Arm injury: can identify pressure to the top of the index finger, fifth finger, and web between the thumb Leg injury: can identify pressure applied to great toe and sole of the foot at the base of the towa
Neurovascular Mobility Assessment
Arm injury: spread fingers on affected hand and can press thumb to last digit on affected hand Leg injury: can flex and extend ankle
Which of the following diagnostic studies are done to relieve joint pain due to effusion?
Arthrocentesis
Which is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or wrist?
Arthrography
A patient is scheduled for a procedure that will allow the physician to visualize the knee joint in order to diagnose the patient's pain. What procedure will the nurse prepare the patient for?
Arthroscopy
Assessment - history
Ask questions to find out information on pain/injury: Broken bone sticking out always ask when they last had a tetanus shot Length of time of injury/pain Any alleviating factors Any aggravating factors Tried any OTC meds Tried heat/ice
Arthrocentesis
Aspirate synovial fluid Can inject drug such as steroid
pain, cramping, weakness
Asses presenting problem S/S of muscle problems:
medications, past, family
Assess ___________, _____ medical history(congenital defects, trauma, inflammation, fractures, back pain), __________ history (arthritis, gout)
lifestyle
Assess patients ____________: -patterns of activity & exercise (limitations in ADL, use of assistive devices) -nutrition & diet (obesity) -occupation (sedentary, heavy lifting, or pushing)
stiffness, swelling, pain, redness, heat, limitation of movement
Assess presenting problem -S/S of problems with bones & joints:
Tendons
Attach muscle to bone
Factors that affect bone formation: bone formation facilitators and bone formation retardants
BFF: Calcium, phosphorus, estrogen, testosterone, calcitonin, vitamins A C D, growth hormone, exercise and insulin BFR: Estrogen/androgen deficiency, vitamin deficiency, starvation, diabetes, steroids, inactivity/immobility, heparin, and excess parathyroid hormone
Examples of skeletal muscles
Biceps in the arms and the gastrocnemius in the claves
Musculoskeletal system supports
Body and facilitated movement
An older adult client has symptoms of osteoporosis and is being assessed during her annual physical examination. The assessment shows that the client will require further testing related to a possible exacerbation of her osteoporosis. The nurse should anticipate what diagnostic test?
Bone densitometry
Bone Densitometry estimates
Bone mineral density (BMD)
Musculoskeletal system consists of
Bones, muscles, joints, tendons, ligaments, cartilage, and bursae
A patient tells the physician about shoulder pain that is present even without any strenuous movement. The physician identifies a sac filled with synovial fluid. What condition should the nurse educate the patient about?
Bursitis
Which of the following is an example of a hinge joint? a) Joint at base of thumb b) Carpal bones in the wrist c) Knee d) Hip
C) Knee
Bone Formation Facilitators
Calcitonin
Which hormone inhibits bone reabsorption and increases calcium deposit in the bone?
Calcitonin
Bone Formation Facilitators
Calcium
Nutrition
Calcium Dairy and NON-Dairy Sources Calcium is necessary for contracting muscles, forming and strengthening bones and teeth, conducting nerve impulses throughout the body, clotting blood, and maintaining a normal heartbeat, as well as other important processes.
2 types of bony tissue
Cancellous bone/ spongy bone Cortical bone/ compact bone
Which is an indicator of neurovascular compromise?
Capillary refill of more than 3 seconds
osteoarthritis (DJD)
Cartilage wears away, joint space narrows, and bone rub together. Bone spurs and cysts develop resulting in joint deformity. Pain occurs and joint movement becomes limited. Joint stiffness after inactivity. Heberden nodes develop. Frequently affected sites are the hips, knees, spine, hands, and shoulders. Treatment includes rest when needed, low impact exercises to promote ROM and strength, weight loss, assistive devices, NSAIDs, corticosteroids, topical analgesics, TENS unit, and reconstructive joint surgery.
Osteoclasts
Cells involved in the destruction, resorption, and remodeling of bone
Osteoblasts
Cells that build bones. They secrete bone matrix (mostly collagen) in which inorganic mineral such as calcium salts are deposited. This process of ossification and calcification transforms the osteoblasts into mature bone cells called osteocytes
Bone is composed of
Cells, protein matrix, and mineral deposits
fibromyalgia
Chronic syndrome with fatigue, sleep disturbance, and mood disorders. Widespread chronic pain is the most common finding. Tender points to palpation. Diagnosis is made on signs and symptoms and by ruling out other diseases. Treatment is managed by a rheumatologist. Medications include analgesics, NSAIDs, muscle relaxers, and anti-depressants. Avoid alcohol, caffeine, reduce stress, exercise, and get plenty of sleep.
The nurse is performing an assessment of a client's musculoskeletal system and is appraising the client's bone integrity. What action should the nurse perform during this phase of assessment?
Compare parts of the body symmetrically.
Lordosis
Concave curvature of spine; swayback
Ligaments
Connect bone to bone
Tendons
Connect muscle to bone
Cartilage
Connective tissue, reduces friction and absorbs shock
Ligaments
Consist of fibrous connective tissue Connect bone to bone
Ligaments
Consisting of fibrous tissue connect 2 adjacent, freely movable bones
Kyphosis
Convex curvature of spine; humpback
Tendons
Cordlike structures attaching muscles to periosteum of bone
Tendons
Cordlike structures that attach muscles to the periosteum of the bone
Bony tissues
Cover the ends of the bones; 2 kinds: Cancellous- ends of long bones; spongy Cortical- long shafts; dense, hard
Periosteum
Covers bones Inner layer contains osteoblasts needed for bone formation Contain blood vessels and lymph vessels
Periosteum
Covers the bones (but not the joint)
Which assessment parameter would the nurse expect to find when assessing the older adult with a musculoskeletal disorder? Select all that apply.
Decreased endurance Decreased range of motion Joint stiffness
Osteoclasts
Destruction, resorption, remodeling of bone
Bone scan
Detects bone tumors, osteomyelitis (bone infection)
X-rays
Detects injuries and tumors
Bone Formation Retardants
Diabetes
Which term refers to the shaft of the long bone?
Diaphysis
Neurovascular circulation assessments
Distal pulses Capillary refills Skin color Skin temperature Local edema
Inactive ROM
Done for the patient
hyaline/articular cartilage examples:
Elbow, costal cartilage, ribs, semilunar cartilage, fibrous cartilage, and elastic cartilage
Electromyography or EMG
Electrical potential of muscles and nerves leading to muscles
The nurse would expect which of the following diagnostic tests to be ordered for a patient with lower extremity muscle weakness?
Electromyograph (EMG)
Examples of other diagnostic blood tests and finding of various musculoskeletal disorder include the following:
Elevated alkaline phosphates level which may indicate bone tumors and healing fractures Elevated acid phosphatase level which may indicate Paget's disease (a disorder characterized by excessive bone destruction and disorganized repair) and metastatic cancer Decreased serum calcium level which may indicate osteomalacia, osteoporosis, and bone tumors Increased serum phosphorus level which may indicate bone tumors and healing fractures Elevated serum Uris acid level which may indicate gout (treated or untreated) Elevated antinuclear antibodies level which may indicate systemic lupus erythrmatosus (a connective tissue disorder)
Joint cavity
Enclosed by fibrous capsule Lined with synovial membrane
Bone Formation Facilitators
Estrogen
Bone Formation Retardants
Estrogen/androgen deficiency
Bone Formation Retardants
Excess parathyroid Harmone
Bone Formation Facilitators
Exercise
Yellow bone marrow consists primarily of
Fat cells and connective tissue
Long bone examples
Femur and ulna
Ligaments
Fibrous tissue connecting 2 adjacent freely movable bones
short bones examples
Fingers and toes
Cartilage
Firm, Dense, Connective Tissue
A patient has had a stroke and is unable to move the right upper and lower extremity. During assessment the nurse picks up the arm and it is limp and without tone. How would the nurse document this finding?
Flaccidity
Red Bone Marrow
Found in Ileum, Vertebrae, sternum, ribs Production of blood cells and hemoglobin
Yellow Bone Marrow
Found in long bones Consists of fat cells and connective tissue Can take on characteristics of red marrow when blood cells supply is compromised
diarthrodial joints (synovial joints)
Freely movable Hyaline cartilage —
Cartilage
Functions are to reduce friction, absorb shock, and reduce stress
NSAIDs =
GI Bleeding, must be taking with food.
Bone Formation Facilitators
Growth hormone
cardiac muscles are found in the
Heart
Bone Formation Retardants
Heparin
A nurse is taking a health history on a new client who has been experiencing unexplained paresthesia. What question should guide the nurse's assessment of the client's altered sensations?
How does the feeling in the affected extremity compare with the feeling in the unaffected extremity?
1200
How many mg of Ca daily should a person over 50 receive?
1000
How many mg of Ca daily should a person under 50 receive?
Types of cartilage
Hyaline (articular)- movable; like elbow Costal- ribs/sternum Semilunar- knee Fibrous- vertebrae Elastic- larynx, epiglottis, outer ear
biopsy
Identifies composition of the bone, muscle, or synovium (needle or surgical) -watch for swelling or bleeding
CT, XRays, & MRI are used to help
Identify traumatic disorders (fractures & dislocations) and other bone disorders
How does muscles contracts ?
Impulses from the central nervous system cause the release of acetylcholine at the motor end result, calcium ions are released, and the release stimulates actin and myosin in the sarcomeres to slide closer together. (When calcium is depleted, the actin and myosin fibers move apart, causing relaxation of the sarcomeres, and thus the muscle)
Bone Formation Retardants
Inactivity/Immobility
osteomyelitis
Infection of the bone. Difficult to treat due to limited blood supply. May become chronic. The most common pathogen is staph aureus. Infected bone is prone to fracture. Risk for septicemia. Treatment includes IV antibiotic therapy for several weeks (4-8) followed by oral antibiotics, surgery to debride, amputation, and analgesics for pain.
CBC is ordered to detect
Infections, inflammation, or anemia
Bursitis
Inflammation of a bursa ( the sacs)
CBC - All will be increased EXCEPT Calcium
Inflammation/infection/anemia Alkaline phosphatase: bone tumors & healing fractures Acid phosphatase: Paget's & mets Calcium: bone tumors, osteoporosis Phosphorus: bone tumors/healing fracture Uric acid: gout Antinuclear antibody level: lupus
Arthrocentesis
Insertion of a needle into the joint to aspirate synovial fluid for diagnostic purposes or to remove excess fluid (pt may have too much synovial fluid)
Arthoscopy
Insertion of fiberoptic endoscope into the joint to visualize, perform biopsies, or remove loose bodies from the joint -Performed in OR
palpate, swelling, tenderness
Inspect & _______ joints for _________, deformity, masses, movement, _____________, crepitations, warmth, ROM
size, symmetry, strength
Inspect & palpate muscles for _______, ___________, tone & ___________
body, posture, gait
Inspect for overall ________ build, ________, & _______
The nurse's comprehensive assessment of an older adult involves the assessment of the client's gait. How should the nurse best perform this assessment?
Instruct the client to walk away from the nurse for a short distance and then toward the nurse.
Bone Formation Facilitators
Insulin
Arthroscopy
Internal inspection of a joint using an arthroscope Knee is the most common Can remove fluid or bits of cartilage during procedure
arthroscopy
Internal inspection of a joint using an instrument called an arthroscopy
TCDB, turn q2hrs, rom
Interventions Preventing complications of immobility:
Smooth and cardiac are
Involuntary muscles, their activity is controlled by mechanisms in their tissue of origin and by neurotransmitters released from the autonomic nervous system
Cartilage
Is a firm dense type of connective tissue that consists of cells embedded in a substances called the matrix
Joint
Is a junction between 2 or more bones
Cortical bone (compact bone)
Is dense and hard
Biopsy
Is done to identify the composition of bone, muscle, or synovium
cancellous or spongy bone
Is light and contains many spaces
arthrocentesis
Is the aspiration of synovial fluid
What is a Joint?
Junction between or more bones
Which of the following is an example of a hinge joint?
Knee
The nurse is performing an assessment on an older adult patient and observes the patient has an increased forward curvature of the thoracic spine. What does the nurse understand this common finding is known as?
Kyphosis
Scoliosis
Lateral curvature of spine
Scoliosis
Lateral curvature of the spine
Cortical bony tissue covered bone and is found in
Long shafts or diaphyses of bones in the arms and legs
Bone scan
Look for fractures See if cancer metastasized to bone
The client presents with an exaggeration of the lumbar spine curve. The nurse interprets these findings as indicative of:
Lordosis
Which of the following deformity causes a exaggerated curvature of the lumbar spine?
Lordosis
osteoporosis
Loss of bone density. Occurs mostly in older adults. More prevalent in women. Bones become porous, brittle, and fragile. Vertebral compression fractures are common. Aging causes decreased levels of calcitonin and estrogen (postmenopausal). Risk factors include smoking, excessive caffeine intake, postmenopausal, hyperthyroidism, and chronic low calcium intake. Small framed, thin Caucasian women are at the greatest risk.
Which of the following is an age-related change to the musculoskeletal system?
Loss of bone mass
DEXA is most often done on the
Lower spine and hips
Osteocytes
Maintain bone tissue
Osteocytes
Maintaining bone tissue
Synovial membrane
Makes synovial fluid which lubricates the joints
synovial fluid analysis
May do for for C&S -normal - clear & nearly odorless -used to dx traumatic arthritis, septic arthritis, gout, rheumatic fever, systemic lupus erythmatosus
Electromyography (EMG)
Measures and records activity of contracting muscles in response to electrical stimulation -helps differentiate muscle disease from motor neuron dysfunction
spasms, tremors
Monitor muscles for __________ or __________ -Monitor for muscle wasting
Origin
More fixed
Insertion
More moveable
CPK, aldolase, SGOT (AST)
Muscle enzyme tests:
Skeletal muscles is composted of
Muscles cells or fibers that contain several myofibrils
Bones, muscles, joints, cartilage, tendons, ligaments, and bursae
Musculoskeletal system consists of:
color, temp, swelling, blanching, sensation, mobility, pulses
Neurovascular assessment includes: (7 things)
pain
Never move joint past point of ________
Synovial fluid analysis
Normally clear and colorless
injury, immobility, alterations
Nursing care Goals Client will: -Be free from __________ -Be free from complications of _______________ -Attain optimal level of mobility -perform self-care at optimal level -adapt to ____________ in body image -achieve max comfort level
A muscle has 2 or more attachments
Origin and insertion
Bone Cells
Osteoblasts Osteocytes Osteoclasts
Inner layer of periosteum contains the
Osteoblasts necessary for bone formation. Rich in blood and lymph vessels and supplies the bone with nourishment
Symptoms of musculoskeletal dysfunction
Pain and altered neurosensory
Injury or disease to the musculoskeletal system can cause
Pain, immobility, or disability and potentially affect the quality of life
Neurovascular Pain Assessment
Pain: proportional to injury but relieved with analgesia or nursing interventions
Active ROM
Patient does this
Osteoblasts
Perform ossification and calcification Build bones Transforms blast cells into mature cells called osteocytes
Which nerve is being assessed when the nurses asks the client to dorsiflex the ankle and extend the toes?
Peroneal
Bone Formation Facilitators
Phosphorus
A nurse on the orthopedic unit is assessing a client's peroneal nerve. The nurse should perform this assessment by doing what action?
Pricking the skin between the great and second toe
Major function of the musculoskeletal system
Provide a structural framework for the body and to provide a means for movement Other functions: -calcium storage -blood cell production in bone marrow -protection & support to the body organs (heart, lungs, brain)
Muscles
Provide movement
Bones
Provide support
What would not be included in client and family teaching after a musculoskeletal injury?
Pursue any physical activities that are comfortable.
A patient has a fracture of the right femur sustained in an automobile accident. What process of fracture healing does the nurse understand will occur with this patient?
Reactive phase, reparative phase, remodeling phase
Inside a bone is 2 types of bone marrow
Red and yellow
complete blood count (CBC)
Red blood cell count Hemoglobin level White blood cell count Differential
Types of bone marrow
Red- sternum, ileum, vertebrae, ribs; manufactures blood cells and Hgb Yellow- long bones; mostly fat and connective tissue
Bursae Function
Reduce friction between (Ex. Tendon and Bone)
Bursae can
Reduce friction between areas such as tendon and bone and tendon and ligament.
Functions of cartilage is to
Reduce friction between articulate surfaces, absorb shocks, and reduce stress on joint surfaces
Cartilage
Reduces friction between surfaces
After a fracture, during which stage or phase of bone healing is devitalized tissue removed and new bone reorganized into its former structural arrangement?
Remodeling
Biopsy
Removing something with a needle or by surgery to be analyzed
Cancellous bone is found at the
Rounded, irregular ends, or epiphyses of long bones
A patient has a fracture that is being treated with open rigid compression plate fixation devices. How will the progress of bone healing be monitored?
Serial x-rays
The bones of the skeleton are classified as
Short bones Long bones Flat bones Irregular bones
A client is receiving ongoing nursing care for the treatment of Parkinson disease. When assessing this client's gait, what finding is most closely associated with this health problem?
Shuffling gait
Only voluntary Muscles
Skeletal
Muscle types
Skeletal Smooth Cardiac
3 kinda of muscles
Skeletal, smooth, and cardiac
amphiarthrodial joints
Slightly movable (Between the vertebrae)
Bursae
Small sac filled with synovial fluid
Bursae
Small sack filled with synovial fluid
Ligaments help protect the joints by
Stabilizing their surfaces and keeping them in proper alignment
Bone Formation Retardants
Starvation
A patient is scheduled for a bone marrow biopsy. The nurse explains to the family that the bone marrow is located mainly in four areas. She tells the family that the site to be used would be the:
Sternum
flat bone examples
Sternum
Bone Formation Retardants
Steroids
Functions of musculoskeletal system include
Storage of calcium, phosphorus, magnesium, and fluoride; production of blood cells in the bone marrow; and protection and support to body organs (lungs, heart, and brain)
Musculoskeletal system (M/S)
Supports body and facilitates movement, stores Ca, produces blood cells, protects & supports body organ
Joints (table 60-1, p 1042)
Synarthrodial- immovable; suture lines of skull Amphiarthrodial- slightly moveable; between vertebrae Diarthrodial- freely movable; fingers, elbows, etc.
Skull sutures are an example of which type of joint?
Synarthrosis
rheumatoid arthritis
Systemic inflammatory process of connective tissue and joints. Chronic disease with episodes of remission and exacerbation. Crippling destruction of bone and cartilage. Cause unknown but possibly autoimmune. There is no cure. Genetic predisposition with onset between the ages of 20-40. Goal of treatment is to minimize destruction and inflammation, maintain function, and relieve pain. Treatment is usually managed by a rheumatologist and includes DMARDs, NSAIDs, corticosteroids, and surgery to correct joint deformities. Monitor and assess patient for joint deformity throughout therapy. Monitor if patient is able to perform ADLs.
The nurse working in the orthopedic surgeon's office is asked to schedule a shoulder arthrography. The nurse determines that the surgeon suspects which finding?
Tear in the joint capsule
Tendons are cordlike structures that attach muscles to the periosteum of the bone. Which is not true about tendons?
Tendons attach muscle to a bone in just one location.
Bone Formation Facilitators
Testorerone
electromyography
Tests the electrical potential of the muscles and nerves leading to the muscles. It is done to evaluate muscle weakness or deterioration, pain, and disability and to differentiate muscle and nerve problems
A client is scheduled for a bone scan to rule out osteosarcoma of the pelvic bones. What would be most important for the nurse to assess before the client's scan?
That the client emptied the bladder
Joints
The junction between two or more bones
If a long standing musculoskeletal dysfunction the nurse obtains a
Thorough medical, drug, and allergy history
A nurse is explaining a client's decreasing bone density in terms of the balance between bone resorption and formation. What dietary nutrients and hormones play a role in the resorption and formation of adult bones? Select all that apply.
Thyroid hormone, Growth hormone, Estrogen
lyme disease
Tick borne disease bacteria. Results in chronic inflammatory process and multisystem disease. There are three stages. Tick usually must be attached for 36-48 hours for contraction of the disease. Treatment includes antibiotics for several weeks (doxycycline). Early identification and treatment improves prognosis. Wear light colored clothing, use DEET repellent on clothing, do a tick check after being outdoors, pull hair back, tuck pants into boots, remove ticks properly.
synovial fluid is aspirated and examined to diagnosis disorders such as
Traumatic arthritis, septic arthritis (caused by a microorganisms) gout, rheumatic fever, and systemic lupus erythematosus
True or False: Although bone formation and resorption continue throughout life, net bone loss exceeds net bone gain in all people after peak bone mass is attained sometime between the ages of 30 and 35.
True
When assessing a client's peripheral nerve function, the nurse uses an instrument to prick the fat pad at the top of the client's small finger. This action will assess what nerve?
Ulnar
24 hour urine
Uric acid Calcium loss
arthrogram
Uses radiopaque contrast or air injected into a joint to view irregular surfaces and movement of the joint (ankles, knees, hips, shoulders, or wrists)
Bone scans
Uses the intravenous injection of a radionuclide to detect the uptake of the radioactive substance by the bone.
irregular bone examples
Vertebrae
Assess Traumatic Injury
Vital Signs Compare one side to the other Observe Assess circulation Sensation Open Wound/Bone Protrusion Assess Beyond Injury Malalignment of Limb Pain-Type/Location ******Do not Disturb open wounds or move the injured extremity until physician advises
Nutrition
Vitamin D Facilitates absorption of calcium Exposure of the skin to ultraviolet light facilitates synthesis of vitamin D. Dietary sources are limited..
Bone Formation Retardants
Vitamin Deficiency
Bone Formation Facilitators
Vitamins A, C, and D
Skeletal muscles are
Voluntary muscles; impulses that travel from efferent nerves of the brains and spinal cord control their function. Promote movement of the bones of the skeleton
Smooth muscles can be found in the
Walls of certain organs or cavities of the body (stomach, intestine, blood vessels, and ureters)
Lupus erythematosus cells
What lab test is also known as LE prep and is done for lupus?
Uric acid
What lab test is done for gout?
C-reactive protein
What lab test is done for rheumatoid arthritis and autoimmune disorders?
ANA (antinuclear antibody test)
What lab test screens for autoimmune disorders such as lupus (aka SLE)?
erythrocyte sedimentation rate (ESR)
What lab test will be done for lupus or arthritis and is also known as SED rate?
Rheumatoid factor
What lab test will test positive for rheumatoid arthritis?
Physical exam
What you can see by looking at the patient Look at their gait and the symmetry of their extremities Examine skin and surrounding areas of injury Palpate muscles and joints Do neurovascular assessment
Surfaces of joints are covered with hyaline cartilage
Which decreases friction with movement
EMG
With what procedure does the nurse need to advise that some discomfort may occur due to needle insertion?
Arteriogram
With what procedure should the nurse assess for allergy to seafood & advise patient cracking clicking noises may be heard 2 days after procedure?
Bone scan
With what procedure should the nurse have clients void immediately before?
Arthoscopy
With what procedure should the nurse maintain pressure dressing for 24 hours -advise client to limit activity for several days -elevate entire leg without flexing the knee & ice for 24 hours to reduce edema -take Rx pain medicine every 4 hours prn (Tylenol #3)?
Arteriogram
X-ray of usually the knee or shoulder with use of contrast medium
Diagnostic labs & procedures
X-rays, CT, MRI, arthrogram, arthroscopy, arthrocentesis, synovial fluid analysis, bone density, bone scan, EMG, biopsy, CBC, 24 hour urine
Long bones
Yellow bone marrow
When red bone marrow becomes inadequate
Yellow bone marrow will take on making RBCs
spinal inspection
_______ ___________- assess curvature of back
tendon
a flexible, inelastic cord of strong fibrous collagen tissue that *attaches a muscle to a bone*
What is traction?
a method of pulling structures of the musculoskeletal system
ligament
a strong elastic band of connective tissue that *connects bone to bone or joint to bone*
open reduction
a surgical procedure where the bone is exposed and realigned/stabilized
Following a total knee replacement, the surgeon orders a continuous passive motion (CPM) device. The client asks about the purpose of this treatment. The best response by the nurse is: a) "CPM increases range of motion of the joint." b) "CPM delivers analgesic agents directly into the joint." c) "CPM strengthens the muscles of the leg." d) "CPM prevents injury by limiting flexion of the knee."
a) "CPM increases range of motion of the joint."
The nurse is performing an assessment of a patient's musculoskeletal system and is appraising the patient's bone integrity. What action should the nurse perform during this phase of assessment? a) Compare parts of the body symmetrically. b) Administer analgesia 30 to 60 minutes before assessment. c) Assess extremities when in motion rather than at rest. d) Percuss as many joints as are accessible.
a) Compare parts of the body symmetrically.
The human body is designed to protect its vital parts. A fracture of what type of bone may interfere with the protection of vital organs? a) Flat bones b) Long bones c) Short bones d) Irregular bones
a) Flat bones Flat bones, such as the sternum, provide vital organ protection. Fractures of the flat bones may lead to puncturing of the vital organs or may interfere with the protection of the vital organs. Long, short, and irregular bones do not usually have this physiologic function.
The nurse is performing an assessment on an older adult patient and observes the patient has an increased forward curvature of the thoracic spine. What does the nurse understand this common finding is known as? a) Kyphosis b) Scoliosis c) Osteoporosis d) Lordosis
a) Kyphosis
Choice Multiple question - Select all answer choices that apply. The nurse is performing an assessment for a patient who may have peripheral neurovascular dysfunction. What signs does the patient present with that indicate circulation is impaired? (Select all that apply.) a) More than 3-second capillary refill b) Cool temperature of the extremity c) Limited range of motion d) Tenting skin turgor e) Pale, cyanotic, or mottled color
a) More than 3-second capillary refill b) Cool temperature of the extremity e) Pale, cyanotic, or mottled color
After a fracture, during which stage or phase of bone healing is devitalized tissue removed and new bone reorganized into its former structural arrangement? a) Remodeling b) Reparative c) Revascularization d) Inflammation
a) Remodeling
A patient has a fracture that is being treated with open rigid compression plate fixation devices. How will the progress of bone healing be monitored? a) Serial x-rays b) Remove the plate and determine if the bone is growing back. c) The bone will heal on its own without intervention. d) Arthroscopy
a) Serial x-rays
Tendons are cordlike structures that attach muscles to the periosteum of the bone. Which of the following is not true about tendons? a) Tendons attach muscle to a bone in just one location. b) Tendons attach muscle to bone with two or more attachments. c) One of the attachments is called the origin and is more fixed. d) A second attachment is called the insertion and is more movable.
a) Tendons attach muscle to a bone in just one location.
Which of the following are true statements about smooth muscles? Choose all that are correct. a) They are found mainly in the walls of certain organs or cavities of the body. b) They are involuntary muscles; their activity is controlled by mechanisms in their tissue of origin and by neurotransmitters released from the autonomic nervous system. c) They promote movement of the bones of the skeleton. d) Their function is controlled by impulses that travel from efferent nerves of the brain and spinal cord.
a) They are found mainly in the walls of certain organs or cavities of the body. b) They are involuntary muscles; their activity is controlled by mechanisms in their tissue of origin and by neurotransmitters released from the autonomic nervous system.
The human body has 206 bones, which are classified into four categories. Which types of bones are located in the digits? a) Short bones b) Long bones c) Irregular bones d) Flat bones
a) short bones
A patient is receiving ongoing nursing care for the treatment of Parkinson's disease. When assessing this patient's gait, what finding is most closely associated with this health problem? a) Shuffling gait b) Spastic hemiparesis gait c) Rapid gait d) Steppage gait
a) shuffling gait
A nurse practitioner assesses a patient's movement in his left hand after a cast is removed. The nurse asks the patient to turn his wrist so the palm of his hand is facing up. This movement is known as: a) Supination. b) Eversion. c) Pronation. d) Extension.
a) supination
The nurse working in the orthopedic surgeon's office is asked to schedule a shoulder arthrography. The nurse determines that the surgeon suspects which of the following findings? a) Tear in the joint capsule b) Injury to the radial nerve c) Decreased bone density d) Fracture of the clavicle
a) tear in the joint capsule
A 16-year-old patient is seen in the emergency room for a knee injury that happened during a basketball game. Diagnostic tests reveal torn cords of fibrous connective tissue that connect muscles to bones. The nurse knows that the patient had sustained a tear of the: a) Tendon. b) Fascia. c) Ligament. d) Bursa.
a) tendon
The nurse is performing an assessment for a patient who may have peripheral neurovascular dysfunction. What signs does the patient present with that indicate circulation is impaired? (Select all that apply.)
a. Pale, cyanotic, or mottled color b. Cool temperature of the extremity c. More than 3-second capillary refill
AKA
above the knee amputation
skeletal traction
applying devices directly to the bone by using wire, pin, or cranial tongs
skin traction
applying devices to the skin that indirectly affect the muscles and bones
arthrocentesis
aspiration (pulling) of synovial fluid.
Patient education for musculoskeletal conditions for the aging is based on the understanding that there is a gradual loss of bone after a peak of bone mass at age: a) 50 years. b) 30 years. c) 20 years. d) 40 years.
b) 30 years
A client has undergone arthroscopy. After the procedure, the site where the arthroscope was inserted is covered with a bulky dressing. The client's entire leg is also elevated without flexing the knee. What is the appropriate nursing intervention required in caring for a client who has undergone arthroscopy? a) Apply warm compresses to the insertion site. b) Apply a cold pack at the insertion site. c) Assist with performing ROM exercises. d) Provide a gentle massage.
b) Apply a cold pack at the insertion site.
A patient is scheduled for a procedure that will allow the physician to visualize the knee joint in order to diagnose the patient's pain. What procedure will the nurse prepare the patient for? a) Electromyography b) Arthroscopy c) Arthrocentesis d) Bone scan
b) Arthroscopy
The orthopedic surgeon has prescribed balanced skeletal traction for a patient. What advantage is conferred by balanced traction? a) Balanced traction can be applied at night and removed during the day. b) Balanced traction allows for greater patient movement and independence than other forms of traction. c) Balanced traction facilitates bone remodeling in as little as 4 days. d) Balanced traction is portable and may accompany the patient's movements.
b) Balanced traction allows for greater patient movement and independence than other forms of traction.
Which hormone inhibits bone reabsorption and increases calcium deposit in the bone? a) Vitamin D b) Calcitonin c) Sex hormones d) Growth hormone
b) Calcitonin
Which of the following biologically active vitamin functions to increase the amount of calcium in the blood? a) C b) D c) A d) E
b) D Biologically active vitamin D (Calcitrol) functions to increase the amount of calcium in the blood by promoting absorption of calcium from the gastrointestinal tract.
Ms. Cramer is in your clinic and the physician has scheduled a bone scan for her. A bone scan may be ordered to detect metastatic bone lesions, fractures, and certain types of inflammatory disorders. Select all of the following nursing considerations that are correct in preparing a client for a bone scan. a) Ensuring the client is NPO for 12 hours before the test b) Encouraging the client to drink fluids to help distribute and eliminate the isotope c) Informing the client that the radiopaque isotope will be administered intravenously d) Ensuring that the client does not have any allergies to the isotope
b) Encouraging the client to drink fluids to help distribute and eliminate the isotope c) Informing the client that the radiopaque isotope will be administered intravenously d) Ensuring that the client does not have any allergies to the isotope
The client presents with an exaggeration of the lumbar spine curve. The nurse interprets these findings as indicative of: a) Dowager's hump b) Lordosis c) Scoliosis d) Kyphosis
b) Lordosis
A nurse is performing a musculoskeletal assessment of a patient with arthritis. During passive range-of-motion exercises, the nurse hears an audible grating sound. The nurse should document the presence of which of the following? a) Effusion b) Crepitus c) Fasciculations d) Clonus
b) creptius
dorsiflextion
backward bending or flexion of the hand or foot
BKA
below the knee amputation
Flexion
bending of a joint
greenstick fracture
bone does not break in two but splinters; common fracture in children
closed reduction
bone restored to a normal position by external manipulation
Cortical Bone
bony tissue that is dense and hard.
Cancellous Bones
bony tissue that is light and contains many spaces.
fracture
break of the bone due to an injury, direct or indirect force, or underlying disease (bone infection, tumor, osteoporosis)
A patient is undergoing diagnostic testing for suspected Paget's disease. What assessment finding is most consistent with this diagnosis? a) Altered serum sodium levels b) Altered serum potassium levels c) Altered serum calcium levels d) Altered serum magnesium levels
c) Altered serum calcium levels
Which of the following is an indicator of neurovascular compromise? a) Warm skin temperature b) Pain on active stretch c) Capillary refill of more than 3 seconds d) Diminished pain
c) Capillary refill of more than 3 seconds
Which of the following is a benefit of a continuous passive motion (CPM) device when applied after knee surgery? a) It provides active range of motion. b) It prevents infection and controls edema and bleeding. c) It promotes healing by increasing circulation and movement of the knee joint. d) It promotes healing by immobilizing the knee joint.
c) It promotes healing by increasing circulation and movement of the knee joint.
The results of a nurse's musculoskeletal examination show an increase in the lumbar curvature of the spine. The nurse should recognize the presence of what health problem? a) Scoliosis b) Kyphosis c) Lordosis d) Osteoporosis
c) Lordosis
Each bone is comprised of cells, protein matrix, and mineral deposits. Which type of bone cell is not only a mature bone cell; it is involved in maintaining bone tissue. a) Osteoblasts b) Osteomytes c) Osteocytes d) Osteoclasts
c) Osteocytes Mature bone cells, called osteocytes, are involved in maintaining bone tissue.
The nurse is caring for a patient who underwent a total hip replacement yesterday. What should the nurse do to prevent dislocation of the new prosthesis? a) Keep the affected leg in a position of adduction. b) Keep the hip flexed by placing pillows under the patient's knee. c) Protect the affected leg from internal rotation. d) Have the patient reposition himself independently.
c) Protect the affected leg from internal rotation.
A patient has a fracture of the right femur sustained in an automobile accident. What process of fracture healing does the nurse understand will occur with this patient? a) First intention, secondary intention, third intention b) Active phase, dormant phase, restructure phase c) Reactive phase, reparative phase, remodeling phase d) Primary phase, secondary phase, third phase
c) Reactive phase, reparative phase, remodeling phase
While assessing a patient who has had knee replacement surgery, the nurse notes that the patient has developed a hematoma at the surgical site. The affected leg has a decreased pedal pulse. What would be the priority nursing diagnosis for this patient? a) Risk for Infection b) Unilateral Neglect c) Risk for Peripheral Neurovascular Dysfunction d) Disturbed Kinesthetic Sensory Perception
c) Risk for Peripheral Neurovascular Dysfunction The hematoma may cause an interruption of tissue perfusion, so the most appropriate nursing diagnosis is Risk of Peripheral Neurovascular Dysfunction. There is also an associated risk for infection because of the hematoma, but impaired neurovascular function is a more acute threat. Unilateral neglect and impaired sensation are lower priorities than neurovascular status
A 19-year-old client presents at the emergency department with a compound fracture of the right femur. Skeletal traction is applied to align the bones. What type of traction would you expect to be used? a) Thomas splint b) Buck's traction c) Steinmann traction d) Russell traction
c) Steinmann traction Skeletal traction is applied directly to a bone by using a wire (Kirschner), pin (Steinmann), or cranial tongs (Crutchfield). General or local anesthesia may be used when inserting these devices.
An older adult patient has symptoms of osteoporosis and is being assessed during her annual physical examination. The assessment shows that the patient will require further testing related to a possible exacerbation of her osteoporosis. The nurse should anticipate what diagnostic test? a) Hip bone radiography b) Computed tomography (CT) c) Bone densitometry d) Magnetic resonance imaging (MRI)
c) bone densitometry
Sliding filaments
called sarcomeres make up myofibrils.
bone scan
can be used to detect metastatic bone lesions, fractures, and certain types of inflammatory disorders.
osteoclasts
cells involved in the destruction, resorption, and remodeling of bone.
osteoblasts
cells that build bones.
How does the nurse assess the neurovascular status of an extremity?
check/monitor the color, motion, and sensation of the extremity (cap refill, pulses, temperature of the extremity, edema)
cortical bone
compact bone, dense and hard.
ligaments
consisting of fibrous tissue connect two adjacent, freely movable bone.
yellow bone marrow
consists primary of fat cells and connective tissue.
tendons
cordlike structures that attach muscles to the periosteum of the bone.
The nurse reading a patient's chart notices that the patient is documented to have paresthesia. The nurse plans care for a patient with which of the following? a) Involuntary twitch of muscle fibers b) Absence of muscle tone c) Absence of muscle movement suggesting nerve damage d) Abnormal sensations
d) Abnormal sensations Abnormal sensations, such as burning, tingling, and numbness, are referred to as paresthesias. The absence of muscle tone suggesting nerve damage is referred to as paralysis. A fasciculation is the involuntary twitch of muscle fibers. A muscle that holds no tone is termed flaccid.
A patient has had a cast placed for the treatment of a humeral fracture. The nurse's most recent assessment shows signs and symptoms of compartment syndrome. What is the nurse's most appropriate action? a) Assess the patient's joint function symmetrically. b) Arrange for a STAT assessment of the patient's serum calcium levels. c) Perform active range of motion exercises. d) Contact the primary care provider immediately.
d) Contact the primary care provider immediately. This major neurovascular problem is caused by pressure within a muscle compartment that increases to such an extent that microcirculation diminishes, leading to nerve and muscle anoxia and necrosis. Function can be permanently lost if the anoxic situation continues for longer than 6 hours. Therefore, immediate medical care is a priority over further nursing assessment. Assessment of calcium levels is unnecessary.
The nurse would expect which of the following diagnostic tests to be ordered for a patient with lower extremity muscle weakness? a) Bone scan b) Biopsy c) Arthrocentesis d) Electromyograph (EMG)
d) Electromyograph
A nurse is caring for a patient who is postoperative day 1 right hip replacement. How should the nurse position the patient? a) Seat the patient in a low chair as soon as possible. b) Keep hips flexed at no less than 90 degrees. c) Elevate the head of the bed to high Fowler's. d) Keep the patient's hips in abduction at all times.
d) Keep the patient's hips in abduction at all times. The hips should be kept in abduction by an abductor pillow. Hips should not be flexed more than 90 degrees, and the head of bed should not be elevated more than 60 degrees. The patient's hips should be higher than the knees; as such, high seat chairs should be used.
What is the term for a lateral curving of the spine? a) Epiphysis b) Lordosis c) Diaphysis d) Scoliosis
d) Scoliosis
The nurse is conducting a musculoskeletal assessment on a patient documented to have rheumatoid arthritis. Which of the following would the nurse anticipate finding when inspecting the patient's fingers? a) Hard nodules of bony overgrowth b) Hard nodules adjacent to the joints c) Soft, nodules along the palmar surface d) Soft, subcutaneous nodules along the tendons
d) Soft, subcutaneous nodules along the tendons
Skull sutures are an example of which type of joint? a) Diarthrosis b) Amphiarthrosis c) Aponeuroses d) Synarthrosis
d) Synarthrosis Skull sutures are considered synarthrosis joints and are immovable. Amphiarthrosis joints allow limited movement, such as a vertebral joint. Diarthrosis joints are freely movable joints such as the hip and shoulder. Aponeuroses are broad, flat sheets of connective tissue.
A nurse is caring for a patient with a diagnosis of cancer that has metastasized. What laboratory value would the nurse expect to be elevated in this patient? a) Potassium b) Creatinine c) Bilirubin d) Alkaline phosphatase
d) alkaline phosphatase
Eric Darwin, a 19-year-old college athlete, presents at the ED where you practice nursing with a compound fracture of his right femur. Due to the nature of the fracture, open reduction will be used to align the femur. What other rationale requires the use of open reduction? a) Wound débridement is necessary b) Fracture causes wide bone separation c) Fracture involves several, small pieces of bone d) All options are correct
d) all options are correct
kyphosis
exaggerated convex curvature of the thoracic spine (humpback)
lordosis
excessive concave curvature of the lumbar spine (swayback)
Hyperextension
extension beyond straight or neutral position
hyperextension
extension of a limb or part of the body beyond the normal limit
cartilage
firm, dense type of connective tissue that consists of cells embedded in a substance called the matrix.
origin
fixed, non-movable.
red bone marrow
found primarily in the sterum, ileum, vertebrae, and ribs; manufactures blood cells and hemoglobin
spiral fracture
fracture twisting around the bone shaft; using caused by a twisting force and commonly seen in child abuse cases
comminuted fracture
fracture where bone has splintered into several fragments
internal fixation
hardware (screws, pins, rods) applied to the bone during open reduction surgery
kyphosis
hunchback
synarthrodial joints
immovable joints (At the suture line of skill between the temporal and occipital bones)
strain
injury to a muscle when it stretched or pulled beyond its capacity
sprain
injury to ligaments surrounding a joint; most common site is the ankle
arthroscopy
internal inspection of a joint using an instrument called an arthroscope.
What is the purpose of a cast?
it immobilizes an injured area, provides structure, and maintains alignment of bones while they heal
joint
junction between two or more bones.
scoliosis
lateral curvature of the spine.
Periosteum
layer of tissue covering bones, rich in blood and lymph vessels provides nourishment to bone
periosteum
layer of tissue that covers the shaft of the bone.
The human body has 206 bones, which are classified into four categories. Which types of bones are located in the forearm?
long bones
diaphyses
long shaft of the bone.
Diaphyses
long shafts of bones in the arms and legs.
avascular necrosis
loss of blood to the bone (bone death) *this can occur as a complication of ORIF surgery or fractures*
ostecytes
mature bone cells.
external fixation
metal pins inserted into the bone through the skin during surgery; a compression device is sometimes attached to the pins
insertion
movable.
Abduction
movement away from the body
External (outward) rotation
movement away from the center
abduction
movement of a body part *away from the median line* of the body
adduction
movement of a body part *toward the median line* of the body
external rotation
movement of a joint away from the midline of the body
internal rotation
movement of a joint toward the midline of the body
Dorsiflexion
movement that flexes hand back toward body or foot toward leg
Internal (inward) rotation
movement toward the center
Adduction
movement towards the body
compound fracture
open fracture where bone is exposed and skin/mucous membranes are involved
3 types of bone cells
osteoblasts, osteocytes, osteoclasts
A bone biopsy has just been completed on a client with suspected bone metastases. The nurse should prioritize assessments for:
pain
red bone marrow
primarily in the sternum, ileum, vertebrae, and ribs; manufactures blood cells and hemoglobin.
Extension
return movement from flexion
A client reports being consistently tired, with no energy. The client's CBC indicates low hemoglobin. Where is hemoglobin manufactured?
ribs
Pronation
rotation of forearm so that palm of hand is down
Supination
rotation of the forearm so that palm of hands is up
epiphyses
rounded, irregular ends in bone.
Epiphyses
rounded, irregular ends of long bones.
bursa
small sac filled with synovial fluid.
cancellous bone
spongy bone, light and contains many spaces.
An example of a flat bone is the
sternum.
Musculoskeletal System
supports the body and facilitates movement.
What is the treatment for avascular necrosis?
surgery (may require amputation if severe)
lordosis
swayback
extension
the act of extending a part of the body into or toward a straight position
flexion
the act of flexing or bending
pronation
the act of turning the palm downward
supination
the act of turning the palm upward
Why is traction used?
to relieve muscle spasms, align bones, maintain immobilization, and relieve pain
Rotation
turning or movement of a part around its axis
arthrogram
use radiopaque contrast or air injected into a joint to view irregular surfaces and movement of the joint.
The most common use of arthroscopy is
visualization of the knee joint
skeletal muscle
voluntary muscles; impulses that travel from efferent nerves of the brain and spinal cord control their function.
