Theories Test 4

what stage of bone healing is this Fibroblasts and osteoblasts migrate to fracture site

stage 2: fibrocartilanginous callus formation

what stage of bone healing is this Ossification begins during 3rd or 4th week

stage 3: Bony callus formation

what stage of bone healing is this Osteoclasts remove necrotic bone

stage 4: Remodeling

Pulled muscle injury to the musculotendinous unit

strain

immovable joints

synarthroses

Is the following statement true or false? Bone is in a constant state of turnover

true

Is the following statement true or false? Testing for crepitus can produce further tissue damage and should be avoided

true

´Affects 95% of adults with diabetes, onset over age 30 years, increasing in children r/t obesity

type 2 diabetes

nursing interventions for a patient with lower back pain

1. Pain management 2. Exercise 3. Body mechanics 4. Work modifications 5. Stress reduction 6. Health promotion; activities to promote a healthy back 7. Dietary plan and encouragement of weight reduction

collaborative problems and potential complications of bone tumors

1. delaying wound healing 2. nutritional deficiency 3. infection 4. hypercalcemia

rehabilitation of radial, ulnar, wrist, and hand fractures

1. early functional rehabilitation exercises 2. active ROM exercises of fingers and sholders

nursing interventions for MRI

1. may hear knocking sounds 2. assess for contraindications 3. assess for allergies and contrast testing

Clinical manifestations of diabetes

-depends of level of hyperglycermia 1. Three P's - Polyuria - Polydipsia - Polyphagia 2. Fatigue, weakness, vision changes, tingling or numbness in hands or feet, dry skin, skin lesions or wounds that are slow to heal, recurrent infections 3. Sudden weight loss with sudden weight loss

insulin regimen varies between how many injections

1-4 injections per day

diabetes prevention for people at high risk (prediabetes)

1. A1c of 5.7-6.4 2. maintaining healthy weight 3. engaging in physical activity 4. living tobacco free 5. getting adequate sleep 6. participating in group education to prevent diabetes

major goals got the patient undergoing foot surgery

1. Adequate tissue perfusion 2. Relief of pain 3. Improved mobility 4. Absence of complications

relief of pain for fractures

1. Administer analgesics as prescribed 2. Use of Buck traction as prescribed 3. Handle extremity gently 4. Support extremity with pillows and when moving 5. Positioning for comfort 6. Frequent position changes 7. Alternative pain relief methods

prevention of HHS (hyperglycemic hyperosmolar syndrome)

1. BGSM 2. Diagnosis and management of diabetes 3. Assess and promote self-care management skills

what joints in the body are diarthrosis joints

1. Ball and socket 2. Hinge 3. Saddle 4. Pivot 5. Gliding

Role of the nurse in diabetics

1. Be knowledgeable about dietary management 2. Communicate important information to the dietician or other management specialists 3. Reinforce patient understanding Support dietary and lifestyle changes

common conditions of the upper extremities

1. Bursitis and tendonitis 2. Loose bodies (joint mice) 3. Impingement syndrome 4. Carpal tunnel syndrome 5. Ganglion 6. Dupuytren contracture

common foot problems

1. Callus 2. Corn 3. Hallux valgus 4. Hammer toe 5. Ingrown toenail 6. Morton neuroma 7. Clawfoot: pes cavus 8. Flatfoot: pes planus 9. Plantar fasciitis

Glycemic index

1. Combining starchy foods with protein and fat slows absorption and glycemic response 2. Raw or whole foods tend to have lower responses than cooked, chopped, or pureed foods 3. Eat whole fruits rather than juices; this decreases glycemic response because of fiber (slowing absorption) 4. Adding food with sugars may produce lower response if eaten with foods that are more slowly absorbed

nursing diagnoses for the patient with osteoporosis

1. Deficient knowledge about the osteoporotic process and treatment regimen 2. Acute pain related to fracture and muscle spasm 3. Risk for constipation related to immobility or development of ileus (intestinal obstruction) 4. Risk for injury: additional fractures related to osteoporosis

interview for patient with lower back pain

1. Detailed description of the discomfort including location, severity, duration, characteristics, radiation, leg weakness 2. Description of how the pain occurred, and how the pain has been managed by the patient 3. Work and recreational activities

exercise precautions for diabetics

1. Exercise elevates blood sugar levels; insulin must be adjusted 2. Insulin normally decreases with exercise; patients on exogenous insulin should eat a 15-g carbohydrate snack before moderate exercise to prevent hypoglycemia 3. Potential postexercise hypoglycemia: refer to Chart 51-5 4. Need to monitor blood glucose levels 5. Gerontologic considerations

Assessment for the care of the patient undergoing foot surgery

1. Explore the need for home assistance and the structural characteristics of the home (e.g., distances required to walk and the presence of stairs or steps)

why does osteomyelitis occur

1. Extension of soft tissue infection 2. Direct bone contamination 3. Bloodborne spread from another site of infection 4. This typically occurs in an area of bone that has been traumatized or has lowered resistance

acute complications of diabetes

1. Hypoglycemia 2. DKA 3. Hyperglycemic hyperosmolar syndrome (HHS)

medical management of open fracture

1. Internal fixation devices hold bone fragment in position (metallic pins, wires, screws, plates)

rehabilitation for femoral shaft fractures

1. Lower leg, foot, and hip exercises to preserve muscle function and improve circulation 2. Early ambulation stimulates healing 3. Physical therapy, ambulation, and weight bearing are prescribed 4. Active and passive knee exercises are begun as soon as possible to prevent restriction of knee movement

long term complications of diabetes

1. Macrovascular: accelerated atherosclerotic changes, coronary artery disease, cerebrovascular disease, and peripheral vascular disease 2. Microvascular: diabetic retinopathy (refer to Figure 51-8), and nephropathy 3. Neuropathic: peripheral neuropathy, autonomic neuropathies, hypoglycemic unawareness, neuropathy, sexual dysfunction

promoting physical mobility with fractures

1. Maintain neutral position of hip 2. Use trochanter rolls 3. Maintain abduction of hip 4. Isometric, quad-setting, and gluteal-setting exercises 5. Use of trapeze 6. Use of ambulatory aids 7. Consultation with physical therapy

causative organisms of osteomyelitis

1. Methicillin-resistant Staphylococcus aureus 2. Other: Proteus and Pseudomonas spp., Escherichia coli

5 components of diabetes management

1. Nutritional therapy 2. Exercise 3. Monitoring 4. Pharmacologic therapy 5. Education

genetic factors of diabetes

1. some people are born with increased risk for developing diabetes 2. race/ethnicity 3. parents or siblings with diabetes 4. mother who had gestational diabetes

treatment of osteomalacia

1. Physical, psychological, and pharmaceutical measures to reduce discomfort and pain 2. Correct underlying cause 3. Kidney disease: supplement calcitriol 4. Malabsorption: Increased doses of vitamin D and calcium are usually recommended 5. Exposure to sunlight may be recommended; ultraviolet radiation transforms a cholesterol substance (7-dehydrocholesterol) present in the skin into vitamin D

function of musculoskeletal system

1. Protection of vital organs 2. Framework to support body structures, mobility 3. Movement; produce heat and maintain body temperature 4. Facilitate return of blood to the heart 5. Reservoir for immature blood cells 6. Reservoir for vital minerals

treatment of HHS (hyperglycemic hyperosmolar syndrome)

1. Rehydration 2. Insulin administration 3.Monitor fluid volume and electrolyte status

treatment of DKA

1. Rehydration with IV fluid 2. IV continuous infusion of regular insulin 3. Reverse acidosis and restore electrolyte balance 4. Note: rehydration leads to increased plasma volume and decreased K; insulin enhances the movement of K+ from extracellular fluid into the cells 5. Monitor blood glucose, renal function and urinary output, ECG, electrolyte levels, VS, lung assessments for signs of fluid overload

major goals for patients with low back pain

1. Relief of pain 2. Improved physical mobility 3. Use of back conservation techniques of proper body mechanics 4. Improved self-esteem 5. Weight reduction

functions of insulin

1. Transports and metabolizes glucose for energy 2. Stimulates storage of glucose in the liver and muscle as glycogen 3. Signals the liver to stop the release of glucose 4. Enhances storage of dietary fat in adipose tissue 5. Accelerates transport of amino acids into cells 6. Inhibits the breakdown of stored glucose, protein, and fat

medical management of a closed fracture

1. Uses manipulation and manual traction 2. Traction may be used (skin or skeletal)

diabetes management

1. a1c of >6.5 2. maintaining healthy weight 3. eating healthy 4. engaging in physical activity 5. living tobacco free 6. getting adequate sleep 7. participating in individual and or group education to manage diabetes 8. adhering to personalized diabetes treament plans

Nursing diagnoses for patients with osteomyelitis

1. acute pain 2. impaired physical mobility 3. risk for extension of infection: bone abscess formation 4. deficient knowledge

manifestations of fracture

1. acute pain 2. loss of function 3. deformity 4. shortening of extremity 5. crepitus 6. local swelling and discoloration 7. diagnosis by symptoms and radiography 8. patient usually reports an injury to the area

symptoms of diabetes

1. always hungry 2. unexplained weight loss 3. frequent urination 4. sexual disorder 5. extreme fatigue 6. always thirsty

pharmacoloigc management

1. antineoplastic therapy 2. NSAIDs 3. calcitonin 4. biphosphonates (etidronate- Didronel) 5. plicamcyin (Mithracin)

nursing interventions for bone scans

1. assess for allergies to radioisotopes 2. encourage fluids to distribute isotope

nursing interventions for electromyography

1. assess for use of anticoagulants; electrodes may cause bleeding 2. active skin infection

prevention of osteoporosis

1. balanced diet high in calcium and vitamin D throughout life 2. use of calcium supplements to ensure adequate calcium intake: take in divided doses with vitamin C 3. regular weight bearing exercises: 20-30 minutes a day (increases balance, reduced incidence of falls and fractures) 4. weight training stimulates bone mineral density (BMD)

assessment of DKA

1. blood glucose levels >300 to 1000 2. severity of DKA not only due to blood glucose level 3. ketoacidosis is reflected in low serum bicarb, low pH, low PCO2, reflects respiratory compensation (kussmaul respirations) 4. ketone bodies in blood and urine 5. electrolytes, vary according to degree of dehydration; increase in creatinine, Hct, BUN

diabetes complications

1. brain and cognition 2. ears 3. emotions/ mental health 4. eyes 5. feet 6. heart 7. kidneys 8. nerves 9. reproductive organs 10. skin 11. teeth and gums

lifestyle choices risk factors for osteoporosis

1. caffeine 2. alcohol 3. smoking 4. lack of exposure to sunlight ** reduces osteogenesis in bone remodeling**

pharmacologic therapy for osteoporosis

1. calcium and vitamin D 2. biphosphonates 3. calcitonin 4. estrogen agonists/ antagonists 5. parathyroid hormone 6. receptor activator of nucelar factor kappa B ligand inhibitors

complications of diabetes

1. candida 2. wounds heal slowly 3. peripheral neuropathy 4. eye damage 5. coronary heart disease 6. diabetic neuropathy 7. cerebrovascular disease

Caloric requirements and calories distribution throughout the day.

1. carbs: 50-60%; emphasize whole grains 2. fat: 30% limiting saturated fats to 10% and <300mg cholesterol 3. nonanimal sources of protein and increase fiber

genetic risk factors for osteoporosis

1. caucasian or asian 2. female 3. family history 4. small frame **predisposes to low bone mass**

other malignant (primary) bone tumors besides osteosarcoma

1. chrondrosarcoma 2. Ewing sarcoma 3. fibrosarcoma

types of fractures

1. closed or simple 2. open or compound/ complex

Goals of dietary management for diabetics

1. control of total caloric intake to attain or maintain a reasonable body weight 2. control of blood glucose levels 3. normalization of lipids and blood pressure to prevent heart disease

Two general approaches to insulin therapy

1. conventional 2. intensive

Blood glucose monitoring

1. cornerstone of diabetes management 2. self monitoring of blood glucose levels has dramatically altered diabetes care

delayed complications of fractures

1. delayed union, malunion, nonunion 2. avascular necrosis of bone 3. complex regional pain syndrome (CRPS) 4. heterotopic ossification

medications risk factors for osteoporosis

1. ex: corticosteroids, antiseizure, heparin, thyroid hormone 2. comorbidities: anorexia nervosa, hyperthyroidism, malabsorption syndrome, kidney failure **affects calcium absorption and metabolism**

pathophysiology of paget disease

1. excessive bone resorption by osteoclasts is followed by increased osteoblastic activity; bone structure disorganized, weak, and highly vascular

prevention of diabetes

1. exercise 2. healthy food 3. avoid alcohol 4. control 5. see a doctor

Diagnostic findings of diabetes

1. fasting blood glucose 126 mg/dl or more 2. casual glucose exceeding 200 mg/dl

muscle tone

1. flaccid 2. spastic 3. atonic

causes of osteomalacia

1. gastrointestinal disorders 2. severe renal insufficiency 3. hyperparathyroidism 4. dietary deficiency

how to manage hypoglycemia

1. give 15 g of fast acting, concentrated carbohydrate (3-4 glucose tablets or 4-6 oz of juice or regular soda) 2. retest blood glucose in 15 minutes; retreat if >70 mg/dl or if symptoms persist ore than 10 -15 minutes and testing is not possible 3. provide a snack with protein and carbohydrate unless the patient plans to eat a meal within 30 to 60 minutes

assessment for a patient with the fracture of a hip

1. health hx and presence of concomitant problems 2. pain 3. VS, respiratory status, LOC and s/sx of shock 4. affected extremirt including frequent neurovascular assessment 5. bowel and bladder elimination; bowel sounds, I&O 6. skin condition 7. anxiety and coping

4 stages of bone healing

1. hematoma formation 2. fibrocartilaginous callus formation 3. bony callus formation 4. remodeling

collaborative problems and potential complications for fractures

1. hemorrhage 2. peripheral neurovascular dysfunction 3. DVT 4. pulmonary complications 5. pressure ulcers

clinical features of DKA

1. hyperglycemia 2. dehydration 3. acidosis

exercise, disuse and repair can lead to what in muscles?

1. hypertrophy 2. atrophy

emergency management of a fracture

1. immobilize the body part 2. splinting (joints distal and proximal to the suspected fracture site must be supported and immobilized) 3. assess neurovascular status before and after splinting 4. open fracture (cover with sterile dressing to prevent contaminiation) 5. dont attempt to reduce the fracture

central nervous system symptoms of hypoglycemia

1. inability to concentrate 2. headache 3. confusion 4. memory lapses 5. slurred speech 6. drowsiness

factors that affect fracture healing

1. inadequate fracture immobilization 2. inadequate blood supply to the fracture site or adjacent tissue 3. multiple trauma 4. extensive bone loss 5. infection 6. poor adherance to prescribed restrictions 7. malignancy 8. certain medications (corticosteriods) 9. older age 10. some disease processes ( rheumatoid arthritis)

assessment of the muscloskeletal system-- History

1. include data related functional ability -ADLs, IADLs, ability to perform various activities, note any problems related to mobility 2. family history 3. general health maintenance; occupation 4. learning needs; socioeconomic factors 5. medications (include over the counter)

treatment of septic (infectious) arthritis

1. includes aspiration of joint to remove fluid, exudate and debris 2. immobilization of joint 3. pain relief 4. antibiotics

Signs and symptoms of osteomyelitis

1. infection 2. localized pain 3. edema 4. erythema 5. fever (low grade and occur in the afternoon or evening) 6. drainage 7. superinfections (complications of antibiotic therapy)

symptoms of paget disease

1. insidious 2. attributed to old age or arthritis 3. most patients dont have symptoms

structures of a joint

1. joint capsule 2. ligaments 3. tendons 4. bursa sac

what are some common primary sites that metastasize in bone tumor (secondary)

1. kidney 2. prostate 3. lung 4. breast 5. ovary 6. thyroid

the major goals for a patient with osteoporosis

1. knowledge about osteoporosis and the treatment regimen 2. relief of pain 3. improved bowel elimination 4. absence of additional fractures

Major goals for a patient with a bone tumor

1. knowledge of disese process and treatment regimen 2. control of pain 3. absence of pathological fractres 4. effective coping patterns 5. improved self esteem 6. absence of complications

Complications of insulin therapy

1. local allergic reactions 2. systemic allergic reactions 3. insulin lipodystriphy 4. resistance to injected insulin 5. morning hyperglycemia

patient and family education for osteomyelitis

1. long term antibiotic therapy and managament of home IV administration 2. mobility limitations 3. safety and prevention of injury 4. postoperative and follow up care

nutrition related risk factors for osteoporosis

1. low calcium intake 2. low vitamin D intake 3. high phosphate intake (carbonated beverages) 4. inadequate calories **reduces nutrients needed for bone remodeling**

keys to exercise with diabetes

1. lowers blood sugar 2. aids in weight loss, easing stress, and maintaining a feeling of well being 3. lowers cardiovascular risk

modifiable risk factors for diabetes

1. maintaining a healthy weight 2. eating healthy 3. engaging in physical activity 4. living tobacco free 5. getting adueqate sleep

rehabilitation for pelvic fractures

1. management depends on type and extent of fracture and associated injuries 2. stable fractures are treated with a few days of bed rest and symptom 3. early mobilization reduces problems related to immobility

nursing interventions for arthrography

1. may feel discomfort and tingling 2. may experience clicking or cracking in joints 24 to 48 hours after

rehabilitation for elbow fractures

1. monitor regularly for neurovascular compromise and signs of compartment syndrome 2. potential for Volkmann contracture 3. active exercises and ROM are encouragede to prevent limitation of joint movement after immobilization and healing (4-6 weeks for nondisplaced, casted) or after internal fixation (about 1 week )

nursing interventions for biopsy

1. monitor site for bleeding and edema 2. administer analgesics and antibiotics

nursing interventions for the patient going under foot surgery

1. neurovascular assessment is vital (assess swelling and neurovascular status every 1 to 2 hours for the the first 24 hours, instruct patient in signs and symptoms to assess and report) 2. relieving pain (elevate foot, use of intermittent ice, medications oral analgesics) 3. improving mobility (instruction in weight bearing restrictions as prescribed, use of assistive devices, measures to ensure patient safety) 4. measures to prevent infection (wound or pin care, keep dressing clean and dry, s/sx of infections) 5. patient education

Nursing care of the patient undergoing surgery of the hand or wrist

1. neurovascular assessment is vital; ever two hours for the first 24 hours, assess motor function only as prescribed; instruct pt in signs and symptoms and report 2. pain control and measures (meds, evalulation, intermittent ice or cold) 3. prevention of infection (keep dressing clean and dry, wound care, signs and symptoms of infection) 4. assistance with ADLs and measure to promote independence

assessment of patient with osteoporosis

1. occurrence of osteopenia and osteoporosis 2. family history 3. previous fractures 4. dietary consumption of calcium 5. exercise patterns 6. onset of menopause 7. use of corticosteroids as well as alcohol, smoking and caffeine intake 8. symptoms such as back pain 9. physical assessment may disclose (localized pain, constipation, altered body image)

assessment for a patient with a bone tumor

1. onset and course of symptoms 2. knowledge of disease and treatment 3. pain 4. patient coping 5. family support and coping 6. physical examination of area, including neurovascular status and ROM 7. mobility and ADL abilities

physical assessment of musculoskeletal system

1. pain,tenderness, altered sensation 2. posture and gait 3. bone integrity 4. joint dunction 5. muscle strenth and size 6. skin 7. neurovascular status

postoperative assessment of a patient with a bone tumor

1. post operative assessment as for a patient who has had orthopedic surgery 2. monitor VS, LOC, neurovascular status, pain 3. monitor lab results (WBC and serum calcium level) 4. signs and symptoms of hypercalcemia

nursing interventions for arthroscopy

1. post procedure wrap joint with compression dressing to control swelling 2. monitor neuro status 3. instruct family to monitor signs and symptoms of complications

age risk factors for osteoporosis

1. postmenopause 2. advanced age 3. low testosterone in men 4. decreased calcitonin **hormones (estrogen, calcitonin and testosterone) inhibit bone loss

nursing interventions for patients with osteoporosis

1. promoting and understanding of osteoporosis and treatment regimens; education 2. relieving pain (short periods of rest, supportive mattress, intermittent local heat and back rubs) 3. improving bowel elimination (high fiber diet, increase fluids, stool softeners) 4. preventing injury (physical activity to strengthen muscles, improve balance, and prevent disuse atrophy)

interventions for the patient undergoing orthopedic surgery

1. promoting proper nutrition (administer antiemetics as prescribed, relaxation techniques, oral care, nutritional supplements) 2. provide adequate hydration 3. se strict aseptic technique

Diagnostic Tests

1. radiographs 2. CT 3. MRI 4. arthrography 5. bone desnitometry 6. bone scan 7. arthroscopy 8. arthrocenteisis 9. electromyography 10. biopsy 11. lab studies

types of insulin

1. rapid acting 2. short acting (regular) 3. intermediate acting (NPH) 4. very long acting (peakless)

major goals for the care for a patient with a hip fracture

1. relief of pain 2. achievement of a pain free, functional and stable hip 3. healed wound 4. maintaince of normal urinary elimination pattern 5. use of effective coping mechanisms 6. absence of complications

Major goals for the patient with osteomyelitis

1. relief of pain 2. improved physical mobility with therapeutic limitations 3. control and eradication of infection 4. knowledge of therapeutic regimen

nursing interventions for the patient with osteomyelitis

1. relieving pain (immobilization, elevation, handle with great care and gentleness, administer prescribed analgesics) 2. improving physical mobility (activity restricted, gentle ROM to joints above and below the affected part, participation in ADLs within limitations) 3. prophylactic antibiotics 4. encourage adequate hydration, vitamins, and protein 5. administer and monitor antibiotic therapy 6. patient and family education 7. referral for home health care

nursing interventions for arthrocentesis

1. remove hair from procedure site 2. administer analgesics 3. apply ice 24-48 hours post procedure

RICE

1. rest 2. ice 3. compression 4. elevation

physical exercise risk factors for osteoporosis

1. sedentary 2. lack of weight bearing exercise 3. low weight and body mass index **bones need stress for bone maintenance**

symptoms of severe hypoglycemia

1. seizure 2. disorientation 3. loss of consciousness 4. death

early complications of fractures

1. shock 2. fat embolism 3. compartment syndrome 4. VTE 5. PE

manifestations of paget disease

1. skeletal deformities 2. mild to moderate aching pain 3. tenderness and warmth over bones

where are metastatic bone tumors commonly found

1. skull 2. spine 3. pelvis 4. femur 5. humerus

rehabilitation for humeral neck and shaft fractures

1. slings and bracing 2. activity limitations until adequate period of immobilization

physical exam for patient with lower back pain

1. spine curvature, back and limb summetry 2. palpate paraspinal muscles 3. movement ability and effects on ADLs 4. DTRs, sensation, and muscle strength 5. asses posture, position changes, and gait

clinical indications of diagnostic tests

1. study changes in the structure of bone 2. assess for tumors, soft tissue injury, fractures 3. visualize torn muscles, ligaments, cartilage, herniated discs 4. ID cause of unexplained joint pain and joint disease progression 5. evaluation of bone mineral density

Emergency measures for diabetics

1. subQ or intramusclar glucagon (1 mg) 2. 25-50 ml of 50% dextrose solution IV

nursing interventions for a patient with a bone tumor

1. support affected extremities at all times and handle gently 2. external supports or fixation devices may be required 3. restrict weight bearing and activity as prescribed 4. use of assistive devices

rehabilitation of hip fracture

1. surgery is usually done to reduce and fixate the fracture 2. care is similar to that of a patient undergoing other orthopedic surgery or hip replacement surgery

adrenergic symptoms of hypoglycemia

1. sweating 2. tremors 3. tachycardia 4. palpitations 5. nervousness 6. hunger

Methods of Insulin Delivery

1. traditional subQ injections 2. insulin pens 3. jet injectors 4. insulin pumps 5. future (implantable insulin pumps)

classifications of diabetes

1. type 1 2. type 2 3. Latent autoimmune diabetes of adults (LADA) 4. gestational diabetes 5. diabetes associated with other conditions or syndromes

Educating patients in Insulin Self Management

1. use and action of insulin 2. symptoms og hypoglycemia and hyperglycemia (required actions) 3. blood glucose monitoring 4. self injection of insulin 5. insulin pump use

rehabilitation of a clavicle fracture

1. use of clavicular strap or sling 2. exercises for elbow, wrist fingers ASAP 3. dont elevate arm above shoulder for approximately 6 weeks

Abnormally low blood glucose level (below 50 to 60 mg/dL); too much insulin or oral hypoglycemic agents, excessive physical activity, and not enough food

hypoglycemia

The ADA now recommends HgbA1c less than..

7 percent

s/sx of a dislocation

A traumatic dislocation is an emergency with pain change in contour, axis, and length of the limb and loss of mobility

What findings can be identified with the use of radiography of the spine? A. Fracture, dislocation, infection, osteoarthritis, or scoliosis B. Infections, tumors, and bone marrow abnormalities C. Soft tissue lesions adjacent to the vertebral column D. Spinal nerve root disorders

A. Fracture, dislocation, infection, osteoarthritis, or scoliosis Radiography 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. Computed tomography is useful in identifying soft tissue lesions adjacent to the vertebral column. An electromyogram is used to evaluate spinal nerve root disorders

What category of insulin is rapid acting? A.Humalog B.Humalog R C.Humulin N Glargine (Lantus)

A.Humalog rationale: Aspart is a rapid-acting insulin, Humalog R is a short-acting insulin, Humulin N is an intermediate-acting insulin, and Glargine (Lantus) is a very long-acting insulin

What is atrophy? A.Shrinkage-like decrease in the size of the muscle B.Fluid-filled sac found in connective tissue C.Rhythmic contraction of muscle D.Grating or crackling sound or sensation

A.Shrinkage-like decrease in the size of the muscle Atrophy is shrinkage-like decrease in the size of the muscle. Bursa is a fluid-filled sac found in the connective tissue. Clonus is rhythmic contraction of muscle. Crepitus is a grating or crackling sound or sensation

What is a contusion? A. A musculotendinous injury B. Blunt force injury to soft tissue C. A break in the continuity of a bone D. An injury to ligaments and other soft tissues at a joint

B.Blunt force injury to soft tissue Strain is a musculotendinous injury. Contusion is blunt force injury to soft tissue. Fracture is a break in the continuity of a bone. Sprain is an injury to ligaments and other soft tissues at a joint

How long does a patient taking bisphosphonates need to stay upright after administration? A. 10 minutes B. 20 minutes C. 30 minutes 120 minutes

C.30 minutes Bisphosphonates are administered on arising in the morning with a full glass of water on an empty stomach, and the patient must stay upright for 30 to 60 minutes

Which statement is false about magnetic resonance imaging? A. Credit cards with magnetic strips may be erased B. Nonremovable cochlear implant devices can become inoperable C. Transdermal patches that have a thin layer of aluminized back must be covered with gauze D. Jewelry and hair clips must be removed before the MRI is performed

C.Transdermal patches that have a thin layer of aluminized back must be covered with gauze True statements are credit cards with magnetic strips may be erased. Nonremovable cochlear implant devices can become inoperable. Jewelry and hair clips must be removed before the MRI is performed. Transdermal patches that have a thin layer of aluminized back must be covered with gauze is false. Transdermal patches that have a thin layer of aluminized back must be removed before the MRI is performed because they can cause burns

What is pes cavus? A.Flexion deformity of the interphalangeal joint that may involve several toes B.Deformity in which the great toe deviates laterally C.Common disorder in which the longitudinal arch of the foot is diminished D.Foot with an abnormally high arch and a fixed equinus deformity of the forefoot

D.Foot with an abnormally high arch and a fixed equinus deformity of the forefoot Hammer toe is flexion deformity of the interphalangeal joint that may involve several toes. Hallux valgus is a deformity in which the great toe deviates laterally. Pes planus is a common disorder in which the longitudinal arch of the foot is diminished. Pes cavus is a foot with an abnormally high arch and a fixed equinus deformity of the forefoot

freely movable joints

Diarthrosis

Is the following statement true or false? Avascular necrosis is prolongation of expected healing time for a fracture

False Avascular necrosis is death of tissue secondary to poor perfusion and hypoxemia. Delayed union is prolongation of expected healing time for a fracture

Is the following statement true or false? Epiphysis is the bone-forming cell

False Epiphysis is the end of a long bone. Osteoblast is a bone-forming cell

major side effect of oral antidiabetic agents

hypoglcemia

what type of fracture is this Extends into the joint surface of a bone

intra-articular

s/sx of a sprain

Joint is tender, and movement is painful, edema; disability and pain increases during the first 2 to 3 hours

- Subtype of diabetes in which progression of autoimmune beta cell destruction in the pancreas is slower than in types 1 and 2 diabetes - Not insulin dependent in the initial 6 months of disease onset. - Clinical manifestation of this shares the features of types 1 and 2 diabetes -Emerging subtype has led some to propose the diabetes classification scheme should be revised to reflect changes in the beta cells in the pancreas

Latent Autoimmune Diabetes of Adults (LADA)

s/sx of a strain

Pain, edema, muscle spasm, ecchymosis, and loss of function are on a continuum graded first, second, and third degree

s/sx of contusions

Pain, swelling, and discoloration: ecchymosis

injury to ligaments and supporting muscle fiber around a joint

spain

regulating factors of bone formation an maintenance

Stress and weight bearing -Vitamin D -Parathyroid hormone and calcitonin -Blood supply

Is the following statement true or false? Proper standing posture occurs when the abdominal muscles contract, giving a feeling of upward pull, and the gluteal muscles contract, giving a downward pull

True Proper standing posture occurs when the abdominal muscles contract, giving a feeling of upward pull, and the gluteal muscles contract, giving a downward pull

- Insulin-producing beta cells in the pancreas are destroyed by a combination of genetic, immunologic, and environmental factors - Results in decreased insulin production, unchecked glucose production by the liver and fasting hyperglycemia

Type 1 Diabetes

-Insulin resistance and impaired insulin secretion - Slow, progressive glucose intolerance and may go undetected for years

Type 2 diabetes

which is more common a. bone tumor (secondary) b. bone tumor (primary)

a. bone tumor (secondary)

A nurse is preparing to administer an insulin injection to a client. Which of the following actions should the nurse take a. insert the needle at a 45 degree angle into pinched skin b. pull the skin 2.5cm (1in) to the side with the ulnar surface of the nondominant hand c. insert the needle at a 15 degree angle to form a wheal when injecting the medication d. aspirate for blood for 5-10 seconds after inserting the needle

a. insert the needle at a 45 degree angle into pinched skin

A nurse is teaching a client about selecting injection sites for insulin. Which of the following sites should the nurse recommend as best for injection a. the abdomen below the costal margins to the iliac crests b. the outer aspects of the upper arms c. the anterior surface of the thighs d. the upper back in the scapular area

a. the abdomen below the costal margins to the iliac crests

what stage of bone healing is this 1 to 2 days after fracture

stage 1: hematoma formation

allow limited movement

amphisarthrosis

a nurse is preparing to administer an insulin injection. Which of the following needles should the nurse select? a. 21 gauge, 1.5 in needle b. 30 gauge, 5/8 in needle c. 23 gauge, 1 in needle d. 25 gauge, 1/4 in needle

b. 30 gauge, 5/8 in needle

a nurse is teaching about the carbohydrate counting diet with a parent of a child who has diabetes mellitus. Which of the following information should the nurse include in teaching a. exchanges need to be within the same food group b. a single carbohydrate choice is equivalent to 15 grams of carbohydrate c. The timing of when you eat doesn't matter as long as you eat all of the required carbohydrates in a day d. one teaspoon of light margarine does not need to be counted as a carbohydrate choice

b. a single carbohydrate choice is equivalent to 15 grams of carbohydrate

A nurse is teaching about the use of subcutaneous infusion to the parents of a child who has diabetes mellitus. Which of the following information should the nurse include in the teaching a. discard and use a new syringe of insulin on the pump daily b. rotate injection sites using the thighs and the abdomen c. change the needle and catheter every 7 days d. turn the insulin infusion off during the night

b. rotate injection sites using the thighs and the abdomen

expanding lesions within the bone

bone cysts

a nurse is teaching about sick day management to a parent of a child who has diabetes mellitus. Which of the following statements by the parent indicates an understanding of the teaching a. I should check my childs urine for ketones twice a day b. I should decrease my childs prescribed insulin at the onset of illness c. It is more important for my child to drink fluids than eat during illnesses d. It is important to avoid simple sugars during time of illness

c. It is more important for my child to drink fluids than eat during illnesses

A nurse is teaching a client who is to start self administering a regimen of regular and NPH insulin twice each day. Which of the following instructions should the nurse include a. store unopened vials of insulin in freezer b. allow 1.3cm (0.5 in) between injection sites within the same areas c. keep prefilled syringes in the refrigerator for up to 1 week d. draw up the NPH insulin before the regular insulin

c. keep prefilled syringes in the refrigerator for up to 1 week

a nurse is preparing to obtain a capillary blood glucose level from a child who has diabetes mellitus. Which of the following actions should the nurse take a. puncture the central tip of the ring finger to obtain the specimen b. gently smear the blood on the reagent strip c. massage the finger in a dependent position prior to collecting the specimen d. inject the lancet using a quick motion at a 45 degree angle

c. massage the finger in a dependent position prior to collecting the specimen

what type of fracture is this no break in the skin

closed or simple

soft tissue injury produced by blunt force

contusion

A nurse is assessing a child who has diabetes mellitus. The nurse should identify that which of the following is a manifestation of hypoglycemia? a. flushed skin b. bradycardia c. dry mucus membranes d. headache

d. headache

A nurse is preparing for to administer 6 units of regular insulin and 20 unites of NPH insulin to a client. Which of the following actions should the nurse take first a. withdraw 6 units of insulin from the regular insulin vial b. inject 6 units of air into the regular insulin vial c. withdraw 20 units of insulin from the NPH insulin vial d. inject 20 units of air into the NPH insulin vial

d. inject 20 units of air into the NPH insulin vial

Absence or inadequate amount of insulin resulting in abnormal metabolism of carbohydrate, protein, and fat

diabetic ketoacidosis (DKA)

articular surfaces of the joint are not in contact

dislocation

muscle cell fibers react to..

electrical stimulation

: restoration of the fracture fragments to anatomic alignment and positioning

fracture reduction

Anaerobic pathways using glucose metabolized from stored __________ provide energy for more strenuous muscle activity

glycogen

-caused by a lack of sufficient insulin; ketosis is minimal or absent. causes osmotic diuresis, loss of water and electrolytes, hypernatremia, and increased osmolality -Manifestations include hypotension, profound dehydration, tachycardia, and variable neurologic signs caused by cerebral dehydration High mortality rate

hyperglycemia hyperosmolar syndrome

what does the prognosis of malignant (primary) bone tumor depend on

it depends on the type and whether the tumor has metastasized

what population is disproportionately affected by diabetes

minorities and older adults

nursing interventions for oral antidiabetic agents

monitor blood glucose for hypoglycemia and other potential side effects

what type of fracture is this -Wound extends to the bone -Grade I: 1 cm long clean wound -Grade II: larger wound without extensive damage -Grade III: highly contaminated, extensive soft tissue injury, may have amputation

open or compound/complex

-Used for patients with type 2 diabetes who require more than diet and exercise alone -Combinations of oral drugs may be used

oral antidiabetic agents

the process of formation of the bone matrix and deposition of minerals

ossification

Function in bone formation

osteoblasts

what is the most common benign bone tumors

osteochondroma

benign for long periods but may invade local tissue and cause destruction

osteoclastomas

-Multinuclear cells function in destroying, resorbing, and remodeling bone -Located in Howship lacunae

osteoclasts

-Mature bone cells that function in bone maintenance -Located in the lacunae

osteocytes

-process of bone formation

osteogenesis

Painful tumor in children and young adults

osteoid osteoma

-A metabolic bone disease characterized by inadequate bone mineralization -Softening and weakening of the long bones causes pain, tenderness, and deformities caused by the bowing of bones and pathologic fractures -Deficiency of activated vitamin D causes lack of bone mineralization and low extracellular calcium and phosphate

osteomalacia

Infection of the bone

osteomyelitis

-Most prevalent bone disease in the world; more than 1.5 million osteoporotic fractures occur each year -Normal homeostatic bone turnover is altered, and the rate of bone resorption is greater than the rate of bone formation, resulting in loss of total bone mass -Bone becomes porous, brittle, and fragile and breaks easily under stress -Frequently results in compression fractures of the spine, fractures of the neck or intertrochanteric region of the femur, and Colles' fractures of the wrist

osteoporosis

most common and most often fatal malignant (primary) bone tumor

osteosarcoma

-Disorder of localized bone turnover: skull, femur, tibia, pelvic bones, and vertebrae -Incidence: 2% to 3% of the population older than age 50 years -More common in men, and risk increases with aging; familial predisposition has been noted

paget disease

a cytotoxic antibiotic may be used for severe disease resistant to other therapy

plicamcyin (Mithracin)

what is the goal for metastatic bone tumors

relieve pain and promote quality of life

the contractile unit of skeletal muscle that contains actin and myosin

sarcomere

-High risk: older adults >80, and those with comorbid conditions such as diabetes, RA, skin infections -Most commonly single knee and hip joints -Presents with a warm, painful, swollen joint with decreased range of motion. Systemic chills, fever, and leukocytosis are sometimes present Prompt recognition and treatment are key

septic (infectious) arthritis