MedSurg Test 1
Terms
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- Bouchard's Nodes
- raised bony growths over the proximal phangeal joint of the hand, less frequent than heberdean's nodes in osteoarthritis
- Cancellous Bone
- a spongy bone resulting from structural units fitting loosly together leaving many spaces between bone tissue.
- Compact bone
- a dense structured bone resulting from structural units fitted closely together,
- Compartments Syndrome
- occurs when circulation to a compartment is impeded due to excessive pressure against the non elastic fascia
- What does Compartments syndrome result in?
- tissue death and nerve injury
- countertraction
- a pulling force exerted in the opposite direction to prevent the client from sliding to the end of the bed
- crepitation
- a grading or popping sound caused bones rubbing together
- degenerative joint disease
- a slowly progressive disorder or articulating joints esp weight bearing, primarily affecting middle aged to older adults
- gout
- a metabolic disorder char by elevated uric acid levels in the blood resulting in deposition of uric crystals in synovial fluid and joint tissues
- Heberden's nodes
- raised bony growths over distal interphalangeal joints that occur freq. in osteoarthritis and are a common manifestation of the disease in women.
- Internal fixation
- a surgical implanted fracture immobilization device to realign a fracture
- laminectomy
- a surgical incision of the lamina, done to relieve symptoms related to intervertebral disk
- Osteomylitis
- a acute or chronic infection of the bone usually caused by staph aureus organism
- osteoporosis
- disease char by low bone mass and deteroration of bone tissue causing the bone to become fragile and susceptible to fractures
- sprain
- a stretch and/or tear of a ligament
- strain
- a stretch or tear of muscle fibers
- traction
- direct pulling force applied to a fractured extremity that results in realignment of bone
- what are the two classifications of bones?
- compact (dense) cancellous (spongy)
- Why is a fracture worse than a tear?
- fracture takes longer to heal, reduction in calcium, RBC production
- a decreased H and H means?
- RBC prod down, O2 to RBC's down, # RBC's down
- What is the most common test of musculoskeletal problems?
- X Ray
- Post arthroscopy nsg implications
- take pain meds, limit activity, look for hemotoma or bleeding, NV assessment, temp color cap refill sensation, teach S/S of infect
- Arthrogram
- contrast media injection, series of pics taken while ct. moves joint
- Pre op edu for arthrogram
- feeling of warmth, nausea, H/A, itching, hives, rash, salty tast
- post op edu arthrogram
- temp discolor of skin and urine normal , ck NV status of site
- CT Scan
- combines Xrays with comp. tech to get cross section of structures of body
- ct edu for CT scan
- if dye is used, increase fluid intake, monitor evac of contrast media, white stools normal,
- Bone scan
- tech used to create images of bones on a comp screen or film using a sm amt of radioactive material traveling through blood stream
- What in a bone scan details blood flow to a bone
- the amount of dye absorption
- What are the 4 types of bones?
- long, short, flat, irregular
- What type of tissue is bone?
- connective
- What is responsible for laying down new bone?
- osteoblasts
- What are the 5 functions of bone?
- support, protection, movement, hematopoiesis, mineral homeostasis
- In what way do bones provide support?
- provide skeletal framework, and give form and shape of body
- How do bones provide protection?
- protect body organs
- How do bones provide movement?
- muscular attachments to one and by joint movement
- What is hematopoiesis?
- formulation of RBC's
- Where are RBC's formed
- bone marrow
- If the RBC's are being formed outside of the marrow what is this a sign of?
- disease
- how do bones provide mineral homeostasis
- bones store CA, phosphate, carbonate, magnesium
- what is remodeling?
- process by whcich existing bone is resorbed and new bone replaces the old
- Where is 99 percent of the bodies calcium found?
- bone
- What is necessary for bone formation
- calcium
- What has an inverse relationship with calcium?
- phosphorus
- What controls calcium and phosphorus
- PTH
- What results in the release of phosphorus?
- bone resorption
- What inhibits bone resorption
- calcitonin
- What vitamin elevates calcium and phosphorus?
- vitamin D
- Where is Growth hormone secreted?
- anterior lobe of pituitary gland
- What is a manifestation of decreased levels of GH?
- dwarfism
- What is a manifestation of increased levels of GH?
- acromegaly
- what regulates the metabolism of proteins
- glucocorticoids
- What stimulates osteoblast activity and inhibits PTH?
- estrogen
- What happens if a bone is not stressed?
- bone resorption
- what are the three types of muscle?
- visceral, cardiac, skeletal
- what is each skeletal muscle covered in?
- fascia
- tonic contraction
- continual partial contraction that is vital in the maintenance of posture
- Isotonic contraction
- tension within the muscle is constant but the length of muscle changes
- Isometric contraction
- tension within the muscle increases, but muscle does not shorten
- a twitch contraction
- jerky reaction to a single stimulus
- tetanic contraction
- more sustained contraction than the twitch produced bhy a series of stimuli in rapid succession
- spasm contraction
- involuntary contraction caused by stimulation of an entire motor unit
- treppe contraction
- stronger twitch contractions in response to regularly repeated
- Fibrillation contraction
- a synchronous contraction of individual fibers
- convulsive contractions
- abnormal uncoordinated tetanic contractions cocurring in varying groups of muscles
- what sets off the contraction of a muscle?
- acetylcholine
- What is the most common type of cartilate
- hyaline
- what is cartilage?
- composed of fibers embedded in a firm gel, strong but flexible
- What are ligaments?
- parallel angds of flexible, dense fibrous connective tissue
- What is the primary function of ligaments
- connect the ends of bones and provide stability
- Ligaments and movements
- ligaments permit movement in some directions but limit it in others
- What are tendons?
- bands of dense fibrous tissue that ofrm the origin of muscle to bone
- What is bursae?
- small sacs of connective tissue located wherver pressure is exerted over moving parts.
- what are joints
- places where bones come together and allow movement
- What happens with cartilege when you age?
- it becomes more rigid
- How much bone mass has a women usually lost by age 70
- 50
- when does muscle strength reach its peak
- 25 to 30 years
- what is sarcopenia
- age-related skeletal muscle loss
- How does bone change with aging?
- decreased total bone mass, impaired osteoblastic activity, resorption exceeds growth, erosion of haversian systems, corticol bone changes to cancellous bone
- What are potential problems with bones and aging?
- osteoporosis, pathologic fracture, delayed healing
- Changes in muscles with aging?
- decline in strength past 70 years, decline in # of muscle fibers, decrease in muscle mass, atrophy of muscle cells
- What are some potential problems with muscles and aging
- weakness, uncoordination, disuse atrophy, slow unsteady gait, poor posture, falls, contractures
- Changes with joints and aging
- decreased elasticity of cartilage, increased susceptibility to tears in cartilage
- potential problems with joints and aging
- arthritis, decreased range of motion, contractures
- What races are at a greater risk for osteoporosis?
- asians, caucasians
- what is posture indicative of?
- char of specific prob like scoliosis, kyphosis
- What does being overweight possible indicate
- diminished ability to perform reg. exercise or activity, excess weight causes increased stress on joints
- Underweight risk factors
- inability to make nutricious meals, may relate to anorexia, N/V or malabsorption of food
- a malnourished female is at risk for?
- osteoporosis
- What happens to skin with aging?
- down turgor, thinner skin,
- What are individuals with limited mobility subject too?
- skin breakdown, pressure ulcers, watch for shearing forces
- what does warmth over a joint possible indicate
- inflammation or infection in a joint
- What does a bony enlargment in a joint show?
- disease process
- What are subcutaneous nodules indictative of?
- rheumatoid arthritis,
- What are tophaceous deposits indictative of?
- Gout
- what is a swan neck deformity?
- flexion and hyperextension of joints in hand
- In what disease is a swan neck deformity found?
- rheumatoid arthritis
- What is a ulnar deviation
- fingers deviate at the metacarpophalangeal joints toward ulnar aspect of hand
- What is a valgus deformities
- distal arm of the angle of the joint points away from the midline of the body
- hallux valgus
- great toe turn towards other toes
- genu valgum
- knock knees
- talipes valgus
- eversion of the foot
- genu varum
- bowing of knees
- talipes varus
- inversion of foot
- scoliosis
- lateral curvature of spine
- kyphosis
- throacic spinal curvature, posterior
- atorphy
- reduction in size of extremity or body part
- hypertrophy
- abnormal enlargement of an organ or body part
- pes planus
- flat feet
- pes cavus
- high instep
- range of motion
- normal arc of movement provided for by the structure of a joint
- What ROM is performed independently?
- active
- What ROM is performed with the assistance of someone else
- passive
- scoliosis screening
- forward bend test to observe symmetry and height of scapulae, shoulders, iliac crests, rib cage
- what is a myelography
- radiologic examination of the spinal canal
- What is elevated in serum muscle enzymes
- muscle diseases
- What levels are most commonly used to diagnose and monitor treatmetn of muscular dystrophy
- Aldolase
- What should be avoided when aldolase is being monitored
- IM injections
- What are enzyme levels an index of?
- both the progress of myopathic disorders and effectiveness of treatment
- normal values of AST
- 8-20 U/L
- normal aldolase values
- 3-8.2 U/dl
- CPK-MM normal value
- 90 to 97%
- What does the FTA-ABS exclude
- presence of syphalis
- what is the rheumatoid factor?
- found in individuals with rheumatoid artritis
- What is the level of RA to be considered positive
- titrations of 1:40 or more
- ESR
- erythrocypte sedimentation rate
- ESR indicates what?
- increased rate of settling of erythrocypes is an important index or presence of inflammation
- Serum complement
- low levels show rheumatoid arthritis
- Normal vales of ESR?
- < 15mm/hr men and < 20 mm/hr female
- What are symptoms of anemia?
- extreme tiredness, fatigue, weakness,
- normal hematocrit levels
- 45-50 men, 40 - 45 female
- normal values of calcium
- total 9 - 10.5
- What is monitored in treatment for osteoporoisis
- ALP
- What does ALP stand for?
- alkaline phosphatase
- What with calcium plays a vital role in bone metabolism
- phosphorus
- normal phosphorus levels
- 2.5-4.5
- What is used as nonspecific indicator of infection and inflammation
- C reactive protein
- 24 hour urine test is used to determine
- creatine creatinine ratio
- with muscle disease the ability of muscle to convert creatine is
- decreased
- the amount of creatine excreted by kidneys is ? in muscle disease
- increases
- Urinary uric acid levels are helpful in ?
- diagnosis and decisions regarding treatment modialities for gout
- What is the normal value in urinary uric acid levels?
- not exceeding 900 mg uric acid excretion a day
- Dpd
- Deoxypyridinoline
- what type of biopsy is used on the skin?
- punch biopsy
- What type of procedure is a muscle biopsy
- operative procedure
- how does inadequate immobilization effect bone healing?
- movement of fragments
- how does poor approximation of fracture fragment impede bone healing
- inaccurate reduction or malalignment of fracture fragments
- How does a compromised blood supple impede bone healing?
- damage to nutrient vessels, periosteal or muscular injury, severe comminution, avascularity
- How does excessive edema at fracture site impede bone healing?
- tissue swelling impedes supply of nutrients to area of fracture
- how does bone necrosis impede bone healing
- injury to blood vessels impedes supple of nutrients to involved bone
- how does an infection at the fracture site impede bone healing
- an infection disrupts normal clalus formation
- how do metabolic disorders or diseases impede bone healing
- retard osteogenesis
- how does soft tissue injury impede bone healing
- disruption of blood supply
- how does medication use impede bone healing
- steroids cause osteoporosis
- what can long term use of heparin cause?
- osteoporosis
- What type of film can be used to document healing
- XRay
- 1st step in treating a fx
- maintinaing airway and assessing for signs of shock
- 2nd step in treating a fx
- splint the fracture
- why do you splint the fracture
- to prevent movement that may cause further injury, also can decrease pain
- What is the 3rd thing you do in tx of a fracture
- preserve correct body alignment
- What is the 4th things you do in tx of a fracture
- elevate
- what do you do after you elevate a fracture
- apply cold packs
- What does applying cold packs to a fracture do?
- reduces hemorrhage, edema and pain
- How long after a fracture are cold packs useful?
- 24 hours
- What do you observe for after all other steps of treating a fx are completed?
- color, sensation, circulation, movement and temp
- What is the most common type of external fixation device
- casts
- What is the mechanism by which a steady pull is exerted on a part or parts of the body
- traction
- When is traction used?
- reduce a fracture, maintain correct alignment of bone frag, immob. a limb, overcome muscle spasm, stretch adhesions, correct derformities
- What is countertraction
- a force that counteracts the pull of traction
- What is generally the thing that provides countertraction
- the body
- What type of traction uses the body as countertraction
- Bucks
- What is suspension?
- use equip to suspend not pull on a body part
- What are the two types of traction?
- skin and skeletal
- What are the two most common types of skin traction?
- bucks and russells
- What is traction applied directly to the bone
- skeletal traction
- What is used in conjuction with skin or skeletal traction to give the pt more movement
- balanced supension
- In traction, should ropes be straight and run straight through pulleys?
- yes
- What do you do when you are adjustion traction for a pt.
- remove the weights
- when a person is in traction, should you encourage them to change positions as much as possible
- yes
- What are the guidelines for positionng a pt with a fx?
- maintain align, maintin direction of pull of traction, integrity of cast, positioning,
- What are guidelines for pt in a cast?
- see page 148
- what is leading cuase of nonunion and delayed nion
- infection
- What is the primary symptom of infection
- pain
- What is pseudoarthrosis
- impaired fx healing
- CRPS
- complex regional pain syndrom
- what are fracture blisters
- skin bullae and blisters representing areas of epidermal necrosis with separaion of the stratified squamous cell layer by edema fluid
- Can fracture blisters be caused by compartmetn syndrome
- yes
- FES
- fat embolism syndrom
- when is FES most common
- fractures of the pelvis, femur and tibia
- what are some symptoms of FES
- hypoxemia, tachypena, tachycardia, petechiae, fever, lipuria, chest pain, etc
- pathophysiology of FES
- fat globules released from marrow following fracures enter the bloodstream and obstruct pulmonary circulation
- Pato of PE
- DVT dislodges and obstructs pulmonary circulation
- When does a FES usually occur?
- 1-4 days after injury
- when does a PE usually occur?
- 4-10 days after trauma of devel of thrombophlebitis
- What are some symptoms of a PE?
- dyspnea, chest pain, apprehension, anxiety, cough, hemoptysis, fever
- What are some risk factors of FES?
- hypovolemia, shock, delayed immobilization of fracture, multiple fractures
- What are some risk factors of PE
- venous stasis, immobility, obesity, trauma, major sx, hx heart disease, older than 40, hx of DVT
- What is compartment syndrome
- complication of trauma in which increased pressure within a limited anatomic space compromises circulation, and fx
- Waht is acute compartment syndrom usually a complication of?
- trauma
- What is chronic compartment syndrome caused by
- people active in sports,
- What are the bleeding causes of compartment syndrome?
- vascular injury, coagulation defect
- What are the excessive muscle use causes of compartment syndrom?
- exercise, seizures, tetany eclampsia
- what are the trauma causes of compartment syndrome
- fractures, crush injuries, hypothermia, frostbite, burns, snake or spider bites
- What is the leading cause of morbidity and mortality in the elderly population
- hip fractures
- risk factors for osteoporosis
- advanced age, female and white, down estrogen levels, alzheimers, institutional residence
- intracapsular hip fracture
- femoral neck, iwthin the hip join t and capsule
- extracapsular
- outside the hip joint and capsule to an area 5 cm below lesser trochanter
- S/S of hip fracture
- severe pain at fracture site, inability to move leg, external rotation, shortening,
- Nsg management of hip fx
- pt teaching, NV checks, anticoagulants, read pgs 1491 to 1493
- Mild Class one soft tissue injuries
- stretching ligament without tear
- moderate class 2 injuries
- several ligament fibers torn with a partial loss of function
- severe, class 3 injuries
- sever or complete disruption of the ligament with resulting instability
- S/S class 1 injuries
- mild pain, and swelling
- S.S class II injuries
- moderate pain and swelling,
- Class III injuries S/S
- sever pain, swelling joint instability and disability loss of fx
- RICE
- rest, ice, compression, elevation
- how long should you ice a soft tissue structures
- 48 to 72 hours
- early symptoms of RA
- fatigue, weight loss, fever, malaise, morning stiffness, pain at rest and with movment, night pain, edema
- late symptoms of RA
- pallor, anemia, color changes, muscle weakness, joint deformities, decreased joint mobility, contractures,
- in RA how long does morning stiffness last
- greater than an hour and at least 6 weeks in duration
- how long will a pt have swelling of joints for RA
- 6 weeks
- Medications for RA
- PG 1511
- arthroscopy
- endoscopic examination of a joint
- arthrotomy
- opening of a joint
- arthroplasy
- reconstruction of a joint
- interposition arthroplasty
- replacement of part of a joint with a prosthesis or with soft tissue
- hemiarthroplasty
- replacement of one articulating surface
- TKA
- total knee arthroplasty
- synovectomy
- removal of part or all of the synovial membrane
- osteotomy
- cutting a bone to change its alignment
- arthrodesis
- surgical fusion of a joint
- tendon transplants
- moving a tendon from its anatomic position
- DJD
- degenerative joint disease
- OA
- osteoarthritis
- COMPARE OA AND RA
- PG 1523
- DJD and pain
- worse with weight bearing, improves with rest, paresthesia
- Pain meds for OA
- PG 1525
- Pt with Total knee
- PG 1531
- review preop and post op care for pts
- chp 47
- post op care
- 1535
- home instructions for total hip pts
- 1536
- review complications of total joint arthroplasties
- pg 1541
- causes of secondary gout
- 1541
- what is podagra
- food pain
- lab studies and gout
- increased uric acid levels usually 24 hours
- good choice for therapy for pts with gout
- NSAIDS
- red wold
- systemic lupus erythematous
- Who does SLE usually affect?
- women of childbearing age
- LUPUS CLASSIFICATIONS
- 1549
- what is the most common cause of death in lupus
- kidney failure