Unit 3 Review

Why are thigh, leg, arm, and forearm bones called “long bones?”

Because they are longer than they are wide.

What kind of bones comprise your wrist and ankles?

Short bones

Typically, what shape are short bones?

cube shaped

What is the usual purpose of flat bones?

To protect organs.

The sternum, cranial, scapulae, and ribs are what kind of bones?

Flat bones.

What kind of bones make up the vertebrae, and some skull bones?

Irregular bones.

What is ossification?

The development of bones

What kind of cells form bones?

Osteoblasts (B-build)

What kind of cells demineralize, or destroy, old bone?

Osteoclasts. (C-crack)

What hormone plays a role in the concentration of osteoclasts vs. osteoblasts?

Estrogen

Why do women typically get osteoporosis after menopause?

The decrease in estrogen.

What kind of cells are associated with bone spurs?

Osteophytes

Do we move “smooth muscle” voluntarily?

No, it is involuntary.

Which body system is typically associated with smooth muslce?

The GI system.

Are we able to move skeletal muscle voluntarily?

Yes, it is attached to our bones so we can move it voluntarily.

What kind of muscle makes up the walls of the heart?

Cardiac muscle.

What kind of joints are typically immovable?

Non-synovial joints.

What allows synovial joints to move freely?

Having a synovial fluid filled space that lubricates the joint and decreases friction.

Are these joints non-synovial, or synovial: knee, hip, shoulder.

Synovial

In every ortho trauma situation, what acronym must the nurse remember?

RICE (rest, ice/immobilize, compress, elevation)

What do tendon’s connect?

Muscle to bone.

What do ligaments connect?

Bone to bone.

What kind of injury is a stretch and/or tear to one or more ligaments?

Sprain.

What kind of injury is a stretch to a muscle or muscle/tendon unit?

Strain.

What is a usual cause of a strain?

Mechanical overload.

What are the 3 clinical steps required to heal a fracture?

Realignment, immobilization, and restoration of function.

When a bone breaks but stays aligned its called a….

simple fracture

A patient comes into the ED with their fibula sticking through their skin. What kind of fracture is this?

Compound, or open

When a bone is fractured but the break doesn’t go all the way through the bone its called a …..

greenstick fracture

A fracture that involves a bone being broken in more than two places and has fragments broken off is called…

comminuted fracture

What kind of complication can arise from a comminuted fracture?

Fat embolism

This kind of fracture is common in car accidents due to one bone crashing into another.

impacted fracture

How does a bone heal?

Hematoma transforms into granulation tissue transforms into callous transforms into bone

What kind of treatment does not require the doctor to visualize a fracture?

closed reduction (immobilize with cast,splint,brace)

A doctor determines they need to perform surgery on a patient with a femur fracture. The surgery will involve placing a rod and screws. What kind of treatment is this considered to be?

Open reduction (body is open, surgeon can visualize) internal fixation (realigned internally with rod and screws that will remain in the body)

What is the procedure called when rods and pins connected to an external frame are surgically placed into a fractured bone?

open reduction (body is open in surgery) external fixation (realigned externally)

What are the main reasons traction is used for a fracture?

stabilizes/realigns and reduces muscle spasms

You walk into a patients room and see a weighted boot or harness secured to one of their extremities. What kind of traction is this and what are it’s benefits?

skin traction, relieve muscle spasm and maintain bone

You walk into a patients room and see a weight system connected to pins, tongs, screws, or wires that were surgically secured to the patients bones. What kind of traction is this and what is it’s main benefit?

skeletal traction, realignment of the bone

How often should a nurse assess CWMS (neurovascular assessment) on a patient with traction?

Every 1-2 hours for the first 24-48 hours

What is one of the most important nursing interventions for patients with skeletal traction or external fixators?

pin site care (high risk of infection)

Why would a patient using traction be required to use an incentive spirometer?

To encourage proper inflation of lungs in order to prevent pneumonia.

If a patient is immobilized what kind of medication will they likely be on while in the hospital?

blood thinner, prevent DVT

What three assessments are particularly important in post-operative care?

Pain assessment (30min-1 hour after meds are given), tissue perfusion (peripheral pulses and cap refill, edema), and neurovascular (CWMS)

A patient just came out of surgery. The nurse notices that their blood pressure has dropped and their heart rate has increased. What could this indicate?

Patient could be in hypovolemic shock

A patient had a comminuted fracture in their femur. A day after surgery the nurse observes petechiae and the patient complains of breathing trouble. What does this indicate?

Fat embolism

What is a fat embolism?

When fat from the bone marrow enters the blood and clogs smaller vessels.

How soon can neurovascular damage become irreversible?

4-6 hours

A patient had surgery to fix a fibula fracture and was put in a cast. During an assessment the nurse realizes the patient is experiencing a lot of pain, paresthesia in their toes, and lack of color in their skin. What is happening to the patient?

Compartment syndrome

What are the 6 P’s?

Passive pain, pressure, paresthesia (all early stage) pallor, paralysis, pulselessness (all late stage)

Muscular dystrophy manifests as:

muscle weakness, waddling gait, toe walking (in children), cardiac abnormalities

Is there a cure for muscular dystrophy?

No, it is fatal.

What kind of care can be offered to someone with muscular dystrophy?

multidisciplinary involving OT/PT, support for the patient and family.

What is the most common form of muscular dystrophy?

Duchenne Muscular Dystrophy (DMD)

Is muscular dystrophy an acute disorder or progressive?

Progressive, gets worse over time.

When are we considered to have our peak bone mass?

In our 30’s.

What is the most common cause of osteoporosis?

age related bone loss

What happens when a person’s osteoclasts are more active than their osteoblasts?

osteoporosis, bone cannot build fast enough to replace what is being broken down, resulting in soft and porous bones.

What are the most common fracture sites for someone with osteoporosis?

forearm/wrist, spine, and hips

What are modifiable risks factors for osteoporosis?

diet, exercise, substance use

What medications contribute to a higher risk for developing osteoporosis?

steroids and/or seizure meds

What medication is most commonly used to treat osteoporosis?

bisphosphonates (Fosamax)

What is considered to be the opposite of osteoporosis?

Paget’s disease (accelerated bone remodeling)

A patient has bones that are abnormally large and soft. What condition might they have?

Paget’s Disease

What is a hallmark manifestation of Paget’s disease?

deep ache that gets worse at night

How is Paget’s disease diagnosed?

X-ray, bone scan, or MRI

What is osteomyelitis?

bone infection (osteo = bone, myel = marrow, itis = infection/inflammation)

What labs can be ran to indicate inflammation?

ESR and CRP

How is osteomyelitis diagnosed?

bone biopsy

Are antibiotics typically given PO or IV for osteomyelitis?

IV

A concrete spacer with antibiotics infused into it helps aid in what?

treatment of osteomyelitis after a previously replaced joint becomes infected

What is osteoarthritis?

degenerative joint disease (osteo = bone, arthr = joint, itis = inflammation)

Does osteoarthritis effect joints individually or BL?

individually

A progressive loss of cartilage in the joint which leads to crepitus with movement. What is the cause?

osteoarthritis

A patient presents with a swollen joint that is cool to the touch and is stiff after periods of immobility. What could be causing this?

Osteoarthritis

Joint’s which split and get longer are also called Heberden’s joints. They are typically found in the fingers. What causes this?

Osteoarthritis

Why would a care team opt to use celecoxib (Celebrex) for a osetoarthritis patient?

if the patient is at risk for a GI bleed or they don’t tolerate NSAID’s

What is a topical NSAID used for osteoarthritis?

diclofenac (Voltaren)

What do corticosteroids do?

reduce pain/inflammation (can be used for osteoarthritis or RA)

A patient with osteoarthritis is scheduled for an arthroscopy. What will this procedure consist of?

Inserting a thin tube with a camera to visualize and repair damage of tissues in the joint.

What kind of procedure removes pieces of bone from a joint?

osteotomy

If a patient is told they need a TKA (total knee arthroplasty) what does this mean?

They need a total knee replacement.

What is the second most common form of arthritis?

Rheumatoid arthritis (RA)

What causes compartment syndrome?

edema within the compartment space under fascia

The nurse realizes their patient has compartment syndrome. What are the three treatment options available?

split the cast, relieving pressure. STAT fasciotomy (procedure cutting through tissue layers to relieve pressure). possible amputation.

Rheumatoid arthritis is an autoimmune disease. True or false?

True

What increases inflammation in RA?

an increased amount of synovial fluid and a thickened membrane (pannus)

Rheumatoid arthritis is considered a chronic condition. Are patients having symptoms everyday?

Not necessarily. There can be periods of remission and exacerbation.

You are taking care of a patient during their hospital stay. You notice both ankles are swollen and are hot to the touch. What could this indicate?

The patient suffers from RA.

Swan neck is a hallmark of what inflammatory disorder?

RA

What are the most common joints effected by RA?

wrists, hands, ankles, feet

How is rheumatoid arthritis diagnosed?

Serology lab work (serum RF)

DMARDs stand for what?

disease modifying antirheumatic drugs

methotrexate, sulfasalazine, and antimalarial drugs can all be used to combat what?

Rheumatoid arthritis

What is a SQ medication used for RA?

Humira

Your patient is scheduled for a synovectomy. What does this procedure entail?

an excision of the synovial membrane to provide temporary relief from RA

Sometimes treatment for RA will include an arthrodesis. What is this procedure?

A fusion of the joints to stabilize and reduce friction. done in cervical vertebrae, wrists, and ankles

Thickening, hardening, and tightening of the skin, blood vessels, and internal organs caused by excess collagen production is known as what?

Scleroderma - systemic sclerosis

Upon assessing your patient’s extremities, you notice non-pitting edema on their ankles, and their fingers are cold to the touch (Raynaud’s phenomenon). What disorder can you expect to see in her chart?

Scleroderma

What disorder is considered to be the “great imitator”?

Systemic Lupus Erythematosus (SLE)