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Charity NAC 1 Test 5
Ortho, Male GU, GYN, Community, RA/OA
| Question | Answer |
|---|---|
| What are the 4 main focuses of Musculoskeletal Trauma? | Mobility, Perfusion, Comfort, Infection |
| Education for musculoskeletal trauma should include? | Proper use of equipment, avoidance of hazards in workplace, wear proper shoes, avoidance of throw rugs, clear pathways for ambulating. |
| Most common soft tissue injuries | Sprain and strain |
| Injury to the tendinoligamentous structures surrounding the joint. | Sprain |
| Excessive stretching of a muscle and its fascial sheath. Often involves the tendon. | Strain |
| What are symptoms of sprain and strain? | Pain, Edema, decrease in function and contusion. |
| The ligament pulls loose from a fragment of the bone. | Avulsion fracture |
| Bleeding into the joint/cavity may occur. | Hemarthrosis |
| Ottawa Rules | Based on age, ability to flex, location of tenderness, ability to bear weight. |
| What is included in health promotion for soft tissue injuries? | Encourage stretching/warm up exercises, balancing and endurance exercises, use of elastic support bandages. |
| What is used for immediate intervention of soft tissue injuries, strain or sprain? | RICE (rest, ice, compression, elevate) |
| What is used in the post acute phase of soft tissue injury? | Moist heat for 20-30 minutes allowing for cool down time, NSAIDS for pain control, use of limb if protected. |
| A partial or incomplete displacement of the joint surface. | Subluxation |
| A dislocation injury to the ligamentous structures that surround a joint. | Dislocation |
| What test is best used to determine is displacement has occurred? | X-Ray |
| What are the joints most frequently displaced? | Thumb, elbow, shoulder, hip |
| Dislocation is considered a medical emergency due to the possibility of | Avascular necrosis |
| How is realignment accomplished for dislocation? | Closed reduction using local or general anesthesia |
| Associated with ligament sprains, usually occur in athletes engaged in sports, caused by rotational stress. | Meniscus injuries |
| Patient states "my knee popped, clicked, or locked or gave way." | Meniscus injury |
| Pain is usually present in this type of injury but edema is not. | Meniscus injury |
| Though either form of arthritis can occur at any age, this form of arthritis usually affects older people. | Osteoarthritis |
| Heberden's nodes and Bouchard's nodes are characteristic of | Osteoarthritis |
| This type of arthritis is considered an inflammatory, autoimmune disease | Rheumatoid arthritis |
| The most common type of arthritis | Osteoarthritis |
| A positive rheumatoid factor, elevated sedrate, elevated CRP, and anemia are diagnostic lab tests consistent with | Rheumatoid arthritis |
| X-ray evidence of bone spurs or osteophytes are consistent with | Osteoarthritis |
| Slow or gradual onset of joint pain is consistent with | Osteoarthritis |
| Joint damage which occurs with bilateral symmetry (same joint on both sides of body) is characteristic of | Rheumatoid arthritis |
| Tests which can measure the amount of muscle damage (as can occur in rheumatic diseases) include: | CPK and Aldolase |
| Treatment plans for fibromyalgia patients may include: | Patient education, stress reduction, exercise, medications. |
| Neurovascular assessment for musculoskeletal trauma includes: | Color, temperature, capillary refill, peripheral pulses, edema, sensation, motor function, pain. |
| A break in the continuity of the structure of the bone. | Fracture |
| What is the main cause of fractures? | Trauma |
| What are the two causes of fractures? | Trauma and pathologic disease. |
| Fractures are described as | Stable, unstable, Open |
| What should be assessed (signs/symptoms) for with fractures? | Patient history of injury, location of pain, decreased function, inability to bear weight guarding and protecting the site. |
| During the neurovascular assessment of a fracture how should pulses be measured? | On both extremities manually or with a doppler |
| What are the steps in order of fracture healing? | Hematoma, Granulation tissue, Callus formation, Ossification, Consolidation |
| Why is the presence of a hematoma a good thing for fracture healing? | Because it shows circulation |
| What are the factors influencing fracture healing? | Age, displacement of the fracture, blood supply to the area, immobilization, infections, implants, hormones. |
| Fractures that do not heal in the expected time | Delayed Union |
| Fractures that do not heal at all | Non-union |
| What are causes of delayed and non-union fractures? | Movement of fracture fragments, infection, poor nutrition, systemic disease. |
| What is a method to stimulate bone healing? | Electrical stimulation and pulse electromagnetic fields (PEMF's) |
| What are the goals of fracture healing? | Anatomic realignment of bone fragments, immobilization, restore normal or near normal functioning |
| Non-surgical, manual realignment, traction applied to bone fragments to restore position, length, and alignment, local or general anesthesia, brace or splint applied after. | Closed reduction |
| Performed through surgical incision, fixation with wires, screws, pins, plates, intramedullary rods, or nails. | Open reduction |
| What are disadvantages of open reduction? | Post op infection, complications from anesthesia, previous existing medical condtions. |
| What kind of diet is recommended for a fracture patient with reduced mobility? | Fresh fruits, vegetables, high in bulk/roughage, 2500 ml/day unless contraindicated |
| Besides nutrition what are other recommendations for patients with reduced mobility due to fracture? | Increase activity and fluid intake to prevent constipation, stool softeners, warm fluids, laxatives, suppositories, sitting or dangling on bed or standing exercises. |
| What is included in post op care of a (ORIF) open reduction with internal fixation? | Early initiation of ROM, continuous passive motion machine, get patient up and moving asap |
| The application of a pulling force to an injured part of the body while counter traction pulls in the opposite direction. | Traction |
| What are the purposes of traction? | Prevent or reduce muscle spasms, immobilization of a joint or body part, reduce fracture or dislocation, treat a pathologic joint condition. |
| Traction used for short term, aligns injured bones/joints, may be used until surgery is scheduled, tape, boots, or splits applied directly to skin, weights limited to 5-10 lbs. | Skin traction |
| Aligns injured bones/joints/contractures/congenital hip dysplasia, pins, wires are inserted into the bone, weight usually 5-45 lbs. | Skeletal traction |
| What are disadvantages to skeletal traction? | Infection and prolonged immobility |
| If extremity traction to be effective | The force must pull in the opposite direction to prevent the patient from sliding to the foot of the bed. |
| Metallic device composed of metal pins which are inserted into the bone and attached to external rods that stabilize the fracture. Usually last resort before amputation. | External fixator |
| Common treatment following closed reduction, allows for normal activities of daily living | Cast |
| Application incorporates the joints above and below the fracture and assist with joint stabilization | Cast |
| Sets in 15 minutes, not strong enough for weight bearing until 24 hours, avoid direct pressure on any hard surface, may need to be petaled around rough edges. | Plaster of Paris cast |
| What type of fracture complication includes bone infection, bone union, and or avascular necrosis? | Direct |
| What type of fracture complication includes blood and or nerve damage resulting in compartment syndrome, venous thrombosis, fat embolism, shock? | Indirect |
| Manifested by increased compartmental pressure within a confined myofascial complex. Causes compromise in the neurovascular function. | Compartment syndrome |
| Compartment syndrome is associated with | trauma, fractures, soft tissue damage, crushing injury, IV therapy, venomous snake bite |
| What are the six P's if impending compartment syndrome? | Paresthesia, pain, pallor, paralysis, pulselessness, pressure |
| What are acute interventions for compartment syndrome? | Do not elevate above the heart, avoid cold compress, may be necessary to remove or loosen bandages and bivalve the cast, reduction in traction weight. |
| Chronic disorder, widespread, non-articular musculoskeletal pain, fatigue, multiple tender points, poor sleep, morning stiffness, irritable bowel syndrome, anxiety. | Fibromyalgia Syndrome |
| What two criteria must be met for a fibromyalgia diagnosis? | Pain in 11 of 18 tender points upon palpation, widespread pain noted for 3 months |
| Symptoms of fibromyalgia | Widespread burning pain, head or facial pain, TMJ, fatigue, 11 tender points, migraine headaches, depression, anxiety, paresthesia, restless legs syndrome, IBS |
| Treatment of fibromyalgia includes | Rest, support groups, analgesics, antidepressants, skeletal muscle relaxants, anti-anxiety medication, exercise, nutritional support. |
| The first drug approved by the FDA to treat fibromyalgia that helps reduce pain and improve function. | Lyrica (pregabalin) |
| Side effects include dizziness, sleepiness, blurred vision, swelling of hands/and or feet, dry mouth. | Lyrica (pregabalin) |
| A systemic disease caused by an increase in uric acid production, an underexecretion of uric acid by the kidney, or an increased intake of foods containing purines. | Gout |
| Hereditary disorder of purine metabolism which leads to the overproduction or retention of uric acid. | Primary Gout |
| Excessive uric acid in the blood caused by another disorder or drug. | Secondary Gout |
| Phase of gout consisting of excruciating pain; rapid onset; inflammation of one or more small joints, especially the great toe. | Acute |
| Phase of gout with repeated episodes caused by deposits of urate crystals (tophi)under the skin and within the major organs, especially the renal system. | Chronic |
| Signs and symptoms of Gout | Excruciating pain, swelling and inflammation, tophi, low grade fever, malaise and headache, pruritis, renal stones, elevated serum uric acid levels, elevated ESR, presence of sodium urate crystals in aspirated joint fluid. |
| Elevated serum uric acid levels | >6 mg/dl |
| ESR 40-70 | Moderate inflammation |
| ESR 70-105 | Severe inflammation |
| What constitutes a definitive diagnosis of gout? | Presence of sodium urate crystals in aspirated joint fluid. |
| Used for the prevention of gout, blocks the production of uric acid. | Allopurinol (Zyloprim) |
| Uricosuric drug (gets rid of uric acid), inactivated by aspirin. | Probenecid (Benemid) |
| Anti-inflammatory, no analgesic properties but usually provides dramatic relief within 24-48 hours. | Colchicine |
| Patient teachings for gout | Avoid red meats, wine/beer, aged cheese, shellfish, achovies, sardines, mussels, venison, herring, lentils, asparagus, spinach, increase fluid intake to prevent stone formation, encourage weight reduction, avoid starvation diets. |
| Nursing care for gout | Bed rest during acute attacks, monitor joint ROM, elevate affected extremity, protect from contact with sheeets, administer meds as prescribed, skin care, educate. |
| Grating sensation caused by irregular & loose particles of cartilage in the joint. | Crepitus |
| DMARD used to treat RA that can cause severe vision changes, must see eye doctor every 6 months. | Plaquenil (hydroxychloroquine) |
| Initial DMARD for most RA patients, used for moderate to severe disease, suppresses the immune system, rapid acting. | Rheumatrex (methotrexate) |
| While using this DMARD for treatment of RA, the patient should be taught to avoid large crowds. | Rheumatrex (methotrexate) |
| Slow acting, may be used alone or in combination with other drugs, can diminish progression of RA, can cause birth defects. | DMARD's |
| Complication of RA seen in later disease that cause pulmonary effects (nodules in lungs and heart). | Sjogrens, Felty Syndrome |
| Enlargement of prostate gland resulting from increase in number of epithelial cells and stromal tissue, most common urologic problem in males. | Benign prostate hyperplasia |
| Diminished amount of urine | Oliguria |
| Large volume of urine in given time | Polyuria |
| No urinary output or <100 mL | Anuria |
| Obstructive symptoms of BPH | Decrease in caliber of force of urinary stream, difficulty in initiating urination, intermittency, dribbling at end of voiding. |
| Irritative symptoms of BPH | Urinary frequency and urgency, dysuria, bladder pain, nocturia, incontinence. |
| Risk factors for BPH include | Family history, enviornment, obesity, diet high in saturated fatty acids. |
| Possible causes of BPH | Excessive accumulation of dihydroxytestosterone, stimulation by estrogen, local growth hormone action. |
| Typically develops in inner part of prostate. | BPH |
| Complications related to urinary obstruction | Acute urinary retention, UTI and sepsis, bladder stones. |
| Diagnostic studies used for BPH | History and PE, DRE, urinalysis with culture, PSA level, serum creatinine, TRUS scan, uroflometry, cystourethroscopy. |
Created by:
Angiea
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