Term
| In the healthy individual Calcium level and Phosphorus level does what? |
|
Definition
| Calcium level decreases and phosphorus level increases and vice versa |
|
|
Term
| Disorders in ____ and ____ are often reflected in an alteration of serum clacium or phosphorus level |
|
Definition
| bone and the parathyroid gland |
|
|
Term
| Alkaline Phasphatase is an enzyme normally present where? |
|
Definition
|
|
Term
| The concentration of Alkaline phosphatase (ALP) increases with what? |
|
Definition
| With bone or liver damage |
|
|
Term
| In metabolic In metabolic bone disease and bone cancer ALP concentration (rises/decreases)in proportion to the osteoblastic activity? Which indicates what? |
|
Definition
Rises
Indicates bone formation |
|
|
Term
| The level of ALP is normally what in older adults? |
|
Definition
|
|
Term
| The Major muscle enzymes affected in skeletal muscle disease or inuries are? |
|
Definition
creatine kinase (CK-MM)
aspartate aminotransferase (AST)
Aldolase (ALD)
Lactic dehydrogenase (LDH) |
|
|
Term
| The serum CK level begins to rise how long after muscle injury? Example? |
|
Definition
|
|
Term
AST is moderately elevated (3-5x's normal) in certain muscle diseases such as....
What other isoenzymes also increase with these disorders? |
|
Definition
muscular dystrophy and dermatomyositis
Aldolase A and LDH |
|
|
Term
| What is visible on standard X-rays |
|
Definition
|
|
Term
| what are the inital screening views on x-rays? |
|
Definition
| Anteroposterior and lateral projections |
|
|
Term
| Stress views and oblique views on x-rays depend on what? |
|
Definition
| the part of the skeleton to be evaluated and the necessity of the x-ray |
|
|
Term
| What do you instruct the client about the X-ray? |
|
Definition
| The table will be cold and hard and that they should remain still during the filming process |
|
|
Term
| ___ involves the injection of contrast medium or dye into the subarachnoid space of the spine, usually by spinal puncture |
|
Definition
|
|
Term
| what can be visualized in the myelography? |
|
Definition
| the vertebral column, intervertebral disks, spinal nerve roots, and blood vessels |
|
|
Term
| What is typically used instead of myelography? |
|
Definition
| computed tomography (CT) and magnetic resonance imaging (MRI) |
|
|
Term
| What position is a client typically placed in after a Myelography and why? |
|
Definition
| sitting position to prevent the contrast medium from getting into the brain. |
|
|
Term
| ____ is an x-ray study of a joint after contrast medium (air or solution) has been injected to enhance its visualization |
|
Definition
|
|
Term
| When is double contrast arthrography performed? |
|
Definition
| when a traumatic injury is suspected |
|
|
Term
| What can a physicion determine with an arthrogram? |
|
Definition
| bone chips, torn ligaments or other loose bodies within the joints |
|
|
Term
| What are the most common joints studied with an arthrogram? |
|
Definition
|
|
Term
| Before an arthrogram, what do you question the client about? |
|
Definition
| allergy to contrast media |
|
|
Term
| Most joints are now studied by?? |
|
Definition
| Magnetic resonance imaging |
|
|
Term
| The computed tomography detects musculoskeletal problems particularly those of the ____ |
|
Definition
|
|
Term
| What kind of allergies should the nurse ask the patient about before a CT scan? |
|
Definition
| iodine-based contrast allergies |
|
|
Term
| CT scans may be requested with IV contrast if What is suspected? |
|
Definition
| tumor or postsurgicalchanges |
|
|
Term
| In a ___ the physician extracts a specimen of bone for microscopic examination |
|
Definition
|
|
Term
| Bone biopsy is an invasive test that may confirm the presence of? |
|
Definition
|
|
Term
| Two techniques used for a bone biopsy |
|
Definition
| needle (closed) or incisional (open) |
|
|
Term
| ___ is done for the dx of atrophy and inflammation. Example |
|
Definition
Muscle biopsy
atrophy (muscular dystrophy)
inflammation (polymyositis) |
|
|
Term
| __ is usually accompanied by nerve conduction studies for determining the electrical potential generated in an individual muscle |
|
Definition
|
|
Term
|
Definition
| neromuscular, lower motor neruon and peripheral nerve disorders |
|
|
Term
| What do you need to inform the client about an EMG procedure? |
|
Definition
| EMG may cause temp discomfort, especially when the client is subjected to episodes of electrical current |
|
|
Term
| What might the physician discontinue for someone undergoing an EMG and why? |
|
Definition
| d/c of skeletal muscle relaxants several days before the procedure to prevent meds from having effects on the test results |
|
|
Term
| When both EMG and nerve conduction studies are done, which is usually tested first? |
|
Definition
|
|
Term
| With EMG study how do you know nerve conduction is accomplished? |
|
Definition
|
|
Term
| with EMG the degree of nerve and muscle activity is recorded on |
|
Definition
|
|
Term
| After EMG the nurse does what? |
|
Definition
| provides comfort and inspects the needle sites for hematoma formation |
|
|
Term
| what can prevent hematoma formation from needle sites after an EMG? |
|
Definition
|
|
Term
| __ is a fiberoptic tube inserted into a joint for direct visualization |
|
Definition
|
|
Term
| which are the most commonly evaluated joints for an arthroscopy? |
|
Definition
|
|
Term
| What can be accomplished through arthroscope? |
|
Definition
| synovial biopsy and surgical procedures to repair traumatic injury |
|
|
Term
| Arthroscopy is performed on what basisi? |
|
Definition
| ambulatory or same-day surgery |
|
|
Term
| who are not candidates for arthroscopy? |
|
Definition
| clients who cannot flex their knees at least 40 degrees or who have infected knees |
|
|
Term
| what is the client given depending on the arthroscopy procedure? |
|
Definition
| local, light general, or epidural anesthesia |
|
|
Term
| What is used to minimize bleeding during arthroscopy? |
|
Definition
| a large pneumatic tourniquet around the thigh and/or meds promoting vasoconstriction |
|
|
Term
| What is the nurses role AFTER arthroscopy? |
|
Definition
| evaluate the nerurovascular status. Monitor distal pulses, warmth, color, cap refill, pain, movement and sensation of affected extremity |
|
|
Term
| If client has pain after the diagnostic athroscopy what is prescribed? |
|
Definition
| mild analgesic such as acetaminophen |
|
|
Term
| What is used for the first 24 hrs after arthroscopic surgery? |
|
Definition
|
|
Term
| How long should extremity be elevated after arthoscopy? |
|
Definition
|
|
Term
| When arthroscopic surgery is performed the health care provider usually prescribes what? Example? |
|
Definition
opioid-analgesic combo
oxycodone and acetaminophe (percocet, tylox) |
|
|
Term
| What would the nurse teach the client to observe for after an arthroscopy? |
|
Definition
swelling
hypothermia resulting from the use of the tourniquet during the procedure
Increased joint pain attributable to mechanical injury
Thrombophlebitis
Infection |
|
|
Term
| Severe joint or limb pain after discharge may indicate what after an arthroscopy? |
|
Definition
| possible complication and the client contacts the physician immediately |
|
|
Term
| The health care provider may see the clietn when after the arthroscopic test to check for complications? |
|
Definition
|
|
Term
| ___ is a radionuclide test in which radioactive material is injected for visualization of the entire skeleton |
|
Definition
|
|
Term
| What is a bone scan used for? |
|
Definition
| primarily to detect tumors, arthritis, osteomyelitis, osteoporosis, vertebral compression fractures and unexplained bone pain |
|
|
Term
| A bone scan is very useful in detecting what? |
|
Definition
| hairline fractures in clients with unexplained bone pain and diffuse metastic bone disease |
|
|
Term
| THe __ or __ is similar to the bone scan but is more specific and sensitive in detecting bone problems |
|
Definition
|
|
Term
| ___ is the radioisotope most commonly used in a gallium or thallium scan |
|
Definition
|
|
Term
| Gallium citrate migrates where? |
|
Definition
| brain, liver and breast tissue |
|
|
Term
| Clients with osteosarcoma which is better for dx the extent of the disease? Gallium or Thallium? |
|
Definition
|
|
Term
| Thallium has traditionally been used for the dx of ___ but can be used for additional evaluation of what? |
|
Definition
| Myocardial infactions/cancers of the bone |
|
|
Term
| When is the nuclear medicine administered to the test before the gallium scan? |
|
Definition
|
|
Term
| What is contraindicated during the time of the gallium scan? |
|
Definition
| other test taht require contrast media or other isotopes |
|
|
Term
| What should the nurse instruct the client about the radioactive material? |
|
Definition
| It poses no threat bc it readily deteriorates in the body. Gallium is excreted through the intestinal tract and it tends to collect in feces before the scanning procedure. |
|
|
Term
| How long does Gallium Thallium scans take? What should the client do during this time? |
|
Definition
| 30-60 minutes, must lie still for accurate test results |
|
|
Term
| What happens for a client who is not relaxed or a confused older client, or one in severe pain. |
|
Definition
|
|
Term
| What is the follow up care for thallium gallium scans? |
|
Definition
|
|
Term
| What should the nurse encourage the client to do after the gallium/thallium scan? |
|
Definition
| push fluids to facilitate urinary excretion |
|
|
Term
| __ is most appropriate for joints, soft tissue and bony tumors that involve soft tissues |
|
Definition
|
|
Term
| How is the MRI image produced? |
|
Definition
| interaction of magnetic fields, radio waves and atomic nuclei showing hydrogen density |
|
|
Term
| MRI is particularly useful in identifying problems with? |
|
Definition
| muscles tendons and ligaments |
|
|
Term
| what should the client do before the MRI test? |
|
Definition
| remove all metal objects and check clothing zippers and metal fastners |
|
|
Term
| What is acceptable metal in the body for a MRI? |
|
Definition
| joint implants made of titanium or stainless steel |
|
|
Term
| What metal found in the body is not safe for an MRI? |
|
Definition
| pacemakers and surgical clips |
|
|
Term
| What is the contrast agent approved for MRI? |
|
Definition
|
|
Term
| What is Gadolinium-DTPA most commonly used to dx? |
|
Definition
| degenerative vertebral disease and recurrent disk herniation (failed back surgery syndrome) |
|
|
Term
| Ultrasonography uses what to produce an image of the tissue? |
|
Definition
|
|
Term
| an ultrasound procedure may be used to visualize what? |
|
Definition
*soft tissue disorders (masses and fluid accumulation)
*traumatic joint injuries
*osteomyelitis
*surgical hardware palcement |
|
|
Term
| What prep and post test care is needed |
|
Definition
|
|
Term
| a ____ may be used for deterrmining factures or bone density |
|
Definition
|
|
Term
| A nonsurgical procedure may relieve the pain of a herniated disk by drawing the herniated portion away from the nerve root |
|
Definition
| percutaneous laser disk decompression |
|
|
Term
| What is typically prescribed for clients after percutaneous laser disk decompression? |
|
Definition
| 24hrs of bedrest before beginning progressive ambulation. |
|
|
Term
| Typically when can clients return to work after percutaneous laser disk decompression? |
|
Definition
|
|
Term
| In a conventional ___, the spinal nerve is usually lifted to remove the offending portion of the disk |
|
Definition
|
|
Term
| A____ is the removal of one or more vertebral laminae plus osteophytes, if present , and the herniated nucleus pulposus |
|
Definition
|
|
Term
| Standard hospital stay for a laminectomy or diskectomy |
|
Definition
|
|
Term
| When repeated laminectomies are performed or the spine is unstable, the surgeon may perform what? |
|
Definition
| a spinal fusion (arthrodesis) |
|
|
Term
| A spinal fusion is used to do what? |
|
Definition
| stabilize the affected area |
|
|
Term
| How is the spine stabilized in a spinal fusion? |
|
Definition
| Chips of bone are removed, typically from the iliac crest or obtained from donor bone and are grafted between the vertebrae for support and to strengthen the back |
|
|
Term
| An adjunct for clients for whom fusion may be difficult is the pracement of an implantable ___ to promote bone fusion |
|
Definition
| direct current stimulation |
|
|
Term
| 3 alternatives o a laminectomy |
|
Definition
| diskectomy, microdiskectomy and laser-assisted laparoscopic lumbar diskectomy |
|
|
Term
| Process of a percutaneous lumbar diskectomy |
|
Definition
| Surgeon uses fluroscopy to insert a metal cannula or endoscope, adjecent to the affected disk. A speciala cutting tool is threaded through the cannula for removal of disk pieces that are compressing the nerve root. |
|
|
Term
| What hospitalization is needed after a percutaneous lumbar diskectomy? |
|
Definition
|
|
Term
| Size of incision of a microdiskectomy |
|
Definition
|
|
Term
| What is a microdiskectomy used for? |
|
Definition
| allows easier identification of anatomic structures, imporved precision in removing small fragments and decreased tissue trauma and pain. |
|
|
Term
| ___ combines a laser with modified standard disk instruments inserted periumbilically through the laparoscopic cannula |
|
Definition
| laser-assisted laparoscopic lumbar diskectomy |
|
|
Term
| What should the client be warned about before a lumbar laminectomy? |
|
Definition
| various sensations, such as numbness and tingling may be experienced in the affected leg or in both legs bc of the m anipulation of the nerves and muscles during surgery |
|
|
Term
| The surgeon provides what type of information of the type and source of bone for surgery. |
|
Definition
| written and verbal information |
|
|
Term
| What is the nurses postop care of a client after a lumbar laminectomy? |
|
Definition
| preventing and assessing complications that might occur in the first 24-48hrs. |
|
|
Term
| How often does the nurse take vitals after lumbar laminectomy? |
|
Definition
| at least every 4 hours during the first 24 hours to assess for fever and hypotension. |
|
|
Term
| If the client is found to have fever or hypotention after a lumbar laminectomy what could be expected? |
|
Definition
| could indicate bleeding or severe pain |
|
|
Term
| What other assessment is used and how often after a lumbar laminectomy? |
|
Definition
| Nerulogical assessment q4h. **client's ability to move and feel sensation in the extremeties** |
|
|
Term
| If client has inability to void after lumbar laminectomy what would that indicate? |
|
Definition
| damage to the scral spinal nerves, which control the detrusor muscle in the bladder. Opiod analgesics have been associated with difficulty voiding. |
|
|
Term
| When would the nurse allow the client to get out of bed with assistance after a diskectomy or laminectomy? |
|
Definition
| evening of surgery which may facilitate voiding |
|
|
Term
| Client is first given what for pain control after diskectomy or laminectomy? |
|
Definition
| Patient-controlled analgesia or IV meds such as morphine |
|
|
Term
| When will the patient be able to have oral medication after a diskectomy or laminectomy? |
|
Definition
| when the client is able to take fluids. |
|
|
Term
| If a client has bulging at the incision site after a diskectomy or laminectomy what could that indicate? What would the nurse do? |
|
Definition
| may be due to a CSF leak or hematoma. The nurse reports to the surgeon. |
|
|
Term
| After a diskectomy or laminectomy what kind of surgical drain would be used? How often do you record amt of drainage? When is the drain removed? |
|
Definition
**Jaskson-Pratt or Hemovac
**q8hrs
**surgeon normally removes in 24-36hrs |
|
|
Term
| How often should the client log roll after a disk/laminectomy? |
|
Definition
|
|
Term
| What direction is given to the client after a disk/laminectomy about getting out of bed? |
|
Definition
| Be sure to keep his or her back strait. Client should sit in a straight-backed chair with feet resting comfortably on the floor. |
|
|
Term
| What does deep breathing in the client post dickectomy/lamenectomy prevent? How often should the client do this? |
|
Definition
atelectasis and pneumonia.
q2hrs |
|
|
Term
| For the conventional fusion what does the nurse inspect? |
|
Definition
| iliac and spinal incision areas for problems |
|
|
Term
| What does a client wear when he or she is out of bed after convention fusion? |
|
Definition
| a brace or other type of thoracolumbar support |
|
|
Term
| After convention fusion what is the client told about prolonged sitting or standing? |
|
Definition
|
|
Term
| __ is a metabolic disease in which bone demineralization results in decreased density and subsequent fractures |
|
Definition
|
|
Term
| Osteoporosis is often referred to as.. |
|
Definition
|
|
Term
| What is most often the first indication of osteoporosis? |
|
Definition
|
|
Term
| What are most often affected by osteoporosis? |
|
Definition
| the wrist, hip and vertebral column |
|
|
Term
|
Definition
|
|
Term
| When does Osteoporosis and osteopenia occur? |
|
Definition
| when there is a disruption in the bone remodleing process |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| The disruption of the bone remodeling process can be described when... |
|
Definition
| osteoclastic activity is greater than osteoblastic activity |
|
|
Term
| What is the result when osteoclastic activity is greater than osteoblastic activity? |
|
Definition
| decreased bone mineral density |
|
|
Term
| What does bone mineral density determine? and when does it peak? |
|
Definition
bone strength
between 30 and 35 yrs of age |
|
|
Term
| Before and during the peak years osteoclastic activity is followed by osteoblastic activity at what kkind of rate? |
|
Definition
|
|
Term
| What kind of bone is lost first in osteoporosis process? Followed by? |
|
Definition
Trabecular or cancellous (spongy) bone.
coritcal (compact) bone |
|
|
Term
| Osteopenia is present when the T-score is between.. |
|
Definition
|
|
Term
| Osteoporosis in postmenopausal women is defined as a BMD T-score more than ... |
|
Definition
| 2.5 standard deviations below normal |
|
|
Term
| Two theories of disease development of osteoporosis? |
|
Definition
1. may result from decreased osteoblastic activity. Osteoblasts may have a shortened life span or may be less efficient in the clietn with osteoporosis.
2. increase in osteoclastic activity. (most popular) |
|
|
Term
| How can osteoporosis be classified? |
|
Definition
|
|
Term
| ___ osteoporosis involves many structures in the skeleton |
|
Definition
|
|
Term
| Generalized osteoporsis is divided into two categories |
|
Definition
|
|
Term
| __ osteoporosis is more common and occurs in postmenopausal women and in men in 60's-70's |
|
Definition
|
|
Term
| ___ presumably prevents or decreases the rate of bone resorption in women and is unavailable in sufficient quantities after m enopause |
|
Definition
|
|
Term
| Secondary osteoporosis results from? |
|
Definition
| an associated medical condition, such as hyperparathyroidism; long-term drug therapy such as corticosteroids; or prolonged immobility, such as that seen with spinal cord injury. |
|
|
Term
| How is tx of secondary osteoporosis determined? |
|
Definition
| the cause of osteoporosis when possible. |
|
|
Term
| ____ osteoporosis occurs when a lib is immobilized related to a fracture, injury, paralysis or joing inflammation |
|
Definition
|
|
Term
| Immobilization for periods of time greater than how long can result in regional osteoporosis? |
|
Definition
|
|
