center of the diaphysis

(shaft) contains the bone marrow

1. Epiphysis
2. Diaphysis
3. Epiphysis
4. Spongy bone
5. Epiphyseal line
6. Compact bone
7. Medullary cavity 

Compact bone

(lamellar)

Where are the nerves and blood vessesls contained in the bones

haversian canal

rings of bone around the haversain canal contain the nerves and blood vessels

• found at the ends of long bones and center of other bones
• Contains red bone marrow

where is the yellow marrow found?

 what is yellow marrow compsed of?

central cavities of the long bones

 (Femur and Humerus)

mostly fat

osteocytes

 (Lacuna)

2 hormones that regulate the amount of calcium in the body

calcitonin

parathormone

26

7 Cervical

12 thoracic

5 lumbar

1 sacral (5 fused)

1 coccygeal

breakfast 7am - cervical

lunch 12 noon- thoracic

dinner 5pm - lumbar

humerus - upper arm

ulna and radius - forearm

femur - thigh

Tibia and Fibula - lower leg

lateral curvature of the vertebral column

may affect breathing

exaggeration of the thoracic curve

hunchback

excessive lumbar curve

swayback

joint cavity that contains synovial fluid

1. hinge
2. pivot
3. ball and socket
4. saddle
5. condyloid
6. gliding

1. actin
2. myosin
3. ATP
4. calcuim

a compound that is produced when muscles work without oxygen

tone remains the same, but the muscle shortens

(lifting weights)

the movement toward the dorsum

(or top of the wrist of foot)

when having a pt dorsiflex what are we checking for?

Name

DVT

Homan's Sign

report pain in calf

1. how tall are you?
2. do you take calcium supplements? 

kyphosis

who is it common in

exaggerated curvature of the thoracic spine

older adults

lordosis

who is it common in?

exaggerated curvature of the lumbar spine

toddler years and pregnancy

what is worn during and x-ray?

 what must be removed?

what test is important to perform befoe and x-ray?

gown

 jewelry, eye glasses, and any metal objects or clothing that might interfere with the x-ray images

HCG= pregnancy test

what is important for women to notify the healthcare provider of before getting an x-ray?

what test is performed

if they are pregnant

hcg = pregnancy test

nursing considerations for myelogram

assess for allergies to shell fish or iodine

lay flat after procedure to reduce spinal headache

nuclear scanning

(radioisotope scan or radionuclide scan)

nursing considerations:

1. monitor BUN and cratinine before test (kidney function)
2. assess for allergies to shellfish and iodine
3. push fluids, post test to aid in elimination of the dye
4. have client flush toilet 3 times

MRI

magnetic resonance imaging

• a medical imaging technique used to visualize the structures and function in the body
• shows detailed images of the body in any plane
• shows greater tissue than a CT scan
• uses a powerful magnetization of hydrogen atoms in water in the body

• remove jewelry and metals
• NO pacemakers or prosthetic metal implants
• assess for allergies of shellfish or iodine if contrast is used.
• monitor BUN and Creatinine
• Push fluids if contrast is used
• assess for claustrophobia 

what is important for a diabetic scheduled for MRI OR CT SCAN

CT or CAT scan nursing considerations

NPO  3-4 hours pretest

assess allergies

labs BUN and Creatinine

push fluids

DEXA scan

what does DEXA stand for

a DEXA scanner produces two x-ray beams;

one beam is high energy, the other is low energy

• stop calcium supplements and osteoporosis medications at least 48 hours pretest
• contraindicated in pregnancy
• remove all jewelry, interferes with test results

INVASIVE - need informed concent

minimally invasive surgical procedure; examination and sometimes treatment of damage of the interior of a joint

• informed consent
• NPO, general anesthesia
• stop smoking before surgery
• teach s/s of infection
• monitor CMST

what is normal s/s when a contrast dye is used

abnormal

warm feeling

sensation of urinating

----------------------------------------------------

hives

swelling

SOB

• puncture of a joint with a needle and withdrawal of synovial fluid
• fluid should be straw colored and clear or slightly clouded; teach s/s of infection

serum calcium test

found on what panels ?

blood test

BMP-basic metabolic panel (measures electrolytes)

CMP- Comprehensive Metabolic Panel (liver function)

what is ESR?

WHAT DOES IT MEASURE?

Erythrocyte Sedimentation Rate - blood test

non specific measure of inflammation

what does RF stand for?

what is RF?

rheumatoid factor

measures the amount of rheumatoid factor in the blood

rheumatoid factor is a protein (antibody) that attacks IgG another protien (antibody) - auto immune

ANA test

What does it detect?

what is a positive result and indication of?

Antinuclear Antibody test

An ANA test detects antinuclear antibodies in the blood

A positive ANA test may indicate an autoimmune disease such as lupus or rheumatoid arthritis

excess serum accumulation of uric acid in the blood can lead to? 

what is rheumatoid arthritis?

chronic, systemic, inflammatory autoimmune disease

what are the characteristics of RA?

resulting in?

what are the deformities caused by RA -

rheumatoid arthritis

1. destruction of cartilage, bone  and ligaments
2. ulnar drift
3. swan neck deformity
4. boutonnier deformity

• women
• young adulthood 20-30 years 

U

S

B

s/s of RA

Ulnar Drift

Swan Neck

Boutonnier - deformity of the thumb

1. reddened, swollen, warm joints
2. joint pain and stiffness in the morning upon waking 
3. weight loss and fever
4. decreased ROM

what is the goal of the treatment for RA?

name 3 goals

1. reduce joint inflammation and pain
2. maximize joint function
3. prevent joint deformity and destruction 

x-ray

ESR (increased)

RF ( increased)

ANA test

chronic, non-systemic non inflammatory disorder

overuse of joints

low impact such as:

swimming, slow walking or bicylcing

• age - the older the client the more wear and tear (degeneration) on the joint
• prior injury
• obesity- the heavier the person the more strain on the weight bearing joints
• gender-after age 55, women 

• pain that worsens with activity
• decreased ROM
• crepitation
• Herberden's - distal joint
• Bouchards's -proximal joint 

Bouchard's node closes to palm - proximal

Heberden's node farthest from the palm- distal

Treatment of DJD / osteoarthritis

name 3

1. weight loss 
2. balanced rest and exercise
3. medications 

Exercise during which the body works against the force of gravity and the feet and legs carry a person's weight.

Examples include walking, jogging and dancing.

what is the most important nursing consideration for DJD?

what are these pts at risk for?

• increased fluids to protect the kidney
• Low purine diet
• medications: nsaids for inflammation and pain, Colchicine-for acute gout, Probenecid or Allopurinol -for prevention

probenecid or Allopurinol

watch for rash

• Encourage fluids to reduce uric acid levels and protect the kidneys
• immobilize joints
• teach client to avoid meats, shellfish, fowl, nuts, beans and alcohol
• provide medications as ordered, monitor for adverse reactions

immobility and sedentary lifestyle

menopause

smoking , alcoholism, caffeine

• asymptomatic until a fracture occurs
• pathological fractures
• fractures with minimal trauma
• progressive deformity (kyposis, height los
• low back pain
• porous brittle bones 

• teach client to limit alcohol, caffeine and tobacco use
• provide high calcium diet
• prevention of falls
• physical therapy, promotion of weight bearing exercises 

sardines

milk

dairy products

broccoli

cheese

• sudden pain and tenderness in the affected bone
• swelling
• fever
• chills
• nausea
• malaise

• elevated WBC and ESR
• blood and wound cultures

The rate at which red blood cells settle out in a tube of unclotted blood, expressed in millimeters per hour; elevated sedimentation rates indicate the presence of inflammation.

• immobilize the affected part
• analgesics and IV fluids
• I&D of abscess or sinus tract/wound care
• systemic antibiotics
• surgery-debridement/amputation 

• apply ice bags or cold compress intermittently
• elevate extremity to reduce edema

overstretching of the muscle

may result in muscle tears

how may muscle or tendon strains occur

name 5 ways

• falls
• sprinting
• throwing
• inadequate exercise warm-ups
• degenerative changes

Ligament

R - rest

I - ice

C - compression 

E - elevation

rear-facing infant carseats

 short- sature drivers (less than 4'6")

children under 12 years

carpal tunnel syndrome

who is frequently affected

a form of repetitive stress injury

computer, keyboard and mouse users