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yanira
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yanira
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2011-10-25 21:36:46
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CHAPTER 62 MED SURGE BOOK
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  1. Where does RBC production in an adult usually occur?
    • It normally occurs in the red bone marrow of the skull, ribs, sternum, pelvis, vertebrae, and shoulder bones. (hematopoiesis)
    • -the yellow marrow only will be used in times of emergencys
  2. Where does bone growth occur in a child
    In the epiphyseal plate...if interrupted it can lead to functional problems
  3. Name the 3 types of cell found in bone and their functions?
    • Osteoblast-synthesizes organic bone matrix (collagen) and are the basic bone forming cells
    • Osteoclast- participate in bone remodeling (that is the removel of old bone, called resorption) by assisting in the breakdown of bone tissue
    • Osteocytes- are the mature bone cells
  4. Anatomy of the bone
    • Epiphysis- are the end of the bones
    • Metaphysis- Just below the epiphysis and inbetween the epi and the diaphysis...by the epiphyseal plate
    • The shaft of the bone is cover by periosteum andthe end are covered by articular cartilage
  5. What does hematopoietic tissue do?
    here the production of RBC take place (hematopoiesis)
  6. How many bones do we have and there classification
    • 206
    • Long bones- with diaphysis and epiphyses
    • Short bones- composed of cancellous bone(spongy) cover by a thinn layer of compact bone (corticol)
    • Flat bones- two layers of compact bone seperated by cancellous bone- ribs, scapulla, skull
    • Irregular
  7. What are Joints
    its basically the cavity that is made inbetween the bones..they are called synovial joints or Diarthrodial joints. In there you will find synovial fluid that lubricates the space for the bones....purposes is to decrease friction.
  8. What is cartilage?
    • is a rigid connective tissue
    • found around the bone ( the articular cartilage)
    • its the epiphyseal plate in children
    • -its avascular so its very hard for it to heal
  9. Name the three types of cartilage
    • The hyaline cartilage-most common containing collagen fibers, found in the trachea, bronchi, nose, epiphyseal plate,
    • Elastic cartilage- ( more flexible) found in the ear, epiglotis, larynx
    • Fibrous cartilage- mostly collagen and is though tissue mostly for shock absorber...found in the vertebrae
  10. Name the 3 types of muscles
    • Smooth, cardiac, skeletal
    • Smooth- found in the walls of hallow structures such as airways, arteries, GI, urinary bladder, and uterus (invouluntary, nonstraitated)
    • cardiac muscles- strated, involuntary), found in the heart
    • Skeletal- requires stimulation
  11. Anatomy structured of the muscle
    • The epimysium sorrounds the whole muscle
    • The perimysium sorrounds the fasciculi bundles and the each individual fiber is sorrounded by endomysium
  12. The sarcomere is the contractile unit of the myofibrils
  13. What is the difference between isotonic and isometric contractions?
    • Isotonic contractions- shorten a muscle to produce movement
    • Isometric contraction- increase the tension within a muscle but do not produce movement
  14. Where is the olecranon proncess located at and the acromion process
    in the elbow...and the other in the upper portion on the humerus
  15. Almost 30% of muscle mass is lost by age 70yr
  16. Data that should be gathered during the muscularskeletal assessment
    -at least cover 14 areas
    • Past health history
    • -any illness that the client had that may affect the bones, family history (genetic), any infections they recently had,
    • -Medications
    • -For woman....mentrual cycle (menapause and amenorrhea) and any estrogen therapy
    • -Immunization-tetanus and polio vacc
    • -the stress the put on body while working or doing work outs
    • -Nutrition
    • -Elimination
    • -Activity and exercise
    • -Sleep and rest
    • -Pain
    • Selp perception-image after deformity
    • Role relationship pattern
    • Sexuality reproductive pattern
    • Coping stress tolerance
    • Value belief pattern
  17. What drugs that can interfere with the muscularskeletal system
    • Muscle relaxants
    • opioids
    • NSAIDs
    • Corticosteroids
    • -antiseizures drugs- osteomalacia
    • -phenothiazines- gait disturbances
    • -corticosteroids- avascular necrosis,decreaed bone and muscle mass
    • Diuretics-muscles cramps and weakness
  18. Rickets
    Rickets is a softening of bones in children due to deficiency or impaired metabolism of vitamin D, magnesium [1], phosphorus or calcium,[2] potentially leading to fractures and deformity. Rickets is among the most frequent childhood diseases in many developing countries
  19. Scurvy
    Scurvy is a disease resulting from a deficiency of vitamin C, which is required for the synthesis of collagen in humans. The chemical name for vitamin C, ascorbic acid, is derived from the Latin name of scurvy, scorbutus, which also provides the adjective scorbutic ("of, characterized by or having to do with scurvy"). Scurvy often presents itself initially as symptoms of malaise and lethargy, followed by formation of spots on the skin, spongy gums, and bleeding from the mucous membranes. Spots are most abundant on the thighs and legs, and a person with the ailment looks pale, feels depressed, and is partially immobilized. As scurvy advances, there can be open, suppurating wounds, loss of teeth, jaundice, fever, neuropathy and death.
  20. Osteomalacia
    Osteomalacia is the softening of the bones caused by defective bone mineralization secondary to inadequate amounts of available phosphorus and calcium, or because of overactive resorption of calcium from the bone as a result of hyperparathyroidism (which causes hypercalcemia, in contrast to other etiologies).[1] Osteomalacia in children is known as rickets, and because of this, use of the term osteomalacia is often restricted to the milder, adult form of the disease. It may show signs as diffuse body pains, muscle weakness, and fragility of the bones. The most common cause of the disease is a deficiency in vitamin D, which is normally obtained from the diet and/or lack of sunlight exposure.[2]
  21. Objective date you should gathered during musculoskeletal assessment
    • Inspection- as a general assessment inspect the skin, color change, scars, spots, assymetry, the nodules, massess that can be seen
    • Palpate- any massses. skin temp,local tenderness, swelling,
    • Motion- Assess joint mobility ROM passive and active.
    • Muscle strenght
  22. Cafe au lait spots
    • Having six or more café au lait spots greater than 5 mm in diameter before puberty, or greater than 15 mm in diameter after puberty, is a diagnostic feature of neurofibromatosis type I, but other features are required to diagnose NF-1.
    • Familial multiple café au lait spots have been observed without NF-1 diagnosis.[4]
    • can be normal andrun in family (jocy)
  23. Goniometer
    • measures angle of the joints
    • -used if a problem is suspected
  24. How do you document a 5 on a muscle streght
    5 bilaterally with full resistance to oppostion
  25. Where do you measure the lenght and mass of a limb
    The affected limb is measure in the anterior superior iliac crest and the bottom of the medial malleolus and compared to the other limb...muscle mass is measure circumferentially at the largest area of the muscle
  26. Muscle streght table
    • 0- No detection of muscular contraction
    • 1- A barely detectable flicker or trace of contraction with observation or palpation
    • 2- Active movement of body part with elimination of gravity
    • 3- Active movement against gravity only and not against resistance
    • 4- Active movement against gravity and some resistance
    • 5- Active movement against full resistance without evident fatigue
  27. Scoliosis
    • is a S shaped curvature of the thoracic ad lumbar spine
    • asymmetric elevationof shoulder scapulae, and iliac crest, if the deformity is greater than 45 degreee it can cause cardiac and resp problems
    • have the patient place fingers together as if divingand slowly bend forward
  28. How to assess sciatica or leg pain
    • have the patient in a supine position, raise the client leg passively up to 60 degrees or less, if the client complaints of pain along its a positive test
    • Positive test indicates nerve root irritation from intervertebral disk prolapse and herniation, usually in L4-5 L5-S1
  29. What do you find in the joint of a Gout diagnose client
    presence of uric acid crystals and the color is whiteish yellow
  30. If you find floating flat globules in the joints it indicates
    bone damage
  31. Synovial fluid should be what color?
    • normal synovial fluid should be transparent and colorless or straw colored, low viscosity
    • if the fluid is infected it might be purulent and thick or gray and thin.
  32. Diagnostic test that can be used in musculoskeletal system
    • x-ray
    • diskogram
    • computed tomography scan (CT scan)
    • myelogram with or without ct
    • magnetic resonance imaging (MRI)
  33. Diskogram
    • an x ray of cervical and lumbar intervertebral disk with a dye
    • -make sure that the patient is not allergic to the dye
  34. CT scan
    • x ray beams 3D pic it helps identify soft tissue abnormalities, bony abnormalities, musculoskeletal trauma
    • -make sure that the client is not allergic to shellfish
  35. MRI
    • radiowavesand magnetic field
    • view soft tissue, useful in the diagnosis of avascular necrosis, disk disease, tumors, osteomyelitits, ligament tears, cartilage tears
    • -gadolinium can be injected to enhance visualiation
    • contraindication-aneurysm clips, metallic implants,pacemakes, electronic devices, hearing aids,shrapnel
  36. Myelogram with or without ct
    • injection of a dye into the sac of the nerve roots
    • -main risk is a spinal headache for 1-2days it should be resolve with rest and fluids an reported to MD
  37. Dual energy x ray absorptiometry DEXA
    • technique measure bone mass of spine,femur,forearm, and total body weight
    • little radiation used
  38. Quantitive ultrasound QUS
    evaluates density, elasticity and strenght of patella and calcaneus using ultrasound rather than radiation
  39. Bone scan
    • it involves injecting technetium-99m that is taken by bone
    • increased intake is seen in osteoporosis, osteomyelitis, fractures
    • decreased is seen in areas of avascular necrosis
    • radioisotope is given 2hrs before procedure, procedure takes an hr and the client should increase fluid intake.
  40. What is alkaline phosphate, its normal values, and what does an increase indicate?
    • this enzyme is produced by osteoblast, its needed for mineralization of organic bone matrix.
    • Elevated levels indicate healing fractures, bone cancers, osteoporosis, osteomalacia, and pagets disease
    • 30-120 U/L
  41. decreased and increase calcium indicates?
    • Decreased indicates osteomalacia, renal disease, and hypoparathyroidism
    • Increase indicates hyperparathyroidism, some bone tumor
    • Normal 8.5-10.5
  42. Phosphorus
    • decresed levels is found in osteomalacia
    • increased- chronic renal disease, healing fractures, osteolytic, metastatic tumor
  43. What is Rheumatoid factor
    • Normal is Negative or titer <1:20
    • Rheumatoid factor (RF or RhF) is an autoantibody (antibody directed against an organism's own tissues) most relevant in rheumatoid arthritis.[1] It is an antibody against the Fc portion of IgG, which is itself an antibody. RF and IgG join to form immune complexes that contribute to the disease process.
  44. Erythrocyte sedimentation rate
    • study measures rapidity with RBC settle out of unclotted blood in 1hr
    • -elevation are seen in inflammatory responses such as theumatoid arthritis, rheumatic fever, osteomyelitits, and resp infection
    • Normal- <20mm/hr

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