Integumentary/musculoskeletal
Help!
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| aloplecia | loss of hair
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| angioma | benign tumors made up of small blood vessels or lymph vessels, birthmark
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| crust | dried serum, blood, purulent exudate, slightly elevated, size varies
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| furuncle | boil, inflammation deep in the hair follicle, spreads to surrounding tissues
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| carbuncle | cluster of furuncles
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| dermatitis | inflammations of the skin-through direct contact with an agent
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| eczema | 1.commonly associated with allergies 2.seen in infants 3.papular and vesicular lesions that rupture
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| keloid | tough, irregularly shaped scar that becomes enlarged
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| macule | discolored spot, not raised above surface
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| papule | elevated, firm, circumscribed area
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| nodule | elevated, firm, circumscribed lesion extending deeper into the dermis
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| vesicle | elevated circumscribed skin lesion, not into the dermis, filled with serous fluid
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| pustule | elevated, superficial lesion, filled with purulent fluid
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| tinea pedia | athlete's foot
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| wheal | elevated, irregularly shaped area of edema
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| 1. stratum corneum 2. pigment layer 3. stratum germinativum | epidermis
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| 1. "true skin" 2. contains blood vessels, nerves, glands, hair follicles 3. cells composed of connective tissue and elastic fibers, bathed in interstitial fluid 4.papillae | dermis
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| 1. "fatty layer" 2. adipose tissue and loose connective tissue 3. stores water and fat, insulates, protects organs, pathway for nerves and blood vessels | subcutaneous
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| sudoriferous glands | sweat glands
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| ceruminous glands | 1. secrete wax like substance called cerumen 2. located in external ear canal
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| sebaceous glands | 1. "oil glands" 2. lubricate skin and hair 3. inhibits bacterial growth
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| bleb | large blister filled with serous fluid
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| atheroma | abnormal mass of fat or lipids
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| 1. caused by herpes virus hominis 2. two types | herpes simplex virus
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| 1. area reddened and edematous 2. vesicles ulcerate and crust over 3. general malaise 4. no cure | Herpes Simplex type 1
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| 1. vesicles rupture and encrust causeing ulcerations 2. lesions may be present for 2-3 weeks 3. headache, fatigue, myalgia, and elevated temperature occur 3-4 days after vesicles erupt | herpes simplex type 2
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| 1. caused by varicella virus 2. lesions along the nerve fibers of spinal ganglia 3. pain, itching, and heightened sensitivity along nerve pathway 4. vesicle formation, crusting of skin 5. severe pain | Herpes Zoster (Shingles)
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| 1. caused by staphylococcus aureus, streptococci 2. lesions start as macules and develop into vesicles 3. rupture and crust 4. crust leaves skin smooth/red 5. highly contagious from contact | Impetigo
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| medical management of impetigo | 1. erythromycin 2. cephalosporin 3. rocephin 4. bactroban
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| what causes furuncle? | staphylococcus infection of a hair follicle
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| tinea capitis | ringworm of the scalp
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| tinea corporis | ringworm of the body
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| tinea cruris | "jock itch"
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| oral antifungal drugs | 1. Fulvicin 2. Grifulvin
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| what is used to diagnose tinea capitis? | Wood's light- ultraviolet light
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| Contact dermatitis | 1. skin reaction from direct contact with agents in environment to which one is hypersensitive
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| dermatitis venenata | poison ivy or poison oak
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| wheals from an allergic reaction (hives) | urticaria
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| acne vulgaris | 1. develops when oil glands become occluded 2. inflammatory skin eruption from sebaceous glands
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| 1. noninfectious 2. sloughing and new generation of skin cells occurs more rapidly than 28 days 3. chronic, hereditary | psoriasis
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| ______ and ______ decrease the shedding of skin | keratolytic agents (tar preparations), salicylic acid (Calicylic)
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| PUVU therapy | photochemotherapy used in treatment of psoriasis
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| pediculosis | (lice) parasitic disorder of skin associated w/poor living conditions or poor hygiene
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| Pediculicides used in lice | 1. Lindane (Kwell) 2. pyrethrins (RID)
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| 1. parasitic skin disorder 2. female itch mite penetrating skin, laying eggs 3. eggs mature and rise to skin surface 4. wavy, brown threadlike lines on body, sever pruritis | scabies
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| treatment specific to scabies | crotamiton (Eurax) 4-8% solution of sulfur in pretrolatum
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| 1. NSAIDS 2. Corticosteroids 3. disease-modifying anti-rheumatics (DMARDS) | types of antirheumatic agents
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| 1. celebrex 2. advil 3. indocin | NSAIDS
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| 1. betamethasone 2. dexamethasone 3. methylprednisolone 4. prednisone | corticosteriods
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| 1. Enbrel 2. Arava 3. Remicade 4. Folex | DMARDS
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| DMARDS side effects | 1. pulmonary fibrosis 2. anemia 4. hepatotoxicity 5. nephropathy
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| be cautious of ________ in use of DMARDS | immunosuppression
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| ankylosis | fixation of a joint, usually in an abnormal postition resulting from destruction of cartilage or bone
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| arthrocentesis | puncture of a joint with a needle to withdraw fluid used for diagnostic purposes
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| bipolar hip replacement | prosthetic implant used to replace the femoral head and neck in hip fractures when the vascular supply to the femoral head is or may become compromised
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| Blanching test | test of the rate of capillary refill
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| callus | bony deposits formed between and around the broken ends of a fractured bones during healing
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| Colles' fracture | a fracture of the distal portion of the radius within 1 inch of the wrist
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| crepitus | sounds that represent the cracking noise heard when rubbing hair between fingers, assoiciated with broken bones
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| fibromyalgia | a musculosskeletal chronic pain syndrome of unknown etiology that causes pain in muscles, bones, or joints
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| kyphosis | abnormal condition of the vertebral column, characterized by increased convexity in the curvature of the thoracic spine
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| lordosis | an increase in the curve at the lumbar space region that throws the shoulders back
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| paresthesia | any subjective sensation, such as prickling "pins and needles" or feeling of numbness
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| scoliosis | curvature of the spine usually consisting of two curves, the original abnormal curve and compensatory curve in the opposite direction
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| sequestrum | a fragment of necrotic that is partially or entirelydetached from the adjacent healthy bone
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| subluxation | partial dislocation
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| Volkmann's contracture | a permanent contracture with clawhand
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| Functions of Musculoskeletal system (5) | 1. support 2. protection 3. movement 4. mineral storage 5. hematopoiesis
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| found in extremitites | long bones
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| found in the hand | short bones
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| found in the vertebrae | irregular bones
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| functions of joints (2) | 1. hold bones together to form skeleton 2. allow movement and flexibility of skeleton
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| no movement joints | synarthrosis
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| slight movement joints | amphiarthrosis
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| free movement joints | diarthrosis
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| epimysium | connective tissue that surrounds each muscle fiber
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| 7Ps of neurovascular assessment | 1. pulselessness 2. paresthesia 3. paralysis 4. polar temperature 5. pallor 6. puffiness (edema) 7. pain
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| normal calcium levels | 9-10.5 mg/dl
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| erythrocyte sedimentation rate | 1. indicates presence of inflammation (rheumatoid arthritis) 2. (males) 15 mm/hr; (females) 20 mm/hr
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| muscle functions (3) | 1. motion 2. maintenance of posture 3. production of heart
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| normal uric acid levels | 1. (males) 2.1-8.5 mg/dl 2. (females) 2.0-6.6 mg/dl
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| common types of arthritis (4) | 1. rheumatoid arthritis 2. osteoarthritis 3. gout 4. ankylosing spondylitis
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| 1. systemic inflammatory disorder of connective tissue/joints 2. chronicity, remissions, and exacerbation 3. cause unknown, strongly believed to be autoimmune | rheumatoid arthritis
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| 4 classic symptoms of rheumatoid arthritis | 1. morning stiffness 2. joint pain 3. muscle weakness and atrophy 4. fatigue
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| classic deformities of RA | 1. swan neck deformity 2. boutonniere deformity 3. ulnar deviation
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| methotrexate (Rheumatrex is used in RA when there are _______ _____________ | bony erosions
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| injections of viscosupplements (Hyalgan, Synvisc and Supartz) act as... | lubricants to provide joint tissue viscosity
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| Degenerative joint disease | 1. also known as osteoarthritis 2. most common type 3. typically affects "weight-bearing" joints 4. no remission, no systemic systems 5. non-inflammatory disorder that progressively causes bones and joints to degenerate
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| s/s of degenerative joint disease | 1. joint stiffness and pain 2. joint enlargement 3. limitation of movement 4. Herberden's/Bouchard's nodes
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| 1. metabolic disease resulting from accumulation of uric acid in blood 2. affects men 8-9 times more than women 3. three types (primary, secondary, idiopathic) | Gout
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| primary gout | linked to hereditary factors, severe dieting or starvations, excessive ingestion of purines
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| secondary gout | resulting from use of certain medications or complications of another disease
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| s/s of gout | 1. sudden onset of pain and tenderness in one joint 2. swelling and redness of joint 3. fever 4. joint deformities
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| medical management of gout: | 1.uricosuric drugs 2. decrease ingestion of purine 3. use of NSAIDS
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| ankylosing spondylitis | 1. aka Marie- Strumpell Disease 2. chronic connective tissue disorder of the spine and surrounding cartilaginous joints 3. ususally begins in early childhood 4. more common in men than women
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| Legg-Calve-perthes disease | when ball of thighbone in the hip doesn't get enough blood causing the bone to die
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| pathophysiological changes associate with ankylosing spondylitis | 1. immobility and fixation of the joints in the hip and ascends the vertebrae 2. respiratory functions may be compromised 3. inflammation of aorta 4. iridocylitis 5. pulmonary fibrosis
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| s/s of ankylosing spondylitis | 1. difficulty in expanding ribcage 2. vision loss from glaucoma and pupil damage 3. low back pain and stiffness 4. sciatica pain 5. weight loss 6. edema
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| 1. disorder that results in a reduction in bone mass which interferes with mechanical support function of the bone 2. women between ages of 55-65 at higher risk due to loss of estrogen | osteoporosis
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| risk factors for osteoporosis | 1. use of steroids 2. high caffeine intake 3. diet low in cacium 4. smoking 5. excessive protein
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| clinical manifestations of osteoporosis | 1. disorder develops slowly 2. first symptoms is backache 3.bone becomes porous and brittle
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| osteomyelitis | 1. local or generalized infection of the bone and bone marrow 2. infection introduced through trauma or surgery
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| fibromyalgia | 1. chronic pain syndrome of unknown etiology that causes pain in muscles, bones, or joints 2. affects more women than men 3. no permanent damage, not life-threatening
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| clinical manifestations of fibromyalgia | 1. generalized achiness (neck/lower back) 2. stiffness (worse in the morning) 3. aggravated by sever factors (cold, humidity, fatigue, stress)
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| additional problems that accompany fibromyalgia | 1. irritable bowel syndrome 2. tension headaches 3. paresthesia of upper extremities 4. sensation of edematous hands with no visible edema 5. sleep dysfunction
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| why are tricyclic antidepressants used in fibromyalgia? | 1. antidepressant effects 2. anti-inflammatory effects 3. central skeletal muscle relaxant effects 4. pain inhibition
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| corticosteroid side effects | 1. personality changes 2. adrenal suppression 3. muscle wasting, osteoporosis
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| Important nursing implications for patients taking corticosteroids | 1. assess potassium, blood glucose, urine glucose 2. monitor daily weight 3. monitor I
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| DMARDS important nursing implication: | assess for pain and ROM
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| bone resorption inhibitors | primarily used to treat and prevent osteoporosis in postmenopausal women
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| biphosphonates | 1. type of bone resorption inhibitor 2. inhibit hydroxyapatite crystal dissolution and osteoclast activity 3. alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel)
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| raloxifene | 1. type of bone resorption inhibitor 2. binds to estrogen receptor, producing estrogen-like effects on bone
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| do not use biphosphonates on patients with... | hypocalcemia
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| bone resorption inhibitor side effects | 1. acid regurgitation 2. esophageal ulcer 3. musculoskeletal pain
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| _______ __________ decrease absorption of biphosphonates | calcium supplements
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| when should alendronate be administered? | 1st thing in the morning with 8 oz of water 30 minutes before meals
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| 1. cortisone 2. hydrocortisone | systemic short-acting corticosteroids
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| 1. methylprednisolone 2.prednisolone 3.prednisone | systemic intermediate-acting corticosteroids
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| 1. betamethasone 2. dexamethasone | systemic long-acting corticosteroids
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| skeletal muscle relaxants | 1. spasticity associates with spinal cord diseases or leasions 2. adjunctive therapy in the sumptomatic relief of acute painful musculoskeletal conditions
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| central-acting spinal muscle relaxants | 1. inhibits reflexes at the spinal level 2. i.e. baclofen, carisoprodol, cyclobenzaprine
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| direct-acting spinal muscle relaxants | 1. acts directly on skeletal muscle, causing relaxation by decreasing calcium release 2. i.e. dantolene
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| skeletal muscle relaxant side effects | 1. seizures 2. drowsiness 3. hypotension 4. nausea
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| avoid ____ and _____ _________ while taking skeletal muscle relaxants | alcohol, CNS depressants
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| tophi | calculi containing sodium urate deposits that develop in periarticular fibrous tissue, resulting in inflammation of the joint
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| allopurinol | 1. antigout agent 2. prevention of attack of gouty arthritis and nephropathy 3. treatment of secondary hyperuricemia 4. inhibits production of uric acid
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| colchicine | 1. antigout agent 2. acute attacks of gouty arthritis 3. prevention of gout reocurrences 4. interferes with the functions of WBCs in initiating and perpetuating the inflammatory response to monosodium urate crystals
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| allopurinol side effects | 1. drowsiness 2. rash 3. bone marrow depression
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| cochicine side effects | 1. anuria 2. agranulocytosis 3. aplastic anemia 4. peripheral neuritis
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| colchicine may cause malabsorption of | vitamin B12
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| taking oral hypoglycemics or warfarin with allopurinol will ______ the effects | increases
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| minimum fluid intake for a patient on allopurinol | 2500-3000mL/day
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| signs of colchicine toxicity | 1. weakness 2. abd pain 3. nausea 4. vomiting 5. diarrhea
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| important labs to monitor for patient on colchicine | CBC, AST, and alkaline phosphatase
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| __________ does not relieve acute attacks of gout | allopurinol
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| to coincide with the body's normal secretion of cortisol, administer __________ in the morning | corticosteroids
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| clinical improvement from allopurinol will show within... | 2-6 weeks
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| colchicine will show improvement in pain and swelling within | 12 hours
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| open (compound) | bone breaks through the skin
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| closed (simple) | a fracture that does not break the skin
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| displaced | the bone ends are separated at the fracture line
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| incomplete | bone breaks through only one cortex
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| greenstick | one side of a bone is broken and the other side is bent
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| complete | the fracture line extends entirely through the bone
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| comminuted | the bone is splintered into many small fragments at the fracture site with the bone ends separated and usually misaligned
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| impacted (telescope fracture) | one bone fragment is forcibly wedged into another
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| transverse | break runs directly across the bone, a right angle
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| oblique | break slants the length of the bone, at a 45 degree angle
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| spiral | breaks coils around the bone
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| Colles' fracture | fractures of the distal portion of the radius within 1 inch of the joint of the wrist, commonly occurs from the attempt to break a fall
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| Pott's fracture | distal end of the fibula, chiping off a piece of the medial malleolus with a displacement of the foot outward
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| false motion | 1. unnatural motion 2. sign of fracture
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| closed reduction | manual manipulations, moving bony fragments into position by applying traction and pressure
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| gas gangrene | 1. severe infection of the skeletal muscle caused by gram positive Clostridium bacteria- C. perfringens 2. occurs in the presence of compound fractures/lacerated wound 3.s/s- crepitation, gas bubbles, foul odor
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| assess for Homan's sign to determine if there is a _________ | thromboembolus
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| thermal burns | 1. flames, scalding and thermal energy (heat) 2. most common type
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| nonthermal burns | 1. electricity 2. chemicals 3. radiation
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| superficial (1st degree) | 1. epidermis is damaged, dermis unharmed, heals in less than 5 days 2. i.e. sunburn
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| partial thickness (2nd degree) | 1. affects both epidermis and dermis 2. up to three weeks to heal, may scar 3. scalds, chemicals
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| full thickness (3rd degree) | 1. all layers of skin are detroyed- no pain 2. can lead to sepsis, scarring and contractures
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| inhalation burns | Categorized as one of the most lethal types of burns especially when there is a cutaneous injury associated with the respiratory tract burn
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| three causes of inhalation burns | 1. heat inhalation 2. inhalation of toxic chemicals or smoke 3. inhalation of carbon monoxide gas
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| effects of inhalation burns on the body | 1. mucosa in lungs swell and break, leaking fluid into nearby alveolar spaces and damaging cilia 2. mucus builds up and plugs passages 3. oxygen is reduced and can lead to death
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| very late signs of carbon monoxide poisoning | 1. cherry-red coloring to unburned skin 2. changes in color of mucous membrane 3. neurological damage
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| s/s of inhalation burns | 1. edema of face and neck 2. burned mucosa in mouth and throat 3. hoarseness 4. stridor 5. AMS
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| 4cc lactated ringers X %burn X weight(kg)= initial 24 hour fluid replacement | modified brooke formula for fluid replacement
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| dosing for fluid replacement | 1. first 8 hours- give 1/2 of total calculated fluid 2. during second 8 hours, give 1/4 of total fluids 3. during 3rd 8 hours, give 1/4 total fluids
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| emergent phase (stage 1) | 1. initital 24-48 hours 2. capillaries dilate and become hyperpremeable causing a shift of intravascular fluid into interstitial space
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| burn shock | 1. hypostension 2. decreased urine output 3. increased pulse 4. rapid and shallow respirations 5. most burn deaths
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| intermediate or acute phase (stage 2) | 1. aka diuretic phase 2. 48-72 hours after burn 3. potential for circulatory overload as a result of fluid shift from interstitial into the capillaries 4. kidneys excrete large volumes
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| long term rehabillitation phase (stage 3) | begins when treatment begins
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| autograft | uses the patients own skin
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| allograft or homograft | from a cadaver
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| heterograft | 1.obtained from animals, usually pigs 2. temporary
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| alternative materials used to cover wounds and promote healing | 1. TransCyte 2. Biobrane
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| purpose of skin graft | 1. lessen chance of infection 2. minimize fluid loss 3. reduce scarring and function loss
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| Silver sulfadiazine (Silvadine) | 1. most affective if applied immediately 2. pain free 3. diadvantage- may delay epithelialization, bone marrow suppression
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| mafenide acetate (Sulfamylon) | 1. best when treating highly contaminated wounds 2. disadvantages- exaggerates post-burn hyperventilation, painful application
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| Silver nitrate | 1. causes loss of sodium, potassium, chloride and calcium 2. best if applied immediately 3. does NOT eschar 4. ineffective if infection already established
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| spider angiomas | 1. a group of venous capillaries that dilate like a branch of spiders 2. associated with liver disease
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| verruca (wart) | 1. viral lesion 2. contagious
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| plantar's wart | occur on soles of feet and are very painful
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| nevus (mole) | 1. a congentital, non-vascular skin blemish 2. usually benign but may become cancerous 3. raised, and black is considered pre-cancerous and removal is recommended
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| basal cell carcinoma | 1. malignant tumor 2. occurs in epidermis 3. usually scaly, pearly papule w/central crater 4. favorable outcome if treated early
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| squamous cell carcinoma | 1. occurs in the epidermis layer on areas exposed to sun 2. firm, nodular lesion topped with a crust or ulceration
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| malignant melanoma | 1. occur in dermis and epidermis 2. originates in melanocytes of epidermis
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| ABCD's of melanoma | 1. A= assymmetry 2. B= border is irregular 3. C= color is varied from one area to another 4. D= diameter is generally larger than 6mm
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| phantom pain | occurs because the nerve tracks that register pain in the amputated area continue to send messages to the brain
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| how often should you assess for neurovascular impairment in a postoperative amputation patient | hourly
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| place the patient in a prone postitiona minimum of twice a day, in order to stretch the ______ ________ | flexor muscles
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| tx for sevre and persistent phantom pain | 1. stump revision with reamputation at a higher level 2. local infiltration of the stump with procaine 3. mechanical percussion (shrink neuromas) 4.sympathetic nerve block
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