MEDICAL N101 Exam 2 Study Guide | Eastwick College

Chapter 35 —
o Parathyroid Hormone (PTH) = pulls Ca out of bone into
blood
o Calcitonin = inhibits bone resorption, puts Ca into bone

Assessment of o
o
Estrogen protects bone
Excess thyroid hormone/cortisol = bone loss


Musculoskeletal
 Poor blood supply = ↓ osteogenesis, can cause bone necrosis
4. Bone healing
4 stages

Function 1. Hematoma: first 1–2 days, bleeding/clot forms
2. Inflammatory/soft callus: fibroblasts + osteoblasts move in, soft
fibrocartilage bridge forms
3. Reparative/bony union: week 3–4+, mature bone replaces soft
1. Big picture callus, x-ray shows alignment
 Arthritis = leading cause of musculoskeletal-related disability 4. Remodeling: compact bone replaces spongy bone, can take
 Musculoskeletal (MSK) system = bones + joints + muscles + months to years
tendons + ligaments + bursae  Healing depends on blood supply, alignment, immobilization,
 Jobs: support body, protect organs, move body, make heat, help age, health
venous return, store minerals, house marrow  Serial x-rays monitor healing
 If one part gets hurt, the rest get messed up too. 5. Joint system
2. Skeletal system  Joint = articulation
 206 bones  Types:
 Types: o Synarthrosis = immovable
o Long = femur, humerus o Amphiarthrosis = slight movement
o Short = hand/ankle bones o Diarthrosis/synovial = freely movable
o Flat = skull, sternum; protects organs  Synovial joint parts:
o Flat bones (sternum, skull) = provide vital organ o Articular cartilage
protection; fractures may puncture underlying organs o Joint capsule
o Irregular = vertebrae, jaw o Synovium → makes synovial fluid
 Long bone basics: o Meniscus/discs in some joints
o Diaphysis = shaft = mostly cortical/compact bone o Ligaments = bone to bone
o Epiphysis = ends = mostly cancellous/trabecular bone o Tendons = muscle to bone
o Epiphyseal plate = growth plate in kids o Bursa = fluid sac that cushions movement
o Articular cartilage = smooth, avascular joint covering  Synovial joint types:
 Bone cells: o Ball-and-socket = hip/shoulder
o Osteoblast = builds bone o Hinge = elbow/knee
o Osteocyte = mature bone cell, maintains bone o Saddle = thumb
o Osteoclast = breaks down/resorbs bone o Pivot = radius/ulna
 Outer cover = periosteum o Gliding = wrist/carpals
 Inner lining = endosteum 6. Skeletal muscle system
 Red marrow = makes RBCs, WBCs, platelets  Skeletal muscle = striated, used for movement, posture, heat
 Yellow marrow = fat, mostly adult long bones  Muscle made of:
3. Bone formation + maintenance o fasciculi
 Osteogenesis = bone formation o fascia/epimysium
 Ossification = mineral gets laid into matrix
o muscle fibers
 Bone = collagen for flex + calcium/phos for strength
o myofibrils
 Bone always remodeling:
o sarcomeres
o kids/teens = build > break down
o actin + myosin
o peak bone mass around age 20
o full skeletal turnover about every 10 years
 Contraction needs:
o nerve signal
 Bone builders:
o calcium
o Weight-bearing exercise
o ATP
o Calcium 1000–1200 mg/day
o Vitamin D for Ca absorption
 Isometric = tension up, no length change, no joint move
o ex: push against wall
 Hormones:
o Calcitriol (active vit D) = absorbs Ca from
 Isotonic = muscle shortens, joint moves
o ex: flex forearm
Gastrointestinal (GI)
 Hard exercise with low O2 = more lactic acid
 Fatigue = glycogen depletion + lactic acid buildup


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,7. Muscle tone + actions  alcohol/tobacco
 Muscle tone = baseline resting tension  calcium/vit D intake
 Flaccid/atonic = low or no tone  comorbidities/disability
 Spastic = increased tone 11. Common symptoms
 Upper motor neuron lesion = ↑ tone, hyperreflexia Pain
 Lower motor neuron lesion = ↓ tone, atrophy  Bone pain = dull, deep, boring ache; may mess with sleep
 Muscle roles:  Muscle pain = sore/aching/cramps
o Prime mover = main muscle doing motion  Fracture pain = sharp/piercing; better with immobilization
o Synergist = helps  Joint pain = in/around joint, worse with movement
o Antagonist = opposes motion  Pain stimulates the sympathetic nervous system — can raise
8. Exercise, disuse, repair Blood Pressure (BP), HR, and respirations
 Hypertrophy = muscle bigger from repeated use  Pain worse with activity = think strain/sprain/compartment
syndrome
 Atrophy = muscle smaller from disuse/aging
 Bed rest, traction, casting = muscle loss
 Steady worsening pain = think infection, tumor, neurovascular
problem
 Prevent loss with:
 Radiating pain = nerve root pressure
o isometric exercises
 Morning pain = more inflammatory/rheumatic
o quad sets
 Tendonitis = worse early morning
o gluteal sets
 Osteoarthritis (OA) = worse as day goes on
o Quad sets technique = supine, legs extended, push Altered sensation
knees into bed while contracting anterior thigh; no  Paresthesia = burning, tingling, numbness
prone position, no bending the knees  Causes = nerve pressure or circulation problem
o active/resistance exercise of unaffected parts  Compare affected side to unaffected side
 Injured muscle needs:  If worsening, think neurovascular compromise
o rest first 12. Fracture Risk Assessment Tool (FRAX) high-yield
o then progressive exercise after healing Fracture Risk Assessment Tool (FRAX) = 10-year fracture risk tool
9. Gerontologic changes Risk factors:
Older adult Musculoskeletal (MSK):  older age
 Loss of height  female
 Kyphosis  low Body Mass Index (BMI)
 ↓ flexibility  prior fracture
 ↓ strength/endurance/agility  parent hip fracture
 slower response time  smoker
 wider base of support  corticosteroid use
 ↑ falls  rheumatoid arthritis
 cartilage deterioration  alcohol ≥3 drinks/day
 intervertebral disc thinning  secondary osteoporosis risks:
 lax ligaments  Mattress alarm may prevent falls in confused postoperative
 ↑ fractures clients; night-lights reduce fall risk
 women lose more bone mass than men o type 1 Diabetes Mellitus
 hand/wrist problems common: Osteoarthritis (OA), trigger finger, o osteogenesis imperfecta
carpal tunnel o hyperthyroidism
 Pronator drift = arm drifts downward + pronates with eyes closed; o hypogonadism/premature menopause
indicates upper motor neuron problem
o malnutrition/malabsorption
 5/5 muscle strength = moves against full resistance; symmetrical
o chronic liver disease
movement and slightly greater mass in dominant arm = normal
13. Physical assessment
10. Health history
Posture
Ask:
Know the 3 spinal deformities:
 onset
 Kyphosis = increased thoracic curve
 location
 Lordosis = increased lumbar curve
 severity
 Scoliosis = lateral spine curve
 duration
Check shoulder + hip symmetry and spine while standing and
 frequency
bending.
 what makes it worse/better
 Brace care: no lotions/powders under brace; wear soft clothing
 progression/remission beneath the brace
 family hx of similar issues Gait
 trauma/falls hx
 occupation/heavy lifting Developmental dysplasia of the hip (Developmental Dysplasia of the Hip
 exercise (DDH))


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,  Limited hip Range of Motion (ROM) = common finding  paresthesia
 Ortolani maneuver used during assessment  weakness/paralysis
Normal = smooth, rhythmic  coolness
Abnormal:  pale/cyanotic/mottled skin
 limp = pain or leg length issue  cap refill >3 sec
 spastic hemiparesis gait = stroke This is limb-threatening. Function can be lost if >6 hrs.
 steppage gait = Lower Motor Neuron (LMN) disease 14. Peripheral nerve checks
 shuffling gait = Parkinson’s  Peroneal nerve
Bone integrity o sensation: between great toe + 2nd toe
Look for: o movement: dorsiflex foot, extend toes
 deformity  Tibial nerve
 angulation o sensation: sole of foot
 shortening
o movement: plantar flex foot/toes
 amputation
 Radial nerve
 crepitus
o sensation: back of hand near thumb/index
 motion where no joint should move
o movement: extend wrist/thumb/fingers
 distal pulse/color/temp/cap refill/sensation/motion/edema
Do not move fracture fragments around.
 Ulnar nerve
Joint function o sensation: small finger
Check: o movement: abduct fingers
 Range of Motion (ROM) active + passive  Median nerve
 deformity o sensation: index finger
 stability o movement: touch thumb to little finger, check wrist
 tenderness flexion
 nodules 15. Diagnostic tests + nursing points
 warmth/swelling/effusion X-ray
 Effusion = excess fluid in joint  Shows bone density, texture, erosion, joint changes, fracture
 Knee tests: healing
o Balloon sign  Need multiple views sometimes
Computed Tomography (CT)
o Ballottement
 Better cross-sectional detail
 Crepitus = rough grating crackling sound
 Good for tumors, soft tissue/ligament/tendon injury, severe
 Nodule patterns:
trauma, hard-to-see fractures
o Rheumatoid Arthritis (RA) = soft nodules
Magnetic Resonance Imaging (MRI)
o Ballottement test for knee effusion: milk fluid below
 Best for soft tissue: muscles, ligaments, cartilage, discs, hip/pelvis
patella → press top to block → push lower portion →  No pain, but noisy, 30–90 min
positive = fluid present
 No metal: jewelry, hearing aids, hair clips, magnetic cards
o Gout = hard, may leak white crystals
 Some transdermal patches must come off because burn risk
o Osteoarthritis (OA) = hard, painless bony overgrowth
 Claustrophobia may need sedation; open Magnetic Resonance
Muscle strength + size Imaging (MRI) = lower quality but easier to tolerate
 Test against resistance Arthrography
 Handshake = quick grip check  Contrast or air injected into joint
 Clonus = rhythmic contraction  Joint moved through Range of Motion (ROM) while x-rays taken
 Fasciculation = involuntary twitching  Used for unexplained joint pain/joint disease
 Measure girth same exact spot each time  Contrast = nephrotoxic; check Blood Urea Nitrogen
 1 cm difference = significant (BUN)/creatinine + allergy to iodine/shellfish/seafood before
Skin giving; hold metformin 48 hr before/after iodinated contrast
Check:  Tear = contrast leaks out
 edema  Post-test: mild analgesia/ice; clicking/crackling for 24–48 hr can
 temp be normal
 color Bone densitometry
 bruises/cuts  Measures Bone Mineral Density
 circulation changes  Main test = DXA/Dual-Energy X-ray Absorptiometry (DEXA)
 inflammation signs  Best for osteoporosis + fracture risk, especially hip/spine
Neurovascular status  Assess pregnancy/position tolerance/claustrophobia/metal if
Think Circulation, Motion, and Sensation (CMS) = circulation, motion, relevant for imaging prep
sensation Bone scan
Compartment syndrome red flags:  Detects bone tumors, osteomyelitis, some fractures, aseptic
 pain out of proportion necrosis, degenerative disease
 pain on passive stretch


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,  Intravenous (IV) radioisotope, scan 2–3 hr later  Alkaline Phosphatase (ALP) ↑ early fracture healing + increased
 Brighter uptake = abnormal bone activity osteoblastic activity
 Nursing:  Calcitonin, Parathyroid Hormone (PTH), vitamin D, thyroid
o check pregnancy/breastfeeding studies = bone metabolism
o Bone biopsy = painful; dehiscence not possible  Creatine Kinase (CK) + Aspartate Aminotransferase (AST) ↑ with
(incision not linear); infection signs not evident in muscle damage
immediate recovery period  Osteocalcin = bone turnover
o explain flushing/warmth may happen  Urine calcium ↑ with bone destruction
o encourage fluids  Bone markers:

o empty bladder before scan
o NTx, Dpd = ↑ bone resorption/osteoclast activity

Arthroscopy o bone-specific Alkaline Phosphatase (ALP), osteocalcin,
 Direct look inside joint with scope P1NP = ↑ bone formation/remodeling
 Can diagnose + treat tears/defects
o Yellow bone marrow = old red marrow turned to fat →
why long bone fractures risk fat emboli
 Post-op:
o compression dressing
o Ca normal = 8.2–10.6 mg/dL; >13 = DANGEROUS →
notify provider immediately
o ice
o Ca intake = 1,000–2,000 mg/day; must take with
o elevate/extend joint
Vitamin D for proper absorption
o monitor neurovascular status
o Troponin = cardiac gold standard (most specific);
o avoid strenuous joint use myoglobin = nonspecific — any muscle damage
o teach report fever, bleeding, swelling, numbness, cool o Reticulocyte count = immature RBCs released during
skin hemorrhage; carry LESS oxygen
Arthrocentesis o Creatine Kinase (CK) (Creatinine Kinase) = muscle
 Joint aspiration damage marker (elevated in fractures, rhabdomyolysis,
 Used to get synovial fluid or relieve effusion pain compartment syndrome)
 Helps dx septic arthritis, inflammatory arthropathies, o Platelet bags must be kept in constant motion to
hemarthrosis prevent clumping — do NOT refrigerate
 Can inject anti-inflammatory meds 17. Super high-yield one-liners
 Nursing:  Osteoblast builds, osteoclast breaks
o teach procedure  Parathyroid Hormone (PTH) pulls Ca from bone
o sterile dressing  Calcitonin puts Ca into bone
o ice first 24–48 hr  Estrogen protects bone
o watch for infection/bleeding  Corticosteroids weaken bone
Electromyography (EMG)  Fracture healing: hematoma → soft callus → bony union →
 Measures electrical activity of muscle + nerve remodeling
 Used for weakness, pain, disability, nerve damage  Crepitus = grating
 Needle electrodes inserted  Effusion = fluid in joint
 Nursing:  Clonus = rhythmic contraction
o ask about anticoagulants  Fasciculation = twitching
o check for skin infection  Atrophy = disuse
o no lotions/creams day of test  Compartment syndrome = emergency

o warm compress after for soreness
 Circulation, Motion, and Sensation (CMS) checks = circulation,
motion, sensation
Biopsy
 Magnetic Resonance Imaging (MRI) = no metal
 Bone marrow, bone, muscle, or synovium sample
 Bone scan = drink fluids after isotope
 Nursing:
 Arthroscopy post-op = compression, ice, elevate
o explain procedure
 Magnetic Resonance Imaging (MRI) with contrast = invasive →
o give analgesia as ordered
consent required; without contrast = non-invasive → no consent
o monitor bleeding, edema, hematoma, infection needed
o Bone marrow biopsy: patient feels pressure not pain  Dual-Energy X-ray Absorptiometry (DEXA) scan = non-invasive →
(Jamshidi needle used); Tylenol after; no tub bath 24 NO consent needed; bone scan uses radioisotopes → patient
hrs; patient does NOT need to isolate does NOT need to isolate (safe dose)
o ice as ordered  Functional ability = priority assessment in older adults — can
o teach to report fever/chills/redness/bleeding/pain they perform Activities of Daily Living (ADLs) and Instrumental
16. Lab studies Activities of Daily Living (IADLs) independently?
 Serum Ca altered in osteomalacia, parathyroid problems, Paget, ________________________________
metastatic bone tumors, prolonged immobility
 Phosphorus low in osteomalacia with malabsorption
 Acid phosphatase ↑ in Paget + metastatic cancer


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