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ortho
ortho diseases
| Question | Answer |
|---|---|
| osteoporosis | compromised bone strength (demineralization), increased risk for fracture |
| osteopenia | low bone mineral density |
| peak bone mass | achieved at 30 years old |
| who's at risk for osteoporosis | caucasian women, small frame, men (later in life),60-80% inherited |
| when does bone loss begin | perimenopausal period, loss of testosterone/estrogen |
| other disease process that can contribute to osteoporosis | cushings, hyperparathyroidism, anorexia, thyrotoxicosis, ( they deplete the calcium in bone) |
| drugs that contribute to osteoporosis | lasix, steroids, thyroid hormones, dilantin |
| clinical manifestations of osteoporosis | vertebral compression fractures, wrist fractures, hip fractures, kyphosis, downward compression by the ribs causes distension & bloating |
| diagnosis of osteoporosis | dexascan |
| how to prevent osteoporosis | calcium, vit.D, dairy, salmon, supplements, limit caffine, decrease sodium, limit pop, increase protein,exercise,no smoke, no alcohol |
| osteoporosis meds | non hormone replacement 1st, evista, fosamax, actonel, boniva |
| evista | estrogen receptor modulator, less risk of breast cancer, increase risk of uterine cancer |
| fosomax | biophosonate, prevents bone breakdown, empty stomache, 30 min before eating |
| actonel | biophosphonate, daily or weekly, take with a full glass of water |
| boniva | biophosphonate, once a month |
| Pagets disease | idiopathic disorder, abnormal bone breakdown, abnormal formation, more prevalent in men |
| patho of pagets disease | normal bone replaced by abnormal, structurally weaker bone, risk for fracture |
| location of pagets disease | painful deformities of femur, tibia, lower spine, pelvis, skull, upper humerus |
| assessment of pagets | aching bones, skeletal deformity, bowing deformity, fractures, nerve compression, vertigo & hearing loss (due to ear bone) |
| tx or pagets | nsaids, heat, massage therapy, biophosphonates |
| osteomalacia | widespread decalcification and softening of bones, spine, pelvis, lower extremities |
| cause of osteomalacia | lack of sunlight, anticonvulsants, vegans, renal failure, low fat diets |
| interventions for osteomalacia | Vit D, calcium, high protien |
| gout | uric acid build up in joints, altered protein metabolism, mainly big toe, ankle, foot |
| Dx of gout | history, symptoms, blood/urine uric acid levels, x-ray |
| Sx of gout | pain, swelling, redness of affected joint |
| tx for acute attacks | colchicine, nsaid, steroid, ice, bedrest, NO ASPRIN (increases uric acid level) |
| longterm tx for gout | allupurinol (cholchichine), wt management, decrease dietary purine, no alcohol, increase fluids to 2-3 L/day |
| source of dietary purine | organ meat, shell fish, wild game, beef, pork, |
| scoliosis | lateral curve of spine |
| kyphosis | posterior rounding of thoracic spine |
| lordosis | inward swaying of lumbar spine |
| osteomyelitis | infectin of bone and surrounding tissue, can be chronic if not treated promptly |
| possible outcome of osteomyelitis | loss of function, amputation, death |
| cause of osteomyelitis | viral, often drug resistant bacteria (MRSA) |
| typical locations for osteomyelitis | femur, sacrum, heels, new prsthesis |
| who is at risk for osteomyelitis | males, diabetics, IVDA, trauma, pressure ulcers, bloodstream infections |
| Assessment of osteomyelitis | acute,localized pain (long bones), fever, malaise, redness |
| vertebral osteomyelitis coorelates with what | IVDA, GU infections |
| osteomyelitis in the foot coorelates with what | vascular insufficiency (diabetes |
| diagnosis of osteomyelitis | elevated WBC, elevated ESR (= inflammation), x-ray 7-10 days after infection, bone scan, MRI (most definitive) |
| treatment of osteomyelitis | Iv antibiotics 4-8 wks via PICC, then oral for 4-8 wks, open and drain wounds possibly |
| osteosarcoma | most common bone tumor, distal femur, proximal tibia, age 10-30 |
| ewing's sarcoma | mimics osteomyelitis, 5-15 yrs old |
| fibrosarcoma | malignant collagen fibers, age 5-80 |
| chrondosarcoma | formation of cartilage by tumor celss, femur, pelvis, ribs, scapula, age 30-60 |
| What lab will rise if primary or secondary bone tumors are present | alkaline phosphates |
| how to tx bone tumors | chemo, radiation, round the clock narcotics, anti-inflammatories, anti-depressants |
| risk factors for spinal cord injury | #1 trauma (MVS, MCA,bullets,falls,sports), more than half involve cervical spine, high morbidity & mortality |
| types of spinal cord injuries | hyperflexion (most common), hyperextension (after fall), compression (fall on head) |
| most common spinal cord injury sites | c1-2, c4-6, T11-12 |
| patho for spinal cord injury | edema , temporary loss of sensation/function, longterm inflamm processm, sympathetic nerve response, spasticity |
| development of edema in spinal cord injury | develops in 1-2 hrs, peaks in 2-3 days, subsides within 7 days |
| diagnosis of spinal cord injury | 1st x-ray then CT scan, MRI |
| immediate nursing concern for spinal cord injury | neurogenic shock, systemic effects of shock, immobility, depression, aspiration |
| neurogenic shock in spinal cord injury | poor sympathetic tone, hypotension due to vasodilation (decrease BP) |
| systemic dffects of shock in spinal cord injury | pulmonary failure, renal perfusion, gut perfusion |
| effects of immobility in spinal cord injury | skin breakdown, DVT, contractures |
| What is spinal shock | complete loss of skeletal muscle function, bowel & bladder tone, sexual func., autonomic reflexex, venous return, hypotension,loss of temp control, |
| how long does spinal shock usually last | 1-6 weeks |
| 2 signs spinal shock is improving | hyperreflexia & babinski reflex ( toes fan) |
| central cord injury | more weakness in the upper extremities, elderly w/ spinal stenosis, diving, falling |
| anterior cord syndrome | complete motor function loss, decreased pain sensation, deep pressure, position sense, 2 point discrimination remain intact |
| brown-sequard syndrome | lateral hemisection of the cord (bullet/knife wound), same side motor loss, loss of vibratory & position sense, opposite side loss of pain and temp sensation |
| conus medullaris | damage to lumbar roots, loss of bowel, bladder reflex, flaccid lower extremities |
| cauda Equina syndrome | injury to the lumbosacral nerve roots, loss of bowl, bladder refles, flaccid lower extremities |
| nursing care for HALO patient | pin care, skin care under vest, wrench at bedside (cardiac/resp. emergency) |
| what do you do if a halo pin pops out | 1st stabalize head then call for help |
| what causes change in reflexes | poor bp & temp regulation in immediate phase, no integration between sensory & motor systems, neurogenic bladder, reflex bladder |
| neurogenic bladder | stimulation of abd. or thigh may cause reflex urination |
| reflex bladder | reflex ejaculation,priapism |
| nursing concerns for muscle spasms | intense, painful spasms of the lower extrem. can throw a person oob, maintain safety, aggravated by cold, immobility, infection, emotions, |
| what can trigger reflex spasms | visceral stimulus such as a full bladder |
| what stimulates autnomic dysreflexia | bladder & bowel distension, pressure ulcers, muscle spasms, pain , pressure on penis, excessive rectal stim. |
| autnomic dysreflexia | exaggerated sympatheric responses, parasympathetic system cannot respond due to damaged cord |
| symptoms of autnomic dysreflexia | seizure, extreme hypertension, cerebral hemorrhages |
| prevention of autnomic dysreflexia | assess frequntly for s/s, educate about early warning signs, monitor & prevent stimuli |
| what are classic indicators for autnomic dysreflexia | full bladder, constipation |
| tx of autnomic dysreflexia | elevate HOB 1st, monitor bp, check for source of irritation & remove, antihypertensives |
| percautions for tx of autnomic dysreflexia | asses for s/s 1st then tx pain, check bp before giving analgesics, remove urine slowly(500ml/5-15min), monitor bp when removing fecal impaction |
| function/impairment & goal of C1-2 | no phrenic nerve function, no sensation below neck, respirations managed w/ phrenic pace maker |
| function/impairment & goal of C3-4 | neck control, scapular elevators, diaphragm function may be weak or absent, manipulate electric wheelchair with breath control, chin control, or voice activation |
| function/impairment & goal of C5 | fair to good shoulder control, functional deltoids/biceps, elbow flextion, no sensation below clavicles, dress upper trunk,turn self in bed, propel self in wheel chair, assist in getting in/out of bed, type or write |
| function/impairment & goal of C6 | ability to lift shoulders, elbows, (partial)wrists, no sensation below clavicle, a little in arms & thumb than in C5, dress upper trunk, some lower, propel wheel chair, transfer, self cath |
| function/impairment & goal of T5-L2 | partial to good trunk stability, able to use intercostal muscles, no sensation below level of injury, total wheelchair independece, limited ambulation w/ crutches or braces |
| nursing diagnoses for spinal cord injury | risk for hypotension, ineffective airway clearance, risk for aspiration, ineffective thermoregulation |
| bowel incontinence or constipation in spinal cord injury | avoid staining, enema to avoid autonomic dysreflexia, bowel program, fluid intake 3 L/day |
| Urinary incontinence in spinal cord injury | prevent uti, cath in early phase of injury, fluid intake 3L/day |
| rheumatoid arthritis (RA) | autoimmune disorder, erosive inflammation of joints |
| what does RA affect | metacarpophalangeal (MCP) joints & proximal (PIP) joints, swan neck deformities, boutonnier deformity, ulnar drift, women more than men |
| other manifestations of RA | SC nodules, vasculitis, pulmonary nodules, interstitial fibrosis, pericarditis |
| systematic manifestations of RA | anorexia, wt.loss, fatigue, muscle ache & stiffness in MORNING, |
| clinical manifestations of RA | infalmmation of PIP, MCP joints, shoulders, cervical, feet, knees, elevated ESR, elevated c-reactive protein, thrombocytosis |
| extra articular symptoms of RA | fatigue, fever, visual discomfort,sjogrens syndrome, cough,dyspnea, pericardial friction rub, mitral valve disease, complete heart block, enlarged spleen, proteinuria, myelopathy, carpal tunnel, anemia |
| tx of RA | rest, exercise, joint protection, pain relief, maintain function, strength, ROM (not during inflammation) |
| meds for RA | steroids, NSAID |
| nursing management of RA | chronic pain, meds, sleep, most activity at night, education |
| systemic lupus erythematosus (SLE) | multi-system inflammatory disorder, women15-40 hormonal,genetic |
| Patho for SLE | autoimmune disease, body reacts against its own tissues, cells & serum proteins |
| symptoms of SLE | inflammation, vasculopathy, vasculitis,susceptible to clots & artery disease |
| drugs that cause SLE response | hydralazine, procainamide |
| subjective manifestations of SLE | fever, fatigue, malaise, painful joints, photosensitivity, hair loss |
| objective manifestations of SLE | butterfly rash, cutaneous vascular lesions, hypertension (tx agressively potential for renal complication) |
| other complications of SLE | Raynauds, SLE GLOMERULONEPHRITIS, pericarditis, pleural effusion, hepatomegaly, lymphadenopathy, psychosis,convulsions, serum immuno antibody abnorm, thrombocytopenic pupura, severe hemolytic anemia, increased susceptibility to clotting due to casculitis |
| medical management for SLE | reduce inflamm, NSAID, low dose steroid, immunosuppressive agent IMURAN |
| nursing management of SLE | assess for symptoms, monitor for seizure, skin/musculoskeletal asess, manage stress, avoid infection, |
| major contributor to SLE exacerbation of symptoms | sunlight |
| leading cause of morbidity & mortality in SLE patients | renal failure from glomerulonephritis |
| scleroderma | hard skin, multisystem inflammatory disease causing skin thickening, excessive quantities of collagen resulting in severe fibrosis |
| scleroderma affects | women more than men, skin, blood vessels,synovium, skeletal muscle, microvasculature, internal organs |
| clinical manifestation of scleroderma | skin thickening on extremities, face, trunk, hype & hypopigmentation, mask like face, malabsorbtion syndrome(diarrhea,constipation) |
| scleroderma CREST | C=calcinosis, R=raynauds, E=esophageal hardening, S=sclerodactyly scleroderma of digits, T=telangiectasis capillary dilations form vascular lesions on face,lips,fingers |
| medical management of scleroderma | low dose prednisone, imuran, ace inhibitors for hypertension, meds for diarrhea/constipation, proton pump inhibitors |
| nursing magement of scleroderma | assess change in body image, prevent raynauds, assess nutritionsl stat, assess integumentary stat, assess joints (pain), |
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aclelan
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