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Med Surg 1
|What are the basic functions of the skeletal system?
|Support, protection, movement, mineral storage (Ca & Phos.), and hematopoiesis (blood cell formation - long bones)
|What are the divisions of the skeletal system?
|Axial & Appendicular
|What is the axial skeleton composed of?
|Skull, hyoid bone in the neck, vertebral column, and thorax
|What is the appendicular skeleton composed of?
|Upper extremities, lower extremities, shoulder girdle, and pelvic girdle
|What are the bones in the skull?
|Cranium, ear bones, face
|What are the bones of the spine?
|What are the bones of the thorax?
|What are the bones of the upper extremities?
|Shoulder (pectoral) girdle, arms, wrist, hands
|What are the bones of the lower extremities?
|Hip (pelvic girdle), legs, ankles, and feet
|How many vertebrae are in the cervical column?
|How many vertebrae are in the thoracic column?
|How many vertebrae are in the lumbar column?
|How many vertebrae are in the sacrum?
|5 - fused together
|How many vertebrae are in the coccyx?
|3-5 - fused together
|What are four major muscles in the head & neck?
|Frontal, temporal, sternocleomastoid, and trapezius
|What are four major muscles in the upper extremities?
|Pectoralis major, latissumus dorsi, deltoid, and biceps brachii
|What are four major muscles in the trunk?
|External oblique, internal oblique, transversus abdominus, rectus abdominus
|What are four major muscles in the lower extremities?
|Llipoas, satorius, gluteus maximus, quadricep group
|What are muscles necessary for?
|What are the three vital functions muscles perform when they contract?
|Motion, maintenance of posture, and production of heat
|What does muscle contraction assist in?
|Return of venous blood & lymph to the right side of the heart
|What are the types of body movement?
|Flexion, extension, abduction, adduction, rotation, supination, pronation, dorsiflexion, and plantar flexion
|How does a radiograph (x-ray) diagnose problems?
|Reveals fluid, irregularity of the joint with spur formation, or changes in the size of the joint contour. X-ray is used to determine presence of skeletal fracture
|How does a myelogram diagnose problems?
|Involves injection of a radiopaque dye into the subarachnoid space at the lumbar spine & vertebral column. Used to detect structural disorders such as herniated disk or presence of infection
|How does MRI diagnose problems?
|Uses magnetism & radio waves to make images of cross sections of the body. MRI assist in diagnosing abnormalities of bones & joints & surrounding soft tissue structures including cartilage, synovium, ligaments, and tendons
|How does CT diagnose problems?
|Uses narrow x-ray beam & produces three dimensional picture of structure being studied; Iodine contrast is sometimes used. CT is useful in locating injuries to ligaments, tumors of soft tissue, tendons, and fractures in difficult areas
|How does a bone scan diagnose problems?
|IV administration of nuclides (atomic material) approx. 2-3hrs before the test is scheduled. Valuable in detecting metastatic & inflammatory bone disease
|How does a arthrocentesis diagnose problems?
|Puncture of a patients joint with a needle & withdrawal of synovial fluid for diagnostic purposes. Helpful in diagnosing trauma, SLE Lupus, gout, OA, & RA. Also used to instil medications in patients with systemic arthritis
|How does a electromyogram diagnose problems?
|Insertion of needle electrodes into the skeletal muscles so that electrical activity can be heard, seen on an oscilloscope. Used to detect chronic low back pain based on muscle fatigue patterns
|Which patients cannot undergo an MRI and why?
|Patients with metal-prostheses such as heart valves, orthopedic screws, or cardiac pacemakers. The magnets in MRI will pull metal to surface of skin
|What is arthroscopy?
|An endoscopic exam that enables direct visualization of a joint
|What are three reasons that arthroscopy may be done?
|Explore joint in disease process, drain fluid from joint cavity, and remove damaged tissue or foreign bodies
|What is the pathophysiology of RA?
|Inflammation of synovial membrane, destruction of bones, ligaments, tendons, cartilage, and joint capsule
|What is the pathophysiology of OA?
|Degeneration of cartilage from wear & tear; spur formation
|What joints are affected with RA?
|Symmetrical joint involvement noted in wrist, knee's, and knuckles
|What joints are affected with OA?
|Often, only 1 side of body is affected with changes noted in hands, spine, knee's, and hips
|What are s/s of RA?
|Edema, erythema, heat, pain, tenderness, nodule formation, fatigue, stiffness, muscle aches, fever, vaculitis, complication infections, and osteoporosis
|What are s/s or OA?
|Localized pain, stiffness, bony knobs of end joints at end of fingers, edema. No systemic involvement, no organ involvement, fever or fatigue
|What are the ages of onset for RA?
|Children nearing adolescence and adults between 20 -50
|What are the ages of onset for OA?
|45-90; most people have features that increase with age
|What sex is mostly affected by RA?
|Females more than males; ratio 3:1
|What sex is mostly affected by OA?
|Males & females are affected equally
|Is RA hereditary?
|Yes, familial tendency
|Is OA hereditary?
|Knoby fingers can be hereditary
|What diagnostic test are done to diagnose RA?
|Rheumatic Factor (RF) found in serum, SED rate, C-reactive protein, CBC, and x-rays
|What diagnostic test are done to diagnose OA?
|X-rays, no specific lab abnormalities are useful in diagnosing OA. RF negative
|What is the treatment for RA?
|Control inflammation & pain with medications, balance exercise & rest, provide joint protection, encourage weight control & stress reduction, surgically replace joints
|What is the treatment for OA?
|Maintain activity level, control pain with medications, encourage exercise, joint protection, weight control, stress reduction, surgical joint replacement may be necessary
|What are 5 medications that are used for RA?
|Salicylates, NSAID's, Cox 2 inhibitor, Potent anti-inflammatory, and slow acting anti-inflammatory
|What is Ankylosing spondylitis (AKS)?
|Chronic, progressive disorder affecting spine
|What two exercises are good for patients with OA of the knee?
|Swimming & bicycling
|What types of activity should be avoided in a patient with OA?
|Climbing stairs, bending, stooping, or squatting
|Where do nodes appear in Heberden's nodes?
|The sides of distal joints of fingers
|Where do nodes appear in Bouchard's nodes?
|Proximal joints of fingers; these nodes are hard, bony, and cartilaginous enlargements
|What is gout?
|Metabolic disease resulting from accumulation of uric acid in the blood, acute inflammatory condition assoc. with ineffective metabolism of purines
|When does gout typically attack?
|Nighttime, with excruciating pain, edema, and inflammation
|What medication is used for a gout patient?
|What medication is used for a gout patient with GI issues?
|What three medication are given to treat elevated uric acid & tophi development?
|allopurinol (Zyloprim), probenecid (Probulan), and sulfinpyrazone (Anturane)
|What foods should a gout patient avoid?
|Food high in purine (sardines, herring, anchovies, alcohol, and beer)
|What 5 medications may be prescribed to a patient with osteoporosis?
|aledronate (Fosomax), etidronate (Didronel), pamidronate (Aredia), tildronate (Skelid), ibandronate (Boniva)
|What are the dietary needs for a patient with osteoporosis?
|1500mg of Ca. is needed daily, Vit. D helps with Ca. absorption & stimulates bone formation; diets low in Na., animal protein, and caffeine are recommended.
|What foods are high in Ca.?
|Whole & skim milk, yogurt, turnip greens, cottage cheese, ice cream, sardines with bones, and spinach
|Who does gout affect?
|Men more than women
|What part of the body does gout usually affect?
|How do steroids work?
|Overriding the body's normal inflammatory response
|What is patient teaching for patient that has gout flare up?
|Maintain rest & joint immobilization
|What is osteoporosis?
|Disorder that results in a loss of bone density
|What happens to the bones in osteoporosis?
|Become porous & brittle
|What can osteoporosis interfere with?
|Mechanical support function of the bone
|Who does osteoporosis primarily affect?
|Women 55-65 are the high risk groups
|What increases the incidence of osteoporosis?
|White/Asian women, increased caffeine intake, steroid usage, post menopausal women, and anticonvulsive therapy
|What would you teach a patient with osteoporosis?
|Relaxation techniques, encourage them to stop smoking, safety measures such as hand rails, side rails, bedside commodes with seat elevators, rubber mats in showers, encourage weight bearing activities to increase bone density & diet high in Ca.
|What three ways can bacteria enter the bone to cause osteomyelitis?
|Trauma, bloodstream, or surgery
|What type of therapy does osteomyelitis require?
|Long term antibiotic
|How is wound care performed in a patient with osteomyelitis?
|Irrigated with NS, antiseptic or antibiotic solution, and then covered with sterile dressing **use strict surgical asepsis**
|How is pain managed in osteomyelitis?
|Handle extremity very gently, administer pain meds as ordered, and always assess and document effectiveness of pain medication (use appropriate pain scale)
|What is fibromyalgia?
|Chronic syndrome of unknown origin that causes pain in the muscles, bones, or joints. Associated with tenderness @ multiple sites. Contributes to poor sleep, headaches, altered thought process, and stiffness or muscle aches
|What age group and sex are most often affected by fibromyalgia?
|Women more than men, ages 20-50yrs old
|What is flexion?
|A movement allowed by certain joints of the skeleton that decreases the angle between two adjoining bones
|What is extension?
|A movement allowed by certain joints of the skeleton that increases the angle between to adjoining bones
|What is abduction?
|A movement of an extremity away from the midline of the body
|What is adduction?
|A movement of an extremity toward the axis of the body
|What is rotation?
|A movement of a bone around its longitudinal axis
|What is supination?
|A movement of the hand and forearm that causes the palm to face upward or forward
|What is pronation?
|A movement of the hand and forearm that causes the palm to face downward or backward
|What is dorsiflexion?
|A movement that causes the top of the foot elevate or tilt upward
|What is plantar flexion?
|A movement that causes the bottoms of the foot to be directed downward
|What is arthrodesis?
|Surgical fusion of joint, performed when severe joint destruction has occurred
|What is arthroplasty?
|Repair/fastening of one or both sides, parts, or specific tissue within a joint. Often in an elbow, hip, knee, or shoulder to restore or increase mobility
|What are the three clinical manifestations of a hip fracture?
|Severe pain & tenderness in region of fx., inability to move leg voluntarily, shortening or external rotation of leg
|What is the proper care when turning a patient with ORIF?
|Use abduction pillow for 7-10 days post op., turn patient with extremities in perfect alignment (2 nurses), most orders will have patient turned to unaffected side, let patient pivot on affected leg, and don't elevate affected leg while sitting
|When is total hip replacement (THP) performed?
|When arthritis involves head of the femur & acetabulum. Additional factors are fx., tumors, and injuries
|When is open reduction with internal fixation (ORIF) performed?
|Allows fracture alignment under direct visualization while using various internal fixation devices applied to the bone
|What are the "DO NOT" rules for a patient with a hip prosthetic implant (THR)?
|Stand w/ toes turned in, cross legs, pull blankets up from end of bed, bend way over, stand up from chair in right angle, sit on low toilet/chair, lie in bed with out pillow between legs
|How do you prevent respiratory complications with a patient who has had ORIF?
|Encourage patient to turn, deep breathe, and cough. Also, use incentive spirometer
|What are the 7 p's when completing circulation check or neurovascular assessment?
|Pulselessness, parasthesia (numbness & tingling), paralysis or paresis, polar temperature, pallor, puffiness, or pain
|When a stable plate and screw fixation is used to repair hip fracture, how long must patient wait to bear weight?
|6 weeks to 3 months
|What does a telescoping nail fixation allow?
|Minimal to partial weight bearing during the first 6 weeks to 3 months
|What is a closed fracture (simple)?
|Bone does not protrude through skin
|What is an open fracture (compound)?
|Bone protrudes through the skin and is more serious because they involve more soft tissue damage which requires surgical repair. Also, increases risk of infection significantly
|What is a complete fracture?
|Fracture line extends entirely through the bone, with the periosteum disrupted on both sides
|What parts does a total hip replacement involve?
|Ball & socket
|What parts does a partial/bipolar hip replacement involve?
|Just the ball
|How does a pathological (spontaneous) fracture occur?
|Without trauma, often because bone has been weakened by osteoporosis or tumors
|What is a greenstick fracture?
|Incomplete fracture - bone is broken and bent but still secure on one side
|What is a comminuted fracture?
|Bone is splintered into 3 or more fragments at site of break, with more than one fracture line
|What is an oblique fracture?
|Break that runs at a 45 degree angle to the length of the bone
|What is an impacted fracture?
|Bone fragment is forcibly wedged into another bone fragment; also called a telescoped fracture
|What is a transverse fracture?
|Break runs directly across the bone horizontally
|What is a compression fracture?
|Fracture of the vertebrae due to pressure; often seen in osteoporosis
|How does a bone heal?
|Bleeding at the site of fracture, clot forms at ends of fractured bone, hematoma becomes organized and a fibrin network is created, osteoblasts enter the fibrous areas, callus forms, collagen strengthens & Ca. deposits increase, remodeling occurs
|How long does it take for a fracture to heal?
|What additional measures are taken for an open fracture?
|Wound undergoes debridement, tetanus shot is given if pt. hasn't had one in 5yrs, wound culture is done, prophylactic antibiotics are given, observe for infection, closure of wound will occur when there are no signs of infection
|What are objective assessments when a fracture is suspected?
|Warmth, edema, ecchymosis @ site, obvious deformity, loss of abnormal function (inability to move the affected part)
|What are signs of systemic shock?
|Circulatory, motor, or sensory impairment; increased pulse & resp, BP declines after an initial slight increase, restlessness, anxiety, or change in LOC, pallor along with cool & moist skin
|Fractures of what bones are more susceptible of systemic shock?
|What interventions do you do if you suspect systemic shock?
|Lay patient in supine position and administer high flow 02
|What is compartment syndrome?
|Pathological condition caused by arterial vessel compression and reduced blood supply to an extremity
|How does compartment syndrome occur?
|Tight cast or dressing
|What are some long lasting affects that result from compartment syndrome?
|Irreversible muscle ischemia (within 6hrs), Volkmann's contracture (permanent contracture), and paralysis / sensory loss
|What do you look for when assessing for compartment syndrome?
|Pain complaints that are unrelieved by medications and may be accompanied by numbness or tingling. Unable to flex fingers or toes, cool extremity, threads or absent pulses, decrees in capillary refill, paleness in extremity
|What is a fasciotomy?
|Incision into the fascia to relieve pressure
|What are common nursing interventions for compartment syndrome?
|Assess & control pain, keep limb at a level no higher than the heart, apply cold packs, and remove constricting material
|What are the five common causes of fractured vertebrae?
|Diving accidents, blows to the head, osteoporosis/metastatic cancer, motorcycle/car accidents, compression fractures
|What is a halo brace?
|External immobilization device in which a plaster or plastic brace that incorporates metal struts attached to pins is inserted into bone, used to allow patients to be mobile
|What are the nursing interventions for a fractured pelvis?
|Monitor patient for progressive signs of shock (hypotension, tachypnea, tachycardia, & decreased urinary output) measure abd. girth at q 8hrs for signs of abd pressure (hemorrhaging), monitor I&O for signs of hypovolemia
|What is the most life threatening complication with a pelvis fracture?
|Can shock occur with a fractured bone?
|Yes, because bone is vascular / Shock can occur as a result from blood loss from fx. bone or frame severed blood vessels, seen especially in open fractures
|What are nursing interventions for a patient experiencing shock?
|IV fluids, monitor v/s q 15min until stable, monitor urinary output, if there are no head injuries - elevate lower extremities a little, keep patient warm, NPO - and no sedatives/narcotics, administer high flow O2
|What is a fat embolism?
|Embolization of fat tissue into the bloodstream form a trauma. Risk factors: long bone & pelvic fractures, crush injuries and hip replacement surgery. Can be life threatening, as fat occluded the pulmonary artery which leads to hypoxia and tissue death
|How do you assess for fat embolism?
|Mental status, orientation, irritability, chest pain, muscle weakness, tachypnea, dyspnea, hypoxemia, crackles, wheezes
|What is 'Buck's' skin traction?
|Temporary measure to provide support and comfort to fractured extremity while waiting for more definitive treatment. Traction is in a horizontal plane with the affected extremity
|What is 'Russell's' skin traction?
|Similar to bucks, however, a knee sling supports the affected leg. Allows more movement in bed & permits flexion of the knee joint. (Commonly used for hip & knee fracture)
|What is proper pulley care for a patient in traction?
|Pulley's must remain off the floor to ensure correct allignment
|What is a muscle sprain?
|Results from wrenching or hyperextension of a joint, tearing the capsule or ligaments
|What is a muscle strain?
|Microscopic muscle tears as a result of over stretching muscles and tendons
|What is carpal tunnel syndrome?
|Inflammation & edema of synovial lining of the tendon sheaths in the carpal tunnel of the wrist. Tunnel space is narrowed, resulting in compression
|What symptoms do patients with carpal tunnel experience?
|Altered ability to grasp/hold small objects, burning pain, numbness, and weakness (esp. in the thumb)
|How does a patient manage a herniated disk?
|4 week course of conservative therapy such as braces, corset, or belt; local heat & ice, ultrasound & massage, and use of a TENS unit
|What are two subjective findings that may indicate possibility of bone cancer?
|Complaints of pain (weight bearing) and spontaneous fractures
|What are objective findings that may indicated the possibility of bone cancer?
|Assessment of painful part which may reveal edema and discoloration of skin
|What is the cause of phantom limb pain?
|The nerve tracts that register pain in the amputated area continue to send a message to the brain
|What is the treatment for phantom limb pain?
|Patient can gently rub the residual extremity or take analgesics for relief
|What is the purpose of stump-wrapping?
|Shrink and reshape the residual extremity into a cone to facilitate the proper fit and use of prosthesis
|What is the difference between stump wrapping an above the knee amputation and a below the knee amputation?
|Above the knee, the bandage is secured around the patients waist, below the knee it is not
|What are two principles of positioning to remember when caring for a patient with a leg amputation?
|To prevent hip contracture post-op, raise foot of bed slightly to elevate residual extremity, also encourage movement from side to side, and placing patient in prone position at least twice a day
|What is a contusion?
|Injury to soft tissues from blow or blunt force
|What is whiplash?
|Hyperextension injury at the cervical spine
|What is a dislocation?
|Involves tearing of the joint capsule
|What do you assess for traumatic injury?
|Edema, discoloration, disfigurement, and pain
|What is the treatment for traumatic injury?
|R I C E - Rest, Ice, Compression, Elevation. Cold for the first 48hrs, then heat
|Explain bone cancer
|Tumors of the bone may be primary or secondary. They may be malignant or benign. Clinical manifestations are spontaneous fractures, anemia, and pain
|What is scoliosis?
|Lateral or "S" curve of the spine
|What is kyphosis?
|Rounding of the thoracic spine
|What is lordosis?
|An increase in the curve of the lumbar region