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68WM6 Phs 2 test 16

68WM6 Phase 2 test 16 Musculoskeletal/Integumentary

QuestionAnswer
alopecia loss of hair
angioma Benign tumors made up of small blood vessels or lymph vessels; a birthmark.
tx for angioma electrolosis, radiation
crust dried serum, blood, purulent exudate, slightly elevated
furuncle boil, inflammation deep in hair follicle
carbuncle a cluster of furuncles
Irritation causing inflammation of the skin though direct contact with an agent. Dermatitis
Eczema Commonly associated with allergies and seen in infants. Papular and vesicular legions that rupture
Redness or inflammation of the skin or mucous membranes Erythema
Keloid tough, irregularly shaped scars that progressively enlarge
flat, distinct, colored area of skin that is less than 1 centimeter in diameter and does not include a change in skin texture or thickness macule
necrosis Premature cell death caused by external factors
An elevated, firm, circumscribed area papule
Elevated, firm, circumscribed lesion extending deeper into the dermis than a papule nodule
the symptom of itching puritus
Elevated, circumscribed skin legion, not into the dermis. Filled with serous fluid vesicle
Elevated, superficial legion, filled with purulent fluid pustule
athlete's foot tinea pedis
elevated, solid legion - extends into subcutaneous layer tumor
Elevated, irregularly shaped area of edema wheal
functions of the skin protection, sensory organ, homeostasis, temp control, Vit D synthesis, prevent dehydration, excrete waste
from top to bottom - layers of the skin epidermis, dermis, subcutaneous
layers of the epidermis Stratum corneum Pigment Layer Stratum germinativum
"true skin", contains blood vessels, nerves, glands, hair follicles dermis
"fatty layer" of skin, composed of adipose tissue, and loose connective tissue, provides shape for the body, subcutaneous layer
functions of SQ layer of skin store water and fat, insulation, protection of body organs, provides pathway for nerves and blood vessels
Sudoriferous sweat glands
Ceruminous glands Secrete a wax like substance called cerumen. Located in the external ear canal
Sebaceous (oil) glands Secrete sebum through the hair follicles Function is to lubricate the skin and hair Sebum also inhibits bacterial growth
nails are composed of packed _____ keratin
how does the skin show signs of aging? Includes decreased tissue fluid, subcutaneous fat, and sebaceous secretions Skin of older persons more fragile and susceptible to impairment Hyperkeratotic changes seen in nails
more changes of the skin r/t aging Localized clusters of melanocytes surrounded by areas of decreased pigmentation Incidence of basal and squamous cell carcinoma
when getting your hx of a skin d/o what do you ask? Onset of symptoms and precipitating factors Changes in the progression of symptoms
Diseases that may affect the skin Diabetes Cancer Kidney failure Thyroid Disease Liver disease Anemia
Atheroma an accumulation and swelling in artery walls that is made up of (mostly) macrophage cells, or debris, that contain lipids
Bleb large flaccid vesicle, usually at least 1 cm
Cyst a fluid-filled sac. They can form anywhere in the body
Excoriation any superficial loss of substance, To tear or wear off the skin of; abrade
fissure narrow opening or crack of considerable length and depth usually occurring from some breaking or parting
Hyperplasia increased cell production in a normal tissue or organ
Petechiae Pinpoint flat round red spots under the skin surface caused by intradermal hemorrhage (bleeding into the skin)
To assess rashes and skin inflammation, rely on ..... palpation for warmth and indurations rather than observation
patients with dark skin are more predisposed to what skin conditions Pseudofolliculitis Keloids Mongolian spots
how are most skin d/o diagnosed? observation
Therapeutic Baths are used to Used to relieve inflammation and itching Use cornstarch, baking soda or oatmeal
describe Phototherapy Promotes shedding of the epidermis Treats chronic skin conditions Pruritus may occur after therapy Observe for signs and symptoms of phototoxicity
Herpes Simplex (Viral)is caused by Herpes virus hominis
Type 1 HSV characterized by vesicles at the corner of the mouth, lips, or in the nose caused by common cold sores
Type 2 HSV characterized by vesicles in the genital areas transmitted primarily through sexual contact
_____ is an antiviral agent used to alter the course of the disease Acyclovir (Zovirax)
_____ (____) and topical anesthetics may be prescribed for pain Analgesics (Tylenol)
nursing considerations r/t HSV keep lesions dry, avoid contact, wear gloves, warm compresses to relieve pain and severe pruritus
r/t HSV outbreaks; Periodic recurrences are expected and may be triggered by stress fever trauma fatigue
Herpes Zoster (Shingles) (Viral) is caused by Caused by the varicella virus that causes chicken pox (Herpes varicellae)
shingles is characterized by: Characterized by lesions along the nerve fibers of spinal ganglia
1st symptoms of shingles First symptoms are pain, itching, and heightened sensitivity along the nerve pathway
Describe the manifestations of Shingles vesicle formation, severe pain for 7-28 days, able to be spread to people not exposed, elderly and immunosurpressed at risk
medical tx for Shingles Acyclovir, Lotions (Kenalog/Lidex), wet dressing soaked in Burrow's solution, tranquilizers (Ativan / Atarax), medical baths, analgesics,
r/t Shingles, eat more Vit ___ to promote healing Vitamin C
Lesions start as macules that develop in pustulant vesicles Pustules rupture and form a crust Crust drops off, the skin is smooth/red Impetigo: (Bacterial)
Impetigo: (Bacterial) is caused by Caused by staphylococcus aureus, streptococci or a mixed bacterial infection of the skin
Impetigo is ____ ____ from contact highly contagious; May spread by touching personal articles, linens and clothing of the infected person
will include symptoms of pruritus, pain, malaise and spread to other parts of the body, honey-colored crust over the dried lesions and smooth, red skin under the crust, low grade fever, leukocytosis Impetigo
Antibiotics r/t Impetigo Erythromycin, Dicloxacillin, Cephalosporin, Rocephin; Topical antibiotics (Bactroban) started early in the treatment
Clean the area with antiseptics such as ____ and ____ , then remove dry exudates using special instruments Betadine or Hibiclens
nursing interventions r/t Impetigo: inspect lesions every ____ for drainage, size and extent of body covered. Keep clean and dry every day
A bacterial inflammation of the skin caused by Staphylococcus infection of a hair follicle Furuncle (Boil)
Clinical Manifestation of Furuncle (Boil) Sudden onset of red, tender, and hot skin around the hair follicle, which spreads to the surrounding skin The center forms pus, and the core may need to be excised
what is the medication tx for a series of furuncle? systemic antibiotics
ringworm of the scalp, Erythematous, round lesions with pustules around the edges Causes alopecia at the site Tinea capitis
ringworm of the body; Flat lesions that are clear in the center w/ erythematous borders Scaliness is found Pruritus is severe Tinea corporis
that migrate out from the groin area Pruritus Excoriation due to scratching Tinea cruris
Most common of all fungal infections Fissures and vesicles found around and below the toes Tinea pedis
A ___ ___ is an ultraviolet light used to diagnose tinea capitis Wood's light
what medications could you expect to use for tinea capitis? Topical (Tinactin and Desenex) or oral (Fulvicin and Grifulvin) antifungal drugs (2 to 6 week tx)
nursing interventions r/t tinea infections clean and dry, wear loose fitting clothing and shoes, apply medications
how long could a tinea infection last? possibly months
Skin reaction from direct contact with agents in the environment to which a person is hypersensitive Contact Dermatitis
Common causes are detergents, industrial chemicals and plants Contact Dermatitis
clinical manifestations r/t contact dermatitis Epidermis becomes inflamed and papules form Vesicles appear most often on the dorsal surfaces There is burning, pain, pruritus and edema
r/t contact dermatitis, what would you expect of the lab values? elevated IgE and eosinophils
medication tx for contact dermatitis Corticosteroids and Benadryl to treat the inflammation, edema and pruritus
nursing interventions r/t contact dermatitis Wet dressings using Burow's solution Use aseptic technique when applying medication to the open lesion Cold compresses to the skin will cause vasoconstriction  Clothing should be lightweight and loose
It is the common term for poison ivy and poison oak Dermatitis Venenata
commonly called hives Urticaria; presence of wheals caused by an allergic reaction
An inflammatory papulopustular skin eruption that involves the sebaceous glands; when the oil glands become occluded Acne Vulgaris
noninfectious disease where skin sloughing and generation of new skin cells occurs more rapidly than the normal 28 days Psoriasis
Lesions appear as raised, erythematous, silvery, scaling plaques Located on the scalp, elbows, knees, chin and trunk Psoriasis
what kind of medications can be used to tx Psoriasis? Keratolytic agents such as tar preparations and Salicylic Acid (Calicylic) decrease the shedding of skin Topical steroids (Valisone) are used to decrease inflammation
PUVU Therapy Photochemotherapy involves the use of methoxsalen (Psoralen) is given orally The patient then is placed under ultraviolet light A
Vitamin __ may reduce epidermal proliferation Vitamin D
Since the disease is chronic, consider the patient's emotional needs and encourage the patient to focus on their __ __. positive attributes
Nursing diagnosis goals in general.... the patient should VERBALIZE desired results. IE...verbalize effective coping mechanism, states and demonstrates priciples of self care.
pediculosis is Lice
a parasitic d/o of the skin usually associated with poor living conditions and poor hygiene pediculosis
what meds would you expect for lice? Lindane (Kwell) or pyrethrins (RID)
how long should you put items in a sealed plastic bag r/t lice 2 weeks
what temp should your water be according to the CDC to kill both head lice and nits? 130 degrees
only items that have been incontact with the head of an infected Lice patient in the last ___ hours before tx should be considered for cleaning 48
what other method can you use to kill lice? freezing temps for several days
caused by the female itch mite penetrating and burrowing under the skin scabies
wavy, brown, threadlike line on the body with severe pruritus and often secondary infection due to excoriation caused by scratching scabies
scabies is normally found ?? hands, arms, body folds, genitalia
medical management for scabies Lindane (Kwell) or pyrethrins (RID) and crotamiton (Eurax)-solution of sulfur in petrolatum
most distressing part of a skin disease often the social stigma and emotional trauma the pt must endure
Ankylosis fixation of a joint, usually in an abnormal position resulting from destruction of cartilage or bone
Arthrocentesis puncture of a joint with a needle to withdraw fluid used for diagnostic purposes
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
a test of the rate of capillary refill Blanching test
bony deposits formed between and around the broken ends of a fractured bone during healing callus
a fracture of the distal portion of the radius within 1 inch of the wrist Colles' fracture
sounds that represent the cracking noise heard when rubbing hair between fingers. It is associated with broken bones Crepitus
a musculoskeletal chronic pain syndrome of unknown etiology that causes pain in the muscles, bones or joints Fibromyalgia
an abnormal condition of the vertebral column, characterized by increased convexity in the curvature of the thoracic spine Kyphosis
an increase in the curve at the lumbar space region that throws the shoulders back Lordosis
a surgical procedure allowing fracture alignment under direct visualization while using various internal fixation devices applied to the bone Open reduction with external fixation
any subjective sensation, such as prickling "pins and needles" or feeling of numbness Paresthesia
curvature of the spine usually consisting of two curves; the original abnormal curve and a compensatory curve in the opposite direction Scoliosis
a fragment of necrotic that is partially or entirely detached from the adjacent healthy bone Sequestrum
partial dislocation Subluxation
a permanent contracture with clawhand Volkmann's contracture
wasting atrophy
sprain the ligament over-stretching
strain muscle over-stretching
Structures & Functions of the Musculoskeletal System support, protect, movement, Mineral Storage, Hematopoiesis
Hematopoiesis blood cell formation
There are three types of joints Synarthrosis - no movement, Amphiarthrosis - slight movement, Diathrosis - free movement
Muscles are necessary for movement and perform three vital functions motion maintenance of posture production of heat
each muscle fiber is surrounded by a connective tissue called epimysium
Remember the 7Ps of a neurovascular assessment pulselessness paresthesia paralysis polar temperature pallor puffiness (edema) pain
It is important to assess your patient's r/t a neurovascular assessment ability to stand ability to move ability to perform ADLs for any weakness for problems with their gait
is used to determine presence of fluid, joint irregularity, or fractures X-ray
involves the injection of a radiopaque dye into the subarachnoid space at the lumbar spine to detect the presence of herniated disks Myelogram
used to detect pathological conditions of the cerebrum and spinal cord MRI
Body sections can be examined from many different angles using a CT scanner that produces a narrow x-ray beam CT
IV admin of nuclides 2-3 hours before the test, A scanning camera detects the areas concentration of radionuclide uptake which may represent a tumor or other abnormality Bone scan
Endoscopic Exam a lighted tube is used to visualize inside a body cavity
is done to obtain a specimen of body fluid Aspiration
is a procedure that involves the insertion of needle electrodes into the skeletal muscle so that electrical activity can be recorded Electromyogram
Normal values 9-10.5 mg/dl Calcium
Increased in tumor of the bone, renal failure, Vitamin D deficiency, etc Calcium related
Normal values - males up to 15 mm/hr and females up to 20mm/hr, Indicates presence of inflammation as seen in rheumatoid arthritis Erythrocyte sedimentation Rate
Normal values - no LE seen Lupus Erythematosus
Normal values < 60U/ml Rheumatoid factor
Normal value - males 2.1-8.5 mg/dl and females 2.0-6.6 mg/dl Increases with with gout, kidney failure, dehydration, etc Uric acid
What are the three terms relating to the curvature of the spine? lordosis, kyphosis, and scoliosis
General condition characterized by inflammation and degeneration of a joint Arthritis
The 4 most common types of arthritis Rheumatoid arthritis (RA) Osteoarthritis (degenerative joint disease) Gout (Gouty arthritis) Ankylosing spondylitis (AKS)
A systemic inflammatory disorder of connective tissue/joints Characterized by chronicity, remissions, and exacerbation Rheumatoid Arthritis
Strongly believed to be an autoimmune disorder (meaning own immune system is attacking tissue due to mixed-up information), attacks small joints early and involves large joints later Rheumatoid Arthritis
Rheumatoid Arthritis 4 Classic Symptoms Morning stiffness Joint pain Muscle weakness and atrophy Fatigue Mobility limitations Spongy tissue on joint palpation Accumulation of fluid on joints
Rheumatoid synovitis advances, leading to pannus formation. What is "pannus"? abnormal layer of fibrovascular tissue or granulation tissue
Systemic Signs and Symptoms of RA Fatigue Malaise Anorexia Weight loss Fever Vasculitis Neuropathy Pericarditis Splenomegaly Anemia
more Systemic Signs and Symptoms of RA Sjogren's syndrome (dry eyes and mucus membranes) Rheumatoid nodules (usually non-tender and movable) Muscle weakness and atrophy Smooth glossy appearance of extremities; may be cold and clammy Muscle wasting at affected joints
Swan neck deformity (hyperextension of proximal interphalangeal joints with fixed flexion of distal interphalangeal joints
Boutonniere deformity (persistent flexion of proximal interphalangeal joints with hyperextension of distal interphalangeal joints)
Radiographic films show characteristic joint changes and the extent of damage such as narrowed joint spaces and body erosions
in an Arthrocentesis you would expect the fluid to look like what? Fluid appears cloudy, milky or dark yellow; contains many inflammatory cells
examination to visualize the extent of joint damage as well as to obtain a sample of synovial fluid Arthroscopy
may be elevated, C-reactive protein test, CBC, CD4 complement component is decreased, ANA (anti-nuclear antibody) may be positive ESR (erythrocyte sedimentation rate)
medication tx for RA NSAIDS, Salicylates, Celebrex (used for RA and osteoarthritis). Vioxx (only for osteoarthritis).
DMARDs; Disease-modifying antirheumatic drugs Antimalarials (hydrochloroquine) Gold salts (auranofin, aurothioglucose) Penicillamine Sulfasalazine
If there are bony erosions, ___ an anti-neoplastic agent is started methotrexate (Rheumatrex)
r/t RA, ___ and ___ are immunosuppressants used only in severe cases Cyclosporine (Neoral) and Azanthioprine (Imuran)
Another new treatment is injection of viscosupplement ____, ____, and ____. They act as a lubricant, substituting for hyalonuric acid, the substance that provides joint tissue viscosity Hyalgan, Synvisc and Supartz
Prosorba therapy blood is taken from patient's arm and run through a pheresis machine, 12 week sessions for 2 to 2 1/2 hour sessions
what is something you can do for your patient to help relieve symptoms of RA application of heat/cold packs
Collaboration with occupational therapists to provide utensils, equipment and instruction regarding : energy conservation and maintenance of joint alignment
Degenerative Joint Disease (DJD) also know as osteoarthritis
Disorder that results in a reduction in bone mass which interferes with the mechanical support function of the bone osteoporosis
Women between the ages of 55 and 65 are at higher risk for post menopausal osteoporosis due to loss of estrogen
Studies suggest that Estrogen deficiency is connected with increased bone reabsorption and sensitivity to parathyroid hormone
Other factors that contribute to osteoporosis include Immobilization Use of steroids High intake of caffeine Genetics Individuals most at risk are small-framed, non-obese, menopausal, white females who smoke
Other Risk Factors r/t osteoporosis Diet low in calcium throughout life span Smoking Excessive protein in diet Sedentary life style (Culture / Ethnic background)
Clinical Manifestations of Osteoporosis Disorder develops slowly First symptom is backache Bones become porous and brittle with progression due to a lack of available calcium
dowager's hump spinal deformity and height loss
r/t osteoporosis, Treatment aimed at: promoting the increase of bone density and retardation of bone loss
r/t osteoporosis, Recommend 50,000 IU of Vitamin __ 1-2 times week for post menopausal women Vitamin D
Alendronate (Fosamax) bone resorption inhibitor; Absorbs calcium phosphate crystal in bone and treats symptoms of osteoporosis
r/t Alendronate, what are the nursing considerations r/t administration? Administer first thing in morning with 6 to 8 ounces of water, at least 30 minutes before other medications, beverages, or food
Risendronate (Actonel) Bone resorption inhibitor
Inhibits calcium phosphate crystal in bone and inhibits bone resorption without inhibiting bone formation or mineralization Risendronate
One significant nursing consideration r/t Risendronate/Actonel Patient must sit upright for 30 minutes to prevent esophageal irritation
nursing goals r/t osteoporosis Aimed at preventing further bone loss and fractures
dietary counseling r/t osteoporsis increase calcium and Vit D, decrease caffeine and phosphorus and protein
food that is high in calcium include: green leafy veges, milk, soy milk, turnip greens, spinach
Inform patients about risks of estrogen including: Thromboembolism Endometrial cancer Breast cancer
T/F: r/t osteoporosis, you should encourage ambulation and weight bearing exercises TRUE
Healthy lifestyle measures to reduce the risk of developing osteoporosis Ensure an adequate daily intake of calcium and vitamin D Exercise regularly Avoid smoking Decrease coffee intake Decrease excess protein in the diet  Engage in regular moderate activity
Osteomyelitis Local or generalized infection of the bone and bone marrow that can occur from bacteria introduced through trauma or surgery, Bacteria invade bone and degeneration of bone tissue occurs
Most common causative agents are Staphylococci Osteomyelitis
r/t Osteomyelitis, you need to assess vital signs. What would you expect r/t VS? temperature elevation, tachycardia, and tachypnea
medical management for osteomyelitis IV, broad spectrum antibiotic, parenteral antibiotics for several weeks
r/t osteomyelitis, what would you use to irrigate the wound? hydrogen peroxide or antibiotic solution
recommended diet for a osteomyelitis Need for diet high in calories, protein, and vitamins
Chronic pain syndrome of unknown etiology that causes pain in muscles, bones, or joints Associated with soft tissue tenderness at multiple sites Fibromyalgia Syndrome (FMS) 
Referred to as fibrositis, fibromyositis, myofascial pain syndrome, and psychogenic rheumatism Fibromyalgia Syndrome (FMS)
Characterized by generalized achiness (usually neck/lower back) Stiffness that is worse in the morning Condition aggravated by several factors Fibromyalgia Syndrome (FMS)
what are some stressors for FMS? Cold or humid weather  Physical or mental fatigue  Excess physical activity: Anxiety of stress
issues that run side by side with FMS IBS, tension headaces, Paresthesia of upper extremities, Paresthesia of upper extremities, Dysfunctional or nonrestorative sleep
what is the tx approach r/t Fibromyalgia Syndrome? education and reassurance, Tricyclic antidepressants (anti-inflammatory, skeletal muscle relaxation, Pain inhibition through suppressing serotonergic and noradrenergic pathways)
medical management for FMS is also focused on goals that empower the patient; education, exercise, and relaxation techniques
dietary considerations r/t FMS Avoid large meals 2 to 3 hours before bedtime
what are some exercises you could recommend for a patient with FMS? swimming, walking, stationary cycling
total knee replacement knee Arthroplasty
Assess wound for drainage at least every ___ ___ r/t knee/hip atrthroplasty 4 hours
what is a Continuous Passive Motion (CPM) machine? continuous passive flexion of the repaired knee for 22 hours a day, it bends your knee all day long...
what exercises would you recommend for a knee arthroplasty patient? dorsiplantar flexion of ankles, quad setting, straight leg raises, active flexion exercises 3-4 x p/day
what exercises would you recommend on the 1st day post op r/t knee arthroplasty? light weight bearing w/assistance device, up in chair w/ leg elevated
respiratory considerations r/t knee/hip arthroplasty o2 2-3 L/min via NC, C&DB q 2 hrs, IS q 2 hrs, antiembolic stockings or pneumatic pump stockings
positioning r/t knee arthroplasty maintain abduction position using abduction pillow
r/t hip arthroplasty, sitting in a chair should be limited to 10 to 15 minutes, two to three times daily for first week
DRUGS... Here we go again....
used to manage symptoms (pain, swelling) and in more severe cases to slow down joint destruction and preserve joint function Antirheumatic Agents
used to manage symptoms such as pain and swelling, allowing continued motility and improved quality of life NSAIDs, aspirin, and other salicylates
reserved for more advanced swelling and discomfort, primarily because of their increased side effects, especially with chronic use. They can be used to control acute flares of disease. Corticosteroids
sometimes called slow-acting agents, slow the progression of rheumatoid arthritis and delay joint destruction Disease modifying anti-rheumatics (DMARDs)
_____ are reserved for severe cases because of their toxicity DMARDs
Antirheumatic Agents Categories Corticosteroids. DMARDs. NSAIDs. Miscellaneous
One common thing with the name of this classification of drugs is "sone / olone / solone" Corticosteroids
examples of this class include anakinra, etanercep, methotrexate, infliximab DMARDs
examples of this class include indomethacin, ibuprofen, sulindac, celecoxib NSAIDs
examples of this class include cyclosporine, sulfasalazine Miscellaneous
Metabolism/Excretion: mostly by the liver, Distribution: widely distributed, cross the placenta and enters breast milk. Absorbed well orally. Corticosteroids
Absorption: well absorbed. Distribution: bound to plasma proteins. Metabolism: mostly by the liver. Excretion: in the urine NSAIDs
Patients who are allergic to ____ should not receive other NSAIDs aspirin
Should not be used in patients with active untreated infections. Females should not breast feed during treatment Corticosteroids
Corticosteroids should be used with caution in diabetic patients
Stevens-Johnson syndrome is a side effect of NSAIDs
Assess K+, blood glucose, urine glucose (hypokalemia and hyperglycemia are common); notify prescriber if weekly gain > 5 lbs; drug masks symptoms of infection Corticosteroids
assess for pain and range of motion prior to and periodically during therapy; Document: Type. Location. Intensity DMARDs
Assess pain and range of motion. Document: Type. Location. Intensity; Monitor prolonged bleeding time NSAIDs
Assess creatinine level. Monitor I&O ratios. Daily weights. Assess for pain and range of motion Miscellaneous
____ therapy should be started at the onset of treatment with NSAIDs to prevent gastric ulcers Misoprostol (Cytotec)
Your patient is taking corticosteroids for rheumatoid arthritis. What lab values should you monitor and why? Assess K+, blood glucose, urine glucose (hypokalemia and hyperglycemia are common).
are primarily used to treat and prevent osteoporosis in postmenopausal women; Treatment of Paget’s disease of the bone; Management of hypercalcemia Bone Resorption Inhibitors
inhibit resorption of bone by inhibiting hydroxyapatite crystal dissolution and osteoclast activity Biphosphonates
aldendronate (Fosamax). etidronate (Didronel). ibandronate (Boniva). pamidronate (Aredia). risedronate (Actonel). tiludronate (Skelid). zoledronic acid (Zometa). Biphosphonates
_______ binds to estrogen receptors, producing estrogen-like effects on bone including decreased bone resorption and decreased bone turnover Raloxifene
raloxifene (Evista). Selective Estrogen Receptor Modulators
______ should not be used in patients with hypocalcemia Biphosphonates
___ should not be used in women with childbearing potential or a history of thromboembolic disease. Raloxifene
Bone Resorption Inhibitors side effects abdominal distention, abdominal pain, acid regurgitation, constipation, dyspepsia, dysphagia, esophageal ulcer, flatulence
symptoms of Paget’s disease bone pain, headache, decreased visual and auditory acuity, increased skull size
Assess ____ ____ prior to each treatment. Increase of 0.5 mg/dl within 2 wks of next dose should have the next dose withheld until it is within 10% of baseline serum creatinine
Administer ___ first thing in the morning with 8 ounces of water 30 minutes before meals or other medications; also Have patient sit upright or stand for 30 minutes to prevent GI distress aldendronate
Administer other oral biphosphonates on an empty stomach at least 2 hours before or after food, milk or milk products, antacids, other medications high in iron, or other mineral supplements.
r/t Bone Resorption Inhibitors, two nursing implications Advise pt to stop taking evista at least 72 hours before and during prolonged immobilization. Instruct pt to avoid prolonged restrictions of movement during travel because of the risk of venous thrombosis.
A client has started drug therapy with etidronate (Didronel). The nurse determines that the client understands adverse drug effects when the client states that the drug can lead to which of the following? Bone pain
Used in replacement doses (20 mg of hydrocortisone or equivalent) systemically to treat adrenocortical insufficiency Corticosteroids
Systemic (short-acting) Corticosteroids cortisone (Cortone Acetate). hydrocortisone (Cortef, Hydrocortone, Solu-Cortef).
Systemic (intermediate-acting) Corticosteroids methylprednisolone (Depo-Medrol, Depoject, Solu-Medrol). prednisolone (Delta-Cortef, Nor-Pred, Predacort, Prednisol). prednisone (Cordrol, Deltasone, Meticorten, Prednicot). triamcinolone (Aristocort, Kenalog, Triamolone, Trilone).
Systemic (long-acting) Corticosteroids betamethasone (Celestone, Cel-U-Jec). dexamethasone (Decadrol, Decadron, Dexameth, Dexasone, Dexone, Premethasone, Solurex)
Corticosteroids Contraindications serious infections, live vaccines with pts on larger doses
r/t taking corticosteriods, r/t dose nursing considerations Use lowest dose possible for shortest time possible. Alternate-day therapy is preferable during long-term treatment
Corticosteroids Side Effects / Adverse Reactions moon face, depression, acne, thromboembolism, muscle wasting, HTN
Most common type of arthritis Referred to as "wear and tear" disease Typically affects the weight-bearing joints Degenerative Joint Disease; osteoarthritis (OA)
how does DJD differ from RA? DJD has no remission periods, and no systemic symptoms
A non-systemic, non-inflammatory disorder that progressively causes bones and joints to degenerate Degenerative Joint Disease
A break in the continuity of a bone fracture
If a fracture occurs without trauma, it’s called pathological or spontaneous; result from: Osteoporosis Metastatic cancer Tumors of the bone
The bone ends are separated at the fracture line Displaced fracture
Bone breaks through only one cortex Incomplete fracture
one side of a bone is broken and the other side is bent, primarily occur in children Greenstick fracture
the fracture line extends entirely through the bone Complete fracture
the bone is splintered into many small fragments at the fracture site with the bone ends separated and usually misaligned Comminuted fracture
one bone fragment is forcibly wedged into another Impacted- (telescope fracture)
break runs directly across the bone, a right angle Transverse
break slants the length of the bone, at a 45 degrees angle Oblique
breaks coils around the bone spiral
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 Colles' fracture
distal end of the fibula, chipping off a piece of the medial malleolus with a displacement of the foot outward Pott's fracture
7 P's of orthopedic assessment Pain Pallor Paresthesia or numbness Paralysis Polar temperature Puffiness from edema or hematoma Pulseless
tests to diagnose fracture Radiographic examination Fluoroscopy
what are some examples of immediate management of fractures? splinting, body alignment, elevation, cold packs, analgesics, signs of shock
examples of secondary management of fractures closed reduction - manual manipulation, traction, ORIF-open reduction with internal fixation,
r/t compound fractures, seconday management would include surgical debridement, tetanus shot, culture wound, signs of osteomyelitis, tetanus, gangrene, close wound, reduce fracture, immobilize
r/t a mandible fracture, where does the nurse keep the wire cutters? Wire cutters should be taped to the head bed or around the patient's neck when they are OOB
explain procedure for oral hygiene r/t a pt w/ a mandible fracture Patient’s mouth should be cleansed thoroughly after each meal and every two hours. Patient’s cheeks are retracted with a tongue blade and a flashlight is used to see into the mouth
s/s of a hip fracture PAIN, Shortening & adduction of affected leg External rotation of the leg and foot
post op nursing interventions r/t hip fx monitor VS q 4 hrs, jackson-pratt drain, hemovac q 4 hrs, drainage
proper body alignment r/t post op hip fx avoid elevating extremity while sitting, HOB MAX is 45degrees, do NOT cross legs, abduction split for 7-10 days
diagnostic tests for vertabrae fracture x-ray, myelography, or CT scans
what are some things you will look for during neurological assessment r/t vertabrae fx Pupillary reaction to light Hand grips Ability to move extremities Level of orientation Vital signs Reaction to painful stimuli
signs of hemorrhage r/t vertabrae fx Hypotension Tachycardia Tachypnea Decrease renal functions
Pelvic Fractures Diagnosis tests Abdominal radiography CT scan IV pyelogram Lab tests: CBC urine stool
what kind of medical management would you expect r/t pelvic fx Bedrest X3 weeks, then walks with crutches X6 weeks, Bilateral pelvic fracture Pelvic sling Skeletal traction Spica cast/body cast
Marked increases in tissue pressure within a space enclosed by fascia that affects arteries, veins, muscles, and nerves Compartment Syndrome
Must be treated in 12-24 hours or nerve and muscle ischemia results in permanent functional loss and the development of Volkmann's ischemic contracture or amputation Compartment Syndrome
incision into the muscle layers Fasciotomy
nursing considerations r/t Fasciotomy Relieve pressure and allow return to normal blood flow in the area Need to be done within 30 minutes The incision is left open to heal by granulation
s/s of shock Monitor vital signs Typical= hypotension, tachycardia, tachypnea Hypothermia Pallor, cool, moist skin Oliguria
nursing interventions r/t shock bed-FLAT, VS q 15min, NPO, no sedatives or tranquilizers
Blood clot or fat globule that travels through systemic circulation to the pulmonary circulation causing partial or complete obstruction Fat Embolism- Pulmonary Embolism
Embolism Medical Management IV fluids Steroid therapy Digoxin Oxygen Incentive spirometry
Embolism Diagnosis Occur within 24-48 hrs Blood gases CBC Urine Sedimentation rate
Severe infection of the skeletal muscle caused by gram positive Clostridium bacteria- C. perfringens Gas Gangrene
Gas Gangrene Medical Management Establish a larger wound to admit air to promote drainage Antibiotic- PCN, Keflin
A condition in a which blood vessel is occluded by an embolus; Affected area become cold, numb and cyanotic Thromboembolus
hematemesis vomiting of blood
Diagnostic tests r/t thromboembolus Doppler ultrasonography or duplex scanning CT scan
Nursing Interventions r/t thromboembolus Bedrest with foot of bed elevated Active exercise Hot, moist compress Antiembolic stockings Assess lung sounds Anticoagulants: monitor PT, PTT
name 1 ways to increase bone healing r/t delayed fracture healing Electrical stimulation a new method of treatment in promoting healing Electrical probes stimulate bone production
Provides support of comminuted open fractures, infected nonunions, and infected unstable joints External Fixation Device
nursing interventions r/t External Fixation Device pins checked q 8 hrs, remove gunk 1-2 times a day using hydrogen peroxide or alcohol using surgical asepsis
The process of putting an extremity, bone, or group of muscles under tension by means of weights and pulleys Traction
Nonsurgical procedure that indirectly applies traction to the patient's skeletal system, Only 5 to 10 lbs of force Skin Traction
Horizontal pull is exerted on the extremity by Buck's extension
Most often used to treat the patient with fracture of the femoral shaft Russell's Traction
Uses a pin, tongs, or wires inserted into the patient's bone and attached to traction weight skeletal traction - Useful for patients with fractures of the cervical spine or femur
___ ___ are inserted into the patient's skull and provide traction in cases of fracture of the cervical spine Crutchfield tongs
Most common type of arthritis Referred to as "wear and tear" disease Degenerative Joint Disease also referred to as osteoarthritis (OA
Unlike Rheumatoid Arthritis, DJD.... DJD has no remission periods, and no systemic symptoms
A non-systemic, non-inflammatory disorder that progressively causes bones and joints to degenerate Degenerative Joint Disease
what two occupations are considered to be high risk leading to DJD? coal mining and boxing
Risk Factors for OA Increased age Previous joint injuries Obesity Congenital and developmental disorders (such as Legg-Calve-Perthes disease) Heredity factors Increased bone disease
Signs and Symptoms of OA Joint stiffness and pain Joint enlargement Limitation of joint movement Herberden's nodes Bouchard's nodes Progressive limitation of ROM in affected joint
(body enlargement of distal interphalangeal joints Herberden's nodes
(body enlargement of proximal interphalangeal joints) Bouchard's nodes
demonstrate disruption of the joint cartilage and bony changes X-Ray (radiographic films)
two ways to diagnose DJD ESR (erythrocyte sedimentation rate) may be elevated & X-Ray (radiographic films)
medications r/t osteoarthritis Large doses of acetaminophen may be used initially, Corticosteroids may be administered into inflamed joints but long term use discouraged, The use of narcotics is deferred
r/t osteoarthritis; Post Operative Complications you need to be aware of as a nurse… Hemorrhage Subluxation or dislocation of the artificial hip Infection Thromboembolism Vascular necrosis
Aspirin and NSAIDs can cause GI bleeding, so advise the patient to take medications with food
Head of the bed (HOB) is positioned at __ degrees or less r/t post op for osteoarthritis 45
Patient with hip replacement needs to have legs abducted and extended
Position of adduction and flexion beyond ___ degrees can dislocate the prosthetic femoral head from the acetabulum 90
Why is DJD also referred to as osteoarthritis? Because of the slow and steady progression of destructive changes in the weight-bearing joints and those that are repeatedly used for work.
A metabolic disease resulting from an accumulation of uric acid in the blood (hyperuricemia) gout
Acute inflammatory condition associated with ineffective metabolism of purines Gout
primary gout is linked to what? heredity factors, severe dieting / starvation, or excessive ingestion of purines
secondary gout is linked to what? Resulting from use of certain medications or complication of another disease
Signs and Symptoms of Gout Sudden onset of pain and tenderness in one joint (commonly the great toe) Swelling, and redness of the joint Joint becomes hypersensitive to touch Fever Presence of Tophi Joint deformities
diagnostic test for Gout would show what? Synovial fluid aspirates contain urate crystals; Elevated serum uric acid levels (hyperuricemia)
what is Gout medical management geared toward? Geared towards decreasing sodium urate in the extracellular fluid so that deposits do not form
medical management r/t Gout Using Uricosuric drugs to promote excreting of urates by inhibiting the reabsorption of uric acid in the renal tubules; Decreasing ingestion of purine; Use of NSAIDs such as Ibuprofen and Indomethacin, colchicine or phenylbutazone for acute attacks
when would a Gout pt be a candidate for surgery? Only performed to remove a large Tophi or to correct the crippling deformities
Why are patients told to increase their fluid intake if they are diagnosed with gout? Increase fluid intake helps increase the excretion of uric acid
A chronic connective tissue disorder of the spine and surrounding cartilaginous joints Ankylosing Spondylitis; or Marie-Strumpell Disease
what are some bodily changes r/t Ankylosing Spondylitis aortitis, iridocyclitis, pulmonary fibrosis
s/s of Ankylosing Spondylitis Difficulty in expanding the rib cage Vision loss from glaucoma and pupil damage Low back pain and stiffness Sciatica pain Weight loss Edema Decreased ROM
diagnostic tests for Ankylosing Spondylitis Elevated ESR Elevated alkaline phosphates and creatinine phosphokinase, X-rays and CT scans
medical management for ankylosing spondylitis tx is supportive, Aspirin and other NSAIDs to relieve pain and swelling, sleep on a firm mattress w/o a pillow, follow prescribed exercise program
Hypokalemia may increase the risk of ___ ___. digoxin toxicity
Corticosteroids Nursing Implications Assess patient for signs of adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness)
Corticosteroids baseline assessment should include; Weight. VS. I&O. Electrolytes. Nutrition
Corticosteroids Nursing implications r/t meals and timing? If dose is ordered daily or every other day, administer in the morning to coincide with the body's normal secretion of cortisol. PO: Administer with meals to minimize gastric irritation.
r/t to recommended diet while taking corticosteriods Encourage patients on long-term therapy to eat a diet high in protein, calcium, and potassium and low in sodium and carbohydrates
Two major uses of skeletal muscle relaxants Spasticity associated with spinal cord diseases or lesions & the symptomatic relief of acute painful musculoskeletal conditions
IV dantrolene is also used to treat and prevent malignant hyperthermia
centrally acting skeletal muscle relaxants baclofen, carisoprodol, cyclobenzaprine, diazepam, and methocarbamol
action of centrally acting skeletal muscle relaxants inhibits reflexes at the spinal level
action of directly acting skeletal muscle relaxants acts directly on skeletal muscle, causing relaxation by decreasing calcium release from sarcoplasmic reticulum in muscle cells.
directly acting skeletal muscle relaxants dantrolene
side effects for skeletal muscle relaxants seizures, dizziness, drowsiness (most common), fatigue, weakness. hypotension. nausea
skeletal muscle relaxants; what lab values we gonna watch for? monitor serum glucose, alkaline phosphatase, AST, and ALT levels -LIVER
dietary considerations r/t skeletal muscle relaxants Administer with milk or food to minimize gastric irritation
name the drug associated w/: Prevention of attack of gouty arthritis and nephropathy. Treatment of secondary hyperuricemia, which may occur during treatment of tumors or leukemias allopurinol
name the drug r/t Acute attacks of gouty arthritis. Prevention of recurrences of gout colchicine
inhibits the production of uric acid. allopurinol
interferes with the functions of WBCs in initiating and perpetuating the inflammatory response to monosodium urate crystals colchicine
Dietary considerations r/t anti-gout meds Administer with milk or meals to minimize gastric irritation. May be crushed and given with food or fluid.
rectangular steel with two pieces of canvas stretched tightly and laced to the frame. A space is left in the buttocks area for toileting and hygiene Bradford Frame
wooden or steel attachment to the hospital bed. The frame has adjustable pulleys and a trapeze bar attached to an overhead bar Balkan Frame
are similar and assist in changing the patients position from supine to prone. Stryker wedge turning frame and Foster bed
vertical turning bed that can be operated electrically by one person and can be placed in a variety of positions. CircOlectric Bed
can rock a patient as much as 62 degrees 17 times an hour. The electric powered bed can promote decubitus healing, prevent venous thrombosis, and reduce kidney stone formation. RotoRest Bed
____ is the first concern when ambulatory devices are used safety
A pathological of spontaneous fracture, and may result from? Osteoporosis, Metastatic cancer, Tumors of the bone.
A fibrin network forms between the fractured bone ends which changes into? Granulation Tissue
what would you report to physician r/t a skin tumor change in size, color, border, surface or elevation of a lesion
Develop when a group of blood vessels dilate and form a tumor like mass, non-elevated stain on the skin Angioma; a birthmark
Are a group of venous capillaries that dilate and branch out like spiders Spider Angiomas - associated with liver disease
Viral lesion that is contagious; rough papillomatous growth Verruca
A congenital, non-vascular skin blemish Usually benign but may become cancerous Nevus (mole)
Usually scaly in appearance, pearly papule with a central crater and waxy pearly border Malignant Tumors; Basal Cell Carcinoma
where are malignant tumors (basal cell carcinoma) most often found? Most commonly found on the face and upper trunk
Firm, nodular lesion topped with a crust or ulceration and indurated margins Malignant Tumors  (Squamous Cell Carcinoma)
where are Malignant Tumors (Squamous Cell Carcinoma) most often found? Can metastasize quickly via the lymphatic system Most commonly found on head, neck and lower lips
Occurs in the dermis and epidermis layers, can occur in the subcutaneous tissue also This cancer originates in the melanocytes of the epidermis Malignant Tumors (Malignant Melanoma)
what are some risk factors for Malignant Tumors  (Malignant Melanoma) family hx of skin cancer, fair complexion, exposure to the sun
ABCD’s of Melanoma A = Asymmetry (one half unlike the other) B = Border is irregular C = Color is varied from one area to another D = Diameter is generally larger than 6 mm (size of a pencil eraser)
treatment of choice for well-defined tumors without metastasis surgical incision
is not indicated for primary melanomas because they are radioresistant but radiation is indicated for metastatic cancer originating from a melanoma radiation
Chemotherapy for tumors includes what meds Cisplatin, Methotrexate, and Dacarbazine
affect cells that rapidly proliferate by interfering with the cycle of cell reproduction or by destroying the cell Antineoplastic drugs
dosage for antineoplastics are usually based on .... patient's weight
nursing considerations r/t pre-treatment of antineoplastics give 1-2 liters of IV fluid prior to drugs
Excessive growth of hair Hypertrichosis (Hirsutism)
A disorder where the nails get soft or brittle Paronychia
Absence of hair or a decrease in hair growth (balding included) Hypotrichosis
An injury to a muscle when it is stretched or pulled beyond its capacity; microscopic muscle tears as a result of overstretching  Strains
A soft tissue injury resulting from a blow or blunt trauma Contusion
Injuries to the ligaments surrounding a joint Sprains
Injury to the cervical spine Involves hyperextension and resulting compression whiplash
what are the three areas of focus r/t dislocations and other traumatic injuries Reduce edema and discomfort Immobilization of injured part to promote healing Patient education
Disorder of the wrist and hand induced by compression on the median nerve of the wrist carpal tunnel syndrome
s/s of carpal tunnel paresthesia and/or hypoesthesia of the thumb, index fingers and middle fingers
Inflammation and edema of the synovial lining of the tendon sheaths result in a narrowed tunnel space and compression of the median nerve; altered ability to grasp or hold small objects carpal tunnel syndrome
two ways a pt may describe carpal tunnel Burning pain or tingling in hand that is relieved by shaking or exercise of hands Pain may be intermittent or constant and is more intense at night
carpal tunnel diagnostic tools Physical examination Electromyogram Magnetic resonance imaging Handheld electroneurometer
Rupture of the fibrocartilage surrounding an intervertebral disk with resulting pressure on nerve roots Herniated Intervetebral Disk
s/s of lumbar spine herniations 20-45 y/o, lower back pain, radiates over butt and down the leg; numbness and tingling
s/s of cervical spine herniations 45 y/o and older, neck pain/rigidity, headache, alternation of bowel and bladder elimination
diet recommendations r/t herniated disk high protein, iron & vitamin enriched diet
pt teaching r/t herniated disk (HNP) No lifting anything heavier than 5 lbs for at least 8 weeks No driving until permitted by physician Avoid twisting motions of trunk F/U appts
Surgical removal of the bony arches or one or more vertebrae performed to relieve compression of the spinal cord Laminectomy
Administration of chymopapain into the nucleus pulposus to destroy the nucleus pulposus. Chemonucleolysis
Amputations Preoperative Assessment; diagnostic tests include CBC BUN Urinalysis Electrocardiogram (ECG)
If the amputation is related to a traumatic injury the physician's interventions will be aimed at: Controlling pain Preventing infection in the wound Perform a repair at the site that facilitates the use of prosthesis
Occurs because the nerve tracks that register pain in the amputated area continue to send messages to the brain phantom pain; it's NORMAL
Amputation Nursing Interventions are aimed at prevention of deformities & contractures. Place the patient in prone position a minimum of twice a day. Will stretch the flexor muscles
name ways to tx severe phantom limb pain Local infiltration of the stump with procaine Mechanical percussion; believed to shrink neuromas Sympathetic nerve block
commonly used med for amputations Indomethacin (indocin); analgesic, anti-inflammatory, Ibuprofen (Motrin), Naproxen (naprosyn)
how would Indomethacin be recommended to be given r/t diet with food, milk, or antacid
Do not take oral ___ with other medications as it may block the absorption calcium; Take oral calcium with meals to enhance absorption
You are preparing a 77 year old patient for an amputation of a lower extremity, when performing your nursing assessment, what is the key objective data that is documented? VS, Arterial Blood Flow, Wound, Nutritional status, and upper body strength
most common type of burns Flames, scalding and thermal energy (heat)
Non-thermal burns Electricity Chemicals Radiation
A current of only ___ ___to the heart can cause ventricular fibrillation 0.1 AMP
The epidermis is injured, but the dermis is unaffected. It heals in less than 5 days, usually spontaneously with symptomatic treatment; redness, no vesicles, painful Superficial (First Degree) burn
Affects both the epidermis and the dermis A superficial partial thickness burn can heal within 2 weeks with only some pigmentation changes but no scarring Partial Thickness (Second Degree) burn
Appearance - blistered, moist, mottled pink or reddened, blanches on pressure and refills Partial Thickness (Second Degree) burn
All the layers of the skin are destroyed and thus there is no pain If not debrided, this type of burn leads to sepsis, extensive scarring and contractures Full Thickness (Third Degree)
Appearance - tough with leathery eschar; white, charred, dark, brown, tan or red; does not blanch on pressure; dull and dry; little pain Full Thickness (Third Degree)
Categorized as one of the most lethal types of burns especially when there is a cutaneous injury associated with the respiratory tract burn inhalation burn
When noxious fumes are inhaled, what happens? the mucosa in the lungs swell and break, leaking fluid into the nearby alveolar spaces and damaging the cilia; mucus builds up and plugs the passages
Usual cause of death in inhalation cases is from pneumonia; more immediate death is often caused by respiratory edema
Very late signs of carbon monoxide poisoning include cherry red coloring to unburned skin, changes in color of the mucus membrane, unconscious, and obvious neurological damage
Signs and Symptoms for Inhalation Burns Dyspnea Hoarseness - Stridor (a medical emergency) - Altered mental status
Treatment for Inhalation Burns Administer 100% humidified oxygen Place in semi-fowlers position to allow for easier breathing Clear air way with suctioning Mouth to mouth / mask maybe required Maintain a open airway Hyper baric treatment for critical cases
Modified Brooke Formula for Fluid Replacement determine total BSA, pt weight in kg; 4ml X % burn X kg weight = initial 24 hour fluid replacement
how do you divide the total fluid for doses r/t Modified Brooke Formula 1st 8 hours give 1/2 of total fluid, during 2nd/3rd 8 hours give 1/4 of total fluid
The Closed (Occlusive) r/t burn tx The burn area is covered with a non-adherent dressing Gauze impregnated with petroleum jelly Ointment based antimicrobials. Outer dressing is an occlusive dressing that prevents bacteria from entering
uses the patient’s own skin, which is transplanted from one part of the body to another autograft
is human skin obtained from a cadaver. This is a temporary graft, which is used to cover a large area Allograft or homograft
skin graft obtained from animals, principally pigs heterograft
Alternative materials used to cover the wound and promote healing TransCyte Biobrane
advantages of Mafenide Acetate(Sulfamylon) Best when treating highly contaminated wounds, penetrates eschar, joint unimpeded and broad anti-gram-negative activity
advantage of Silver Sulfadiazine (Silvadine) Most effective if it is applied to burns immediately; Pain free, does not require occlusive dressing, joint motion unimpeded and it penetrates the eschar, broad antimicrobial agent
Causes losses of sodium, potassium, chloride and calcium, best if applied immediately, does not penetrate eschar, ineffective if the infection is already established Silver Nitrate
disadvantages of Mafenide Acetate (Sulfamylon) Exaggerates post-burn hyperventilation, painful application for 30 minutes, hypersensitivity, delayed eschar separation
Created by: jrstrader