Musculoskeletal System - Fractures
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| antagonistic | muscle groups working against each other
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| synergistic | muscle groups working together
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| muscle tone | normal state of balanced muscle tension
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| ligaments | bind joints together and connect bones and cartilage
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| tendons | connect muscles to bone
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| cartilage | a supportive tissue; located in joints, thorax, trachea, nose, and ears
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| ossification | hardening of bones
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| catabolism | eating away of dead flesh
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| ateleclasis | collapsing of the lung
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| urinary stasis | UTI
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| renal calculi | kidney stones
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| acute care | Metabolic: provide high protein, high-calorie diet with vitamin B & C supplements. Respiratory: have patients cough & breathe deep every 1 to 2 hours.
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| cardio-vasular changes | orthostatic hypotension, increased cardiac workload, thrombus formation
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| musculoskeletal changes | patient loses lean body mass, muscle weakness/atrophy, disuse osteoporosis, joint contracture
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| urinary elimination & integumentary changes | urinary stasis, renal calculi, integumentary changes, pressure ulcers-inflammation, ischemia, less collagen
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| health promotion | weight bearing exercises (like walking)
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| steroids | suck calcium and contributes to skin breakdown
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| fractures secondary to the disease process | cancer/osteoporosis
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| open fracture | skin broken with bone and soft tissue exposed
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| complete fracture | break is completely through the bone
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| incomplete | bone is still in one piece but the break occurs across the bone shaft
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| transverse | the break is straight across the bone (horizontal)
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| oblique | diagonal break
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| greenstick | break is not all the way through (picture a broken, green twig)
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| closed fracture | skin is intact
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| fracture, 1st stage of healing | fracture hematoma = initial 72 hours (bleeding, elevate, rest, ice)
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| fracture, 2nd stage of healing | granulation = 3 to 4 days post injury (basis for new bone)
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| fracture, 3rd stage of healing | callus
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| fracture, 4th stage of healing | ossification = hardening of the bone
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| fracture, 5th stage of healing | consolidation
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| fracture, 6th stage of healing | remodeling (up to a year after the injury)
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| closed reduction | nonsurgical, manual realignment of bone fragments, traction and counter traction
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| open reduction | correction of bone alignment through surgical incision
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| primary intention | surgical wounds are brought together
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| ORIF | open reduction with internal fixation
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| CPM | continuous passive motion (machine that stops adhesions - scar tissue)
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| traction | provides immobilization to prevent soft tissue damage, reduce muscle spasm, short term treatment, weights 5 to 10 pounds
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| pin care | clean with hydrogen peroxide and water
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| Buck's traction | a running skin traction that can be used temporarily to immobilize a fracture of the hip/femur until it is possible to do surgery
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| setting time for plaster | 15 minutes
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| petaling plaster | cutting the edges to avoid skin irritation
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| cast syndrome | chills, fever, nausea, vomitting, odour, or drainage on or under the cast
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| initial fracture care | elevate extremity above heart level for 24 to 48 hours (or edema might result)
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| cast care | apply ice directly over fracture for 24 hours, move joints above and below cast regularly, don't bear weight on it for 48 hours
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| compartment syndrome, card 1 | compartment syndrome occurs when injured tissue swells within the fascia and connective tissues inside a limb causing an increase in the pressure within that “compartment”.
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| compartment syndrome, card 2 | pressure within the closed fascia “compartment” becomes a tourniquet for the surrounding tissue within the compartment.
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| 6 P's | pain, pallor, pressure, pulses, paresthesia, paralysis
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| 6 P's | pain, pallor, pressure, pulses, paresthesia, paralysis
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| postoperative management | vitals every 15 minutes the first hour, then every 1/2 hour for the next 2 hours
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| significant increase in size of drainage area | increased size of drainage should be reported
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| prolonged best rest results in | orthostatic hypotension, decreased lung capacity
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| NWBA | non-weight-bearing ambulation
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| TTWB | touch-down/toe-touch weight bearing
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| DVT | deep vein thrombosis - one complication of a fracture
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| osteomyelitis | infection of the bone
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| compartment syndrome and ischemia | can occur within 4 to 8 hours after onset
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| compartment syndrome, card 3 | severe pain despite pain meds, extremity SHOULD NOT be elevated above the heart (no cold compress)
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| fractures that cause fat embolism the most | long bones, ribs, tibia, and pelvis (24 to 48 hours after injury)
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| osteoporosis | metabolic bone disease (porous bone, low bone mass, structural deterioration of bone tissue) - non-inflammatory (bone on bone)
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| most affected by osteoporosis | one in two women and one in eight men (more common in women)
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| risk factors of osteoporosis | cigarette smoking, sedentary, insufficient calcium, steroids (long use), thyroid replacement, anti-seizure drugs, low T
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| peak bone mass | achieved before age 20
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| areas of osteoporosis | spine, hips, and wrists (mostly)
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| diseases associated with osteoporosis | intestinal malabsorption, kidney disease, RA, alcoholism, cirrhosis, diabetes mellitus
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| BMD | bone mineral density
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| osteopenia | happens before osteoporsis
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| RA | causes swelling & inflammation around the joints, affects the whole body - including organs
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| on hands of people with OA | Heberden’s nodes are a permanent condition and often make your fingers look misshapen.
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| systemic manifestations | not present in OA
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| degenerative joint disease | OA
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| inflammation | not characteristic of OA
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| OA joint pain | worsens with joint use
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| early morning stiffness | usually resolves within 30 minutes
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| overactivity | can cause mild joint effusion and temporarily increases stiffness
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| crepitation | grating caused by loose particles of cartilage in joint cavity
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| asymmetrically | OA - joints are not affected the same bilaterally
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| DIP | distal interphalangeal
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| PIP | proximal interphalangeal
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| MCP | metacarpophalangeal joint
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| MTP | metatarsophalangeal
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| Bouchard's nodes | OA red, swollen, tender - visible disfigurement
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| knee OA | often leads to joint malalignment, altered gait
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| no abnormal labs or biomarkers | OA
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| OA management | rest, heat (used more than ice), cold (do not immobilize for more than one week)
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| RA | chronic, systemic autoimmune disease, inflammation of connective tissue, periods of remission
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| RA time of onset | any time of life
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| RA & women | 3 times greater chances of developing RA
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| RA cause | unknown
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| pannus | scars and shortens supporting structures causing joint laxity, subluxation, and contracture
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| unarrested RA | progresses in 4 stages.
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| RA - stage 1 | early - no destructive changes on x-ray
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| RA - stage 2 | moderate - x-ray evidence of osteoporosis with or without bone or cartilage destruction - no joint deformities
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| RA - stage 3 | x-ray evidence with evidence of cartilage and bone destruction, deformity
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| RA - stage 4 | fibrous or bony ankylosis, stage III criteria
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| RA onset | insidious, fatigue, anorexia, weight loss, generalized stiffness (precipitating events - might be mumps or diabetes 1)
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| RA - affects | symmetrical affects small joints of hands and feet
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| RA - mornings | morning stiffness may last from 60 minutes to several hours or longer
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| RA - finger | may become spindle shaped from synovial hypertrophy and thickening of joint capsule
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| RA - joint pain | increases with motion, varies in intensity, may not be proportional to degree of inflammation
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| RA progression | inflammation and fibrosis of joint capsule & supporting structures may lead to deformity and disability
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| RA - clinical manifestations | atrophy of muscles and destruction of tendons around joint cause one another to slip past each other
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| RA - deformities | ulnar drift, Boutonmere deformity, Hallux valgus, Swan neck deformity
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| three most common RA manifestations | rheumatoid nodules (non-tender, granuloma type), Sjogren's syndrome (itchy, dry eyes with diminished tears & salivary glands), Felty syndrome ( inflammatory eye disorder, splenomegaly - large spleen, enlarged lymph nodes, pulmonary disease)
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| RA complications | diminished grasp, cataracts, progressive hoarseness from nodes, pericarditis, cardiomyopathy, carpal tunnel syndrome
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| RA - labs | positive RF, titers rise during active disease (ANA titers), ESR is elevated (estimated sedimentation rate), elevated C-reactive protein
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| straw colored fluid | RA
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| increased WBC | can be elevated up to 25,ooo in RA
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| RA timeline & criteria | 6 weeks with morning stiffness lasting more than an hour and swelling in three or more joints, symmetric joint swelling, rheumatoid nodules
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| RA care | PT to help maintain joint motion and muscle strength, OT to help with extremity function and joint protection, warm shower or water on joints, firm mattress or bed board, extension positions, heat (not to exceed 20 minutes)
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| pain process | transduction (initiates the action potential), transmission (sends impulse across sensory pain nerve fiber), perception, modulation (release of neurotransmitters - endorphins, histamine, substance P, bradykinin)
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| pain neurotransmitters | prostaglandins, bradykinin, potassium, histamine, substance P (vasodilation & edema)
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| pain -afferent | from site of injury to the brain
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| pain - A-delta fibers | send sharp, localized, distinct sensations
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| pain - unmyelinated C fibers | slow & small. They send poorly localized, burning, persistent pain
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| Gate-control theory | Pain has emotional & cognitive components aside from the physical sensation. Pain impulses pass through when a gate is open and are blocked when a gate is closed.
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| reflex arc | reflex to pain stimulus
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| acute pain | transient, identifiable, short duration, limited emotional response
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| chronic - noncancer | not protective, no purpose, may or may not have an identifiable cause
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| chronic episodic | occurs sporadically over an extended period of time
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| inferred pathological | musculoskeletal, visceral, or neuropathic
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| idopathic | chronic pain without an identifiable physical or psychological cause
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| poorest pain care received by | people with chronic pain (they doctor shop looking for answers and get accused of being addicts - pseudo-addiction)
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| symptoms of chronic pain | fatigue, insomnia, mood changes - irritable, anger/frustration/depression,
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| pain tolerance | the level of pain a person is willing to accept
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| pain management | systematic (regular intervals to keep the pain at manageable levels)
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| PCA | Patient-Controlled Analgesia (pump the patient uses to self medicate - within predetermined limits). Two nurses must do the programming. Monitor O2 continuously.
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| A postoperative patient with a PCA | evaluate effectiveness by comparing current assessment with baseline pain
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| monitoring patients using pain medication | check for depressed CNS (over sedation, respiratory depression)
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| activation of large-diameter A fibers | closes gate, inhibits transmission to the brain (TENS, massage, ...)
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| activation of small C fibers | opens the gate and allows the perception of pain
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| PCA by proxy | someone other than the patient pushes the pump
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| adjuvant drugs | NSAIDS, antidepressants, anticonvulsants, corticosteroids (amitriptyline, Gabapentin)
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| opioid - adverse effects | euphoria, CNS depression, nausea/vomiting, urinary retention, diaphoresis and flushing, pupil constriction (miosis), constipation, itching
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| naloxone (Narcan), naltrexone (Revia) | used for complete or partial reversal of opioid induced respiratory depression
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| pain threshold | 1st time pain is felt
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| age related bowel and urinary changes | bladder is smaller, loss of sensation, loss of muscle
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| one cause of dirrhea | stress
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| nocturia | night-time urinary eleimination
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| polyuria | lots of urinary elimination
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| oliguria | low amount of urinary output
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| anuria | no urinary output
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| diuresis | increased excretion of urine
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| diseases affecting urination | diabetes mellitus, MS, benign prostatic hyperplasia, cognitive impairment (Alzheimer's), end-stage renal disease uremic syndrome (toxins that can't be removed - they end up oozing out of the pores giving the person a frost-like appearance).
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| Indication for dialysis | renal failure uncontrolled by conservative management, worsening of uremic syndrome (ESRD), severe electrolyte & or fluid abnormalities
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| factors influencing urination | surgical procedures, stress, medications, diagnostic procedures
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| alterations in urinary elimination | BPH (males - benign prostate hyperplasia), UTI, unrinary incontenence, urinary diversion, bladder prolapse (women).
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| sterile urine collection - catheter | scrub connection for 15 seconds and allow it to dry before getting the sample
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| social isolation | disturbed body image
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| urinary related pain | urinary incontinence (functional, stress, urge, overflow)
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| urinary risk for infection | toileting self-care deficit
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| urinary impaired skin integrity | impaired urinary elimination
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| constipation | urinary retention
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| cholinergic drugs | increase bladder contraction and improves emptying
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| I & O | example: IV = 3000mL in the bag. 1800mL has flowed through tube into pt. 1500mL has been voided. 1800 (in) - 1500 (out) = 300 mL = amount of urine over a 10 hour shift.
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| digestive track | mouth, esophagus, stomach, small intestine, large intestine, anus
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| common bowel problems | constipation, impaction, diarrhea, incontinence, flatulence, hemorrhoids
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| bowel diversion | temporary or permanent in the stomach wall = stoma
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| Ilesotomy | usually rt. upper, green liquid stool
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| colostomy | usually lower left, solid stool
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| dehydration could be | a sign constipation
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| end colostomy | permanent
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| double-barrel colostomy | temporary. one produces mucus and one produces stool
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| anastomosis | reverse ostomy. Fast heart rate is a sign of leakage.
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| enemas | no more than 500 cc's (warm - not cold or cramping may happen)
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| ostomy irrigation | cone that fits in the ostomy (not an enema)
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| new ostomy nutrition | low fiber for first weeks, eat slow & chew completely, 10 to 12 glasses of water daily
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| laxatives | can cause the body to become dependent
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| OA indicators | one side (1 knee replaced),weight bearing exercises help, lack of calcium, vertebrae cracks, smoking makes it worse
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| RA indicators | starts at any age, both sides of the body
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| sign of compartment syndrome | lack of a pulse
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| bucks traction | pre-surgical
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| What does hot & cold due? | hot = vasodilation
cold = decrease inflammation
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| monitor pt's on PCA and opiods for | change in LOC and decreased respiration. Stop meds and call doc
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| acute pain is | protective, has a cause, short duration, limited tissue damage, emotional response
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| neuropathic pain | treatment usually includes adjuvant analgesics
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