68WM6 Phase 2 test 16 Musculoskeletal/Integumentary
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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| alopecia | loss of hair
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| angioma | Benign tumors made up of small blood vessels or lymph vessels; a birthmark.
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| tx for angioma | electrolosis, radiation
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| crust | dried serum, blood, purulent exudate, slightly elevated
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| furuncle | boil, inflammation deep in hair follicle
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| carbuncle | a cluster of furuncles
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| Irritation causing inflammation of the skin though direct contact with an agent. | Dermatitis
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| Eczema | Commonly associated with allergies and seen in infants. Papular and vesicular legions that rupture
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| Redness or inflammation of the skin or mucous membranes | Erythema
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| Keloid | tough, irregularly shaped scars that progressively enlarge
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| 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
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| necrosis | Premature cell death caused by external factors
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| An elevated, firm, circumscribed area | papule
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| Elevated, firm, circumscribed lesion extending deeper into the dermis than a papule | nodule
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| the symptom of itching | puritus
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| Elevated, circumscribed skin legion, not into the dermis. Filled with serous fluid | vesicle
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| Elevated, superficial legion, filled with purulent fluid | pustule
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| athlete's foot | tinea pedis
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| elevated, solid legion - extends into subcutaneous layer | tumor
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| Elevated, irregularly shaped area of edema | wheal
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| functions of the skin | protection, sensory organ, homeostasis, temp control, Vit D synthesis, prevent dehydration, excrete waste
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| from top to bottom - layers of the skin | epidermis, dermis, subcutaneous
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| layers of the epidermis | Stratum corneum Pigment Layer Stratum germinativum
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| "true skin", contains blood vessels, nerves, glands, hair follicles | dermis
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| "fatty layer" of skin, composed of adipose tissue, and loose connective tissue, provides shape for the body, | subcutaneous layer
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| functions of SQ layer of skin | store water and fat, insulation, protection of body organs, provides pathway for nerves and blood vessels
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| Sudoriferous | sweat glands
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| Ceruminous glands | Secrete a wax like substance called cerumen. Located in the external ear canal
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| Sebaceous (oil) glands | Secrete sebum through the hair follicles Function is to lubricate the skin and hair Sebum also inhibits bacterial growth
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| nails are composed of packed _____ | keratin
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| 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
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| 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
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| 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
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| Diseases that may affect the skin | Diabetes Cancer Kidney failure Thyroid Disease Liver disease Anemia
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| Atheroma | an accumulation and swelling in artery walls that is made up of (mostly) macrophage cells, or debris, that contain lipids
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| Bleb | large flaccid vesicle, usually at least 1 cm
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| Cyst | a fluid-filled sac. They can form anywhere in the body
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| Excoriation | any superficial loss of substance, To tear or wear off the skin of; abrade
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| fissure | narrow opening or crack of considerable length and depth usually occurring from some breaking or parting
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| Hyperplasia | increased cell production in a normal tissue or organ
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| Petechiae | Pinpoint flat round red spots under the skin surface caused by intradermal hemorrhage (bleeding into the skin)
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| To assess rashes and skin inflammation, rely on ..... | palpation for warmth and indurations rather than observation
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| patients with dark skin are more predisposed to what skin conditions | Pseudofolliculitis Keloids Mongolian spots
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| how are most skin d/o diagnosed? | observation
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| Therapeutic Baths are used to | Used to relieve inflammation and itching Use cornstarch, baking soda or oatmeal
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| describe Phototherapy | Promotes shedding of the epidermis Treats chronic skin conditions Pruritus may occur after therapy Observe for signs and symptoms of phototoxicity
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| Herpes Simplex (Viral)is caused by | Herpes virus hominis
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| Type 1 HSV | characterized by vesicles at the corner of the mouth, lips, or in the nose caused by common cold sores
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| Type 2 HSV | characterized by vesicles in the genital areas transmitted primarily through sexual contact
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| _____ is an antiviral agent used to alter the course of the disease | Acyclovir (Zovirax)
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| _____ (____) and topical anesthetics may be prescribed for pain | Analgesics (Tylenol)
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| nursing considerations r/t HSV | keep lesions dry, avoid contact, wear gloves, warm compresses to relieve pain and severe pruritus
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| r/t HSV outbreaks; Periodic recurrences are expected and may be triggered by | stress fever trauma fatigue
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| Herpes Zoster (Shingles) (Viral) is caused by | Caused by the varicella virus that causes chicken pox (Herpes varicellae)
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| shingles is characterized by: | Characterized by lesions along the nerve fibers of spinal ganglia
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| 1st symptoms of shingles | First symptoms are pain, itching, and heightened sensitivity along the nerve pathway
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| 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
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| medical tx for Shingles | Acyclovir, Lotions (Kenalog/Lidex), wet dressing soaked in Burrow's solution, tranquilizers (Ativan / Atarax), medical baths, analgesics,
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| r/t Shingles, eat more Vit ___ to promote healing | Vitamin C
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| 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)
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| Impetigo: (Bacterial) is caused by | Caused by staphylococcus aureus, streptococci or a mixed bacterial infection of the skin
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| Impetigo is ____ ____ from contact | highly contagious; May spread by touching personal articles, linens and clothing of the infected person
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| 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
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| Antibiotics r/t Impetigo | Erythromycin, Dicloxacillin, Cephalosporin, Rocephin; Topical antibiotics (Bactroban) started early in the treatment
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| Clean the area with antiseptics such as ____ and ____ , then remove dry exudates using special instruments | Betadine or Hibiclens
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| nursing interventions r/t Impetigo: inspect lesions every ____ for drainage, size and extent of body covered. Keep clean and dry | every day
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| A bacterial inflammation of the skin caused by Staphylococcus infection of a hair follicle | Furuncle (Boil)
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| 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
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| what is the medication tx for a series of furuncle? | systemic antibiotics
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| ringworm of the scalp, Erythematous, round lesions with pustules around the edges Causes alopecia at the site | Tinea capitis
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| ringworm of the body; Flat lesions that are clear in the center w/ erythematous borders Scaliness is found Pruritus is severe | Tinea corporis
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| that migrate out from the groin area Pruritus Excoriation due to scratching | Tinea cruris
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| Most common of all fungal infections Fissures and vesicles found around and below the toes | Tinea pedis
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| A ___ ___ is an ultraviolet light used to diagnose tinea capitis | Wood's light
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| 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)
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| nursing interventions r/t tinea infections | clean and dry, wear loose fitting clothing and shoes, apply medications
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| how long could a tinea infection last? | possibly months
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| Skin reaction from direct contact with agents in the environment to which a person is hypersensitive | Contact Dermatitis
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| Common causes are detergents, industrial chemicals and plants | Contact Dermatitis
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| 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
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| r/t contact dermatitis, what would you expect of the lab values? | elevated IgE and eosinophils
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| medication tx for contact dermatitis | Corticosteroids and Benadryl to treat the inflammation, edema and pruritus
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| 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
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| It is the common term for poison ivy and poison oak | Dermatitis Venenata
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| commonly called hives | Urticaria; presence of wheals caused by an allergic reaction
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| An inflammatory papulopustular skin eruption that involves the sebaceous glands; when the oil glands become occluded | Acne Vulgaris
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| noninfectious disease where skin sloughing and generation of new skin cells occurs more rapidly than the normal 28 days | Psoriasis
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| Lesions appear as raised, erythematous, silvery, scaling plaques Located on the scalp, elbows, knees, chin and trunk | Psoriasis
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| 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
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| PUVU Therapy | Photochemotherapy involves the use of methoxsalen (Psoralen) is given orally The patient then is placed under ultraviolet light A
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| Vitamin __ may reduce epidermal proliferation | Vitamin D
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| Since the disease is chronic, consider the patient's emotional needs and encourage the patient to focus on their __ __. | positive attributes
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| Nursing diagnosis goals in general.... | the patient should VERBALIZE desired results. IE...verbalize effective coping mechanism, states and demonstrates priciples of self care.
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| pediculosis is | Lice
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| a parasitic d/o of the skin usually associated with poor living conditions and poor hygiene | pediculosis
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| what meds would you expect for lice? | Lindane (Kwell) or pyrethrins (RID)
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| how long should you put items in a sealed plastic bag r/t lice | 2 weeks
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| what temp should your water be according to the CDC to kill both head lice and nits? | 130 degrees
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| 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
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| what other method can you use to kill lice? | freezing temps for several days
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| caused by the female itch mite penetrating and burrowing under the skin | scabies
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| wavy, brown, threadlike line on the body with severe pruritus and often secondary infection due to excoriation caused by scratching | scabies
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| scabies is normally found ?? | hands, arms, body folds, genitalia
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| medical management for scabies | Lindane (Kwell) or pyrethrins (RID) and crotamiton (Eurax)-solution of sulfur in petrolatum
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| most distressing part of a skin disease | often the social stigma and emotional trauma the pt must endure
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| Ankylosis | fixation of a joint, usually in an abnormal position resulting from destruction of cartilage or bone
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| Arthrocentesis | puncture of a joint with a needle to withdraw fluid used for diagnostic purposes
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| 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
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| a test of the rate of capillary refill | Blanching test
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| bony deposits formed between and around the broken ends of a fractured bone during healing | callus
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| a fracture of the distal portion of the radius within 1 inch of the wrist | Colles' fracture
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| sounds that represent the cracking noise heard when rubbing hair between fingers. It is associated with broken bones | Crepitus
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| a musculoskeletal chronic pain syndrome of unknown etiology that causes pain in the muscles, bones or joints | Fibromyalgia
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| an abnormal condition of the vertebral column, characterized by increased convexity in the curvature of the thoracic spine | Kyphosis
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| an increase in the curve at the lumbar space region that throws the shoulders back | Lordosis
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| a surgical procedure allowing fracture alignment under direct visualization while using various internal fixation devices applied to the bone | Open reduction with external fixation
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| any subjective sensation, such as prickling "pins and needles" or feeling of numbness | Paresthesia
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| curvature of the spine usually consisting of two curves; the original abnormal curve and a compensatory curve in the opposite direction | Scoliosis
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| a fragment of necrotic that is partially or entirely detached from the adjacent healthy bone | Sequestrum
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| partial dislocation | Subluxation
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| a permanent contracture with clawhand | Volkmann's contracture
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| wasting | atrophy
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| sprain | the ligament over-stretching
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| strain | muscle over-stretching
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| Structures & Functions of the Musculoskeletal System | support, protect, movement, Mineral Storage, Hematopoiesis
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| Hematopoiesis | blood cell formation
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| There are three types of joints | Synarthrosis - no movement, Amphiarthrosis - slight movement, Diathrosis - free movement
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| Muscles are necessary for movement and perform three vital functions | motion maintenance of posture production of heat
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| each muscle fiber is surrounded by a connective tissue called | epimysium
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| Remember the 7Ps of a neurovascular assessment | pulselessness paresthesia paralysis polar temperature pallor puffiness (edema) pain
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| 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
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| is used to determine presence of fluid, joint irregularity, or fractures | X-ray
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| involves the injection of a radiopaque dye into the subarachnoid space at the lumbar spine to detect the presence of herniated disks | Myelogram
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| used to detect pathological conditions of the cerebrum and spinal cord | MRI
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| Body sections can be examined from many different angles using a CT scanner that produces a narrow x-ray beam | CT
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| 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
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| Endoscopic Exam | a lighted tube is used to visualize inside a body cavity
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| is done to obtain a specimen of body fluid | Aspiration
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| is a procedure that involves the insertion of needle electrodes into the skeletal muscle so that electrical activity can be recorded | Electromyogram
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| Normal values 9-10.5 mg/dl | Calcium
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| Increased in tumor of the bone, renal failure, Vitamin D deficiency, etc | Calcium related
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| 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
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| Normal values - no LE seen | Lupus Erythematosus
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| Normal values < 60U/ml | Rheumatoid factor
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| 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
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| What are the three terms relating to the curvature of the spine? | lordosis, kyphosis, and scoliosis
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| General condition characterized by inflammation and degeneration of a joint | Arthritis
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| The 4 most common types of arthritis | Rheumatoid arthritis (RA) Osteoarthritis (degenerative joint disease) Gout (Gouty arthritis) Ankylosing spondylitis (AKS)
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| A systemic inflammatory disorder of connective tissue/joints Characterized by chronicity, remissions, and exacerbation | Rheumatoid Arthritis
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| 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
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| 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
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| Rheumatoid synovitis advances, leading to pannus formation. What is "pannus"? | abnormal layer of fibrovascular tissue or granulation tissue
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| Systemic Signs and Symptoms of RA | Fatigue Malaise Anorexia Weight loss Fever Vasculitis Neuropathy Pericarditis Splenomegaly Anemia
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| 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
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| Swan neck deformity | (hyperextension of proximal interphalangeal joints with fixed flexion of distal interphalangeal joints
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| Boutonniere deformity | (persistent flexion of proximal interphalangeal joints with hyperextension of distal interphalangeal joints)
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| Radiographic films show characteristic joint changes and the extent of damage such as | narrowed joint spaces and body erosions
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| in an Arthrocentesis you would expect the fluid to look like what? | Fluid appears cloudy, milky or dark yellow; contains many inflammatory cells
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| examination to visualize the extent of joint damage as well as to obtain a sample of synovial fluid | Arthroscopy
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| may be elevated, C-reactive protein test, CBC, CD4 complement component is decreased, ANA (anti-nuclear antibody) may be positive | ESR (erythrocyte sedimentation rate)
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| medication tx for RA | NSAIDS, Salicylates, Celebrex (used for RA and osteoarthritis). Vioxx (only for osteoarthritis).
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| DMARDs; Disease-modifying antirheumatic drugs | Antimalarials (hydrochloroquine) Gold salts (auranofin, aurothioglucose) Penicillamine Sulfasalazine
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| If there are bony erosions, ___ an anti-neoplastic agent is started | methotrexate (Rheumatrex)
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| r/t RA, ___ and ___ are immunosuppressants used only in severe cases | Cyclosporine (Neoral) and Azanthioprine (Imuran)
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| 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
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| 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
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| what is something you can do for your patient to help relieve symptoms of RA | application of heat/cold packs
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| Collaboration with occupational therapists to provide utensils, equipment and instruction regarding : | energy conservation and maintenance of joint alignment
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| Degenerative Joint Disease (DJD) also know as | osteoarthritis
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| Disorder that results in a reduction in bone mass which interferes with the mechanical support function of the bone | osteoporosis
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| Women between the ages of 55 and 65 are at higher risk for post menopausal osteoporosis due to | loss of estrogen
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| Studies suggest that Estrogen deficiency is connected with | increased bone reabsorption and sensitivity to parathyroid hormone
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| 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
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| Other Risk Factors r/t osteoporosis | Diet low in calcium throughout life span Smoking Excessive protein in diet Sedentary life style (Culture / Ethnic background)
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| 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
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| dowager's hump | spinal deformity and height loss
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| r/t osteoporosis, Treatment aimed at: | promoting the increase of bone density and retardation of bone loss
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| r/t osteoporosis, Recommend 50,000 IU of Vitamin __ 1-2 times week for post menopausal women | Vitamin D
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| Alendronate (Fosamax) | bone resorption inhibitor; Absorbs calcium phosphate crystal in bone and treats symptoms of osteoporosis
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| 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
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| Risendronate (Actonel) | Bone resorption inhibitor
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| Inhibits calcium phosphate crystal in bone and inhibits bone resorption without inhibiting bone formation or mineralization | Risendronate
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| One significant nursing consideration r/t Risendronate/Actonel | Patient must sit upright for 30 minutes to prevent esophageal irritation
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| nursing goals r/t osteoporosis | Aimed at preventing further bone loss and fractures
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| dietary counseling r/t osteoporsis | increase calcium and Vit D, decrease caffeine and phosphorus and protein
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| food that is high in calcium include: | green leafy veges, milk, soy milk, turnip greens, spinach
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| Inform patients about risks of estrogen including: | Thromboembolism Endometrial cancer Breast cancer
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| T/F: r/t osteoporosis, you should encourage ambulation and weight bearing exercises | TRUE
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| 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
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| 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
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| Most common causative agents are Staphylococci | Osteomyelitis
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| r/t Osteomyelitis, you need to assess vital signs. What would you expect r/t VS? | temperature elevation, tachycardia, and tachypnea
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| medical management for osteomyelitis | IV, broad spectrum antibiotic, parenteral antibiotics for several weeks
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| r/t osteomyelitis, what would you use to irrigate the wound? | hydrogen peroxide or antibiotic solution
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| recommended diet for a osteomyelitis | Need for diet high in calories, protein, and vitamins
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| 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)
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| Referred to as fibrositis, fibromyositis, myofascial pain syndrome, and psychogenic rheumatism | Fibromyalgia Syndrome (FMS)
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| Characterized by generalized achiness (usually neck/lower back) Stiffness that is worse in the morning Condition aggravated by several factors | Fibromyalgia Syndrome (FMS)
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| what are some stressors for FMS? | Cold or humid weather Physical or mental fatigue Excess physical activity: Anxiety of stress
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| issues that run side by side with FMS | IBS, tension headaces, Paresthesia of upper extremities, Paresthesia of upper extremities, Dysfunctional or nonrestorative sleep
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| 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)
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| medical management for FMS is also focused on | goals that empower the patient; education, exercise, and relaxation techniques
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| dietary considerations r/t FMS | Avoid large meals 2 to 3 hours before bedtime
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| what are some exercises you could recommend for a patient with FMS? | swimming, walking, stationary cycling
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||||
| 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
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| Injuries to the ligaments surrounding a joint | Sprains
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| Injury to the cervical spine Involves hyperextension and resulting compression | whiplash
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| 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
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| Disorder of the wrist and hand induced by compression on the median nerve of the wrist | carpal tunnel syndrome
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| s/s of carpal tunnel | paresthesia and/or hypoesthesia of the thumb, index fingers and middle fingers
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| 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
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| 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
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| carpal tunnel diagnostic tools | Physical examination Electromyogram Magnetic resonance imaging Handheld electroneurometer
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| Rupture of the fibrocartilage surrounding an intervertebral disk with resulting pressure on nerve roots | Herniated Intervetebral Disk
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| s/s of lumbar spine herniations | 20-45 y/o, lower back pain, radiates over butt and down the leg; numbness and tingling
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| s/s of cervical spine herniations | 45 y/o and older, neck pain/rigidity, headache, alternation of bowel and bladder elimination
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| diet recommendations r/t herniated disk | high protein, iron & vitamin enriched diet
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| 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
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| Surgical removal of the bony arches or one or more vertebrae performed to relieve compression of the spinal cord | Laminectomy
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| Administration of chymopapain into the nucleus pulposus to destroy the nucleus pulposus. | Chemonucleolysis
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| Amputations Preoperative Assessment; diagnostic tests include | CBC BUN Urinalysis Electrocardiogram (ECG)
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| 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
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| Occurs because the nerve tracks that register pain in the amputated area continue to send messages to the brain | phantom pain; it's NORMAL
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| 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
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| name ways to tx severe phantom limb pain | Local infiltration of the stump with procaine Mechanical percussion; believed to shrink neuromas Sympathetic nerve block
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| commonly used med for amputations | Indomethacin (indocin); analgesic, anti-inflammatory, Ibuprofen (Motrin), Naproxen (naprosyn)
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| how would Indomethacin be recommended to be given r/t diet | with food, milk, or antacid
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| Do not take oral ___ with other medications as it may block the absorption | calcium; Take oral calcium with meals to enhance absorption
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| 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
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| most common type of burns | Flames, scalding and thermal energy (heat)
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| Non-thermal burns | Electricity Chemicals Radiation
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| A current of only ___ ___to the heart can cause ventricular fibrillation | 0.1 AMP
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| 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
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| 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
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| Appearance - blistered, moist, mottled pink or reddened, blanches on pressure and refills | Partial Thickness (Second Degree) burn
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| 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)
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| 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)
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| 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
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| 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
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| Usual cause of death in inhalation cases is from | pneumonia; more immediate death is often caused by respiratory edema
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| 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
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| Signs and Symptoms for Inhalation Burns | Dyspnea Hoarseness - Stridor (a medical emergency) - Altered mental status
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| 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
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| Modified Brooke Formula for Fluid Replacement | determine total BSA, pt weight in kg; 4ml X % burn X kg weight = initial 24 hour fluid replacement
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| 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
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| 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
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| uses the patient’s own skin, which is transplanted from one part of the body to another | autograft
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| is human skin obtained from a cadaver. This is a temporary graft, which is used to cover a large area | Allograft or homograft
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| skin graft obtained from animals, principally pigs | heterograft
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| Alternative materials used to cover the wound and promote healing | TransCyte Biobrane
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|
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| advantages of Mafenide Acetate(Sulfamylon) | Best when treating highly contaminated wounds, penetrates eschar, joint unimpeded and broad anti-gram-negative activity
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| 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
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| 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
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| disadvantages of Mafenide Acetate (Sulfamylon) | Exaggerates post-burn hyperventilation, painful application for 30 minutes, hypersensitivity, delayed eschar separation
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|
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