222- Test 2!! Flashcards
MRI
(Magnetic Resonance Imaging)
Identifies soft tissue, ligament tears and herniated disks.
(Sports Injury)
Osteomyelitis
Bone with infection inside
Myelography
X-rays of the spinal column after injection of the contrast medium into the subarachnoid space via a catheter.
Used when spinal lesion is suspected (herniated disks, tumor
GIVE PRE-EMPTIVE MEDS (LOAD EM UP)
Myelography
- Ask about IODINE/SHELLFISH allergy
- must lie flat for a few hours after (headache, nausea)
- Monitor for neurological changes: tingling/numbness
- Increase fluids to eliminate dye through urine (3000 ml/day)
Uric Acid
-Normally excreted in the urine, LEVELS ARE INCREASED IN GOUT.
Assessment of musculoskeletal system
- Inspection
- Palpation HEAD TO TOE (look for crepitis)
- Active motion- pt able to take own joints through all the movements
- Passive motion- another person moves the joints without assistance from the patient
STOP IF PAIN OR RESISTANT IS MET
Low Back Pain
-Elevate the HOB and flex the knees
Clinical Manifestations of Fractures
- Edema/ Swelling (bleeding into surrounding tissue)
- Pain/Tenderness (muscle spasms)
Hip Fractures
-Affected limb is shorter and externally rotated.
Open Fracture
IFOPEN FRACTURE AND PATIENT HAS DEVELOPED A TEMPERATURE OF 101.4 TWO DAYS LATER, CALL THE DR!!
Reduction
-anatomic realignment of bone fragments (put back in place)
Complications of open fractures
INFECTION- r/t disruption of skin integrity
Open Reduction with Internal Fixation (ORIF)
-Facilitates early ambulation (With an assistive device; walker, crutches)
-The earlier they get out of the hospital the faster they heal becaues theyre more mobile.
Bucks Traction for Fracture Reduction
- Apply a pulling force to attain realignment while counter traction pulls in the opposite direction.
- Skin traction reduces the fracture, diminishes muscle spasms.
Uses body weight as counter weight.
A complication of Bucks traction is pt is unable to dorsiflex the affected foot.
Skeletal Traction
- Aligns injured bones and joints, joint contractures, congenital hip dysplasia
- Forces must be in opposite direction
DO NOT INTERRUPT THE WEIGHT APPLIED TO THE TRACTION.. bone can become unaligned and they have to go back to surgery.
Assess pressure points from groin to toes
1 Complication of Fracture
Fat Embolism
s/s: chest pain, confusion, dyspnea, tachypnea, petechiae of neck and anterior chest wall.
Clinical Manifestations of Compartment Syndrome
-Do regular neurovascular assessments especially in pts with distal humurus or proximal tibial fractures.
Assess the 6 P’s
-Peresthesia (numbness/tingling)
-Pain (distal to the injury) Unrelieved with Narcotics Administration
- Pressure of compartment (rises)
- Pallor
- Paralysis
- Pulselessness (late sign)
EDEMA AND DECREASED PULSE
Clinical manifestations of Compartment Syndrome
Assess for myoglobinuria
- As mucles are damaged, myoglobin is released, and excreted in urine
- Urine will be dark, reddish brown
Collaborative Care Compartment Syndrome
DO NOT elevate about level of the heart.
This raises venous pressure and slow arterial perfusion.
DVT
Especially in hip fractures
Fat Embolism Syndrome
Fat globules in tissue after skeletal injury
-After total joint replacement, spinal fusion, liposuction, crash injuries and bone marrow transplants
S/S of fat embolism
- Occurs 24-48 hrs after surgery
- Chest Pain
- Tachypnea
- Cyanosis
- Tachycardia
- Decrease in PaO2
- Change in LOC
-OXYGEN is #1 priority
Short Arm Cast
-Keep arm elevated above the level of the heart.
Amputation Care
Avoid pillows under surgical extremity to prevent flexion contractures.
Lie on abdomen for 30 min 3-4 times/d.
-Minimize pain (phantom pain) LOAD EM UP
Nursing Interventions for Amputation
- Teach patient to AVOID dangling limb
- Talk to the patient about how the surgery will affect him/her
Reducing the Risk of Osteoporosis
-Diet rich in calcium!!
Sardines, yogurt, skim milk, cheese
Collaborative Care for Osteoporosis
-Encourage walking 30 min; 3x/week
Osteoarthritis
“Wear and tear disease”
-Increases with age, affects only the joints, affects sOBESE people, slowly progressive
Can affect any joint, but usuallly in the knees, hips, spine, and fingers.
Drug therapy for Osteoarthritis
- Tylenol q6hrs (hepatotoxic!)
- ASA & NSAIDS (DONT USE IN COMBINATION)
watch fo G.I bleeding
Lumbar Laminectomy
- Removes a portion of the vertebrae.
- Ruptured disk pushes on the nerves causing pain and dysfunction
- Any post op neuromuscular changes (numbness/tingling)
-Compare findings with pre-op neuromuscular assessment symptoms.
Lumbar Laminectomy Post op
- Assess for bowel and bladder dysfuntion. (Urinary retention;; palpate or bladder scan)
- Place a pillow between legs and turn body as one unit.
S/S of Rhumatoid Arthritis (RA)
Hand disfigurement
Swan-neck deformity
Boutinniere deformities
Diagnostics for RA
-Erythrocyte Sedimentation Rate (ESR)
Normal is <22mm/hr
Monitors response to treatment (if decreased tx is not working)
-THE ESR IS ALMOST ALWAYS ELEVATED WITH THESE PTS.
Med for RA
Remicade- mouse urine
Hip Arthroplasty
Total Hip Arthroplasty (THA)
- relieves pain and improves function
- implants are cemented in place and bonds to bone
- Cemented procedure may need to be revised.
Nsg interventions post hip
-Elevated Toilet Seats
(hips cant be lower than knees)
-Have pts spouse or someone put on shoes and socks
Total Hip Post
Teach pt they need PROPHYLACTIC antibiotic before dental procedures
-Also teach use of assistive device; walker/ crutches before discharge
Knee Arthroplasty
- POST op exercise is EXTREMELY important
- Isometric quadriceps sitting begins first day post op
GOUT
-Major complication of gout is KIDNEY stones
-hyperuricemia, low grade fever, joint swelling, pain, occurs in one or more joints
**-Usually hx of ETOH use and renal failure. **
Collab. Care of Gout
-Antiinflammatory agents
Colchicine- treats pain for acute attacks
Allopurinal- PREVENTS; helps control serum uric acid levels and prevents future attacks!
KNOW DIFF BETWEEN THE TWO
Causes of Lupus
- Genetic, hormones, symptoms occur after onset of menarche, oral contraceptives, pregnancy.
- SUN EXPOSURE
SLIP SLOP SLAP!!!!
SLIP on a shit
SLOP on some suncreen
SLAP on a hat!
Clinical Manifestations of Lupus
It is chronic multisystem inflammatory disease.
-fever, weight loss, arthralgia, excessive fatigue
severe skin rashes in photosensitive people, teach to avoid sun
wash rash with warm water and use Anti-malarial drugs!
Hematologic Clinical manifestations of lupus
- Anemia
- Coagulopathy HGB 7.8 (LOW)
excessive bleeding
Open Reduction with External Fixation
PIN CARE- PRIORITY OF CARE
-If severe pain in operative extremity that is unrelieved with meds with numbness and tingling of the extremity;
COMPLETE NEUROVASCULAR ASSESSMENT AND CALL THE DOC
Collaborative care for osteoarthritis
- Delegation includes keeping the room free from clutter
- Ambulate for 30 min 3times/week
Repetative Strain Injury
-MUSCLE AND TENDON TEARS THAT BECOME INFLAMED= PAIN AND WEAKNESS
caused by repetative tasks, forceful exertions, vibrations, mechanical compression (pressing against hard surfaces) or sustained awkward positions.
What does progesterone do?
protects the lining of the uterus, maintains the implanted egg.
In relative to brest cancer, where is the most common area to feel a lump?
The tall of spence
What are the gonadal hormones?
Estrogen, progesterone, and testosterone.
How can painful menstral cycles be effectively treated?
BC (birth control)
After menopause, what is something important to report to your doctor?
Any menstral bleeding.. could be a sign of CA
Need a biopsy of uterine tissue
Whats important for a women to keep doing as she ages??
Have Sex !! if you dont use it ya loose it !! get freakkyyyy ;)
Should you emphasize to eldery to keep having sex?
yes, let them know that it is normal !
What do idiot teens think about being on BC pills?
That they are being protected from STDs too.. you dumb hoe..
What to avoid doing before a PAP?
Sex, tub baths, and douching(never do this, not good for normal flora)
schedule test prior to or before period.
Pelvic pain is associated with…
Pelvic inflammatory disease (PID), ovarian cysts, endometriosis.
What should you always do when touching and gential areas?
Wear gloves, well duhhhhh! I aint touching your shit bare headed !
When inspecting gentials and noticed discharge.. ask what?
if they have had any recent sexual contact with partners with and STD… really…
What to remember about chlamydia and gonorrhea?
They usually coexist, if you have one you probably have the other..
STDs in general tend to coexist
If you have and STD should be evaluated for others.
Female and male symptoms on Gonorrhea
Females: usually asymptomatic or minor: vag discharge, dysuria or frequency, changes in menstration.
male: Urethritis-dysruia, profuse, prulent discharge 2-5 days after infection.
What is important with treatment of STDS?
To make sure your partner is treated too, or you will keep spreading it back and forth.
Drug therapy for Gonorrhea?
Combination antiobiotics prescribed to treat any ocoexisting chlamydial infection.
Secondary stage of syphilis, you will see what on hands?
Bilateral, symmetrical copper-colored rash on plams and soles (wear gloves, ew obviously)
If chlamydia is left untreated it could lead to what?
PID amd infections of the epididymis, ectopic pregnancy, and infertility.
How to treat candidiasis (yeast infection)
mycostatin vag supoositories
- adminster at bedtime
- partner needs to wear condom during intercoarse until its cleared up
PMS happens when?
prior to her period (pre-menstral)
PMS clinical manifestations.
Headache, anixety, mood swings, depression, irritability
Its important to do what after a TAH?
leg exercise, and early post-op ambulation to prevent DVT and pneumonia.
Remember any abdonimal surgery can cause a DVT!
In a TAH, what is being removed?
The uterus alone.
perimenopause, what happens to the hormones?
There is a marked increase in FSH, and a decrease in estrogen.
If a women is on hormonal replacement therapy (HRT) and she is getting estrogen, what is important to make sure of?
That she has had a hysterectomy.
Vulvar infections caused my viruses are:
Herpes and genital warts
Genital warts are associated with what?
Cervical cell dysplasia and cervical cancer.
Caused by HPV.
Untreated HPV can lead to cancer.
What to teach patients about herpes..
They dont need to come in contact with the virus for reoccurence to happen, to avoid all sexual contact when lesions are present to avoid transmission of the virus, recurrent episodes may be triggered by emotional stress and menses.
Drug therapy for genital herpes?
There is no cure.
Give Acyclovir (Zovriax) shortens the duration of acute attacks.
anti-viral
Nursing intervention: PID
To promote healing and complication prevention:
- early treatment with ABX=dont take tums, maaloz, or mylanta with ABX, it decreases effectiveness of them.
- increase fluids= 8-10 glasses/d while taking ABX
- maintain absolute bedrest (ABR)=semifowler to promote gravity drainage of the infection, decreases pain
- Avoid kegal exercises
- avoid d
Endometriosis
Occurs when endometrial tissue outside the uterus bleeds in response to the mentral cycle
common symptoms: dyspareunia (pain with intercorse)
Drug therapy for endometriosis
Combined oral contraceptives
- Depro-provera (q 3 months)
- *-Danocrine- goal:ovarian suppression and atrophy of endometrial tissue**
Lupron (gonadotropin-releasing hormone -GnRH) for endometriosis
give 4-6 to decrease in lesions before or after surgery
tx for hormone-responsive cancers and estrogen-dependent conditions (endometriosis and uterine fibroids)
Nursing diagnosis for TAH
Grief related to the loss of child bearing ability
Nursing intervention for urinary retention
Palpate bladder, if you can feel it, scan the bladder for the amount of residual urine, if theres retention expect about 350 mL, should be less then 50 mL if no retention.
Leiomyomas (Uterine Fibroids) are non cancerous.. what are some manifestations of them..
Abnormal uterine bleeding, chronic pain r/t increase abd pressure, rectal discomfort, bladder distention, abd distention, lower abd discomfort.
Why are obese people at greater risk for estrogen driven disorders and cancers..
because estrogen hangs out in fat
Risk factors for developing cervical CA
Unprotected sex with multiple partners, early age of sexual activity.
Having an annual pap will protect women from developing cerical CA
HPV can cause..
Cervical cancer
When should you start getting a PAP?
at the onset of sexual activity, if no sexual activity, after age 21.
They all <100% accurate.
Cryosurgery is done to..
Ablate abnormal cells from the cervix detected by a pap smear.
done for younger females, it preserves fertility.
What is the prognonsis of ovarian CA?
Not good, most are advanced at diagnosis.
Risk factors for ovarian CA
Nullparity- never having children, hx of infertility, early menache & late menopause due to having a long flucuation of estrogen in your body.
Manifestations of ovarian CA
Pain (late symptom), abd girth increases, bowel and bladdre dysfunction, presistent pelvic or abd pain, ascites.
Nursing diagnosis for stage II or III ovarian CA
Anticipatory grieving r/t poor prognosis
After having radiation procedure for vulvar CA what are some precations..
Place in lead line private room, ABR to prevent dislodgement of material, can not sure the bathroom, no nurse should work with patient longer then 30 mins.
DVT prevention
Assess for calf enlargement and tenderness, assess pain on 1-10 scale, apply SCDs to legs.
Fibrocystic breasts
does not increase risk for breast CA, breasts will increase in sixe and tenderness prior to menses
what to teach pts who have fibrocystics breasts
To montior changes to breast size and tenderness of all lumps in relation to ger menses
Fibrocystic breats can be cause by..
consumption of caffeine premenstrually
mobile/tender nodules may be r/t…
menstral cycle
If any palpable immobile lumps are noted on breast exam, you should ask…
if there is any family history of breast CA
risk factors for breast CA
early menarch <12, late menopause >55
Patients with osteoporosis that are on estrogen hormone replacement should..
weight the protective affects of estrogen against osteoporosis versus the possible risk of breast CA
Breast CA commonly reoccurs so teach client to..
continue to perform bilateral self breast exams post mastectomy (especially on incision line) on any consistent day of the month.
Axillary node dissection can be controlled by..
wearing gloves while gardening to avoid trama to the hand and arm
lymphedema management
encourage participation of ADLs, post signs on bedside warning against blood draws and BPs on affected arm.
flex fingers and wrist, not shoulder
post-op mastectomy with lymphnode dissection
instruct hosp staff and the client that venapuncture and BP cuffs are not allowed on the affected arm
hormonal therapy for breast CA
Tamoxifen
blocks or removes the source of estrogen
any perineal resection is increase risk for..
pelvic prolapse
Rectocele
weakening between the vagina and rectum
tx for cystocele and rectocele
kegal exercise
