3/9 Flashcards
Daily weights
Same time every day with same amount of clothing and same scale
How evaluate fluid status esp renal pt
Depends on severity of tear - most able to back to norm activities in couple months; lifting requirements; not fully functional within until 1 year after
How long recover from rotator cuff injury
Repetitive motions
Trauma
Getting older - risk factor
rotator cuff injury
Special splints used
Change position frequently - not stay in same spot
Correct this - surgical procedure if can correct it
Able move own and change position - not concern
Concern: lot time in bed; turn; if trying to prevent pressure injuries - prevent this as well
Contractures
Depends
Keep in mind what else is going wrong
See if too unstable
Move ASAP unless contraindicated
Ambulate after surgery
Dehydration - high BUN with norm Cr - eventually lead to AKI - hypovolemia
No damage - min damage - time to replace fluid
AKI
high BUN with norm Cr - signs dehydration
Muscle tissue damage - bruising
Staying in same spot for long time
Rhabdomyolysis
Lactic acidosis - going towards rhabo - systemic and issue with kidneys
Intrarenal
Lack intake fluids; fluid volume deficit
Hypotension
Lack fluid within vascular space
Prerenal
Same rib broken in sev areas
Hallmark: paradoxical chest wall movement - go opp direction with rest of rib cage
Effects lung expansion - not able breathe
O2 on pts
Often intubate them with high end expiratory pressures - allow for full lung expansion until to surgery - so pin in place and let heal
Not oxygenating well esp flail chest - intubation first line
Lung collapses - whole area lung where not doing gas exchange - atelectasis and blocking off
Main N. diagnosis: impaired gas exhange
Flail chest
Renal - depends on what stage renal failure; stage 4 - edge of dialysis
MS issues
Difference in nutrition between renal issues and MS issues
Low protein limit damage to kidneys
Low Na - not want them having lots Na - fluid volume overload
No salt substitute - K high
Consult dietician as well
Renal - depends on what stage renal failure; stage 4 - edge of dialysis - Difference in nutrition between renal issues and MS issues
High protein for bone healing
High carbs for bone healing
More calcium
Vit D appropriate
MS issues - Difference in nutrition between renal issues and MS issues
No protein added - hurting kidneys because proteins excreted in urine - still pull more fluid and protein
Can use albumin - last ditch effort - pee it out
Very high state of supporting pt or slowing down progression
Supportive measure: antihyperlipidemic (Zocor), BP med (ACEI)
Kayxelatye - for kidney relate - higher K happens in renal failure
Nephrotic syndrome
Emergent set meds: shift K intracellular: insulin and D50 - pulls K inside cell - not get rid K - need get rid K - inside cell cardio protective - not hurt heart which concerned about with high K
Kayxelatye - get rid K in stool
Deal with high K
pneumothorax - treatment: chest tube
Tracheal deviation -
pain - med: allopurinol (reduce uric acid levels - preventative maintance mediation) and ibuprofen - drink lot water
Gout -
systemically dry - stool dry - need help bring water - increased fiber, stool softeners, laxatives later
Pts not filtering appropriately -
Always have it once have it - exacerbations preventable with diet and meds - high pruine foods avoids
Can affect diabetic pts - lifestyle habits that exacerbate gout exacerbate DM
Gout
Tissue swelling related
Cast sometimes
Often need surgical intervention
Rapid response good
Follow facility protocols
Acute compartment syndrome
Once infection bone harder treat - often leads to amputation - high risk for sepsis
What kill pt first
Priority make sure getting to surgery or notified who needs to notified to preserve limb
Osteomyelitis
All Ps
Cyanosis - worse - decreased blood flow
Compartment syndrome
- rhabdomyolysis which can lead to renal failure - (also on telemetry - high K)
Same position for extended period time and trauma
Do not touch them - call provider
Traction - Weights on floor
Give them pain med
Phantom limb pain
Take deep breaths
Monitor end tidal CO2
Expert consultation
Not mean not give opioids but will give potential epidurals (caines) and less resp depression
Control pain and high pain level but resp depression
Chest tube
Pneumothorax
PE
d/c after fracture with cast - comes back with extreme SOB
High risk for big bone break
Paget’s disease
No
If not break bone - at risk fat emboli
No - not blood clot; it is fat
Medication that dilates the vessel
Often bed rest to not dislodge clot to dangerous area
Petichae above clot - distinct line - purple from nipple line up
TPA fat embolism
Both can lead to each other
Compartment - acute loss of circ to limb or tissue - go in and get circ restored; muscle - fasciotomy; abdominal - open, burn - remove; surgical to relieve pressure
Crush - myoglobin released into bloodstream as result - do damage to further organs; acute renal failure
How prevent it - cannot; disaster - days - in condition; fluids to flush substances out; dialysis if cannot process anymore; combo; maybe use some bicarb to help if caught early
Compartment syndrome vs crush syndrome
