Concepts Flashcards
Complete
complete break
incomplete
partial break
Closed (simple, nondisplaced)
bone is in alignment
Closed (simple, displaced)
bone is not in alignment, more painful.
Open (Compound)
bone is sticking out, complete break
Avulsion
overstretching or tearing of tendons or ligaments, separates from the bone
Comminuted
bone shattered into fragments
Compression
bone collapses on itself, also from osteoporosis
Depressed
skull, but also face, broken and pushed inward
Greenstick
incomplete, but one side is bent, common in children.
Oblique
45 degree angle across the bone
Spiral
fracture that wraps around the bone
Impacted
bone is wedged into each other.
Compartment Syndrome
Pain (esp at rest) Pressure Paresthesia Pallor Paralysis Pulselessness
Person with a cast has pressure and pain at the site, what should the nurse do?
Prepare the patient for the fasciotomy
Skin Traction
Skin traction: no holes in body, just boot a boot and ace wrap, and hang a weight, and pull the bone straight. For displaced fractures.
If its on the floor, move the patient up.
Skeletal Traction
pins in the bone
If a traction is removed, what can the nurse expect?
Muscle spasms
Pathophysiology of Strains
1st degree strain: minimal inflammation, shouldn’t affect ROM, symptoms can last several days
2nd strain: actual tearing of muscles and tendons, ecchymosis, swelling/inflammation for several hours or days, can last up to a week or several weeks
3rd: internal bleeding tearing of muscles or tendons, may need surgical repair
Pathophysiology of Sprains
1st: stretching, shouldn’t be tearing, edema, pain, should still be able to move joint, its intact, able to ambulate
2nd: tearing of ligament fibers, increased swelling, bruising, pain, might have weight bearing issues
3rd: patient unable to ambulate, joint is unstable
Management of Sprains and Strains
Management: Diagnosis based on history and physical examination, Confirmed by radiography, ultrasound, or MRI
Treatment of 1st and 2nd degree strains/sprains: RICE
3rd degree strains: may require surgical repair of the torn tendon or muscle
RICE
Rest, 72 hours, Ice no longer than 30 minutes 3-5 times per day for 24-72 hours, decrease inflammation (vasoconstrict, decrease bleeding and fluid accumulation in injured area), must wrap the ice in something, compression (ace wrap, compression dressing, wrap tightly but not to the point of altering neurovascular function (cutting circulation off)). Ensure that circulation, movement, sensation is intact. Assess pulses. Elevate affected area, NSAIDS.
Traumatic Amputations
Accident
Immediately control bleeding and replace blood lost from injury
Tourniquet can remain in place for up to 6 hours before the tissue becomes necrotic
Elective amputations
for some reason that limb has become necrotic, such as diabetes, cancer, PVD
Occur with chronic disorders
Amputation Complications
Hemorrhage
Infection: older patients with peripherovascular disease
Contractures: residual limb
Phantom limb pain: numbess, tingling, sharp pain
Neuromas: clumps of nerve axons in the distal area of the residual limb that have regenerated
Infection
is the invasion and multiplication of microorganisms in body tissues, which may be unapparent or the result of local cellular injury caused by competitive metabolism, toxins, intracellular replication, or antigen-antibody response.
Examples of Parasites
Parasitic: worms, malaria
Examples of Fungi
Fungal: yeast, candidiasis, tenia pedis
Examples of bacteria
Bacterial: E. Coli, MRSA, strep, C. Diff
Examples of viruses
Viral: flu, HIV, hepatitis,
Localized Infection Symptoms
red, swollen, red, edema, pain
Disseminated Infection
starts in one area and spreads, STI
Systemic Infection Symptoms
fever, fatigue, malaise
Hospital Acquired Infection examples
MRSA, C. Diff
Community acquired infection examples
MRSA
Primary
first infection
Secondary
infection that takes advantage of a situation
Endemic
common in a certain culture, geographic location, chickenpox in school age kids, usually predictable rate
epidemic
rapid spread, usually lasts less than two weeks (short time). Swine flu
pandemic
world wide spread of a new disease. Flu, HIV
Anatomy and Physiology of the Immune System
Lymphoid organs: spleen, thymus, tonsils,
Lymphoid cells: T cells, B cells, activated with immune response
Immune response: activates T and B cells
Chain of Infection
Pathogen: bacteria, viruses, fungi, protozoa
Host: a person, unvaccinated, immunocompromised, disease process (diabetes, maybe they’re sick)
Reservoir: people, equipment, where the pathogen stays, water
Portal of exit: vomit, body fluids, coughing, secretions, excretions, skin, droplets
Mode of transmission: contact, airborne, droplet, through ingestion
Portal of entry: cut, mouth, eyes, mucous membranes, orifices, GI tract, respiratory tract
Immune responses to bacterial invasion:
B lymphocytes
activated, resulting in the production of antibodies.
Immune responses to bacterial invasion: T lymphocytes
T lymphocytes are activated, resulting in phagocytosis.
Immune responses to bacterial invasion:
Complement System
enhance overall response.
Bacteria release…?
Endotoxins or exotoxins which damage the cells of the host and initiate an inflammatory response.
Once the body’s compensatory mechanisms (e.g., vascular, renal, nervous, respiratory) are overcome, the following process occurs.
Septic shock, multisystem failure, death
Lab tests
Complete blood count (with WBC differential): WBC’s should go down as infection is resolved
Culture and sensitivity: it will work if certain antibiotic is given
C-reactive protein (CRP)
Erythrocyte sedimentation rate (ESR)
Serological tests to detect specific antibodies or viruses
Radiographic tests for infection X-rays
X-rays MRI CAT PET indium scans (osteomyelitis)
Common Infection Screenings
Sexually transmitted infection in high-risk groups
Tuberculosis screening in high-risk groups
Interventions for Infection
Antimicrobial therapy Rest and comfort care measures Nutritional support Fluids Disinfection of physical environment
Antibiotic Agents
Penicillin Cephalosporins First, second, third, and fourth generation Fluoroquinolones Tetracyclines Macrolides Aminoglycosides
Other Antimicrobial Agents
Antiviral
Antifungal
Antiprotozoal
Chemotherapy
Use of chemicals against invading organisms
Antibiotic
Strictly speaking—a chemical that is produced by one microbe and has the ability to harm other microbes
Antimicrobial
Any agent that has the ability to kill or suppress microorganisms
Antibiotic Combinations
To Treat severe infections of unknown etiology
Mixed infections
Decreased toxicity
Additive effect
Antibiotic Combination Disadvantages
Cost
increased risk of adverse effects
increased risk of superinfection
Prophylactic Use
To prevent infection in: Surgery Bacterial endocarditis Neutropenia Frequent UTI’s STD exposure
Essential Implications of antibiotic therapy
It is ESSENTIAL to obtain cultures from appropriate sites BEFORE beginning antibiotic therapy
Signs of Superinfection
fever, perineal itching, cough, lethargy, or any unusual discharge
Common Adverse effects of antibiotics
nausea, vomiting, and diarrhea
Best way to absorb antibiotics
with 6-8 oz of water
Sensory Perception
refers to the ability to receive sensory input and, through various physiological processes in the body, translate the stimulus or data into meaningful information.
Sensation
Physical feeling
Perception
become aware of the sensation
Presbycusis
sensory hearing loss that is common in elderly
Ototoxity
toxic to the hear, Lasix, antibiotics, some are reversible, some are not.
Visual Examination
Inspection of the external eye Visual acuity Eye movement Ophthalmic examination Pupillary response Visual fields test, noncontact tonometry
Hearing Examination
Evaluation of hearing
Inspection of the external ear
Inspection of the internal ear
Pure tone air conduction hearing test, otoacoustic emissions (OAEs), auditory brainstem response (ABR)
Taste and smell examination
Inspect tongue and oral cavity Inspect nose Check for patency of nasal airway Test tasting ability Test smell
Tactile assessment
(touch)
Romberg test for balance
Tests of hot and cold, sharp and dull, localization of sensation
Monofilament testing
Myringotomy
Tubes in ears
Silver Nitrate is used
to prevent infection in newborns’ eyes
Acid-Base balance definition
is the process of regulating the pH, bicarbonate concentration, and partial pressure of carbon dioxide of body fluids
pH
7.35 (acid)-7.45 (base)
PaCO2
45 (acid)-35 (base)
HCO3
22 (acid)-26 (base)
Base:
alkaline
Acid production
Generation of acid through cellular metabolism
Acid buffering
Process to control changes in pH by neutralizing acids with buffers
Acid excretion
Removal of acid from the body
Buffers
prevent swings of acids or bases
Lungs remove
carbon dioxide, an acid
kidneys secrete
HCO3, a base
what compensates for metabolic acidosis/alkalosis?
Lungs (happens quickly)
What compensates for respiratory acidosis/alkalosis
kidneys (slow, may take days to compensate)
Respiratory acidosis
CO2 retention, makes blood acidic
Respiratory alkalosis
excessive CO2 is lost, makes blood basic
Metabolic acidosis
HCO3 (base) loss or H+ (acid) retention, makes blood acidic
Metabolic alkalosis
HCO3 (base) excess or H+ loss (acid), makes blood basic
Respiratory Acidosis
Low pH
High PaCO2
less than 12 breaths per minute, not expelling CO2, blood is acidic, lower pH. Build up of CO2 due to bradypnea, low pH, high PCO2, HCO3 will go up (to try an compensate, but may not be if its not fully compensated),
Respiratory Acidosis Causes
Things that slow down breath, or cause it hard to breathe:
drugs (opioids), neuromuscular disorders (myasthenia gravis, GB) pulmonary edema (lungs do not work), pneumonia, injury to respiratory center of the brain, embolism (fat or blood clot), asthma (constricted bronchioles), COPD, emphysema.
May cause hyperkalemia
Respiratory Acidosis S/Sx
altered LOC, drowsy, confused, neuro changes, fall asleep, headache, respiratory rate below 12, low BP.
Respiratory Acidosis Tx
bronchodilators, cough and deep breathe, no more narcs, Narcan, intubate pneumonia: give antibiotics, monitor for respiratory distress, give oxygen, Semi-Fowler’s, hydration to thin secretions, restlessness (decrease this), may need suction, monitor electrolytes
Respiratory Alkalosis
High pH
Low PaCO2
excessive loss of CO2, due to tachypnea (greater than 22 breaths per minute), kidneys will compensate, but they are slow. pH goes up, HCO3 goes up, PCO2 will go down,
Respiratory Alkalosis causes
pain, fever, anxiety, hyperventilation, during intubation, mechanical ventilation, aspirin toxicity, neuro injuries, asthma, and embolism
Respiratory Alkalosis S/Sx
fast respiratory rate, greater than 22, neuro changes, tired, fast heart rate, low Calcium, can cause muscle excitability (cramps), hypokalemia, fast heart rate
Respiratory Alkalosis Tx
breath into a bag, something to slow breathing, give something for pain or anxiety. Emotional support, monitor for respiratory distress, teach to slow breathing, monitor K and Ca, may administer Ca to decrease tetany. Give antibiotics/meds if needed
Metabolic Acidosis
Low pH
Low HCO3
kidneys, too much acid, pH is low, bicarb is low, PaCO2 can be low of high depending on if its compensating or not, lungs hyperventilate (Kussmaul’s respirations), cardiac changes
Metabolic Acidosis Causes
aspirin toxicity, carbs that are not metabolized (lactic acid buildup or pyruvic acid), insufficient kidney function, diarrhea (rich in bicarb), Diabetic KetoAcisosis (excessive keytones), ostomy drainage, fistula. Diamox (diuretic), high fat diet, renal failure,
Metabolic Acidosis S/Sx
weak, confused, rapid respirations, Kussmaul’s, cardiac changes
Metabolic Acidosis Tx
dialysis, I & O, S/Sx of respiratory distress, monitor LOC, replace and monitor electrolytes, may give bicarb. Safety and seizure precautions
Metabolic Alkalosis
High pH
High HCO3
loss of hydrogen acid, elevated bicarb, hypoventilation,
Metabolic Alkalosis Causes
aldosterone production, angiotensin renin release holds sodium, loses Hydrogen, get elevated bicarb. Loop diuretics, hydrochlorothiazide. (HCTZ), K wasting, high bicarb foods, baking soda, antacids, milk, high citrate (given with dialysis, also with blood infusions, loss of fluids (vomiting, NG suction), increased bicarb infusion
Metabolic Alkalosis S/Sx
slowed breathing to keep CO2, hypokalemia
Metabolic Alkalosis Tx
stop diuretics, stop suction, treat, antiemetics, monitor for respiratory distress, monitor ABG’s, potassium, and calcium, give meds to increase excretion of bicarb. May have to replace K, safety precautions,
Consequences of Impaired Cellular and Organ Function
Altered cell function, especially in the brain when CO2 crosses the blood–brain barrier
Change in intracellular enzyme activity resulting in cell dysfunction
Acidosis: decreases the level of consciousness (LOC)
Alkalosis: decreases the LOC and has other neurological manifestations; may cause dysrhythmias (hypokalemia)
Prevention of Acid Base Imbalances
Healthy eating habits Safe weight loss Smoking prevention or cessation Poison control measures Safe food handling
Collaborative Interventions for Acid/Base Imbalances
Problems caused by an underlying respiratory condition require respiratory support
Problems caused by an underlying metabolic
Fluid and Electrolyte Balance
is the process of regulating the extracellular fluid volume, body fluid osmolality, and plasma concentrations of electrolytes.
Osmolality
degree of concentration of a fluid
Extracellular Fluid
carries water, nutrients, and oxygen to the cell, and removes waste products. .
Interstitial (within cells)
Vascular: within the blood
Third Spacing
ECF, when fluid accumulates in areas such as the abdomen to create ascites, pericardial space, or blisters
Intracellular
fluid within the cell
What organ regulates fluid?
Kidneys
A system that also regulates fluid
Endocrine (Addison’s disease, Cushing’s disease, diabetes insidious)
Insensible Loss
occurs through skin, lungs, stool this type isn’t really controllable
Output greater than intake and absorption
hypernatremia and electrolyte deficits and ECV deficit
Output less than intake and absorption
Hyponatremia and electrolyte excess and ECV excess
Hypovolemic shock
when a person is deficient in ECF (which provides tissue perfusion and cell oxygenation)
Hyponatremia
water moves into cells
Hypernatremia
water moves out of cells
electrolytes involved in muscle function
Ca, Mg, K,
Heart muscle contraction
K
Symptoms of a fluid and electrolyte imbalance
Unexplained nausea, fatigue, dizziness, shortness of breath, muscle cramping, edema, sudden changes in weight
Na (Sodium)
135-145
Ca (Calcium)
8.6-10.2
Mg (Magnesium)
1.3-2.3
Sodium Patient teaching
avoid foods that are processed
Potassium rich foods
fresh fruits, vegetables, bananas, potatoes
most accurate measurement of fluid balance
weight
If patient has edema
limit fluid intake
Drugs to correct fluid and electrolyte imbalances
Drugs used to correct disorders of fluid volume and osmolality
Drugs used to correct disturbances of hydrogen ion concentration
Drugs used to correct electrolyte imbalances
Agents that affect the volume and ion consent of body fluids
Disorders of fluid volume and osmolality
Acid-base disturbances
Electrolyte imbalances
What organ maintains fluid volume and osmolality?
Kidneys
Isotonic Contraction
Definition
Volume contraction in which sodium and water are lost in isotonic proportions
Decrease in total volume, but no change in osmolality
Causes
Vomiting, diarrhea, kidney disease, and misuse of diuretics
Treatment
Fluids that are isotonic to plasma
0.9% NS
Replenish slowly to prevent pulmonary edema
Hypertonic Contraction
Definition
Loss of water exceeds loss of sodium
Reduced extracellular fluid volume and increase in osmolality
Causes
Excessive sweating, osmotic diuresis, concentrated food given to infants
Secondary to extensive burns or CNS disorders that interfere with thirst
Treatment
Hypotonic fluids (0.45% sodium chloride) or fluids that contain no solutes at all (D5W)
Initial therapy: Drink water
Hypotonic Contraction
Definition
Loss of sodium exceeds loss of water (
Adverse effects of diuretics
hypovolemia, acid-base imbalances, electrolyte imbalances
Loop
Furosemide (Lasix): Most frequently prescribed loop diuretic
Mechanism of action
Acts on ascending loop of Henle to block reabsorption
Pharmacokinetics
Rapid onset (PO 60 minutes; IV 5 minutes)
Therapeutic uses
Pulmonary edema (fluid in lungs, backing up (HF), IV)
Edematous states (depends on where it’s at)
Hypertension (PO)
Kidneys working (can give Lasix and makes kidneys work again)
Furosemide [Lasix] adverse effects
Adverse effects Hyponatremia, hypochloremia, and dehydration Hypotension Loss of volume Relaxation of venous smooth muscle Hypokalemia Ototoxicity Hyperglycemia Hyperuricemia Use in pregnancy (do not) Impact on lipids, calcium, and magnesium ? lowers HDL raises LDL
Furosemide [Lasix] Drug Interactions
Digoxin
Ototoxic drugs: add another med, increased risk
Potassium-sparing diuretics:
Lithium: a salt, accumulate sin blood when Na is pulled
Antihypertensive agents: added effect
Nonsteroidal anti-inflammatory drugs: COX inhibitors block the COX which maintains the kidneys, and giving a NSAID, it will block this, so kidneys will not work as well when you give Lasix.
Other High-Ceiling (Loop) Diuretics
Ethacrynic acid [Edecrin] Bumetanide [Bumex] Torsemide [Demadex] All can cause: Ototoxicity, hypovolemia, hypotension, hypokalemia, hyperuricemia, hyperglycemia, and disruption of lipid metabolism
Thiazides and Related Diuretics
Also known as benzothiadiazides
Effects similar to those of loop diuretics
Increase renal excretion of sodium, chloride, potassium, and water
Elevate levels of uric acid and glucose
Maximum diuresis is considerably lower than with loop diuretics
Not effective when urine flow is scant (unlike with loop diuretics)
Hydrochlorothiazide [HydroDIURIL]
Hydrochlorothiazide [HydroDIURIL] Most widely used Action: Early segment distal convoluted tubule Peaks in 4 to 6 hours Therapeutic uses Essential hypertension Edema Diabetes insipidus
Hydrochlorothiazide [HydroDIURIL] Adverse Effects
Hyponatremia, hypochloremia, and dehydration Hypokalemia Use in pregnancy and lactation Hyperglycemia Hyperuricemia Impact on lipids, calcium, and magnesium
Hydrochlorothiazide [HydroDIURIL] Drug Interactions
Drug interactions
Digoxin
Augments effects of hypertensive medications (beta blockers)
Can reduce renal excretion of lithium (leading to accumulation)
NSAIDs may blunt diuretic effect
Can be combined with ototoxic agents without increased risk of hearing loss
Potassium-Sparing Diuretics
Useful responses Modest increase in urine production Substantial decrease in potassium excretion Rarely used alone for therapy Aldosterone antagonist Spironolactone Nonaldosterone antagonists Triamterene Amiloride
Spironolactone [Aldactone] Mechanism of action
Blocks aldosterone in the distal nephron
Retention of potassium
Increased excretion of sodium
Spironolactone [Aldactone] Therapeutic Uses
Hypertension Edematous states Heart failure (decreases mortality in severe failure) Primary hyperaldosteronism Premenstrual syndrome Polycystic ovary syndrome Acne in young women
Spironolactone [Aldactone] Adverse Effects
Hyperkalemia
Benign and malignant tumors
Endocrine effects
Spironolactone [Aldactone] Drug Interactions
Thiazide and loop diuretics
Agents that raise potassium levels
Triamterene [Dyrenium] Mechanism of Action
Disrupts sodium-potassium exchange in the distal nephron
Direct inhibitor of the exchange mechanism
Decreases sodium reuptake
Inhibits ion transport
Triamterene [Dyrenium] Therapeutic uses
Hypertension
Edema
Triamterene [Dyrenium] Adverse Effects
Hyperkalemia Leg cramps Nausea Vomiting Dizziness Blood dyscrasias (rare)
Amiloride [Midamor] Mechanism of Action
Blocks sodium-potassium exchange in the distal nephron
Amiloride [Midamor] Therapeutic use
Counteract potassium loss caused by more powerful diuretics
Amiloride [Midamor] Averse effects
Hyperkalemia
Amiloride [Midamor] Drug interactions
ACE inhibitors, other drugs with hyperkalemia (spironolactone)
Osmotic Diuretics: Mannitol [Omitrol]
Promotes diuresis by creating osmotic force within lumen of the nephron
Pharmacokinetics
Drug must be given parenterally
Mannitol [Omitrol] Therapeutic uses
Prophylaxis of renal failure
Reduction of intracranial pressure
Reduction of intraocular pressure
Mannitol [Osmitrol] Adverse Effects
Edema Headache Nausea Vomiting Fluid and electrolyte imbalance
How much urine must a person output per hour?
at least 30 mL
Perfusion
refers to the flow of blood through arteries and capillaries, delivering nutrients and oxygen to cells.
Infarction
death of tissue with inability to regenerate
Central Perfusion
Force of blood movement generated by cardiac output Requires adequate cardiac function, blood pressure, and blood volume Cardiac output (CO) = Stroke volume × heart rate
Tissue or Local Perfusion
Volume of blood that flows to target tissue
Requires patent vessels, adequate hydrostatic pressure, and capillary permeability
Impairment of central perfusion occurs when
cardiac output is inadequate
Reduced cardiac output results in
a reduction of oxygenated blood reaching the body tissues (systemic effect).
If severe, associated with shock
If untreated, leads to ischemia, cell injury, and cell death
Impaired tissue perfusion
is associated with loss of vessel patency or permeability, or inadequate central perfusion
Results in impaired blood flow to the affected body tissue (localized effect)
Leads to ischemia and, ultimately, cell death if uncorrected
Risk factors for impaired perfusion
Middle-aged and older adults
Men
African Americans
Infants with inadequate central perfusion
Poor feeding
Poor weight gain
Failure to thrive
Dusky color
Toddlers and Children with inadequate perfusion
Squatting and fatigue Developmental delay (failure to hit milestones)
Creatine kinase
can be brain related, myocardial related. Tells you that there is breakdown in muscle so that CKMB (related to muscle) will be elevated in an MI. It also is elevated if someone’s had an orthopedic surgery or muscular injury.
Lactic dehydrogenase
elevated when there is damage to the myocardium.
Natriuretic peptides
BNP, used to detect heart failure.
Troponin
elevated with an MI, can predict MI probability. Usually get Q6 hours.
Homocysteine
predictor of CAD, stroke, venous thrombus, and used for people at risk (familial or complaints)
CRP
acute inflammation
Serum lipids
hyperlipidemia (at risk for vessel disease)
Platelet
150K-450K
Prothrombin time (PT)
bleeding time (coumadin or warfarin)
Partial thromboplastin time (PTT)
bleeding time, heparin
INR
goes with PT, usually what doctor will use to dose the coumadin off of
aPTT and PTT
Heparin
Primary Prevention of Perfusion Issues
Smoking and nicotine cessation
Diet
Exercise
Weight control
