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NUR 340 > Exam 1: week 1 > Flashcards

Exam 1: week 1 Flashcards

1
Q

What are some treatments for a herniated disc

A
  • NSAIDS
  • Muscle relaxers (flexeril, robaxin)
  • PT
  • Massage
  • Pelvic Traction
  • ice/heat
  • electrical stimulation
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2
Q

What are some things that could qualify a patient for back surgery

A
  • back/leg pain limits daily life
  • develop leg numbness or tingling
  • loss of normal bladder/bowel function
  • difficulty standing or walking
  • meds and PT ineffective
  • in good health
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3
Q

What are the nursing interventions for back pain

A
  • pain management
  • exercise
  • body mechanics
  • work modifications
  • stress reduction
  • health promotion
  • diet and weight loss
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4
Q

What are some post-op priorities

A
  • pain management
  • monitor surgical site
  • monitor vitals
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5
Q

What are some common conditions of the upper extremities

A
  • bursitis/tendonitis
  • loose bodies (joint mice)
  • impingement syndrome
  • carpal tunnel syndrome
  • ganglion cysts
  • dupuytren contracture
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6
Q

How do you assess a patient for carpal tunnel syndrome

A

Affects the median nerve
- tap the median nerve (in the wrist) and ask if they have numbness or tingling
- have patient press the backs of their hands together fingers pointing down and ask patient if they feel numbness or tingling

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7
Q

What is dupuytren contracture

A

when the ligaments in the ring and pinky finger are contracted
seen in smokers

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8
Q

What are some nursing management techniques used for a patient undergoing hand/wrist surgery

A

Usually outpatient surgery
- post-op neurovascular assessments for 24 hours (teach them how to check this)
- pain control (meds, elevation, ice)
- prevent infection (teach them the S/S of infection)
- assistance with ADLs
- education

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9
Q

What are some common foot problems seen in patients

A
  • plantar fasciitis
  • corn
  • callus
  • ingrown toenail
  • hammer toe
  • bunion (hallux valgus)
  • flat foot (pes planus)
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10
Q

What is osteoarthritis

A

Noninflammatory degenerative disorder of the joints
- most common form of joint disease
- either primary or secondary
- limited to joints; no systemic symptoms

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11
Q

What is the difference between primary and secondary osteoarthritis

A

primary - spontaneous; unknown cause
secondary - caused by previous joint injury or inflammatory disorder (such as RA)

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12
Q

What is the pathophysiology of osteoarthritis

A

Breakdown of articular cartilage leading to damage of the bone and the formation of osteophytes (bone spurs)
- joint space is narrowed
- decreased joint movement; further damage
- joint progressively degenerates
- used be thought of as normal wear and tear of aging

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13
Q

What are the risk factors for osteoarthritis

A
  • old
  • female
  • obesity
  • occupations (manual labor)
  • playing sports
  • history of injuries
  • genetics
  • certain diseases
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14
Q

What are the signs and symptoms of osteoarthritis

A
  • stiffness in the morning lasting less than 30 minutes
  • functional impairment
  • joint pain aggravated by movement and relieved by rest
  • progressive over many years
  • enlarged joint with decreased ROM
  • Most often in weight bearing joints like the knees, hips, lumbar and cervical spine
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15
Q

What is osteoporosis

A

When the spongy bone is more porous and less supportive.
This usually is asymptomatic until a fracture happens.
Due to overactive osteoclasts.

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16
Q

What are osteoclasts

A

cells that breakdown bone tissue in order to increase serum calcium

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17
Q

What are osteoblasts

A

cells that build up bone tissue using serum calcium

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18
Q

*What are the risk factors of osteoporosis

A

C - calcium (low)
A - age (low hormone levels)
L - lifestyle (sedentary, smoker)
C - Caucasian or Asian
I - inherited
U - underweight (BMI<19)
M - medications (glucocorticoids, anticonvulsants)

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19
Q

*What are the signs and symptoms of osteoporosis

A

F - fractures (hip, spine, wrist, Colles [radius close to the wrist])
R - rounding of upper back (hunchback)
A - asymptomatic
I - inches of height (lost while aging)
L - low back, hip, neck pain

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20
Q

What test is used to diagnose osteoporosis

A

bone density

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21
Q

What is a bone density test measuring

A

amount of calcium in the blood and bones

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22
Q

What education is important to give a patient who is scheduled for a bone density test

A

No calcium supplements 24 hours before test (this includes antacids)

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23
Q

*Which medications are used to treat osteoporosis

A

Bisphosphonates
- alendronate
- ibandromate
Calcium supplements
Vitamin D supplements
Calcitonin
HRT (hormone replacement therapy)
Evista (estrogen receptor modulator)

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24
Q

*What education is important to give to a patient who is taking bisphosphonates

A

Can cause GI upset; take on an empty stomach with a full glass of water and remain upright for at least 30 minutes after taking the medication

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25
Q

What is osteomalacia

A

Called “rickets” in children
softening and weakening of the long bones due to inadequate vitamin D

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26
Q

What are the signs and symptoms of osteomalacia

A

pain, tenderness, and deformities of the long bones
- bowing of long bones
- pathologic fractures

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27
Q

What are the causes of osteomalacia

A
  • GI disorders
  • Severe renal insufficiency
  • hyperparathyroidism
  • dietary deficiency
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28
Q

What is the main treatment for osteomalacia

A

Adding Vitamin D in the diet

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29
Q

What is Paget’s disease

A

Genetic disorder where new bone grows over old bone (localized bone turnover)
- most common in men
- risk increases with age
- at risk for fractures, arthritis, and hearing loss

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30
Q

What are the signs and symptoms of Paget’s disease

A

Usually asymptomatic but may present with
- skeletal deformities
- aching pain
- tenderness/warmth over bone

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31
Q

Which patients are at a higher risk of developing septic arthritis

A

Older adults with comorbidities
- diabetes
- RA
- skin infections

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32
Q

What are the symptoms of septic arthritis

A

Usually in the hip and knee joints
- warm, painful joints with decreased ROM

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33
Q

How is septic arthritis diagnosed

A

culture of the synovial fluid (many different organisms)

34
Q

*What are the treatments for septic arthritis

A
  • Immobilization of joint
  • Pain meds
  • Antibiotics
35
Q

What is osteomyelitis

A

infection of the bone caused by MRSA or other bacterial agents

36
Q

How does a patient get osteomyelitis

A
  • direct bone contamination
  • soft tissue infection spread to the bone
  • bloodborne (infection in the blood that spreads to whole body including the bones)
37
Q

How do we treat osteomyelitis

A
  • antibiotics for 4-6 weeks
  • restrict activity other than gentle ROM of joints directly above and below infected bone
  • pain meds
  • elevate affected area
38
Q

What are primary bone tumors

A

Tumors that originate in the bone
- benign (more common, few symptoms)
- malignant (osteogenic sarcoma most common/most fatal)

39
Q

What are metastatic bone tumors

A

Tumors that originate in another area of the body and have metastasized to the bone
- more common than primary

40
Q

What is the course of symptoms seen with bone tumors

A
  • painless until swelling eventually causes pain
  • weight loss
  • limb swelling
  • fracture near the site of tumor
  • high calcium levels
41
Q

*What are the signs and symptoms of hypercalcemia

A
  • bone pain
  • N/V
  • fatigue
  • muscle weakness
  • mental status change
42
Q

*What precautions should the nurse take for a patient who had a hip replacement

A
  • abduction of leg to prevent dislocation (abductor pillow)
  • do not flex more than 90 degrees
  • avoid internal rotation
43
Q

What are some possible complications following orthopedic surgery

A
  • hypovolemic shock
  • atelectasis
  • pneumonia
  • urinary retention
  • thromboembolism
  • constipation
44
Q

*What are some important education topics for a patient who is discharging home after orthopedic surgery

A
  • take pain meds as directed
  • wear support stockings they were given
  • tell all providers (including dentist) of the artificial joint before any procedure
  • arrange to have staples removed 2 weeks after surgery
  • when to start PT
  • who to contact if something is wrong (signs of infection)
45
Q

*What education should you give a patient discharging home after orthopedic surgery regarding their incision

A
  • check daily for signs of infection
  • wash hands often
  • call provider right away if infection is suspected
  • wash incision w/soap and water and pat dry
46
Q

*What is a contusion

A
  • injury to soft tissue
  • ecchymosis/hematoma
47
Q

*What are strains and sprains

A

strain - stretched ligament
sprain - torn ligament
(pain and swelling for both)

48
Q

*what is the difference between a dislocation and subluxation

A

subluxation is a partial or incomplete dislocation

49
Q

How do you treat a contusion

A
  • ice for 24 hours (20 min on 20 min off)
  • followed by moist heat
  • apply elastic bandage
50
Q

How do you treat strains and sprains

A
  • rest/elevation of affected part
  • ice for 24 hours (20 min on 20 min off)
  • followed by warm compress
  • elastic pressure bandage
  • minimize use/wear a brace
51
Q

*What is the standard procedure for managing soft tissue injuries

A

R - rest
I - ice
C - compression
E - elevation

52
Q

What are the different types of fractures

A
  • complete (across whole bone)
  • incomplete (piece of bone)
  • open (through skin)
  • closed (skin intact)
53
Q

*What is important to remember about patients presenting to the ER with long bone fractures

A

pain meds administered within 45 minutes of arrival

54
Q

What is the procedure for managing a fracture in an emergency setting

A
  • immobilize body part
  • splint (area distal and proximal to the break is immobilized and supported by splint)
  • assess neurovascular status before and after splinting (cap refill, numbness, tingling, skin color)
  • do not attempt to reduce (align) the fracture

Open fractures: apply sterile dressing to avoid contamination

55
Q

What is the procedure for managing a fracture in the hospital setting

A
  • fracture reduction (align broken pieces of bone)
  • traction (closed)
  • external fixation (open)
  • immobilization
56
Q

*What are some complications that can occur with fractures

A
  • fat emboli (caused by fx of long bones)
  • hemorrhage
  • delayed union (caused by infection)
  • malunion (improper alignment due to premature wt bearing)
  • non-union (healing hasn’t occurred 4-6 months after fx)
  • sepsis
  • peripheral nerve damage
  • compartment syndrome
57
Q

*What are the signs and symptoms of a fat embolus

A
  • petechiae rash
  • shortness of breath
  • mental status change
  • tachycardia
  • chest pain
58
Q

What is compartment syndrome

A

When a cast is applied, and the body part continues to swell, pressure is put onto the vessels causing extreme pain, numbness, and tingling
(this is why we use a splint before casting)

59
Q

How do we treat a fracture of the clavicle

A

A figure 8 sling (no surgical intervention)
- ROM for elbow wrist and fingers
- keep arm below shoulder for at least 6 weeks

60
Q

How do we treat a fracture of the humoral neck/shaft

A

Sling with a brace to immobilize arm
- no surgical intervention

61
Q

What is the biggest risk in pelvis fractures

A

Hemorrhage
(very vascular)

62
Q

What is a cast

A

rigid, external immobilizing device made of either fiberglass or plaster

63
Q

What is the difference between the fiberglass and plaster casts

A

fiberglass is lighter, quick drying, heat activated, and more expensive whereas plaster is heavy, slow drying, cold activated, and less expensive

64
Q

What is a splint

A

Two pieces of cast that are used to stabilize and support a reduced fracture that is wrapped with ace bandage

This stays on for about a week before casting to account for swelling and reduce the risk of compartment syndrome

65
Q

What is a brace

A

custom fitting devices that are used to support an injured part of the body

usually used in strains and sprains

66
Q

*What are some important education topics when teaching about cast care

A
  • Keep it dry
  • Do not cover with plastic
  • elevate extremity (use a sling)
  • hygiene
  • don’t stick stuff in the cast
67
Q

*What is the most important assessment when caring for a patient with a cast, splint, or brace

A

Neurovascular assessment (5 P’s)
- pain
- pallor
- paresthesia
- pulses
- paralysis

68
Q

What is an external fixation device

A

Used in management of open fractures
- pins are inserted and connected to external device
- pin care very important to avoid infection

69
Q

Can the nurse adjust the clamps on the external fixator device

A

NO

70
Q

What is traction

A

addition of a pulling force in order to reduce or immobilize a fractured bone
- a counter force must be applied (can be patients body weight)
- must be continuous

71
Q

what are the two types of traction

A

skin
skeletal

72
Q

what is skin traction

A

noninvasive form of traction where weight is added to the trunk or extremity to reduce or immobilize a fracture
- Buck’s traction
- cervical head halter
- pelvic traction

73
Q

What is skeletal traction

A

Pins are inserted into the bone and weight is applied to the pins to reduce or immobilize a fracture

74
Q

*What are some major concerns when caring for a patient in traction

A
  • immobility (pressure injuries)
  • neurovascular issues
  • infection at pins (skeletal)
75
Q

*What is the determining factor when planning a discharge date for a patient in traction

A

Must be able to transfer safely

76
Q

*how often is pin care done for a patient in traction

A

Q8 hours

77
Q

What are the different types of amputations

A
  • AKA
  • BKA
  • disarticulation
  • guillotine
  • closed/flap
78
Q

What is a disarticulation amputation

A

amputation done at the joint (hip, knee, ankle)

79
Q

*What is phantom limb pain

A

Occurs immediately post op up to 2-3 month post op
- more frequently in AKA
- feels like the limb is being crushed, twisted, or intense burning/cramping

80
Q

*What can be done for phantom limb pain

A

Medications
- nerve pain meds (gabapentin)
Elevation of stump
Ice

NUR 340 (10 decks)

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