Exam 3 Flashcards
What is the main function of the gallbladder?
store excess bile from the liver
What does the gallbladder do while we eat?
push bile into small intestine to aid in digestion
When bile leaves the liver, where does it travel?
liver –> common bile duct –> cystic duct –> gallbladder
What are the components of bile?
- bilirubin
- bile salts
- cholesterol
What is bilirubin a product of
the breakdown of RBCs in the liver
What is the function of bile salt s
help fat breakdown in the small intestine
Why is our stool brown colored
bilirubin colors it
What is cholecystitis commonly caused by
triggered by a high-fat diet because this overworks the gall bladder
remember that bile salts aid in the digestion of fat
What is cholecystitis?
inflammation of the gallbladder
What is cholelithiasis
gall stone
What is choledocholithiasis
stones in the common bile duct
What is cholangitis
bile duct inflammation
What is the main difference between acute and chronic cholecystitis
acute has a rapid onset and more severe symptoms
White gallstones are usually caused by
excess cholesterol (hypercholesterolemia)
black gallstones are usually caused by
bilirubin
(liver failure pts due to cirrhosis)
What are risk factors for cholecystitis?
- 4 F’s
- high cholesterol/high fat diet
What are the four F’s?
female, fat, forty, fertile (premenopausal)
Is a female postmenopausal female on hormone replacement therapy at risk of cholecystitis
YES
Where is pain usually located with cholecystitis
right upper quadrant
Where may pain radiate to with cholecystitis
right shoulder
What is biliary colic?
extreme pain caused by obstruction of cystic duct due to stone
Biliary colic usually increases when
the stone is moving
What are other assessment findings of cholecystitis?
-flatulence
-dyspepsia
-eructation
-N/V
What are chronic manifestations of cholecystitis?
-jaundice
-clay colored stools
-icterus
-steatorrhea
What do patients with chronic cholecystitis develop jaundice
-build up of bilirubin in the blood (blockage of common bile duct is prohibiting the movement of bilirubin from moving to the small intestine)
Why do patients with chronic cholecystitis develop clay colored stools
lack of bilirubin the small intestine
What is icterus
yellowing of the eyes
Why do patients with cholecystitis have steatorrhea
bile salts are not breaking down fats
WBCs will be elevated, decreased, or normal in cholecystitis
elevated (mostly due to inflammation)
Liver enzymes will be elevated, decreased, or normal in cholecystitis?
MAY elevate if there is an obstruction and they cannot leave the liver
What were the liver enzymes she mentioned in class
-alkaline phosphatase
-aspartate
-amintotransferase (AST)
-lactate dehydrogenase (LDH)
Bilirubin will increase, decrease, or be normal with cholecystitis?
may elevate with obstruction
Pancreatic enzymes may increase, decrease, or be normal with cholecystitis?
may elevate if there is a blockage
What are the pancreatic enzymes
amylase and lipase
What diagnostic imaging is done to diagnosis cholecystitis
-ultrasound
-CT for followup
-HIDA scan
What is a hepatobiliary imilodiacetic acid (HIDA) scan
a nuclear medicine test to watch the function of the gallbladder
is the HIDA scan better for chronic or acute cholecystitis
chronic
Should we assess for allergies to shellfish, iodine, or contrast dye with HIDA scan? why or why not
NO because contrast dye is not used
What is inserted into the patient during a HIDA scan
radioactive tracer
Should our client be NPO prior to a HIDA scan>
yes
what is the treatment for acute cholecystitis in most cases
surgery
Why is surgery the most common treatment for cholecystitis
prevent peritonitis
What are non-surgical interventions for cholecystitis
- pain management
- dissolving stones
- lithotripsy
- percutaneous transhepatic biliary catheter
What medications are used to dissolve or stabilize gallstones?
-ursodiol and chenodiol
What is the most important thing to remember if a patient is receiving medication to dissolve their gall stones
they need and ultrasound q 6 months
How does lithotripsy help in treating gallstones?
breaks them down into smaller pieces so they can pass through ducts
What is a percutaneous transhepatic biliary catheter
-relieves pressure and promotes the flow of bile into the small intestine or into an external drainage bag
Nursing considerations for bile drainage bag following transhepatic biliary catheter
-empty regularly and track the output
-investigate if there is decreased output
-check surrounding skin and make sure no drainage is leaking out
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What is a cholecystectomy
removal of the gallbladder
What are the two ways a cholecystectomy can be performed
laparoscopic or open
what are the benefits to a laparoscopic cholecystectomy
decreased risk of complications, recover faster
What are complications to monitor for after cholecystectomy
-bleeding, infection, etc
Nursing interventions after cholecystectomy
pain management, monitoring for complications
What key education points should we provide for a patient who has had a cholecystectomy
importance of maintaining low fat diet
What are the two types of pancreatic functions
endocrine and exocrien
Endocrine functions of the pancreas includes
glycemic control - release of insulin and glucagon
Exocrine functions of the pancreas include
release of pancreatic enzymes to break down carbs, proteins, fats
Acute vs chronic pancreatitis
acute has rapid onset and more severe symptoms
What is the most common cause of pancreatitis
alcohol use (chronic or short term binge drinking)
Is pancreatitis more common in men or women
men
When is acute pancreatitis seen more often in the ER
during holiday season when drinking is involved
Can gallstones cause the development of pancreatitis
yes
How do gallstones lead to pancreatitis
amylase and lipase get stuck in pancreatic duct and begin to autodigest the pancreas
What diagnostic procedure increases the risk of pancreatitis?
ERCP
what does ERCP stand for
endoscopic retrograd e cholangiopancreatography
What is an ERCP
extension of EGD that is used to assess for problems in the pancreatic and biliary ducts
How does an ERCP sometimes lead to the development of pancreatitis
this increases pancreatic inflammation
Pancreatitis presents with pain where
epigastric / LUQ
Pain from pancreatitis may radiate to the ?
back, flank, or shoulder
What position may relieve pain from pancreas
fetal position
Other symptoms of pancreatitis include?
1 . N/V
2. fever
3. jaundice
4. cullens sign
5. turners sign
What is Cullens sign?
dark blue discoloration around the naval
What is turners sign?
dark blue discoloration in the flank area
What is the cause of cullens sign and turners sign
hemorrhaging
Will pancreatic enzymes increase during pancreatitis?
Yes
-amylase will be 3x normal
Will liver enzymes (ALT and AST)increase, decrease, or remain normal in pancreatitis
elevate if blockage is occurring
Will bilirubin increase, decrease, or remain normal in pancreatitis
increase if there is a blockage
Why does glucose increase during pancreatitis
- increased stress on the bdoy
- inability to secrete insulin
Pancreatitis can lead to the development of what disease?
Type 1 DM
Will CRP be increased, decreased, or normal during pancreatitis
increased
What electrolyte imbalances are expected during pancreatitis
hypocalcemia, hypomagnesemia
Why are patients NPO with NG tube placement with pancreatitis
to decompress, prevent N/V
What IV meds are given during pancreatitis
-IV fluids
-electrolyte replacements
Why is a PPI given for a patient with pancreatitis?
decease gastric acid secretion
What pain medication may we expect a patient with pancreatitis be placed on?
PCA morphine or hydromorphone (dilaudid)
Patients with pancreatitis may be placed on prophylactic ________
antibiotics
Complications of pancreatitis include (long list sorry)
infection, abscess, pseudocysts, diabetes, MODS, ARDS, DIC, paralytic ileus
Is pain as severe with chronic pancreatitis?
no
Is the presence of ascites more likely to develop in acute or chronic pancreatitis
chronic
Is steatorrhea more likely to develop in acute or chronic pancreatitis
chronic
Are patients with chronic pancreatitis at risk of developing jaundice
yes
Patients with chronic pancreatitis may develop dark urine due to?
bilirubin
What diagnostic scan is used to identify pancreatitis
CT
What laboratory values are used to diagnose pancreatitis
amylase/lipase
bilirubin
alkaline phosphatase
glucose
What nutrition requirements are needed for a client with chronic pancreatitis
high protein-high calorie
clients with chronic pancreatitis are at risk of
significant loss of weight and muscle mass, DM
Is pain management a priority when treating clients with chronic pancreatitis
yes
To decrease gastric acid, clients with chronic pancreatitis are placed on
long term PPI
What is pancreatic enzyme replacement therapy
synthetic forms of amylase and lipase
When must PERT synthetic enzymes be taken
every time the patient eats to help aid in digestion
Does pancreatic cancer have a poor prognosis
yes
s/s of pancreatic cancer include
- painless jaundice
- pale stool
- itching
- dark urine
- glucose intolerance
- LUQ mass
Why do patients developing itching with pancreatic cancer
build up of bile salts and bilirubin
Is treatment for pancreatic cancer ever curative
no - goal is to extend life and quality of life
What are the treatments for pancreatic cancer
- chemo and radiation
- pain management
- surgery
what are surgical options for treating pancreatic cancer
- Whipple procedure
- partial pancreatectomy
- radical pancreatectomy
What is removed during a Whipple procedure
head of pancreas, duodenum, portion of jejunum, part or all of stomach, gallbladder
Clients post-op for pancreatic cancer procedure will be sent to the
ICU
Interventions post-op for pancreatic cancer include
- NPO with NG tube
- IV fluids
- biliary drains
Patients post-op from pancreatic cancer procedures should be placed in what position and why
semi-fowlers to reduce pressure on the abdomen
Nurses should monitor for what complications after a Whipple procedure
hemorrhage
infections
electrolyte imbalances
What is the function of the kidneys?
acid-base balance
filter and excrete waste
maintain BP
fluid balance
hormone secretion (EPO)
How does the kidneys help maintain normal hemoglobin and hematocrit
-releases erythropoietin which is a hormone that stimulates the production of red blood cells
How do the kidneys help with absorption of calcium
kidneys activate vitamin D –> vitamin D helps intestines absorb calcium
Characteristics of AKI
-sudden onset
-may not progress
-good prognosis
-high mortality if RRT is required or illness is prolonged
Characteristics of CKD
-gradual onset
-progressive to permanent
-prognosis depends
-ESKD fatal without RRT
Without RRT, ESKD will likely lead to
cardiac failure
why is it so important to manage CKD properly
it can slow the progression of the disease
What is meant by pre-renal AKI
caused by decreased perfusion!
Causes of pre-renal AKI include
-hemorrhage
-heart failure
-MI
-hypovolemia
-sepsis
-shock
What is meant by Intra-renal AKi
happens within the kidneys
Causes of intra-renal AKI include
-glomerulonephritis
-nephrotoxic drugs
-pyelonephritis
another name for intra-renal AKI
intrinsic AKI
Examples of nephrotoxic drugs that can cause intra-renal AKI
- NSAIDs
- antibiotics
- contrast dye
Special consideration for type 2 diabetics and contrast dye
metformin must be held to prevent AKI
How to assess kidney function after receiving contrast dye
-monitor creatinine levels before and after administration
What is meant by post renal AKI
occurs after the kidneys
Causes of post renal AKI
-stones
-BPH
-cystitis
-Hydronephrosis
-prostate, cervical, bladder, and colon cancers
Assessment findings of AKI include
- oliguria
- hypertension
- FVO
- SOB
- azotemia
What is azotemia
build-up of waste products in the blood
in AKI, serum BUN and creatinine will?
increase
What is creatinine
a byproduct of muscle breakdown
The breakdown of creatinine should usually occur at
a constant rate
IN AKI, GFR and creatinine clearance will?
decrease
What electrolytes will be elevated in AKI
Potassium, sodium, and phosphorus
in AKI, which electrolyte will decrease
calcium
What ABG will be seen in patients with AKI
metabolic acidosis
in AKI, H/H will eventually
decrease
What is the number one intervention for treatment of AKI
treat underlying cause!! (ex. hemorrhage = blood products ; kidney stone = lithotripsy)
If AKI is caused by hypovolemic shock, would we give fluids or diuretics?
fluids
If AKI is caused by hypovolemic shock, would we give vasopressors or antihypertensives?
vasopressors
If AKI is caused by heart failure, would we give fluids or diuretics
diuretics
T or F: maintaining fluid balance, BP, and electrolyte balance is crucial for managing patients with AKI
TRUE! remember types of interventions are based on underlying cause!!!
What type of dialysis are patients with AKI typically placed on?
continuous renal replacement therapy
Nutrition therapy is a very crucial aspect of managing AKI and is typically done by
the registered dietician!
Why is nutrition hard to manage in AKI
there is an increased rate of protein breakdown in the muscles
What is a common finding in stage 1 CKD
nocturia
What is a common finding in stage 2 CKD
microalbuminuria
When should discussion of RRT begin in the CKD stages
stage 4 to being preparing patient
In stage 5 CKD, GFR is less than
15
In stage 5 CKD, interventions include
RRT and kidney transplant
For a diabetic patient with CKD, they require a _____ q _____ months
urinalysis ; 3
What are we monitoring for when we have diabetic patients submit for a UA
microalbuminuria (monitors their progression of kidney disease!)
What are the two main causes of CKD
- hypertension
- diabetes
Other causes of CKD include
-lupus
-rheuatoid arthritis
-HIV
-NSAIDs
-smoking / tobacco
Over time, patients with CKD will experience less
urine production
is FVO common in CKD
yes
What blood dyscrasia should we monitor for in our patients with CKD
anemia
Electrolyte imbalances for clients with CKD are
the same as AKI
The buildup of waste products in the blood (uremia) can lead to this complication
pericarditis
Why is heart failure a complication of CKD?
the heart is having to work so much harder and will eventually weakne
Fluid volume overload is patients with CKD will lead to this complicaiton
hypertension
the kidneys reduced ability to filter blood components also contributes to this complicationl
hyperlipidemia
How does anemia develop in patients with CKD
reduced production of EPO = less production of RBCs
What is asterixis?
tremors
How does CKD cause asterixis?
waste product build up
What is renal osteodystrophy
complication of CKD due to loss of vitamin D
-vitamid D loss = loss of calcium absorption = brittle bones
Patients with renal osteodystrophy require ?
calcium and vitamin D supplementation
Uremic symptoms that develop in patients with CKD include?
-uremic frost
-halitosis
-mouth inflammation
What is halitosis?
foul smelling breath
The biggest intervention for managing CKD includes
-lifestyle medications
-controlling hyperlipidemia
-controlling blood glucose
-controlling hypertension
Patient teaching for CKD includes
-maintain a healthy weight
-get plenty of exercise
-eat healthier
-manage diabetes and hypertension
In broad terms, hemodialysis functions as an
external kidney
the external kidney in the hemodialysis machine is known as the
dialyzer
What is used as the filter in peritoneal dialysis
the peritoneal sac
IN peritoneal dialysis, waste products drain from the peritoneal cavity and into
a drainage bag
Long term dialysis access is typically an
AV fistula
What is an AV fistula
where an artery and vein are connected
What is important to assess when our patient has an AV fistula
-a thrill is palpated
-a bruit is heard
-surrounding skin for infection
Important considerations when our patient has an AV fistula
they are a limb restriction in that arm!
-no IVs, no BPs
A temporary dialysis catheter is known as a ?
hemodialysis catheter
Although hemodialysis catheters are very similar to central lines, they have a larger lumen. what does this increase the risk of ?
clots forming inside
Will clients with a short term hemodialysis catheter have peripheral IV lines
yes!
Should medications be given through hemodialysis catheter
NO
What special circumstances may allow for hemodialysis catheters to be used as central line
- no peripheral IV can be obtained
- during a codeW
What MUST be obtained before giving meds through a hemodialysis catheter
Provider permission
What is done to prevent clots in a hemodialysis catheter line
they are heparinized (heparin left to sit in catheter)
Before giving meds through hemodialysis catheter, the nurse should
-remove 10 ML of blood to ensure there is no heparin left in line
Complications of AV fistula include
-thrombosis of AV access
-stenosis of AV access
-ischemia to site distal of AV access
Complications of dialysis include
- infection
- heart failure
- aneurysms
Why is heart failure a complication of dialysis
hemodynamic overload from AV access
Why may aneurysms form as a complication of dialysis
-from repeated needle punctures and pressure exerted during dialysis
Considerations for peritoneal dialysis
-they must be able to do it at home
Is multiple sclerosis a chronic disease?
yes
What are the causes of multiple sclerosis?
auto-imune, genetic, infection
What is the pathophysiology of MS
there is a breakdown of myelin sheath leading to decreased nerve impulses/ messages
What is the leading cause of disability in young and middle age adults
multiple sclerosis
Most adults are diagnosed with MS before the age of
50
What is the function of myelin?
transmission of electrical impulses
What are the types of MS?
- relapsing-remitting
- secondary progressive
- primary progressive
- progressive-relapsing
what is relapsing - remitting MS
symptoms vague in beginning –> then symptoms go COMPLETELY away –> then come back a little worse
what type of MS does relapsing-remitting turn into
secondary progressive
What is secondary progressive MS?
progression without remission periods
What is primary progressive MS?
they never have any period of no sx or less severe sx
What is progressive-relapsing MS?
symptoms never completely go away but there are periods where they are more vague
What type of climate is MS more common in
colder climates
What increases the risk of developing MS
-Northern European ancestry
-1st degree relative
-onset 20-50 years old
-being a woman
Why is MS so hard to diagnose
vague symptoms in the beginning stages are often missed as MS
What are early symptoms of MS
-muscle weakness
-fatigue
-brain fog
What are assessment findings of those with MS
-tremors
-mobility issues
-dysphagia
-difficulty speaking
-vision problems
-bowel and bladder dysfunction
-sexual dysfunction
Psychosocial and cognitive findings of MS
-depression and anxiety
-self-esteem / body image issues
-alterations in ADLs
-short-term memory loss
-inability to concentrate
-impaired judgment
Is there a definitive diagnostic test for MS?
NO
What is the gold standard diagnostics used for MS
- must have presence of symptoms
- must have 2 areas of white looking plaque on MRI
how does MS appear on an MRI
-white spots on MRI that are plaques/lesions
A lumbar puncture for CSF will contain these if the patient has MS
-increased proteins
-white blood cells
What is evoked potential testing
where electrodes are placed on patient to assess the transmission of impulses on the optic nerve
A dysfunction of impulses during an evoked potential test may indicate
MS
What medications are given for MS patients
-immunomodulators
-anti-inflammatories
Why are immunomodulators given for patients with MS
slow disease progression and suppress immune system
Medical marijuana is approved for patients with MS. What symptoms does this aim to aid in?
pain, tremors, spasms, muscle stiffness
Nursing consideration for use of medical marijauan
-alters judgment and cognition (which may make these symptoms of MS worse)
What can be done for clients with MS to improve their mobility?
-assistive devices
-PTOT
-rehab
-exercise
What interventions may be needed to help patients with MS manage their cognition
-therapy
-caledars
-reminders for medications
-med boxes
-safe home
-items accessible to them
What vision change is often seen in MS
diplopia (double vision)
How to manage diplopia
-patching one eye and alternating sides q few hours
What should patients with MS avoid to prevent exacerbation
-overexertion
-stress
-extreme temp
-extreme humidity
-people with infections
What is a complete spinal cord injury
-across entire width of spinal cord
-full deficits
What is an incomplete spinal cord injury
-through only some of the spinal cord
-partial deficits
1/3 of spinal cord injuries occur from
MVAs
Who is most likely to receive a spinal cord injury
young, caucasian man
What is the most common cervical cord injury
C5
SCI between c2-c5 result in
loss of breathing ; will require mechanical ventilation
SCI between c5-c6 result in
paraplegia and arm weakness
Most common thoracic injury
T12
Most common lumbar injury
L1
Injuries to T12 and L1 often result in
paraplegia
What happens during a SCI caused by hyperflexion
a sudden and forceful movement of head forward
what happens during SCI caused by hyperextension
sudden movement of head backwards
What happens during a SCI caused by excessive rotation
very quick and sudden rotation beyond point of normal
What happens during a SCI caused by penetrating trauma
spinal cord severed by knife, gunshot, etc
What happens during spinal cord injury caused by axial loading
the spinal cord is compressed
Head rests are meant to prevent which type of SCI
hyperextension
Critical teaching about car safety to prevent SCI
-make sure there are headrests
-make sure headrest is at appropriate height !
what is important to know before treating a SCI
-how the injury occurred
-baselines motor and sensory function before injury
Order of assessment for SCI includes
-ABC
-neuro status
-spina cord perfusion
-GCS
How to assess mobility and sensory function in clients with SCI
-go down the body and evaluate where patient can move and feel
-mark the place where this stops on the body
Overtime, control of _____ and _____ function can be lost after SCI
bowel and bladder
GI/GU changes after SCI include
-loss of control
-loss of sensation to go
-loss of knowing when to go
Psychosocial issues after SCI include
-depression and anxiety
-potenital loss of job/income
-unable to live at home
-etc
Initial management of SCI includes
-maintaining airway
-IV fluids
-pressors
-monitoring for complications
Immobilization of the spinal cord should be done with a
c - collar
Patients with SCI are at risk of developing this GI complication
stress ulcers
What medications are given to prevent the development of stress ulcers in patients with SCI
PPI / histamine blockers
Nursing considerations for c - collar include
- always assume there is a cervical spine injury until they are cleared
- do not take it off
- correct size
How to position patients in C - collars
make sure we are log rolling
Complications to monitor for when our patient is in a C-collar
skin breakdown
airway clearance/ compression
what is a halo device
-a type of traction used to relieve pressure on cervical spine by holding head up
A major complication of the halo device is
infection
Nursing considerations for halo device
- infection prevention - pin care
- monitoring neurostatus
- skin breakdown
To prevent the halo from moving, it is important to monitor
that it is always in the right spot
Can the fleece part of the halo device be changed?
yes
Can patients go home with a halo device?
yes
Client teaching for halo device
- do not remove
- do not drive
For a patient in a halo device, what must be kept with them at ALL times
-a device to remove the halo if needed
How do patients in halo devices sleep
sitting up
How do patients in halo devices drink
using a straw
Patient teaching for getting dressed in halo device
-use button up shirt that is 2-3 times too big
3 major complications of SCI include
- neurogenic shock
- spinal shock
- autonomic dysreflexia
What type of shock is neurogenic shock
distributive
What causes neurogenic shock?
-loss of sympathetic tone and autonomic control
-loss of epi and norepi
Where in the spinal cord is more likely to cause neurogenic shock
T6 and above
Symptoms of neurogenic shcok
bradycardia, hypotension
Neurogenic shock is treated iwth
atropine, fluids
What is spinal shock?
temporary loss of sympathetic activity below level of injury
In what time frame can spinal shock occur
within 30-60 minutes of injury to 6 weeks after injury
Will spinal shock reverse?
yes ; is only temporary
is spinal shock considered a localized shock?
yes ; directly in spinal cord
Manifestations of spinal shock include
-flaccid paralysis
-loss of reflexes
-loss of bowel and bladder
What is autonomic dysreflexia?
exaggerated sympathetic response
What triggers autonomic dysreflexia?
stimulation of bowel or bladder
Examples of bowl or bladder stimulation include?
severe constipation, urinary catheters, UTI, bladder distention, scrotal compression, UTI, hemorrhoids
Symptoms of autonomic dysreflexia include
-severe hypertension
-headache
-bradycardia
Other symptoms of autonomic dysreflexia include
-nausea
-blurred vision
-sweating
Complications of autonomic dysreflexia include
-seizures
-coma
-death
What position should patients with autonomic dysreflexia be placed in
sitting / high followers
Why are patients with autonomic dysreflexia placed in high fowlers positioin
lower blood pressure and intracranial pressure
Treatment for autonomic dysreflexia depends on
the cause
What will be given to manage the HTN in autonomic dysreflexia
nifedipine
nitrates
make sure to continuously monitor BP
Long term complications of SCI include
-immobility
-skin breakdown
-infection (PNA)
-VTE
-depression
home environment changes
Musculoskeletal changes for SCI include
-osteopenia
-muscular atrophy
-heterotopic ossification
what is heterotypic ossification
when bone tissue forms outside of the skeletal system
SCI can cause longterm changes to
sexual functions, bladder and bowel functions
What percentage of adults experience back pain
80%
What is the leading cause of work disability
back pain
Examples of lower back pain
sciatic nerve - burning, stabbing, pain down leg or footE
Examples of cervical back pain
burning, stabbing pain down arm, pain in neck, upper back and shoulder pains, headache
Does back pain include numbness and tingling
yes
Will managing weight and getting regular exercise prevent back pain
yes
Avoiding this substance will help reduce back pain
nicotine
Adequate intake of ______ and _____ __ will help prevent back pain
calcium; vitamin D
Do high heels increase risk of back pain
yes
Occupational education to prevent back pain
- lift with legs
- use working height
- ask for help
What is most commonly used to diagnose back pain
-symptoms
Pain, limited mobility, paresthesias
What imaging is typically done first in back pain complaints
x-rays
What is usually done before insurance will approve CT/MRI for back pain
-physical therapy
-medication management
What is a bone scan?
-used to assess perfusions to bone using a radioactive tracer
Does a bone scan require contrast
NO (it is nuclear)
Increased vascularity to a bone seen on a bone scan indicates
presence of a tumor
Can massage and heat be used as back pain interventions
yes
Is spinal manipulation okay to use for addressing back pain
Yes
Patient education if they are seeking chiropractor/ spinal manipulation
- make sure they are licensed
- make sure they do x-rays before
What medications can be given for back pain
- NSAIDs
- creams and sprays
A tens unit does what?
-gives little electrical impulses into muscles and may help relieve back pain
What is ziconotide?
a central acting analgesic
How does ziconotide help with back pain?
-it is an implantable pain pump
-gives a little bit of medication at a time
Is a ziconotide pain pump considered a last resort
YES
Ziconotide has a BBW for
-mental health issues (psychosis)
Patient teaching for ziconotide
- do not take if you are struggling with mental health
- report changes ot mental health
- you must come back in for medication to be refilled
What are key concerns to address immediately post op any spinal surgery
- ABC’s
- Bleeding
- infection
Can CSF leak occur following spinal surgery?
yes
Clients experiencing a CSF leak will experience
severe headache
what is halo’s sign?
-CSF leak: will appear red with yellow around the edges
GI/GU complications following spinal surgery include
-urinary retention
-paralytic ileus
Why are fat embolisms common after spinal surgery?
many surgeries manipulate bone where fat globules are stored
Key sign of fat embolism (difference between PE and FE)
petechiae on the chest
Nerve root pain is common after spinal surgery and is known as
persistent or progressive lumbar radiculopathy
What is failed back surgery syndrome?
when symptoms persist even after surgery
