Exam 3, Part 2 Flashcards
post-op assessments for prevention of complications
respiratory status CV status temp fluid status wound site GI status (N/V or decreased bowels)
management of shock
- keep flat with legs elevated
- O2
- vitals, HCT, and blood gas
- maintain temp
- maintain volume
- medication administration
when should you remove an oral airway
when gag reflex returns
prevention of dehiscence/ evisceration
teach the patient splinting
what to do in the case of evisceration
find sterile lap pad and cover it; do not push contents back in
important pre-op assessments
- make sure they have actually fasted
- anticoagulants
risk factors for osteoporosis
ACCESS alcohol use corticosteroids calcium low estrogen low smoking sedentary lifestyle
clinical manifestations of osteoporosis
lordosis or kyphosis, bone loss of 25-40% must occur efore it can be identified on an xray
diagnosis of osteoporosis
bone density scans starting at age 40
best exercise for osteoporosis
walking (it is weight bearing but not high impact)
medications for osteoporosis
- Fosamax (Alendronate): sit upright for 30 mins and take on empty stomach, these drugs are very absorbant and will get stuck and cause erosion in the esophagus
- Boniva: once a month
- Calcitronin: s/e GI upset, inflammation at injection site; monitor serum calcium
complications of osteoporosis
- hip fractures
- T8 and below fractures
- spinal compression and shortened stature
calcium and vitamin D sources
- calcium: spinach, fish, orange juice, oatmeal, fortified cereals
- vitamin D: milk, yogurt, eggs, cheese, fish
childhood diseases that could result in osteoporosis
- juvenile idiopathis arthritis
- osteogenesis imperfecta
paget’s disease
excessive bone destruction occurs with replacement of bone by fibrous tissues and abnormal bone, most commonly affecting skull, femur, pelvis, and vertebrae
clinical manifestations of paget’s disease
- bowing of the legs
- waddling gait
- pain, tenderness, and warmth over bones
Tx of paget’s disease
- *NSAIDS
- Cacitonin
- Fosamax
complication with skeletal traction
more likely to get infections
-low grade fever, abscess around the pin with green, smelly drainage
nursing diagnosis for a patient with musculoskeletal problems and/or an ambulation device
- activity intolerance
- impaired mobility
- risk for falls
when is a brace used for scoliosis
for 25-45 degree abnormalities, anything greater requires surgery
clinical manifestations of DDH
- one leg shorter than the other
- restricted abduction of the hip
- unequal gluteal folds when infant is prone
- if bilateral dislocations: waddling gait and marked lordosis
tests for DDH
- ortolani test- move the leg out (abduct)
- barlow test- move the leg in (adduct)
- trendelenburg- greater trochanter is prominent and appears above the line from the anterosuperior iliac spine to the tuberosity of the ischium
therapeutic management of DDH in infants newborn to 6 months
pavlik harness
care of a child in a pavlik harness
- provide skin care
- check 2-3 times a day for redness
- gently massage the skin once a day
- avoid lotions and powders
- diaper under straps
- remove for bathing
test for juvenile idiopathic arthritis
slit lamp eye exam: find iridocyclitis and uveitis (inflammation of the uvea- middle later of the eye that consists of the iris, ciliary body and choroid)
-this is unique to JIA
pathophys of JIA
- chronic inflammation of the synovium with joint effusion
- destruction of cartilage
- ankylosis (stiffening) of the joints as the disease progresses
goals of therapy for JIA
preserve function, prevent deformities, and relieve symptoms
main therapy for JIA
NSAIDS and pool exercises
systemic lupus erythematosus
- chronic, multi-system autoimmune disease of connective tissues and blood vessels
- characterized by inflammation
- symptoms are variable and unpredictable
- most common in girls age 10-19
therapies for osteosarcoma
- radical resection or amputation of area
- limb-salvage procedures with prosthetic replacement
- chemo accompanying surgery
therapes for ewings sarcoma
- irradiation is first approach
- chemo is adjunct to irradiation
- sometimes surgical resection
where do you find ewings sarcoma
in the marrow (femur, tibia, ulna, humerus, vertebrae, pelvis, scapula, ribs, skull
treatment of osteomyelitis
antibiotics for 6-8 weeks
Legg-calve-perthes disease
- self-limiting, idiopathic in children age 3-12 years
- avascular necrosis of the femoral head
clinical manifestations of legg-calve-perthes disease
- insidious onset
- may have limp
- soreness or stiffness
- limited ROM
- vague history of trauma
goal of treatment for legg-calve-perthes disease
keep the head of the femur in the acetabulum
