exam 4 Flashcards
what is Perioperative nursing
care provided immediately before during and after surgery
Preoperative
Intraoperative
Postoperative
Preoperative: prior to surgery, anywhere from phone call to preop appointment
Intraoperative: during the procedure itself
Postoperative: immediately following surgery inro end of recovery stay
Purpose of Surgery -whats purpose
diagnostic
ablative
construction
reconstructive
palliative
transplant
invasive procedure to restore, repair, treat injury and restore function, or alter body features
Diagnostic- determine or confirm diagnosis- bioposy or diagnostic lap-like breast biopsy
Ablative-removal of disease tissue or organ- amuputation, apendectomy
Construction- build tissue or organds that are absent- cleft palate
Reconstructive- rebuild tissue or organs- skin graft, totl joint
Palliative- elevates symtpoms for disease – is not curative- could be bowel resection
Transplant- replace organs or tissues to restore function
Types of surgeries
elective
urgent
emergency
Elective (cosmetic, ex tubal ligation or cataract)(suggested, no unforeseen effects if postponed)
Urgent (1-2 days)-necessary to be performed in 1-2,
Emergency –done immediately- life threatening- c section, trauma
surgery settings
Hospitals
Ambulatory Surgery Centers
Outpatient settings- used for diagnostic, minimally invasive surgery’s
outpatient setting advantages
decreased
decreased
less
could
decreased cost
decreased risk of nosocomial infections,
less interruptions in patients life,
could reduce time in lost time from work
outpatient setting disadvantages
learn
need
wrong
learn a great amount of information in short time,
need family to recover,
if something goes seriously wrong they need to go to hospital
outpatient setting discharge
tolerating
vs
need able
controlled
need to
ao
family
need to be tolerating food/fluids,
vs needs to be within 10% of perioperative,
need to be able to stand/walk
, pain needs to be controlled,
need to urinate
, need to be alert/orientated,
family is responsible for discharge functions.
outpatient setting nursing
v
bs
ability
ability
family
vitals,
bowel sounds to make sure they can eat/drink.
ability to walk,
ability to urinate,
assess family understanding instructions- teachback
informed consent
what is it
Need for procedure/purpose/outcome
Risk and Benefits
Likelihood of successful outcome
Alternative Treatments
Right to refuse treatment or withdraw consent
Who can legally provide consent for procedure/surgery?? –
who cannot
–alert and orientated patients who can make own decisions/
/Cannot-minors, pts that have active POA or guardian
Universal Protocol- what is it
process
mark
perform
used to reduce surgical errors
Procedure Verification process
Mark the procedure/surgical site
Perform a time out
preop assessment
age
meds
medical history
cardiac history
Age-decreased tolerance to medication, delayed wound healing sand med metabolization
Meds and substances, some can increase pulmonary and resp issues, some illegal drugs can interfere with anesthesia, pts can have tolerance buildup, ensure on what meds currently on, some Herbal/natural substances can interact with anesthesia , include OTC and vits
Medical history-any that is pertinent to surgery, or meds that interfere with bleeding, history of post of N/V and bleeding
Cardiac history- disease risk of heart failure and stroke, hemorrhage, hypotension, meds are given preop to give baseline, nurses will take vitals, I and o and report hypoxia
preop assessment
pulmonary history
previous surgeries
anticagulants
Pulmonary history- higher risk of pneumonia or altetcises, not maintaining own airway following surgery, monitor hypoxia, resp status , have CDB, incentive spirometer, get pt up and moving early
Previous surgeries and anesthesia- how did they tolerate it, any NV
Anticoagulants & blood donation0 can cause interoperative bleeding, can lead to postop issues, any aspirin or nsaids, might need blood consent, getting signed
risk factor for operation
aa
m
o
lss
npo
advanced age,
malnutrition,
obesity- problems with gas exchange,
low socioeconomic status and
pts needs to be NPO for 6 hours or greater , increased risk for aspiration
pre op physical
when from provider/nurse
what is it
from provider-typically within 1 month- head to toe, from
nursing- typically within the hour of surgery-
this is medical clearance so physician ins giving okay to precede with surgery
pre op Psychosocial-
who will take home
, who is helping with discharge intructions
pre op Diagnostic assessments
Chest x-ray
EKG
Any labs- surgery may be cancelled if ptt, pt, or inr are elevated
pre op lab assessments
electrolyres
u/a
cbc
type and cross match
inr and ptt
pregnancy test
Electrolytes- potassium, sodium, chloride, kidney/cardiac status
U/A- determine any underlying infection, or any abnormal substances in urine
CBC- baseline h and h, platelets, looking for infection or oxygenation, vs and bleeding
Type and cross match, part of blood consent, have on hand incase blood is needed
INR and PTT- asses clotting times
Pregnancy test- general anesthesia will be altered to prevent harm to fetus, surgery can be canceled
Patient & Procedure Identification/Safety
pt
universal protocol–
prepreocedure
mark
perform
Patient must be actively involved in the identification process
Universal protocol -
Pre-procedure verification process
Mark the procedure site – pt
sign with initials if able
Perform a timeout
Patient & Procedure Identification/Safety
medication reconciliation
complete history
interactions
continue/discontinue
Complete history –dose, frequency, when took last, OTC, herbal , supplements
Interactions-watch and assess that can lead to complications of bleeding,
Continue/discontinue -, when is last dose of each medication, and when to keep continuing meds post op
Thromboembolism
risk
balanced
how prevent(give/wear/get up)
complications of surgery
risk of bleeding
,needs to be balanced against risk of DVT and risk of embolism
// how prevent-
give low dose heparin and coumadin,
wear teds or graduated compression,
get pt up and early moving
Hypothermia
risk
inability
surgery center
normal temp
reduces risk
complications of surgery
risk during surgery,
inability to regulate and store body temp,
surgery center is generally cold to prevent risk of infections and bacteria growth,
–96.8-99.5
reduces risk of infection, cardiac mobility, ischemia and surgical bleeding/
Hypothermia
nursing interventions
warm/limit
risk factors-(#, requirements,nutrition, preexisting)
complications of surgery
warming blankets// limit exposure of skin-
risk factors are
age,
underbody requirements
, poor nutrition or preexisting diagnosis-// on other side could have malignancy hyperthermia, inability to regulate temperature
Surgical Site Infections
sterile
pts get
removal
tight
right
complications of surgery
sterile field,
pts get antibiotics,
removal of hair,
tight glucose control
and right temp
Adverse Cardiac Events
worst case
risk
distressed
alterations
complications of surgery
mi/heart attack,
risk in older adults,
circ system is distressed and Inc. risk for ischemia,
any alterations in vitals need to be notified to physician
antibiotics
prevents what//in what
never list
reduce risk
assess for
Medications- Preoperative
prevent surgical site infections – in orthopedic and general surgeries,
on never list infection after orthopedic surgery, so need antibiotics–
also reduces risk of morality
and assessing for allergies
Benzodiazepines
meds
decreases/produces
monitor
look for
reversal agent
Medications- Preoperative
diapaem, lorazepam–
decrease anxiety and produce sedation and amnesia effects
– monitor resp status,
look for resp depression
reversal agent- Flumazenil
Opioids
meds
allows
provides
assess
reversal agent
Medications- Preoperative
: morphine, fentanyl, hydromorphone–
allows reduced anesthesia dose,
provides pain control,
assess allergies and resp status
reversal agent-naloxone
Antacids
meds
reduces
given to pts
Medications- Preoperative
: sodium citrate, omeprazole, pantoprazole—
reduced gastric acid volume and secretion-
pts that have GERD
Antiemetic
when given/why
meds
works how
Medications- Preoperative
preop and postop to prevent NV
/ ondansetron, metoclopramide
enhance gastric emptying and work on vomiting center of brain
Anticholinergics
meds
reduces
dries
Medications- Preoperative
atropine sulfate or cicolomine
reduce secretions and aspiration risk
dries pt out,
Proton pump inhibitor
meds
suppresses
monitor
Medications- Preoperative
-pantoprazole, omeprazole,
suppression gastric acid secretion,
monitor dizziness headache rash
Nursing Care preop
what helps
pediatric
Therapeutic listening & Support
Pediatric population; props, demonstrate, tour-reduce anxiety
Pre-op preparation
verify
look
take
assessment
6hrs
look
what’s marked
remove
provide
give what
verify consent is signed,
look at labs,
take vitals,
head to toe assessment
, go npo for 6 hrs,
look allergies,
surgical site is marked,
remove jewelry, dentures, makeup
, provide skin/bowel prep,
give meds if needed
Prepare the patient for post operative cares
CDB( improves, prevents, utilize)
leg ankle and foot(use, passive, get, early, pumps)
post op positioning(bed, brace, utilize, positioning, teaching eating)
teach C&DB- improves lung health, prevent post op atelectasis and pneumonia, utilize incentive spirometer
Leg, Ankle and Foot exercise:- use ted SCDs , passive movement machines, get up and moving, early ambulation, leg and ankle pumps
Post op positioning and movement: how to move in bed, brace area that will give pain, utilize pillows for support, legs and upper arms for positioning, teaching how to control pain, and what eating after
Safety in surgery
whos repsoiblity
assess need for what
right x2
how do they handle what
what types of burnes
what administered
what helps
everyone’s responsibility
assess need any surgical specimens
right person, right procedure
How do they handle bodily fluids
Electrical, thermal or chemical burns
What meds are administered
Positioning helps
Never events
situation
no retained
no following
infection
reasonable and preventable situations
No Foreign object retained after surgery
No DVT following surgery
Surgical site infection
Surgical Methods
O
L
R
Open
laparoscopic
robotic
Surgical Attire & Scrub
hand scrub
facilitate infection control, cross contamination and reduces bacterial shedding
Hand and Arm scrub
Inhibits: bacterial growth by removing dirt and preventing any additional growth
Patient preparation in the surgical environment
removal
what helps
prep
what after
Hair removal,
positioning,
skin prep like chlorhexidine
, may need cath after
General Anesthesia
produces what affect
pros
cons
what feelings
IV & inhalation produced cns depression and amnesia affect
Pros: rapid excreted and quick reversal
Cons: circulatory, respiratory and renal side effects, malignant hyperthermia,
Nausea, vomiting, groggy feelings
Regional/epidural Anesthesia:
what does
pros
cons
treat when
No perceived pain due to medications instilled around nerve, which blocks nerve impulses
Pros: affective pain control, pt. can walk sooner, quick, effective, much less adverse reactions
Cons: anxiety is not altered, leaking of CSF, hypotension, monitor oxygen and resp status
treat pain before it wears off
Conscious Sedations
moderate
pts can
safety
Moderate sedation; amnesia
pts can maintain own airway, make sure pt can maintain airways, and can follow commands
Safety have reveral agent on hand
Nursing Care- Intra-Op
focus
universal protocol
positioning
sterile
Focus – environmental safety, pt positioning and phycological support, and outcomes
Universal protocol: Time out –always
Positioning prevent skin breakdown, protecting bony prominences
Sterile Technique making sure sterile is followed- if anything is away from sterile field
documentation intra op
counts
administrations
runner
managment
collection
Sponge counts, needle counts
Medication administration
Runner: Supplies, medications etc.
Drain management
Specimen Collection
pain post operative
not practical
meds provide
helps with
meds-watch
what kinds
not practical to get rid of all pain,
meds should provide relief,
can help with CDB, early ambulation/
/narcotics, NSAIDS -ketorolac - watching bleeding, caution with over 65 age
Oral, IV, suppository
Scheduled and PRN
PCA vs PCEA
nursing considerations-whatare they
pca
pcea
Nursing Considerations: vs mental status, labs, bleeding history, reps assessment
PCA-patient controlled- use regular –parameters that nurse will set
PCEA-pt controlled epidural- parameters, pt can push on demand or basil rate
Nausea meds postop
suppository
waiting for
auscultating
promoting
what causes
Oral, IV, suppository
Waiting for return of bowel sounds,
auscultating bowel sounds,
promoting movements
, pain meds can cause nausea,
//NSAIDS
Infection risk; post operative antibiotics
biggest risk
administer
changes
CDB helps with
– incision is infection risk,
administer antibiotics as ordered,
dressing changes,
CDB-pnamnua and ateleticis
nursing care post op immediately
p___
focus
PACU
focus- airway, vitals, mental status, emotional support, pain control
Malignant Hyperthermia
disorder
causes
early signs
LT
genetic disorder triggered by inhalation of anesthetic meds.
Causes hypermetabolism in body and can go to over 109 degrees
Early signs: tachycardia, tachypnea, muscle stiffness, escalating temp
life threatening
treatment of malignant hyperthermia
others
muscle relaxant
Treatment: oxygen, cooled iv fluids, cooling interventions
Oxygen, IV, Medication, cooling interventions
Dantrolene- Muscle relaxant
Once patient is stable
transfer where
ga
vs
htta
l
p
n
d
f
d
d
Transferred to recovery area (room or home today surgery)
General appearance
Vitals signs
Full head to Toe Assessment
LOC
Pain
N/V
Dressing/Incision
Fluids
Diet
Drains
Nausea, Uncontrolled pain
how assess
pain meds (moderate/severe)
nursing care post op complications
assess w/ numerical scale
pain meds-
nsaids- moderate
opiods- severe
Bowel Sounds & Diet
diet advancement
how know if ready for diet
nursing care post op complications
clear liquids->full liquid-> soft diet -> regular diet
know if ready with bowel sounds, n/v
Wound healing
diet
purpose of drains
3 prorities with drain management
nursing care post op complications
diet-> protein, dairy, vit c
purpose- receive pressure by removing excess fluid
prorities -> cleaning around, replacing absorbent dressing, monitor discharge/drainage
serous
sangionous
purulent
Serous- clear yellow
sanginous- thick red
purulent- wbc,debris from infection
types of drains
what to monitor for
Jackson pratt- grenade suction out fluid
hemovac- suction out fluid
Penrose-rubber drain
montitor I and o and consistency
dehiscence
what is it
what nurse do about it
how treat
what is it- separation in layers of incision and wound
what nurse do-make sure iv works, go npo. get vitals
how treat- surgery
evisceration
what is it
how treat
will need
what is it- protrusion of organ from body
how trat - cover wound with sterile dressing moistened with normal saline
will need emergency surgery
Dressings
what is normal
compare
if leaking//dont
who does first change
nursing care post op complications
normal is anything but purulent
compare with amount, circle
if leaking through reinforce with new dressing, dont take off
surgeon will do first dressing change
hemorrhage s/s
r
a
tacky
cool
decreased
leads to
resltess
anxiety
tachycardia
cool pale skin
decreased urine output
leads to shock
shock s/s
severe
altered
c
r
tacky
tacky
weak
hypo
severe vomiting
altered loc
confusrion
restlessness
tachycardia
tachypnea
weak pulses
hypotension
Hemorrhage/Shock
nursing interventions
stopping
lines
ultimately need what
nursing care post op complications
stopping bleeding-pressure is applied with moist dressing or gloved hands
iv lines w/ isotonic fluids
emergency surgery
DVT/PE
treatments
nursing care post op complications
scd,
ambulating early
-give subq, enoxaparin, can cause bruising
pneumonia, Atelectasis
most at risk
assess
interventions
education
nursing care post op complications
obese, copd, elderly most at risk
assess vitals, sp02,ability to tolerate activity
elevate hob, administer oxygen, mobility, increcntice spirometer,
educate on CDB, hydration and hygiene
Urinary retention/Altered Bowel Habits
provide
assist
stand
what stimulates
increase
passing
nursing care post op complications
provide privacy,
assist to bathroom-ambulation early and often
stand to void
warm water to stimulate
increase fluids and fiber
passing flatus
3 phases of wound healing
inflammatory
proliferative
remodeling
Assessing the musculoskeletal system
how many bones
in addition to bones
considerations
interview
physical assessment
206 bones
In addition cartilage, muscles, joints, ligaments & tendons
Genetic considerations
Health assessment interview
Physical Assessment
Deformity, muscle grade, strength, equality, swelling, redness, over ROM
Arthrocentesis
why done
what happens
done to obtain synovial fluid from joint for diagnosis or to remove excess fluid-
needle is inserted and fluid is aspirated out
Arthroscopy
endoscope procedure to look at the interior structure of the joint and can be used to fix or repair tendons or muscles
Bone Density (Dexa Scan):
overall strength of bone, done in osteoporosis
Bone Scan:
what injected
uptake
what is present
radioisotope medication injected
uptake is increased within bone tissue if
osteomyelitis, porous or bone cancer is present
Skeletal X ray:
identify structure and density of bone
CT/MRI:
3d picture of bone, trauma, abnormalities, tumors, cysts, herniated disks, assess allergies or metal implants
Ultrasound:
imagines withing muscles tendons and ligaments
c reactive protein
Blood Tests:
indicates a non specific inflammatory response
Alkaline phosphatase (ALP),
blood tests
diagnosis of liver and bone disease
Rheumatoid factor
blood tests
assist in diagnosing rheumatoid arthritis
Changes with Aging musculoskeletal
decreased
increases
posture
degen
decreasd
muscle
slowed
Decreased bone density
Increased bone prominence
Kyphotic posture
Cartilage degeneration
Decreased ROM
Muscle atrophy
Slowed movement
Contusion
goal
Musculoskeletal trauma
bleeding in soft tissue, skin is intact and large amount of bleeding which lead to hematoma
goal-RICE Rest, Ice, compression, elevation
Strain
goal
Musculoskeletal trauma
stretching injury to muscle or muscle tendon, forced to extend
Goal of any of the above:
RICE Rest, Ice, compression, elevation
Sprain
goal
Musculoskeletal trauma
stretching or tear of ligament surrounding joint
Goal of any of the above:
RICE Rest, Ice, compression, elevation
Joint Trauma
Rotator Cuff Injuries
Knee Injuries
Dislocation
Joint trauma
treatment
priority
Treatment: Reduction of joint, surgery, RICE therapy
Priority: rehab, pain, appropriate use of injured area
Carpal Tunnel
what is it
when occurs
Canal through which flexor tendons and median nerve pass from the wrist to hand
occurs when canal is narrowed and irritation of the nerve
manifestations of carpal tunnel
Nighttime pain
Numbness, tingling of thumb, index finger
diagnosis / treatment of carpal tunnel
Diagnosis history/physical, presentation of manifestations
Treatment: surgery, physical therapy, pain control and corticosteroids
fractures
what are they
open vs closed
Break in continuity of bone
Open Vs Closed-
skin intact in closed,
skin open is open
Manifestations: of fractures
Deformity,
pain,
swelling,
numbness,
guarding spasms
Compartment Syndrome
what is
educate with
check
complications of fractures
Increased pressure within confined space constricts structures within –
educate with casts for numbness and tingling or cold extremities
check cms
Infection
check what
administer what
complications of fractures
–temp
if need antibiotics,
DVT –
treat with what
make sure
complications of fractures
anticoagulant,
make sure no numbness tingling or pain
delayed what
complications of fractures
Delayed bone healing
fracture treatments
tractions
Pulling/straitening force to return or maintain bone function
Traction Care
pins
cms
skin
ropes and pulleys
weights
fracture treatments
Pins-surrounding skin
CMS-color motion sensation –color, able to move toes, can feel touching, pedal pulses
Skin-report any redness, swelling drainage or increase in tenderness
Ropes and pulleys- used to maintain pulling force and direction of traction, make sure nothing is laying on ropes
Weights-ordered by physician, never remove weights for postion change sor anything, always stay on
Cast
and
nursing care(checks, inspection education)
Fracture Treatments
Rigid device for immobilization
nursing care
CMS checks –numbness tingling and color changing
Inspection drainage, hotspots
Educate to report: report pain and changes in sensation
cast pt education
nothing
report
keep
do what
Nothing inside the cast ever
report Sensation/pain changes /cool skin
Keep cast clean + dry
elevate extremity and rom
casted extremity
meds
Pain meds (NSAIDs /Analgesics)
- Anticoagulants (decrease risk of DvT)
Amputations
what is
caused by
Partial or total removal of an extremity
Caused by trauma or chronic issues, delayed healing
complications of amputations
Infection
Delayed healing
Phantom pain;
Contractures:
phantom pain
pain meds control
Narcotics,
gabapentin ()
, pregabalin ()
Contractures: extend/perform
lay
elevation
Extend the joint and perform exercises,
lay prone throughout day increases blood flow to muscles and prevents contractures.
Elevation promotes venous return
osteoporosis
What is it?
loss of
leads to
increase risk
porous bones,
loss of bone mass,
leads to fragile bones
increase risk of fractures
Risk factors osteoperosis
non modifiable
advanced
history
F___
frame
advanced age,
family history,
female,
thin small frame
Modifiable osteoperosis
low what
deficiency
use
i____
use
low estrogen or testosterone,
dietary deficiency of calium or vit d,
use of corticosteroids
, inactivity,
smoking or alchohol use
manifestations of osteoporosis
loss of height,
curvature of spine,
low back pain,
fractures
Diagnosis: osteoporosis
Bone density (DEXA Scan)
lumbar spine and hip
Osteoporosis Treatment -does what
med
common
used to preserve bone mass and increase bone density
-Bisphosphonates current drug of choice for preventing & treating
Common —alendronate, zoledronic acid
Other Medications
osteoperosis
et
ca
estrogen therapy-raloxifene & tamiofloxen
calcitonin- hormone that increases bone formation
diet and lifestyle osteoperosis
diet-intake
high calcium foods
encourage
discourage
Diet; intake increase of vit D & calcium-
What is high in calcium??? Fish, Diary products, dark vegatbles
Encourage Exercise; lifestyle changes
decrease:smoking/alcohol/ corticosteroids
osteoporosis
pt teaching
intake
regular
asssitve
good
fall prevention
calcium intake-supplements or foods
regular exercise- 30-40 mins 3x a week
assistive devices to maintain independence In ADL
good posture to prevent stress on spine
indoor and outdoor fall prevention-assistive devices, rubber grips, salt and grass when wet
osteoarthritis
characterized by
progressive loss of joints, cartilage,
joint inflammation,
stiffness / loss of joint motion
osteoarthtis
nursing assessment
pain,
ROM/mobility,
muscle strength,
crepitus,
color
, weight
-CMS!
Osteoarthritis
what is it
leading to
Degenerative joint disease
leading to cause of pain and disability in older adults
Osteoarthritis
risk factors
Age,
genetics,
excessive weight,
inactivity (Too little),
repetitive joint use (Too Much)
Osteoarthritis
goal
modifable
non modifiable
Goal: Moderation
Modifiable- lose wight,
non modifiable – age, previous joint damage and genetics
manifestations
pain/rele;eived
diagnosis
of osteoarthritis
Pain and joint stiffness; deep ache
pain with use of joint, relieved with rest
Diagnosis H&P, X rays, MRI
osteoarthritis meds
NSAIDS,
Tylenol
topical treatments
hyluronic acid
, cortisone injections,
opioids
other Treatments osteoarthritis
ROM,
heat/ice,
balance between exercise & rest
Assistive device,
weight loss
Rehab//therapy
osteoarthtis
diet
0
supplements
-0 night shade foods: potatoes, tomatoes, peppers, eggplant
- supplements: boron, zinc, copper, glucosamine
Surgery osteoarthritis
Joint arthroplasty,
joint replacement
pre op care
___ assessment
__prior
education
__hygiene
__control
__prep
pre op __
total joint replacement
Knowledge assessment
ROM prior
education Restrictions post op
Respiratory hygiene –cdb incentive spirometer
Pain control –don’t eliminate all pain
Skin prep –chlorhexidine wash pre surgery
Pre-op antibiotics
Post operative
total joint replacement
nuerovascualr
checks
&
management
therapy
IS
safety
use
Vitals, neurovascular checks-cms, ensure they can feel you are touching them, check pedal pulses
Incisional checks
Intake & output
Drain management-may or may not
Therapy –occupational and physical
Incitive spirometer, SCDs, continuous passive motion
Rehab/home safety
Device use
Activity Post Joint Replacement
CPM-helps with what
sequential
Continuous Passive Range of Motion
Helps maintain range of motion-done leave on continuously
Sequential Compression Devices –prevention of dvt
Activity Post Joint Replacement
Prophylactic Medication
NSAIDs,
aspirin,
Enoxaparin SQ (),
Heparin SQ
Activity Post Joint Replacement
assistive devices
Handrails, grab bars, shower chair, shoehorns, tongs/grippers
Walker/Cane use: Move device & affected extremity first, followed by strong
maintain prescribed
using
WB vs NWB
Positioning Post Joint Replacement
Maintain prescribed position of affected,
using splint, immobilizer, abduction pillow
Weight bearing vs non weight bearing- need to know activity
total hip
prevent what
use what
no what
proper use-leading w
Prevent flexion or adduction of affected leg
Toilet seat risers, abduction pillow
No bending
Proper walker use-leading with affected leg
Total Knee
utilize what
exercises
Utilize continuous passive range of motion (CPM)
ROM exercises
GOUT
metabolic disorder->
caused from
inflammatory arthritis triggered by crystallization of urate within joint
Caused from too much uric acid in body, high levels of uric acid in blood and joints
risk factors of gout
male,
age,
hypertension,
obesity,
CKD,
DM 2
Acute manifestations gout
where is it
what feels like
what does to body
in joints of great toe, ankle, knee, wrist
Pain, red, hot, swollen, tender
Fever, chills, elevated WBC
advanced gout manifestations
tophi
stiff
limited
Tophi- urate deposits in tissues
Joint stiffness,
limited ROM
gout diagnosis
Presentation of symptoms
Diagnosed with Serum uric acid-best to diagnose, if above 8.5
gout meds
and
prophylactic treatment
NSAIDS, colchicine, corticosteroids
Prophylactic treatment Allopurinol
Complementary/alternative treatments gout
vitamin e,
amino acids,
acuputcure
, diet of dark berries
Rheumatoid Arthritis
what is
Chronic Systemic Autoimmune Disorder
inflammation of connective tissue in joints
manifestations of Rheumatoid Arthritis
characterized by
Inflammation, fatigue, nonspecific joint aches and stiffness
characterices by remissions and exacerbations
Rheumatoid Arthritis diagnosis
what’s elevated
what is used
C-Reactive proteins and Sedimentation rate- elevated due to inflammation
Synovial fluid analysis, X ray
Rheumatoid Arthritis meds
nsaids
corciosteroids teaching
DMARDS
NSAIDS –aspirin, ibuprofen, naproxen, meloxicam
cortico– risk for infection-s/s of infection
DMARDS- disease modifying anti-rheumatic drugs: slow and prevent progression –methotrexate,tamara
Rheumatoid Arthritis treatments
rest/exercise ( balanced, see who, regular, training and exercises)
heat/cold( heat, take for, finding what)
assistive devices
nutrition
surgery
Rest & exercise balanced program, need to see pt and ot , regular rest periods, strength training and low impact excercixes
Heat & Cold moist heat, take bath for stiffnes and aches, finding whatever works best for pt
Assistive devices & Splints cane or walker to elp inderpednece and rom and adl
Nutrition well balanced
Surgery replaced damage joint
Systemic Lupus Erythematosus
chronic
cell/tissue damage
Chronic inflammatory disease affecting all body systems
Cell and tissue damage caused by antibody deposits in connective tissue
Systemic Lupus Erythematosus
meds/ treatments
__ care
pain management->
agents
topical
avoid
Supportive Care
Pain management nsaids,
Immunosuppressive agents
Topical corticosteroids
Avoid Exposure to ultraviolet rays-flare ups
Systemic Lupus Erythematosus
manifestations
Painful, swollen joints and muscles pain
Unexplained fever
Red “butterfly” rash on face
Sensitivity to sun
Enlarged lymph nodes
Systemic Lupus Erythematosus
diagnosis
Antibody Testing,
Sed Rate elevated
Systemic Lupus Erythematosus
warning signs of a disease flare
Increased fatigue
Pain
Rash
Headache
Fever
Dizziness
manifestations Lyme disease
bullseye lesion,
can mimic arthritis
Flu like symptoms
Rash, fatigue, chills
Treatment of Lyme
antibiotic therapy
nsaids,
supportive care
Lyme disease
What is it?
patho
inflammatory disease that is transmitted by tick
Patho body is infected at site of tick bite 30 days migration period
complications of Lyme disease
Chronic recurrent arthritic issues
Neurological issues
Scleroderma
what is
characterized by
Hardening of skin;
chronic issue characterized by deposits of excess collagen in skin and organs
scleroderma charcertic
shiny
taunt
hyperpigmented skin
meds and treatment scleroderma
treatment
agents
therapy
Symptomatic treatment
Immunosuppressive agents, corticosteroids
Therapy to support affecting tissues
fibromyalgia
chronic syndrome characterized by
patho
CSCB–>pain, stiffness, tenderness
Patho complex syndrome involving CNS, autoimmune and endocrine system
manifestations
diagnosis of fibromyalgia
onset of chronic, achy pain
H&P, presentation of symptoms
Fibromyalgia meds
Tricyclic antidepressants
SSRI
Cymbalta and Savella
Lyrica
Tramadol or NSAIDs
Fibromyalgia
daily actvities
Aerobic exercise/stretching
Daily rest is key!
Medications
Foot Disorders -what is
Disorders that cause pain or difficulty walking
Manifestations foot disorders
Deformity,
pain,
inflammation
Morton’s Neuroma- pain is burning in nature
examples with foot disorders
Bunion:
Hammertoe:
Morton’s Neuroma:
Plantar fasciitis
canes
hold where
move what first
hold cane on strong side
move affected leg first first
walkers
when full suppport
when one leg is better
Full support-move walker, right foot then left foot-weight goes from both, left side, right side
one leg-> weak leg w/ walker, then strong leg
crutches stairs
up
down
up-> good- unaffected leg goes onto step first
down-> bad-> affected leg goes onto step first
below knee amputation
assessment
p
s
lab
wound
temp how often
pain
skin
wbc
wound-redness/edems
temp every 4-8 hrs
below knee amputation
interventions
change
administer
wash
mass
expose
change
-change wound dressing PRN or scheduled
- Administer antibiotics
- wash stump w soap or water, dry throught skin
- massage stump
- Expose open area of skin to air 1 hr –4x day
- Change stump socks 1x/day, wash
below knee amputation
diet
protein
vitamin c
dairy
below knee amputation
meds
meds
hz antagonist
ss
resume meds
- hz antagonist /PPi > decreased peptic ulcer formation
- Stool softener
below knee amputation
lifestyle mods
p
therapy
care
grab
handhels
chair
prosthetic
- PT /OT
- Home care
- grab bars
- handheld shower heads
- Shower chair
below knee amputation
pt teaching
appropriatly
stump
pos
resume
wrap stump appropriately
- stump exercises
- positioning of stump
- resume physical activity asap
abdominal surgery
assessment
rr/vs
emotional status
loc
pain
dressing
n/v
comfort
skin integrity/colot/temp
sensory/motor function
abdominal surgery
interventions
pain
drain
dressing
am
pain meds
drain cleaning/empy
dressing change
ambulate
abdominal surgery
meds
nsaids(caution over 65)
opids
pca/pcea
abdominal surgery
diet progression
clear liquid ->
full liquid->
soft->
regular
abdominal surgery
teaching
s/s
care
control
meds
activity
s/s of infection
wound care
control pain
meds as ordered/prn
physical activity limitations
Total hip/total knee
assessment
vs q
checks
incisional
p
s/s
vital signs q 4 hrs
neuron checks-> cms
incisional bleeding
pain
s/s of dislocation
Total hip/total knee
interventions
reinforce
maintain
record
proper
is
therapy
early
wear
reinforce dressing
maintain iv
record I and o
proper position >90 degrees
Incective spirometer//CDB
PT/OT
early ambulation
SCD/Stockings
Total hip/total knee
diet
increase fluids
inc fiber
protein vitamin c dairy
Total hip/total knee
meds
nsaids/opiods
anticoagulants
Total hip/total knee
lifestyle modifications
whatin shower
what in toiler
asssitive
what kind of socks
what around house
shower chair
toilet risers
assistive devices-walker/cane
grippers
handrails
Total hip/total knee
pt teaching
s/s
daily
whattype of meds
ss of
what tyoe of socks
I+e
s/s infection
exercise daily
anticoagulants
s/s of dvt/pe
compressions
ice + elevation
