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d-health promotion(former alteration) > exam 4 > Flashcards

exam 4 Flashcards

1
Q

what is Perioperative nursing

A

care provided immediately before during and after surgery

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2
Q

Preoperative

Intraoperative

Postoperative

A

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

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3
Q

Purpose of Surgery -whats purpose

diagnostic
ablative
construction
reconstructive
palliative
transplant

A

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

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4
Q

Types of surgeries

elective
urgent
emergency

A

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

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5
Q

surgery settings

A

Hospitals

Ambulatory Surgery Centers

Outpatient settings- used for diagnostic, minimally invasive surgery’s

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6
Q

outpatient setting advantages

decreased
decreased
less
could

A

decreased cost

decreased risk of nosocomial infections,

less interruptions in patients life,

could reduce time in lost time from work

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7
Q

outpatient setting disadvantages

learn
need
wrong

A

learn a great amount of information in short time,

need family to recover,

if something goes seriously wrong they need to go to hospital

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8
Q

outpatient setting discharge

tolerating
vs
need able
controlled
need to
ao
family

A

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.

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9
Q

outpatient setting nursing
v
bs
ability
ability
family

A

vitals,

bowel sounds to make sure they can eat/drink.

ability to walk,

ability to urinate,

assess family understanding instructions- teachback

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10
Q

informed consent

what is it

A

Need for procedure/purpose/outcome

Risk and Benefits

Likelihood of successful outcome

Alternative Treatments

Right to refuse treatment or withdraw consent

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11
Q

Who can legally provide consent for procedure/surgery?? –

who cannot

A

–alert and orientated patients who can make own decisions/

/Cannot-minors, pts that have active POA or guardian

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12
Q

Universal Protocol- what is it

process
mark
perform

A

used to reduce surgical errors

Procedure Verification process

Mark the procedure/surgical site

Perform a time out

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13
Q

preop assessment

age
meds
medical history
cardiac history

A

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

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14
Q

preop assessment

pulmonary history

previous surgeries

anticagulants

A

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

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15
Q

risk factor for operation

aa
m
o
lss

npo

A

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

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16
Q

pre op physical

when from provider/nurse

what is it

A

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

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17
Q

pre op Psychosocial-

A

who will take home

, who is helping with discharge intructions

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18
Q

pre op Diagnostic assessments

A

Chest x-ray

EKG

Any labs- surgery may be cancelled if ptt, pt, or inr are elevated

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19
Q

pre op lab assessments

electrolyres

u/a

cbc

type and cross match

inr and ptt

pregnancy test

A

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

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20
Q

Patient & Procedure Identification/Safety

pt

universal protocol–
prepreocedure
mark
perform

A

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

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21
Q

Patient & Procedure Identification/Safety

medication reconciliation

complete history
interactions
continue/discontinue

A

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

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22
Q

Thromboembolism

risk
balanced

how prevent(give/wear/get up)
complications of surgery

A

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

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23
Q

Hypothermia

risk
inability
surgery center
normal temp
reduces risk
complications of surgery

A

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/

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24
Q

Hypothermia
nursing interventions

warm/limit

risk factors-(#, requirements,nutrition, preexisting)

complications of surgery

A

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

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25
Q

Surgical Site Infections

sterile
pts get
removal
tight
right

complications of surgery

A

sterile field,

pts get antibiotics,

removal of hair,

tight glucose control

and right temp

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26
Q

Adverse Cardiac Events

worst case
risk
distressed
alterations

complications of surgery

A

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

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27
Q

antibiotics

prevents what//in what
never list
reduce risk
assess for

Medications- Preoperative

A

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

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28
Q

Benzodiazepines

meds
decreases/produces
monitor
look for
reversal agent

Medications- Preoperative

A

diapaem, lorazepam–

decrease anxiety and produce sedation and amnesia effects

– monitor resp status,

look for resp depression

reversal agent- Flumazenil

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29
Q

Opioids

meds
allows
provides
assess
reversal agent

Medications- Preoperative

A

: morphine, fentanyl, hydromorphone–

allows reduced anesthesia dose,

provides pain control,

assess allergies and resp status

reversal agent-naloxone

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30
Q

Antacids

meds
reduces
given to pts

Medications- Preoperative

A

: sodium citrate, omeprazole, pantoprazole—

reduced gastric acid volume and secretion-

pts that have GERD

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31
Q

Antiemetic

when given/why
meds
works how

Medications- Preoperative

A

preop and postop to prevent NV

/ ondansetron, metoclopramide

enhance gastric emptying and work on vomiting center of brain

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32
Q

Anticholinergics

meds
reduces
dries

Medications- Preoperative

A

atropine sulfate or cicolomine

reduce secretions and aspiration risk

dries pt out,

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33
Q

Proton pump inhibitor

meds
suppresses
monitor

Medications- Preoperative

A

-pantoprazole, omeprazole,

suppression gastric acid secretion,

monitor dizziness headache rash

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34
Q

Nursing Care preop

what helps

pediatric

A

Therapeutic listening & Support

Pediatric population; props, demonstrate, tour-reduce anxiety

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35
Q

Pre-op preparation

verify
look
take
assessment
6hrs
look
what’s marked
remove
provide
give what

A

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

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36
Q

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)

A

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

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37
Q

Safety in surgery

whos repsoiblity
assess need for what
right x2
how do they handle what
what types of burnes
what administered
what helps

A

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

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38
Q

Never events

situation
no retained
no following
infection

A

reasonable and preventable situations

No Foreign object retained after surgery

No DVT following surgery

Surgical site infection

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39
Q

Surgical Methods
O
L
R

A

Open

laparoscopic

robotic

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40
Q

Surgical Attire & Scrub

hand scrub

A

facilitate infection control, cross contamination and reduces bacterial shedding

Hand and Arm scrub
Inhibits: bacterial growth by removing dirt and preventing any additional growth

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41
Q

Patient preparation in the surgical environment

removal
what helps
prep
what after

A

Hair removal,

positioning,

skin prep like chlorhexidine

, may need cath after

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42
Q

General Anesthesia

produces what affect
pros
cons
what feelings

A

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

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43
Q

Regional/epidural Anesthesia:

what does
pros
cons
treat when

A

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

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44
Q

Conscious Sedations

moderate
pts can
safety

A

Moderate sedation; amnesia

pts can maintain own airway, make sure pt can maintain airways, and can follow commands

Safety have reveral agent on hand

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45
Q

Nursing Care- Intra-Op

focus
universal protocol
positioning
sterile

A

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

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46
Q

documentation intra op

counts
administrations
runner
managment
collection

A

Sponge counts, needle counts

Medication administration

Runner: Supplies, medications etc.

Drain management

Specimen Collection

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47
Q

pain post operative

not practical
meds provide
helps with
meds-watch
what kinds

A

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

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48
Q

PCA vs PCEA

nursing considerations-whatare they

pca
pcea

A

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

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49
Q

Nausea meds postop

suppository
waiting for
auscultating
promoting
what causes

A

Oral, IV, suppository

Waiting for return of bowel sounds,
auscultating bowel sounds,

promoting movements

, pain meds can cause nausea,
//NSAIDS

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50
Q

Infection risk; post operative antibiotics

biggest risk
administer
changes
CDB helps with

A

– incision is infection risk,

administer antibiotics as ordered,

dressing changes,

CDB-pnamnua and ateleticis

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51
Q

nursing care post op immediately

p___
focus

A

PACU

focus- airway, vitals, mental status, emotional support, pain control

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52
Q

Malignant Hyperthermia

disorder
causes
early signs
LT

A

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

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53
Q

treatment of malignant hyperthermia

others

muscle relaxant

A

Treatment: oxygen, cooled iv fluids, cooling interventions

Oxygen, IV, Medication, cooling interventions

Dantrolene- Muscle relaxant

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54
Q

Once patient is stable

transfer where
ga
vs
htta
l
p
n
d
f
d
d

A

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

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55
Q

Nausea, Uncontrolled pain

how assess

pain meds (moderate/severe)

nursing care post op complications

A

assess w/ numerical scale

pain meds-
nsaids- moderate
opiods- severe

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56
Q

Bowel Sounds & Diet

diet advancement

how know if ready for diet

nursing care post op complications

A

clear liquids->full liquid-> soft diet -> regular diet

know if ready with bowel sounds, n/v

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57
Q

Wound healing

diet

purpose of drains

3 prorities with drain management

nursing care post op complications

A

diet-> protein, dairy, vit c

purpose- receive pressure by removing excess fluid

prorities -> cleaning around, replacing absorbent dressing, monitor discharge/drainage

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58
Q

serous

sangionous

purulent

A

Serous- clear yellow

sanginous- thick red

purulent- wbc,debris from infection

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59
Q

types of drains

what to monitor for

A

Jackson pratt- grenade suction out fluid

hemovac- suction out fluid

Penrose-rubber drain

montitor I and o and consistency

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60
Q

dehiscence

what is it

what nurse do about it

how treat

A

what is it- separation in layers of incision and wound

what nurse do-make sure iv works, go npo. get vitals

how treat- surgery

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61
Q

evisceration

what is it

how treat

will need

A

what is it- protrusion of organ from body

how trat - cover wound with sterile dressing moistened with normal saline

will need emergency surgery

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62
Q

Dressings

what is normal
compare
if leaking//dont
who does first change

nursing care post op complications

A

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

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63
Q

hemorrhage s/s
r
a
tacky
cool
decreased
leads to

A

resltess
anxiety
tachycardia
cool pale skin
decreased urine output

leads to shock

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64
Q

shock s/s

severe
altered
c
r
tacky
tacky
weak
hypo

A

severe vomiting

altered loc

confusrion

restlessness

tachycardia

tachypnea

weak pulses

hypotension

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65
Q

Hemorrhage/Shock

nursing interventions
stopping
lines
ultimately need what

nursing care post op complications

A

stopping bleeding-pressure is applied with moist dressing or gloved hands

iv lines w/ isotonic fluids

emergency surgery

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66
Q

DVT/PE 
treatments

nursing care post op complications

A

scd,

ambulating early

-give subq, enoxaparin, can cause bruising

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67
Q

pneumonia, Atelectasis

most at risk
assess
interventions
education

nursing care post op complications

A

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

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68
Q

Urinary retention/Altered Bowel Habits

provide
assist
stand
what stimulates
increase
passing

nursing care post op complications

A

provide privacy,

assist to bathroom-ambulation early and often

stand to void

warm water to stimulate

increase fluids and fiber

passing flatus

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69
Q

3 phases of wound healing

A

inflammatory

proliferative

remodeling

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70
Q

Assessing the musculoskeletal system

how many bones
in addition to bones
considerations
interview
physical assessment

A

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

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71
Q

Arthrocentesis

why done

what happens

A

done to obtain synovial fluid from joint for diagnosis or to remove excess fluid-

needle is inserted and fluid is aspirated out

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72
Q

Arthroscopy

A

endoscope procedure to look at the interior structure of the joint and can be used to fix or repair tendons or muscles

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73
Q

Bone Density (Dexa Scan):

A

overall strength of bone, done in osteoporosis

74
Q

Bone Scan:

what injected

uptake

what is present

A

radioisotope medication injected

uptake is increased within bone tissue if

osteomyelitis, porous or bone cancer is present

75
Q

Skeletal X ray:

A

identify structure and density of bone

76
Q

CT/MRI:

A

3d picture of bone, trauma, abnormalities, tumors, cysts, herniated disks, assess allergies or metal implants

77
Q

Ultrasound:

A

imagines withing muscles tendons and ligaments

78
Q

c reactive protein

Blood Tests:

A

indicates a non specific inflammatory response

79
Q

Alkaline phosphatase (ALP),

blood tests

A

diagnosis of liver and bone disease

80
Q

Rheumatoid factor

blood tests

A

assist in diagnosing rheumatoid arthritis

81
Q

Changes with Aging musculoskeletal

decreased
increases
posture
degen
decreasd
muscle
slowed

A

Decreased bone density

Increased bone prominence

Kyphotic posture

Cartilage degeneration

Decreased ROM

Muscle atrophy

Slowed movement

82
Q

Contusion

goal

Musculoskeletal trauma

A

bleeding in soft tissue, skin is intact and large amount of bleeding which lead to hematoma

goal-RICE Rest, Ice, compression, elevation

83
Q

Strain

goal
Musculoskeletal trauma

A

stretching injury to muscle or muscle tendon, forced to extend

Goal of any of the above:
RICE Rest, Ice, compression, elevation

84
Q

Sprain 

goal

Musculoskeletal trauma

A

stretching or tear of ligament surrounding joint

Goal of any of the above:
RICE Rest, Ice, compression, elevation

85
Q

Joint Trauma

A

Rotator Cuff Injuries

Knee Injuries

Dislocation

86
Q

Joint trauma

treatment

priority

A

Treatment: Reduction of joint, surgery, RICE therapy

Priority: rehab, pain, appropriate use of injured area

87
Q

Carpal Tunnel

what is it

when occurs

A

Canal through which flexor tendons and median nerve pass from the wrist to hand

occurs when canal is narrowed and irritation of the nerve

88
Q

manifestations of carpal tunnel

A

Nighttime pain

Numbness, tingling of thumb, index finger

89
Q

diagnosis / treatment of carpal tunnel

A

Diagnosis history/physical, presentation of manifestations

Treatment: surgery, physical therapy, pain control and corticosteroids

90
Q

fractures

what are they

open vs closed

A

Break in continuity of bone

Open Vs Closed-

skin intact in closed,

skin open is open

91
Q

Manifestations: of fractures

A

Deformity,

pain,

swelling,

numbness,

guarding spasms

92
Q

Compartment Syndrome

what is
educate with
check

complications of fractures

A

Increased pressure within confined space constricts structures within –

educate with casts for numbness and tingling or cold extremities

check cms

93
Q

Infection

check what

administer what

complications of fractures

A

–temp

if need antibiotics,

94
Q

DVT –
treat with what
make sure

complications of fractures

A

anticoagulant,

make sure no numbness tingling or pain

95
Q

delayed what

complications of fractures

A

Delayed bone healing

96
Q

fracture treatments

tractions

A

Pulling/straitening force to return or maintain bone function

97
Q

Traction Care

pins
cms
skin
ropes and pulleys
weights

fracture treatments

A

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

98
Q

Cast
and
nursing care(checks, inspection education)

Fracture Treatments

A

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

99
Q

cast pt education

nothing
report
keep
do what

A

Nothing inside the cast ever

report Sensation/pain changes /cool skin

Keep cast clean + dry

elevate extremity and rom

100
Q

casted extremity

meds

A

Pain meds (NSAIDs /Analgesics)

  • Anticoagulants (decrease risk of DvT)
101
Q

Amputations

what is

caused by

A

Partial or total removal of an extremity

Caused by trauma or chronic issues, delayed healing

102
Q

complications of amputations

A

Infection

Delayed healing

Phantom pain;

Contractures:

103
Q

phantom pain
pain meds control

A

Narcotics,

gabapentin ()

, pregabalin ()

104
Q

Contractures: extend/perform

lay

elevation

A

Extend the joint and perform exercises,

lay prone throughout day increases blood flow to muscles and prevents contractures.

Elevation promotes venous return

105
Q

osteoporosis

What is it?
loss of
leads to
increase risk

A

porous bones,

loss of bone mass,

leads to fragile bones

increase risk of fractures

106
Q

Risk factors osteoperosis

non modifiable

advanced
history
F___
frame

A

advanced age,

family history,

female,

thin small frame

107
Q

Modifiable osteoperosis

low what
deficiency
use
i____
use

A

low estrogen or testosterone,

dietary deficiency of calium or vit d,

use of corticosteroids

, inactivity,

smoking or alchohol use

108
Q

manifestations of osteoporosis

A

loss of height,

curvature of spine,

low back pain,

fractures

109
Q

Diagnosis: osteoporosis

A

Bone density (DEXA Scan)

lumbar spine and hip

110
Q

Osteoporosis Treatment -does what

med
common

A

used to preserve bone mass and increase bone density

-Bisphosphonates current drug of choice for preventing & treating

Common —alendronate, zoledronic acid

111
Q

Other Medications

osteoperosis

et

ca

A

estrogen therapy-raloxifene & tamiofloxen

calcitonin- hormone that increases bone formation

112
Q

diet and lifestyle osteoperosis

diet-intake
high calcium foods
encourage
discourage

A

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

113
Q

osteoporosis

pt teaching

intake
regular
asssitve
good
fall prevention

A

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

114
Q

osteoarthritis
characterized by

A

progressive loss of joints, cartilage,

joint inflammation,

stiffness / loss of joint motion

115
Q

osteoarthtis

nursing assessment

A

pain,

ROM/mobility,

muscle strength,

crepitus,

color

, weight

-CMS!

116
Q

Osteoarthritis

what is it
leading to

A

Degenerative joint disease

leading to cause of pain and disability in older adults

117
Q

Osteoarthritis

risk factors

A

Age,

genetics,

excessive weight,

inactivity (Too little),

repetitive joint use (Too Much)

118
Q

Osteoarthritis

goal
modifable
non modifiable

A

Goal: Moderation

Modifiable- lose wight,

non modifiable – age, previous joint damage and genetics

119
Q

manifestations

pain/rele;eived

diagnosis

of osteoarthritis

A

Pain and joint stiffness; deep ache

pain with use of joint, relieved with rest

Diagnosis H&P, X rays, MRI

120
Q

osteoarthritis meds

A

NSAIDS,

Tylenol

topical treatments

hyluronic acid

, cortisone injections,

opioids

121
Q

other Treatments osteoarthritis

A

ROM,

heat/ice,

balance between exercise & rest

Assistive device,

weight loss

Rehab//therapy

122
Q

osteoarthtis

diet

0
supplements

A

-0 night shade foods: potatoes, tomatoes, peppers, eggplant

  • supplements: boron, zinc, copper, glucosamine
123
Q

Surgery osteoarthritis

A

Joint arthroplasty,

joint replacement

124
Q

pre op care

___ assessment
__prior
education
__hygiene
__control
__prep
pre op __

total joint replacement

A

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

125
Q

Post operative
total joint replacement

nuerovascualr
checks
&
management
therapy
IS
safety
use

A

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

126
Q

Activity Post Joint Replacement

CPM-helps with what

sequential

A

Continuous Passive Range of Motion

Helps maintain range of motion-done leave on continuously

Sequential Compression Devices –prevention of dvt

127
Q

Activity Post Joint Replacement

Prophylactic Medication

A

NSAIDs,

aspirin,

Enoxaparin SQ (),

Heparin SQ

128
Q

Activity Post Joint Replacement

assistive devices

A

Handrails, grab bars, shower chair, shoehorns, tongs/grippers

Walker/Cane use: Move device & affected extremity first, followed by strong

129
Q

maintain prescribed
using

WB vs NWB

Positioning Post Joint Replacement

A

Maintain prescribed position of affected,

using splint, immobilizer, abduction pillow

Weight bearing vs non weight bearing- need to know activity

130
Q

total hip

prevent what
use what
no what
proper use-leading w

A

Prevent flexion or adduction of affected leg

Toilet seat risers, abduction pillow

No bending

Proper walker use-leading with affected leg

131
Q

Total Knee

utilize what

exercises

A

Utilize continuous passive range of motion (CPM)

ROM exercises

132
Q

GOUT

metabolic disorder->

caused from

A

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

133
Q

risk factors of gout

A

male,

age,

hypertension,

obesity,

CKD,

DM 2

134
Q

Acute manifestations gout

where is it
what feels like
what does to body

A

in joints of great toe, ankle, knee, wrist

Pain, red, hot, swollen, tender

Fever, chills, elevated WBC

135
Q

advanced gout manifestations

tophi

stiff
limited

A

Tophi- urate deposits in tissues

Joint stiffness,

limited ROM

136
Q

gout diagnosis

A

Presentation of symptoms

Diagnosed with Serum uric acid-best to diagnose, if above 8.5

137
Q

gout meds
and

prophylactic treatment

A

NSAIDS, colchicine, corticosteroids

Prophylactic treatment Allopurinol

138
Q

Complementary/alternative treatments gout

A

vitamin e,

amino acids,

acuputcure

, diet of dark berries

139
Q

Rheumatoid Arthritis

what is

A

Chronic Systemic Autoimmune Disorder

inflammation of connective tissue in joints

140
Q

manifestations of Rheumatoid Arthritis

characterized by

A

Inflammation, fatigue, nonspecific joint aches and stiffness

characterices by remissions and exacerbations

141
Q

Rheumatoid Arthritis diagnosis

what’s elevated
what is used

A

C-Reactive proteins and Sedimentation rate- elevated due to inflammation

Synovial fluid analysis, X ray

142
Q

Rheumatoid Arthritis meds

nsaids
corciosteroids teaching
DMARDS

A

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

143
Q

Rheumatoid Arthritis treatments

rest/exercise ( balanced, see who, regular, training and exercises)
heat/cold( heat, take for, finding what)
assistive devices
nutrition
surgery

A

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

144
Q

Systemic Lupus Erythematosus

chronic
cell/tissue damage

A

Chronic inflammatory disease affecting all body systems

Cell and tissue damage caused by antibody deposits in connective tissue

145
Q

Systemic Lupus Erythematosus

meds/ treatments
__ care
pain management->
agents
topical
avoid

A

Supportive Care

Pain management  nsaids,

Immunosuppressive agents

Topical corticosteroids

Avoid Exposure to ultraviolet rays-flare ups

146
Q

Systemic Lupus Erythematosus

manifestations

A

Painful, swollen joints and muscles pain

Unexplained fever

Red “butterfly” rash on face

Sensitivity to sun

Enlarged lymph nodes

147
Q

Systemic Lupus Erythematosus

diagnosis

A

Antibody Testing,

Sed Rate elevated

148
Q

Systemic Lupus Erythematosus

warning signs of a disease flare

A

Increased fatigue

Pain

Rash

Headache

Fever

Dizziness

149
Q

manifestations Lyme disease

A

bullseye lesion,

can mimic arthritis

Flu like symptoms

Rash, fatigue, chills

150
Q

Treatment of Lyme

A

antibiotic therapy

nsaids,

supportive care

151
Q

Lyme disease
What is it?
patho

A

inflammatory disease that is transmitted by tick

Patho body is infected at site of tick bite 30 days migration period

152
Q

complications of Lyme disease

A

Chronic recurrent arthritic issues

Neurological issues

153
Q

Scleroderma
what is
characterized by

A

Hardening of skin;

chronic issue characterized by deposits of excess collagen in skin and organs

154
Q

scleroderma charcertic

A

shiny

taunt

hyperpigmented skin

155
Q

meds and treatment scleroderma

treatment
agents
therapy

A

Symptomatic treatment

Immunosuppressive agents, corticosteroids

Therapy to support affecting tissues

156
Q

fibromyalgia

chronic syndrome characterized by

patho

A

CSCB–>pain, stiffness, tenderness

Patho complex syndrome involving CNS, autoimmune and endocrine system

157
Q

manifestations

diagnosis of fibromyalgia

A

onset of chronic, achy pain

H&P, presentation of symptoms

158
Q

Fibromyalgia meds

A

Tricyclic antidepressants

SSRI

Cymbalta and Savella

Lyrica

Tramadol or NSAIDs

159
Q

Fibromyalgia

daily actvities

A

Aerobic exercise/stretching

Daily rest is key!

Medications

160
Q

Foot Disorders -what is

A

Disorders that cause pain or difficulty walking

161
Q

Manifestations foot disorders

A

Deformity,

pain,

inflammation

Morton’s Neuroma- pain is burning in nature

162
Q

examples with foot disorders

A

Bunion:

Hammertoe:

Morton’s Neuroma:

Plantar fasciitis

163
Q

canes

hold where

move what first

A

hold cane on strong side

move affected leg first first

164
Q

walkers

when full suppport

when one leg is better

A

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

165
Q

crutches stairs

up

down

A

up-> good- unaffected leg goes onto step first

down-> bad-> affected leg goes onto step first

166
Q

below knee amputation

assessment

p
s
lab
wound
temp how often

A

pain

skin

wbc

wound-redness/edems

temp every 4-8 hrs

167
Q

below knee amputation

interventions

change
administer
wash
mass
expose
change

A

-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
168
Q

below knee amputation

diet

A

protein

vitamin c

dairy

169
Q

below knee amputation

meds

meds
hz antagonist
ss

A

resume meds

  • hz antagonist /PPi > decreased peptic ulcer formation
  • Stool softener
170
Q

below knee amputation

lifestyle mods

p
therapy
care
grab
handhels
chair

A

prosthetic

  • PT /OT
  • Home care
  • grab bars
  • handheld shower heads
  • Shower chair
171
Q

below knee amputation

pt teaching
appropriatly
stump
pos
resume

A

wrap stump appropriately

  • stump exercises
  • positioning of stump
  • resume physical activity asap
172
Q

abdominal surgery

assessment

A

rr/vs

emotional status

loc

pain

dressing

n/v

comfort

skin integrity/colot/temp

sensory/motor function

173
Q

abdominal surgery

interventions

pain
drain
dressing
am

A

pain meds

drain cleaning/empy

dressing change

ambulate

174
Q

abdominal surgery

meds

A

nsaids(caution over 65)

opids

pca/pcea

175
Q

abdominal surgery

diet progression

A

clear liquid ->

full liquid->

soft->

regular

176
Q

abdominal surgery

teaching

s/s
care
control
meds
activity

A

s/s of infection

wound care

control pain

meds as ordered/prn

physical activity limitations

177
Q

Total hip/total knee

assessment

vs q
checks
incisional
p
s/s

A

vital signs q 4 hrs

neuron checks-> cms

incisional bleeding

pain

s/s of dislocation

178
Q

Total hip/total knee

interventions

reinforce
maintain
record
proper
is
therapy
early
wear

A

reinforce dressing

maintain iv

record I and o

proper position >90 degrees

Incective spirometer//CDB

PT/OT

early ambulation

SCD/Stockings

179
Q

Total hip/total knee

diet

A

increase fluids

inc fiber

protein vitamin c dairy

180
Q

Total hip/total knee

meds

A

nsaids/opiods

anticoagulants

181
Q

Total hip/total knee

lifestyle modifications

whatin shower
what in toiler
asssitive
what kind of socks
what around house

A

shower chair

toilet risers

assistive devices-walker/cane

grippers

handrails

182
Q

Total hip/total knee

pt teaching

s/s
daily
whattype of meds
ss of
what tyoe of socks
I+e

A

s/s infection

exercise daily

anticoagulants

s/s of dvt/pe

compressions

ice + elevation

d-health promotion(former alteration) (10 decks)

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