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PN2 > Final > Flashcards

Final Flashcards

1
Q

5 Ps - circulation assessment ? What to asses?

A 
Pain 
Pulse 
Pallor - white color?
Parenthesia- can you feel this?
Patslysis- can you move this?
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2
Q

This is when you pull a muscle

A

Strain

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3
Q

This is when you damage a ligament?

A

Sprain

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4
Q

This is when a few fibers of the ligament muscle are torn and loss of function is mild?

A

First degree

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5
Q

About half of fibers of the ligament muscle is torn and loss of function is moderate to severe

A

Second degree

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6
Q

All or most of the fibers/ ligament muscle are torn and loss of function is severe

A

Third degree

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7
Q

What does RICE mean when talking about strains and sprains ?

A

Rest
Ice
compression
Elevation

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8
Q

Nursing interventions for fractures?

A

Splint before transferring

Elevate

Circulation checks

Maintain immobilization and prevent complications of immobilization

Casts/skin care

Look for Infections

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9
Q

Risk factors for fractures? (What can cause it)

A 
Trauma and 
Pathological- osteoporosis 
-multiple myeloma 
-osteogenic sarcoma 
- metabolic diseases
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10
Q

What can result after a fracture?

A

Immobilization
FX (fracture) reduction

Cast 
Traction-
Skin 
Skeletal 
ORIF
External fixation
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11
Q

If immobilized after fracture, what complications can occur?

Common sites?

A

Delayed or non union

Angulation

Infection

Acute compartments syndrome (ACS)

Common sites: lower legs and forearm

Venous stasis

Thrombus

Fat embolism

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12
Q

How to diagnose fractures?

A

X-rays

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13
Q

What symptoms will one have after a fracture?

A 
Pain
Edema
Deformity
Function decrease 
False movement 
Crepitation (loss of bone)
Sensation decrease
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14
Q

Types of fractures ?

A 
Avulsions - tip of bone 
Overriding - diminishing 
Comminuted- half shattered 
Oblique- slit in half 
Transverse-cute straight down 
Green stick- curve down
Spiral- twisted
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15
Q

Types of fraction with location?

A

Distal/middle/proximal -(top of leg)

Simple/complex/episyphical

Stable vs unstable

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16
Q

What to watch for with post op hip fractures?

A

Severe pain

Inability to move leg

Shortening and external rotation of the leg

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17
Q

Complications of post of hip fractures ?

A

DVT
Neurovascular complications (bleeding , swelling)
Pulmonary complications (atelectasis)
Skin breakdown (pressure ulcers )
Urinary retention
Delayed complications (infection nonunion)

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18
Q

Nursing care for post op hip fracture patients ?

A

Cough/deep breath a 2 hrs

Compression stockings to lower DVT

Turn q2h maintain leg abduction

Circulation and neurological status checks of affected leg

Pain control

Mobilize ASAP

Check under client for drainage

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19
Q

stump care after wound has healed — what to do ?

A

Asses for skin breakdown

Wash, rinse and dry stump daily

Alcohol, lotion

Encourage client to wear prosthesis when he gets up and all day to prevent stump swelling

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20
Q

Stump wound care and instructions to patient

A

Elevate stump first 24-48 hrs

Prevent contractions of joints

Discuss phantom pain

Analgesics

Evaluate healing

Compression dressing

Discourage semi Fowler’s position in client with above the knee amputation to prevent contractures of the hip

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21
Q

Clients with amputations - nursing implications…

A

Prevent further loss of circulation to extremity.

Promote comsoat?

Promote optimum and level of mobility

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22
Q

Osteoporosis risk factors (what leads to it?

ACCESS

A 
Alcohol use 
Corticosteroid use 
Calcium low
Estrogen low
Smoking 
Sedentary lifestyle
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23
Q

Osteoporosis occurs most commonly after what in women? Why?

A

Metapause - decrease in estrogen

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24
Q

Generalized progressive Reduction of bone density, causing weakness of skeletal strength

A

Osteoporosis

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25
Q

Who Are at highest risk for osteoporosis

A

Slender, female, cookies and, alcohol users, smokers and steroid users are at higher risk

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26
Q

What fractures are most common with osteoporosis?

A

Crush factors- especially at T-8 and below hip and Colles fractures are most common

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27
Q

Two types of spinal deformities due to osteoporosis

A

Dorsal kyphosis - hunch back

Cervical lordosis - arched back and butt out

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28
Q

What to treat first with hip fractures?

A

Pain

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29
Q

Degenerative changes seen in OA include what?

A

Bone spurs at the edge Of articular surfaces

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30
Q

Clinical manifestations of OA include?

A

Pain, stiffness, crepitus, and functional impairment

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31
Q

What is OA ?

A

A chronic degenerative disease

that usually picks in the young, old, 60s or so

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32
Q

Risk factors of OA

A 
Obesity 
Female 
Joint injury hx 
Genes
Old age
Occupations
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33
Q

Common pharmacologic therapy for the management of OA includes the use of?

A

NSAIDs

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34
Q

Nonpharmacologic therapy for the management of osteoarthritis may include?

A

Low impact exercise, weight reduction, massage of affected joints

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35
Q

When undergoing me replacement surgery a patient will require careful nursing attention due to the increased risk of what?

A

Thrombosis formation

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36
Q

Physical therapy is an important component of the care of the patient who has just undergone a knee replacement. which of the following would be most important for this type of patient’s recovery?

A

Flexion

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37
Q

Discharge planning for the patient fine joint replacement is likely to include instructions on what?

A

Anticoagulant medication

38
Q

If pain level is high, you are unable to rotate your wrist, and the area is reddish purple and swollen is this most likely a fracture or a sprain ?

A

Fracture

39
Q

Important things to know about newly applied plaster cast?

A

Don’t place objects inside , reposition, keep dry

40
Q

Nursing interventions to prevent skin irritation?

A

Cover edges, don’t put anything down cast

41
Q

What to asses after application of cast?

A

Check for redness, swelling, infection, color , movement , sensation

42
Q

What equipment is used for cast removal ?

A

Oscillating cast saw

43
Q

If a pt is freaked out about cutting off a cast.. what can we do as a nurse to calm them down?

A

Tell them It only cuts cast, not painful

44
Q

You should still assess limbs the same with plaster and synthetic casts, What advantages are there to a synthetic cast over a plaster cast?

A

Light weight , last longer

45
Q

What is done to a fractured femur with bucks traction ?

A

Limb wrapped, placed in boot, weights

46
Q

What is Balanced suspension traction for a fractures femur ?

A

Sling that supports the limb, pulls limb up and out

47
Q

What is important to remember about weights applied with traction?

A

Do not change the amount of weight without an order, avoid bumping the weights, make sure the weights hang free.

48
Q

Describe pin care?

A

Keep area dry and clean
Cleanse site with gauze pad and sterile solution
New gauze pad for each pin
Remove any crust and drainage from site
Notify dr if any redness swelling, pus, pain, or looseness of pin or if fever of 101.5 or higher

Page 934

49
Q

Color motion sensation is helpful when you suspect what?

A

Fracture

50
Q

Nursing diagnosis of hip fracture consists of what?

A

Acute pain

Risk for infection

Impaired mobility

Impaired sensory perception

51
Q

Safety and hip fractures -

Joint replacement: puts bones back together with plates and screws?

Avoid doing what to joint ?

Maintain what?

A

ORIF- open reduction internal fixation

Displacing

Alignment

52
Q

Positioning :

Patients should not do 4 things?

Patients should keep hips ________? And may need this between legs ? Why?

Keep ankles_____?

A

Bend at waist, tie shoes , pick stuff off floor, and cross legs

Abducted

Abductor pillow - to prevent injury

Ankles separated.

53
Q

Weight bearing :

Patients with joint replacement often have _____ weight bearing ability

What patients have limited weight bearing ?

What helps prevent dangers of immobility ?

A

Full

Pins, screws or rods

Activity, gait bets and looking at dr orders

54
Q

What are some health dangers of low mobility?

A

Blood clots , weakening muscles

55
Q

People with joint replacements/pins,screws or rods - before getting them up make sure they are what??

A

Stable

56
Q

What is important to keep joint in place?

A

Strengthening

57
Q

This may be done to injury where knee is damaged, but this not as common as what?

A

Knee replacement

-hip fracture

58
Q

Knee replacement is inflammation Often done because of what health problem ?

A

Osteoarthritis

59
Q

What are the basic post surgical cares for knee replacement ?

A

*ROM

Up and ambulatory

Ice (reduce swelling and increase blood flow) -20 min on and 20 off

Monitor for blood clots

60
Q

What to increase before one is mobile after surgery such as knee replacement?

A

Strength

61
Q

Nursing care for patients with internal fixation devices?

A

Neurovascular assessment (treat pain)

Know when to asses pain and what to do

Suture and staple care

Hemovac- blood loss. Know what labs to watch for?

Hazards of immobility

62
Q

What to watch for with -hazards of immobility with internal fixation devices ?

A 
Watch lungs
Heart 
Legs
Bowles 
Blood clots 
Labs for infection
63
Q

Causes or reasons for amputations ?

A
  • PVD (peripheral vascular disease)
  • Trauma to limb (if beyond repair)
  • Infections (such as diabetes/wounds that don’t heal)
  • Tumors
64
Q

When or what situation would be the correct time to amputate a limb?

A

The patients last resort - after trying everything else. Life saving measure

65
Q

What to teach patients after amputation?

Do this so it is able to fit into Prosthesis ?

Position stump to prevent what?

Circulation to promote ?

Phantom limb pain?

Physical activities

Referrals

What to watch for after amputation?

Use this with caution?

A

Wrap stump

Contractors and swelling

Healing

Pain that is not really there in amputated limb that can be treated with meds

PT/OT

Such as other therapy ?

Watch for infection

Ice, caffeine

66
Q

Emotional issues that clients deal with after amputation?

BSI

A

Body image

Self concept

Independence

67
Q

When is a good time to start teaching amputation client about prosthesis ?

A

Don’t start teaching until they can look at amputation/ prosthesis (when they are ready)

68
Q

What are some reasons amputation may be done ?

A

Necrosis (death of cells in body) severe injury, cancerous tumor of bone or muscle (malignancy), neuroma (tumor of nerve muscle), frostbite,Infections, poor circulation

69
Q

What is the rational for performing an amputation over a lesser procedure?

A

When I will improve the longevity or comfort of malignancy

Life saving measure

Nothing else will work

70
Q

What does BKA and AEA mean when talking about amputations?

A

Below knee amputation, above elbow amputation

71
Q

Following an amputation surgery your patient has a rigid tight dressing in place, in fact it is almost looks like a small football helmet over the limb. What is the reason for this type of dressing?

A

Protect the limb, it controls Adema, it minimizes pain, it allows healing

72
Q

Wrapping the stump becomes part of the healing process. What is the reason for this?

A

Reduce edema (keeps it shaped) and will help fit into the prosthesis later

73
Q

How should the stump be wrapped?

A

Wrap it so it forms a cone shape

74
Q

What is gangrene and how might you know your patient has it?

A

It’s an infection that usually grows usually where the circulation is bad.

You will see skin breakdown discolored tissue, red to purple black necrotic. Fever, sepsis, swelling, pain May have discharge.

75
Q

What does IVD stand for and what are the typical symptoms your patient might complain?

A

Intervertebral disc disease,

pain in the back, muscle spasms depressed deep tendon reflexes and neurological function

76
Q

When a person has surgery on her spine, why is especially important to provide careful wound care, don’t we always want to provide good wound care?

A

To avoid infection, especially meningitis do to close proximity to the Coy’s

77
Q

Following spinal surgery how will you reposition your patient in bed?

A

Log roll-use A turning sheet until the doctor allows the patient to be up

78
Q

If you have a patient with osteoporosis what wrist does this bring to their life?

A

Pain, compression fractures, kyphosis ,loss of height

79
Q

Other than calcium, vitamin D and bisphosphonate’s , What can a person do to fight osteoporosis?

A

Weight-bearing activities

80
Q

Patients with Osteoporosis is prone to injury, a common injury is called compression fracture, what is that?

A

Usually from a fallStriking the butt and causing pressure of the spine

The compression causes SM fractures with in the vertebral body

81
Q

If a patient with us to Osteoporosis they are at risk for fracture. If you are the nurse caring for a patient who fell and is complaining of hip pain, what might you see if they have suffered a hip fracture?

A

Pain in the hip, Groin and knees. Shortening of affected extremely External rotation, pain worse with movement, bruising, maybe about to break weight?

82
Q

Hip dislocation after surgery for hip replacement is a real concern. What are the “Nevers” you should teach your patient in order to prevent this?

A

Never cross legs , never bend more than 90 degrees, never bend at hip, never allow inward rotate

83
Q

What are the symptoms of a bone tumor? (Sarcomas)

A

Aching, decreased movement, pathological fractures

84
Q

What are common treatments of bone cancer?

A

Radiation, removal, chemo

85
Q

If giving a NSAID what is the most common nursing consideration to be aware of?

A

Can cause stomach problems, give with food

86
Q

If a patient is given immunosuppressive such is methotrexate or so cytoxin to treat RA —what are some important things to watch for a new patient?

A

Signs of infection, decreased wbc , Decreased platelets, pulmonary Edema

87
Q

What is important to teach a patient when they are taking medication such as fosamax and boniva for osteoporosis?

A

Take with full glass of water

Do not lay down for 30 minutes after taking

88
Q 
Traumatic injuries (catastrophic) such as head or spinal injuries or accidental injuries or homicide disease 
in general effect what population more so?
A

Younger population 18-24 age

But older people are more prone to falls hip fractures which can lead to complications

89
Q

What are the risk factors for acute injuries and impaired mobility?

A

Lifestyle choices, extreme physical activity and risk-taking behaviors

90
Q

Short-term changes in mobility may be related to what type of injuries?

A

Musca skeletal injuries such as sprains, strains and simple fracture’s due to sports or other physical activity

91
Q

Clinical judgment includes a multidisciplinary team approach to help one with what? to permanent changes in functional ability?

A

Coping and adjusting

92
Q

What causes temporary or permanent changes in mobility ?

A

Acute illness, infections, traumatic injuries

PN2 (10 decks)

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