Final Flashcards
5 Ps - circulation assessment ? What to asses?
Pain Pulse Pallor - white color? Parenthesia- can you feel this? Patslysis- can you move this?
This is when you pull a muscle
Strain
This is when you damage a ligament?
Sprain
This is when a few fibers of the ligament muscle are torn and loss of function is mild?
First degree
About half of fibers of the ligament muscle is torn and loss of function is moderate to severe
Second degree
All or most of the fibers/ ligament muscle are torn and loss of function is severe
Third degree
What does RICE mean when talking about strains and sprains ?
Rest
Ice
compression
Elevation
Nursing interventions for fractures?
Splint before transferring
Elevate
Circulation checks
Maintain immobilization and prevent complications of immobilization
Casts/skin care
Look for Infections
Risk factors for fractures? (What can cause it)
Trauma and Pathological- osteoporosis -multiple myeloma -osteogenic sarcoma - metabolic diseases
What can result after a fracture?
Immobilization
FX (fracture) reduction
Cast Traction- Skin Skeletal ORIF External fixation
If immobilized after fracture, what complications can occur?
Common sites?
Delayed or non union
Angulation
Infection
Acute compartments syndrome (ACS)
Common sites: lower legs and forearm
Venous stasis
Thrombus
Fat embolism
How to diagnose fractures?
X-rays
What symptoms will one have after a fracture?
Pain Edema Deformity Function decrease False movement Crepitation (loss of bone) Sensation decrease
Types of fractures ?
Avulsions - tip of bone Overriding - diminishing Comminuted- half shattered Oblique- slit in half Transverse-cute straight down Green stick- curve down Spiral- twisted
Types of fraction with location?
Distal/middle/proximal -(top of leg)
Simple/complex/episyphical
Stable vs unstable
What to watch for with post op hip fractures?
Severe pain
Inability to move leg
Shortening and external rotation of the leg
Complications of post of hip fractures ?
DVT
Neurovascular complications (bleeding , swelling)
Pulmonary complications (atelectasis)
Skin breakdown (pressure ulcers )
Urinary retention
Delayed complications (infection nonunion)
Nursing care for post op hip fracture patients ?
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
stump care after wound has healed — what to do ?
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
Stump wound care and instructions to patient
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
Clients with amputations - nursing implications…
Prevent further loss of circulation to extremity.
Promote comsoat?
Promote optimum and level of mobility
Osteoporosis risk factors (what leads to it?
ACCESS
Alcohol use Corticosteroid use Calcium low Estrogen low Smoking Sedentary lifestyle
Osteoporosis occurs most commonly after what in women? Why?
Metapause - decrease in estrogen
Generalized progressive Reduction of bone density, causing weakness of skeletal strength
Osteoporosis
Who Are at highest risk for osteoporosis
Slender, female, cookies and, alcohol users, smokers and steroid users are at higher risk
What fractures are most common with osteoporosis?
Crush factors- especially at T-8 and below hip and Colles fractures are most common
Two types of spinal deformities due to osteoporosis
Dorsal kyphosis - hunch back
Cervical lordosis - arched back and butt out
What to treat first with hip fractures?
Pain
Degenerative changes seen in OA include what?
Bone spurs at the edge Of articular surfaces
Clinical manifestations of OA include?
Pain, stiffness, crepitus, and functional impairment
What is OA ?
A chronic degenerative disease
that usually picks in the young, old, 60s or so
Risk factors of OA
Obesity Female Joint injury hx Genes Old age Occupations
Common pharmacologic therapy for the management of OA includes the use of?
NSAIDs
Nonpharmacologic therapy for the management of osteoarthritis may include?
Low impact exercise, weight reduction, massage of affected joints
When undergoing me replacement surgery a patient will require careful nursing attention due to the increased risk of what?
Thrombosis formation
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?
Flexion
Discharge planning for the patient fine joint replacement is likely to include instructions on what?
Anticoagulant medication
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 ?
Fracture
Important things to know about newly applied plaster cast?
Don’t place objects inside , reposition, keep dry
Nursing interventions to prevent skin irritation?
Cover edges, don’t put anything down cast
What to asses after application of cast?
Check for redness, swelling, infection, color , movement , sensation
What equipment is used for cast removal ?
Oscillating cast saw
If a pt is freaked out about cutting off a cast.. what can we do as a nurse to calm them down?
Tell them It only cuts cast, not painful
You should still assess limbs the same with plaster and synthetic casts, What advantages are there to a synthetic cast over a plaster cast?
Light weight , last longer
What is done to a fractured femur with bucks traction ?
Limb wrapped, placed in boot, weights
What is Balanced suspension traction for a fractures femur ?
Sling that supports the limb, pulls limb up and out
What is important to remember about weights applied with traction?
Do not change the amount of weight without an order, avoid bumping the weights, make sure the weights hang free.
Describe pin care?
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
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Color motion sensation is helpful when you suspect what?
Fracture
Nursing diagnosis of hip fracture consists of what?
Acute pain
Risk for infection
Impaired mobility
Impaired sensory perception
Safety and hip fractures -
Joint replacement: puts bones back together with plates and screws?
Avoid doing what to joint ?
Maintain what?
ORIF- open reduction internal fixation
Displacing
Alignment
Positioning :
Patients should not do 4 things?
Patients should keep hips ________? And may need this between legs ? Why?
Keep ankles_____?
Bend at waist, tie shoes , pick stuff off floor, and cross legs
Abducted
Abductor pillow - to prevent injury
Ankles separated.
Weight bearing :
Patients with joint replacement often have _____ weight bearing ability
What patients have limited weight bearing ?
What helps prevent dangers of immobility ?
Full
Pins, screws or rods
Activity, gait bets and looking at dr orders
What are some health dangers of low mobility?
Blood clots , weakening muscles
People with joint replacements/pins,screws or rods - before getting them up make sure they are what??
Stable
What is important to keep joint in place?
Strengthening
This may be done to injury where knee is damaged, but this not as common as what?
Knee replacement
-hip fracture
Knee replacement is inflammation Often done because of what health problem ?
Osteoarthritis
What are the basic post surgical cares for knee replacement ?
*ROM
Up and ambulatory
Ice (reduce swelling and increase blood flow) -20 min on and 20 off
Monitor for blood clots
What to increase before one is mobile after surgery such as knee replacement?
Strength
Nursing care for patients with internal fixation devices?
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
What to watch for with -hazards of immobility with internal fixation devices ?
Watch lungs Heart Legs Bowles Blood clots Labs for infection
Causes or reasons for amputations ?
- PVD (peripheral vascular disease)
- Trauma to limb (if beyond repair)
- Infections (such as diabetes/wounds that don’t heal)
- Tumors
When or what situation would be the correct time to amputate a limb?
The patients last resort - after trying everything else. Life saving measure
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?
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
Emotional issues that clients deal with after amputation?
BSI
Body image
Self concept
Independence
When is a good time to start teaching amputation client about prosthesis ?
Don’t start teaching until they can look at amputation/ prosthesis (when they are ready)
What are some reasons amputation may be done ?
Necrosis (death of cells in body) severe injury, cancerous tumor of bone or muscle (malignancy), neuroma (tumor of nerve muscle), frostbite,Infections, poor circulation
What is the rational for performing an amputation over a lesser procedure?
When I will improve the longevity or comfort of malignancy
Life saving measure
Nothing else will work
What does BKA and AEA mean when talking about amputations?
Below knee amputation, above elbow amputation
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?
Protect the limb, it controls Adema, it minimizes pain, it allows healing
Wrapping the stump becomes part of the healing process. What is the reason for this?
Reduce edema (keeps it shaped) and will help fit into the prosthesis later
How should the stump be wrapped?
Wrap it so it forms a cone shape
What is gangrene and how might you know your patient has it?
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.
What does IVD stand for and what are the typical symptoms your patient might complain?
Intervertebral disc disease,
pain in the back, muscle spasms depressed deep tendon reflexes and neurological function
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?
To avoid infection, especially meningitis do to close proximity to the Coy’s
Following spinal surgery how will you reposition your patient in bed?
Log roll-use A turning sheet until the doctor allows the patient to be up
If you have a patient with osteoporosis what wrist does this bring to their life?
Pain, compression fractures, kyphosis ,loss of height
Other than calcium, vitamin D and bisphosphonate’s , What can a person do to fight osteoporosis?
Weight-bearing activities
Patients with Osteoporosis is prone to injury, a common injury is called compression fracture, what is that?
Usually from a fallStriking the butt and causing pressure of the spine
The compression causes SM fractures with in the vertebral body
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?
Pain in the hip, Groin and knees. Shortening of affected extremely External rotation, pain worse with movement, bruising, maybe about to break weight?
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?
Never cross legs , never bend more than 90 degrees, never bend at hip, never allow inward rotate
What are the symptoms of a bone tumor? (Sarcomas)
Aching, decreased movement, pathological fractures
What are common treatments of bone cancer?
Radiation, removal, chemo
If giving a NSAID what is the most common nursing consideration to be aware of?
Can cause stomach problems, give with food
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?
Signs of infection, decreased wbc , Decreased platelets, pulmonary Edema
What is important to teach a patient when they are taking medication such as fosamax and boniva for osteoporosis?
Take with full glass of water
Do not lay down for 30 minutes after taking
Traumatic injuries (catastrophic) such as head or spinal injuries or accidental injuries or homicide disease in general effect what population more so?
Younger population 18-24 age
But older people are more prone to falls hip fractures which can lead to complications
What are the risk factors for acute injuries and impaired mobility?
Lifestyle choices, extreme physical activity and risk-taking behaviors
Short-term changes in mobility may be related to what type of injuries?
Musca skeletal injuries such as sprains, strains and simple fracture’s due to sports or other physical activity
Clinical judgment includes a multidisciplinary team approach to help one with what? to permanent changes in functional ability?
Coping and adjusting
What causes temporary or permanent changes in mobility ?
Acute illness, infections, traumatic injuries
