Final Cumulative Flashcards
1
Q
MRIs
A
- radio waves of magnetic field are used to view soft tissu
- especially useful in the diagnosis of avascular necrosis, dise disease, tumors, osteomyelitis, ligament tears, cartilage tears
- contraindicated in pts with aneurysm clips, metallic implants, pacemakers, electronic devices, hearing aids and shrapnal
procedure is painless, loud tapping noises - no metal on clothing
- check for allergies to contrast if ordered
2
Q
sprains vs strains
A
- sprains: injury to ligaments. can be extremely painful
- strains: excessive stretching oa muscle, fascial sheath or tendon.
1) stop activity and limit movement
2) apply ice compresses to injured area
3) compress the extremity
4) elevate extremity
5) provide analgesia as necessary
RICE = rest, ice, compression , elevation - rest: movement restricted and extremity rested as soon as pain is felt
- ice: causes vasoconstrition and reduction of transmission and perception of pain. reduce inflamm and edema. apply immediately and keep on for 20-30 minutes
- compression: start wrapping distally and progress proximatly. keep on 30 minutes then remove for 15 minutes
- elevate: above heart level. elevate during sleep. NSAIDs for pain
3
Q
compartment syndrome
A
- condition in which swelling and increased pressure within a limited space presses on and compromises the function of blood vessels, nerves and/or tendons that run through that compartment
- causes capollary perfusion to be reduced below a level necessary for tissue viability
1) decreased compartment size resulting from restictive dressings, splints, casts, excessive traction, premature closure of fascia
2) increased compartment contents related to bleeding, inflamm, edema, IV infiltration - s/s: ischemia to extremity, contracture, disability, loss of function can occur
- 6 Ps: (1) pain distal to the injury that is not relieved by opiods and pain on passive stretch of extremity (2) pressure in compartment (3) paresthesia, numbness and tingling (4) pallor, coolness and loss of normal color of the extremity (5) paralysis or loss of function (6) pulselessness or diminshed or absent pulses
- causes: trauam, crushing injuries, humerous and tibia fractures are most common cause, extremity trapped under something with pressure
- care: assess urine for myoglobin = kidney and muscle damage, do NOT elevate above heart, do NOT apply cold, fasciotomy, monitor for infection after procedure
4
Q
purpose of traction
A
- the application of pulling force to an injured or diseased part of the body or an extremity
1) prevent or reduce pain and muscle spasms assocaited with low back pain or cerbvical sprain/whiplash
2) immobilize a joint or part of the body
3) recude a fracture or dislocation
4) treat a pathologic joint condition (tumor, infection) - provides immobolization to prevent soft tissue damage, promote active and passive exercise, expand a joint
- reallignment, decease pain and muscle spasms
- weights off floor
- pin care, watch for infection
5
Q
nursing care for fractured hip pt
A
- pain meds before activity
- how weight bearing status
- know assist status
- make sure to assess circulation if in a cast
6
Q
complications of an open fracture
A
- infection
- skin is open, exposing bone and soft tissue
7
Q
in-hospital and home care/treatment for osteomyelitis
A
- long term IV abx
- teach about how to care for their PICC line and how to administer their meds
- teach family members how to care
- scheduling Abx admin
- when to have follow up appts and lab testing
8
Q
how do we treat osteoporosis
A
- porous bone, chronic progressive metabolic bone disease characterized by low bone mass and structural deterioration of bone tissue, leading to increased bone fragility
- weight bearing exercise
- calcium and vitamin d supplements
- biphosphonates (foasamax, bonefos, didronel, boniva, aredia)
- salmon calcitonin (calcimar)
- selevtive estrogen receptor modulator
9
Q
risk factors, treatment and nursing care for gout
A
- risk factors: alcohol, red meats exacerbate flare ups, increase in uric acid production, underexcretion of uric acid in the kidneys, or inreased intake of foods containing purines which turn into uric acid in the body, prolonged fasting
- s/s: usually occurs in less than 4 joints, joints may appear dusky or cyanotic and extremely tender, inflamm of the great toe is the first problem that appears, tophi
- treatment/nursing care: low purine diet, protect foot and toes, blankets off feet, allopurinol, colchicine, NSAIDs, cortcosteroids, weight reduction, avoid alcohol, avoid red meat
10
Q
side effects and concerns of using NSAIDs
A
- GI bleeding
- renal impairment
11
Q
symtoms of osteoarthritis
A
- not normal part of aging
- cartilage destruction or joint instability
- not systemic
- joint pain, joint pain with rest, early morning stiffness but resolves
- heberden’s nodes, bouchard’s nodes
12
Q
care and treatment for ankylosing spondylitis
A
- males with hump backs
- respiratory issues due to bent back
- teach them to cough and deep breath
- maintain maximal skeletal mobility while decreasing pain and inflammation
- NSAIDs and salicylates
- once pain is managed, exercise is essential, postural control
13
Q
what meds should be given to a patient dependenton alcohol and in what order should they be given?
A
1) thiamine/banana bag
2) dextrose
14
Q
symptoms of withdrawl from nicotine
A
- cravings, irritabikity, headache
- give them a nicotine replacement while in the hospital to help with these effects
- always try to get pts to quit
15
Q
symptoms and complications of simulant overdose
A
- restlessness, paranoia, agitated delirium, confusion, and repetitive sterotyped behaviors
- death can result from dysrhythmias, MI, stoke, increased BP
- no antidote
16
Q
breakthrough pain
A
- when a pt is treated with sustained-release pain meds, but they develo a high pain level during the treatment
- treat with same immediate release medication
- drip of morphine, give morphine IVpush
17
Q
best pain med for the elderly
A
- tylenol
- don’t give NSAIDs - renal issues
18
Q
common concerns regarding tylenol use and how much can be given in 24 hours
A
- don’t give more than 3-4grams/day
- can result in acute or chornic liver failure, hepatotoxicity
19
Q
common causes of respiratory problems in the PACU? what action do you take for each?
A
- obstruction: tongue – jaw thrust, lay on side, sit up bed
- hypoxemia: pulse ox
20
Q
signs of resp problems in patients after surgery?
A
- decreased pulse ox reading
- decreaesd respiration rate
- crackles
- note sputum and color
- note gag reflex
21
Q
risks associated with poor wound healing
A
- infection
- poor nutrition
- diabetes with poor wound healing
22
Q
side effects of external radiation to the pelvis? how do you manage them?
A
- stomatitis, mucositis, esophagitis: encourage nutritional supplements, be aware of sawllowing difficulties, clean oral cavity, discourage smoking
- diarrhea: give antidiarrheals as needed, encourage low fiber, low residue diet, fluids 3L/day
- skin issues: clean with mild soap and water, nonmedicated lotion, rinse with saline, avoid harsh fabrics, avoid direct exposure to sun,
- increased infection risk
- reproductive dysfunction: harvest eggs prior
23
Q
nursing are for vomiting, mucositis, anorexia?
A
- vomiting: encourage pt to eat and drink when not nauseated; administer antiemetics, use diversional activities
- mucositis: assess oral health, encourage nutritional suppliments, artificial saliva
- anorexia: monitor weight, encourage pt to eat small frequent meals with lots of protein, food diary, serve food in pleasant environment
24
Q
what lab values are of most concern wwhen a patient is receicing cancer treatment?
A
- CBC: wbc, H&H, platelets
- neutrophils
RBC: 4-5.5 Hemoglobin: 12-17 hematocrit: 35-50% WBC: 4-11 Platelet: 150-450
25
Q
what do you know about “lols”
A
- Best blockers
- atenolol, bisoprolol, metoprolol
- action: decreaed BP, decrease CO, decrease renin secretion
- nursing considerations: monitor BP and pulse
26
Q
how do you know the treatment of ADHF is working?
A
- ADHF: acute decompensated heart failure
- decreased SOB, decreased crackles, decreased weight
- give diuretics and morphine
- my
27
Q
what is BNP and how does it relate to heart failure?
A
- checks for heart failure
- substance secreted in response to heart changes
