Lewis 67 - Musculoskeletal Trauma and Orthopedic Surgery

Question 1

MOA/Class

cyclobenzaprine, tizanidine

Answer 1

Acts on the brainstem to decrease muscle spasms

Centrally-acting muscle relaxant

Tucker 25

Question 2

Side Effects

cyclobenzaprine, tizanidine

Answer 2

CNS depression; may have some anticholinergic effects

Tucker 25

Question 3

Nursing Considerations

cyclobenzaprine, tizanidine

Answer 3

Do not combine with alcohol or other CNS depressants.

Tucker 25

Question 4

Indications

cyclobenzaprine, tizanidine

Answer 4

Short-term/intermittent treatment of acute muscle spasms/injuries.

Tucker 25

Question 5

MOA/Class

morphine, oxycodone, hydrocodone, hydromorphone, fentanyl

Answer 5

Binds to opioid receptors producing analgesia and sedation. Dilates pulmonary and systemic blood vessels. Decreases anxiety (morphine).

Tucker 26

Question 6

Side Effects

morphine, oxycodone, hydrocodone, hydromorphone, fentanyl

Answer 6

respiratory depression, itching (from histamine release), orthostatic hypotension, CNS depression, constipation (with long-term use)

Tucker 26

Question 7

Nursing Considerations

morphine, oxycodone, hydrocodone, hydromorphone, fentanyl

Answer 7

Antidote - naloxone
Monitor respiratory status, BP, neuro status, and oxygenation.
May be combined with acetaminophen for synergistic effect.

Tucker 26

Question 8

Indications

morphine, oxycodone, hydrocodone, hydromorphone, fentanyl

Answer 8

pain
(adjunct management of anxiety, angina/HF, and air hunger)

Tucker 26

Question 9

MOA/Class

tetanus toxoid

Answer 9

Introduces antigen to the body so that body can mount an immune response and create a pattern for easy replication of antibodies in the event of subsequent exposure

Active Immunization

Tucker 18

Question 10

Side Effects

tetanus toxoid

Answer 10

Localized pain/soreness from injection.

Tucker 18

Question 11

Nursing Considerations

tetanus toxoid

Answer 11

May be combined with diptheria and pertussis vaccinations (DTaP for children; TDaP for adults).

Tucker 18

Question 12

Indications

tetanus toxoid

Answer 12

Prevention of tetanus (commonly contracted through dirty wounds).

Tucker 18

Question 13

MOA/Class

tetanus immunoglobulin

Answer 13

Provides passive immunity (temporary protection) in the setting of current/suspected infection

Passive Immunization

Tucker 18

Question 14

Side Effects

tetanus immunoglobulin

Answer 14

Localized pain/soreness from injection.

Tucker 18

Question 15

Nursing Considerations

tetanus immunoglobulin

Answer 15

Consider need for administration for patients with dirty wound who are not current on tetanus vaccination

Tucker 18

Question 16

Indications

tetanus immunoglobulin

Answer 16

Tetanus exposure

Tucker 18

Question 17

MOA/Class

cefazolin, cefepime

Answer 17

Weakens bacterial cell wall causing death.

Beta-lactam antibiotic

Tucker 09

Question 18

Side Effects

cefazolin, cefepime

Answer 18

C. diff, rash/SJS, anaphylaxis

Tucker 09

Question 19

Nursing Considerations

cefazolin, cefepime

Answer 19

Obtain culture before starting abx if possible
Ingesting alcohol may cause acetaldehyde syndrome
Patients with PCN allergy may have cross-allergy with cephalosporins

Tucker 09

Question 20

Indications

cefazolin, cefepime

Answer 20

Coverage for bacterial infections for open fractures.

Tucker 09

Question 21

MOA/Class

warfarin

Answer 21

Inhibits hepatic synthesis of vitamin K-dependent clotting factors (II, VII, IX, & X)

Anticoagulant

Tucker 48

Question 22

Side Effects

warfarin

Answer 22

Bleeding

Tucker 48

Question 23

Nursing Considerations

warfarin

Answer 23

Monitor PT/INR
Therapeutic INR typical 2-3 (2.5-3.5 for high-risk patients)
May need bridge therapy with heparin or enoxaparin until INR is therapeutic
Need consistent intake of vitamin K-rich foods
Administer vitamin K to reverse anticoagulation (effective up to 7 days)
Monitor for abnormal bleeding (bleeding gums, blood in stool or urine, epistaxis, heavy menstrual cycles, mental status changes)

Tucker 48

Question 24

indications

warfarin

Answer 24

Long-term DVT prevention; Prevention of clot formation for patients with A-fib to decrease stroke risk.

Tucker 48

Question 25

# MOA/Class heparin, enoxaparin

Answer 25

Block the formation of thrombin to prothrombin | Anticoagulant - heparin ## Footnote Tucker 48

Question 26

# Side Effects heparin, enoxaparin

Answer 26

Bleeding ## Footnote Tucker 48

Question 27

# Nursing Considerations heparin, enoxaparin

Answer 27

Enoxaparin has longer half-life and more predictable effects than heparin. Since effects are more predictable, PTT monitoring is not needed. (Enoxaparin is a low-molecular weight heparin). Protamine sulfate may be used for toxicity if necessary. Monitor for abnormal bleeding (bleeding gums, blood in stool or urine, epistaxis, heavy menstrual cycles, mental status changes) Monitor for heparin-induced thrombocytopenia. ## Footnote Tucker 48

Question 28

# Indications heparin, enoxaparin

Answer 28

DVT prevention ## Footnote Tucker 48

Question 29

# MOA/Class Aspirin (ASA)

Answer 29

Inhibits the synthesis of prostaglandin (pain) Inhibits platelet aggregation by inhibiting the synthesis of thromboxane A2 and prostacyclin. | Salicylate ## Footnote Tucker 16

Question 30

# Side Effects Aspirin (ASA)

Answer 30

GI upset, bleeding, salicylism ## Footnote Tucker 16

Question 31

# Nursing Considerations Aspirin (ASA)

Answer 31

Risk for Reye's syndrome when given to children or with concurrent chicken pox or influenza. Salicylism manifestations - tinnitus, sweating, headache, dizziness, acidosis. Give activated charcoal and/or bicarbonate. Dose of 81 mg is typically for antiplatelet activity. May give larger dose for antiplatelet effect in acute situations (i.e., active MI). Risk for hypersensitivity in patients with asthma and/or nasal polyps. ## Footnote Tucker 16

Question 32

# Indications Aspirin (ASA)

Answer 32

Mild-moderate pain/fever Inflammatory conditions (IBD, RA, etc.) MI/TIA prevention ## Footnote Tucker 16

Question 33

# MOA/Class rivaroxaban, apixaban

Answer 33

Interrupts the clotting cascade by inhibiting factor Xa thus preventing thrombin generation and clot development | Factor Xa inhibitor Anticoagulant ## Footnote Tucker 48

Question 34

# Side Effects rivaroxaban, apixaban

Answer 34

Bleeding ## Footnote Tucker 48

Question 35

# Nursing Considerations rivaroxaban, apixaban

Answer 35

Monitor for abnormal bleeding (bleeding gums, blood in stool or urine, epistaxis, heavy menstrual cycles, mental status changes) ## Footnote Tucker 48

Question 36

# Indications rivaroxaban, apixaban

Answer 36

Clot prevention ## Footnote Tucker 48