med surg test 2 part 7 Flashcards
3 major concerns of post op period
infection
atelectasis
bleeding
What kind of fracture has the highest DVT risk
knee
If you see an area is swollen, the number 1 thing to assess is
pulse
if there are multiple fractures you watch out for
fat emboli
In a fracture, some degree of ___ is expected
swelling
When you help someone out of bed, help them on their __ side
strong
Osteomyletis Tx (2 things)
3 months Abx PICC line (they're going home with it)
Comminuted fracture, 2 complications
fat emboli
hemorrhage
4 substances that increase risk for osteoporosis
steroids
caffeine
alcohol
smoking
Normal BMD range
-1 to +1
2 diseases that increase risk for osteoporosis
CKD (kidney problem)
hyperparathyroidism
CKD patients are in a constant state of
acidosis
Biggest issue with prosthetics (like hip replacement) is
dislocation (so watch out for how you position them etc)
2 things that are a “gotcha” for hip fracture
external rotation
leg shortening
Hip fracture, biggest thing to check is
circulation
First thing you check for with hip fracture pt
mental status
Validate its a hip fracture with this test
x ray
If the person has been laying on the floor for a long time, or has other reason to suspect muscle damage, test for
CK
The complication of elevated CK (from muscle damage) is
renal problems
Total hip arthroplasty is aka
totally replacing the ball and socket
THA patient is not allowed to
lean forward more than 90 degrees
THA home modification
raised toilet seat
When fiber glass cast is drying, place it on
a soft pillow
because someone with a cast is at risk for DVT, they may need to go home on what meds
lovanox or aspirin
What do you teach the patient about the tingling feeling
elevate that tingling extremity
if that doesn’t work, call doctor
Between cast syndrome and DVT, first r/o
DVT
Main problem area for External Fixation Device is
perfusion
A type of traction that can be used for spine fracture
Garender-Willis Traction (screwed into head)
If they have C2 vertebrae damage, assess for
sensation everywhere form the neck down
constipation
urine retention
Halo traction is at risk for
falls because they can’t bend properly
Bucks traction is at risk for
heel ulcer
Bucks traction: when you’re moving the pt, start by
disconnecting the weights
If there’s a lot of gunk and you need a sample, first
clean away with NS
AVN
acute vascular necrosis
If someone is bleeding, which IV do you give
RL
complication of RL
alkalosis b/c lactate becomes bicarbonate
ketorolac
really effective NSAID
contraindicated in PUD
In compartment syndrome, check the urine for
myoglobin
What tests are you going to order for DVT pt
doppler ultrasound
fibrinogen test
High blood sugar inhibits
healing
after surgery, a stump should be
elevated
2 supplements needed for healing
vit c
protein
fracture that occurs spontaneously as opposed to from a trauma
pathological
Osteoporosis 3 Tx
weight bearing (walking)
calcium and vit D
Biphosphate
Biphosphate is contraindicated in
GERD and other GI disease
Osteoporosis labs, check for
calcium levels
Causes of Dehydration: has to do with breathing pattern
hyperventilation
Causes of Dehydration: has to do with diabetes type 1
DKA
with dehydration, temp will be
increased
dehydration, oxygen status will be
hypoxemic
Dehydration Nursing Care: Administer supplemental __ as prescribed.
oxygen
Dehydration Nursing Care: Initiate and maintain
IV access
Dehydration Nursing Care: Place the client in shock position which is
on back with legs elevated
Nursing Actions for Hypovolemic Shock: Administer
O2
Nursing Actions for Hypovolemic Shock: Provide fluid replacement with the following:
Colloids
Crystalloids
Nursing Actions for Hypovolemic Shock: administer what class of drugs
vasoconstrictors
Hypervolemia can be caused by interstitial to plasma fluid shifts, which can be caused by
burns
Hypervolemia can be caused by Water replacement without ___ replacement
electrolyte
In hypervolemia, what test reveals possible pulmonary congestion
x ray
In hypervolemia position pt in
semi-Fowler’s
Pulmonary Edema, postion pt in
high-Fowler’s position to maximize ventilation
Pulmonary Edema 2 meds that may be needed
morphine and diuretic
Hyponatremia delays and slows the __ of __
depolarization of membranes
Hyponatremia: Compensatory mechanisms include the renal excretion of sodium-free water.
pissing out sodium-free water.
SIADH causes which electrolyte imbalance
hyponatremia
Full compensation occurs when
the pH level of the blood returns to normal (7.35 to 7.45)
If the pH level is not able to normalize, then it is referred to as
partial compensation
RESpiRAtoRy AcidoSiS – skin
pale or cyanotic
Respiratory acidosis and alkalosis can be treated with
O2
DXA scans are done to estimate the
density of a client’s bone mass – usually in the hip or spine – and the presence/extent of osteoporosis.
refers to the surgical removal of a diseased joint due to osteoarthritis, osteonecrosis, rheumatoid arthritis, trauma, or congenital anomalies
Arthroplasty
Arthroplasty refers to the surgical removal of a diseased joint and
replacing it with prosthetics
Goal of both hip and knee arthroplasty is to eliminate
pain
Goal of both hip and knee arthroplasty is to restore
restore joint motions
before arthroplasty, r/o
anemia, infection, or organ failure
___ alfa may be prescribed preoperatively to increase Hgb.
Epoetin
Contraindications of Arthroplasty: ___ impairment to the affected extremity
Arterial
Arthroplasty: May use ___ or ___ anesthesia
spinal or general
Arthroplasty: Components may or may not be ___ in place
cemented
Knee arthroplasty: 3 postoperative complications
deep vein thrombosis, anemia, infection
Arthroplasty: CPM machine may be prescribed to promote motion in the knee and prevent
prevent scar tissue formation
When is CPM started
right after surgery
CPM: The prescribed duration of its use should be followed, but it should be turned off during
meals
Knee arthroplasty: avoid pillows
behind the knee
Knee arthroplasty: To prevent pressure ulcers from developing on the heels,
place a small blanket or pillow slightly above the ankle area to keep heels off the bed
Knee arthroplasty: A continuous peripheral nerve block is a
continuous infusion of local anesthetic directly into sciatic or femoral nerve
Knee arthroplasty: Ice or cold therapy may be applied to
reduce swelling
Hip arthroplasty: The client should not be turned to the
operative side, which could cause hip dislocation.
Hip arthroplasty: ___ rotate a client’s toe
externally
Knee arthroplasty – Dislocation is not common following total knee arthroplasty. Kneeling and deep-knee bends are, however,
limited indefinitely
Lower extremity amputations are usually done due to
peripheral vascular disease as a result of arteriosclerosis
Management of Traumatic Amputation: in an emergency, position the extremity
above the heart
most common amputation technique used
Closed amputation
Closed amputation: ___ __ is sutured over end of residual limb, closing site
Skin flap
Open amputation: This technique is used when an
active infection is present
Phantom limb pain occurs less frequently following ___ amputation
traumatic
Nurses need to differentiate between phantom limb and __ pain
incisional (tesoro said you’re going to ask the client about the pain, how’s it feel?)
Phantom limb pain may be treated with
beta blockers
antiepileptics
antidepressant
Amputation may not heal if performed below the level of adequate
tissue perfusion
Amputation: IF there’s infection and/or nonhealing of incision, than you position the stump
dependently to promote blood flow
Residual limb must be shaped and ___ in preparation for prosthetic training.
shrunk
Flexion contractures are more likely with the hip or __ joint following amputation due to improper positioning.
knee
Flexion Contractures: Nursing action: have client lay
prone for 20 or 30 min
Flexion Contractures: Nursing action: discourage
sitting in a chair to long
