medsurg lecture 6 Flashcards
the muscular system is made of what
muscle and tendons
what are the functions of the muscular system
-movement
-heat production
-blood return in legs
what connects muscle to bone
tendons
what is the skeletal system made of
bones, cartilage and ligaments
what are the functions of the skeletal system
-movement
-protection
-calcium storage
what connects bone to bone
ligaments
how many bones are in the body
206
two types of the skeletal system
axial and appendicular
skull, vertebral column and rib cage are part of what
axial skeleton
limbs, shoulders, pelvic bones, and synovial joints are part of what
appendicular skeleton
the appendicular skeletons function is what
movement
the axial skeletons function is what
protection
how many skeletal muscles are there
about 700
the muscles are anchored to bones by _______
tendons
agonist muscle is
prime mover
antagonist muscle is
opposite action of the agonist
synergist assists what
the primary moving muscle
the muscular system maintains ____ and ______ motor control
balance and fine
agonist and antagonist have to work ______
opposite
if agonist and antagonist contract at the same time what would happen
they body wouldnt be able to move
agonist, antagonist and synergist muscles do what
all work together for movement
changes in the musculoskeletal system as a person ages
-decreased muscle mass/strength
-decreased elasticity of ligaments, tendons and cartilage
-decrease in intervertebral space
-changes in posture and gait changes
subjective data of an assessment history
-injuries
-disorders
-occupation
-nutritional history
subjective data of an assessment psychosocial
-are needs being met
-how are they doing thier ADLs
-how can we assist where they lack
physical exam assessment - inspection
-posture
-gait
-mobility aids
-deformities/swelling
-crepitation
physical assessment - palpation
-warmth
-tenderness
-neurovascular checks (six Ps)
total physical exam assessment for musculoskeletal system includes what
inspection, palpation, range of motion, muscle tone
diagnostic imaging for musculoskeletal system
bone density scan
xray
ct
mri
diagnostic labs for musculoskeletal system
-alp
-calcium
-creatinine kinase
what will ALP labs show for musculoskeletal system
elevation with new bone formation if there was a break or fracture
what will creatinine kinase show for musculoskeletal system
elevated with muscle damage
soft tissue injury that occurs when a muscle or tendon is excessively stretched
-strain
three categories of strains
-mild
-moderate
-severe
minimal inflammation of tissue with swelling and tenderness is considered what categories of strain
mild
partial tearing of the tissue with pain and inability to move affected part is considered what type of strain
moderate
tissue is ruptured with separation with severe pain and disability is considered what type of strain
severe
with severe strain what should we do to prevent further damage to the tissue
immobilize
excessive stretching of ligaments
sprain
what are the three categories of sprains
-mild
-moderate
-severe
tearing of a few ligament fibers with tenderness is considered what type of sprain
mild
more fibers are torn but stability of the joint is not affected with uncomfortableness with activity is considered what type of sprain
moderate
instability of the joint is considered what type of sprain
severe
a severe sprain usually requires what
surgical intervention for repair
a moderate sprain may require what
immobilization
nursing interventions for strains and sprains
-rest
-ice
-compression
-elevation
-nsaids
-muscle relaxers
a break in a bone is called a what
fracture
what are some causes of fractures
tramua
pathological from disease
how are fractures categorized
-open
-closed
a fracture that breaks skin
open
a fracture that doesnt break the skin
closed
what is the patient at risk for when they have an open fracture
infection
signs and symptoms of a fracture
-pain
-decreased ROM
-deformity
-swelling
-bruising
deformities with a fracture
-limb rotation
-shortening of limb
-protrusion of bone
diagnostic tests for a fracture
-xray
-ct
-mri
-calcium levels
-RBCS, hgb, hct
what is the first line imaging for a fracture
xray
diagnostic test that is better for complex areas such as pelvis, hip, rib to view bone and some tissue if bone is protruding into tissues
ct scan
soft tissue damage, ligaments and tendons can be seen with this diagnostic test
MRI
less invasive immobilizers
-splints
-casts
more invasive immobilizers
-closed reduction
-open reduction with fixation devices
removable immobilization using elastic wrap used for swelling and wound care
splints
stronger support using plaster cast that is worn for longer periods of time
cast
splints are important in the first stages of injury to what
assess for swelling and provide wound care
manual realignment with immobilization by splint or cast
closed reduction
surgical intervention to realign the fractures
open reduction with fixation
fixation devices
plates, pins, screws and rods
fixation devices can be placed ______ and ______
internally and externally
what is the most important thing to remember when external fixation devices are in place
infection control. must keep sites clean
complications of fractures
-infection
-DVT or PE
-compartment syndrome
reduction of circulation due to increased swelling
compartment syndrome
signs and symptoms of compartment syndrome
-severe pain not relieved with opioids
-decreased sensation
-ischemia to limb
how can you check for ischemia to a limb with compartment syndrome
six Ps
what is the first sign to look for with compartment syndrome
decreased sensation
why would you want a splint on instead of a cast with compartment syndrome
splint can be removed quickly in case of an emergency casts cannot
nursing interventions for fractures
-emergency care
-pain management
-monitor for complications
-encourage nutrition for healing
-physical therapy/ROM
-assist with ADLs and mobility
what is involved in emergency care nursing interventions for fractures
-immobilize and secure affected limb
-with open fractures cover protruding bone with sterile dressing
-never attempt to straighten or realign extremity
-move limb as little as possible
-neurovascular assessment - 6 Ps
when immobilizing a fracture splint in as it _____
lies
metabolic disorder of low bone mass and deterioration of bone structure
osteoporosis
porous or fragile bones are more prone to ______
fractures
what bones are most affected by osteoporosis
-spine
-wrist
-hips
nonmodifiable risk factors for osteoporosis
-gender/females
-aging
-Caucasian or Asian
-small bone, petite body build
-postmenopausal status
-low testosterone and estrogen in men
-family history of osteoporosis or fractures
-history of fractures
modifiable risk factors for osteoporosis
-low calcium and vitamin d intake
-excessive caffeine, protein, sodium
-sedentary lifestyle
-excessive alcohol use
-cigarette smoking
signs and symptoms of osteoporosis
-may go unnoticed until facture occurs
-decrease in height
-kyphosis
-pain may or may not be present
how do you diagnose osteoporosis
dexa scan
what is a dexa scan
lose-dose xray to identify low bone density in the hip and spine
nursing interventions for osteoporosis
-calcium and vit d supplements or diet intake
-reduce risk factors
-exercise
-fall prevention
-bisphosphonates
what kind of exercise should be encouraged for osteoporosis
-weight-bearing to promote bone building
-walking is the best to encourage in older patients
what binds to the bones to prevent breakdown
bisphosphinates
two examples of bisphosphonates
-alendronate (fosamax)
-risedronate (actonel)
parts of the urinary tract
-two kidneys
-two ureters
-urinary bladder
-urethra
parts of the kidneys
-cortex
-medulla
-calyx
-renal pelvis
what is the outer region of the kidney
cortex
what is the inner region of the kidney
medulla
this contains the renal pyramids where urine formation occurs
medulla
this part of the kidney collects urine leaving the renal pyramids
calyx
this part of the kidney receives collected urine to continue to the ureter
renal pelvis
what are the functions of the kindeys
-formation of urine
-regulate fluid balance
-regulate electrolyte balance
-regulate acid-base balance
-excrete end products of metabolism
-excrete bacterial toxins, water-soluble drugs, and drug metabolites
-activation of vitamin d
-production of erythropoietin
-production of renin so regulates blood pressure
urine allows removal of excess _____, waste products and excess ______
products
materials
the kidneys regulate _______ or _______ of fluid and electrolytes
excretion or conservation
the kidneys regulate acid-base balance and forms ______
bicarbonate
what end products of metabolism do the kidneys excrete
urea
what is the importance of activation of vitamin d by the kidneys
required for calcium absorption
helps regulate calcium levels in the body
erythropoietin stimulates the bone marrow to produce what
red blood cells
renin is a powerful ______
vasoconstrictor
labs to asses kidney function
-BUN
-creatinine
-eGFR
-creatinine clearance
normal BUN levels
10-20
normal creatinine levels
0.6-1.2
normal egfr levels
> 60
normal creatinine clearance levels
about 120
urine formation in the nephrons
-glomerular filtration
-tubular reabsorption
-tubular secretion
blood pressure forces water and small solutes out of the glomerular and into bowman capsules forming renal filtrate
glomerular filtration
renal filtrate then enters the renal tubules where reabsorption of useful materials from the filtrate is returned to the capillary system
tubular reabsorption
as the filtrate continues to move through the renal tubules, substances are still actively being secreted from the blood into the filtrate for disposal
tubular secretion
what happens in the ureters during urine emilination
smooth muscle walls contract in peristaltic waves to propel urine into the bladder
the ureters extend from the _______ connecting to the bladder
kidneys
what happens in the bladder during urinary elimination
the bladder fills, expands and compressed the lower ends of the ureters to prevent backflow
what is the muscular sac that temporarily holds urine for excretion
bladder
release of urine from the bladder to the urethra involving the relaxation of urethral sphincters
urination
urination occurs with the relaxation of the ______ and _____ sphincters
internal and external
what happens to the kidneys as we age
-decreased ability to concentrate urine
-GFR decreases so body cannot eliminate drugs as easily
-number of nephrons decreases
what happens to the bladder as we age
-decreased bladder size and muscle tone that causes:
-dysuria
-increased frequency
-incontinence
-urine retention
what happens to males urinary system as they age
prostate enlarges causing urine retention and difficulty voiding
what happens to females urinary system as they age
-pelvic floor muscles weaken
-more prone to UTIs and incontinence
the urinary tract is sterile beyond the _____
urethra
invasion of the urinary tract by bacteria
UTI
UTIs are often caused by and ______ infection
ascending
two lower uti names
urethritis
cystitis
urethritis is an infection where
urethra
cystitis is an infection where
the bladder
two upper utis are called what
pyelonephritis
ureteritis
pyelonephritis is an infection where
they kidney
ureteritis is an infection where
the ureter
utis are the most common hospital acquired infection due to _____
catheters
UTI risk factors
-urine stasis
-contamination
-prior utis
-female anatomy
-aging
examples of urine stasis
-incomplete bladder emptying
-obstruction
-not voiding frequently
examples of contaimination
-improper wiping/hygiene
-sexual intercourse
-instrumental
-piercings
signs and symptoms of UTI
-increased urgency
-polyuria
-dysuria
-foul-smelling, cloudy urine
-hematuria
signs and symptoms of uti in older adults
-fatigue
-confusion
-delirium
signs and symptoms with cystitis
pelvic pain or pressure
signs and symptoms with pyelonephritits
-flank tenderness
-high fever
-chills
-nausea and vomiting
diagnosis of a uti
-risk factors present
-signs and symptoms
-inspection of urine (volume, color, concentration, cloudiness, odor, blood)
-urinalysis
-urine culture
nursing care for uti
-antibiotic administration
-pain control
-monitor I/Os
-proper foley cath care
-education
-prevention
what medication is used for pain control with UTI and what does it do to the urine
phenazopyridine (pyridium)
turns the urine to a red/orange color
what education should the nurse give for UTI
-take all antibiotics as prescribed
-increase fluid intake
what should be done to prevent UTIs
-void when urge is present and allow time to empty
-proper wiping and hygiene
-cotton underwear
-avoid feminine hygiene products or scented products
-void after sexual intercourse
chronic kidney disease is _____ and ______
progressive and irreversible
with chronic kidney disease there is a ______ decrease in kidney function
gradual
in the early stages of chronic kidney disease the patient usually what
doesnt experience any symptoms
with chronic kidney disease a large proportion of _______ are damaged
nephrons
when a person has chronic kidney disease the body is unable to maintain ______, _____, and ______ balance
metabolic, fluid and electrolyte
which body systems does chronic kidney disease affect?
all of them
which disease progresses to chronic kidney disease
acute kidney disease
uncontrolled HTN causing _______ can cause chronic kidney disease
nephrosclerosis
_______ nephropathy can cause chronic kidney disease
diabetic
what is the level of kidney damage with stage one chronic kidney disease and what is the egfr
mild kidney damage with eGFR of 90 or greater
what is the level of kidney damage with stage two chronic kidney disease and what is the egfr
mild kidney damage with egfr between 60 and 89
what is the level of kidney damage with stage three-A chronic kidney disease and what is the egfr
mild to moderate kidney damage with egfr between 45 and 59
what is the level of kidney damage with stage three-B chronic kidney disease and what is the egfr
mild to moderate kidney damage with egfr between 30 and 44
what is the level of kidney damage with stage four chronic kidney disease and what is the egfr
moderate to severe kidney damage with egfr between 15 and 29
what is the level of kidney damage with stage five chronic kidney disease and what is the egfr
close to failure or completely failed with egfr less than 15
what electrolyte changes occur with chronic kidney disease
hyperkalemia and hypocalcemia
what lab values will be elevated with chronic kidney disease
-bun
-creatinine
what lab values will be decreased with chronic kidney disease
-eGFR
-creatinine clearance
-RBC
-hgb
-hct
what neurological signs and symptoms will be present with chronic kidney disease
-weakness
-fatigue
-confusion
what hematological signs and symptoms will be present with chronic kidney disease
anemia
what cardiovascular signs and symptoms will be present with chronic kidney disease
-htn
-pitting edema
-weight gain
-at risk for cardiac dysrhythmias due to potassium and chronic heart failure because of fluid overload
what gastrointestinal signs and symptoms will be present with chronic kidney disease
-anorexia
-nausea
-vomiting
what integumentary signs and symptoms will be present with chronic kidney disease
pruritus- urea
-uremic frost - high urea concentration in sweat
-ecchymosis - bruising
what pulmonary signs and symptoms are present during chronic heart failure
pulmonary edema
what musculoskeletal signs and symptoms will be present with chronic kidney disaese
-muscle weakness and cramps due to electrolyte imbalances
-bone density loss due to decreased calcium
what urinary signs and symptoms are present with chronic kidney disease
oliguria or anuria
what diet should a person with chronic kidney disease be on
-high calorie
-low protein
-low sodium, potassium, phosphorus
-increased calcium
-fluid restriction
medication therapy for chronic kidney disease
-diuretics
-antihypertensives
-phosphate binders
-vitamin d and calcium supplements
-sodium polystyrene sulfonate
when are diuretics given to a patient with chronic kidney disease and why
given early in disease to increase output medication doesnt work if kidneys dont work
when are phosphate binders given for chronic kidney disease and why
given with meals to decrease phosphate levels
medications bind to phosphate and excrete through stool
why are sodium polystyrene sulfonates given for chronic kidney disease
laxative that binds to potassium to rid body of excess potassium
artificial kidney machine to remove waste products and excess fluid from body/blood
hemodialysis
when is hemodialysis started
when patient develops severe fluid overload, hyperkalemia, acidosis, or other life threatening symptoms
patients must go to the dialysis center ____ days a week for _____ hours to have their blood dialyzed
three days a week for 3-4 hours
dialysis is usually scheduled what days of the week
m-w-f
tu-th-s
if a patient misses a dialysis session if could be life threatening due to ____ and ____
toxic waste and fluid build up
what is common for a patient after dialysis treatment
weakness
fatigue
hypotension
what should you do before sending a patient to dialysis
-obtain morning weight
-ensure all care is provided
-encourage patient to eat breakfast
once a patient returns to your care from dialysis what are the priorities
-vital signs
-weight
-focused assessment
-monitoring for bleeding from the access site
-encourage rest
central line access for hemodialysis is surgically inserted through the what
internal jugular vein
a central line may exit thee body through the ____ or _____
neck or chest
a central line access is a ______ access site
temporary
central line access is not used long term due to increased what
risk for infection
a central line access is used until when
and AV fistula or graft matures and is ready
a central line access should only be used for what and what must you ensure with the line
only used for dialysis and must ensure line does not get clotted
nursing priorities for central line access
-keep clean and dry
-change dressing when required using sterile technique
-assess site for signs and symptoms of infection and bleeding
surgical procedure where a vein and artery are sewn together under the skin
fistula
surgical procedure that uses synthetic tubing to attach an artery and a vein
graft
fistula and graft access are ______ access sites
permanent
it is not necessary for you to identify if the permanent dialysis access is a fistula or graft but you must realize it is ______
present
after the patient returns from dialysis there will be a bandage over the site when can it be removed?
4-6 hours after dialysis
the access site doesnt need to be covered with a bandage any other time as it is what?
closed off to the outside
nursing priorities for a fistula/graft
-assess site each shift to ensure patency
-assess site for signs and symptoms of infection
-assess site for signs and symptoms of bleeding
-no procedures may be performed on the arm of the fistula/graft
to assess a site for patency you can assess for a ____ or _____
thrill or bruit
how do you assess for a thrill
-use fingers and place them over the access site
-palpate for a tremor
how do you assess for a bruit
-place the diaphragm of the stethoscope over the access site
-auscultate for a swishing/whooshing sound
a decreased thrill or bruit or absence of either indicate what and what should you do
indicates occlusion, notify HCP immediately
