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med surg > medsurg lecture 6 > Flashcards

medsurg lecture 6 Flashcards

1
Q

the muscular system is made of what

A

muscle and tendons

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2
Q

what are the functions of the muscular system

A

-movement
-heat production
-blood return in legs

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3
Q

what connects muscle to bone

A

tendons

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4
Q

what is the skeletal system made of

A

bones, cartilage and ligaments

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5
Q

what are the functions of the skeletal system

A

-movement
-protection
-calcium storage

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6
Q

what connects bone to bone

A

ligaments

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7
Q

how many bones are in the body

A

206

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8
Q

two types of the skeletal system

A

axial and appendicular

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9
Q

skull, vertebral column and rib cage are part of what

A

axial skeleton

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10
Q

limbs, shoulders, pelvic bones, and synovial joints are part of what

A

appendicular skeleton

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11
Q

the appendicular skeletons function is what

A

movement

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12
Q

the axial skeletons function is what

A

protection

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13
Q

how many skeletal muscles are there

A

about 700

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14
Q

the muscles are anchored to bones by _______

A

tendons

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15
Q

agonist muscle is

A

prime mover

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16
Q

antagonist muscle is

A

opposite action of the agonist

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17
Q

synergist assists what

A

the primary moving muscle

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18
Q

the muscular system maintains ____ and ______ motor control

A

balance and fine

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19
Q

agonist and antagonist have to work ______

A

opposite

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20
Q

if agonist and antagonist contract at the same time what would happen

A

they body wouldnt be able to move

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21
Q

agonist, antagonist and synergist muscles do what

A

all work together for movement

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22
Q

changes in the musculoskeletal system as a person ages

A

-decreased muscle mass/strength
-decreased elasticity of ligaments, tendons and cartilage
-decrease in intervertebral space
-changes in posture and gait changes

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23
Q

subjective data of an assessment history

A

-injuries
-disorders
-occupation
-nutritional history

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24
Q

subjective data of an assessment psychosocial

A

-are needs being met
-how are they doing thier ADLs
-how can we assist where they lack

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25
Q

physical exam assessment - inspection

A

-posture
-gait
-mobility aids
-deformities/swelling
-crepitation

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26
Q

physical assessment - palpation

A

-warmth
-tenderness
-neurovascular checks (six Ps)

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27
Q

total physical exam assessment for musculoskeletal system includes what

A

inspection, palpation, range of motion, muscle tone

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28
Q

diagnostic imaging for musculoskeletal system

A

bone density scan
xray
ct
mri

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29
Q

diagnostic labs for musculoskeletal system

A

-alp
-calcium
-creatinine kinase

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30
Q

what will ALP labs show for musculoskeletal system

A

elevation with new bone formation if there was a break or fracture

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31
Q

what will creatinine kinase show for musculoskeletal system

A

elevated with muscle damage

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32
Q

soft tissue injury that occurs when a muscle or tendon is excessively stretched

A

-strain

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33
Q

three categories of strains

A

-mild
-moderate
-severe

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34
Q

minimal inflammation of tissue with swelling and tenderness is considered what categories of strain

A

mild

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35
Q

partial tearing of the tissue with pain and inability to move affected part is considered what type of strain

A

moderate

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36
Q

tissue is ruptured with separation with severe pain and disability is considered what type of strain

A

severe

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37
Q

with severe strain what should we do to prevent further damage to the tissue

A

immobilize

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38
Q

excessive stretching of ligaments

A

sprain

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39
Q

what are the three categories of sprains

A

-mild
-moderate
-severe

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40
Q

tearing of a few ligament fibers with tenderness is considered what type of sprain

A

mild

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41
Q

more fibers are torn but stability of the joint is not affected with uncomfortableness with activity is considered what type of sprain

A

moderate

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42
Q

instability of the joint is considered what type of sprain

A

severe

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43
Q

a severe sprain usually requires what

A

surgical intervention for repair

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44
Q

a moderate sprain may require what

A

immobilization

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45
Q

nursing interventions for strains and sprains

A

-rest
-ice
-compression
-elevation
-nsaids
-muscle relaxers

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46
Q

a break in a bone is called a what

A

fracture

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47
Q

what are some causes of fractures

A

tramua
pathological from disease

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48
Q

how are fractures categorized

A

-open
-closed

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49
Q

a fracture that breaks skin

A

open

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50
Q

a fracture that doesnt break the skin

A

closed

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51
Q

what is the patient at risk for when they have an open fracture

A

infection

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52
Q

signs and symptoms of a fracture

A

-pain
-decreased ROM
-deformity
-swelling
-bruising

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53
Q

deformities with a fracture

A

-limb rotation
-shortening of limb
-protrusion of bone

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54
Q

diagnostic tests for a fracture

A

-xray
-ct
-mri
-calcium levels
-RBCS, hgb, hct

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55
Q

what is the first line imaging for a fracture

A

xray

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56
Q

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

A

ct scan

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57
Q

soft tissue damage, ligaments and tendons can be seen with this diagnostic test

A

MRI

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58
Q

less invasive immobilizers

A

-splints
-casts

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59
Q

more invasive immobilizers

A

-closed reduction
-open reduction with fixation devices

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60
Q

removable immobilization using elastic wrap used for swelling and wound care

A

splints

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61
Q

stronger support using plaster cast that is worn for longer periods of time

A

cast

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62
Q

splints are important in the first stages of injury to what

A

assess for swelling and provide wound care

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63
Q

manual realignment with immobilization by splint or cast

A

closed reduction

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64
Q

surgical intervention to realign the fractures

A

open reduction with fixation

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65
Q

fixation devices

A

plates, pins, screws and rods

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66
Q

fixation devices can be placed ______ and ______

A

internally and externally

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67
Q

what is the most important thing to remember when external fixation devices are in place

A

infection control. must keep sites clean

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68
Q

complications of fractures

A

-infection
-DVT or PE
-compartment syndrome

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69
Q

reduction of circulation due to increased swelling

A

compartment syndrome

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70
Q

signs and symptoms of compartment syndrome

A

-severe pain not relieved with opioids
-decreased sensation
-ischemia to limb

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71
Q

how can you check for ischemia to a limb with compartment syndrome

A

six Ps

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72
Q

what is the first sign to look for with compartment syndrome

A

decreased sensation

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73
Q

why would you want a splint on instead of a cast with compartment syndrome

A

splint can be removed quickly in case of an emergency casts cannot

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74
Q

nursing interventions for fractures

A

-emergency care
-pain management
-monitor for complications
-encourage nutrition for healing
-physical therapy/ROM
-assist with ADLs and mobility

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75
Q

what is involved in emergency care nursing interventions for fractures

A

-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

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76
Q

when immobilizing a fracture splint in as it _____

A

lies

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77
Q

metabolic disorder of low bone mass and deterioration of bone structure

A

osteoporosis

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78
Q

porous or fragile bones are more prone to ______

A

fractures

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79
Q

what bones are most affected by osteoporosis

A

-spine
-wrist
-hips

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80
Q

nonmodifiable risk factors for osteoporosis

A

-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

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81
Q

modifiable risk factors for osteoporosis

A

-low calcium and vitamin d intake
-excessive caffeine, protein, sodium
-sedentary lifestyle
-excessive alcohol use
-cigarette smoking

82
Q

signs and symptoms of osteoporosis

A

-may go unnoticed until facture occurs
-decrease in height
-kyphosis
-pain may or may not be present

83
Q

how do you diagnose osteoporosis

A

dexa scan

84
Q

what is a dexa scan

A

lose-dose xray to identify low bone density in the hip and spine

85
Q

nursing interventions for osteoporosis

A

-calcium and vit d supplements or diet intake
-reduce risk factors
-exercise
-fall prevention
-bisphosphonates

86
Q

what kind of exercise should be encouraged for osteoporosis

A

-weight-bearing to promote bone building
-walking is the best to encourage in older patients

87
Q

what binds to the bones to prevent breakdown

A

bisphosphinates

88
Q

two examples of bisphosphonates

A

-alendronate (fosamax)
-risedronate (actonel)

89
Q

parts of the urinary tract

A

-two kidneys
-two ureters
-urinary bladder
-urethra

90
Q

parts of the kidneys

A

-cortex
-medulla
-calyx
-renal pelvis

91
Q

what is the outer region of the kidney

A

cortex

92
Q

what is the inner region of the kidney

A

medulla

93
Q

this contains the renal pyramids where urine formation occurs

A

medulla

94
Q

this part of the kidney collects urine leaving the renal pyramids

A

calyx

95
Q

this part of the kidney receives collected urine to continue to the ureter

A

renal pelvis

96
Q

what are the functions of the kindeys

A

-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

97
Q

urine allows removal of excess _____, waste products and excess ______

A

products
materials

98
Q

the kidneys regulate _______ or _______ of fluid and electrolytes

A

excretion or conservation

99
Q

the kidneys regulate acid-base balance and forms ______

A

bicarbonate

100
Q

what end products of metabolism do the kidneys excrete

A

urea

101
Q

what is the importance of activation of vitamin d by the kidneys

A

required for calcium absorption
helps regulate calcium levels in the body

102
Q

erythropoietin stimulates the bone marrow to produce what

A

red blood cells

103
Q

renin is a powerful ______

A

vasoconstrictor

104
Q

labs to asses kidney function

A

-BUN
-creatinine
-eGFR
-creatinine clearance

105
Q

normal BUN levels

A

10-20

106
Q

normal creatinine levels

A

0.6-1.2

107
Q

normal egfr levels

A

> 60

108
Q

normal creatinine clearance levels

A

about 120

109
Q

urine formation in the nephrons

A

-glomerular filtration
-tubular reabsorption
-tubular secretion

110
Q

blood pressure forces water and small solutes out of the glomerular and into bowman capsules forming renal filtrate

A

glomerular filtration

111
Q

renal filtrate then enters the renal tubules where reabsorption of useful materials from the filtrate is returned to the capillary system

A

tubular reabsorption

112
Q

as the filtrate continues to move through the renal tubules, substances are still actively being secreted from the blood into the filtrate for disposal

A

tubular secretion

113
Q

what happens in the ureters during urine emilination

A

smooth muscle walls contract in peristaltic waves to propel urine into the bladder

114
Q

the ureters extend from the _______ connecting to the bladder

A

kidneys

115
Q

what happens in the bladder during urinary elimination

A

the bladder fills, expands and compressed the lower ends of the ureters to prevent backflow

116
Q

what is the muscular sac that temporarily holds urine for excretion

A

bladder

117
Q

release of urine from the bladder to the urethra involving the relaxation of urethral sphincters

A

urination

118
Q

urination occurs with the relaxation of the ______ and _____ sphincters

A

internal and external

119
Q

what happens to the kidneys as we age

A

-decreased ability to concentrate urine
-GFR decreases so body cannot eliminate drugs as easily
-number of nephrons decreases

120
Q

what happens to the bladder as we age

A

-decreased bladder size and muscle tone that causes:
-dysuria
-increased frequency
-incontinence
-urine retention

121
Q

what happens to males urinary system as they age

A

prostate enlarges causing urine retention and difficulty voiding

122
Q

what happens to females urinary system as they age

A

-pelvic floor muscles weaken
-more prone to UTIs and incontinence

123
Q

the urinary tract is sterile beyond the _____

A

urethra

124
Q

invasion of the urinary tract by bacteria

A

UTI

125
Q

UTIs are often caused by and ______ infection

A

ascending

126
Q

two lower uti names

A

urethritis
cystitis

127
Q

urethritis is an infection where

A

urethra

128
Q

cystitis is an infection where

A

the bladder

129
Q

two upper utis are called what

A

pyelonephritis
ureteritis

130
Q

pyelonephritis is an infection where

A

they kidney

131
Q

ureteritis is an infection where

A

the ureter

132
Q

utis are the most common hospital acquired infection due to _____

A

catheters

133
Q

UTI risk factors

A

-urine stasis
-contamination
-prior utis
-female anatomy
-aging

134
Q

examples of urine stasis

A

-incomplete bladder emptying
-obstruction
-not voiding frequently

135
Q

examples of contaimination

A

-improper wiping/hygiene
-sexual intercourse
-instrumental
-piercings

136
Q

signs and symptoms of UTI

A

-increased urgency
-polyuria
-dysuria
-foul-smelling, cloudy urine
-hematuria

137
Q

signs and symptoms of uti in older adults

A

-fatigue
-confusion
-delirium

138
Q

signs and symptoms with cystitis

A

pelvic pain or pressure

139
Q

signs and symptoms with pyelonephritits

A

-flank tenderness
-high fever
-chills
-nausea and vomiting

140
Q

diagnosis of a uti

A

-risk factors present
-signs and symptoms
-inspection of urine (volume, color, concentration, cloudiness, odor, blood)
-urinalysis
-urine culture

141
Q

nursing care for uti

A

-antibiotic administration
-pain control
-monitor I/Os
-proper foley cath care
-education
-prevention

142
Q

what medication is used for pain control with UTI and what does it do to the urine

A

phenazopyridine (pyridium)
turns the urine to a red/orange color

143
Q

what education should the nurse give for UTI

A

-take all antibiotics as prescribed
-increase fluid intake

144
Q

what should be done to prevent UTIs

A

-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

145
Q

chronic kidney disease is _____ and ______

A

progressive and irreversible

146
Q

with chronic kidney disease there is a ______ decrease in kidney function

A

gradual

147
Q

in the early stages of chronic kidney disease the patient usually what

A

doesnt experience any symptoms

148
Q

with chronic kidney disease a large proportion of _______ are damaged

A

nephrons

149
Q

when a person has chronic kidney disease the body is unable to maintain ______, _____, and ______ balance

A

metabolic, fluid and electrolyte

150
Q

which body systems does chronic kidney disease affect?

A

all of them

151
Q

which disease progresses to chronic kidney disease

A

acute kidney disease

152
Q

uncontrolled HTN causing _______ can cause chronic kidney disease

A

nephrosclerosis

153
Q

_______ nephropathy can cause chronic kidney disease

A

diabetic

154
Q

what is the level of kidney damage with stage one chronic kidney disease and what is the egfr

A

mild kidney damage with eGFR of 90 or greater

155
Q

what is the level of kidney damage with stage two chronic kidney disease and what is the egfr

A

mild kidney damage with egfr between 60 and 89

156
Q

what is the level of kidney damage with stage three-A chronic kidney disease and what is the egfr

A

mild to moderate kidney damage with egfr between 45 and 59

157
Q

what is the level of kidney damage with stage three-B chronic kidney disease and what is the egfr

A

mild to moderate kidney damage with egfr between 30 and 44

158
Q

what is the level of kidney damage with stage four chronic kidney disease and what is the egfr

A

moderate to severe kidney damage with egfr between 15 and 29

159
Q

what is the level of kidney damage with stage five chronic kidney disease and what is the egfr

A

close to failure or completely failed with egfr less than 15

160
Q

what electrolyte changes occur with chronic kidney disease

A

hyperkalemia and hypocalcemia

161
Q

what lab values will be elevated with chronic kidney disease

A

-bun
-creatinine

162
Q

what lab values will be decreased with chronic kidney disease

A

-eGFR
-creatinine clearance
-RBC
-hgb
-hct

163
Q

what neurological signs and symptoms will be present with chronic kidney disease

A

-weakness
-fatigue
-confusion

164
Q

what hematological signs and symptoms will be present with chronic kidney disease

A

anemia

165
Q

what cardiovascular signs and symptoms will be present with chronic kidney disease

A

-htn
-pitting edema
-weight gain
-at risk for cardiac dysrhythmias due to potassium and chronic heart failure because of fluid overload

166
Q

what gastrointestinal signs and symptoms will be present with chronic kidney disease

A

-anorexia
-nausea
-vomiting

167
Q

what integumentary signs and symptoms will be present with chronic kidney disease

A

pruritus- urea
-uremic frost - high urea concentration in sweat
-ecchymosis - bruising

168
Q

what pulmonary signs and symptoms are present during chronic heart failure

A

pulmonary edema

169
Q

what musculoskeletal signs and symptoms will be present with chronic kidney disaese

A

-muscle weakness and cramps due to electrolyte imbalances
-bone density loss due to decreased calcium

170
Q

what urinary signs and symptoms are present with chronic kidney disease

A

oliguria or anuria

171
Q

what diet should a person with chronic kidney disease be on

A

-high calorie
-low protein
-low sodium, potassium, phosphorus
-increased calcium
-fluid restriction

172
Q

medication therapy for chronic kidney disease

A

-diuretics
-antihypertensives
-phosphate binders
-vitamin d and calcium supplements
-sodium polystyrene sulfonate

173
Q

when are diuretics given to a patient with chronic kidney disease and why

A

given early in disease to increase output medication doesnt work if kidneys dont work

174
Q

when are phosphate binders given for chronic kidney disease and why

A

given with meals to decrease phosphate levels
medications bind to phosphate and excrete through stool

175
Q

why are sodium polystyrene sulfonates given for chronic kidney disease

A

laxative that binds to potassium to rid body of excess potassium

176
Q

artificial kidney machine to remove waste products and excess fluid from body/blood

A

hemodialysis

177
Q

when is hemodialysis started

A

when patient develops severe fluid overload, hyperkalemia, acidosis, or other life threatening symptoms

178
Q

patients must go to the dialysis center ____ days a week for _____ hours to have their blood dialyzed

A

three days a week for 3-4 hours

179
Q

dialysis is usually scheduled what days of the week

A

m-w-f
tu-th-s

180
Q

if a patient misses a dialysis session if could be life threatening due to ____ and ____

A

toxic waste and fluid build up

181
Q

what is common for a patient after dialysis treatment

A

weakness
fatigue
hypotension

182
Q

what should you do before sending a patient to dialysis

A

-obtain morning weight
-ensure all care is provided
-encourage patient to eat breakfast

183
Q

once a patient returns to your care from dialysis what are the priorities

A

-vital signs
-weight
-focused assessment
-monitoring for bleeding from the access site
-encourage rest

184
Q

central line access for hemodialysis is surgically inserted through the what

A

internal jugular vein

185
Q

a central line may exit thee body through the ____ or _____

A

neck or chest

186
Q

a central line access is a ______ access site

A

temporary

187
Q

central line access is not used long term due to increased what

A

risk for infection

188
Q

a central line access is used until when

A

and AV fistula or graft matures and is ready

189
Q

a central line access should only be used for what and what must you ensure with the line

A

only used for dialysis and must ensure line does not get clotted

190
Q

nursing priorities for central line access

A

-keep clean and dry
-change dressing when required using sterile technique
-assess site for signs and symptoms of infection and bleeding

191
Q

surgical procedure where a vein and artery are sewn together under the skin

A

fistula

192
Q

surgical procedure that uses synthetic tubing to attach an artery and a vein

A

graft

193
Q

fistula and graft access are ______ access sites

A

permanent

194
Q

it is not necessary for you to identify if the permanent dialysis access is a fistula or graft but you must realize it is ______

A

present

195
Q

after the patient returns from dialysis there will be a bandage over the site when can it be removed?

A

4-6 hours after dialysis

196
Q

the access site doesnt need to be covered with a bandage any other time as it is what?

A

closed off to the outside

197
Q

nursing priorities for a fistula/graft

A

-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

198
Q

to assess a site for patency you can assess for a ____ or _____

A

thrill or bruit

199
Q

how do you assess for a thrill

A

-use fingers and place them over the access site
-palpate for a tremor

200
Q

how do you assess for a bruit

A

-place the diaphragm of the stethoscope over the access site
-auscultate for a swishing/whooshing sound

201
Q

a decreased thrill or bruit or absence of either indicate what and what should you do

A

indicates occlusion, notify HCP immediately

med surg (7 decks)

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