medsurg lecture 6 Flashcards
(201 cards)
1
Q
the muscular system is made of what
A
muscle and tendons
2
Q
what are the functions of the muscular system
A
-movement
-heat production
-blood return in legs
3
Q
what connects muscle to bone
A
tendons
4
Q
what is the skeletal system made of
A
bones, cartilage and ligaments
5
Q
what are the functions of the skeletal system
A
-movement
-protection
-calcium storage
6
Q
what connects bone to bone
A
ligaments
7
Q
how many bones are in the body
A
206
8
Q
two types of the skeletal system
A
axial and appendicular
9
Q
skull, vertebral column and rib cage are part of what
A
axial skeleton
10
Q
limbs, shoulders, pelvic bones, and synovial joints are part of what
A
appendicular skeleton
11
Q
the appendicular skeletons function is what
A
movement
12
Q
the axial skeletons function is what
A
protection
13
Q
how many skeletal muscles are there
A
about 700
14
Q
the muscles are anchored to bones by _______
A
tendons
15
Q
agonist muscle is
A
prime mover
16
Q
antagonist muscle is
A
opposite action of the agonist
17
Q
synergist assists what
A
the primary moving muscle
18
Q
the muscular system maintains ____ and ______ motor control
A
balance and fine
19
Q
agonist and antagonist have to work ______
A
opposite
20
Q
if agonist and antagonist contract at the same time what would happen
A
they body wouldnt be able to move
21
Q
agonist, antagonist and synergist muscles do what
A
all work together for movement
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
23
Q
subjective data of an assessment history
A
-injuries
-disorders
-occupation
-nutritional history
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
25
physical exam assessment - inspection
-posture
-gait
-mobility aids
-deformities/swelling
-crepitation
26
physical assessment - palpation
-warmth
-tenderness
-neurovascular checks (six Ps)
27
total physical exam assessment for musculoskeletal system includes what
inspection, palpation, range of motion, muscle tone
28
diagnostic imaging for musculoskeletal system
bone density scan
xray
ct
mri
29
diagnostic labs for musculoskeletal system
-alp
-calcium
-creatinine kinase
30
what will ALP labs show for musculoskeletal system
elevation with new bone formation if there was a break or fracture
31
what will creatinine kinase show for musculoskeletal system
elevated with muscle damage
32
soft tissue injury that occurs when a muscle or tendon is excessively stretched
-strain
33
three categories of strains
-mild
-moderate
-severe
34
minimal inflammation of tissue with swelling and tenderness is considered what categories of strain
mild
35
partial tearing of the tissue with pain and inability to move affected part is considered what type of strain
moderate
36
tissue is ruptured with separation with severe pain and disability is considered what type of strain
severe
37
with severe strain what should we do to prevent further damage to the tissue
immobilize
38
excessive stretching of ligaments
sprain
39
what are the three categories of sprains
-mild
-moderate
-severe
40
tearing of a few ligament fibers with tenderness is considered what type of sprain
mild
41
more fibers are torn but stability of the joint is not affected with uncomfortableness with activity is considered what type of sprain
moderate
42
instability of the joint is considered what type of sprain
severe
43
a severe sprain usually requires what
surgical intervention for repair
44
a moderate sprain may require what
immobilization
45
nursing interventions for strains and sprains
-rest
-ice
-compression
-elevation
-nsaids
-muscle relaxers
46
a break in a bone is called a what
fracture
47
what are some causes of fractures
tramua
pathological from disease
48
how are fractures categorized
-open
-closed
49
a fracture that breaks skin
open
50
a fracture that doesnt break the skin
closed
51
what is the patient at risk for when they have an open fracture
infection
52
signs and symptoms of a fracture
-pain
-decreased ROM
-deformity
-swelling
-bruising
53
deformities with a fracture
-limb rotation
-shortening of limb
-protrusion of bone
54
diagnostic tests for a fracture
-xray
-ct
-mri
-calcium levels
-RBCS, hgb, hct
55
what is the first line imaging for a fracture
xray
56
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
57
soft tissue damage, ligaments and tendons can be seen with this diagnostic test
MRI
58
less invasive immobilizers
-splints
-casts
59
more invasive immobilizers
-closed reduction
-open reduction with fixation devices
60
removable immobilization using elastic wrap used for swelling and wound care
splints
61
stronger support using plaster cast that is worn for longer periods of time
cast
62
splints are important in the first stages of injury to what
assess for swelling and provide wound care
63
manual realignment with immobilization by splint or cast
closed reduction
64
surgical intervention to realign the fractures
open reduction with fixation
65
fixation devices
plates, pins, screws and rods
66
fixation devices can be placed ______ and ______
internally and externally
67
what is the most important thing to remember when external fixation devices are in place
infection control. must keep sites clean
68
complications of fractures
-infection
-DVT or PE
-compartment syndrome
69
reduction of circulation due to increased swelling
compartment syndrome
70
signs and symptoms of compartment syndrome
-severe pain not relieved with opioids
-decreased sensation
-ischemia to limb
71
how can you check for ischemia to a limb with compartment syndrome
six Ps
72
what is the first sign to look for with compartment syndrome
decreased sensation
73
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
74
nursing interventions for fractures
-emergency care
-pain management
-monitor for complications
-encourage nutrition for healing
-physical therapy/ROM
-assist with ADLs and mobility
75
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
76
when immobilizing a fracture splint in as it _____
lies
77
metabolic disorder of low bone mass and deterioration of bone structure
osteoporosis
78
porous or fragile bones are more prone to ______
fractures
79
what bones are most affected by osteoporosis
-spine
-wrist
-hips
80
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
81
modifiable risk factors for osteoporosis
-low calcium and vitamin d intake
-excessive caffeine, protein, sodium
-sedentary lifestyle
-excessive alcohol use
-cigarette smoking
82
signs and symptoms of osteoporosis
-may go unnoticed until facture occurs
-decrease in height
-kyphosis
-pain may or may not be present
83
how do you diagnose osteoporosis
dexa scan
84
what is a dexa scan
lose-dose xray to identify low bone density in the hip and spine
85
nursing interventions for osteoporosis
-calcium and vit d supplements or diet intake
-reduce risk factors
-exercise
-fall prevention
-bisphosphonates
86
what kind of exercise should be encouraged for osteoporosis
-weight-bearing to promote bone building
-walking is the best to encourage in older patients
87
what binds to the bones to prevent breakdown
bisphosphinates
88
two examples of bisphosphonates
-alendronate (fosamax)
-risedronate (actonel)
89
parts of the urinary tract
-two kidneys
-two ureters
-urinary bladder
-urethra
90
parts of the kidneys
-cortex
-medulla
-calyx
-renal pelvis
91
what is the outer region of the kidney
cortex
92
what is the inner region of the kidney
medulla
93
this contains the renal pyramids where urine formation occurs
medulla
94
this part of the kidney collects urine leaving the renal pyramids
calyx
95
this part of the kidney receives collected urine to continue to the ureter
renal pelvis
96
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
97
urine allows removal of excess _____, waste products and excess ______
products
materials
98
the kidneys regulate _______ or _______ of fluid and electrolytes
excretion or conservation
99
the kidneys regulate acid-base balance and forms ______
bicarbonate
100
what end products of metabolism do the kidneys excrete
urea
101
what is the importance of activation of vitamin d by the kidneys
required for calcium absorption
helps regulate calcium levels in the body
102
erythropoietin stimulates the bone marrow to produce what
red blood cells
103
renin is a powerful ______
vasoconstrictor
104
labs to asses kidney function
-BUN
-creatinine
-eGFR
-creatinine clearance
105
normal BUN levels
10-20
106
normal creatinine levels
0.6-1.2
107
normal egfr levels
>60
108
normal creatinine clearance levels
about 120
109
urine formation in the nephrons
-glomerular filtration
-tubular reabsorption
-tubular secretion
110
blood pressure forces water and small solutes out of the glomerular and into bowman capsules forming renal filtrate
glomerular filtration
111
renal filtrate then enters the renal tubules where reabsorption of useful materials from the filtrate is returned to the capillary system
tubular reabsorption
112
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
113
what happens in the ureters during urine emilination
smooth muscle walls contract in peristaltic waves to propel urine into the bladder
114
the ureters extend from the _______ connecting to the bladder
kidneys
115
what happens in the bladder during urinary elimination
the bladder fills, expands and compressed the lower ends of the ureters to prevent backflow
116
what is the muscular sac that temporarily holds urine for excretion
bladder
117
release of urine from the bladder to the urethra involving the relaxation of urethral sphincters
urination
118
urination occurs with the relaxation of the ______ and _____ sphincters
internal and external
119
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
120
what happens to the bladder as we age
-decreased bladder size and muscle tone that causes:
-dysuria
-increased frequency
-incontinence
-urine retention
121
what happens to males urinary system as they age
prostate enlarges causing urine retention and difficulty voiding
122
what happens to females urinary system as they age
-pelvic floor muscles weaken
-more prone to UTIs and incontinence
123
the urinary tract is sterile beyond the _____
urethra
124
invasion of the urinary tract by bacteria
UTI
125
UTIs are often caused by and ______ infection
ascending
126
two lower uti names
urethritis
cystitis
127
urethritis is an infection where
urethra
128
cystitis is an infection where
the bladder
129
two upper utis are called what
pyelonephritis
ureteritis
130
pyelonephritis is an infection where
they kidney
131
ureteritis is an infection where
the ureter
132
utis are the most common hospital acquired infection due to _____
catheters
133
UTI risk factors
-urine stasis
-contamination
-prior utis
-female anatomy
-aging
134
examples of urine stasis
-incomplete bladder emptying
-obstruction
-not voiding frequently
135
examples of contaimination
-improper wiping/hygiene
-sexual intercourse
-instrumental
-piercings
136
signs and symptoms of UTI
-increased urgency
-polyuria
-dysuria
-foul-smelling, cloudy urine
-hematuria
137
signs and symptoms of uti in older adults
-fatigue
-confusion
-delirium
138
signs and symptoms with cystitis
pelvic pain or pressure
139
signs and symptoms with pyelonephritits
-flank tenderness
-high fever
-chills
-nausea and vomiting
140
diagnosis of a uti
-risk factors present
-signs and symptoms
-inspection of urine (volume, color, concentration, cloudiness, odor, blood)
-urinalysis
-urine culture
141
nursing care for uti
-antibiotic administration
-pain control
-monitor I/Os
-proper foley cath care
-education
-prevention
142
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
143
what education should the nurse give for UTI
-take all antibiotics as prescribed
-increase fluid intake
144
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
145
chronic kidney disease is _____ and ______
progressive and irreversible
146
with chronic kidney disease there is a ______ decrease in kidney function
gradual
147
in the early stages of chronic kidney disease the patient usually what
doesnt experience any symptoms
148
with chronic kidney disease a large proportion of _______ are damaged
nephrons
149
when a person has chronic kidney disease the body is unable to maintain ______, _____, and ______ balance
metabolic, fluid and electrolyte
150
which body systems does chronic kidney disease affect?
all of them
151
which disease progresses to chronic kidney disease
acute kidney disease
152
uncontrolled HTN causing _______ can cause chronic kidney disease
nephrosclerosis
153
_______ nephropathy can cause chronic kidney disease
diabetic
154
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
155
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
156
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
157
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
158
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
159
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
160
what electrolyte changes occur with chronic kidney disease
hyperkalemia and hypocalcemia
161
what lab values will be elevated with chronic kidney disease
-bun
-creatinine
162
what lab values will be decreased with chronic kidney disease
-eGFR
-creatinine clearance
-RBC
-hgb
-hct
163
what neurological signs and symptoms will be present with chronic kidney disease
-weakness
-fatigue
-confusion
164
what hematological signs and symptoms will be present with chronic kidney disease
anemia
165
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
166
what gastrointestinal signs and symptoms will be present with chronic kidney disease
-anorexia
-nausea
-vomiting
167
what integumentary signs and symptoms will be present with chronic kidney disease
pruritus- urea
-uremic frost - high urea concentration in sweat
-ecchymosis - bruising
168
what pulmonary signs and symptoms are present during chronic heart failure
pulmonary edema
169
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
170
what urinary signs and symptoms are present with chronic kidney disease
oliguria or anuria
171
what diet should a person with chronic kidney disease be on
-high calorie
-low protein
-low sodium, potassium, phosphorus
-increased calcium
-fluid restriction
172
medication therapy for chronic kidney disease
-diuretics
-antihypertensives
-phosphate binders
-vitamin d and calcium supplements
-sodium polystyrene sulfonate
173
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
174
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
175
why are sodium polystyrene sulfonates given for chronic kidney disease
laxative that binds to potassium to rid body of excess potassium
176
artificial kidney machine to remove waste products and excess fluid from body/blood
hemodialysis
177
when is hemodialysis started
when patient develops severe fluid overload, hyperkalemia, acidosis, or other life threatening symptoms
178
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
179
dialysis is usually scheduled what days of the week
m-w-f
tu-th-s
180
if a patient misses a dialysis session if could be life threatening due to ____ and ____
toxic waste and fluid build up
181
what is common for a patient after dialysis treatment
weakness
fatigue
hypotension
182
what should you do before sending a patient to dialysis
-obtain morning weight
-ensure all care is provided
-encourage patient to eat breakfast
183
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
184
central line access for hemodialysis is surgically inserted through the what
internal jugular vein
185
a central line may exit thee body through the ____ or _____
neck or chest
186
a central line access is a ______ access site
temporary
187
central line access is not used long term due to increased what
risk for infection
188
a central line access is used until when
and AV fistula or graft matures and is ready
189
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
190
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
191
surgical procedure where a vein and artery are sewn together under the skin
fistula
192
surgical procedure that uses synthetic tubing to attach an artery and a vein
graft
193
fistula and graft access are ______ access sites
permanent
194
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
195
after the patient returns from dialysis there will be a bandage over the site when can it be removed?
4-6 hours after dialysis
196
the access site doesnt need to be covered with a bandage any other time as it is what?
closed off to the outside
197
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
198
to assess a site for patency you can assess for a ____ or _____
thrill or bruit
199
how do you assess for a thrill
-use fingers and place them over the access site
-palpate for a tremor
200
how do you assess for a bruit
-place the diaphragm of the stethoscope over the access site
-auscultate for a swishing/whooshing sound
201
a decreased thrill or bruit or absence of either indicate what and what should you do
indicates occlusion, notify HCP immediately
