Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NSG 430 - Critical Care > T7: Muscular Dystrophy and Acute Low Back Pain and Intervertebral Disc Disease > Flashcards

T7: Muscular Dystrophy and Acute Low Back Pain and Intervertebral Disc Disease Flashcards

1
Q

muscular dystrophy

A

group of inherited diseases characterized by progressive symmetric wasting of skeletal muscles with no evident neurological involvement
(no cure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the blood test for muscles

A

CK (creatine kinase)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

diagnostics for muscular dystrophy

A

*Creatine kinase
*EMG testing
*Muscle fiber biopsy (Fat and connective tissue deposits and dystrophin)
*ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

due to progressive weakness and deformity, what my be considered fo muscular dystrophy

A

ambulatory devices, braces, PT, activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the biggest concern in muscular dystrophy

A

heart failure and respiratory failure because their intercostal muscles and heart muscles are wasting and getting weak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

those with respiratory failure and muscular dystrophy are often…

A

Ventilator-CPAP dependent with tracheostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

supportive treatment fro muscular dystrophy

A

steroids (delay progression for up to two years but increases risk of fracture because steroids leech calcium out of the bone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

localized back pain

A

*patients will feel soreness or discomfort when a specific area of the lower back is palpated or pressed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

diffuse back pain

A

*Diffuse pain occurs over a larger area and comes from deep tissue layers.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

radicular pain

A

pain is caused by irritation of a nerve root. Radicular pain is not typically isolated to a single location, but instead radiates or moves along a nerve distribution.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

referred pain

A

*pain is “felt” or perceived in the lower back, but the source of the pain is another location (e.g., kidneys, lower abdomen).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

risk factors for low back pain

A

*Lack of muscle tone
*Excess body weight
*Pregnancy
*Stress
*Poor posture
*Cigarette smoking
*Prior compression fractures
*Congenital spinal problems
*Family history of back pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

thoracic nerve damage may cause

A

GI or bladder dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

diagnostics for acute low back pain

A

*Straight-leg raising test
* Crossover straight leg test
* Trendelenburg test
*MRI and CT scan only for trauma or suspected systemic disease
*Lasts 4 weeks or less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

symptoms of acute low back pain

A

*Symptoms usually appear within 24 hours
*Muscle ache to shooting/stabbing pain
*Limited flexibility/ROM
*Inability to stand upright

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

goals for the patient with acute low back pain

A

*Satisfactory pain relief
*Return to previous level of activity
*Correct performance of exercises
*Adequate coping
*Adequate self-help management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

health promotion for acute back pain

A

*Proper body mechanics
*“Back School”
*Appropriate body weight
*Proper sleep positioning
*Firm mattress
*Stop smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

outpatient treatment for acute back pain if not severe

A

*NSAIDs, muscle relaxants
*Massage
*Back manipulation
*Acupuncture
*Cold and hot compresses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

treatment for severe acute low back pain

A

*Corticosteroids
*Opioids-IV, PO, PCA, Patches, Long acting, Short acting (tramadol patches)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

teaching for patients with acute low back pain

A

*Cause of their pain
*Ways to prevent additional episodes
*Strengthening and stretching exercises

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

“DOs” of low back pain

A

*Sleep in a side-lying position with knees and hips bent
*Sleep on back with a lift under knees and legs or back with 10-inch-high pillow under knees to flex hips and knees
*Prevent lower back from straining forward by placing a foot on a step or stool during prolonged standing
*Maintain appropriate body weight
*Exercise 15 minutes in the morning and evening regularly
*Carry light items close to body
*Use local heat and cold application
*Use a lumbar roll or pillow for sitting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

“DO NOT” of low back pain

A

*Lean forward without bending knees
*Lift anything above level of elbows
*Stand in one position for prolonged time
*Sleep on abdomen or on back or side with legs out straight
*Exercise without consulting health care provider if having severe pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is an intervertebral disc

A

*Intervertebral discs separate vertebrae and help absorb shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

intervertebral disc disease

A

rupture or protrusion of the cushioning disc found between the vertebrae that results in pressure on the spinal cord or spinal nerve roots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Degenerative disc disease (DDD)

A

*results from increased wear and tear on the intervertebral discs with aging. The discs lose their elasticity, flexibility, and shock-absorbing abilities. Unless it is accompanied by pain, this wear and tear condition is a normal process.

26
Q

what do we do for bulging discs

A

reduce inflammation!
-NSAIDS and apply ice

27
Q

what do we do for herniated discs

A

corticosteroids and may need surgery (discectomy) to remove the disc

28
Q

process of Degenerative disc disease (DDD)

A

Disc becomes thinner as nucleus pulposus dries out → load shifted to annulus fibrosus → progressive destruction →pulposus seeps out (herniates)

29
Q

what is more causes a more serious issue with herniated discs

A

radiculopathy because the nerves of the spine become compressed

30
Q

S/S of radiculopathy

A

*Radiating pain
*Numbness
*Tingling
*↓ Strength and/or range of motion

31
Q

Intervertebral Disc DiseaseClinical Manifestations

A

Low back pain most common
*Radicular pain
*+ Straight leg raise
*↓ or absent reflexes-unilateral or bilateral
*Paresthesia
*Muscle weakness-muscle atrophy (Compare extremities-Grips and Pushes-circumference)

32
Q

HINT HINT: cauda equina syndrome (multiple root compression)

A

MEDICAL EMERGENCY- contact provider immediately
requires surgical decompression to reduce to pressure on the nerves to prevent permanent loss of function

33
Q

Multiple nerve root (cauda equina) compression clinical manifestations

A

*Sever low back pain
*Progressive weakness
*Increased pain
*Bowel and bladder incontinence

34
Q

cervical disc disease clinical manifestations

A

*Pain radiates to arms and hands.
*↓ Reflexes and handgrip
*May include shoulder pain and dysfunction

35
Q

innervation for cervical spine

A

breathing, heart, diaphragm

36
Q

what needs to be done to a patient with cervical disc disease

A

get a collar on them! then X-ray
never remove until c spine is clear

37
Q

Intervertebral Disc DiseaseDiagnostic Studies

A

*X-rays
*Myelogram, MRI, or CT scan
*Epidural venogram or discogram
*EMG

38
Q

conservative therapy for intervertebral disc disease

A

*Limitation of movement
*Local heat or ice
*Ultrasound and massage
*Skin traction
*Transcutaneous electrical nerve stimulation (TENS)
*Drug therapy
*Epidural corticosteroid injections
*Back-strengthening exercises
*Teach good body mechanics
*Avoid extremes of flexion and torsion

39
Q

drug therapy for intervertebral disc disease

A

*NSAIDs
*Short-term corticosteroids
*Opioids
*Muscle relaxants
*Antiseizure drugs, antidepressants (decrease the irritability of the nerve)

40
Q

when is surgical therapy for intervertebral disc disease indicated

A

*Conservative treatment fails
*Radiculopathy worsens
*Loss of bowel or bladder control
*Constant pain
*Persistent neurologic deficit

41
Q

Intradiscal electrothermoplasty (IDET)

A

*Minimally invasive outpatient procedure
*Needle inserted into affected disc
*Wire threaded into disc and heated → denervates nerve fibers

42
Q

Radiofrequency discal nucleoplasty (coblation nucleoplasty)

A

*Needle inserted similar to IDET
*Radiofrequency probe generates energy → breaks up nucleus pulposus
*Up to 20% of nucleus is removed
*Decompresses disc

43
Q

*Interspinous process decompression system (X Stop)

A

*Titanium →fits into mount placed on vertebrae
*To treat lumbar spinal stenosis
*Lifts vertebrae off pinched nerve

44
Q

Laminectomy

A

*Surgically remove disc through excision of part of vertebra

45
Q

*Diskectomy

A

*Surgically decompress nerve root
*Microsurgical or percutaneous technique

46
Q

Charite Disc

A

used in patients with lumbar disc disease associated with DDD. This artificial disc has a high-density core sandwiched between two cobalt-chromium endplates

47
Q

Spinal fusion

A

*Spine is stabilized by creating an ankylosis (fusion) of contiguous vertebrae
*Uses a bone graft from patient’s fibula or iliac crest or from a donated cadaver bone
*Metal fixation can add to stability
*Bone morphogenetic protein (BMP) to stimulate bone grown of graft

48
Q

After vertebral disc surgery, postoperative nursing interventions mainly focus on…

A

maintaining proper alignment of the spine until healing has occurred.

49
Q

Post lumbar fusion care

A

*Pillows under thighs when supine
*Between legs when side-lying

50
Q

reassuring patient after vertebral disc surgery

A

*The patient often fears turning or any movement that may increase pain by stressing the surgical area. Reassure the patient that proper technique is being used to maintain body alignment. Enough staff should be available to move the patient without undue pain or strain for the patient or staff.

51
Q

Spinal Surgery: Postoperative

A

*Opioids for 24 to 48 hours (IV)
*Patient-controlled analgesia (PCA)
*Switch to oral drugs when able
*Muscle relaxants (diazepam (valium))
*Assess and document pain intensity, and pain management effectiveness

52
Q

what do we monitor for since there is a potential for cerebrospinal fluid leakage after spinal surgery

A

*Monitor for and report severe headache or leakage of CSF
*Clear or slightly yellow drainage on dressing
*+ For glucose

53
Q

assessment post op for spinal surgery

A

*Frequently assess peripheral neurologic signs
*Every 2 to 4 hours during first 48 hours post surgery
*Compare with preoperative status
*Assess circulation (temp, capillary refill, pulses)
*Report changes from baseline or status immediately

54
Q

when a patient has a CSF leak, what do they complain of

A

BAD headache

55
Q

post spinal surgery how is the patient moves

A

lay flat and log roll

56
Q

what do we do for a CSF leak

A

give fluids (takes teh body 72 to turn fluid into CSF)

57
Q

post op spinal surgery: GI

A

*Monitor GI and bowel function- PARALYTIC ILEUS
*Administer stool softeners

58
Q

post op spinal surgery: GU

A

*Monitor and assist with bladder emptying-possible catherization
*Notify surgeon immediately if bowel or bladder incontinence, numbness or decreased sensation in the perineal area (Loss of tone may indicate nerve damage)

59
Q

rigid orthosis (thoracic-lumbar-sacral orthosis or chairback brace) teaching

A

Some surgeons want patients to be taught to apply and remove the brace by logrolling in bed. Others allow their patients to apply the brace in a sitting or standing position. Verify the surgeon’s preferred method before starting this activity.

60
Q

If surgery is done on the cervical spine, be alert for…

A

cord edema such as respiratory distress and a worsening neurologic status of the upper extremities.
-may be immobilized in a soft or hard cervical collar.

61
Q

Donor bone graft site care

A

*Regularly assess bone graft donor site (Posterior iliac crest or Fibula)
*Usually more painful than fusion area
*Pressure dressing (BONES BLEED)
*Neurovascular assessments if fibula is donor site
*CMS-watch for compartment syndrome

62
Q

Teaching regarding activity post op from spinal surgery

A

*Proper body mechanics
*Avoid prolonged sitting or standing.
*Encourage walking, lying down, shifting weight
*No lifting, twisting
*Use thighs and knees to absorb shock
*Firm mattress or bed board

NSG 430 - Critical Care (42 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions