Term 3 Flashcards
What is rheumatoid arthritis ?
- A systemic inflammatory disease
- it affects the whole body
What are 3 different type of arthritis ?
Osteoarthritis
Gout
Rheumatoid arthritis
What are signs and symptoms of rhematoid arthritis ?
Painful joints
Morning stiffness
Why is morning stiffness common rhematoid arthritis ?
- Patient did not use their joint all night
- When joint is not used it stiffens
What do patients with rhematoid arthritis have to do to prevent joint deformity ?
- Excersize in moderation
- Pace activities
What caused joint deformity in patients with RA ?
- immobility
- an inflammatory process
How long should an RA patient use their joint ?
- to the point of pain
- when it becomes uncomfortable stop and rest the joint
When you have RA , what happens if you don’t use the joint ?
The tendons and ligament shrink upon contraction
When the tendons and ligaments shrink upon contraction , what does it cause ?
Joint deformities
What is bony ankalosis , that sometimes happen with patients with RA ?
An overgrowth of bones
What produces bony ankalosis ?
The osteoblasts produce it and becomes irregular and tend to infringe on other joints and break off
What can bony ankalosis do ?
- it fuses joints together
- It’s not a good thing
Why do patients with RA do ROM ?
-it assist with the prevention & the reduction of the affects of the disease
Within the limits of pain
What test are done to diagnose RA ?
- sedimentation
- ESR ( Erythrocyte sedimentation rate )
What kind of surgery is done if a joint was destroyed because of RA ?
Arthroplasty
What is arthroplasty ?
To repair a damaged joint orthopedicaly
What causes gout ?
An excess overproduction of uric acid
Where does uric acid crystals settle ?
In the great toe joint ( big toe joint )
What does the uric acid in the great toe cause ?
An inflammatory process
What type of test is done for uric acid ?
Uric acid test
What type of diet is used for patients with gout ? To limit it
No purine diet (organ meat )
What is the treatment or prevention for gout ?
Low purine diet
What kind of disease is osteoarthritis ? ( degenerative arthritis )
- a degenerative disease
- wear and tear disease
What does osteoarthritis affect / what joint ?
The weight bearing joint
How does rhematoid arthritis affect the joint / on what side ?
Bilaterally
On both side
How/where does osteoarthritis affect the joint, on what side ?
- One joint
- On one side of the body
What are signs and symptoms of osteoarthritis ? How does a patient feel when they wake up in the morning ?
Feel fine
- because joint were not being used
How does a osteoarthritis patient feel when they start using their joint ?
- They become uncomfortable
- Patient should stop activity and rest the joint , then start again
What are sign and symptom of osteoporosis ? (Degenerative disease )
Pathological fractures
What causes osteoporosis ?
- Decrease bone density
- Demineralization
- loss of phropous and calcium in the bone
What type of people is osteoporosis common in ?
Females
Post menopausesal
What are patient with osteoporosis more vulnerable too ?
- Pathological fractures
- Hip break (cause pt to fall )
- Compression fracture of the vertebrae
- pain and injury
Where do pathological fracture commonly occur ?
Hips and knees
What is the disease process for pathological fratures with patient with osteoporosis ?
Insufficient bone mass
What is the cause of pathological fractures with a patient with osteoporosis ?
Weak bones
Brittle bones
What is the treatment for osteoporosis ?
Calcium supplement
Low diet to keep phrospous and calcium in the bone
No smoking
No alcohol
What is osteomyelitis ?
-Infection of the bone surrounding tissue
What is osteomyelitis treated with ?
Antibiotics
What is green stick fracture ?
- Splinter on one side and bends on the other
- Like the branch of a tree
What is a closed fracture (simple fracture ) ?
Skin intact over the break
What is a pathological fracture ?
- Osteoporosis
- Caused by a disease
- Malnutrition
What is a compound fracture (open ) ?
Break in the skin with or without portrution of the bone
What is the most dangerous type of fracture ?
Compound fracture
What kind of shot would a patient with compound fracture get ?
- Tetanus shot
- because it opens into the tissue
What is a commutive fracture ?
- bone is broken into small pieces
What is fatty embolism syndrome ? S/s
Confusion
Petechia (classic )
Restlessness- as a result of hypoxia
Dyspnea
Where are petechia found ?
Neck, chest , axillary area
Like a fine rash
What is compartment syndrome ?
When muscle are contained within the fossia an tend to swell
What are s/s of compartment syndrome ?
-Abnormal nerovascular checks
- severe pain (opioids do not relieve )
- edema
- parthesia
Numbness/ tingling
Inability to wiggle toes or feet
Absent /decrease pulse - arterial blood
What does arterial blood do ?
Carries oxygen
What is thrombosis ?
- clot formation
- positive Homans sign
- pain / redness
- warmth in the leg
Post op care for RA/OA
Respiratory and circulatory complication
For replacement -Drains in the knee or hip joint
What are nursing intervention for RA /OA after surgery ?
Check gravitational bleeding / slide your hand under the pt and feel
What is gravitational bleeding ? Hip or knee surgery
Seeking the lowest point
Behind the neck , buttocks or knee
What are we checking when doing nerovascular check ?
Loc Pulselessnes distal and proximal Sensation Capillary refill Color - should not be blanch or cynotic temp /Warm
How can you tell if a pulse is absent or different from each other ?
Check them together at the same time ?
Where do you check capillary refill and for how long ?
The toe or thumb for 3 sec
What is the best way to change a patient in traction bed linens ?
Top to bottom
Bottom to top
Avoid changing side to side
If your caring for a cast in traction and you don’t get out of bed , what good body mechanics would you use ?
Wide sterdy base
It decrease the risk of injury
If your having hip replacement surgery what don’t you want to do ?
- Don’t internally rotate the feet (stand pigeon toe
- don’t bend over to pic up items of the floor (pop ball out of the acetabulum )
- don’t sit with legs crossed ( it put strain in the joint )
If a patient is in skinner skeletal traction, what is the purpose of good body alignment ,o
- for healing purposes
- To keep the bone in alignment
- to prevent muscle spasm
- To prevent contracture from happening
How do you handle a wet cast / new ?
Palms of the hand
What do we have to be concerned about with cast care ?
Skin integrity
Sensation
What is bucks traction ? (Skin traction )
A straight pull on the limb
What is Bryant’s traction ? (Skin traction )
- Vertical extension of the lower extremities
- used with children only
- butt if off the bed
What is Russell traction ? ;Skin traction )
Popliteal Sling placed behind the knee/neck to create upward pull of the knee (for femur fracture )
Skeletal fracture
What is Kirshner wire or steimann pins
- Surgically inserted through the skin and bones
- sterile procedure
What is crucfield ? (Skeletal fracture )
For spinal fracture
Inserted in the skull
What is halo ? (skeletal traction)
- For cervical fracture
- Pins , wire , tongs
How do you care for pins ?
One swab per pin
Use hydrogen peroxide or Benadine ( depend on the facility )
Normal saline
What kind of procedure is used for pins ?
Sterile procedure
Sterile gloves
What is traction ?
- Balance traction
- Pullin traction in two direction to align the bone
- Body acts as counter traction
How do you decrease osteoporosis ?
- Regular excersize w / weight bearing
- Decrease weight to normal
- Dietary prevention
- encourage activity
How do you care for patients equipment ?
- Inspect ropes , polleys , knots are in alignment
- the ropes are not frail
- check for skin care
If a patient is inambulatory what do you want to make sure they have ?
Adequate hydration
-2000- 2500 cc a day
When we have a patient that had amputation , what type of contractures are we concerned about ?
- hip flexion contracture
contractures are shorting of the muscle
What kind of position do we expect the doctor to order for and amputation patient ?
- prone position
- 1-2 hrs or as ordered
When you have a patient in traction , what do you do with the weight ? Or if the pt is on the floor
Don’t touch it
- if pt on floor pull them up
- do not change or discontinue the weight
What is the best position for a fracture hip / prothethesis pt be kept in ?
-Abduction
- if hip abduction pillow
physician can make a order to be turned on any side (specified)
A patient that has been on bedrest for a Long time (fracture ,muscle spasm ) what complication can they have , when getting out of bed ?
Decrease b/p
Othostatic hypotension
What do you do to prevent orthrostatic hypotension ?
Dangle the patient
When a patient have a fiberglass or plater how should it be position ?
- Elevate above heart level to prevent edema
- Check toes and fingers for circulation
- Do not place the cast in a dependent position
Before a patient have a planned surgery what should they do ?
- go to rehab
- visit other amputees
What is lordosis ?
Increase causing Swayback
Curvature of the lumbar
What is kyphosis ?
Hunchback
Curvature of the Thoriac cavity
What is scoliosis ?
Unilateral or bilateral curvature
Curvature of lumbar spine
Patient with OA , do what kind of procedures on outpatient basis ?
Orthoscopic 3-4 incision on the knee
Done under general anesthesia
What kind of bandage are patient that had othroscopic produces sent home with ?
- Bandaid on the incision and ABD pad
- Ace bandage on the entire knee to prevent edema
- do a neuro check on patient
What do you do if you go into a patient room and see something abnormal ?
Do a through assessment
Pain assessment
Neuro assessment
What sign is associated With DVT ?
Homans sign
Compression fractures of the vertebrae is common with what type of patient ?
Osteoporosis
Bouchard’s nodes:
:
enlargment of proximal interphalangeal joints
Herberden’s nodes
OA, appear on dorsigluteal aspect of the distal interphalangeal joints, joints closest to the ends of fingers and toes.
