test 3 Flashcards
hematoma
contusion with a large amount of bleeding
strain
stretching injury to a muscle or muscle tendon unit caused by mechanical overload
back
swelling, tenderness, sharp or dull pain
sprain
injury to a ligament surrounding a joint
loss of ability to use, rapid swelling, pain
ankle or knee
treatment of strains, sprains and contusions
Rest Ice-1st 24hrs Compression Elevation above heart severe injury may require surgery
diagnosis of S,S and C
X-ray show fracture
MRI-soft tissue
meds for S,S and C
analgesics
NSAIDS
muscle relaxants
dislocation
loss of articulation of the bone ends in the joint capsule following severe trauma
most common is shoulder
assessment of dislocation
5P pain pallor paresthesias pulse paralysis
treatment of dislocation
immobilization if necessary
pain relief
pt education
Phases of bone healing
inflammatory
reparative
remodeling
inflammatory phase
bleeding at site
may not see bruising right away
tissue tear
reparative phase
callus forms
2-3 weeks soft callus
4-8 weeks hard callus
2-3 months for repair
remodeling
new bone is laid down
osteoblasts
form new woven bone
may take a yr or more
osteoclasts
dissolve away callous as it is replaced by mature bone
bone may not be completely healed when cast removed
healing influenced by
age health nutrition treatment sought physical acitivty location and type of fx time for healing
complications of hip fractures
big deal pressure ulcers pneumonia anesthesia 50% of those over 80 don't go back to same living conditions
emergency care of fx
immobilization of fx
maintain tissue perfusion
open wounds
immobilization of fracture
above and below joint
maintain alignment
be creative
no stress on injury
maintain tissue perfusion
evaluate before/ after splinting
open wounds
sterile dressings
protect site from bacteria exposure
diagnostic tests for fx
history of incident and assess
x-ray
additional tests for other concerns
medications for fracture
pain meds-narcotics NSAIDS antibiotics anticoagulation stool softener
NSAIDS for fx
beware of bleeding
may interfere with initial bone healing
antibiotics for fx
open fractures
potential for infection
treatment of fx
surgery-in OR in 6hrs
Ext fixation-pins above and below
ORIF-put in alignment
traction
application of straightening or pulling force to maintain or return fracture bone in normal alignment, prevent muscle spasms
complications of bedrest
complications of immobility
skin breakdown
problems urinating
constipation
kidney stones
casting
rigid device applied to immobilize bones and promote healing
long term splint
extends above and below fx
plaster cast
needs 48-72hrs to dry
wait to dry to bear weight
swelling will cause cast to be too tight
don’t get wet
fiberglass cast
used in ER for nondisplaced fx
hardens within an hr
can get wet
complications from casts
compartment syndrome fat embolism syndrome VTE infection reflex sympathetic dystrophy
compartment syndrome
excess pressure in limited space constricting structures within and reducing circulation to muscles and nerves
bruising, swelling, compression
results from hemorrhage, edema or swelling
may result in ischemia
develops in 48hrs
symptoms of compartment syndrom
increasing pain in distal
decreased sensation
loss of motion
decreased distal pulses
interventions for compartment syndrome
bivalve cast
fasciotomy
elevate limb
call OR
fat embolism
fat globules lodge in pulmonary capillaries, no blood flow
long bone fracture
symptoms of fat embolism
dyspnea
cyanosis
petechiae on chest
VTE
blood clot forms in intimal lining of large vein
keep an eye on respiratory status
Precursors to VTE
venous stasis
injury to blood vessels
altered blood coagulation
symptoms of VTE
swelling
tenderness
pain sometimes
treatment of VTE
early immobilization TED hose anticoagulants heparin coumadin
delayed or non-union
prolonged healing of the bones beyond usual period poor nutrition severe trauma age poor alignment inadequate immobilization
treatment of delayed or non-union
surgery
debridement
amputation
partial or total removal of body part
causes of amputation
PVD/PAD
poor circulation
trauma
interruption of blood flow either acute or chronic
goals of amputation
alleviate pain, ulcerations
maintain healthy tissue
increase functional outcome
amputation site healing
assess circulation
rigid or compression dressing to prevent infection
stump wrapped in ACE wrap to prevent edema and maintain shape
complications of amputations
infection delayed circulation if circulation isn’t good
chronic stump pain
phantom limb pain(lyrica,neurontin)
contracture
repetitive use injuries
carpal tunnel
bursitis
carpal tunnel
compression of median nerve in wrist numbness and tingling in thumb and index finger pain inferes with sleep surgery to fix
bursitis
inflammation of bursa(enclosed sac between muscle and tendon)
tender, hot, red, swollen joint with pain of flexion
shoulder and hip most common
collaborative care of repetitive use injuries
pain relief-splint
increasing mobility
rehabilitation
avoid activities that increase risk
treatment of repetitive use injuries
NSAIDS to decrease inflammation
steriod injections into site
immobilization
surgery
osteoarthritis
most common form of all arthritis
loss of articular cartilage and hypertrophy of bones at articular cartilage
male more often until age 55
risk factors of osteoarthritis
age excessive weight inactivity strenuous, repetitive exercise hormonal factors genetics
patho of osteoarthritis
cartilage lining joints degenerates, falls apart
bone spurs form along edges of joints
symptoms of osteoarthritis
gradual, progressive onset pain and stiffness referred pain immobility decreased ROM boney overgrowth
treatment of osteoarthritis
Tylenol NSAIDS corticosteroid joint injections PT rest using ambulation devices weight loss analgesic and anti-inflammatory meds surgery
joint arthroplasty
total joint
most common for hips and knees
also done for shoulder and elbows
complimentary therapies for osteoarthritis
magnet or copper therapy
anti-inflammatory diet
nutritional supplements
yoga
osteoarthritis nursing care
promote comfort maintain mobility pain mobility self-care deficit
low back pain
most often due to strain of muscles and tendons of back caused by abnormal stress or overuse
patho of low back pain
local pain-figure out cause
radicular pain-herniated disc
muscle spasm pain-may be accompanied by poor posture
symptoms of low back pain
mild to chronic pain
gait
loss of bowl or bladder movement
treatment of low back pain
NSAIDS steroids avoid narcotics lying down initially application of heat/ice PT
nursing diagnosis for low back pain
acute pain
deficit knowledge
risk for impaired adjustment
back pain with herniated disc
rupture of cartilage surround disc with protusion of nucleus pulposus
pain radiates
L4, L5, C5-6, L5-S1
changes with aging
pahto of herniated disc
occurs spontaneously or with trauma
abrupt herniation causes pain and muscle spasm
gradual occurs with degenerative changes
symptoms of lumbar disc
recurrent episodes of pain, radiate to butt and lower extremities
foot drop
paresthesias and numbness
symptoms of cervical disc
pain in should, arm or neck
paresthesias and muscle spasm
diagnosis of herniated disc
MRI
CT
X-Ray if not done before
EMG
contusion
bleeding into the soft tissue
blunt force
bruise
shingles
varicella zoster virus people over 50, especially immunocompromised lesions follow path of dermatome very painful lesions 3-5 day recovery 3-6 weeks chicken pox vaccine
treatment of shingles
nerve blocks
antiviral agents-acyclovir
nursing diagnosis for shingles
acute pain
disturbed sleep pattern
risk for 2nd infection
migraine headaches
dilation and inflammation of intracranial arteries
migraine triggers
stress hormones BS levels fatigue bright light
symptoms of migraines
one sided throbbing pain hypersensitivity pain N/V aura
migraine meds
NSAIDS narcotics caffeine containing meds triptanes topomax elavil
migraine nursing diagnosis
pain meds
minimize light, noise and activity
application of heat and cold
education
seizures
episodes of abnormal, sudden discharge of electrical activity within the brain
idiopathic or primary
secondary or acquired
acquired seizure cause
head injury
CNS infection
brain tumor
seizure prevention
safety
lead poisioning
high risk pregnancy
childhood infections
tonic-clonic seizure
most common in adults
aura
post idal
complex partial
limited area of the brain
1-3 min
dont recall
aura
absence
most common
lasts seconds
simple partial
repetitive movements with memory and awareness
aura
status epilepticus
lasts over 5 min
in and out for 30
meds for control of seizures
IV valium
ativan
seizure lifestyle concerns
eliminate factors that cause
have a regular routine
impact on employment and transportation
seizure nursing diagnosis
altered brain perfusion
alteration of self image
low self esteem
anxiety
dilantin
seizure med most widely used empty stomach purple glove syndrome-reaction measle like rash-reaction
tegretol
preferred due to fewer side effects
increasing doses over time
rash and photosensitivity-reaction
depakote
always give with food
rare to have side effects
trigeminal neuralgia
chronic disease involving cranial nerve 5
idiopathic
flu, trauma, infection
symptoms of trigeminal neuralgia
sudden, severe facial pain
frequent or remission
unilateral
triggers of trigeminal neuralgia
infection
viral infection
trauma
pressure on trigger zone
meds for trigeminal neuralgia
anticonvulsants-tegretol
neurontin
muscle relaxants
lyrica
microvascular decompression
small incision
quick pain relief
steriotactic radiosurgery
elderly
radiation aimed at the spot
relief in 3-4 weeks
rhizotomy
severe nerve root by injection
tigeminal neuralgia nursing diagnosis
pain
risk for altered nutrition
bells palsy
7th cranial nerve disorder unilateral weakness of the facial muscles paralysis of the face 80% recover self care deficit, prevent injuries
symptoms of bells palsy
minimal to severe sudden onset pain behind ear or jaw before paralysis numbness/stiffness on affected side impaired taste
bells palsy meds
acyclovir-antiviral
steroids
anti-inflammatory-prednisone
polyneuropathy
more than one area affected distal to proximal numbness and tingling pain slow progression
mononeuropathy
single nerve
carpal tunnel, shingles
trauma, compression
visceral neuropathies
cv-no increase in HR with exercise
GI- change in motility
GU- sexual dysfuction
meds for peripheral disorders
neurontin
lyrica
cymbalta
prevention of peripheral disorders
irreversible
treat underlying disease
symptom managment
