test 4 Flashcards
arthroplasty
replacement surgery
resurfacing
reconstruction surgery
preop for joint replacement
See pain level, what exactly there ROM is, compare one side to the opposite side.
Educate about post op expectations
postop for joint replacement
neurovascular assessment- Pulses, orientation, sensation, pupils, strength
anticoagulant therapy
monitor for infection
pain management
care for hip replacement
abduction pillow- keep joints out
avoid 90 degree flexion
avoid rotation
increase seat height
sleep on unaffected side
no crossing legs
amputation causes
middle and older adults- PVD, atherosclerosis, DM
young- trauma
post op care of amputations
prevent flexions, limb bandages, elevate limb, vitals, dressing, ambulation considerations
benign bone tumors
most common type of bone tumor
types- osteochondroma (overgrowth), osteoclastoma (destruction bone), endochroma
malignant bone tumor
not as common
types- osteosarcoma, chondrosarcoma, ewings sarcoma
bone tumors
Children is more common to originate in bone, adult is more common to metastasize to bone
assess for pain, anemia, decreased mobility, circulation, sensation
prevent fractures
monitor for hypercalcemia due to bone breakdown
best treatment- chemo/radiation
injection med that helps stop bone breakdown
xgeva
causes and dx of intervertebral disc disease
causes- degenerative disk disease, herniated disk
dx- xray, myelogram, CT, EMG (for nerves)
invertebrate disc disease manifestations
low back pain
radicular pain
leg raise pain
absent/diminished reflex
prothesis
muscle weakness
incontinence
invertebrate disc disease care
brace
heat/ice
traction
TENS unit
NSAID, opioid, muscle relaxants (we tense when in pain), anti seizure (nerve pain), antidepressants
surgeries: laminectomy, discectomy, spinal fusion
sign of CSF leakage
bad headache
what to assess if bone graph
the donor and the receiver site.
common donor site- iliac crest
stable vertebrae fracture
no displacement, no pain
greenstick fracture
doesnt break all the way through
comminuted fracture
bone breaks into a bunch of peices
oblique fracture
the break is at a angle
stress fracture
caused by repetitive movement
spiral fracture
bone broken caused by a twisting motion
fractures manifestations
localized pain
decreased function
inability to bear weight
guard movement
deformity
myositis ossifications
calcium deposits in soft tissue
delayed union
takes longer for bone to grow
malunion
bone didnt grow back together in perfect alignment
nonunion
never grew back together
closed reduction vs open reduction for fracture
closed- nonsurgical
open-surgical. infection risk. early amputation encourages
traction
pulling force to attain alignment- counter-traction pulls in opposite direction
these weights need to dangle- not touch ground
patient will always be laying supine when doing this
bucks traction (skin)
short term use (48-72hr)
5-10 lb skin
not surgical- applied to skin by boot
make sure to assess the skin under the cover
balanced suspension traction
long term pull to maintain alignment
goes directly into bone
4-45 lbs
infection risk, consider how patient will move around and prevent sores. too much weight can cuase issues such as malunion
plaster vs synthetic cast
synthetic cast can get wet, and is more recommended
what is a sling used for
to prevent the bone from dangling and to prevent swelling
compartment syndrome
caused by arterial flow compromised, leading to ischemia, cell death and loss of function. can be caused by decreased compartment size or increased compartment contents.
do not elevate above heart- can create even worse blood flow.
dont use ice- impairs flow
reduce traction weight
fasciotomy
external fixation
trying to fix bone from outside. assess the pins
internal fixation
bone is fixed by the inside by screws and pins
why use TDAP for fractures
if we are introducing metal to fix it
nutriton for fractires
increase protein, vitamins, Ca, Mg, P, increase fluid intake, increase fiber
care for fractures
ice for first 24 hours
elevate first 48 hours
report increased pain, swelling, burning/tingling, foul odors
5 ambulation techniques
non weight bearing
touch-down/toe touch weight bearing
partial weight bearing
weight bearing as tolerated
full weight bearing
ischemic stroke
lack of oxygen to brain cells
hemorrhagic stroke
hemorrhage in brain that results in death of brain cells
common complications of stroke
hemaparesis, inability to walk, complete or partial dependence for ADLS, dysphagia, depression
Stroke
also called CVA
2 types- ischemic, hemorrhagic
5th most common cause of death in US
Risk factors of stroke
non-modifiable-
age above 55
more common in men, but more women are most likely to die
african americans
genetics
modifiable-
HTN**
heart disease (AFIB)
cholesterol
smoking
DM
drug/alcohol (cocaine)
obesity
metabolic syndrome
sleep apnea
lack of exercise
Transient ischemic attack (TIA)
mini strokes
**at risk for having a large stroke
WARNING SIGN
caused by micro-emboli, doesn’t cause infarction of brain
symptoms usually last less than a hour
important to educate patient to seek medical attention with any stroke like symptoms
types of ischemic stroke
thrombotic-most common
embolic
types of hemorrhagic stroke
intracerebral
subarachnoid
ischemic thrombotic stroke
Occurs from injury to a blood vessel wall and formation of a blood clot
Results in narrowing of blood vessel
more common in older people with htn, DM
manifestations may occur in first 72 hours
for most patients with ____ stroke they do not have a decreased LOC for at least 24 hours
ischemic
unless due to other conditions like seizures
embolic ischemic stroke
Occurs when an embolus lodges in and occludes a cerebral artery resulting in infarction and edema in that area
patients with this have severe manifestations that occur suddenly
-warning signs are less common in this
intracerebral hemorrhage
bleeding in brain caused by ruptured vessel
sudden onset of symptoms
poor prognosis, high mortality
often occurs in basal gaglia
caused by HTN, anticoagulant and thrombolytic drugs. also ruptured aneursyms, brain tumors
often happens in pons- bad because thats where breathing is in brain
manifestations of intracerebral hemorrhage
headache, N/V, decreased LOC, HTN
right sided brain stroke manifestations
will effect left side
paralyzed left side- hemoplegia
left sided neglect
spatial perceptual deficits
rapid performence, short attention span
impulsive- safety issues
impaired judgement
impaired time concepts
left sided brain stroke manifestations
affects right side of brain
paralyzed right side - hemiplegia
impaired speech/language
impaired discrimination
slow performance
aware of deficits- anxiety, depression
impaired comprehension of math, langauge, etc
what can be affected in stoke- motor functions
mobility
resp function
swallowing and speech
gag reflex
self care abilities
receptive aphasia
loss of comprehension of what someone is trying to tell you
expressive aphasia
loss of production of language- difficulty speaking
global aphasia
total inability to communicate- both understanding and speaking
dysphasia
difficulty communicating- they can but its hard
dysarthia
difficulty speaking because the muscles you use for speech are weak
spatial perceptual alterations of stroke
more common in right side stroke
can cause incorrect perception of self and illness, unilateral neglect of affected side, agnosia (inability to recognize a object by sight, touch, or hearing), apraxia (inability to carry out sequence movements on command)
affect and intellectual function of stoke
patients may have difficulty controlling their emotion
memory and judgement may be impaired
is stroke issues with urinary and bowel usually more permanent or temporary
temporary
diagnostics for stroke
used to confirm its a stroke and identify cause
**CT scan
MRI
Drugs to prevent ischemic stoke
antiplatelets
-aspirin
-clopidogrel (plavix)
Recominant tissue plasminogen activator (tPA) - must be administered within 6 hours of symptoms. used to reestablish blood flow through a blocked artery to prevent cell death.
maintain good BP while taking
surgical intentions wits TIA from carotid disease
carotid endarectomy- reroutes blood flow
transliminal angioplasty- opens stenosed artery in blood flow
stenting
what is critical information we want to know of ischemic strokes
time of onset of symptoms.
care for ischemic stroke
have baseline neuro assessment
know that elevated BP is common immediately after stroke
adequate hydration
monitor UO
manage airway, breathing, circulation
maintain glycemic control
monitor for increased intracranial pressure- more common in hemorrhagic but can still happen. if happens elevate HOB. prevent seizures
what does NIH stroke scale look at
LOC
responsiveness to questions
responsiveness to commands
pupillary response
gaze
visual feilds
dysarthia
motor arm and leg
ataxia
sensory
language
facial palsy
extinction
best score is 0
mild to moderate is 4-20
severe is over 20 points
care for hemorrhagic stroke
manage ABCs and intracranial pressure
management of HTN is main focus for this pt
DONT GIVE anticoagulants and platelet inhibitors
surgeries- resection, clipping a aneurysm, evacuation of hematomas
3 types of headaches
migraine
cluster
tension
tension headaches
“stress headache” most common
characterized by bilateral location and pressing or tightening qualities
can last from mins to days. could be episodic or chronic
photophobia
phonophobia
does not involve N/V
migraine headaches
characterized by throbbing pain
unilateral
triggering events- light, sound, smell sensitivity
manifestations relate to neuro and autonomic nervous system
more common in women in 20s-30s
could be with or without aura
without aura- “common migraines”
with aura- “classic migraines”
aura
neuro symptoms like visual distortion, or motor symptoms that come before a headache
what triggers headaches
food
menstruation
head trauma
fatigue
stress
missed meals
weather
drugs
common foods that cause headaches
chocolate, cheese, oranges, tomatoes, onions, alcohol
cluster headaches
most severe form. sharp, typically around eye
repeated clusters lasting 2 weeks-3 months that occur every day around same time, but will go in remission
age of onset 20-45
more common in men
alcohol, weather changes, and napping are triggers
drugs for tension headaches
ASA, acetaminophen, NSAIDs
drugs for migraines
ASA, NSAIDs, triptans, combination meds
drugs for cluster headaches
triptans, verapamil
what is a seizure
uncontrolled discharge of electrodes in brain
most common cause of seizures in age 2-20
birth injury
infection
head trauma
genetic factors
most common cause of seizures in age 20-30
structural lesions like trauma, brain tumor or vascular disease
most common cause of seizure after age 50
stroke
metastatic brain tumor
how many cases of seizures is idiopathic
1/3
three classes of seizures
generalized
focal
unknown
four phases of seizures
prodromal- behavior changes before seizure
aural- sensory warning before seizure
ictal- from symptom per symptom to end of seizure
postictal- recovery phase
tonic clonic seizure
generalized
loss of consciousness and falling
tonic- stiffening
clonic- jerking
cyanosis, salivation, tongue/cheek bitting, incontinence
postical phase- muscle soreness, fatigue, sleepy, no memory of seizure
drugs-Ethosuximide (Zarontin)
Divalproex
Clonazapam (Klonopin)
generalized seizure
involves both sides of brain
focal seizure
involves one hemisphere of the brain
tonic seizure
generalized
stiff muscles, increases tone
affects both side of body
usually last for 20 secs
usually remains conscious
clonic seizure
generalized motor
loss of consciousness and muscle tone
limb jerking may or may not be symmetric
uncommon
atonic seizures
generalized motor
absent tone- loss of muscle tone resulting in drop to ground.
usually lasts less than 15 seconds
absence seizures
nonmotor generalized
usually only occurs in children
“day dreaming” or staring spell for about 10 secs and could occur for up to 100 times a day
atypical seizure
generalized nonmotor
could continue into adulthood. starts with eye blinking or jerking of lips, as well as a staring spell.
typically last 10-30 secs
myoclonic seizures
generalized nonmotor
characterized by rhythmic arm abduction (3 movements per sec) progressive arm elevation lasting 10-60 secs
eyelid myoclonia
jerking of eyelids in upward deviation
focal seizures
begin in one hemisphere in a specific region of cortex
focal aware of focal impaired awareness
drugs-Phenytoin (Dilantin)
Carbamazepine (Tegretol)
Phenobarbital
Divalproex
pregabalin (lyrica)
focal aware
conscious and alert, but experience unusual feeling that can take many forms, such as joy, anger or sadness
focal impaires awareness
could have loss of consciousness or altered producing dream like experience,
may have strange behaviors like lip smacking
memory loss can occur
last between 30 secs to 2 mins
patients may be tired and confused after
motor vs nonmotor seizure
motor-Atonic, tonic, clonic, myoclonic, epileptic spasms
non motor- Emotional manifestations, strange feelings or symptoms
psychogenic seizures
can be misdiagnosed as seizure disorder but is caused by some history of emotional or physical abuse
status elipticus
most complex seizure - neuro emergency
can occur with any type of seizure
last longer than 5 mins.
the longer the seizure, the less likely it will stop without drug therapy.
convulsive SE is most common could lead to respiratory issues, cardio, brain death etc..
there is also nonconvulsive SE and refratory
treated w lorazepam, diazepam
SUDEP
sudden unexpected death of someone with epilepsy who was otherwise healthy; affects about 1 in 150 persons with uncontrolled seizures each year.
Seizure complications
injuries or death
psychosocial issues
seizure diagnostics
EEG - not definite
CT/MRI
health history and accurate history of seizure
care for seizures
no cure, prevent
antiseizure drugs
phenytoin teaching
avoid alcohol
may discolor urine
good oral hygeine is needed- could cause gum hyperplasia
take directly as ordered, dont stop abruptly
acute care during seizure
maintain airway
turn to side
ease to floor
support head
after the seizure care
suctioning or oxygen as needed
pad bedrails
med alert bracelet
pt education
primary brain tumor vs secondary
primary- arises from tissue within brain
secondary- metastasizes from elsewhere in body
what is the most common metastasizing cancers
breast and lung
primary brain tumors
**gliomas
**meningioma
acoustic neuroma
pituitary adenoma
hemangioblastoma
primary CNS lymphoma
why do primary brain tumors rarely metastasize
due to the meninges and blood brain barrier
manifestations of tumor
depends on location and size of tumor
headaches
seizures
N/V
cognitive dysfunction
muscle weakness
aphasia
cerebral edema
diagnostics of brain tumor
MRI and PET- most reliable
EEG-rule out seizures
cerebral angiography- localize tumor
biopsy
endocrine studies
care for brain tumors
removing or decreasing size
surgery is preferred option
ventricular stunt- will drain fluid into peritoneal cavity
radiation
chemo
nursing management of brain tumor
remain normal ICP and maximum neuro function
have baseline data
maintain LOC
sensory perception
ADLs
motor abilities
maintain bowel and bladder function
types of cranial surgery
Burr Hole
Craniotomy
Craniectomy
Cranioplasty
Stereotactic procedure
Shunt procedures
stereotactic radiosurgery
for brain tumor, vasc abnormalities, CNS infections, cranial cerebral trauma, seizure disorders or retractable pain
often computer guided to aide healthcare provider to specific part of brain
main goal of care for brain tumor durgery
prevent ICP!
HOB at 30 degrees
prevent coughing
use cluster care
normal ICP is 5-15 mmHg
Gullian Barre syndrome (GBS)
autoimmune disease. rare, potentially fetal
acute, rapidly progressive form of poly neuropathy.
affects peripheral nervous system and results in a loss of myelin, and causes edema and inflammation to the affective nerve.
typically starts weakness and numbess in feets.
GBS cause
- The cause is thought to be an immunologic reaction directed at the peripheral nerves. It is often preceded by upper respiratory or gastrointestinal infection.
usually occurs days to weeks after viral or bacterial infection
Precipitating microorganisms:
Cytomegalovirus—most common virus
Campylobacter jejuni—most common bacteria
Other:
Epstein-Barr virus
Mycoplasma pneumoniae
Haemophilus influenza
Hepatitis (A,B, E)
Zika virus
Surgery or trauma may also be triggers
GBS manifestations
*ascending weakness/paralysis (symmetric)
parathesia
*hypotonia
absent reflex
HTN
orthostatic hypotension
bowel/bladder dysfunction
resp failure
infections
aspiration
paralytic ileus
atrophy
DVT/PE
pressure ulcers
impaired nutrition
pain that increases at night
what is most serious complication of GBS
resp failure
GBS diagnostics
H&P- progressive weakness in more than one limb, absent reflexes
labs- liver, electrolytes
CSF analysis- increase in protein
EMG
nerve conduction study (NCS)
GBS management
supportive- prevent complications
acute- focus on ventilation support. may need immunoglobulin, plasmapheresis or IVIG (reduces extent and length of symptoms if started early).
assess neuro, respiratory, cardiac, temp.
recovery may start after 28 days. prognosis depends on age, infection that caused, and how rapid it was.
60% have full recovery within one year
skin functions
Barrier, protects, temp regulation, vitamin D
UVA
responsible for tanning.
it causes aging and wrinkling
absorbed by dermis
UVB
responsible for burning
absorbed by epidermis
skin cancer risk factors
fair skin
blonde/red hair
light eye color
chronic sun exposure
personal/family history of skin cancer
tanning bed use
where does non melanoma skin cancer form
basement membranes
more common in local areas like ears, nose
actinic keratosis
non melanoma skin cancer
can be flat or elevated
plaques and palls
caucasian older adults
could resolve on own
aggressive treatment, typically nonsurgical
basal cell carcinoma
most common non melanoma
best prognosis
in epidermal basal cells
Has dimple/depression in center
Starts small and gets larger
Has pearly/translucent color
treatment depends on size and location
squamous cell carcinoma
non melanoma skin cancer
in keratinizing epidermal cells
often accompanies actinic keratosis
plaque type, firm nodule with indistinct borders
has potential to metastasize
agressive treatment
tobacco use and immunosuppression is a risk factor (especially reno transplant patients)
treatment of AK
crycosurgery, topical medication, chemical peel
treatment of basal cell carcinoma
excision, cryosurgery, radiation, chemo
treatment of squamous cell carcinoma
excision, cryosurgery, radiation, chemo
malignant melanoma
tumor of melanocytes
highest mortality rate
could be in GI tract, oral or geniral membranes, eyesm ears, head, neck, back/trunk (common in men), lower legs (common in women)
more common in whites but more fetal in other skin colors as it is harder to catch
dysplastic nevi is a RF
dx by biopsy
ABCDE for melanoma
Asymmetry
Borders are irreg
Color change- brown, tan, black
Diameter of 6mm or more
Evolving- changing over time
stages of melanoma
0- only in outer layer of skin
1- cancerous tumor formed
2- tumor classified by stage, depending on thickness and ulceration
3- spread to lymph vessels, nodes or near by skin
4- organ involement
treatment of melanoma
chemo
targeted therapy
wide excision
skin cancer guidelines
dont burn , go in shade
spf of 15 or higher daily
keep newborns out of sun
reapply sunscreen every 2 hours
examine skin head-toe monthly
see dermatologist yearly
atypical/dysplastic nevi
increase risk of melanoma
>5mm
iregular borders, resemble melanoma
highest risk from puberty- age 40
increase risk if have multiple
impetigo
highly contagious
honey color crust
needs treated or wont go away
folliculitis
pustule at hair follicle opening
increased risk with DM
Cellulitis
hot, tender, erythematous, edematous areas with fever and chill
abx needed
what causes most bacterial skin infections
staph or strep
viral skin infection
herpes simplex- recurring vesicles. lifelong
herpes zoster- shingles
plantar warts- bottom of foot, pain with pressure, difficult to treat
when should women get mammogram
at age 45 annually to age 54
unless needed earlier for rf
mastalgia
breast pain
mastitis
breast inflammation
fibroadenoma
benign breast lump. biopsy needed. small and round
gynecomastia
enlargement of one or both breast
more common in males
changes in breast tissue
fibrocystic changes
breast cancer RF
women
age greater than 50
hormone use
family/personal history
early menarche
first full time pregnancy after age 30
benign breast disease
weight gain after menopause
radiation exposure
alcohol consumption
types of breast cancer
noninvasive- ductal and lobular in situ. 20%
invasive- ducal carcinoma. 80%. begins in milk dud. invasive lobular
breast cancer manifestations
lump, upper outer quadrant, nipple discharge, often no pain
cervical cancer rf ans s/s
HPV, immunosuppression, low socioeconomic, smoking, chlamydia, hispanic, African amer
s/s-
early- none
unusual discharge, abnormal uterine bleeding, pain, weight loss, anemia
diagnostics for cervical cancer
pap smear
HPV test
endometrial cancer
rf- exposed to estrogen, never been pregnant, age, obesity, smoking, dm
manifestations- abnormal uterine bleeding, pelvic pain
dx- endometrial biopsy
Treated by hysterectomy
ovarian cancer RF, ans S/S
rf- breast/colon cancer, never been pregnant, age, high fat diet, HRT
S/S- pelvic/abdominal pain, bloating, urgency/frequency, unexplained weight loss/gain, menstrual changes
ovarian cancer treatment
initial treatment- total hysterectomy and bilateral salpingo-oophoerctomy with omentectomy and removal of tumor
chemo
radioisotopes
external radiation
BPH
prostate gland enlarges
dx by DRE, PSA, UA
early sign- nocturia
later - decrease in stream, stopping and starting, dribbling, urinary retention
treated by tamulosin, surgery such as TURP, diet changes, voiding schedule
care for TURP
Preop- abx, catheter
post op- bladder irrigation. get strict i&o
prostate cancer
malignant tumor of prostate
slow growing, androgen dependent
spreads by 3 routes- direct, lymphatic, blood stream
rf- age, african american, diet high in red meat and dairy, being a farmer (pesticides)
dx- PSA, prostate tissue biopsy, gleason score
treatment depends
prostate cancer manifestations
frequent urination, blood in semen/urine, weak flow, pain during urination, urge to urinate
prostatitis
s/s- fever, chills, perineal pain, acute urinary symptoms, epidymitis/cystitis, sexual dysfunction
if from infection- treat with abx.
acute- 4 weeks
chronic - 4-12 weeks
noninfectious- focus on comfort
cryptorchidism
Failure of testes to descend into scrotal sac before birth
hydrocele
Fluid filled sac, non tender
varicocele
Dilation of vein that drains testes
orchitis
Acute inflammation of testes, tender and swollen
testicular torsion
surgical emergency
twisting of spermatic cord that supplies blood
common in males under 20
usually from trauma or abnormality
s/s- pain, tenderness, swelling, N,V
dx by ultrasound
needs to be corrected within 4-6 hours
penis cancer
rare
nontender warty lesion
typically squamous cell carcinoma
risk factor- HPV, uncircumcised
treated by laser removal, radical resection, radiation, chemo
testicular cancer
most common in ages 15-34
common w undescended testes
small lump in scrotum, testicular pain, heavy feeling in scrotum, swollen testes, lower back pain
dx by ultrasound and blood work
treated by orchiectomy, possible chemo/radiation
vasectomy
surgical ligation resection of the ductus deferens for sterilization
takes 15-30 mins
sperm will be reabsorbed by body
alternate form of conception needed until exam reveals no sperm- may take 6 weeks
erectile dysfunction
inability to attain/maintain an erection
rf- DM, vascular disease, surgery, trauma, stress, medication
treatment- sildenafil, tadalafil, penile implants, sexual counseling
