theory test #2 Flashcards
1
Q
Partial foot amputations
A
removes one or more of the toes. Affects walking and balance.
2
Q
Ankle disarticulation
A
removal of the foot at the ankle. Able to more around without the need for a prosthesis.
3
Q
transtibial
A
removal of the leg below the knee joint retaining the use of the knee joint.
4
Q
Through the knee
A
removal of the lower leg and knee joint. Still able to bear weight because the femur is retained.
5
Q
transfermoral
A
removal of the leg above the knee joint. Able to bear weight because the femur is retained
6
Q
Hip disarticulation
A
the removal of the entire limb up to and including the femur.
7
Q
leading causes of amputation
A
infection, PAD, diabetes, trauma
8
Q
what method do you use to wrap an amputated limb
A
figure of 8 method
9
Q
Metacarpal
A
removal of the entire hand with the wrist still intact.
10
Q
Shoulder disarticulation and forequarter amputation
A
removal of the entire arm including the shoulder blade and collar bone.
11
Q
two types of surgical amputations
A
open and closed (flap)
12
Q
nursing goals of pt with amputation
A
Support psychological and physiological adjustment
Alleviate pain
Prevent complications
Promote mobility and functional abilities
Provide information about surgical procedure and treatment needs
13
Q
_________ stump to decrease swelling
A
elevate
14
Q
what type of exercises do you want to assist with on the affected limb compared to the non affected limbs
A
ROM on affected and active/isometric exercises for unaffected
15
Q
instruct patient to lie in _______ as tolerated at least twice a day
A
prone position
16
Q
there is a risk for what after amputation
A
infection, ineffective tissue perfusion, and low self esteem
17
Q
what do you what to place on non-operated leg for DVT prophylaxis
A
sequential compression device and give low dose anticoagulants
18
Q
arthroplasty
A
the surgical removal of a diseased joint
due to osteoarthritis, osteonecrosis, rheumatoid arthritis,
trauma, or congenital anomalies, and replacing it with
prosthetics or artificial components made of metal or
plastic.
19
Q
Total Joint arthroplasty
A
total joint replacement involves
replacement of all components of an articulating joint.
20
Q
Total knee arthroplasty
A
replacement of the distal femoral
component, the tibia plate, and the patellar button. Total
knee arthroplasty is a surgical option when conservative
measures fail.
21
Q
Unicondylar knee replacement
A
done when a patient’s joint is diseased in one compartment of the joint.
22
Q
Total hip arthroplasty
A
involves the replacement of the acetabular cup, femoral head, and femoral stem.
23
Q
Hemiarthroplasty
A
refers to half of a joint replacement. Fractures of the femoral neck can be treated only with the replacement of the femoral component
24
Q
how to care for incision after arthroplasty
A
with soap and water
25
avoid positions of _______ of the knee to prevent contractures
flexion and no pillows under knee
26
_________ are given 30 minutes prior to incision
prophylaxis antibiotics
27
intracapsular hip fracture
within the hip joint
28
extracapsular hip fracture
outside the joint
29
types of extracapsular hip fractures
subtrochanteric and trochanteric fracture
30
clinical manifestation of hip fracture
```
External rotation and shortening
Muscle spasm
Severe pain
Shock
No weight!
No walking!
```
31
what type of repair is preferred with intracapsular fracture
endoprosthesis
32
what type of repair is preferred with extracapsular fracture
ORIF - open reduction and internal fixation
33
bucks traction
Skin traction is applied by strapping the patient's affected lower limb and attaching weights.
34
pre-operative care for patients going in for a hip replacement
maintain immobilization of affected leg, monitor neuromuscular status of affected leg, administer pain meds, explain procedure, and apply ice pack
35
post op care for patients that got a hip replacement
ambulation, prevention of thromboembolism, neuromuscular evaluation, splint or pillow, infection prevention, pneumonia prevention,
36
complications of joint surgery
infection and DVT
37
5 Ps
pain, paresthesia, pallor, paralysis, pulselessness
38
surgical drainage devices
hemovac and Jackson pratt
39
open fracture grade 1
minimal skin damage
40
open fracture grade 2
damage includes skin and muscle contusions but without extensive soft tissue injury
41
open fracture grade 3
damage is excessive to skin muscles, nerves, and blood vessels
42
Complete fracture vs. incomplete
through the bone vs through part of the bone
43
Simple vs. comminuted
one fracture line vs multiple
44
Displaced vs non-displaced
not aligned vs aligned
45
Fatigue (stress)
excessive strain – athletic activities
46
Compression
from a loading force, common in osteoporosis, bone metastasis, infection
47
Pathological
occurs to bone that is weak from a disease process, such as bone cancer or osteoporosis
48
oblique fracture
complete fractures that occur at a plane oblique to the long axis of the bone
49
comminuted fracture
a break or splinter of the bone into more than two fragments.
50
spiral fracture
is a type of complete fracture. It occurs due to a rotational, or twisting, force.
51
compound fracture
broken bone
52
greenstick fracture
fracture in a young, soft bone in which the bone bends and breaks
53
impacted fracture
also called buckle or torus. when the broken ends of the bone are jammed together by the force of the injury.
54
clinical manifestations of traumatic injuries/fractures
```
Edema and Swelling
Pain and Tenderness
Muscle Spasm
Deformity
Ecchymosis/contusion
Loss of Function
Crepitation
```
55
treatment of injuries
immobilization/stabilization and fracture reduction
56
types of fracture reduction
closed - manual realignment of the bone
| open - surgical realignment (ORIF)
57
complications of fractures
```
Compartment syndrome
Fat embolism
Deep vein thrombosis (DVT)
Complications of immobility
Complications of fracture healing
```
58
patient may become _______ & ________ with a fat embolism
tachycardia and hypotensive
59
compartment syndrome
Increased pressure within a body compartment usually with the arm or leg following trauma
60
what does comportment syndrome result in
insufficient blood supply to the muscles and nerves
61
what do you need to do for compartment syndrome
Fasciotomy required to relieve pressure and Emergent surgery required to prevent loss of limb
62
causes of compartment syndrome
```
Prolonged compression
Fractures
Casting
Burns
Hemorrhage
```
63
clinical manifestation of compartment syndrome
Pain whose severity appears out of proportion to the injury
Pain described as burning, deep and aching
Pain worsened by passive stretching of the involved muscles
Hardened, tight muscle mass
64
complications of fracture healing
```
Delayed union
Nonunion
Malunion
Angulation
Pseudoarthrosis
Refracture
Myositis ossificans
```
65
fracture angulation
displacement where the normal axis of the bone has been altered
66
nonunion
Nonunion is permanent failure of healing following a broken bone unless intervention is performed
67
myositis ossificans
bone forms within the muscle, and this occurs at the site of the hematoma
68
osteomyletitis
Inflammation of bone caused by infection, generally in the legs, arm, or spine.
69
nursing care for patient getting a cast
monitor neuromuscular status every 1 hour for 24 hours. assess pain. apply ice. elevate casted area 24-48 hours above heart to prevent swelling
70
plaster cast vs fiberglass
plaster is inexpensive, heavy, gives more support. fiberglass has more durability, hardens quickly, fewer skin problems, cost more
71
CSM
C- color plus cap refil, pulse, and temp
S- sensation
M- ability to move
72
sanguineous vs serous-sanguineous vs serous
sanguineous- red discharge (bleeding)
serous-sanguineous- pink discharge
serous- white discharge
73
what is the purpose of traction
decrease muscle spasms and relieve pain prior to surgery
74
what is halo tractions used for
cervical fractures
75
type 1 diabetes
beta cells destroyed by autoimmune process
76
type 2 diabetes
decreased insulin production and decreased sensitivity to insulin
77
clinical manifestations of diabetes
polyuria, polydipsia, polyphagia, fatigue, tingling or numbness, recurrent infections
78
fasting plasma glucose levels
should be below 126
79
Hgb A1C levels
should be below or equal to 6.5
80
2 hour post prandial glucose levels
should be below or equal to 200
81
blood glucose levels do what with age
increase with advancing age
82
1 unit of insulin lowers blood glucose by about
50 mg/dL
83
regular insulin usually given 1 U per _______ carbohydrate
15 g
84
insulin guidelines
0.5-1 units/kg/day
85
regular insulin onset, peak, and duration?
onset - 30 minutes
peak - 2-4 hours
duration 6-8 hours
86
NPH insulin onset, peak, and duration?
onset - 1-2 hours
peak - 6-12 hours
duration 18-24 hours
87
lispro
ultra short acting insulin that is given 15 minutes before meal and leak levels seen within 30 minutes
88
what do you need to use with Lispro
Lantus or other long acting insulin for a Basal/Bolus affect
89
Lantus
called insulin Glargine - provides a continuous low level of insulin secretion and cannot be mixed with any other insulin
90
how often is Lantus administered
once a day
91
hyperglycemic influences
stress, decreased physical activity, medication errors, fear of hypoglycemia
92
hypoglycemic influences
decreased caloric intake, gastrointestinal illness, altered cognition
93
basal insulin
amount of insulin necessary to regulate glucose levels between meals and overnight
94
nutritional insulin
required to cover meals
95
correctional insulin
doses of short or rapid acting insulin given to correct blood glucose elevations
96
when do you check insulin
right before a meal
97
what do you want to encourage the patient to do if they are receiving insulin
eat
98
what do you want to document if patient has hypoglycemia
FSBG, time of hypoglycemic event, if patient is symptomatic, treatment and their response to treatment`
99
most protocols define hypoglycemia as
below 70 mg/dl
100
mild symptoms of hypoglycemia
hunger, weakness, diaphoresis, dizzy, anxiousness, impaired vision, headache, and pounding heart
101
moderate symptoms of hypoglycemia
personality changes, irritability, confusion, difficulty concentrating, slurred speech
102
severe symptoms of hypoglycemia
mental status changes, coma, death, unconsciousness, seizures
103
key to hypoglycemia treatment
do not overtreat because it causes post treatment hyperglycemia
104
target blood sugar for patient with diabetes on a med/surg/tele floor
140-180
105
target blood sugar for patient with diabetes on a critical care
110-140
106
mild/moderate hypoglycemia is defined as
FSBG 41-69 with or without symptoms
107
severe hypoglycemia is defined as
41-69 if patient has mental status change or is unconscious, or NPO or FSBG is 40 or less
108
what is the first thing you do for a patient with mild to moderate hypoglycemia
feed them immediately if meal try is available. if tray is not available then give glucose tablet or juice
109
adding sugar to juice it considered
overtreating
110
if hypoglycemia is resolved but there is an hour before the next meal what should you give
5 crackers and 1 ounce of cheese or 6 crackers and 2 tbsp of peanut butter
111
severe hypoglycemia treatment
stat lab glucose but don't wait for the lab to get back to treat. if IV is available give D50 and retest FSBG 15-20 minutes later. if IV is not available give glucose IM
112
glucagon
important hormone in carbohydrate metabolism that is released by the pancreas. helps maintain the level of glucose by causing liver to release its stored glucose.
113
what can be given for severe hypoglycemia as an IM interjection
glucagon. patient may wake up vomiting or feeling sick
114
what precaution should severe hypoglycemia patient be put on
seizure precautions
115
treating hypoglycemia
give 15-30 grams of carbohydrate every 15-30 minutes until FSBG is above 70 mg/dl
116
diagnostic test for meningitis
nasopharyngeal swab, test for kerning's and brundzinski's sign, x-rays, gram strain, cultures
117
brudzzinski's sign
severe neck stiffness causes a patients hips and knees to flex when the neck is flexed during meningitis
118
kerning's sign
severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed 90 degrees
119
bacterial meningitic labs
WBC- greater than 1000
protein - greater than 500
glucose - decreased
120
viral meningitis
WBC- 25-500
protein 50-500
glucose- normal
121
treatment for bacterial meningitis
isolate patient, antibiotics that penetrate blood brain barrier, dexamethasone to recuse inflammation
122
how do you rule out bacterial meningitis
lumbar puncture
123
encephalitis
acute inflammation of the brain that is usually caused by virus
124
meningitis vs encephalitis
patient with meningitis may be uncomfortable, lethargic, or distracted while encephalitis causes alteration in brain function
125
goal in treatment of encephalitis
regain as much neurological function as possible
126
TIA s/s last
60 minutes or less
127
type fo ischemic strokes
thrombotic - narrowing of artery
| embolic - thrombus breaks off and lodges in vessel
128
clinical presentation of acute stroke
altered LOC, headache, aphasia, paralysis, weakness...
129
BP will be _____ during a hemorrhagic stroke
elevated
130
right hemisphere
attention span, impulse control, movement of left side, drawing skills, remembering visual object, face recognition, left side awareness, measuring distance of objects to body
131
left hemisphere
motor speech, expressive speech, movement of right side, emotion, math, writing, reading letters and numbers, recognizing objects, remembering written info
132
FAST
facial drop, arm weakness, speech difficulty, time to call 911
133
first thing after stroke
assess body systems and gag reflux
134
tonic - clonic seizure (grand mal)
stiff-jerking/loss of consciousness
135
typical absence (petit mal)
usually occurs in children looks like day dreaming and might be smacking their lips
136
atypical absence seizure
staring with peculiar behavior
137
focal seizure
pertain seizures
simple - unexplained feelings/sensation
complex- unable to interact
138
psychogenic seizures
resemble tonic/clonic and are often misdiagnosed. related to emotional/physical abuse
139
testing for seizures
MRI or CT and EEG
140
medications for seizures
Ativan if status epilepticus. tonic-clonic: dilantin, tegretol...
141
nursing care for seizure patients
safety! maintain airway and prevent injury
142
Guillain-Barre syndrome
acute, rapidly progressing motor neuropathy involving segmental demyelination of the nerve roots in the spinal cord and medulla
143
demyelination causes
inflammation, edema, rapidly ascending paralysis
144
clinical manifestations of Guillain barre syndrome
paralysis that starts in lower extremities and ascends bilaterally, paralysis of respiratory muscles, difficulty swallowing and talking, facial flushing, hypotension
145
what happens as patient recovers from Guillain Barre syndrome
paralysis decreases as patient recovers and most often without residual effects
146
stages of Guillain Barre syndrome
acute, plateau, and recovery
147
acute stage of Guillain Barre syndrome
Progressive from 1st symptom until no further deterioration
148
plateau stage of Guillain Barre syndrome
No further worsening or improvement
Attack has stopped
Can last from a few weeks to months
149
recovery stage of Guillain Barre syndrome
spontaneous improvement and recovery
Symptoms gradually disappear
Last a few weeks to years
Some case of relapse
150
CSF will have what in Guillain Barre syndrome
elevated protein concentration
151
treatment for Guillain Barre syndrome
respiratory support, corticosteroids, immunosuppressants, plasmapheresis
152
care for patient with Guillain Barre syndrome
monitor VS especially RR, passive ROM every 4 hours to prevent contractures, pain meds, nutrition, support
