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1430 > Thermoreg and Mobility > Flashcards

Thermoreg and Mobility Flashcards

1
Q

Normothermia

A 
(Attributes to thermoregulation) 
36.5-37.2 degrees C
97.7-99 degrees F
F=9/5C+32
C=F-32* 5/9
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2
Q

Antecedents to Thermoregulation

A

Normal hypothalamus, sweat gland, and skeletal muscle functions.
Chemical Thermogenesis occurs
Sufficient blood flow
brown fat in a newborn

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3
Q

CBC with differential, when ordered and what do the results mean?

A

Order whenever there is fever.
More segmented- older WBCs - new infection
Not as segmented- younger WBCs older
infection
send out mature WBCs first, send younger immature ones when infection persists and out of mature

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4
Q

therapeutic hypothermia (when and why?

A

after cardia arrest with return of spontaneous circulation, but not regaining consciousness. to decrease the inflammatory process. cool to 32-34 degrees C and maintain for up to 24 hours.

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5
Q

If rewarm pt too quickly during rewarming after therapeutic hypothermia

A

can cause hyperkalemia

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6
Q

To avoid and control shivering during therapeutic hypothermia

A

provide adequate sedation and counter warming of extremities

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7
Q

to prevent skin breakdown in pts receiving therapeutic hypothermia, the nurse should

A

use a low air loss bed surface and turn the pt at least every one to 2 hours

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8
Q

to prevent ventilator associated pneumonia (VAP) during therapeutic hypothermia, the nurse should

A

keep the HOB higher than 30 degrees

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9
Q

Extremely high body temperature

A

Hyperpyrexia

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10
Q

physiological changes to keep homeostasis of body temperature are controlled by the

A

hypothalmus

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11
Q

hypothermia mild, moderate and severe

A

mild- 34 to 36 degrees C (93.2-96.8)
moderate 30-34 degrees C (86-93)
severe less than 30 degree C (

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12
Q

Symptoms of hyperthermia

A

Vasodilation- flushed skin that is warm or hot, increased respiratory rate,
dry mucous membranes, decreased urine prodxn, and electrolyte imbalance signs of dehydration. could be excess sweat or inability to sweat.
High Fever, may have seizures.
cognition- slightly confused to delirious to coma

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13
Q

Fever

A

Hypothalamus changes set point to a higher temperature because of tissue destruction, pyrogenic substances or dehydration.

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14
Q

How is a fever produced when there is infection and how is resolved?

A

macrophages release endogenous pyrogens (proteins) (make cut warm) and signal hypothalamus that temperature needs to be reset to a higher temp to fight the infection. high temps damage parenchyma (cell tissue) and the cause of high temp is removed (infection) and the hypothalamus sets the temp set point back to normal

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15
Q

Defense mechanism in children in response to rapid temperature rise from acute illness

A

febrile seizures

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16
Q

preferred antipyretics for children

A

Acetaminophen and Ibuprofen

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17
Q

Diagnostic test when pt presents with a fever

A

** CBC WITH DIFFERENTAL to diagnose type of infection
-Imagining Studies:
Car wreck and fever- get that CTC to see if head trauma
Chest x ray for pneumonia
Abdominal sonogram for peritoneal inflammation
Urinalysis , especially for elderly population or sexually active young women

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18
Q

Use of hypothermia blanket is recommended when?

A

temperature is above 104 F and cannot be controlled with antipyretics or if the high temp is related to a disorder of temp regulation

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19
Q

Malignant Hyperthermia

A

An inherited reaction to inhaled anesthetics that requires immediate action to prevent death. Can develop during surgery or PACU. Sx: increased end-title carbon dioxide levels, Rapid rise in temp, hypertension and increased muscle contractions

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20
Q

Malignant hyperthermia tx

A

immediately terminate the inhaled gas and start 100% O2. push Dentrolene Sodium which will reset the hypothalamus, administer quick cooling with ice.

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21
Q

Heatstroke at risk

A

Medical emergency caused by failure of the heat regulating mechanism of the body most commonly caused by prolonged exposure to an environmental temp greater than 102.5 F. At Risk: Elderly, Very young, individuals not acclimated to heat, unable to care for self, or with chronic and debilitating disease (cardiovascular disease), or on certain medications: Tranquilizers, anticholinergics (dry you up for surgery), diuretics, or beta blockers (mess with dilation/constriction mechanism)

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22
Q

Clinical manifestations of heat stroke

A

Profound CNS dysfunction manifested by confusion, delirium, bizarre behavior, coma
Temp of 105, hot, dry skin, anhidrosis (absence of sweating), tachypnea, hypotension, tachycardia

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23
Q

Management of Heatstroke

A

Reduce body temp as quickly as possible and constantly monitor. Stabilize oxygenation, Establish IV access and administer NS. Remove clothing, circulating fan and one of the following:
Cool sheets and towels or continuous sponging with cool water, ice packs applied to neck, groin, chest and axillae, cooling blankets or immersion of the pt in a cold water bath

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24
Q

Heat Exhaustion

A

persons temp may be normal to 104. Weakness, hypotension, increased HR, increased thirst.

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25
Q

Induced hypothermia, why and how?

A

reduces metabolic rates and lowers cellular demand for 02. used to reduce neurological damage, lessen anoxia. Usually initiated with ice pack and cool saline with a goal of 33 degrees. Hold at 33 for max of 24 hour and the rewarm over a 12-24 hour period. Use sedation, anticonvulsant to inhibit shivering and paralytic meds

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26
Q

During rewarming phase after induced hypothermia, make sure to stop administration of__

A

potassium. huge intracellular shift of electrolytes during hypothermia and all shift back extracellularly during rewarming.

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27
Q

Newborns and thermoreg

A

Large body surface area in relation to mass so lose 4 times more heat than an adult. Shivering is rare, don’t have the glycogen stores for the necessary energy. Non shivering thermogenesis (NST) from Brown Adipose Tissue (BAT) is primary source of heat.
Largest threat is environmental exposure- put on a hat!
NICU has Polyethylene wrapping for low birth weight babies

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28
Q

Frostbite

A

As tissue freezes
− Ice crystals form
− Small vessels vasoconstrict then vasodilate
Continued exposure  vasoconstriction
Superficial frostbite
− Numbness, itching, prickling sensation
− Cyanotic, reddened, white
Deeper frostbite  paresthesias and stiffness

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29
Q

Thawing frostbite

A 
Thawing of tissues
      − Skin white or yellow
      − Loses elasticity
      − Burning pain
      − Edema, blisters
      − Necrosis, gangrene
Start immediately, but go slow, put in warm water, not hot!!
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30
Q

mild hypothermia symptoms

A 
 Fatigue
     Slurred speech
     Poor coordination and clumsiness
     Confusion and poor judgment  
     Inappropriate behavior
     Shivering
     Tachycardia and tachypnea
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31
Q

Moderate hypothermia symptoms

A 
 Depressed mental state
       No shivering
       Depressed respirations
       Slow pulse or irregular heart rate
       Hypotension
       Pale or cyanotic skin
       Hallucinations
       Coma
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32
Q

severe hypothermia symptoms

A

Absence of respirations and pulse
 Ventricular fibrillation
 Dilated and unresponsive pupils
 Coma

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33
Q

Primary prevention hypothermia

A

Reduce Risk Factors

  * Educate regarding avoidance to exposure and extreme temperatures
  * Provide adequate resources
      - Environmental control and shelter
      - Appropriate clothing 
      - Physical activity
      - Social services – assess parent’s ability to meet needs, financial constraints, homelessness
     - Free clinics
     - Manufacturing prescription programs
      - Schools
34
Q

secondary prevention hypothermia

A

Identify underlying cause

  - Provide comfort
  - Monitor vital signs closely
  - Cardiorespiratory monitor
  - Temperature regulation
  - Prevent complications
35
Q

tertiary prevention hypothermia

A

Remove from cold
- Provide warm environment – dry clothes
- Warming blankets
- Administer warm oral fluids
- Keep limbs close to body
- Cover scalp with blanket or cap
- Apply warming pads to axillae, groin, forehead, and nape of neck
- Supply warm oral or intravenous fluids
- Warm fluid gastric lavage
Rapidly rewarm affected areas in circulating warm water, 104°-105° F (40-40.5°C) for 20 to 30 minutes
- Following rewarming, keep on bedrest with affected areas elevated
- Avoid rubbing or massaging affected areas
- Heated humidified oxygen
- Administer analgesics and anti-inflammatory agents
- Debride blisters
- Whirlpool therapy to clean skin and debride necrotic tissue
- Support respiratory and cardiac function
- Reduce handling to decrease risk of cardiac fibrillation
- Hemodialysis and/or peritoneal dialysis

36
Q

Cold stress in newborns

A

chilling causes respiratory distress s/sx.Increased movement, respirations
- Decreased skin temperature, peripheral perfusion
- Development of hypoglycemia
• Result of metabolic effects of cold stress
• Glucometer values

37
Q

Rewarming after therapeutic hypothermia

A

Stop potassium and warm very slowly (over 12-24 hours, 1/3-1 degree a min) to avoid hyperkalemia.
Biggest thing to watch for is arrhythmia, also monitor: urine output, fluids, platelets, cardiac output, electrolytes, hypotension, insulin resistance, shivering and coagulation problems

38
Q

Risk factors for osteoporosis

A

smoking- highest risk factor!!Female gender
Increasing age
Low body weight
White or Asian ethnicity
Family history
Early menopause
Excess alcohol intake, Sedentary lifestyle
Insufficient calcium intake
Long-term use of corticosteroids, thyroid replacement, antiseizure drugs
Low testosterone levels in men

39
Q

Assessment for mobility

A

observe balance, gait and posture-unable to walk, limp, hesitant or jerky? Inspect joints and muscles-swollen, stiff, unable to move? Assess muscle strength- cannot prevent nurse from pushing leg or arm? unable to squeeze fingers?

40
Q

Arthrography:

A

the x-ray examination of a joint space. During arthrography, a contrast material is injected to enable the radiologist to study the joint space that appears on the x-ray image. Xray only works on bone. If it is a real bad sprain, could have torn ligaments. If xray okay, may need to get an mri

41
Q

Arthroscopy

A

Arthroscopy (ahr-THROS-skuh-pee) is a procedure for diagnosing and treating joint problems. During arthroscopy, a surgeon inserts a narrow tube containing a fiber-optic video camera through a small incision — about the size of a buttonhole. The view inside your joint is transmitted to a video monitor.

42
Q

Electromyography

A

Electromyography (EMG) is a diagnostic procedure to assess the health of muscles and the nerve cells that control them (motor neurons).

43
Q

Mobility primary prevention

A

regular physical activity, optimal nutrition, maintaining optimal body weight, and getting adequate rest. Also, taking measures to prevent injury and trauma.
Protection against injury
Wearing a helmet when riding a bicycle, skateboard, etc.
Wearing padding when riding a skateboard
Optimal nutrition
Education: Exercise a minimum of 30 minutes 3 times a week
Wear a helmet when riding a bicycle, skateboard, etc
Optimal nutrition- blood sugar drops when you exercise. Why try to get diabetics to exercise.
Eat healthy meals
Assess the home and yard for potential items that may cause you to trip

44
Q

Tertiary prevention- mobility

A 
Visiting nurse, physical therapist or family member helping pt post surgery to live as normally as possible: Checks environment for potential falls
Loose carpet, Remove area rugs
Don’t forget the outside
Loose or chipped
Sidewalk, Driveway, Veranda
45
Q

mobility secondary prevention

A

older woman getting and osteoporosis check

46
Q

problems from immobility

A 
DVT (deep vein thrombosis)
Pulmonary problems
Pneumonia
Hypoxia 
Bone demineralization
Muscle contractures 
Skin breakdown (decubiti) 
Disuse syndrome
47
Q

osteoporosis

A

Chronic, progressive metabolic bone disease characterized by: Porous bone, Low bone mass, Structural deterioration of bone tissue, and Increased bone fragility
At least 10 million people in the United States have osteoporosis.
One in two women and one in eight men over 50 will sustain an osteoporosis-related fracture

48
Q

Diseases associated with osteoporosis

A 
Intestinal malabsorption (Chromes disease or really bad IBS)
Kidney disease
Rheumatoid arthritis
Hyperthyroidism
Chronic alcoholism (malabsorption, may lead to cirrhosis of the liver)
Cirrhosis of the liver
Hypogonadism (low testosterone)
Diabetes mellitus
49
Q

Drugs that interfere with bone metabolism

A 
Corticosteroids
Antiseizure drugs (e.g., valproate [Depakote], phenytoin [Dilantin]) 
Aluminum-containing antacids
Certain cancer treatments
Excessive thyroid hormones
50
Q

osteoporosis prevention

A

Regular weight-bearing exercise
Fluoride
Calcium
Vitamin D

51
Q

collaborative care for osteoporosis would look like?

A

working with the healthcare team combo of dietitian (proper nutrition), physical therapy(weight bearing exercise, prevention of fractures, gait aid to prevent falls), pharmacist (drug therapy, calcium supplements)

52
Q

Adequate calcium intake?

A

1000 mg/day premenopausal and postmenopausal taking estrogen
1500 mg/day postmenopausal without estrogen
Supplemental calcium
Must be taken in divided doses with food to enhance absorption
Vitamin D necessary for calcium absorption/function; bone formation
Sunlight for 20 minutes adequate
Supplemental (800-1000 IU/day)
Postmenopausal
Older adults
Homebound
Minimal sun exposure

53
Q

Calcium rich foods:

A 
Milk 
Yogurt
Turnip greens
Cottage cheese
Ice cream
Sardines and anchovies (canned with bones)
Spinach
54
Q

Bisphosphonates

A

Inhibit bone resorption
Side effects: anorexia, weight loss, gastritis
Proper administration
Take with full glass of water while sitting up or standing!
Take 30 minutes before food or other meds.
Remain upright for at least 30 minutes. Never crush med. Rarely can cause jaw bone death.

55
Q

Calcitonin

A

is secreted by the thyroid gland and inhibits osteoclastic bone resorption by directly interacting with active osteoclasts.
Salmon calcitonin (Calcimar) is available in intramuscular, subcutaneous, and intranasal forms.
Administration of the intramuscular or subcutaneous form of the drug at night has been shown to decrease the side effects of nausea and facial flushing associated with this drug.
Nausea does not occur with the nasal spray.
If patients are using the nasal form, teach them to alternate nostrils daily. Nasal dryness and irritation are the most frequent side effects.
When calcitonin is used, calcium supplementation is necessary to prevent secondary hyperparathyroidism.

56
Q

osteoarthritis

A

Caused by direct damage or instability, regular exercise can help prevent.Inflammation is NOT a characteristic! Usually recommend acetemetaphin over nsay because nsay treats inflammation. Can have inflammation of synovial fluid- but not considered an inflammatory diseaseLocalized
Joint Cartilage (localized, not systemic!)
Usually occurs after 50*
Usually overweight
Stiffness in AM subsides after 30 minutes; then worsens, relieved with rest
Synovial fluid WBC’s

57
Q

osteoarthritis risk factors

A 
Age
Estrogen reduction at menopause
Obesity
Injury
Frequent kneeling and stooping
58
Q

rheumatoid arthritis

A 
Systemic manifestation
Immune system
Can occur at any age
Usually loses weight
Stiffness lasts 1 hr to all day, may decrease with use, rest does not improve sx
WBC > 20,000 mostly neutrophils
59
Q

osteoarthritis planning goals

A

Maintain or improve joint function
Use joint protection measures
Achieve independence in self-care and maintain optimal role function
Use drug and nondrug strategies to manage pain

60
Q

nursing interventions for osteoarthritis

A 
Pain management
Drugs
Nondrug strategies (exercise, heat, cold, relaxation, yoga)
Splints 
Physical therapy for exercise program
Tai chi 
Warm-up to prevent injury
Patient teaching:
Nature and treatment of disease 
Pain management, Body mechanics , Correct use of assistive devices, Joint protection and energy conservation, Nutrition, Weight and stress management, Exercise, Assure deformity is not usual course of OA, Community resources
61
Q

osteoarthritis health promotion

A

Community education
Alteration of modifiable risk factors
Weight loss
Occupational and recreational hazards
Safety measures in athletic instruction and physical fitness programs
Prompt treatment of traumatic joint injuries

62
Q

open reduction for hip fracture

A

surgical repair

63
Q

closed reduction for hip fracture

A

called a buck’s traction. only used if no surgeon available. when removing, remove weight first and inspect skin for breakdown

64
Q

pos operative care

A 
Following the A-B-C’s
Airway
Breathing
Circulation
Observe for complications
Bleeding
Dehiscing (wound breaks open)
Nausea & or Vomiting
Pain control
Special positioning
65
Q

posterior hip replacement (versus anterior)

A

More of a chance of dislocation
Most keep legs abducted (separated)
Abduction pillow or wedge
Must be careful re: positioning

66
Q

behavioral scale for scoring pain in a nonverbal patient

A

FLACC

67
Q

acute pain

A

Sudden onset
Less than 3 months time for normal healing to occur
Mild to severe
Generally a precipitating event or illness can be identifiedCourse of pain decreases over time and goes away as recovery occurs.
Includes postoperative and trauma pain
Treatment goal
Pain control with eventual elimination
Manifestations reflect sympathetic nervous system activation:
Increased heart rate
Increased respiratory rate
Increased blood pressure

68
Q

chronic pain

A

Persistent pain
Gradual or sudden onset
More than 3-month duration; may start acute but continues past normal recovery time
Cause may be unknown. Does not go away; characterized by periods of waxing and waning
Behavioral manifestations
Decreased physical movement/activity
Fatigue, Withdrawal from others and social interaction.Can be disabling and accompanied by anxiety and depression
Treatment goals
Control to the extent possible
Focus on enhancing function and quality of life

69
Q

Non drug pain therapy

A

Massage, Exercise
TENS or PENS, Acupuncture
Heat or cold therapy,Transcutaneous electrical nerve stimulation (TENS)- Delivery of an electrical current through electrodes on the skin,Acupuncture,Traditional Chinese medicine,Cognitive therapies:
Distraction,Hypnosis, and Relaxation

70
Q

General care guidelines for immobilized patient

A 
Frequent turning, positioning, alignment
Skin assessment and skin care
Range of motion
Deep breathing
Weight bearing (if possible)
Measures to optimize elimination
Nutrition
Exercise therapy
Ambulation
Joint mobility
Stretching
Balance
Pharmacologic agents
Anti-inflammatory agents
Analgesics
Nutrition supplementation
71
Q

Disuse syndrome

A

can be prevented by moving for 5 minutes 2 times a day. Reverse by increasing activity as pt progresses. collaborative care will include nurse, physician, physical therapist, occupational therapist, dietitian and social worker

72
Q

Hoyer lift

A

allow a person to be lifted and transferred with a minimum of physical effort. Can typically lift 400-600 max pounds, but some can go up to 1,000

73
Q

muscle wasting from inactivity

A

Increased nitrogen in the urine
Protein loss of 8 grams a day
Calcium wastage (1.54 grams per day)

74
Q

Cardiovascular problems from inactivity

A

Oxygen intake decreases
Cardiac output decreases
Systolic blood pressure rise
Orthostatic hypotension common problem

75
Q

Occurrences in Blood and Lungs from inactivity

A

Decrease in RBC, Increase in DVTs
Increase in secretions (can block brachial)
Atelectasis
Poor gas exchange

76
Q

Occurence in GI from inactivity

A

Mucosal atrophy

Liver atrophy

77
Q

genitourinary system from inactivity

A

Myoglobin being destroyed, goes out into the bloodstream, myoglobin is very toxic to kidneys. Can put into complete renal failure.
Elevated potassium from degenerating muscles. Potassium is in your muscles, can cause the heart to stop.

78
Q

Reproductive and endocrine systems from inactivity

A

Decrease serum androgen levels
Decrease spermatogenesis
Irregular menstrual cycles
Thyroid and adrenal gland function decreases.

79
Q

Other consequences of inactivity

A

Body temperatures fall, andCircadian rhythms desynchronize
Breakdown of feedback-The body loses the ability to communicate with itself
immune system breaksdown. Stagnation -body fluid prime place for bacteria and fungi to grow, Infection follows, May lead to sepsis
Cardiovascular vulnerability, Obesity, Musculoskeletal fragility, Depression, and Premature aging

80
Q

Respiratory therapy for immobile patient

A 
Ventilator
Breathing treatments
Chest Physiotherapy
Chest percussion 
Nursing Care
Keep Airway open
Suctioning endotracheal tube (after percussion)
Medications to improve oxygenation
Monitoring pulse ox
81
Q

Mobility Primary prevention

A

regular physical activity, optimal nutrition, maintaining optimal body weight, and getting adequate rest. Also, taking measures to prevent injury and trauma.

1430 (4 decks)

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