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NUR 211 Krissa > Unit 3 > Flashcards

Unit 3 Flashcards

1
Q

Type of bone cells that break down bone

A

osteoclasts

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2
Q

Type of bone cells that rebuilds bone

A

osteoblasts

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3
Q

What are osteoclasts

A

bone cells that break down bones

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4
Q

What are osteoblasts

A

Bone cells that rebuild bones

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5
Q

Define osteopnea

A

bone loss

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6
Q

Common area’s of bone loss

A
  • Vertebrae in the lumbar spine
  • Hip
  • Distal radius (near wrist)
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7
Q

bone loss can cause increased risk for what

A

fractures

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8
Q

Calcitonin’s role on osteoperosis

A

decreases osteoclastic activity

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9
Q

Estrogen’s role in osteoperosis

A

Promotes osteoblastic activity aiding in bone formation

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10
Q

Parathyroid hormone’s role in osteoperosis

A

Stimulates new bone formation, increasing bone mass and increases osteoblastic activity
Given to clients at very high risk for fractures
Has been associated with development of Bone Cancer

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11
Q

cigarette smoking
early menopause
excessive use of alcohol
family history
female gender
increasing age
decreasing calcium intake
sedentary lifestyle/immobility
thin, small frame
european descent or asian race

All of the following are risk factors for what?

A

osteoporosis

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12
Q

“silent disease” becuase it is usually not diagnosed until a fracture

A

osteoporosis

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13
Q

Dowagers hump

A

kyphosis of the dorsal spine, a clinical manifestation of Osteoperosis

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14
Q

Fractures
Dowagers hump
loss of height
back pain
pain increased with activity abd relieved by rest
restriction if movement (thoracic and lumbar regions)
hx of falls (fear of falling)
constipation
abd distention
reflux esophogitis

All of the following are clinical manifestations of what?

A

osteoporosis

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15
Q

Dx testing for osteoporosis

A

Gold standard testing: BMD done via DEXA Scan
Quantitative CT
Baseline calcium level
Baseline Vitamin D level

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16
Q

clinical manifestations of osteoporosis

A

Fractures
Dowagers hump
loss of height
back pain
pain increased with activity and relieved by rest
restriction if movement (thoracic and lumbar regions)
hx of falls (fear of falling)
constipation
abd distention
reflux esophogitis

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17
Q

Gold standard testing: BMD done via DEXA Scan
Quantitative CT
Baseline calcium level
Baseline Vitamin D level

All of the following are dx testing for what?

A

Osteoporosis

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18
Q

BMD -0.1 or higher indicates….

Or to the right of the -0.1

A

Normal BMD

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19
Q

BMD less than -1.0 or to the lecft of -1.0 indicates

A

Abnormal BMD

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20
Q

Test that gives precise body measurements at specified skeletal points throughout the body.
Used for screening and diagnosis of osteopenia or osteoporosis

A

BMD through DEXA

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21
Q

BMD through DEXA

A

Test that gives precise body measurements at specified skeletal points throughout the body.
Used for screening and diagnosis of osteopenia or osteoporosis

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22
Q

Test that measures volumetric bone density of spine and hip. Used for diagnostic management (to confirm dx) of osteo

A

QCT

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23
Q

QCT

A

Test that measures volumetric bone density of spine and hip. Used for diagnostic management (to confirm dx) of osteo

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24
Q

Normal Calcium level

A

9-11

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25
Q

Calcium level less than 8 can indicate…

A

calcium deficiency, osteoporosis

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26
Q

Normal vitamin D level

A

30-50

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27
Q

Vitamin D levels 20-30 indicates

A

vitamin D insufficiency, osteoperosis

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28
Q

Vitamin D levels above 50 can indicate what? and cause what?

A

toxicity
Dehydration, hypercalcemia, and kidney damage

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29
Q

Osteoporosis medical management

A

Prevention
Early screening
weight loss
Muscle-strength training
avoid smoking
avoid excessive alcohol intake
use of orthopedic devices (braces)
Administer meds to prevent the disease
Surgery

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30
Q

Prevention tips for osteoporosis

A

Calcium with vitamin D suppluments
15 mins of sun exposure per day

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31
Q

Medications for osteoporosis

A

Bisphosphate
Calcitonin
Estrogen/hormone therapy
estrogen angst
parathyroid hormone/parathyroid hormone analog
dual-acting bone agent
monoclonal activity

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32
Q

Medication impedes bone reabsorption by inhibiting osteoclastic activity, therby absorbing calcium phosphate in the bone.
Route: a Tablet can be taken daily weekly, or monthly on an empty stomach. IV infusion every 3 months. can be an annual IV infusion
S/E: GI disturbance, dysphagia, esophogeal inflammation, Afib
NI: Teach pt to report nausea, take with water and sit up for 30 mins after taking, dental exams for IV

A

Biophosphate

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33
Q

Decreases osteocastic activity in bone, decreases mineral release and collagen breakdown in bone, and assists with renal excretion of calcium
Route: Intranasal spray daily, SubQ
S/E: cause rhinitis and epistaxis

A

Calcitonin

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34
Q

assists with bone remodeling and osteoclastic activity
S/E: MI, Stroke, breast cancer, PE, and DVT

A

Estrogen

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35
Q

Assists with bone remodeling and osteoclastic activity
Route: daily tablet
S/E: DVT

A

Estrogen antagonist

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36
Q

Protects against gonadotropin-releasing hormone agonist-related bone loss
Route: SubQ daily
S/E: Leg cramps, dizziness

A

Parathyroid hormone

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37
Q

Increases bone density and strength
Route: Periumcumbical subQ daily
S/E: Tachycardia, dizziness

A

Parathyroid hormone analog

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38
Q

Decreases osteoclastic activity and increases osteoblastic activity, thereby balancing bone turn over, increasing bone formation and remodeling
Route: Daily soluble sachet

A

Dual-acting bone agent

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39
Q

Inhibits osteoclastic function formation, and survival, thereby reducing osteoclastic bone reabsorption
Route: SubQ every 6 months
S/E: Can cause infections
NI: Can be used in patients who cannot take biophosphates d/t decreased renal function

A

monoclonal activity

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40
Q

Theraputic procedures for Osteoporosis

A

orthotic devices
joit repair/arthroplasty
vertebroplasty or kyphoplasty
PT/rehab

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41
Q

Patient education for orthotic devices

A

Check skin for breakdown
use good posture and body mechanics
Log roll when getting out of bed
Use head and back rubs to promote relaxation

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42
Q

minimally invasive procedure preformed by a surgeon or radiologist. Used with other conservative measures to treat the fractures have proven ineffective. Bone cement is injected into the fractured space of the vertebral column w/ or w/o balloon inflation.

A

vertebroplasty kyphoplasty

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43
Q

Medications that can help prevent Osteoporosis

A

Calcium supplements
Vitamin D suppluments

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44
Q

Fall precautions at home for patients

A

remove throw rugs
provide adequate lighting
clear walkways of clutter
Wear non-stick socks when walking in the house
clear marked thresholds, doorways, and steps

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45
Q

Priority nursing interventions for osteoporosis

A

Prevent injury
Provide personal care to a client to reduce injury
Provide education to promote level of health and functioning
administer meds as ordered
Make appropriate HH referrals

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46
Q

Complications of osteoporosis

A
  • Falls
  • Compression fx
  • Respiratory complications d/t decreased chest expansion
  • Prolonged hospitalization
  • Death
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47
Q

Osteo patients should have limited access to ____________, ______________, and ______________ because they increase bone loss

A

Caffine
alcohol
carbonated beverages

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48
Q

Diet tips for osteoporosis patients

A

Adequate amounts of protein, magnesium, vitamin K, calcium, vitamin D, and other trace minerals needed for bone formation

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49
Q

What kinds of activities should osteoporosis patients avoid and why?

A

Activities that increase body stress such as jarring or strenuous activities

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50
Q

Patient education for osteoporosis patients

A

Limit excess caffeine, alcohol, and carbonated beverages as they increase bone loss
Consume adequate amounts of protein, magnesium, vitamin K, calcium, vitamin D, and other trace minerals needed for bone formation
Avoid slippery surfaces
Wear rubber-bottomed shoes
Exercise under guidance from the care provider to reduce vertebral fractures
Isometric exercises help with strengthening the core
Avoid activities that increase body stress (jarring activities, strenuous lifting)

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51
Q

Protein Sources

A

Eggs
Chicken
Lean beef
Fish
Turkey
Cheese
Greek yogurt
Milk

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52
Q

Magnesium Sources

A
  • Greens
  • Nuts
  • Seeds
  • Dry beans
  • Whole grains
  • Wheat germ- wheat and oat bran
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53
Q

Vitamin K sources

A

Green, leafy vegetables
Soybean
Fortified meal replacement shakes

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54
Q

Calcium rich sources

A
  • Dairy - Cheese, yogurt
  • Fortified plant-based milks
  • Calcium-fortified OJ
  • Butternut squash
  • Green, leafy vegetables
  • Avocado
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55
Q

Vitamin D rich Foods

A

Fortified milk, cereal, and juices
Salmon
Eggs
Tuna and sardines
Trout
Beef liver
White mushrooms

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56
Q

Leading cause of disability world wide

A

Low back pain

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57
Q

Acute onset of low-back pain acts as a warning of what?

A

ongoing tissue damage

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58
Q

Associated with aging and normal loss of structure & function
Nucleus pulposus (inner) loses water and fibers of the annulus (outer) begins to wear out
Body’s ability to lubricate the joint decreases creating friction
Friction damage causes spinal ligaments to weaken -> loses strength & elasticity

Complication associated with osteoarthritis

A

Spinal degeneration

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59
Q

Constriction of spinal foramina and canals-> pressure on cord and nerve roots -> causes pain

A

Spinal stenosis

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60
Q

Sudden, involuntary contraction of a single muscle or muscle group -> caused by inflammation and soreness from sudden movement or bending

A

Muscle spasm

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61
Q

Obesity
Cigarette smoking
Poor posture
Stress
Poor physical condition
Poor sleeping position
Occupations that require heavy lifting

all of the following are risk factors for what?

A

Low back pain

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62
Q

Low back pain dx test

A

History & Physical
CT scan
Diskogram
MRI
Electromyography (EMG)
Nerve conduction study
Bone Scan
Myelogram
X-rays

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63
Q

Non-pharm treatments for low-back pain

A

Exercise/PT
Superficial heat
Acupuncture
Massage therapy
Meditation/yoga

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64
Q

Meds for low back pain

A

NSAIDS
Muscle relaxants
Opioids
Corticosteroids
Tricyclic antidepressants
Benzodiazepines
Local anesthetics
Anticonvulsants

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65
Q

Aspirin, ibuprofen, toradol, and naproxen are all examples of what type of medication?

A

NSAIDS

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66
Q

Soma, flexeril, and valium are all examples of what type of medication?

A

Muscle relaxants

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67
Q

Morphine, codine, oxycodone, and hydrocodone are all examples of what type of medication?

A

Opioids

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68
Q

Prednisone, cortisone, and hydrocortisone are all examples of what type of medication?

A

Corticosteroids

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69
Q

Elavil is an example of what type of medication?

A

Tricyclic antidepressant

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70
Q

Ativan is an example of what type of medication?

A

Benzodiazepine

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71
Q

Neurotin, lyrica, topamax, and tegretol are all examples of what type of medications?

A

Anticonvulsants

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72
Q

Low back pain medical interventions

A

Interventional therapy - nerve blocks, lidocaine, steroids, narcotics injected into affected areas
Transcutaneous electrical nerve stimulation
Back Surgery-Lumbar fusion

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73
Q

Expected vitals for someone in pain

A

HTN
Tachycardia
Tachypnea

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74
Q

Low-back pain patient education

A

Low back exercises
Take medications as ordered
Non-pharm pain relief
Weight control

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75
Q

Connects muscles to bones

A

tendons

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76
Q

connects bone to bones

A

ligaments

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77
Q

projections of new cartilage and bone growth that forms along joint lines, causes joint pain and decreases ROM

A

osteophytes

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78
Q

membrane that line the non-cartilaginous surfaces of highly mobile joints, produces synovial fluid

A

synovium

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79
Q

lubricates joints

A

synovial fluid

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80
Q

overproduction of synovial fluid that can cause ligaments to stretch, making joints unstable is called what

A

effusions

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81
Q

lies adjacent to the cartilage layer and provides mechanical and nutritional support for for the cartilage

A

subchondral bone

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82
Q

Risk factors for osteoarthritis

A
  • Age: over 55
  • Female
  • Obesity
  • Occupation-musicians, teachers, healthcare workers, construction workers, dancers, athletes
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83
Q

Cartilage loss, synovial membrane thickens and over produces synovial fluid. Causes pain, joint instability, muscle atrophy, and deterioration of joint function

A

Osteoarthritis

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84
Q

Located at the proximal interphalangeal joints
Symptom of osteoarthritis

A

bouchards nodes

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85
Q

located at the distal interphalangeal joints
Symptom of osteoarthritis

A

heberden’s nodes

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86
Q

Signs of osteoarthritis in hands

A

bouchards nodes
heberden’s nodes

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87
Q

what causes nodes in hands in osteoarthritis?

A

osteophytes form in the nodes, break off and cause cartilage loss

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88
Q

All of the following are clinical manifestations of what?

  • Progressive aching/pain over time increasing with joint use
  • Pain relieved with rest
  • Decreased range of motion
  • Tenderness to touch
  • Morning stiffness less than 30 minutes
  • Bony swelling (Osteomyelitis)
  • Soft tissue swelling
  • Crepitus
  • Deformity of joints
  • Joint instability
A

osteoarthritis

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89
Q

a cracking, grating sound or feeling, due to air or gas under the skin happens because of cartilage breakdown

A

crepitus

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90
Q

Diagnostic tests for osteoarthritis

A

Lab tests to R/O RAand gout
Lab tests to monitor for s/e of meds
X-ray affected joints

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91
Q

Non-pharm treatments for osteoarthritis

A

Weight loss
Heat and cold compresses
Aerobic exercise
PT to include ROM and muscle-strengthening
Appropriate/therapeutic footwear
Use of ambulatory assistive devices
Appropriate footwear
OT to include assistive devices for ADLs
Energy conservation techniques
Goal setting

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92
Q

Can the progression of osteoarthritis be stopped?

A

no

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93
Q

Goal of care for osteoarthritis

A

decrease pain improve/maintain joint mobility while avoid toxic effects of pharm therapy

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94
Q

Pharmocological treatments for osteoarthritis

A

acetaminophen
NSAIDs
Corticosteroid injections
opioids

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95
Q

Joint irrigated and expanded to remove debris, treatment for osteoarthritis

A

arthroscopic irrigation/debreidement

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96
Q

Remove excessive growth of synovial membrane, surgical treatment for osteoarthritis

A

synovectomy

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97
Q

Fuse joint surfaces to prohibit movement, surgical intervention for osteoarthritis

A

surgical fusion

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98
Q

Surgical options for osteoarthritis

A

surgical fusion
Synovectomy
Arthroscopic irrigation/debreidement
Arthroplasty

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99
Q

Complications of osteoarthritis

A

diabetes, heart failure

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100
Q

Client teaching for osteoarthritis

A

Take medications as prescribed
Report chest pain, abdominal pain, abnormal bleeding
Participate in regular physical activity
Occupational and physical therapy
Orthopedic surgery
Home health referral

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101
Q

Chronic pain disorder of soft, connective tissue. Causes pain signals to be amplified. Can be triggered by stressors like infection and trauma (physical and emotional)

A

fibromyalgia

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102
Q

fibromyalgia cycle

A
  1. Pain
  2. Muscle tension
  3. Daily Stress
  4. Limited activity
  5. Fatigue
  6. Depression
  7. Muscle stiffness
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103
Q

All of the following are clinical manifestations of what?

Widespread pain – sometimes described as stabbing or burning pain
Insomnia
Fatigue
Stiffness
Cognitive dysfunction
Depression and anxiety
Headache
Abdominal pain – painful menstrual cramps
Increased sensitivity to heat, cold, pressure
Numbness in hands and feet
Restless leg syndrome

A

fibromyalgia

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104
Q

Cognitive dysfunction with fibromyalgia can be called what?

A

fibro-fog

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105
Q

How to definitively test for fibromyalgia

A

trigger points are looked at
For diagnosis, patient must experience pain at 11 or more points
The assessment is done by applying 4 kg of pressure to the specific points.

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106
Q

involves both sides of the body and above and below the waist.

A

widespread pain

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107
Q

Non-pharm treatment for fibromyalgia

A
  • Physical therapy
  • Strength training
  • Aerobic exercise
  • Cognitive behavioral therapy
  • Education
  • Self-management
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108
Q

Fibromyalgia Pharmocologial treatment

A

NSAIDs
Antidepressants
Anti-seizure medications
Sleep aids
Non-opioid analgesics

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109
Q

Why aren’t opioids recommended for fibromyalgia?

A

habit forming nature and ineffectiveness of therapy

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110
Q

Nursing diagnosis for fibromyalgia

A

Chronic pain r/t disease process
Ineffective coping skill r/t chronic pain
Depressed mood r/t chronic pain
Ineffective sleep patterns r/t chronic pain

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111
Q

Heating pads for…..

A

painful muscles

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112
Q

Cold packs for….

A

painful joints

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113
Q

Client education for fibromyalgia

A

Taking medications only as prescribed
Participate in regular physical activity
Teach effective coping skills
Explain the purpose of a sleep study, if ordered
Make appropriate mental health referrals, if client demonstrates depression
PT and OT

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114
Q

Expected outcomes for fibromyalgia

A

Your client has decreased pain
Your client has decreased fatigue
You client reports healthy sleep patterns
Your client has improved strength and function
Your client has stable weight, adequate nutrition and hydration

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115
Q

Back pain lasting less than 4 wks

A

Acute back pain

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116
Q

Back pain lasting 4-12 wks

A

subacute back pain

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117
Q

Back pain lasting more than 12 wks

A

Chronic back pain

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118
Q

Scan used to test for Low back pain, can show the back at different angles showing the shape and size of spinal canal, its contents, and structures. Optimal in visualizing bony structures

A

CT scan

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119
Q

Used to test for low back pain. Opaque dye is injected into suspected discks, pictures are taken, and the patients ration and image help determine the disks status

A

Diskogram

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120
Q

Used to test for low back pain. Shows cross sectional images of the spine show the spinal cord, nerve roots, and surrounding spaces. Optimal in detecting soft tissue damage or disease. I.E. disks between vertebrae or ligaments

A

MRI

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121
Q

Used to test for low back pain. Tests electrical impulse within muscle tissue. Can determine if nerve damage is healing, ongoing, and findings correlate to the site of damage

A

Electromyography

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122
Q
  • Tests electrical nerve impulse that indicates damage to the nerve. Electrodes are placed over the skin over a nerve that supplies a specific muscle group .
  • A mild breif stimulus is delivered through the electrode, and the signal strenght and muscle response are measured

Tests for low back pain

A

Nerve conduction study

123
Q

Used to test for low back pain. A dye is injected into the spinal column and an x-ray is taken. This can show pressure on the spinal cord or nerves from herniated disks, tumors, or bone spurs/ This procedure requires a lumbar puncture to inject contrast dye.

Used to test for lowback pain

123
Q
  • Used to test for low back pain.
  • Radiation beam is passed through the back to produce a two-demensional picture.
  • Shows the structure of the vertebrae and joint outlines
124
Q

Fracture that causes disruption that spans across the width of the bone causing bone fragments

A

Complete fracture

125
Q
A

Complete fracture

126
Q

Fracture that disruption occurs through part of the bone cortex; no displacement of bone fragments

A

Incomplete fracture

127
Q
A

Incomplete fracture

128
Q

fracture that is contained with the skin.

A

Closed simple

129
Q

fracture in which bone still is in proper alignment

A

Closed simple, non-displaced

130
Q
A

Closed simple, non-displaced

131
Q

Fracure in which bone is not aligned properly

A

Closed, simple, displaced

132
Q
A

Closed simple, displaced

133
Q

disruption where pieces of bone protrude through the skin, creating an external wound that exposes the fracture site. These fractures are graded based on the severity of the fracture

A

Open compound fracture

134
Q
A

open compound fracture

135
Q

A grade of an open compound fracture with presence of puncture wound, minimal soft tissue injury, vasculature remains intact

A

Grade 1 open compound fracture

136
Q

A Grade of open compound fractures. Puncture wound, fragments of broken bone, moderate skin and muscle contusions, significant wound contamination

A

Grade 2 Open compound fractures

137
Q

A grade of open compound fractures. Severe damage to soft tissues, nerves, muscles, and blood vessels. Open fracture site is extremely contaminated. Contains numerous comminuted fractures

A

Grade 3 open compound fracture

138
Q
A

Avulsion fracture

139
Q

A fracture caused by overstretching and tearing of a tendon or ligament, separating a small segment of bone at the insertion site.

A

avulsion fracture

140
Q

fracture that has shattered bone fragments at the site of disruption.

A

Comminuted fracture

141
Q
A

Comminuted fracture

142
Q

fracture caused by excessive force along the axis of spongy bone, making the bone collapse on itself (vertebral compression fracture r/t fall)

A

Compression fracture

143
Q
A

Compression fracture

144
Q
A

Depression fracture

145
Q

disruptions where bone fragments are forced inward (associated with blunt trauma to facial and skull fractures)

A

depression fracture

145
Q

fracture in which bone fragments not in proper alignment

A

Displaced fracture

146
Q

incomplete disruption where one side of the bone is bent and the other is fractured (typical in children because of their bone flexibility)

A

greenstick fracture

147
Q
A

greenstick fracture

148
Q

fracture in which break occurs at a 45-degree angle across the bone.

A

Oblique fracture

149
Q
A

oblique fracture

150
Q

fracture in which bone fragments are well approximated at the site of disruption (bone pieces are lined up).

A

non-displaced fracture

151
Q
A

Spiral fracture

152
Q

fracture wraps around the shaft of the bone.

A

Spiral fracture

153
Q

fracture in which segments of bone are wedged into each other at the fracture line.

A

impacted fracture

154
Q
A

Impacted fracture

155
Q

All of the following are clinical manifestations of what?

Pain
Deformity sometimes seen
Open wound, in some cases

A

A fracture

156
Q

DIagnostic testing for fractures

A

Physical assessment of injury
X-ray of specific bone or bone group
MRI
Myoglobin level
Creatine Phosphokinase
CBC
CMP
Renal Panel
Urinalysis

157
Q

Presence of rhabdomylosis can mean what?

A

AKI or declining kidney function

158
Q

Anesthesia used in fracture patients

A

Conscious Sedation
General Anesthesia
Nerve Block
Spinal Block

159
Q

Non-surgical treatment of fractures

A

Closed reduction
anesthesia
cast or splint after realignment
Traction (skeletal or skin traction)

160
Q

Surgical treatment for fractures

A

ORIF
Traction

161
Q

Surgical treatment for fractures that involes plates, screw rods into a fracture

162
Q

Surgical treamtent for fractures that involves rods and pins around the fracture to stabilize it

163
Q
A

External fixator

164
Q
A

Traction devices

165
Q

Medications used to treat fractures

A

Pain medications - opoioids and NSAIDs
Admin abx as ordered to prevent osteomyelitis and infection

166
Q

6 P’s

A

Pain
pressure
paralysis
pallor
paresthesia
pulselessness

167
Q

Abscence of the 6 P’s indicates what?

A

indicates that proper treatment is being provided and there is no neurovascular compromise

168
Q

The presence of one or more of the 6 P’s can indicate what?

A

neurovascular compromise
reduced arterial blood flow to the periphery of the affected limb, or reduced blood flow from periphery of the affected limb to the heart.

169
Q

reduced arterial blood flow to the periphery of the affected limb, or reduced blood flow from periphery of the affected limb to the heart

A

This can lead to hemorrhage, compartment syndrome, infection, or permanent loss of function.

170
Q

Immobilization devices should be frequently assessed why?

A

devices can become loose, compromise circulation, or move out of position. Frequent assessment is needed to ensure devices are secure and the healing process is not hindered.

171
Q

Vital signs to watch for in patients with a fracture

A

Low BP, tachycardia, and tachypnea may indicate symptoms of hemorrhagic shock d/t excessive bleeding
Elevate temperature can indicate infection
Tachycardia, tachypnea, and decreased pulse oximetry may indicate a pulmonary embolus

172
Q

A patient with a fracture that has a Low BP, tachycardia, or tachypnea can mean what?

A

Hemorrhagic shock d/t excessive bleeding

173
Q

Tachycardia, tachypnea, and decreased pulse oximetry in a patient with a fracture may indicate a what?

A

Pulmonary embolism

174
Q

Nursing diagnosis for patients with a fracture

A

Acute pain r/t muscle spasms and trauma

Activity intolerance r/t immobility

Impaired mobility r/t limb immobilization

Impaired skin integrity r/t presence of cast, splint, and traction

175
Q

Wound/pin care for fracture patients

A

Providing daily pin site and wound care using strict aseptic technique reduces the risk of infection and promotes healing.

176
Q

If a crushing injury is supected what should you not do and why?

A

Elevate it becuase it reduces arterial pessure

177
Q

What should you do to the effected extremity of a patient with a fracture to reduce pain and edema?

A

Elevate the extremity

178
Q

Fracture patients should be reminded to do what for pulmonary hygiene?

A

Incentive spirometry
Turn, cough, and deep breathing

179
Q

Treatment for fractures that promotes vasoconstriction and decreases edema and pain

A

Applying ice

180
Q

Diet for patients with a fracture

A

Extra protein, calcium, and vitamins A/D/C are needed for adequate bone repair.
Adequate fluid intake is essential to ensure adequate “flushing” of the kidneys to prevent the complications of rhabdomyolysis.
Iron supplements may be required for the treatment of anemia after surgery.

181
Q

If a fall is witnessed what do you do?

A

do not move the patient until the extremity is immobilized. Monitor for swelling, assess for 6 p’s, apply a cold pack to reduce swelling, position extremity above the level of the heart

182
Q

You have a fracture patient that is experiencing:

Decreased blood flow & oxygen to tissues
Severed vessels or nerves by bone fragments

What are they experiencing? What needs to be done to correct it?

A

Neurovasular compromise
Elevate the extremity, remove the cast/splint
Contact HCP ASAP

183
Q

Your patient with a fracture has the following history:

Immobility
trauma
cardiac disease
long surgery
obesity
smoking
Birth control pill use

What are they at risk for during their hospital stay? How to prevent?

A

Venous thromboembolism (VTE)
Early ambulation, anticoagulation therapy

184
Q

All of the following are S/S if what?

Respiratory distress
Acute confusion
Generalized petechiae
Restlessness potentially leading to respiratory failure and death

A

Fat embolism

185
Q

How to ‘fix’ a fat embolism

A

Frequent VS monitoring, aggressive treatment of long bone fx, administer fluids, Prednisone

186
Q

Occurs in long bone fractures, very frequent in fx of the arms and legs (radius, ulnar, humerus, femur, tibia, fibula)
Fatty bone marrow migrate into systemic circulation and clog smaller blood vessels

Complication associated with a fracture

A

Fat embolism

187
Q

Clients who are not candidates for surgery for a fracture require what?

A

Immediate intervention to prevent a DVT

188
Q

A complication in fracture patients that is associated with blood loss

A

Hypovolemia

189
Q

How to correct hypovolemia

A

Fluid replacement

190
Q

All the following are S/S of what?

Severe flank pain
Dark, tea-colored urine
Elevated serum myoglobin level

Complication of a fracture

A

Rhabdomyolysis

191
Q
  • Compression & tissue ischemia -> restricted blood flow to muscle -> myoglobin spills into circulation -> nephrons are clogged -> Renal failure
  • Could also see multiple electrolyte imbalances

A complication of a fracture

A

Rhabdomyolysis

192
Q

How to correct rhabdomyolysis

A

IV fluids to flush kidneys

193
Q

Fracture fail to heal in correct alignment, or fails to heal altogether

Complication in fracture patients

A

Malunion and nonunion

194
Q

How to prevent Malunion and nonunion?

A

Frequently check positioning or immobilization device

195
Q

All of the following are S/S of what?

  • Pain out of proportion to the injury
  • Passive pain at rest of the affected limb, hurts worse when moved
  • All of the 6 P’s are present
A

Compartment syndrome

196
Q

If left untreated Compartment syndrome can lead to what?

A

Loss of affected limb

197
Q

Causes of compartment syndrome

A

burns
Vascular injuries
penetrating trauma
insect bites
IV infiltration
animal bites
bleeding disorders
bone fractures

198
Q
  • Increased edema and hemorrhage in the area of the fracture, causing compression of nerves and blood vessels
  • Can be caused by a cast, immediate removal is necessary

Complication of a fracture

A

Compartment syndrome

199
Q

How to correct compartment syndrome

A

Immediate Fasciotomy – incisions are made through the fascia over the affected compartment to relieve pressure
Notify HCP immediately

200
Q

A pressure on a Stryker device within 30 mmHg of the diastolic pressure or an absolute pressure greater than 30 mmHg indicates what?

A

Compartment syndrome

201
Q

All of the following are clinical manifestations of what?

Sudden, intense dyspnea
Pleuritic chest pain
Tachypnea
Tachycardia
Crackles
Cough
Hemoptysis

Complication of a fracture

A

Pulmonary Embolism

202
Q

Blood clot that breaks off and travels through the heart into the lungs

A

Pulmonary embolus

203
Q

How to correct a pulmonary embolism

A

Anticoagulation (IV Heparin and then oral therapy)

204
Q

What do patients need to be taught about cast care?

A

Notify doc of change in color or temp

205
Q

Client education for a patient with a fracture

A

Treatment process
Overview of healing process
Consume adequate calories
Appropriate use of analgesia
Wound care
Exercise and ambulation
Proper use of slings, splints, casts, and traction
Self-care activities

206
Q

Hip fracture that occurs at the head or neck of the femur within the capsule of the hip joint

A

Intracapsular hip fracture

207
Q

Hip fracture that occurs within the trochanter region

A

Extracapsular hip fracture

208
Q
A

Intracapsular hip fracture

209
Q
A

Extracapsular hip fracture

210
Q

All of the following are risk factors of what?

Aging
Osteoporosis
Decreased muscle mass
Vision and balance problems
Slower reaction time
after menopause
endocrine disorders
intestinal disorders
cancer medications
nutritional problems
physical inactivity
lack of weight-bearing exercise tobacco/alcohol use

A

Hip fractures

211
Q

Testing developed by WHO that uses clinical risk factors with or without BMD to assess a person’s 10-year risk for the development of fractures.

A

FRAX tool
Fracture Risk Assessment Tool

212
Q

Who wouldn’t you use the FRAX tool for?

A

patients under the age of 40 and over the age of 90

213
Q

Ways to diagnose a hip fractures

A

Deformity
Tissue destruction
Loss of function of a specific joint
Joint changes
Stiffness
Pain that limits normal activities
Muscle atrophy
X-rays/MRI

214
Q

Medical treatment for a hip fracture

A

Weight reduction
Activity modification
Nonsteroidal therapy
Joint supplements: glucosamine, chondroitin
Then replacement

215
Q

Teaching for hip fracture patients

A
  • If on warfarin therapy, instruct to maintain current intake of vitamin K foods such as green vegetables. If diet changes, notify the doctor as changes in the warfarin dosage will be changed
  • Reinforce teaching for hip flexion less than 90 degrees for approximately 2-3 months.
  • Use a raised toilet seat.
  • Remove scatter rugs.
  • Safety socks.
  • Shower chair.
  • Assistive devices.
  • Avoid crossing the legs
216
Q

DEXA T-score of -1.0 or higher

217
Q

Normal Dexa T-score

A

-1.0 or higher

218
Q

T-score between -1.0 to -2.5 is indicative of what?

A

osteopenia

219
Q

A T-score of what can indicate osteopenia

A

-1.0 to -2.5

220
Q

T-score of -2.5 or lower in a DEXA scan can indicate what?

A

osteoporosis

221
Q

A T-score of what can indicate osteoporosis

A

-2.5 or lower

222
Q

What is needed to successfully treat low-back pain?

A

Combination of medication and adjunctive therapy

223
Q

diagnosis of low-back pain is based on what?

A

s/s
Duration of pain
Underlying cause
Presence or absence of nerve root involvement

224
Q

Medications used to modify the disease course of MS

A

Avonex
Betaseron
Rebif

225
Q

Immunosuppressive agents used for MS patients

A

Natalizumab
Mitoxantrone

226
Q

Medications used to treat ‘attacks’ in MS patients

A

Corticosteroids
Plasmapheresis (plasma exchange)

227
Q

Medications used to treat clinical manifestations of MS

A

Muscle relaxants
anticonvulsants
antialeptics
stool softeners
laxatives

228
Q

All of the following are clinical manifestations of what?

  • Numbness or weakness in one or more limbs
  • Partial or complete vision loss
  • Pain during eye movement
  • Double or blurred vision
  • Tingling or pain
  • Electric shock sensations occur with head movements
  • Tremor
  • lack of coodination or unsteady gait
  • Fatigue
  • dizziness
  • dysphagia
  • dysarthria
  • arthritis
  • Tinnitus
  • Uhthoff sign
A

Multiple Sclerosis

229
Q

Temporary (less than 24-hr) worsening vision with other worsening neurological functions in response to increased core body temperature

A

Uhthoff sign

230
Q

This is a neurological disease resulting in impaired and worsening function of voluntary muscles. This is an autoimmune disorder that affects the nerve cells in the brain and spinal cord.

A

Multiple sclerosis

231
Q

Possible complications from MS

A
  • Dx can be overlooked for several years d/t vauge findings
  • Can shorten lifespan
  • muscle stiffness
  • muscle spasms
  • Paralysis in legs
  • Problems with bowel, bladder, and sexual function
  • Memory loss
  • Problems concentrating
  • Depression
  • seizures
232
Q

What should you monitor in MS patients?

A
  • visual activity (diplopia)
  • speech patterns
  • swallowing
  • activity intolerance
  • skin integrety
  • cognitive changes
    *
233
Q

Teaching for MS patients

A

Use of adaptive devices
PT/OT
Refer to Speech
Avoid overexertion, stress, extreme temps, humidity, sick people
exercise and strech involved muscles
encourage fluid intake

234
Q

Nursing diagnosis for MS

A
  • Imparied physical mobility
  • Self-care deficit
  • Impaired coping
  • Depression
235
Q

What is this disease?

Progressivly debilitating disease that grossly affects motor function. Characteried by tremors, muscle rigidity, bradykinesia, and postural instability. Degeneration->decreased doapmine production->difficulty making slow controlled movements

A

Parkinson Disease

236
Q

Complication of Parkinsons Disease

A

Aspiration PNA
Altered cognition i.e. dementia, memory deficits

237
Q

All of the following are risk fators for what?

Gender - Male
Genetic predisposition
Environmental exposure - toxins, chemical solvents
Chronic use of antipsychotics

A

Parkinson Disease

238
Q

All of the following are S/S of what?

  • Fatigue
  • Decreased manual dexterity over time
  • Stooped posture
  • Slow, shufflinf, propulsive gait
  • Slow, monotonous speech
  • Tremors/pill-rolling tremor of the fingers
  • Muscle rigidity
  • Bradykinesia/akensia
  • Manlike expression
  • orthostatic hypotension
  • flushing
  • diaphoresis
  • difficulty chewing/swallowing
A

Parkinson Disease

239
Q

slowness of movement and speed.
Progressive hesitation/halts as movements continue

A

Bradykinesia

240
Q

All of the following are S/S of what?

Rhythmic interruption
total resistance to movement
mildly restrictive

A

Muscle rigidity

241
Q

Five stages of Parkinsons

UBPTC

U Be Playing The Class

A
  • Unilateral shaking or tremor of 1 limb: Stage 1
  • Bilateral limb involvement occurs, making walking and balance difficult. Mask-like face, slow shuffling gait. Stage 2
  • Physical movement slows down significantly, affecting walking more. Postural instability. Stage 3
  • Tremors can decrease but akinesia and rigidity make day to day task more difficult. Stage 4
  • Client Unable to walk, is dependent for all care and might exhibit dementia. Stage 5
242
Q

Five stages of parkinsons

Unilateral shaking or tremor of 1 limb

UBPTC

243
Q

Five stages of Parkinson

Bilateral limb involvement occurs, making walking and balance difficult. Mask-like face, slow shuffling gait

UBPTC

244
Q

Five stages of Parkinsons

Physical movement slows down significantly, affecting walking more. Postural instability

UBPTC

245
Q

Five stages of Parkinson Disease

Tremors can decrease but akinesia and rigidity make say to day task difficult

UBPTC

246
Q

Five stages of Parkinson Disease

Client unable to stand or walk, is dependent for all care and might exhibit dementia

UBPTC

247
Q

Theraputic procedures for Parkisons disease

A
  • Stereotactic Pallidotomy or Thalamotomy
  • Deep brain stimulation
248
Q

A treatment for Parkinson’s that allows neurosurgeons to destroy a portion of the globus pallidus, and thereby decrease patients muscle rigidity

A

Stereotactic pallidotomy or Thalamotomy

249
Q

Expected consults for Patients with Parksinon Disease

A

Speech
PT/OT
Social work

250
Q

What to mointor for in Parkinsons patients

A

Swallowing
Nutrition/weight
Mobility
Communication
Cognitive status

251
Q

A symptom of parkinsons

client’s may be unable to control their facial muscles making it hard to express themselves. Does not necessarily mean they are depressed, so ask questions to verify feelings.

A

Mask-like-face

252
Q

S/S of Osteoprosis

FRAIL

A

Fractures
Rounding of the back (dowagers hump)
Asymptomatic
Inches
Lower bacl/hip -neck pain

FRAIL

253
Q

4 Cardinal symptoms of parkinsons

A
  1. Resting tremors
  2. Muscle rigidity
  3. Slowness of movement
  4. Postural instabilituy
254
Q

What type of MS is this?

Most common form
Exacerbations bring NEW clinical manifestations while older ones worsens or reappears
Lasts days or months
Partial or Total recovery which can be slow or almost instant

A

Type 1
Relapsing Re-mitting

255
Q

What type of MS is this?

Condition worsens past relapsing-remitting
Early phase still has relapses
General deterioration occurs
No real recovery even though some improvement may be seen

A

Type 2
Secondary Progressive

256
Q

What type of MS is this?

Progressive course with gradual worsening of clinical manifestations from onset.
Relapses may or may not have recovery.

A

Type 3
Progressive relapsing

257
Q

What type of MS is this?

Gradual progression
No remissions, but may see temporary plateaus
Occurs in late 30s, early 40s
Initial disease activity in spinal cord
Less likely to develop cognitive problems

A

Type 4
Primary Progressive

258
Q

All of the following are S/S of what?

Numbness/tingling or weakness
Partial or complete loss of vision
Optic neuritis
Double or blurred vision
Decreased pain/sensation/temp perception
Electric shock sensations with head movement
Tremor, spasticities
Lack of coordination
Unsteady gait, ataxia
Fatigue
Dizziness, vertigo
Depression/paranoia
Reduced bowel & Bladder control

259
Q

These are S/S of what?

260
Q

Word for unsteady gait

261
Q

How to definitivly diagnose MS

A

2 separate symptomatic events
MRI changes in 2 locations

262
Q

Parkinson’s can cause motor changes which can cause what? Which means the patient should be monitored for what?

A

Drooling and dysphagia
Aspiration

263
Q

How to diagnose Parkinson’s disease

A

2 or more cardinal symptoms
with
asymmetrical presentation is observed in the absence of other causes

264
Q

What medication is this

Reduces tremors
Decreases drooling
S/E: confusion, memory impairment, blurred vision, dry mouth, constipation, urinary retention
Used sparingly in older adults d/t these side effects

A

Anticholinergics

265
Q

How to monitor the progression of Parkinson’s disease

A

Amount of motor decline

266
Q

Medications to treat Parkinson’s

A

Anticholinergics
Dopamine-receptor agonists

267
Q

First line treatment
S/E: N/V, urinary frequency, drowsiness, orthostatic hypotension, lower extremity edema, sleep attacks, poor impulse control (gambling and hypersexuality)
Is most effective in the treatment of bradykinesia, tremors, and rigidity

A

Carbidopa/Levadopa

268
Q

How does Carbidopa/levodopa wrork?

A

Combination drug: carbidopa works as a body-guard for levodopa until it can reach the brain. Once in the brain, levodopa is converted to dopamine which then can inhibit the free-floating acetylcholine

269
Q

These medications are examples of what type of medications?

  • Benxtropine (cogentin)
  • Trihexyphenidyl (Artane)
A

Anticholinergics

270
Q

THese medications are examples of what type of medications?

  • Ropinrole (requip)
  • Pramipexole (Mirapex)
  • Carbidopa/Levodopa (senimet)
A

Dopamine-receptor agonists

271
Q
  • surgically implanted probes connected to impulse generator in upper chest
  • regulates tremors and fine motor coordination

A treatment or parkinson’s

A

Deep brain stimulation

272
Q

Priority Nursing assessments for Parkinson’s Patients

A
  • Four cardinal symptoms
  • Gag reflex and Swallowing ability
  • Musculoskeletal system
  • Bowel and bladder function
273
Q

What to look for when assessing a patient with Parkinsons’ musculoskeletal system?

A
  • Mobility
  • gait
  • weakness/fatigue
  • ability to complete ADL’s
  • Administer medications as prescribed
  • Implement safety precautions
  • Facilitate nutritional intake
  • Elevate HOB
  • Suction equipment at bedside
  • Encourage patients to participate in self-care activities
  • Facilitate interprofessional collaboration
  • Communication strategies
274
Q

All of these foods are rich in what?

  • fortified milk, cereal, juices
  • salmon
  • eggs
  • tuna & sardines
  • Trout
  • Beef liver
  • white mushrooms
275
Q

All of these foods are rich in what?

  • Dairy and fortified plant-based milks
  • Cheese
  • Yogurt
  • Calcium fortified OJ
  • Butternut squash
  • Green leafy vegetables
  • Avacado
276
Q

All of these foods are good sources of what?

  • Green leafy vegetables
  • Soybeans
  • Fortified meal replacement shakes
277
Q

All of the following are good sources of what?

  • Greens
  • Nuts
  • seeds
  • dry beans
  • whole grains
  • wheat germ
  • wheat and oat bran
278
Q

All of the following are good sources of what?

  • Eggs
  • chicken
  • lean beef
  • turkey
  • cheese
  • greek yogurt
  • milk
279
Q

Teaching for parkinson’s patients about walking

A

Teaching the patient to take short, deliberative steps, with the feet somewhat spread, decreases the chance of falls.

280
Q

What to teach Parkinson’s patients about medication compliance

A

The effectiveness of medications prescribed for PD are dependent on compliance with dosing intervals. The patient should contact the provider if the effectiveness of the medications seems to be declining, and a dosage adjustment may be required.

281
Q

All of the following are clinical manifestations of what?

Numbness/tingling or weakness
Partial or complete loss of vision
Optic neuritis
Double or blurred vision
Decreased pain/sensation/temp perception
Electric shock sensations with head movement
Tremor, spasticities
Lack of coordination
Unsteady gait, ataxia
Fatigue
Dizziness, vertigo
Depression/paranoia
Reduced bowel & Bladder control

282
Q

Lab tests for MS

A

No specific test. Only R/O for other conditions
Labs to R/O other inflammatory or infectious disease
Lumbar puncture to r/o viral infections
MRI to ID brain leasions

283
Q

Lumbar puncture teaching points

A

Explain the procedure
Hold antiplatelets and anticoagulants before the procedure
Check labs before procedure
Ensure informed consent is signed
Provide support during procedure
Ensure flat bedrest for 4-6 hrs after the test to prevent CSF leakage (which can cause severe headache)
Encourage fluids postprocedure to decrease headache intensity
If headache is severe and prolonged, a “blood patch” can be performed (a small amount of the client’s blood is injected into the puncture site  the resultant clot seals the leak and stops headache

284
Q

What can be done for someone with a prolonged headache after a lumbar puncture?

A
  • Encourage fluids postprocedure to decrease headache intensity
  • “blood patch” can be performed (a small amount of the client’s blood is injected into the puncture site  the resultant clot seals the leak and stops headache
285
Q

Important teaching for patients AFTER a lumbar puncture

A

Lay flat for 4-6 hrs after testing

286
Q

Treatment of MS focuses on what?

A

Improving speed of recovery from attacks
Reducing the number of attacks
Slowing disease progression

287
Q

All of these medications are used to manage what?

Beta interferons
Interferon beta-1b
Immunosuppressive agents
Corticosteroids
Plasmapheresis
Muscle relaxants and anti-spasmotics
Anticholinergics
Pain medications
Antidepressants & Anticonvulsants
Antimuscarinics
Laxatives

A

Multiple sclerosis

288
Q

Medications used to slow the progression of MS

A

Beta interferons
Interferon beta-1b
Immunosuppressive agents

289
Q

Medications used to treat MS attacks

A

Corticosteroids
Plasmapheresis

290
Q

Medications used to traet clinical symptoms of MS

A

Muscle relaxants and anti-spasmotics
Anticholinergics
Pain medications
Antidepressants & Anticonvulsants
Antimuscarinics
Laxatives

291
Q

Meds Mrs C said to remember for the exam for MS

A

Beta interferons – Interferon beta-1A (Avonex)
Corticosteroids – Prednisone (Solu-Medrol), Hydrocortisone (Cortisone)
Anticonvulsant – Phenytoin (Dilantin)
Muscle relaxer/Antispasmotic – Oxybutynin (Ditropan)

292
Q

An example of a Beta Interferon

A

Interferon beta - 1A Avonex

293
Q

An example of a muscle relaxer/antispasmotic

A

Oxybutin - Ditropan

294
Q

MS Priority Nursing Assesments

A

Neuromuscular Function
Vision/Eye Movement
Skin Integrity
Ability to Perform ADLs
Bowel Function
Bladder Function

295
Q

Complications associated with MS

A

Muscle stiffness or spasms
Paralysis, often in the legs
Problems with bladder, bowel, sexual function
Mental status changes - memory loss & problems concentrating
Depression
Seizures
Pressure injuries r/t immobility
Skin breakdown r/t bowel & bladder incontinence
Ataxic gait r/r weakness and loss of position sense
Speech defects r/t muscle weakness

296
Q

How to help MS patients with visual deficits or diplopia

A

Patch each eye daily as needed in patients with visual deficits and/or diplopia — Alternating the patching of each eye several times per day improves balance and vision.

297
Q

During exasterbations of MS what can be administered to decrease the inflammatory process associated with a flare-up

A

Corticosteroids

298
Q

What can be used to decrease MS exacerbations and slow the disease progression?

A

Interferon Beta-1b or betaseron

299
Q

What type of osteoporosis is this?

Occurs most often in postmenopausal women and men with low testosterone levels

A

Primary Osteoporosis

300
Q

What type of osteoporosis is this?

Can be caused by prolonged steroid use, thyroid-reducing medications, aluminium-containing antacids, or antisezure medications.

301
Q

the presence of the following on a xray indjcates what

Subchondral sclerosis (thickening of the bone)
Subchondral cysts
Osteophytes (bone spurs)
Joint space narrowing

A

osteoarthritis

NUR 211 Krissa (16 decks)

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