Unit 3 Flashcards
1
Q
Type of bone cells that break down bone
A
osteoclasts
2
Q
Type of bone cells that rebuilds bone
A
osteoblasts
3
Q
What are osteoclasts
A
bone cells that break down bones
4
Q
What are osteoblasts
A
Bone cells that rebuild bones
5
Q
Define osteopnea
A
bone loss
6
Q
Common area’s of bone loss
A
- Vertebrae in the lumbar spine
- Hip
- Distal radius (near wrist)
7
Q
bone loss can cause increased risk for what
A
fractures
8
Q
Calcitonin’s role on osteoperosis
A
decreases osteoclastic activity
9
Q
Estrogen’s role in osteoperosis
A
Promotes osteoblastic activity aiding in bone formation
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
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
12
Q
“silent disease” becuase it is usually not diagnosed until a fracture
A
osteoporosis
13
Q
Dowagers hump
A
kyphosis of the dorsal spine, a clinical manifestation of Osteoperosis
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
15
Q
Dx testing for osteoporosis
A
Gold standard testing: BMD done via DEXA Scan
Quantitative CT
Baseline calcium level
Baseline Vitamin D level
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
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
18
Q
BMD -0.1 or higher indicates….
Or to the right of the -0.1
A
Normal BMD
19
Q
BMD less than -1.0 or to the lecft of -1.0 indicates
A
Abnormal BMD
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
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
22
Q
Test that measures volumetric bone density of spine and hip. Used for diagnostic management (to confirm dx) of osteo
A
QCT
23
Q
QCT
A
Test that measures volumetric bone density of spine and hip. Used for diagnostic management (to confirm dx) of osteo
24
Q
Normal Calcium level
A
9-11
25
Calcium level less than 8 can indicate...
calcium deficiency, osteoporosis
26
Normal vitamin D level
30-50
27
Vitamin D levels 20-30 indicates
vitamin D insufficiency, osteoperosis
28
Vitamin D levels above 50 can indicate what? and cause what?
toxicity
Dehydration, hypercalcemia, and kidney damage
29
Osteoporosis medical management
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
30
Prevention tips for osteoporosis
Calcium with vitamin D suppluments
15 mins of sun exposure per day
31
Medications for osteoporosis
Bisphosphate
Calcitonin
Estrogen/hormone therapy
estrogen angst
parathyroid hormone/parathyroid hormone analog
dual-acting bone agent
monoclonal activity
32
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
Biophosphate
33
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
Calcitonin
34
assists with bone remodeling and osteoclastic activity
S/E: MI, Stroke, breast cancer, PE, and DVT
Estrogen
35
Assists with bone remodeling and osteoclastic activity
Route: daily tablet
S/E: DVT
Estrogen antagonist
36
Protects against gonadotropin-releasing hormone agonist-related bone loss
Route: SubQ daily
S/E: Leg cramps, dizziness
Parathyroid hormone
37
Increases bone density and strength
Route: Periumcumbical subQ daily
S/E: Tachycardia, dizziness
Parathyroid hormone analog
38
Decreases osteoclastic activity and increases osteoblastic activity, thereby balancing bone turn over, increasing bone formation and remodeling
Route: Daily soluble sachet
Dual-acting bone agent
39
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
monoclonal activity
40
Theraputic procedures for Osteoporosis
orthotic devices
joit repair/arthroplasty
vertebroplasty or kyphoplasty
PT/rehab
41
Patient education for orthotic devices
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
42
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.
vertebroplasty kyphoplasty
43
Medications that can help prevent Osteoporosis
Calcium supplements
Vitamin D suppluments
44
Fall precautions at home for patients
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
45
Priority nursing interventions for osteoporosis
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
46
Complications of osteoporosis
* Falls
* Compression fx
* Respiratory complications d/t decreased chest expansion
* Prolonged hospitalization
* Death
47
Osteo patients should have limited access to ____________, ______________, and ______________ because they increase bone loss
Caffine
alcohol
carbonated beverages
48
Diet tips for osteoporosis patients
Adequate amounts of protein, magnesium, vitamin K, calcium, vitamin D, and other trace minerals needed for bone formation
49
What kinds of activities should osteoporosis patients avoid and why?
Activities that increase body stress such as jarring or strenuous activities
50
Patient education for osteoporosis patients
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)
51
Protein Sources
Eggs
Chicken
Lean beef
Fish
Turkey
Cheese
Greek yogurt
Milk
52
Magnesium Sources
* Greens
* Nuts
* Seeds
* Dry beans
* Whole grains
* Wheat germ- wheat and oat bran
53
Vitamin K sources
Green, leafy vegetables
Soybean
Fortified meal replacement shakes
54
Calcium rich sources
* Dairy - Cheese, yogurt
* Fortified plant-based milks
* Calcium-fortified OJ
* Butternut squash
* Green, leafy vegetables
* Avocado
55
Vitamin D rich Foods
Fortified milk, cereal, and juices
Salmon
Eggs
Tuna and sardines
Trout
Beef liver
White mushrooms
56
Leading cause of disability world wide
Low back pain
57
Acute onset of low-back pain acts as a warning of what?
ongoing tissue damage
58
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
## Footnote
Complication associated with osteoarthritis
Spinal degeneration
59
Constriction of spinal foramina and canals-> pressure on cord and nerve roots -> causes pain
Spinal stenosis
60
Sudden, involuntary contraction of a single muscle or muscle group -> caused by inflammation and soreness from sudden movement or bending
Muscle spasm
61
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?
Low back pain
62
Low back pain dx test
History & Physical
CT scan
Diskogram
MRI
Electromyography (EMG)
Nerve conduction study
Bone Scan
Myelogram
X-rays
63
Non-pharm treatments for low-back pain
Exercise/PT
Superficial heat
Acupuncture
Massage therapy
Meditation/yoga
64
Meds for low back pain
NSAIDS
Muscle relaxants
Opioids
Corticosteroids
Tricyclic antidepressants
Benzodiazepines
Local anesthetics
Anticonvulsants
65
Aspirin, ibuprofen, toradol, and naproxen are all examples of what type of medication?
NSAIDS
66
Soma, flexeril, and valium are all examples of what type of medication?
Muscle relaxants
67
Morphine, codine, oxycodone, and hydrocodone are all examples of what type of medication?
Opioids
68
Prednisone, cortisone, and hydrocortisone are all examples of what type of medication?
Corticosteroids
69
Elavil is an example of what type of medication?
Tricyclic antidepressant
70
Ativan is an example of what type of medication?
Benzodiazepine
71
Neurotin, lyrica, topamax, and tegretol are all examples of what type of medications?
Anticonvulsants
72
Low back pain medical interventions
Interventional therapy - nerve blocks, lidocaine, steroids, narcotics injected into affected areas
Transcutaneous electrical nerve stimulation
Back Surgery-Lumbar fusion
73
Expected vitals for someone in pain
HTN
Tachycardia
Tachypnea
74
Low-back pain patient education
Low back exercises
Take medications as ordered
Non-pharm pain relief
Weight control
75
Connects muscles to bones
tendons
76
connects bone to bones
ligaments
77
projections of new cartilage and bone growth that forms along joint lines, causes joint pain and decreases ROM
osteophytes
78
membrane that line the non-cartilaginous surfaces of highly mobile joints, produces synovial fluid
synovium
79
lubricates joints
synovial fluid
80
overproduction of synovial fluid that can cause ligaments to stretch, making joints unstable is called what
effusions
81
lies adjacent to the cartilage layer and provides mechanical and nutritional support for for the cartilage
subchondral bone
82
Risk factors for osteoarthritis
* Age: over 55
* Female
* Obesity
* Occupation-musicians, teachers, healthcare workers, construction workers, dancers, athletes
83
Cartilage loss, synovial membrane thickens and over produces synovial fluid. Causes pain, joint instability, muscle atrophy, and deterioration of joint function
Osteoarthritis
84
Located at the proximal interphalangeal joints
Symptom of osteoarthritis
bouchards nodes
85
located at the distal interphalangeal joints
Symptom of osteoarthritis
heberden's nodes
86
Signs of osteoarthritis in hands
bouchards nodes
heberden's nodes
87
what causes nodes in hands in osteoarthritis?
osteophytes form in the nodes, break off and cause cartilage loss
88
# 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
osteoarthritis
89
a cracking, grating sound or feeling, due to air or gas under the skin happens because of cartilage breakdown
crepitus
90
Diagnostic tests for osteoarthritis
Lab tests to R/O RAand gout
Lab tests to monitor for s/e of meds
X-ray affected joints
91
Non-pharm treatments for osteoarthritis
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
92
Can the progression of osteoarthritis be stopped?
no
93
Goal of care for osteoarthritis
decrease pain improve/maintain joint mobility while avoid toxic effects of pharm therapy
94
Pharmocological treatments for osteoarthritis
acetaminophen
NSAIDs
Corticosteroid injections
opioids
95
Joint irrigated and expanded to remove debris, treatment for osteoarthritis
arthroscopic irrigation/debreidement
96
Remove excessive growth of synovial membrane, surgical treatment for osteoarthritis
synovectomy
97
Fuse joint surfaces to prohibit movement, surgical intervention for osteoarthritis
surgical fusion
98
Surgical options for osteoarthritis
surgical fusion
Synovectomy
Arthroscopic irrigation/debreidement
Arthroplasty
99
Complications of osteoarthritis
diabetes, heart failure
100
Client teaching for osteoarthritis
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
101
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)
fibromyalgia
102
fibromyalgia cycle
1. Pain
2. Muscle tension
3. Daily Stress
4. Limited activity
5. Fatigue
6. Depression
7. Muscle stiffness
103
# 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
fibromyalgia
104
Cognitive dysfunction with fibromyalgia can be called what?
fibro-fog
105
How to definitively test for fibromyalgia
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.
106
involves both sides of the body and above and below the waist.
widespread pain
107
Non-pharm treatment for fibromyalgia
* Physical therapy
* Strength training
* Aerobic exercise
* Cognitive behavioral therapy
* Education
* Self-management
108
Fibromyalgia Pharmocologial treatment
NSAIDs
Antidepressants
Anti-seizure medications
Sleep aids
Non-opioid analgesics
109
Why aren't opioids recommended for fibromyalgia?
habit forming nature and ineffectiveness of therapy
110
Nursing diagnosis for fibromyalgia
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
111
Heating pads for.....
painful muscles
112
Cold packs for....
painful joints
113
Client education for fibromyalgia
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
114
Expected outcomes for fibromyalgia
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
115
Back pain lasting less than 4 wks
Acute back pain
116
Back pain lasting 4-12 wks
subacute back pain
117
Back pain lasting more than 12 wks
Chronic back pain
118
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
CT scan
119
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
Diskogram
120
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
MRI
121
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
Electromyography
122
* 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
## Footnote
Tests for low back pain
Nerve conduction study
123
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
Myelogram
123
* 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
X-ray
124
Fracture that causes disruption that spans across the width of the bone causing bone fragments
Complete fracture
125
Complete fracture
126
Fracture that disruption occurs through part of the bone cortex; no displacement of bone fragments
Incomplete fracture
127
Incomplete fracture
128
fracture that is contained with the skin.
Closed simple
129
fracture in which bone still is in proper alignment
Closed simple, non-displaced
130
Closed simple, non-displaced
131
Fracure in which bone is not aligned properly
Closed, simple, displaced
132
Closed simple, displaced
133
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
Open compound fracture
134
open compound fracture
135
A grade of an open compound fracture with presence of puncture wound, minimal soft tissue injury, vasculature remains intact
Grade 1 open compound fracture
136
A Grade of open compound fractures. Puncture wound, fragments of broken bone, moderate skin and muscle contusions, significant wound contamination
Grade 2 Open compound fractures
137
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
Grade 3 open compound fracture
138
Avulsion fracture
139
A fracture caused by overstretching and tearing of a tendon or ligament, separating a small segment of bone at the insertion site.
avulsion fracture
140
fracture that has shattered bone fragments at the site of disruption.
Comminuted fracture
141
Comminuted fracture
142
fracture caused by excessive force along the axis of spongy bone, making the bone collapse on itself (vertebral compression fracture r/t fall)
Compression fracture
143
Compression fracture
144
Depression fracture
145
disruptions where bone fragments are forced inward (associated with blunt trauma to facial and skull fractures)
depression fracture
145
fracture in which bone fragments not in proper alignment
Displaced fracture
146
incomplete disruption where one side of the bone is bent and the other is fractured (typical in children because of their bone flexibility)
greenstick fracture
147
greenstick fracture
148
fracture in which break occurs at a 45-degree angle across the bone.
Oblique fracture
149
oblique fracture
150
fracture in which bone fragments are well approximated at the site of disruption (bone pieces are lined up).
non-displaced fracture
151
Spiral fracture
152
fracture wraps around the shaft of the bone.
Spiral fracture
153
fracture in which segments of bone are wedged into each other at the fracture line.
impacted fracture
154
Impacted fracture
155
# All of the following are clinical manifestations of what?
Pain
Deformity sometimes seen
Open wound, in some cases
A fracture
156
DIagnostic testing for fractures
Physical assessment of injury
X-ray of specific bone or bone group
MRI
Myoglobin level
Creatine Phosphokinase
CBC
CMP
Renal Panel
Urinalysis
157
Presence of rhabdomylosis can mean what?
AKI or declining kidney function
158
Anesthesia used in fracture patients
Conscious Sedation
General Anesthesia
Nerve Block
Spinal Block
159
Non-surgical treatment of fractures
Closed reduction
anesthesia
cast or splint after realignment
Traction (skeletal or skin traction)
160
Surgical treatment for fractures
ORIF
Traction
161
Surgical treatment for fractures that involes plates, screw rods into a fracture
ORIF
162
Surgical treamtent for fractures that involves rods and pins around the fracture to stabilize it
OREF
163
External fixator
164
Traction devices
165
Medications used to treat fractures
Pain medications - opoioids and NSAIDs
Admin abx as ordered to prevent osteomyelitis and infection
166
6 P's
Pain
pressure
paralysis
pallor
paresthesia
pulselessness
167
Abscence of the 6 P's indicates what?
indicates that proper treatment is being provided and there is no neurovascular compromise
168
The presence of one or more of the 6 P's can indicate what?
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
reduced arterial blood flow to the periphery of the affected limb, or reduced blood flow from periphery of the affected limb to the heart
This can lead to hemorrhage, compartment syndrome, infection, or permanent loss of function.
170
Immobilization devices should be frequently assessed why?
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
Vital signs to watch for in patients with a fracture
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
A patient with a fracture that has a Low BP, tachycardia, or tachypnea can mean what?
Hemorrhagic shock d/t excessive bleeding
173
Tachycardia, tachypnea, and decreased pulse oximetry in a patient with a fracture may indicate a what?
Pulmonary embolism
174
Nursing diagnosis for patients with a fracture
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
Wound/pin care for fracture patients
Providing daily pin site and wound care using strict aseptic technique reduces the risk of infection and promotes healing.
176
If a crushing injury is supected what should you not do and why?
Elevate it becuase it reduces arterial pessure
177
What should you do to the effected extremity of a patient with a fracture to reduce pain and edema?
Elevate the extremity
178
Fracture patients should be reminded to do what for pulmonary hygiene?
Incentive spirometry
Turn, cough, and deep breathing
179
Treatment for fractures that promotes vasoconstriction and decreases edema and pain
Applying ice
180
Diet for patients with a fracture
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
If a fall is witnessed what do you do?
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
# 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?
Neurovasular compromise
Elevate the extremity, remove the cast/splint
Contact HCP ASAP
183
# 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?
Venous thromboembolism (VTE)
Early ambulation, anticoagulation therapy
184
# All of the following are S/S if what?
Respiratory distress
Acute confusion
Generalized petechiae
Restlessness potentially leading to respiratory failure and death
Fat embolism
185
How to 'fix' a fat embolism
Frequent VS monitoring, aggressive treatment of long bone fx, administer fluids, Prednisone
186
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
Fat embolism
187
Clients who are not candidates for surgery for a fracture require what?
Immediate intervention to prevent a DVT
188
A complication in fracture patients that is associated with blood loss
Hypovolemia
189
How to correct hypovolemia
Fluid replacement
190
# All the following are S/S of what?
Severe flank pain
Dark, tea-colored urine
Elevated serum myoglobin level
| Complication of a fracture
Rhabdomyolysis
191
* 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
Rhabdomyolysis
192
How to correct rhabdomyolysis
IV fluids to flush kidneys
193
Fracture fail to heal in correct alignment, or fails to heal altogether
| Complication in fracture patients
Malunion and nonunion
194
How to prevent Malunion and nonunion?
Frequently check positioning or immobilization device
195
# 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
Compartment syndrome
196
If left untreated Compartment syndrome can lead to what?
Loss of affected limb
197
Causes of compartment syndrome
burns
Vascular injuries
penetrating trauma
insect bites
IV infiltration
animal bites
bleeding disorders
bone fractures
198
* 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
Compartment syndrome
199
How to correct compartment syndrome
Immediate Fasciotomy – incisions are made through the fascia over the affected compartment to relieve pressure
Notify HCP immediately
200
A pressure on a Stryker device within 30 mmHg of the diastolic pressure or an absolute pressure greater than 30 mmHg indicates what?
Compartment syndrome
201
# All of the following are clinical manifestations of what?
Sudden, intense dyspnea
Pleuritic chest pain
Tachypnea
Tachycardia
Crackles
Cough
Hemoptysis
| Complication of a fracture
Pulmonary Embolism
202
Blood clot that breaks off and travels through the heart into the lungs
Pulmonary embolus
203
How to correct a pulmonary embolism
Anticoagulation (IV Heparin and then oral therapy)
204
What do patients need to be taught about cast care?
Notify doc of change in color or temp
205
Client education for a patient with a fracture
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
Hip fracture that occurs at the head or neck of the femur within the capsule of the hip joint
Intracapsular hip fracture
207
Hip fracture that occurs within the trochanter region
Extracapsular hip fracture
208
Intracapsular hip fracture
209
Extracapsular hip fracture
210
# 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
Hip fractures
211
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.
FRAX tool
Fracture Risk Assessment Tool
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Who wouldn't you use the FRAX tool for?
patients under the age of 40 and over the age of 90
213
Ways to diagnose a hip fractures
Deformity
Tissue destruction
Loss of function of a specific joint
Joint changes
Stiffness
Pain that limits normal activities
Muscle atrophy
X-rays/MRI
214
Medical treatment for a hip fracture
Weight reduction
Activity modification
Nonsteroidal therapy
Joint supplements: glucosamine, chondroitin
Then replacement
215
Teaching for hip fracture patients
* 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
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DEXA T-score of -1.0 or higher
normal
217
Normal Dexa T-score
-1.0 or higher
218
T-score between -1.0 to -2.5 is indicative of what?
osteopenia
219
A T-score of what can indicate osteopenia
-1.0 to -2.5
220
T-score of -2.5 or lower in a DEXA scan can indicate what?
osteoporosis
221
A T-score of what can indicate osteoporosis
-2.5 or lower
222
What is needed to successfully treat low-back pain?
Combination of medication and adjunctive therapy
223
diagnosis of low-back pain is based on what?
s/s
Duration of pain
Underlying cause
Presence or absence of nerve root involvement
224
Medications used to modify the disease course of MS
Avonex
Betaseron
Rebif
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Immunosuppressive agents used for MS patients
Natalizumab
Mitoxantrone
226
Medications used to treat 'attacks' in MS patients
Corticosteroids
Plasmapheresis (plasma exchange)
227
Medications used to treat clinical manifestations of MS
Muscle relaxants
anticonvulsants
antialeptics
stool softeners
laxatives
228
# 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
Multiple Sclerosis
229
Temporary (less than 24-hr) worsening vision with other worsening neurological functions in response to increased core body temperature
Uhthoff sign
230
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.
Multiple sclerosis
231
Possible complications from MS
* 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
What should you monitor in MS patients?
* visual activity (diplopia)
* speech patterns
* swallowing
* activity intolerance
* skin integrety
* cognitive changes
*
233
Teaching for MS patients
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
Nursing diagnosis for MS
* Imparied physical mobility
* Self-care deficit
* Impaired coping
* Depression
235
# 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
Parkinson Disease
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Complication of Parkinsons Disease
Aspiration PNA
Altered cognition i.e. dementia, memory deficits
237
# All of the following are risk fators for what?
Gender - Male
Genetic predisposition
Environmental exposure - toxins, chemical solvents
Chronic use of antipsychotics
Parkinson Disease
238
# 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
Parkinson Disease
239
slowness of movement and speed.
Progressive hesitation/halts as movements continue
Bradykinesia
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# All of the following are S/S of what?
Rhythmic interruption
total resistance to movement
mildly restrictive
Muscle rigidity
241
Five stages of Parkinsons
UBPTC
| U Be Playing The Class
* **U**nilateral shaking or tremor of 1 limb: Stage 1
* **B**ilateral limb involvement occurs, making walking and balance difficult. Mask-like face, slow shuffling gait. Stage 2
* **P**hysical movement slows down significantly, affecting walking more. Postural instability. Stage 3
* **T**remors can decrease but akinesia and rigidity make day to day task more difficult. Stage 4
* **C**lient Unable to walk, is dependent for all care and might exhibit dementia. Stage 5
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# Five stages of parkinsons
Unilateral shaking or tremor of 1 limb
| UBPTC
Stage 1
243
# Five stages of Parkinson
Bilateral limb involvement occurs, making walking and balance difficult. Mask-like face, slow shuffling gait
| UBPTC
Stage 2
244
# Five stages of Parkinsons
Physical movement slows down significantly, affecting walking more. Postural instability
| UBPTC
Stage 3
245
# Five stages of Parkinson Disease
Tremors can decrease but akinesia and rigidity make say to day task difficult
| UBPTC
Stage 4
246
# Five stages of Parkinson Disease
Client unable to stand or walk, is dependent for all care and might exhibit dementia
| UBPTC
Stage 5
247
Theraputic procedures for Parkisons disease
* Stereotactic Pallidotomy or Thalamotomy
* Deep brain stimulation
248
A treatment for Parkinson's that allows neurosurgeons to destroy a portion of the globus pallidus, and thereby decrease patients muscle rigidity
Stereotactic pallidotomy or Thalamotomy
249
Expected consults for Patients with Parksinon Disease
Speech
PT/OT
Social work
250
# [](http://)
What to mointor for in Parkinsons patients
Swallowing
Nutrition/weight
Mobility
Communication
Cognitive status
251
# 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.
Mask-like-face
252
S/S of Osteoprosis
| FRAIL
Fractures
Rounding of the back (dowagers hump)
Asymptomatic
Inches
Lower bacl/hip -neck pain
| FRAIL
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4 Cardinal symptoms of parkinsons
1. Resting tremors
2. Muscle rigidity
3. Slowness of movement
4. Postural instabilituy
254
# 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
Type 1
Relapsing Re-mitting
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# 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
Type 2
Secondary Progressive
256
# What type of MS is this?
Progressive course with gradual worsening of clinical manifestations from onset.
Relapses may or may not have recovery.
Type 3
Progressive relapsing
257
# 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
Type 4
Primary Progressive
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# 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
MS
259
These are S/S of what?
MS
260
Word for unsteady gait
ataxia
261
How to definitivly diagnose MS
2 separate symptomatic events
MRI changes in 2 locations
262
Parkinson's can cause motor changes which can cause what? Which means the patient should be monitored for what?
Drooling and dysphagia
Aspiration
263
How to diagnose Parkinson's disease
2 or more cardinal symptoms
with
asymmetrical presentation is observed in the absence of other causes
264
# 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
Anticholinergics
265
How to monitor the progression of Parkinson's disease
Amount of motor decline
266
Medications to treat Parkinson's
Anticholinergics
Dopamine-receptor agonists
267
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
Carbidopa/Levadopa
268
How does Carbidopa/levodopa wrork?
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
# These medications are examples of what type of medications?
* Benxtropine (cogentin)
* Trihexyphenidyl (Artane)
Anticholinergics
270
# THese medications are examples of what type of medications?
* Ropinrole (requip)
* Pramipexole (Mirapex)
* Carbidopa/Levodopa (senimet)
Dopamine-receptor agonists
271
* surgically implanted probes connected to impulse generator in upper chest
* regulates tremors and fine motor coordination
| A treatment or parkinson's
Deep brain stimulation
272
Priority Nursing assessments for Parkinson's Patients
* Four cardinal symptoms
* Gag reflex and Swallowing ability
* Musculoskeletal system
* Bowel and bladder function
273
What to look for when assessing a patient with Parkinsons' musculoskeletal system?
* 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
# All of these foods are rich in what?
* fortified milk, cereal, juices
* salmon
* eggs
* tuna & sardines
* Trout
* Beef liver
* white mushrooms
Vitamin D
275
# 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
Calcium
275
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# All of these foods are good sources of what?
* Green leafy vegetables
* Soybeans
* Fortified meal replacement shakes
Vitamin K
277
# All of the following are good sources of what?
* Greens
* Nuts
* seeds
* dry beans
* whole grains
* wheat germ
* wheat and oat bran
Magnesium
278
# All of the following are good sources of what?
* Eggs
* chicken
* lean beef
* turkey
* cheese
* greek yogurt
* milk
Protein
279
Teaching for parkinson's patients about walking
Teaching the patient to take short, deliberative steps, with the feet somewhat spread, decreases the chance of falls.
280
What to teach Parkinson's patients about medication compliance
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
# 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
MS
282
Lab tests for MS
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
Lumbar puncture teaching points
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
What can be done for someone with a prolonged headache after a lumbar puncture?
* 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
Important teaching for patients AFTER a lumbar puncture
Lay flat for 4-6 hrs after testing
286
Treatment of MS focuses on what?
Improving speed of recovery from attacks
Reducing the number of attacks
Slowing disease progression
287
# 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
Multiple sclerosis
288
Medications used to slow the progression of MS
Beta interferons
Interferon beta-1b
Immunosuppressive agents
289
Medications used to treat MS attacks
Corticosteroids
Plasmapheresis
290
Medications used to traet clinical symptoms of MS
Muscle relaxants and anti-spasmotics
Anticholinergics
Pain medications
Antidepressants & Anticonvulsants
Antimuscarinics
Laxatives
291
Meds Mrs C said to remember for the exam for MS
Beta interferons – Interferon beta-1A (Avonex)
Corticosteroids – Prednisone (Solu-Medrol), Hydrocortisone (Cortisone)
Anticonvulsant – Phenytoin (Dilantin)
Muscle relaxer/Antispasmotic – Oxybutynin (Ditropan)
292
An example of a Beta Interferon
Interferon beta - 1A Avonex
293
An example of a muscle relaxer/antispasmotic
Oxybutin - Ditropan
294
MS Priority Nursing Assesments
Neuromuscular Function
Vision/Eye Movement
Skin Integrity
Ability to Perform ADLs
Bowel Function
Bladder Function
295
Complications associated with MS
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
How to help MS patients with visual deficits or diplopia
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
During exasterbations of MS what can be administered to decrease the inflammatory process associated with a flare-up
Corticosteroids
298
What can be used to decrease MS exacerbations and slow the disease progression?
Interferon Beta-1b or betaseron
299
# What type of osteoporosis is this?
Occurs most often in postmenopausal women and men with low testosterone levels
Primary Osteoporosis
300
# What type of osteoporosis is this?
Can be caused by prolonged steroid use, thyroid-reducing medications, aluminium-containing antacids, or antisezure medications.
Secondary
301
# the presence of the following on a xray indjcates what
Subchondral sclerosis (thickening of the bone)
Subchondral cysts
Osteophytes (bone spurs)
Joint space narrowing
osteoarthritis
