Unit 4 Flashcards
1
Q
What is fibromyalgia?
A
a disorder characterized by widespread musculoskeletal pain accompanied by pain, fatigue, and sleep/mood issues
2
Q
tx for fibromyalgia
A
pain-relievers antiseizure drugs anti-depressants Physical therapy occupational therapy counseling acupuncture massage therapy yoga tai chi
3
Q
What is something to teach a pt with fibromyalgia
A
stress management sleep hygiene exercise regularly pace yourself maintain a healthy lifestyle
4
Q
what is an amputation?
A
the removal of a limb due to disease process or trauma
5
Q
What are some concerns after surgery?
A
depressing, bleeding/hemorrage, contractures, DVT, PE, pain control
6
Q
How does an amputation effect one’s mobility
A
they often have to learn how to walk with a prosthesis or move with a wheelchair
7
Q
What is OA?
A
Osteoarthritis a disease of the joint that affects all the joints structure. Cartilage and bone ends slowly break down.
8
Q
Risk factors for OA
A
Heredity, age, obesity, activities causing stress
9
Q
What is RA
A
Rheumatoid arthritis.
a chronic, progressive, systematic inflammatory disease that destroys synovial joints and other connective tissues, including organs, joints become deformed.
10
Q
What is the main difference between OA and RA
A
OA the joint is inflammed
RA the joint is deformed
11
Q
Believed causes of OA or primary causes
A
Primary-idiopathic (cause unknown)
obesity
activities causing joint stress
overuse
12
Q
Known causes of OA or secondary causes
A
trauma sepsis congenial abnormalities metabolic disorders rheunatoid arthriis
13
Q
Believed causes of RA
A
peridonatal disease, family hx
14
Q
Known causes of RA
A
Autoimmune
15
Q
Treatments for OA
A
Exercise weight control muscle relaxants Acetaminophen heat and cold therapy surgery complementary and alternative therapies(acupressure, hydrotherapy, imagery, music therapy) Total joint replacement therapy
16
Q
Treatments for RA
A
Antibiotics, heat and cold therapy, NSAIDS, biological response midifier, Prednisone, Disease modifying anti rheumatic drug (DMARD), T-cell modulators, balanced rest and activity Surgery for total joint replacement
17
Q
diagnostic testing for OA
A
X-Ray, MRI
18
Q
Diagnostic testing for RA
A
Labs: increased WBC and PLT
IGG test
MRI
19
Q
early S/S of RA
A
Bilateral and symmetrical joint inflammation
redness, warmth, swelling, stiffness, pain
Stiffness after resting (morning stiffness)
Activity decreases pain and stiffness
low-gread fever, weakness, fatigue, anorexia (mild weight loss)
organ system involvement
20
Q
Late S/S of RA
A
Joint deformity
Secondary osteoporosis
21
Q
S/S of OA
A
Joint pain and stiffness occur
Pain increases with activity and decreases with rest
Nodes on joints of fingers appear (heberdennodes, bouchard nodes)
22
Q
When instilling eyedrops and eye ointments what is the frist thing one should do?
A
Assist the pt to a sitting position with their head tilted back slightly
23
Q
When instilling eye drops or eye ointments what should you do with the lower lid?
A
pull it down to expose the conjunctival sac
24
Q
How long should pt keep their eyes shut after instilling eye drops or ointment
A
1-2 mins
25
What should you always avoid when instilling eye medications
Always avoid the tip of the bottle or tube to the eye because this can cause pathogens to enter the medication
26
What should you instruct the pt to do after you instill eye ointment?
cloase eyelids for 2-3 mins and gently move eyes around under the lids.
27
How high do you hold the eyedropper above the eye when instilling eye drops?
1/2 - 3/4 in
28
What are flexion contractures?
Permanent muscle contractions with fibrosis of connective tissue that occue from lack of use of a muscle or muscle group
29
What are flexion contractures specific to?
Usually amputation due to improper movement that decrease the angle bewteen two adjacent bones. More likely with hip or knee joint
30
What does a flexion contracture prevent?
walking with a prosthesis
31
Ways to avoid flexion contractures
Avoid sitting straight up for long periods
pt should lay prone for 30 (or as long as tolerated) for 3 times a day to help prevent
Trapeze bar can help with strengthening upper body muscles
32
What causes Flexion contractures?
Poor positioning after amputation
Sitting for long periods of time after an amputation
Elevated stump more than 24 hrs
33
What is a facture?
A break in a bone usually secondary to trauma or a pathological condition.
Can be minor and treated on an ambulatory basis or complex with surgical intervention and rehabilitation
34
How can a fracture be treated
```
Closed reduction (internal)
Slpints
CAsts
traction
open reduction (surgical) with internal fixation
external fixation
```
35
S/S of something being wrong with a fracture
Pulslessness, cool skin, dusky skin color, numbness, tingling (neurovascular)
Warmth, redness (infection
Monitor vitals (hemorrage)
ShOB, swelling or tightness in extremity (DVT, PE)
6 P's of compartmental syndrome
Fat embolism
36
Early signs of a fat emoblism
Pulmonary; Dyspnea, tachypnea, cyanosis
37
Main signs of a fat embolism
REspiratory distress, cerebral involvment (drowsiness, confusion, skin patechia)
38
Causes of low back pain
Most prevalent from age 30-60
FAmily hx of back pain or hx of back injury
Job or occupation that requires heavy lifting, twisting or repettitive
Smoking (linked disk degeneration)
Overweight
Having poor posture
osteoarthritis
39
S/S of lower back pain
Dull or Sharp low back pain usually constant
Possible stiff, flexed posture
Pain aggravated by coughing, sneezing or straining
Muscle spasams, cramping, stiffness, often ina location closest to the affected disk
pain radiates to the buttocks
sciatic nerve compression
numbness/tingling of the leg
40
What kind of positioning is important for low back pain?
Semi-flowlers with pillow under flexed knees can alleviate pain associated with LBP from a herniated disk
When sitting in a recliner, elevate the head and legs
Avoid twisting and turning the vertebral column while changing position
Sleep on a firm matress
41
What is MS?
Multiple sclerosis.
A chronic neurological disease that typically resulting in impaired and worsening function of voluntary muscle. It is a autoimmune disorder that affects nerve cells in the brain and spinal cord
42
Probable causes of MS
Occurs twice as often in females
Onset beteen 20-40 yrs of age
Smokers
those with vit D deficiencies
43
ACTUAL causes of MS
```
Viruses/infectious agents
environmental stressors (temp)
Physical injury
Emotional stress
pregnancy
fatigue
overexertion
Hot shower/bath
```
44
S/S of MS
```
Fatigue
pain/paresthesia
Diplopia, changes in peripheral vision, decreased visual acuity, scotomas (patches of blindness), periods of blindness
Temporary or worsening of vision and other neurologic functions after exertion or exposure o heat
Temporary tinnitus, vertigo, decreased hearing acuity
Dysphagia
Dysarthria (slurred and nasal speech)
Muscle spasticity
Ataxia or muascle weakness
Nystagmus
Bowel dysfunction
Cognitive changes
Sexual dysfunction
Anger, depression, euphoria
```
45
How do Visual disturbances usually occur with MS
In one eye at a time
46
How does muscle spasticity effect MS pt's?
It causes bowel and bladder dysfunction, constipation, areflexia (muscles do not respond to stimuli), urgency nocturia
47
What are the neuro effects MS has on pt's?
Difficulty concentrating or forgetfulness
48
MS pt's have muscle weakness and fatuige which makes them what kind of risk?
Fall risk
49
How is death for MS pt's commonly caused?
Pnemonia around 20-35 y/o
50
What is neurogenic shock?
Nervous system injury or dysfunction that causes extensive dialation of peripheral blood vessels.
51
What are some causes of neurogenic shock?
Spinal cord injury, general anesthesia, fever, metabolic disturbances, and brain contusion and concussion
52
S/S of the early phase of neurogenic shock
Hypotension, AMS, bradycardia, warm, dry skin
53
S/S of the late phase of neurogenic shock
Tachycardia, tachypnea, cool clammy skin
54
Races at highest risk for neuropathy:
Native Americans, hispanics, African Americans
55
What is neuropathy?
Nerve damage outside of the brain and spinal cord causing weakness, numbness and pain usually in the hands and feet. It can also effect other areas of the body.
56
What can cause neuropathy?
```
Autoimmune diseases
Diabetes
Infection
Inherited disorder
connective tissue disease
hypothyroidism
Tumors
Exposure to toxins
Bone marrow disorder
Alcoholism
Medications
Trauma
Pressure on the nerves
Vitamin deficiencies (vitamin B, E, and nicacin)
```
57
S/S of Neuropathy
Intense, shooting, burning, or described as pins and needles
58
What is osteoperosis
(porous bone) a metabolic disorder in which there is low bone mass and deterioration of bone structure, resulting in fragile bones that are prone to fracture.
59
S/S of osteoperosis
```
Bone fracture (often first sign)
Have a vertebral compression fracture
loss of height--up to 6 in
development of a curved spine (kyphosis)
back pain
increased fatigue
depression
ADL's may be limited
```
60
Tx for osteoperosis
```
Calcium
Vitamin D
Weight bearing exercises
Medications (antiresorpitive meds, anabolic meds)
Diet
```
61
Way to prevent Osteoperosis:
```
Practicing a healthy lifestyle
Consuming recommended amounts of calcium
Vitamin D
Weight bearing exercises
avoiding alcohol
not smoking
Bone density scan
```
62
Recommended amount of calcium
1,000 mg/day for 10-50 yrs
| 1,200 mg/day for 50 + y/o
63
Recommended amount of Vitamin D
600 IU 15 mcg/day for 1-70 y/o
| 800 mg IU 20mg for 71+
64
That is range of motion?
the movement of a body part or joint to help prevent contractures
65
Active range of motion
Pt does not need help
66
Passive range of motion
Pt DOES need help
67
When preforming ROM you should never what?
Move joint past the point of resistance or pain
68
How do you assess active ROM?
Have pt repeat movements while nurse demonstates
69
When do you admin pain meds for ROM?
30 mins before exercise
70
How often should TCD be preformed?
every 2 hr
71
How high should the bed be to help prevent a PE?
45 degree angle
72
What postion should be encouraged to help prevent PE?
Veritical rather than horizontal
73
How often should the incentive spirometer be encouraged
Taking 10-20 deep breaths every hr
74
What is a sprain?
An excessive streching of ligaments from twisting movements during sports activity, exercise, or fall
75
How is a sprain diagnosed?
X-ray
MRI
CT-scan
Ultrasound
76
Pharmacological treatments for sprains
NSAIDS
Ibuprofen
Naproxen
Acetaminophen
77
Non-Pharmacological tx for a sprain
```
RICE
Rest
Ice
Compression
Elevate
14-20 on/off
```
78
What is a cast?
A way to provide stronger support for fractures
79
Walking cast
a cast with a rubber walking pad at the bottom to assist with ambulation
80
Spica casts
a portion of the trunk and one or two extremities; typically used on children who have congenital hip dysplasia
81
Body cast
encircles trunk of body
82
Plaster casts
heavy
not water resistant
can take 24-72 hr to dry
83
Synthetic fiberglass casts
light, stronger, water resistant, dry very quickly (in 30 mins) and are most used
84
What is fibromyalgia?
a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood issues
85
What are suspected causes of fibromyalgia?
Genetics
Infections
psychological stress
physical trauma
86
What are S/S of fibromyalgia?
widespread pain
fatigue
cognitive difficulties
87
What are some tx for fibromyalgia?
antidepressants, pain relievers, physical therapy
88
Testing for fibromyalgia
CBC
| Pain for 3 months
89
An antispasticity agent, skeletal muscle relaxant
Baclofen
90
An antispasticity agant that can improve bowel and bladder function for MS pt's or spinal cord injury pt's
Baclofen
91
Antispasticity agent that can cause drowsiness or dizziness
Baclofen
92
What symptoms should be reported to the doctor?
Frequent urination
bowel issues
confusion
ringing in the head
93
If you miss a dose of Baclofen it should be taken...
within an hour and NEVER double dose
94
If a pt experiences AMS when taking Baclofen nurse should
Discontinue immediately
95
Baclofen should be taken with...
Food or milk to decrease gastric irritation
96
When taking cymbalta what should be assessed before during therapy?
Suicidal Ideaions
97
Pt's taking cymbalta should be monitored for...
Seritonin Syndrome
98
When a patient is taking cymbalta they should be told to rise...
slowly because of orthostatic hypotension
99
An antidepressant that is often used for pt's with fibromyalgia and neuropathy
Cymbalta
100
How long after disconinuing an MAO inhibitor can you start taking cymbalta?
14 days
101
Cymbalta can cause an increased risk of
Low BP
102
When cymbalta is given too close to an MAO inhibitor it can cause
fatal reactions such as heart irregulate and elevated temps
103
A topical pain med used for rheumatoid arthritis or osteoarthritis.
Capsaicin
104
Pain should be assessed before during and after therapy
Capsaicin
105
If capsaicin gets in the eyes...
area should be flushed with water and washed with warm water
106
Capsaicin can increase
Blood pressure
107
When tx herpes or shingles with capsaicin you should not apply cream until
lesions have healed completely
108
Muscle relaxant used for patients with spinal cord innjury's, stroke's, cerebral palsy, or MS
Dantrium
109
Dantrium causes
Photosensitivity
falls
drooling
110
Dantrium requires periodic testing to monitor
CBC and Liver/renal function
111
Dantrium is used for the emergency tx of
maligant hypothermia
112
If gastric irritation becomes a problem then...
capsules can be opened and put into fruit juices or other liquids
113
When taking dantrium If diahrrea persists
Drug should be discontinued
114
an antifibromyalgia agent that can cause neuroleptic malignant syndrome and cannot be taken with MAO inhibitors
Savella
115
What should be assessed before and during savella therapy?
Suicidal ideations
116
neuroleptic malignant syndrome
106-110 fever during surgery
| family hx increases chances
117
Anantidepressant used to tx anxiety, insomnia, tx resistant depression, and chronic pain syndromes
Amitriptyline
118
During the emergency management of a fracture, you should olf splint the affected limb if...
there is NO bleeding
119
During the emergency management of a fracture, if you find there is bleeding you should
what to splint and apply pressure
| cover the pt to preserve body heat until limb can be assessed.
120
During emergency management of a fracture, how would you splint the affected limb if it was a leg?
assess for bleeding first
It can be splinted to the other leg
if you have to move it support the limb above and below the fracture site.
apply splint and padding over clothing
Assess for color warmth circulation and movement
121
During emergency management of a fracture, how would you splint the affected limb if it was an arm
Assess it for bleeding first
It can be splinted to the chest
if the limb as to be moved then support it above and below the fracture site.
Apply splint and padding over clothing
Assess for color warmth circulation and movement
122
During the emergency management of a fracture, if you find the bone is protruding what should you do?
Cover with clean (sterile preffered) dressing
123
During the emergency management of a fracture, should you attempt to realign or straighten the extremity?
NO
124
During the emergency management of a fracture, what should you do after splint and padding is applied?
assess for color, warmth, circulation, and movement
