week 10 : mobility Flashcards

1
Q

issue of mobility what could be the reason/cause ?

A

genetic ( inherited ) e.g duchenne muscular dystrophy

demyelination of nerve fibers

degeneration of neurons in brain

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2
Q

true or false. issue of mobility: one of them being is degeneration of motor neurons and injury to the bone

A

true

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3
Q

injury to spinal cord ( vertebra or edema pushing on cord ) is also seen as an issue of mobility

A

yes this is true

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4
Q

what else can bring an issue of mobility ?

A

impact on the pt ( mind and body ) and family

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5
Q

issue of mobility : impact on nursing care

A

true

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6
Q

issue of mobility : medications - treat the disease and treat problems caused by decreased mobility , is this true or false.

A

true

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7
Q

what other genetic disease can be a reason for issue in mobility ?

A

change of muscular dystrophy , ms , parkinson disease

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8
Q

what injury can be a reason/cause

A

spinal cord injury
higher level injury - higher impact

als and gillian burre

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9
Q

what is the impact on the patient ? ( mobility )

A

mind - fatigue, self identity, depression , independence, awareness of how they will die

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10
Q

recall that body is the one impacted if there is an issue with the mobiliity , what undergoes this ?

A

cns depression ( significant pain )

— neuropathic pain, and complex

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11
Q

explain how cvs system could have an impact on the patient

A

blood clots and pressure ulcers

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12
Q

what undergoes resp since this would be affected

A

atelectasis and pneumonia patietn can lose ability to clear their resp secretions

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13
Q

what undergoes GI as this would be a problem

A

GI ability to swallow and get good nutrition

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14
Q

GU problem with incontinence /can also have UTIS , is this true ?

A

yes this is true when it comes to mobility

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15
Q

how would pyschosocial be affected?

A

lose their sense of self and identity they have is different ( alot of significant anger ) because they lose their personal independence

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16
Q

impact on nursing care
resp system ( can pt clear secretions ) ?

if u have a pt who cna cough well their lungs is okay but if ot what possibilities are we looking at ?

A

atelectasis and secretions

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17
Q

impact on nursing care : body/limb alignment

what is happening

A

pain, muscle spasm, and perfusion

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18
Q

turning/repositioning – looking at the skin , how frequent are we turning ?

A

2 to 3 hours ( look at the pressure ulcers )

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19
Q

it is important to assesment the body and mind why ?

A

no big pressure underneath hand
thinking pressure points and what the skin looks like - help plan their future

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20
Q

moblity : what else are they in risk for that we should look out for ?

A

risk of falls ( and working hard is managing pain ) always looking for complications

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21
Q

what type of meds are we going to give them

A

prevent potential complications ( e.g dvts )
treat pain ( noiceptive, neurogenic )
treat muscle spasm
maintain general health ( breathing , nutrtion, prevent infeciton )

lets also give them the best mattress

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22
Q

equipment and skulls needed and used

A

wheelchairs, braces, canes, aspen collar

splints, pillows, roho cushions prosthetics

lifts, turning sheets/sliders , transfer board

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23
Q

true or false. staff to assist with mlt
teds/scds, binders, assistive devices ( feeding, writing, bathing )
communciation boars are something we utizlied as equipment and skills needed and used

A

true

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24
Q

spirometer, feeding tubes, urianry catehrs are also used.

A

true

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25
what type of medications are we going to utilized ?
slow disease progression ( nerve impulses ) prevents clots manage pain decrease muscle spasms antidepressants
26
true or false. it is important that a pt takes a med that decrese fatigue and prevent constipation and gu issues such as bladder
true
27
meds that prevent a lot of probelms antidepression is big and decreasing fatigue ( make more energy ). is this true or false.
true
28
interprofessional who are we working with ?
rt social worker rehabilitation units and ltc sppech language therapist/patholigst - communicating /swallowing/eating -0 swallowing assemsnet
29
recall that : rt social worker rehabilitation units and ltc sppech language therapist/patholigst - communicating /swallowing/eating -0 swallowing assemsnet are interprofessional we are going to be working with , who else ?
PT - rom , prevent contractures -steghtening muscles -chest physio/pulmonary toileting OT - wheelchairs/canes/walkers -splints -special cushions (roho ) to relieve pressure -teach pt how to manage
30
mobility-diseases nursing care - the pt is thinking what ?
what is the cause of this disease curable ? any treatment? what are the symptoms ? how can the symptoms be managed? will this be likely cause my death ? how bad will it get
31
duchenne muscular dystrophy ( pediatris ) cannot be caught ( basically means the muscle is weakening )
this is genetic chronic progressive and incapacitating disease
32
respirtory problems for duchenne msucular dystrophy
ecause their chest muscles get progressively weaker there might be another kid that has a cough, this kid might get sick and continue on ( cannot fight it off )n
33
cardiac dysfunction for duchenne muscular dystrophy
cardaic rhythym abdnomalities ( encho and ekgs once a year to keep an eye on them )
34
obesity ( the child is not able to lose calroues. not active ) for duchenne msucular dystrophy
this is true
35
social isolation and pt and fmaily coping discussion s- possible transheotomy , ltc, end of life directives for duchenne muscular dystrophy
this is true
36
these patients die in their 20s and 30s ( shorten life despentencies ) everything gets worst mobility gets impaired they also get contractures ( they are a problem ) the goal is to maintain optimal functioning and prevent contractures in terms of duchenne muscular dystrophy is this true or false
this is true
37
penumonia/ clearing penumonia and all of that could be seen within duchenne mucucla rdistrophy
this is true
38
look at slif 4 for the child walking for the musuclar dystorphy for duchenne
okym
39
ms describe it
chronic progerssibe remission.exacerbation
40
what is ms
autoimmune disorders of cns and demyelination of enrve fibers ( brain sinal cord and optic nerve )
41
what are the s and s for ms
motor, sensory, fatigue, pain , pt manage independence rest adn self care
42
dx and minotr for ms
hx, s and s evoked repsonse testing
43
true or false canada has the hgihest rating for ms
true
44
not going to the bathroom normally myelin is basically attack and tried to regenerate what we see is chronic inflmmation and scaring
this is desciring ms
45
no discovery yet that fizes this diseases ( the cuase is unknown ) but researches have been dne in mb becauee its so high yes this is ms
yes it is
46
what is ms - oerall goal and care
funtioning, independance, in daily living, mamage fatigue, mental health , adjust, reduce factors that lead to exacerbations
47
what is retaline for in ms
give ore energy dont ahve a ath later on teh day after a goodnight sleep lots of differnt things to do
48
dvt penumonia pressure ulcer atelectasis patingteaching is help these people help overal healthy life for ms
yes this si true
49
* Triggers/exacerbations * Hospitalization * Pt teaching are needed for ms overall goal and care
yes this si tru
50
what is importnt for ms potarntially
learn how to straight cath themselves ( invcontinent out and about is decrease )
51
bladder will retain urine and habe reflex emptying , they do not have control over it
yes this is true for ms patients
52
bowel issues and such would what in ms overall goal an care
lactulose or peg
53
IF THESE PEOPLE ARE HOSPITLIZED ( DIAGNOSTIC WORKUP ) ACUTE EXACERBATIONS ( on bed rest ) fam and friedns need help
ms yes this sit rue
54
reduce stress/fatigue/ rest throughout the day/. extreme temperatures very hot temp is very difficult for pts also extreme cols anu type of infections ( stomach flue
yes this sis true or ms ( autoimmune )
55
define if these are signs of duchenne muscular dystrophy ( not walking properly ) shoulders and arms are held back awkwardly sway back weak butt muscles ( hip straightens ) add 3 more
yes knees may bend back to take weight thick lower leg muscles ( the muscle is mostly fat, and not strong ) tight heel cord ( contracture ) child may walk toes
56
why does the belly stick out during duchenne muscula dystrophy
belly sticks out due to weak belly muscles ( child is poor at situps )
57
thin weak tights ( especially front part for duchenne muscle dystrophy )
yes this is true
58
what is the balance like for ducehnne muscle dystrophy?
poor balance : falls often , awakward clumsy if walking
59
weak muscles in front of leg cause foot drop, and tip toe contractures : this is true amongst duchenne muscular dystrophy
true
60
medications for ms what is our goal here ? hint** what is steroid used for ?
goal is decrease progression of disease and control symptoms treatment acute exacerbations ( edema, inflammation at site of demyelination )
61
define if these medications are being utilize for MS * Medications – corticosteroid (methylprednisolone, prednisone) – immunomodulator (Betaseron, Avonex)
yes this is true
62
recall if these meds are used for ms : * Medications : – corticosteroid (methylprednisolone, prednisone) – immunomodulator (Betaseron, Avonex)
– immunosuppressant (Methotrexate, Imuran, Mitoxantrone) – anticholinergic (Ditropan) – help with bladder symptoms (tone) – fight fatigue (Ritalin) – antispasmodic (Baclofen)
63
what is ritalin for ?
we use this in ms helping to fight fatigue ( to give more energy ) pill taken 3 times a day ( decreae muscle spasm ) getting to know their own body and how theyre body reacts ( side effects )
64
what is three biggest indicator of parkinson disease ?
tremors rigidity bradykinesia
65
what is parkinson disease disease process?
chronic, progressive, degenerative disease of cns affects movement : slow to move, rigidity and tremors
66
what are the s & s : for parkinson disease
tremors, rigidity, slow to start moving also depression, fatigue, pain, constipation
67
dx & monitor : Hx and s and s no dx test for parkinson disease are those descriptions accurate
yes it is accurate
68
instead of diagnostics what are we checking for parkinsons pts ?
theres no specific diagnostic test head to toe ( check reflexes, get checked with fam and put it together )
69
true or false. patients have swallowing problems because of what ?
because of the muscle weakness meds that are helpful for this disease ( dopamine receptors and transmitting neurons )
70
recall that remors of the hands even at rest persistent tremors are seen with parkinsons what else ?
shuffling gait unbalanced & small in steps, curved in characteristic way
71
if meds are late for parkinson pt what happens ?
if these meds are late --- it affects their mobility
72
what is our goal in terms of meds for parkinsons
correct imbalance of neurotransmitters within the cns
73
ng care for parkinson
manage issues for mobility, communication, nutrition ( swallowing ) adapt activities
74
what are the different type of meds we are giving parkinson pts
dopaminergic ( L- dopa, sinemet ) beta adrenergic blocke ( inderal ) - manage tremors *titrate dose to effect, combination of meds *symptoms will progress, worsen
75
parkinson disease - overall goal and care can have a risk of what ?
risk of falls we want them to exercise, ( really decrease their muscle atrophy ) decrease contractures also getting exercise plan with physio therapist
76
what are different things we are utilizing for parkinson's disease as an overall goal and care
physical exercise diet physio sleep issues dep and anxiety
77
physical exercise diet physio define these in terms of PD
have trouble ingesting foods, swallowing or coughing swllowing assesments may need , maybe diced tomake it easier to chew and swallow safety alert for falls ( they need to adapt )
78
sleep issues dep and anxiety cognitive function change define for PD
satin shees, and satin pajamas ( have huge impact on turning and sliding ) dep and anxiety- makes so many changes for them cognitive function change - notice settle change in their cognitive ( even progress to full dementia )
79
Severe mobility issues (airway, ventilation) what is ALS
amyotrophic lateral sclerosis
80
what is the descrption of ALS
progressive paralysis, mind is intanct - no treatment , no cure, supportive care
81
what does als patient need eventually ?
tracheostomy and ventilator
82
what does medically assisted suicide mean ?
they know whats going to happen ( hard disease ) and take care of , upset and knows whats going to happen
83
what is Guillain barre syndrome
symmetrical ascending paralysis, demyelination of peripheral nerves , +++ pain peaks at week 3
84
what is the rate of recovery for gbs
85 percent
85
what is the treatment for gbs
plasmapheresis and ivig
86
what is ivig for gbs
intravenous immunoglobulin infusion get from blood taken
87
the amount of pain for some people for als no pain ) but for als ( pain ) tingiling , boarding lighting bols disese peaks aorund 3 weeks meaning bad its gonna get trueor false.
true
88
for gbs what happens when u have the stomach flue ?
ba stomach flue ( whole immune system goes cracy and theyhave this prolem now ) ‘alot of the time they have them sick before a resp gi problem ( not sick enough to go tot he hospital ) but then they develop this
89
cause and symptoms of gbs obstruction of myelin, known as demyelination what are the symptoms?
paralysis, including loss of breath loss of reflexes muscle weakness
90
recall that paralysis, including loss of breath loss of reflexes muscle weakness are all symptoms of gbs what else?
prickly, tingling sensations in the arms and legs ( paresthesia )
91
mobility - injury/trauma what type of diagnostics test are we running ?
xray, ct scan, mri
92
what is th neurovascular asssment are we doing for mobility - injury/trauma
color, temp, cap refull, distal pulses, edema, sensation , motor function , pain
93
what is the number one priority in neurovascular assesment
the number one priority is color
94
what do we want to prevent in mobility- injury/trauma
prevent resp complications ( db and coughing ) , spirometry, turning, ROM exercsies
95
what is ROM exercsies?
range of motion exercises
96
aside from resp complications : what else do we want to prevent ? ( for injury/trauma )
we want to prevent pressure ulcers if they havea cast on, we need to think where is the cast hitting them
97
pain should improve overtime ( as the bone is healing ) if pain is not improving ( they are a complication ) is this true or false.
this is true
98
what is critical in our neurovascular assessment
distal pulses, edema, sensatin, motor function
99
what are the meds that patient is on when they have moblity issues such as injury or trauma
manage pain( baclofen, nsaids, narcotics, t3s ) phantom limb pain with amputation prevent system complications for immobility - cosntipation ( stool softeners ) , clots ( heparin, enoxaparin )
100
if someone had a rib fractures, would we encourage deep breathing and coughing ?
bruh no, this is extremely painful and it is not advisable
101
given this scenario , look at the mar before fentanyl only 3 times now 4 times and pain is still there what do u think could be happening
something is cooking up cant lie ( look further ) ( pain is getting worst )
102
what is the general care for bone injuries what undergoes alignment
midline, neutral position
103
wehat is traction in terms of geenral care for bone injuries
pulling force to keep alignment ( promtoes bone healing, dec muscle spasm , prevent furhter soft tissue and vessel injury )
104
true or false. it is major to assess neurovascular status for our general care for bone injureis
yest his is true
105
what else are we asesing for in terms of our genral care for bone injrueis
surgical site, hematoma
106
assess for complications such as ... for general care for bone injuries
infeciton, venous thromboemvolism, ( dvt, pe ) infection ( wound for skin or abscess )
107
recall that these are complications that could occur within bone injres what else could occur ? recall : infection, venous thromboembolism (DVT, PE), infection (wound fr skin or abscess
osteomyelitis/hardware inserted acute compartment syndrome, fat embolism ( something that can kill the pt )
108
managing pain is also crucial for our general care for bone injuries is this true or false? bonus : what type of pain are we going to encounter for these patients?
muscle spasm, bone pain, soft tissue injury
109
fracture can be open or closed. what does this mean
literally open ( see the bone ) close ( cannot see anything but ) but imagine what is going to do with the vessels and cause issues inside
110
what is the biggest risk for open fracture
high risk of infection and they should have tetanus immunization ( again increase of infection )
111
what is the RICE acronym
rest ice compresison elevation
112
what are we going to assess for fractures and what else after tha
assess vascular status/perfusion additional tissue/vessel damage
113
with fractures bone reducion is one of the option , what does this mean ?
bone reduction but closed method ( pulling or open method surgery ) called fixation , aignement , possibltiy traction, immobilize, time to heal
114
for fractures could we utilize splints and orthopedic boots/shoes , cast
yes we can !
115
what is the serious consequence that could happen with fractures
vertebrae ( SCI - spinal cord injury ) , pelvic, hip
116
what are we giving the pts before bone reduction
give pain killers or ketamine or block ( try to pull force and try to pull it back to place )
117
external fixation what is happening ehre
pin site care vascular assessment alignment pain should decrease with time
118
what is the question we are asking the patients : for external fixation
is it warm, any pain in his toes ? ( white thing — thick sponge , soak in covid dome and wrap it around bascially the scew from the hardware into the leg bone )
119
how is cast like in external fixation
plastic fiber glass vascular assesment - pain assesment and management complciations ( watch out for it ) and general care
120
what if it swells even more, thinking abt any type, of problems or complications that could happen here : what is this describing
external fixation
121
plaster cast go on wet and a then dry give off heat is this true in terms of external fixation
yes this is true
122
ORIF - open reduction internal fixation : what is this
to stabilize a long bone fracture, a plate and screws outside the bone or a rod inside the bone may be used
123
in terms of infection and weight bear for open reduction internal fixation what undergoes it
reduced it - put everything on alignment , internal fixation - inside there they put in hardware
124
leave hardware in or something things have heal up ( take it out ) depends on the situation true or false in terms of open reduction internal fixation
true
124
true or false.u put in a rod or a plate with screw for open reduction internal fixation
true
125
traction - skin or skeletal done operation and xray the operation in the or still not quite an alignment true or false.
true
126
what is skin traction ?
short term treatment also uses light weight ( grabbing the skin ) as far weights 2-3 to 4.5 kg ( this is temporary )
127
like a skin tenser, bandages, and then pulling in to the skin this undergoes what
skin traction
128
what is a skeletal traction
this is where something is drilled into the patients bone , meaning the skeleton bone right at the skeleton short term treatment
129
what is a skeletal traction
the weight is heavier and reuse for a longer amount of time ( needs more pull to get it aligned )
130
nurses don't decrease or increase the weight ( don't touch the wound ) call ortho tech to do it
true
131
weight to hang freely - not rest on the floor bucks traction
u cannot have this weight on the ground , nurses do not have to set this up
132
bone fractures NCP where does this undergo to
splinting, traction alignment , analgesia, pressure points
133
through neurovascular status what undergoes this for bone fractures
skin color and temp , moveent, sensation, pulsses , cap refill, pain
134
bone fractures NCP : analgesia what undergoes this
pain shoulde decrease
135
bone fractures ncp manage edema ( ice, elevate ) this is true in terms of bone fractures.
true
136
teach pt about care, clarify activity level ( increasing mobility )
they cannot wear bear on that leg ( hip that is fracture, clear the orders ) proper nutrition is important increase fibre intake and increase fluid intake 2- 3 liters
137
complications of # assessment and intervention treatment : skin blood clots fat embolism syndrome infection ( open fractures )
this is true
138
acute compartment syndrome what is a possible complication with this
possible fasciotomy
139
pressure ulcer, wet/macerated skin : go more in depth about this
high risk of breaking down , guy in the collar worries about under his chin and neck shoulder ( these are patients on gogles ) we always do 2 nurses ( one person sits head of the bed and the other person takes off collar and wet wash cloth )
140
deep vein thrombosis : give details about this
mainly blood clot ( big thing here is prevention ) heparin or dalteparin
141
true or false. sometimes they do not work ( gets blood clot ) the whole plan changes heparin subcut ( give bolus iv heparin ) based continues of heparin no longer subcut
true. heparin works fast and gets out of ur skin fast, coumadin takes a while
142
what would u like to increase when it comes to DEEP vein thrombosis
increase mobility as much as possible we want to turn these patients every 2 to 3 hours make sure we are doing range of motion exercises where they are working with physio
143
what is fat embolism syndrome: go more in depth
two long bones 10% of these people die fat globules from the bone fracture- breaks off and float through your body
144
what is the sign and symptoms of fat emoblism syndrome
significant hypoxia, tatchycardia, tachypnea , and dyspnea
145
what is this describing : confuse or pass out ( mental status ) sometimes they can get restless respiratory rate will go up and try to get more oxygen in and pending sense of pending due is they think something terrible has happened ( sats will go down )
fat embolism syndrome
146
what is typically the signs and symptoms of fat embolism syndrome
signs and symptoms is poor oxygenation , and what is usually seen first is the patients mentation intubated not on ventilator
147
early infection generally occurs for how long ?
less than 2 weeks after surgery S & S : increasing local pain, redness, swelling, wound drainage, disturbed wound healing, fever
148
what is typically the infecting organisms for infections
typically, infecting organisms are highly virulent ( staphylococcus aureus , gram negative bacilli, clostridial infections ( gas gangrene or tetanus )
149
acute compartment syndrome is what ?
huge build up of fluid outside (cast ) inside ( edema )
150
what is this describing : could have outside pressure or inside pressure
acute compartment syndrome
151
how do we release pressure when someone has acute compartment syndrome
cut cast fasciotomy need to regain perfusion
152
true or false. if its not a cast ( inside pressure ) therefore it is edema bonus: what do they have to do ?
fasciotomy
153
how does the doctor make the incision for acute compartment syndrome
the doctor will get sterile stuff , scapel and make an incision all the way down there u can see the body smile, the pressure is so big
154
what is fasciotomy ?
not simple to heal perfusion is not getting to it DO NOT ELEVATE the leg , it'll make it worse
155
what should we not do : other than do not elevate their legs ( fasciotomy )
no cold compresses ( vasoconstrictor ) if it was just a tenser ( losen ) if its a cast ( call the doctors and ortho and get them to deal with it )
156
fasciotomy : true or false. this wound needs to heal from inside out, packing dressings, likely need a skin graft or some other method of slow/constant closure
true
157
black sterile sponge in the wound bed ( largest clear tape all over it ) and attach the tubing to it and make a hole sterile scissors and attach it to eh machine so it suctions fluids : what does this undergo to?
fasciotomy
158
Hip what undergoes the charactersitics
elderly ( significant of death, osteoporosis increases risk )
159
pain management/multimodal approach, geriatric dosing, regional nerve block when it comes to hip
this is true
160
ng quality care for hip
timing of surgery, mobility, nutrition, foley fr uti, delirium
161
recall : that these timing of surgery, mobility, nutrition, foley fr uti, delirium undergoes ng quality care , what else?
pneumonia, constipation, vte, pressure injury, discharge plan, bone health
162
hip : traction - alignment/turning
true
163
people with hip issues typically may need what ?
may need pinning or replacement a replacement is reffered to as prosthesis - risk for hip dislocation
164
activity orders for hip is what ?
char, ambulate, weight bear
165
use of abduction pillow to prevent hip dislocation after toal hip replacement , what are we doing
1) affected leg should not cross the center of the body 2) hip should not bend more than 90 degrees 3) affected leg should not turn inward
166
what do u have to think about when it comes to the pelvic
think abt internal organs ( bowel, bladder, urethra ) what we worry abt is bone fracture could actually damage organs could cause irrigate the vessels stops doing tis thing
167
pelvic is not life threatening ?
it is life threatening - high mortality rte
168
what can cause a serious intra abdominal injury
pelvic - lacerate an organ ( urethra , bladder, colon ) -lacerate a vessel ( hemorrhage ) -paralytic ileus
169
pain medication, stool softeners are utilized in pelvic
yes this is true
170
Non-weight baring#(bedrest, painful; heal in 2 months – may need rehab/PT after) for pelvic
true
171
Weight baring # - need OR (external fixation, ORIF or both: severity of injury/potential need for traction determines when pt can weight bare is this true in terms of pelvic
yes this is true
172
surgery ( they get hardware put in ) depending on where it is broken non weight bearing ( heals on its own ) need some things such as rehab and physio
true in terms of pelvic
173
in pelvic , they have these hardware that stay in there forever
this is true
173
spinal cord injury : is what ? what are the diagnostics we are looking at
injury to a vertebrae that impacts the cord dx: xray, mri
174
what is the level of injury of spinal cord injury
C,T, L , vertebrae vertebra # complete or incomplete ( more common )
175
bone like a vertebrae you will have problems ( and fractures or elg fractures ) your cord has sensory and motor neurons. Is this true or false.
this is true
176
if u have a vertebra # what happens
never breathe on their own again ( spinal cord injury ) elbow crunches level of injury is huge (tells us what the future will tell us for the patient )
177
level of injury could be complete or incomplete ( more common )
this is true
178
impact on the bod systems : loss of or decreased mobility, sensory perception and bowel and bladder control often result for an sci
this is true
179
the higher the injury the more the effect on the body
this is true ( spinal cord injury )
180
cross messages right through cord or incomplete damage part of the cord ( usually right where the bone came off )
yes this is true
181
what happens if there is a c4 injury c6 injury
c4- tetraplegia c6- tetraplegia
182
what happens if there is a t6 injury or L1 injury
t6- paraplegia L1- paraplegia
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where is cervical located close to ?
right by the neck
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sacral : complete right through the cord cannot move it cannot feel it. true or false.
true
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what is this describing : that area of spinal nerve is involve with
dermatomes
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this is a good image of what an injury or part of the body infected on the level : what is this describing
dermatones
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c6 t4
thumb nipple line
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level of injury will tell us what will be the impact on the patients functioning ?
tells us what that patient functioning will be and will be focusing on our care ( when we think abt the injury the primary injury right when the accident happens )
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injury : what is the initial/primary injry
actual physical disruption of axons
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what is secondary inury
ongoing, progressive damage that occurs after the initial injury
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the damage from the primary make the injury itself a bit worse what is this describing ?
secondary injury
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what is the goal for injury ?
prevent further cord damage/extension of injury
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____ or ____ because of that secondary injury
t4 or t3
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what is the whole goal for injury
to prevent more poor damage
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we do not want the secondary injury to happen ( we immobilize them ) and think abt collars is this true or false.
this is true
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how can we prevent further cord damage/extension of injury
immobilize and methylprednisolone
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IV a big dose ( for 24 to 48 hours ) all that to prevent more swelling or secondary injury true or false.
true
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spinal shock true or false. it does affect vital signs , not only spinal cord
false. it does not affect your vital signs
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spinal shock what happens in the body ?
that is not permanent this is temporary - it depresses all the cord function decrease reflexes, and we also have lose sensation
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true or false. spinal shock also causes flaccid paralysis , below the level of injury , this is a bit of a shock
true
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true or false. spinal cord injury are at risk for spinal shock happening but only 50 percent o them get it
true
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spinal shock may mask what
post injury neurologic function when we get this patient ( never gonna move their arms again ) but once this spinal shock wears off then they move there arms
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what is the treatment for spinal shock ?
last from days to months there is none we dont have to wait to get to patient
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is there an active rehab in spinal shock
no treatment or active rehab right away resolves overtime once it resolves we might see that the functioning is actually better than we initially thought
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complete sci assessment ( spinal cord injury )
effects depend on the level of injury resp c1-3 ( these injuries are fatal , these people have apnea ( cannot breathe in ) they cannot cough if these people do live, they will need 24 hour help for the rest of their life
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if someone has c4 injury what happens
if someone is injured a bit lower c4 - may be able to breathe without a ventilator ( but they have a poor cough ) diaphragmatic breathing or hypoventilation ( they do not take big breaths )
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what happens if someone has c5-t6 injury ( complete sci )
c5-t6 they have decrease resp reserve ( decrease resp reserve means u and i can get cold and feel crap and feel okay ) that cold can turn into horible pneumonia and can be fatal ( if they get sick ) muscle weakness - cannot talk very loud ( cannot get air to get through vocal chords ) maybe even a weak voice
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below t6 , what is the injury
no problem with resp system
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phrenic nerve
the cervical plexus ( make your diaphragm move )
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CVS : above T6 complete sci assesment
absence of vaso motor tone - they also have postural hypotension they also have lower heart rate, low blood pressure ( abdominal binder ) something that helps these people
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complete sci assesment GI : above T5
they cannot control bowel movement or sometimes cannot they need to go no bowel sounds
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people with gi problems above 75 what type of problem do they often have ?
have often have problems with paralytic ileus also problems with abdominal distension,constipation, and fecla incontinence
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complete sci assesment : GU T1-L2
they cannot control when they void urinary this is retention urine is flaccid , kidneys will make urine and sit there
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gu. true or false doesnt get the urge to move away, there bladder can reflex empty
true
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in the photo describe how the man is ( try to recall the picture )
tracheostomy got an iv pump probably tube feed pump
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in the photo ( try recalling the photo ) why bother wearing sneakers ?
runners and when u are not walking runner helps keep their foot protected, and keep their heels flat keep tendons from wanting to shorten
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s
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sci : effect on pt and ng care ncp
manage airway and improve breathing , resp chest physio ( pulmonary toileting )
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SCI: Effect on Pt & Ng Care NCP * Manage airway & improve breathing p881 Respiratory “chest physio” “pulmonary toileting” what undergoes this
effort ( work of breathing ) abg ( po2 and c02 levels ) air entry ( atlectasis ) , asuculate breath sounds adequate cough ( pneumonia ) cough assist
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what undergoes cvs : sci : effect on pt and ng care ncp
rics neurogenic shock adequate hydration, dec CO DVT, PE muscle spasm, neuropathic pain
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DV, PE ( because they are immobile ) what type of intervention are we utilizing for muscle spasm and neurpathic pain
baclofen , sometimes necrotic
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effort of breathing and how strong their heart is cough assist is take a deep breaths and say cough and move in their upper abdomen to help them cough
yes
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cough as hard as u can ( not hard at all ) cvs thinking risk for neurogenic shock
true
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neurogenic shock : what is it ?
loss of sympathetic innervation
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neurogenic shock what does this do ?
vital signs neuro genic shock happens because they have losee their sympathetic innevration
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what type of vasodilation do neurogenic shock get ?
they get peripheral vasodilation also get venous pooling and decrease in cardiac output
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who is at risk for neurogenic shock ?
low blood pressure and low heart rate these patients are warm and dry they do not feel cold and calmy which they should since low bp and low he
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people who are at risk is injured from t5-or above what is this describing ?
neurogenic shock
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what are the s & S for neurogenic shock ?
low blood pressure and low heart rate ( treat this blood pressure )
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true or false. neurogenic shock is always a problem ( life long )
this is true may have to put medarine meds that brings up blood pressure
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what are the s and s resolution
systolic of 60-75 if we do nothing it may not go up and this is trouble and can lead to hear attack ( keep an eye on this )
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when is this goingaway ?
when vital signs become more normal
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bowel and bladder retraing GI neurogenic bowel
hypotomotility and management ( bowel routine ) --> bowel routine this is usual colace everyday , doing this suppersitory, every second day
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bowel and baldder retraing , what do we have to make sure ?
getting enough nutriton and fibre
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bowel and bladder retraing GU neurogenic bladder what undergoes it
urgency, frequnrecy, incontinence management decreasing the risk of UTIs
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getting enough nutrition and fibre for gu ( neuro genic bladder ) problem with what ?
urgency , frequency, incontinence
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these people may need to ct staright of then is always better than stragiht cath than indwelling foley GU ( neurogenic bladder ) . tru or false.
true
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if patient cannot straight cath, they may given indwelling foley
true
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nutrition/GI : bowel and bladder retraing
nutrional intake metabolism ulcer protection
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first 6 months are hypermetabollic meaning they are not moving they are burning calories a lof of calories, make sure they have enough calories and proteina dn metbaplism is the high at the start because of what ?
muscle wasting
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ulcer protecting --- what type of medication are we doing ?
PPI h2 we want to make sure they are getting enough nutrition and not a bleeding ulcer
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bowel and bladder retraing :what else?
thermoregulation ( poikilothermia ) skin inspection : skin care, comfort, mattress; roho cushion for wheelchair
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these pts are a high level of injury ( be careful of body temp ) will take on the environment temperature los the ability tor regulate it
true or false.
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bowel and bladder retraing : sexuality , rehab process, emotional/mental health
sexuality -sensation -fertility rehab process - expectations regarding recovery ( related to level of injury ) emotional/mental health -greif/loss, depression -goal is pyschosocial adjustment
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stabilization and alignment : harcd vercial collar other than that what else
crutchfield tongs - weight/bed angle -turning/logroll -washing skin and pin site care
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stabilization and alignment : harcd vercial collar other than that what else recall : crutchfield tongs - weight/bed angle -turning/logroll -washing skin and pin site care what else ?
halo vest - patient and family education alters patient's balance -skin and pin site assessment and care -washing skin under vest liner - emergency wrench
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is traction and stabilization short or long term
this is short term
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what is the situation for the patient like during traction and stabilization
just to get them stable enough patient is npo turn him ( had to make sure ) foley and clean him and clean the bed again turn a tiny bit ( shift to the weight is okay )
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summary of sci management in acute care give a run down of the meds and surgery
meds : methylprednisone dopamine atropine surgery : ( stabilize, realign, spinal column ) - laminectomy, fusion
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blood pressure up, for dopamine and get heart rate up with atropine is this true or false.
this is true
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how does lainectomy work ?
dr will go in or prone ( faced down ) and make an incision, in that area clean out bone fragments, and clean up any blood and out in hardware
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how is the patient going to recover furing laminectomy ?
back on the unit, and rule is discontinued to get the pt to move around and get up in the wheelchair and then move on to rehab
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what is non surgical intervention for sci management n acute care
spinal immobilization and stabilization
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what do they wear in sci management in acute care
wear hard cervical collar , halo fixation device with jacket
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recall : what do they wear in sci management in acute care wear hard cervical collar , halo fixation device with jacket then when physcially stable the focus move to what ?
physio ( stretching, stregtening, balance 0 braces/canes/wheelchair/mobility rehab and hospital leaving unit on day passes adl and mobility training
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autonomic dysreflexia whcih sci pts are at risk ?why does it occur ?
injured at t6 , or above high level injury problem why does this ocur ? because of a reflex neuro sympathetic response of vasoconstriction
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autonomic dysreflexia why does it occur ?
slower imbounded pulse high blood pressure is one heart rate could be in the 0s or 40s the patient feels terrible, bad headache, blurred vision, and even flushed above the level of injury
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autonomic dysreflexia what is it ?
a massive uncompensated cvs reaction mediated by the sns
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recall that : a massive uncompensated cvs reaction mediated by the sns autonomic dysreflexia
sns response to stimuli > reflex vasococntriction below injury and vasodilation above injury - the return of reflexes ( after spinal shock has resovled) means that hse pts may develop autonmic dysflexia
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what are the s and s for autonomic dysreflexia
systlloc 180-200 slower imbounded pulse ( high blood rpessure is one ) heart rate could be in the 0s or 40s the patient feels terrible , bad headache , blured voison and even flushed above the level of oiijiry
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ng care and tc for autonomic dysrefelxia
vasodilator - we want their blood pressure to be down first thing we do is nursing care , et their head of bed head up - figure out what is the cause and idea with that
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fixed whatver cased this happen : autonomic dysreflexia , is this true or false
this is true
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possible causes of autonomic dysreflexia ?
full bladder, things like a full bowel ( alot of stool in their rectum ) and even like shoes on too tight when was the last time u catherized ur self ? staight cath would solve the problem
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true or false. it is important ot eh tach the pt an family
true what can happen person can have stroke or seizure if not contorlled of blood pressure teach patient and fmailt identify signs and tratments tis can happen in t6 or above
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amputation what undergoes this ?