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60 Cards in this Set
- Front
- Back
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what are the goals of treatment for reumatoid arthritis? slide 49
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satisfactory pain relief, minimal loss of ability participate in planning of therapeutic regimen, maintain positive self image, perform self-care to maximum ability
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what are some ways to protect joints for a person w/ rheumatoid arthritis? slide 50
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rest alternated with activity
,neutral joint position, use strongest joint for task, distribute weight evenly, change positions frequently, no repetitious movements, modify chores |
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why is hot and cold therapy sometimes used for those w/ rhuematoid arthritis? slide 51
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for relief of stiffness, pain, an muscle spasm
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how long should moist heat be used for joint pain? slide 51
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no longer than 20 minutes (used for chronic stiffness)
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how long should ice therapy be used? slide 51
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no longer than 10-15 minutes (used for exacerbations)
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describe gout: slide 54 / pg 1737, lewis
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Purine altered metabolism resulting in a high uric acid level typically this is all managed by the kidneys
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who might have primary gout? slide 54
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80% are male w/ a genetic predisposition to altered metabolism of purine; almost no incidence in premenopausal women
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other than those who are geneticially predisposed to gout, who might aquire hyperuricemia? pg 1737 lewis
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those taking thiazide diuretics, post menopausal women, and organ transplant recipients taking immunosuppresant agents
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Secondary gout is aquired. What things may cause secondary gout? slide 54
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drugs, ETOH, renal disease, bone marrow dysfunction
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describe stage I gout
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asymptomatic hyperuricemia
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describe stage II gout: slide 55
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fever, pain, swelling, erythema of joint
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describe stage III gout: slide 55
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symptom free between attacks
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describe stage IV gout: slide 55
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permanent joint changes, multiple joints involved, uric acid renal stones, CAD
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describe acute gout: pg 1737, lewis
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may occur in one or more joints but usually less than four.
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describe some symptoms of acute gout: pg 1737, lewis
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affected joints may appear dusky or cyanotic and are exteremely tender. Inflamation of the great toe (pdagra) is the most common initial problem
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what is chronic gout characterized by?
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multiple joint involvement and visible deposits of sodium urate crystals called tophi
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where are tophi usually found? page 1737, lewis
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in the synovium, subchondral bone, olecranon bursae, and vertebrae; along tendons, and in the skin and cartilage
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how long does it usually take for tophi to show up in those w/ gout?
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years, usually not seen initially
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chronic inflamation due to gout may lead to what? lewis page 1737
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joint deformity; cartilage destruction may lead to osteoarthritis; large tophaceous deposits may perforate overlying skin that can become infected; renal disease
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what are some tx's for gout? slide 58
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immobilize joint, apply heat and cold, joint aspiration, corticosteroids, meds (nsaids, cholchicine, benemid, allopurinol), avoid foods high in purine
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what are some foods that contain purine and should be avoided by those w/ gout? slide 58 and rheumatology.org
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anchovies, liver, wine, beer, pickles, red meat, shellfish roe scallops, organ meats,
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who is most likely to have a hip fracture? slide 60
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those who are elderly and female (though males have them too)
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how many hip fractures are seen per year in the US? slide 60
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250,000
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what is the mortality rate for hip fractures during initial hospitalization? slide 60
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8%
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what is the morbidity for hip fractures? slide 60
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60 % never return to normal functioning, 25% never walk again,
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what is the length of stay (think hospitalization + rehab)? slide 60
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7-10 days plus 30 days of rehab
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what is the annual cost of hip fractures? slide 60
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6.5 billion
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what causes intracapsular hip fracture? slide 60
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minor trauma, osteoporosis
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what causes extracapsular hip fracture? slide 60
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direct severe trauma
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for what assessments might the nurse make for someone w/ hip fracture? slide 62
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externally rotated, limited movement, dec. hgb/hct, extreme pain, red/warm/ bruised, length difference (shorter on affected side)
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what diagnostic tools might be used to assess someone who may have a hip fracture? slide 65
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plain film, MRI
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when are plain film and MRI used to diagnose hip fractures? slide 65
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plain film – primary method
MRI – used when physical findings / x-ray are not supportive |
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what are some life threatening problems that might be found during assessment of client w/ hip frature? slide 70
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hypo / hypervolemia, electrolyte abnormalities, anemia
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what are some possible comorbidities that may go along w/ dx of hip fracture? slide 70
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diabetes, heart failure, pneumonia
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what did the cochran review find out about the relationship between traction and hip fracture issues? slide 71
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use of traction (bucks/russels) vs no traction produced no benefit to pain or fracture prior to surgery
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surgery for hip fracture w/in 24 hours reduces the likelyhood of what? slide 72
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infection: pneumonia/urinary tract; wound coagulopathy: thrombosis/emboli; wasting: skin and muscle; oxygenation: hypoxia
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what is the typical prophylactic treatment of infection for those w/ hip fracture? slide 73
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One dose IV at start of surgery with second dose if
surgery longer than 2 hours or blood loss > 2 liters |
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what % of those w/ hip fractures have assymptomatic DVT, symptomatic DVT, or Pulmonary embolism? slide 74
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asymptomatic DVT – 45%
symptomatic DVT - 11% PE – 7% |
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what sort of ASA (aspirin) treatment should those w/ hip fractures recieve? slide 75
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160 mg daily x 7 weeks
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the antiplatelette effect lowers assymptomatic DVT by...%, symptomatic DVT by...%, PE by...%, fatal PE by...% ? slide 75
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assymptomatic dvt: 10%
symptomatic dvt: 0.5% PE: 50% fatal PE: 50% |
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a patient who has a hip fracture must have at least two of what symptoms before being administered heparin? slide 76
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age >80, recent MI/CVA, estrogen therapy, paralysis, malignancy, previous DVT, vascular insufficiency
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what can be done to prevent wasting of skin of someone w/ hip fracture? slide 77
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adequate calorie/protein, position change, hygiene, fluid balance, early mobility, ROM, splinting and support devices, *skin assess. w/ each reposition
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what can be done to prevent the wasting of muscles of someone w/ hip fracture? slide 77
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adequate calorie/protein intake early mobility, ROM – passive or active, *early therapy consult, *family involvement
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Hypoxia has been shown to persist from ....until...in patients who did not experience oxygenation difficulty prior injury. slide 78
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from the time of admission until 5 days postoperatively
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how often should O2 saturation be checked for those w/ hip fracture? slide 78
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q four hours
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what is the minimum O2 saturation for hip frature pt? side 78
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92%
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pre surgery for hip fracture: what are the measures used for the symptoms pain, nausea, constipation? slide 79
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pain: morphine IV or PCA
nausea: zofran constipation: stool softeners |
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for hip fracture pt: what teaching should be given to the family? slide 79
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family should pace themselves – rotate members
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what things should be assessed post operatively? slide 80
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VS, I&O, assess for bleeding, wound check, assess circulation, pain control
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what sort of nursing care can be expected for a person w/ hip fracture? slide 81 (it's an anacronym)
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HIP: Help w/ adl's, Inspect wound for color/temp/drainage/healing/circulation in hip and heel, Prevent dislocation
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how can the nurse prevent dislocation in person w/ hip fracure? slide 81
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by transfer training, abduction wedge, toilet seat extender
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how much flexion can the person w/ hip fracture tolerate? slide 81
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< 90%, no leg crossing, adduction of injured leg
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what is the etiology of back pain? slide 85
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Degenerative disk disease,
Injury, Systemic disease, Abnormalities of structure: congenital, Bad posture, obesity, Exercise: poor habits |
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what does degenerative disk disease result in? slide 85
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intervertebral narrowing and lessening of efficiency of the disk to act as shock absorbers
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what are the manifestations of back pain? slide 87
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pain: radiation to buttocks /leg, pain distribution is dependent on location of disease, paresthesia /muscle weakness below level of disease, reflexes depressed or absent, straight leg is positive
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what are complications fo back pain? slide 87
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related to chronic pain, immobility, use of medications
,depression |
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what might be done to dx back pain? slide 88
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MRI/CT, EMG
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why is an EMG used to dx back pain? slide 88
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evaluate the degree of nerve irritation and R/O other problems
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what is done for tx of back pain? slide 87
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Conservative care, Heat or ice locally, Rest no lifting, bending, squatting, prolonged sitting/standing, Observation for improvement/worsening of symptoms, NSAIDs, Insure they have adequate home support to follow orders, Corset to limit flexion/extension of lower back, *surgery only if NO improvement including: steroid injections, laser surgery, etc.
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what nursing care is done for those w/ back pain? slide 91
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Assess pain/complications
Bed rest is limited to short periods, Control pain, Do keep body in proper alignment, support with pillows, Encourage to move legs, deep breathing, ballet toes, Focus on education and prevention |
