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60 Cards in this Set

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