Med-Surg Final Q3

Front 1

Osteoblasts

Back 1

synthesize organic bone matrix(collagen) and are the basic bone forming cells.

Front 2

Osteoclast

Back 2

- participate in bone remodeling by assisting in the breakdown of bone tissue

Front 3

How does a bone heal from a facture?

Back 3

bone remodeling is the removal of old bone by osteoclasts (reabsorption) and the deposition of new osteoblasts

Front 4

[Process of a healing fracture ]

Back 4

1. Fracture hematoma- blood surrounds the ends of the fragments and turns into a semi solid clot. This occurs the first 72 hr after injury
2. granulation tissue- active phagocytosis absorbs the products of local necrosis. Granulation produces the new basis for new bone substance called osteoid.
3. Callus formation- primarily composed of cartilage, osteoblasts, calcium, and phosphorus. Evidence of this can be verified by xray
4. Ossification- occurs from 3 weeks to 6 months. Stops movement at fracture site but the fracture is still evident on xray. The cast may be removed at this point
5. Consolidation- distance between the bones diminish.
6. Remodeling- excess bone tissue is reabsorbed and the union is completed. Weight bearingis gradually introduced

Front 5

Know nursing assessment of musculoskeletal system including:
Past medical history

Back 5

ask about TB, polio, diabetes mellitus, parathyroid problems, hemophillia, rickets, scurvey, soft tissue infection and nueromuscular. Ask about secondary bacterial infections because ey can enter the bone and cause osteomyelitis. medication history- skeletal muscle relaxants, opioids, nsaids, corticosteroids.
Ammenorrhea can be a sign of early osteoporosis

Front 6

Know nursing assessment of musculoskeletal system including:
[past surgeries]- prolonged immobilization

Back 6

prolonged immobilization

Front 7

Know nursing assessment of musculoskeletal system including:
[health perception]

Back 7

- ask about health practices. Tetnus and polio vaccine. How the patient was injured, circumstances related to it, diagnostic evaluations, methods of tx, duration of tx, current status related to the injury, need for assistive devices, and interference with adls
[functional health patterns

Front 8

Know nursing assessment of musculoskeletal system including:
[Nutritional metabolic

Back 8

vit c, d and calcium. Obesity places additional strees on joints

Front 9

Know nursing assessment of musculoskeletal system including:
Elimination pattern

Back 9

decreased mobility secondary to a musculoskeleta problem can cause constipation

Front 10

Know nursing assessment of musculoskeletal system including:
Activity exercise

Back 10

type and duration of exercise. Work

Front 11

Know nursing assessment of musculoskeletal system including:
Sleep

Back 11

discomfort can cause loss of sleep

Front 12

Know nursing assessment of musculoskeletal system including:
Cognitive]

Back 12

pain should be fully explored and documented

Front 13

Know nursing assessment of musculoskeletal system including:
Self perception

Back 13

address feelings about changes

Front 14

Know nursing assessment of musculoskeletal system including:
Assessment

Back 14

including muscle-strength testing, measurement and common assessment abnormalities

Front 15

Know nursing assessment of musculoskeletal system including:
Examination

Back 15

make sure body parts are symmetric

Front 16

Know nursing assessment of musculoskeletal system including:
Muscle strength

Back 16

normal muscle strength is a 5

Front 17

Know nursing assessment of musculoskeletal system including:
Palpations

Back 17

nurse hands should be warm to prevent muscle spasms

Front 18

Know nursing assessment of musculoskeletal system including:
Measurement

Back 18

measure when things look abnormal. Document eexact spot measurements were obtained.

Front 19

Common abnormalities of musculoskeletal system :
Achilles tendinitis

Back 19

pain when running or walking caused by inflammation

Front 20

Common abnormalities of musculoskeletal system :
Ankylosis

Back 20

stiff and fixation of a joint. Rheumatoid arthritis

Front 21

Common abnormalities of musculoskeletal system :
Antalgic gait

Back 21

shortened stride with little weight bearing on affected side

Front 22

Common abnormalities of musculoskeletal system :
Contracture

Back 22

resistance of movement of muscle or joint as a result of fibrosis.

Front 23

Common abnormalities of musculoskeletal system :
Boutonnière deformity

Back 23

finger abnormality. From RA

Front 24

Common abnormalities of musculoskeletal system :
Festinating gait

Back 24

while walking e neck, trunk and knees flex while body is rigid. Cause by parkinsons

Front 25

X-rays

Back 25

determines density of bone. Nurse- avoid excessive exposure. Remove any radiopaque items before, explain and verify pt is not pregnant.

Front 26

Ct scan

Back 26

3d pic. Identifies soft tissue abnormalities, bony and trauma. Nurse- inform that procedure is painless, they must remain still, if contrast medium is being used confirm they have no shellfish allergy

Front 27

Myelogram

Back 27

- injects dye into sac around nerve roots. Good for nerve impingement and can pick up subtle lesions. Nurse- pt may get spinal headache, it will resolve but still call doctor

Front 28

MRI

Back 28

radio waves and magnetic field to view soft tissue. Nurse- painless. Contradicted in patients with aneurysm clips, metallic implants, pacemakers, electronic devices. Make sure they have no metal clothing. They must remain still

Front 29

DEXA

Back 29

measures bone mass of spine, femur, forearm, and total body. Min rAdiation exposure. Used to dx metabolic bone disease. Nurse- painless

Front 30

Arthroscopy

Back 30

insertion of arthroscope into joint for visualization. Nurse- inform pt it is an outpatient procedure with strict asepsis. After procedure cover wound with sterile dressing

Front 31

difference between a sprain and strain?

Back 31

Sprain- injury to tendon ligamentous structures surrounding a joint, usually caused by a wrenching or twitching motion. Most common areas are ankle and wrist
Strain- excessive stretching of a muscle and it's fascial sheath. Often involves the tendon.
Full function should return in 3-6 weeks

Front 32

How is sprain and strain treated?

Back 32

ice and elevation for 24-48 hr after injury to reduce edema. Mild analgesics, elastic wrap- on for 30 then off
RICE

Front 33

Dislocation-

Back 33

severe injury of the ligamentous structures that surround a joint. Complete displacement or separation of the articular surfaces of the joint. Result from forces transmitted to the joint that cause a disruption of the soft tissue support structures surrounding the joint. Most obvious clinical manifestation in deformity, there is also pain, tenderness, loss of function, swelling.major complications- avascular necrosis- bone death due to inadequate blood supply. The joint can be aspirated to detect for fat cells or hemoarthrosis. Fat cells indicate probable I traarticular fracture.

Front 34

Sublaxtion

Back 34

partial or complete displacement of the joint surface. Basically the way to treat, healing time and symptoms from a sublaxtion are less severe but same as dislocation

Front 35

Nurse managment of Dislocation:

Back 35

considered an orthopedic emergency. First goal of mgt is to re align the dislocated protion of the joint to it's original position. You can accomplish this by closed reduction. Anesthesia is needed so muscles will relax. After reduction the extremity is usually immobilized.
Nursing care is directed at relief of pain and protection of the injured joint. Gentle ROM may be started if the joint is stable and well supported.

Front 36

Purpose of traction?

Back 36

The purpose of any traction is to prevent muscle spasm, immobilize a joint or part of the body, reduce fracture and dislocation, treat a pathological joint condition.

Front 37

Skin traction

Back 37

usually short term (48-72 hrs) until skeletal traction or surgery is possible. Tape boots or splints are applied directly to the skin to maintain alignment, assist in reduction, and help diminish muscle spasms. Traction weights are usually limited to 5-10 lbs. Pelvic or cervical may require more weight.
ATI def for skin traction:
used intermittently. Weights are attached to a rope to the client with tape straps boots or cuffs.

Front 38

Skeletal traction

Back 38

long term. Provides a long term pull that keeps bones and joints aligned. A pin is inserted into the bone. Watch out for infection.
When traction is used to treat fractures, Force is on the distal fragment to obtain alignment with the proximal one.
ATI definition:
Skeletal- continuous. Force is applied directly to the bone by weights attached to a rod that goes thru the bone

Front 39

Bucks traction

Back 39

commonly used for hip femur knee and back

Front 40

Traction guidelines? From ATI

Back 40

maintain body alignment and realign if patient looks uncomfortable or seems in pain. Avoid lifting or moving weights. Make sure they hang freely. Replace weights if they are accidentally misplaced. Make sure pulley ropes are free of knots. Monitor skin integrity

Front 41

Care of pin site in skeletal fraction, from ATI?

Back 41

monitor for signs of infection- drainage, loosening or if the skin is rising the pin.

Front 42

Pin care protocols, from ATI

Back 42

one cotton tip swab is used per ion to avoid cross contamination, every 8 hr. A broad spectrum antibx should be prescribed prophylactic

Front 43

What are the complications from fractures and casting?

Back 43

Cast care- a cast can interfere with circulation and nerve function from being applied too tightly bc of excessive edema that occurs after application. Frequent neurovascular assessments are crucial. Nurse needs to teach patients signs of cast complications. Elevate extremity above the level of heart to promote venous return and apply ice to prevent edema. Nurse need to instruct patient to exercise joints above and below the cast
Family teaching with cast care- DO NOT- get it wet, remove any padding, insert any objects into it, bear weight for the first 48 hr or cover with plastic for prolonged periods.
DO- apply ice directly over fracture for first 24 hr, elevate above heart for first 48 hr

Front 44

What are the complications from fractures and casting? from ATI source

Back 44

Casts are more effective than splints or immobilizers bc they can not be removed by the client. Prior to casting- area is cleaned and dried
Casts are applied only if the swelling has subsided, this avoids compartment syndrome
Elevate cast above heart for first 24-48 hr to prevent swelling
A window can be placed on cast if client has a wound that needs to be monitored
If you see any drainage, outline and date and monitor for more.

Front 45

What is the nursing care for a patient with rotator cuff injury?

Back 45

maintaining passive ROM and the return of abduction strength. Rest ice and NSAIDs

Front 46

RN care for a meniscus injury?

Back 46

Meniscus- patient may complain that the knee feels like it is going to give way.
Mgt- proper stretching can help prevent this injury. Initial therapy- ice, immobilization and crutches. Patient should be allowed to ambulated as tolerated.
Rehab- strengthen quads and hamstrings and ROM. Start as soon as acute pain goes away.

Front 47

What are the common reasons for amputations

Back 47

Circulatory impairment from PVD, trauma, malignant tumors, uncontrolled infection,

Front 48

Goals for a patient with a amputation?

Back 48

have adequate relief from underlying health problems. Have satisfactory pain control. Reach max rehab potential with use of prosthesis. Cope with body image changes. Make satisfying lifestyle adjustments.

Front 49

Amputation:
[Health Promotion]

Back 49

nurse should educate to prevent amputation. Educate patient on how to avoid modifiable risks. The pt should be taught to check their lower extremities daily. They need to look at skin temp, color, loss of sensation, burning, tingling or presence of a lesion.

Front 50

Amputation:
Acute intervention

Back 50

an amputation can sometimes cause patient to go through the stages of the grieving process.

Front 51

Amputation:
preoperative

Back 51

make sure patient is educated on why they are getting an amputation and what they are going to be like after. Instruct patient on how to use compression bandages and prosthesis. Warn patient about phantom limb syndrome.

Front 52

Amputation:
post op

Back 52

nursing care must be individualized.

Front 53

Amputation (from ATI):
Disarticulation

Back 53

amputation through the joint

Front 54

Amputation (from ATI):
indications

Back 54

acute disease- trauma, thermal injury, pvd, malignancy. Chronic diseases- pvd resulting in gangrene. Diabetes mellitus- pressure ulcers. Infection- osteomylitis. Metabolic disorders

Front 55

Amputation (from ATI):
Closed amputation

Back 55

most common. Skin flap closes the site

Front 56

Amputation (from ATI):
Open amputation

Back 56

used with active infection, skin is closed at a later date.

Front 57

Amputation (from ATI):
Assessment

Back 57

Tissue perfusion- pink
Pain
Mobility
Infection
Clients feeling about amputation
Coping
Prothesis

Front 58

Amputation (from ATI):
NEUROVASCULAR ASSESMENT---6 P's

Back 58

PAIN
Early sign. Pain should resolve with medication
PARESTHESIA
Early sign. Assess for numbness, tingling, pins and needle sensation
PALLOR
Early sign. Assess capillary refill. Want it to be less tha 3 sec
POLAR/TEMP
Late sign. Assess temp by touch, warm or cold? Cold is bad
PARALYSIS
Late sign. Assess mobility, move fingers or toes, able to plantar and dorsiflex
PULSES
Late sign. Assess pulses distal to injury.

Front 59

Amputation (from ATI):
INTERVENTIONS

Back 59

Assess pain and administer pain meds.
Position extremity in dependent position to promote blood flow and oxygenation
Shape and shrink the residual limb in prep for prosthetic training.
Shrinking interventions- wrap stump using ace bandages (fig 8). Utilize a stump shrinker sock, it's easier for the patient. Use a air splint

Front 60

Amputation (from ATI):
COMPLICATIONS

Back 60

Phantom limb pain- sensation of pain from amputated extremity. Pain is real and manage accordingly.
- flexion contractures- caused by improper positioning. Prevention includes ROM and proper positioning, don't put stump on pillow for the first 24 hr, have the pt lie prone.

• Outline the post-operative management for hip replacement and knee replacement.
Pre op- patient needs to understand and accept the limitations of the proposed surgery and realize that it will not remove the underlying disease. Physical therapist should visit before surgery.
Post op- discharge planning begins immediately. Home environment must be assessed for safety and accessibility. Patient teaching- instructions to report complications- infection, fever, increased pain, drainage or dislocation of prothesis.

Front 61

What are complications from hip replacement and knee replacement?
Surgery complications

Back 61

Complications from surgery- infection, most common organism is gram positive aerobic streptococci and staphylococci. Infection leads to pain and loosening of the prothesis.
DVT is another complication. Prophylactic measures- aspirin, warfarin.

Front 62

What are complications from hip replacement and knee replacement?
KNEE

Back 62

With part of the knee or the entire knee joint may be replaced with a metal and plastic prosthetic device. A compression dressing is used to immobilize the knee in extension immediately after the operation. Great emphasis is placed on post op PT- isometric quadriceps setting begins the first day after surgery. Then the patient progresses to straight leg raises. Cpm machine may also be used

Front 63

What are complications from hip replacement and knee replacement?
HIP

Back 63

Implants are often cemented in place. Over time revision surgery is needed. This is for older people. Younger people get cement less athroplaties bc they last longer.
- internal rotation, adduction and 90 degree flexion must be AVOIDED 4-6 weeks after surgery. A foam abduction pillow may be placed between the legs to prevent dislocation. Patients need elevated toilet seats at home. They can't drive cars or take baths for 4-6 weeks. Knees must be kept apart, they must never cross them or twist. Ambulation with a walker is started first day post op.
Risk of DVT- prothrombin times will be evaluated every week and the anticoagulants will be adjusted accordingly.

Front 64

ARTHROPLASTY

Back 64

Reconstruction or replacement of a joint

Front 65

ARTHROPLASTY defined, from ati:

Back 65

surgical removal of a diseased joint and replacement with prosthetics.
- goal- eliminate pain, restore joint function, and improve client quality of life.

Front 66

What are complications from hip replacement and knee replacement? from ATI
ARTHROPLASTY PREOP

Back 66

CBC, urinalysis, electrolytes, BUN, creatine. Rule out anemia, infection, and organ failure. Chest xray, and ekg

Front 67

What are complications from hip replacement and knee replacement? from ATI
Hemiarthroplasty

Back 67

half of a joint replacement, femoral neck
- monitor for bleeding
Check dressing frequently. Monitor and record drainage from surgical drains. Blood transfusion for hemoglobin levels less than 9.
- take actions to prevent infection- monitor temp, encourage TCDB, monitor lung sounds, monitor CBC, monitor wound site.
- early ambulation- TRANSFER OUT OF BED FROM UNAFFECTED SIDE

Front 68

What are complications from hip replacement and knee replacement? from ATI
Hemiarthroplasty
What do DO!!!

Back 68

use elevated seat.
Use straight chairs with arms
Use abduction pillow between legs
Externally rotate toes

Front 69

What are complications from hip replacement and knee replacement? from ATI
Hemiarthroplasty
What not to DO

Back 69

Flex hip more than 90 degrees
Use low chairs
Cross legs
Internally rotate toes
- client position- supine with head slightly elevated with affected leg in neutral position and a pillow or abduction device between legs to prevent

Front 70

What are complications from hip replacement and knee replacement? from ATI
KNEE

Back 70

Dislocation is not common after dislocation surgery
- positions of flexion of the knee are limited to avoid flexion contractures. Avoid knee batch and pillows placed behind the knee. The goal is for the patient to be able to straight leg raise.
- CPM- used to promote knee motion and prevent scar tissue formation

Front 71

What are complications from hip replacement and knee replacement? from ATI
KNEE COMPLICATIONS

Back 71

DVT resulting in a PE- symptoms of a PE include- dyspnea, tachycardia, and pleuretic chest pain. Prophylaxis- anticoagulants, scd stockings, ankle exercises while in bed, and early mobilization.

Front 72

What are complications from hip replacement and knee replacement? from ATI
What are complications from hip replacement and knee replacement? from ATI
Hip dislocation/sublaxtion

Back 72

- symptoms- acute onset of pain, client reports hearing a pop, or shortened extremity

Front 73

Purpose of a Casts

Back 73

temporary circumferential immobilizers device.
1.Prevent further injury
2.Promote healing/ circulation
3.Reduce pain
4.Correct a deformity

Front 74

Cast care

Back 74

always allow circulation of air in cast because can cause heat build up. Always keep it clean and air dry or with a hair drier..

Front 75

Complications of cast

Back 75

Education is the best prevent measure of complications by patients. Prevent If swelling continues after cast application and causes unrelieved pain, cast can be split on one side or both sides. Should be elevated above the level of the heart during the first 24 to 48 hours. Any drainage should be outlined, dated, and timed to monitor for additional drainage. Plaster debris from falling into cast, which can cause irritation or pressure necrosis. Cotton web roll is to maintain skin integrity. Foreign objects in casts=skin trauma

Front 76

Traction

Back 76

uses a pulling force to promote and maintain alignment to injured area.

Front 77

Traction:
Goal

Back 77

Realignment of bone fragments.
Decreasing muscle spasms and pain
Correcting or preventing further deformities

Front 78

Types of traction:
Skin

Back 78

used intermittently. Pulling force is applied by weights that are attached by rope to client with tape, straps, boots, or cuffs. i.e: chin halter straps, bryant’s traction, and buck’s traction.
1.Short term and decreased muscle spasms

Front 79

Types of traction:
Skeletal

Back 79

used continuously. Pulling force is applied directly to the bone by weights attached by rope directly to rod/ screw placed through the bone. i.e halo traction.
2. Long term and disadvantage: infection and prolonged ability
Apply the 6’s
Pt. is usually given a prophylactic antibiotic (broad spectrum)=cefazolin (Ancef) to minimize infections for fracture that has metals or screws.

Front 80

Osteomyelitis

Back 80

inflammation within the bone secondary to penetration of organisms (trauma, surgery). It is characterized by bone pain that is worth with movement. Initially, erthema, edema, and fever may occur. Definitive diagnosis is with a bone biopsy. Cultures performed for detection of possible aerobic and anaerobic organisms. Treatment includes a long course of IV and oral antibiotic therapy. Surgical debridement may also be indicated. No success-ambutation.

Front 81

Joint replacements
Goal of joint replacement surgery

Back 81

is to eliminate pain, restore joint motions, and improve the pt. functional status and quality of care.

Front 82

Joint replacements
Arthroplasty

Back 82

surgical removal of a diseased joint and replacement with prosthetics. Can be caused by (osteo and rheumatoid arthritis)

Front 83

Joint replacements
Hip joint replacement

Back 83

total hip arthroplasty involves the replacement of the acetabular cup, the femor head, and femoral stem.
Understand the Do’s and Don’t of hip precaution to fall-pg. 935

Front 84

Joint replacements:
Osteoporosis:

Back 84

bone fractures and risk factors- external fixation is used for radius or ulnar fractures in older adult client due to poor vascularity of bone or fragile bone structure

Front 85

Fractures:
A fracture?

Back 85

break or disruption in the continuity of a bone (most are traumatic but can be secondary to disease process)

Front 86

Fractures:
A Closed, or simple

Back 86

fracture does not break through the skin surface

Front 87

Fractures:
An open, or compound fracture

Back 87

disrupts the skin integrity, causing an open wound with a risk of infection.
Open fractures are graded based upon the extend of tissure injury.

Front 88

Open Fracture:
Grade I

Back 88

minimal skin damage.

Front 89

Open Fracture:
Grade II

Back 89

damage includes skin and muscle contusions

Front 90

Open Fracture:
Grade III

Back 90

damage to skin, muscles, nerves, and blood vessels

Front 91

Fractures:
A complete fracture

Back 91

goes through the entire bone dividing it into 2 parts.

Front 92

Fractures:
incomplete fracture

Back 92

goes through part of the bone

Front 93

Risk factor for fracture is

Back 93

osteoporosis, diseases (bone cancer, paget’s disease

Front 94

Fracture healing:
1.Bone hematoma

Back 94

1.Bone hematoma-initial 72 hrs. after surgery

Front 95

Fracture healing
2.Granulation tissue

Back 95

bone substance called “osteiod” production in 3-14 day

Front 96

Fracture healing:
3.Callus formation

Back 96

appears by end of week 2->verified by x-ray

Front 97

Fracture healing
4.Ossification of callus

Back 97

occurs 3-6 weeks after fracture; continues until fx is healed->cast may be healed.

Front 98

Fracture healing:
5.Consolidation

Back 98

5.Consolidation-usually 6 weeks to 1 year “radiologic union”

Front 99

Fracture healing:
6.Bone remodeling

Back 99

6.Bone remodeling completed “1 year” time span.

Front 100

Compartment syndrome ?

Back 100

occurs when pressure within one or more of the muscle compartments of the extremity compromises circulation reslting in an ischemia edema cycle. Capillaries dilate in an attempt to pull oxygen into the tissue. Increased capillary permeability from release of histamine leads to edema from plasma proteins leakings into interstitial fluid space. Increased edema causes pressure on the nerve endings resulting in pain. Blood flow is further reduced and ischemia persists=compromised neurovascular status.

Front 101

Compartment syndrome ?
External source

Back 101

tight cast or constrictive bulky dressing

Front 102

Compartment syndrome ?
Internal source

Back 102

accumulation of blood/ fluid within muscle compartment, can cause pressure.

Front 103

Compartment syndrome ?
Signs and Symptoms

Back 103

s/s-pain unrelieved with elevation, color of tissue (pallor), paresthesia
if untreated tissue cause necrosis

Front 104

Amputation:
Closed amputation

Back 104

the most common technique, allowing the skin flap to close the site

Front 105

Amputation:
Open amputation

Back 105

used with active infection, allowing the skin to be closed at a later date. Reconstructive/ plastic surgery may be necessary

Front 106

Amputation:
Assess/ monitor

Back 106

tissue perfusion(pink in light skin, and non discolored in dark skin), pain, mobility, signs of infection, pt. perception and feelings, coping, prosthesis fit
Apply 6’P’s

Front 107

Osteoporosis:
Secondary osteopororsis results

Back 107

hyperparathyroidism, long-term corticosteroid use, long-term immobility.

Front 108

Osteoporosis:
Signs and Symptoms?

Back 108

fractures are leading complication of osteoporosis

Front 109

Osteoporosis:
Goals

Back 109

1.acute intervention
2.pre-op management
3.post-op-prevent infection, control, pain, assess for hemorrhages, decreased or loss of circulation
4.phantom limb sensation

Front 110

Osteoporosis:
nursing implementation

Back 110

prevent flexion contractures
perform & teach limb care
elderly are at increased risk of complications: DVT

Front 111

Osteoarthritis:

Back 111

disorder characterized by progressive deterioration of the articular cartilage. It is a noninflammatory (unless localized), nonsystemic disease. Believe to be a process where new tissue is produced as a result of cartilage destruction within the joint. The destruction outweighs the production. Cartilage and bone beneath the cartilage erode and osteophytes (bone spurs) form, resulting in narrowed joint spaces. The changes within the joint lead to pain, immonility, muscle spasms, and potential inflammation.

Front 112

Osteoarthritis:
Risk Factors?

Back 112

age, decreased muscle strength, obesity, possible genetic link, early stage-it is hard to distinguish from RA

Front 113

LOOK AT OA vs. RA****

Back 113

Joint pain/ stiffness will resolve with rest or inactivity

Front 114

Osteoarthritis:
Conservative therapy

Back 114

1.balance rest with activity
2.use bracing or splints
3.apply thermal therapies (heat or cold) to relieve pain and ice for acute inflammation
4.analgesic therapy
a.acetaminophen
b.NSAIDS
c.Topical salicylates
d.Glucosamine (rebuilds cartilage)
e.Intra-articular injections of glucocorticoids (treat localized inflammation)
i.Inform on use of NSAIDS and analgesics prior to activity
•When conservative measures fail, the pt. may choose to undergo replacement surgery to relieve the pain and improve mobility and quality of life. Osteotomy is done to remove damaged cartilage and correct deformity.
•Can also use completmentary/ alt. therapy (acupuncture, tai chi, magnets)

Front 115

Sprain

Back 115

injury to the tendin structures that surround a joint. (i.e- most common is ankle and wrist)

Front 116

Sprain:
Cause

Back 116

wrenching or twisting motion

Front 117

Strain

Back 117

excessive stretching of a muscle and its fascial sheath; often involves the tendon.

Front 118

Strain treatment/

Back 118

Apply RICE: rest ice circulation elevation

Front 119

Dislocation

Back 119

severe injury; complete displacement or separation of the articular surface of a joint

Front 120

Subluxation

Back 120

partial; displacement of joint surface; less servere

Front 121

Major complications for sublaxation

Back 121

open joint injuries/ intra articular fx/ avascular necrosis

Front 122

Subluxation
RN Care

Back 122

1.1st goal is realignment/ closed reduction
2.immobilization
3.pain management
4.rehab/ ROM

Front 123

FIBROMYALGIA VS. CHRONIC FATIGUE SYNDROME
similarities

Back 123

Has a lot of same symptoms- these are the similarities
Occurrence-Previously healthy, young, and middle-aged women
Cllinical manifestations: Malaise and fatigue, cognitive dysfunction,
headaches, sleep disturbances, depression, anxiety, fever, generalized musculoskeletal pain
Course of disease- Variable intensity of symptoms, fluctuates over time
Diagnosis-no definitive lab. Test or joint and muscle examination, mainly a diagnosis of exclusion
Collaborative-treatment is symptomatic and may include antidepressant drugs. Other measures are heat, massage, regular stretching, biofeedback, stress management, and relaxation training. Patient and family teaching is essential. Multiple physiologic abnormalities- increase levels of blood flow to thalamus, dysfunction of hypothalamic pituitary adrenal, low level of serotonin of trypophan, abnormalities of cytokin f(x)

Front 124

Fibromyalgia syndrome

Back 124

is a chronic disorder characterized by widespread, nonarticular musculoskeletal pain and fatigue with multiple tender points. It is nondegenerative, nonprogressive, and noninflammatory. It is a major cause of disability. 6X more frequently in woman than men

Front 125

Fibromyalgia syndrome
S/S

Back 125

nonrestorative sleep, morning stiffness, irritable bowel syndrome, and anxiety.
head or facial pain, non restorative sleep, fatigue, tmj dysfunction

Front 126

Fibromyalgia syndrome:
Pregabalin (Lyrica)

Back 126

‐ reduces calcium influx into the nerve terminals

Front 127

Fibromyalgia syndrome:
Side effects

Back 127

dizziness, downiness, ataxia, constipation, dry mouth
anagesics: Tylenol, NSAID’s

Front 128

Fibromyalgia syndrome:
SSRI antidepressants

Back 128

3-4 weeks to take effect

Front 129

FMS:
Skeletal muscle relaxant

Back 129

benzodiazepine prescribed with low doses of ibuprofen but may cause severe sleep disturbance

Front 130

FMS:
Zolpidem

Back 130

for severe sleep disturbances

Front 131

FMS:
RN Managent

Back 131

massage combined with ultrasounds
-apply head and cold packs