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151 Cards in this Set
- Front
- Back
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What decreased the amount of swelling in the joints
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Anti-inflammatory Corticosteroids
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What conditions would use Anti-inflammatory Corticosteroids
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Rheumatoid Arthritis, Busitis, and Tendonitis
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Side Effects of Anti-inflammatory Corticosteroids
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Muscle weakness, osteoporosis, immunosuppression, ployuria, polydipsia, abnormal fat distribution, growth retardation in children, weight gain, mood swings such as depression, edema
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Common Anti-inflammatory Corticosteroids
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Cortisone (Cortone), Prednisone (Deltasone), Betamethasone (Celestone), Hydrocortisone, Methylprednisolone (Solu-Medrol)
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What drug is used to treat symptoms associated with gout
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Anti-gout agents
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What and Anti-gout agents can cause what adverse conditions
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skin reactions and kidney impairment
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What drug helps PREVENT an attack of gout (it does not relieve the pain)
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Allopurinol (Zyloprim)
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What is used to treat the pain of gout
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Colchicine or an NSAID
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Commone Anti-gout agents
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Probenecid (Benemid), Sulfinpyrazone (Anturane)
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What type of drug is used to decreased muscle spasm or muscle spasticity which occures in many different disorders
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Musculoskeletal Relaxants
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What do Musculoskeletal Relaxants act on
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they are mostly central acting drugs
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What is the only Musculoskeletal Relaxant that is peripherally acting medication primarly used to treat neuroleptic malignant syndrome
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Dantrolene (Dantrium)
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Which Musculoskeletal Relaxant may also be given as a continous infusion into the spine via an implanted pump
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Baclofen (Lioresal)
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Which Musculoskeletal Relaxant can cause the urine to become green, brown, or black
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Methocarbarnol (Robaxin)
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Common Musculoskeletal Relaxants
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Carisoprodol (Soma), Chlorphenesin (Maolate), Cyclobenzaprine (Flexeril), Diazepam (Valium), Metaxalone (Skelaxin), Orphenadrine citrate (Norflex), Quinine sulfate (Quinamm), Tizanidine (Zanaflex)
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What is the most worrisome side effect of aspirin
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gastrointestinal bleeding
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What do you never give to a person who has a possible viral illness
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Aspirin and never give aspirin to children
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What will decrease inflammation at a site of an injur without the more severe systemic side effects of steroids
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Nonsteroidal anti-inflammatory drugs (NSAIDS) and Acetaminophen (Tylenol)
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Primary side effects of concern with NSAIDS
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gastrointestinal bleeding and perforated ulcers
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NSAIDS adverse effects are
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possible decrease in kidney function due to inhibition of prostaglandins
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How can I minimize the stomach upset experienced by taking NSAIDS
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take with food or milk
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What is the main use of Acetaminophen
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analgesic and antipyretic
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What analgesic/antipyretic causes the least GI discomfort in those with stomach problesm of history of ulcers
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Acetaminophen
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What is the principle feature of Tylenol overdose
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hepatic toxicity treat with mucamist
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Which NSAID can be hepatotoxic and nephrotoxic and can alter coagulation studies
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Ibuprofen (Motrin)
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If GI discomfort with Ibuprofen
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may take misoprostol (Cytotec) to help with the discomfort
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Indomethacin (Indocin) is to be taken on a schedule to relaive pain associated with
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gout
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Additional NSAIDs
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Kertolac (Toradol), Phenylbutazone (Butaxolidin), Piroxicam (Feldene), Diclofenac sodium (Voltaren), Diclofenac potassium (Cataflam), Etodolac (Lodine), Fenoprofen calcium (Nalfon), Flurbiprofen (Ansiad), Ketoprofen (Orudis, Oruvall), Meloxicam (Mobic), Nabumetone (Relafen), Naproxen (Aleve, Anaprox, Naprosyn), Oxaprin (Daypro), Sulindac (Clinoril), Tolmetin sodium (Tolectin), Tramadol (Ultram)
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COX-2 inhibitors
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decrease inflammation in thos with arthritis
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COX-2 inhibitors can cause what adverse reaction
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gastritis and upper gastrointestinal bleeding
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There is only one COX-2 inhibitors on the market what is it
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Celecoxib (Celebrex)
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Selective estrogen receptor modulators (SERMS) are used for
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treat osteoporosis in postmenopausal women
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Selective estrogen receptor modulators (SERMS) have increased risk of
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blood clots
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Common Selective estrogen receptor modulators (SERMS)
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Raloxifene (Evista)
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Oral biphosphonates and calcitonin (Miacalcin) is used to
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prevent and treat osteoporosis, think of Sally Fields
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Oral biphosphonates and calcitonin (Miacalcin) adverse reactions
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increased risk of infection.
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Oral biphosphonates and calcitonin (Miacalcin) are contraindicated in clients with a history of
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gastroesophageal reflux disease
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Common Oral biphosphonates and calcitonin (Miacalcin)
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Alendronate (Fosamax), Ibandronate sodium (Boniva), Resedronate (Actonel)
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What is used to treat moderate to severe pain
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Opioids
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What do Opioids work on
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the central nervous system to give a therapeutic effect
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Lab effects of Opioid use
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Increased amylase, lipase, liver enzymes, and CPK
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Side effects of Opioids
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Respiratory depression, Hypotension, Palpitations, Constipation, Urinary retention
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Common Opioids
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Alfentanil (Alfenta), Buprenophine (Buprenex), Butophanol (Stadol), Codeine, Fentanyl (Duragesic, Sublimaze), Hydromorphone (Dilaudid), Meperidine (Demerol, Pethidine), Metadone (Dolophine), Morphine sulfate, Nalbuphine (Nubain), Oxycodone (OxyContin), Oxymorphone (Numorphan), Pentazocine (Talwin), Tramadol (Ultram)
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Anti-rheumatoid agent/gold compounds side effects
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Decreased WBC and Hgb, Proteinuria, Hematuria, Nephrotic Syndrome, Increased Liver function studies, Jaundice, N & V
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Common Oral Anti-rheumatoid agents
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Hydroxychloroquine (Plaquenil), Leflunomide (Arava), Methotrexate (Rheumatrex, Trexall), Penicillamine (Cuprimine, Depen), Sulfasalazine (Azulfidine)
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Common Oral Gold Compound
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Auranofin (Ridaura)
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Common Injectable Gold Compound
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Aurothioglucose (Solganol), Gold sodium thiomalate (Aurolate), IV formulation is Infliximab (Remicaid)
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Painful form of arthritis caused by a build up of uric acid
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Gout
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Diet for Gout
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decrease consumption of food with purines such as liver, dried beans, shell fish, or the inability to excrete uric acid
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Crystals formed in joints as a result of high uric acid levels is
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Gout
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Lab effects of Gout
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Increased WBC, Uric Acid, and ESR
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What is a sudden, involuntary, painful muscle contraction which may occur after injury
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muscle spasms
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What is an increse in muscle tone which produces stiff muscle movements
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Muscle Spasticity
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Tx for Muscle Spasms and Muscle Spasticity
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stretching
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Most common form of arthritis leading to degeneration and destruction of the cartilage of any joint, but most often the hands, knees, hips or spine
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Osteoarthritis
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Wear and tear disease is
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Osteoarthritis, enlargement of the joints occurs, in the hands, nodes have been identified at the joint
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Herberden nodes with Osteoarthritis
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Distal joints of hands
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Bouchards nodes with Osteoarthritis
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Proximal joints of hands
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Tx for Osteoarthritis for severe pain
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joint replacements
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Pain and swelling caused by inflammation of the synovial tissue. It is an inflammatory disorder, not degenerative. Considered autoimmune and can become systemic in severe cases
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Rheumatoid Arthritis
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Lab Effects with Rheumatoid Arthritis
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Increase ESR and positive RA factor, note the ESR is normal in Osteoarthritis
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Can Rheumatoid Arthritis go into remission
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YES, early diagnosis is essential
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Assessment for Rheumatoid Arthritis includes
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inspection, palpation, strength testing DO NOT DO ROM BECAUSE IT WILL BE ALTERED AND WILL CAUSE PAIN
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Age group for Rheumatoid Arthritis
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may occur in children between 2-5 and 9-12 years and carry it throughout life
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What happens to cartilage with Rheumatoid Arthritis
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it thins and spurs form
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Will see marked immobility, pain and muscle spasms with
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Rheumatoid Arthritis
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Treatment for Rheumatoid Arthritis
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Corticosteroids, Immobilizaiton and rest, NSAIDS and aspirin for pain
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Do’s with Rheumatoid Arthritis
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exercise slowly and smoothly, exercise to increase mobility, take a hot bath or shower in the morning, lie in the prone position to exten hips and knees, sit in a straight back chair, change position every 20 minutes, slide objects rather then lift them.
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Donts with Rheumatoid Arthritis
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Do not exercise painful, swollen joints, do not exercise to the point of pain, Do not put pressure on the joints, Do not jerk joints with movements
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Joint replacements activity restrictions may include
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do NOT sit longer than 1 hour, do NOT turn them onto the operative hip, do NOT lift leg upward from lying or sitting position, do NOT lean forward in the chair when trying to get up, do NOT drive for 6 weeks after surgery unless allowed by the surgeon.
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If bedpan is needed immediately after a hip replacement how do you teach the patient to move
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fles the unaffected knee and use the trapeze bar to raise their hips.
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Joint replacements care of support stockings
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put support stockings on the unaffected leg and ACE bandage on the affected leg until the swelling has resolved
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What are the most common complications with joint replacements
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DVT in affected leg and infection, know that both are late complications
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Decrease in bone mineral density leading to an increased risk of fracture
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Osteoporosis
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What is the most common cause of fractures in the elderly
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Osteoporosis, especially women, fractures occur due to loss of bone mass
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Most common fractures due to Osteoporosis
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Vertebral fractures may occue due to the loss of bone mass, Hip fractures, Colle’s fracture of the forearm.
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Dietary for Osteoporosis
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High calcium, tums are good but they are high in sodium
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Risk factors for Osteoporosis
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Caucasion or Asion descent, Slender body build, Early estrogen deficiency, Nulliparity, Smoking, Sedentary lifestyle, Family history of osteoporosis
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Chronic autoimmune disease that can be fatal
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Lupus
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What does the immune system attack with Lupus
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bodys cells and tissues, resulting in inflammation and tissue damage which can affect any part of the body, but most often arms, heart, joints, skin, lungs, bood vessels, liver, kidneys, and nervous system.
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Lab effects with Lupus
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ESR increased
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Lupus teachings
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Reduction of stress, avoid sunlight, treatment is with steroids, HEAT for joint pain, Raynauds is often present with Lupus.
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Chronic disease characterized by excessive deposits of collagen in the skin and other organs
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Scleroderma
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What disorder can be localized to the skin or it may be the systemic type which can be fatal due to involvement of the heart, kidney, lung and intestines
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Scleroderma
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With Scleroderma is swallowing difficult
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YES
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With Scleroderma is Raynaud’s commonly associated
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YES
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Teaching with Scleroderma
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keep the skin well lubricated
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What can decrease the risk of a fat embolism
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gentle handling and maintain in the position the extremity is found in.
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What are these symptoms of, tachycardia and petechiae over the chest
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fat embolism remember chest pain is NOT a common complaint with a fat embolism
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Is a greenstick fracture an incomplete fracture
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YES
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With any fracture assess for
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blood vessel injury
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What type of fracture is across the entire shaft with some possible displacement
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Simple fracture
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What can a compound fracture also be called
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Open fracture
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What type of fracture is where the bone has broken into several fragments
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Comminuted Fracture
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What do you see with a spiral fracture
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twisting, may be related to abuse in infants
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Does a intracapsular fracture heal quickly and easily
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NO the fracture is cut off from the blood supply and necrosis can occur
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What can long bone fracture lead to
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Anemia so check hematocrit every 3-4 days to monitor
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What does the initials ORIF stand for
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Open reduction internal fixation
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Infection of bone or bone marrow, usually caused by bacteria
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Osteomyelitis, may do surgery and place in a cast to immobilize
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Condition when all or part of the soft center of a spinal disk is forced through a weakened part of the disc
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Herniated disk
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Why is there pain with Valsalva maneuver with a Herniated disk
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because it puts pressure in the central nervious system canal
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Most common areas for spinal fractures
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Cervical 5th, 6th, and 7th, Thoracic 12th, Lumber 1st
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How many people do you need to log roll after spinal surgery and spinal fusion
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two or more people after surgery with a fusion
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Teaching with spinal surgery and spinal fusion
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no prolonged sitting, stair climbing restricted intially, back brace is generally applied before getting out of bed after spinal surgery
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What can I used for transfering patient from stretcher to bed after surgery
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use a transfer board and the assistance of four people
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What is it called when an amputee has itching, warmth, and cold felt in the area due to intact peripheral nerves in the area
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Phantom limb sensation
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Is Phantom limbe pain lifelong
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YES , it is not well understood
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How can I prevent hip contraction after amputation
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elevation of limb for 24 hours on a pillow, then periodically afterwards, position on the abdomen for 30 minutes periods every 4-6 hours
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Care of surgical site for an amputee
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wear a clean woolen sock each day, clean daily with a gentle soap and water and dry carefully, oil and creams are avoided.
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Teaching with Prosthesis
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use it early to encourage a normal walking pattern, darkened skin edges around the residual limb indicate the prosthesis is a correct fit
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Why does an amputee get darkened skin around the residual limb
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the pressure of the prosthesis causes the release of hemosiderin, an iron-rich pigment, which causes the discoloration
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Where is a bone marrow biopsy usually done
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normally the illiac crest
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What is used to clean the area of the bone marrow biopsy
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povidone-iodine (Betadine) to cleanse the site, chloraprep is also acceptable
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Teaching with bone marrow biopsy
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local anesthetic will be used, mild pain expected afterwards (note causes of SEVERE PAIN early – bleeding, late – infection), Monitor for swelling, bleeding, or hemotoma formation, vital signs will be taken every 4 hours for 24 hours.
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What test will be elevated in inflammatory disorders
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ANA and erythrocyte sedimentation rate
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Rheumatoid factor is positive in
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Rheumatoid Arthritis
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What is injected with a bone scan
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low radioactive substance injected into the vein with a bone scan, the scan detects where the substance is deposited, can detect bone fractures
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How often do I do Circulation and neurovascular checks for musculoskeletal issues
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every hour initially
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What are the five Ps when monitoring for signs of ischemia
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Pain, Paresthesia, Paralysis, Pulselessness, Pallor
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What will be used with an ORIF of the hip or after a knee replacement
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a drain, a frequently a Jackson Pratt drain
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Expected blood loss with a Jackson Pratt drain on a ORIF on the 1st day
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200-500 mL in 24 hours
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Expected blood loss with a Jackson Pratt drain on a ORIF on the 2nd day
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100 mL in 24 hours
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Expected blood loss with a Jackson Pratt drain on a Knee Replacement on the 1st day
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200 in first shift
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What would stop the knee from moving during the initial post op period
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a knee immobilizer which may be ordered for client when getting them up to protect the joint
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What is used to treat fractures and decrease muscle spasms experienced after an injury
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Traction
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What does TRACTION stand for
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T = Temperature of the extremity and oral to monitor for infection, R=Ropes hang freely, A= Alignment of the extremity and the set up, C= Circulation checks for the 5 Ps, T=Type and location of the fracture determins need for traction, I=Increase fluid intake because of limited movement, O=Overhead trapeze to increase independence and muscle strength, N=No weights on the bed or the floow, do not release once established.
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Once traction is applied can it be released periodically
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NO
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Is Bucks traction is skin traction
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Yes
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Is Russells traction skin traction
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Yes, it is two weights pulling 2 different directions
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Is Bryants traction skin traction
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Yes
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Is Pelvic traction skin traction
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Yes
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Does skeletal traction have pins or wires in place distal or proximal to the fracture
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Distal
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How many finger widths below the anterior axillary fold do you measure for crutches
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2-3 finger widths below the anterior axillary fold to a point lateral and slightly in front of the foot
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What angle should the elbow flexion when the handgrip is properly placed
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30 degrees
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How many inches in front and to the side of the clients toes should the crutches be for walking
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6-10 inches
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What does the rule three point gait with crutches mean
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Three points touch down at once
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How do you climb stairs with crutches
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Good leg up bad leg and crutches down “Heaven up, Hell down”
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What side do you use a cane on
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strong side held six inches lateral to the fifth toe
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Advance the cain with what side
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the weak side
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How do you use a walker
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pick it up, set it down 2 feet ahead on all 4 points and walk to it
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Where do belongings go on a walker
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on the side of the walker, not in front due to it obstructs vision
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How do you treat soft tissue injuries
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with RICE for the first 24 hours after injury R=Rest, I=Ice, C=Compression, E=Elevation
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Cast care teaching
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elevate and ice the decrease swelling, swelling may occure after case removal, spica cast covers the lower extremity (will need bed rest, use fracture pan), Petal the edges of the cast to help with skin irritation
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How often should Neurovascular checks for compartment syndrome
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every hour whenever something is first done
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How do you check brachial plexus and stutus of the ulnar nerve
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spread all fingers wide and resist pressure
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How do you check median nerve function
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client should grasp the nurses hand, weakness of the grasp may indicate compromise
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How do you check radial nerve function
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move the thumb toward the palm and back to neutral position
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How do you check the peroneal nerve
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Flex the ankle and exten the toes
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How do you check the tibial nerve
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flex the foot downward
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What are signs of compartment syndrome
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increased pain and loss of sensation, buring pain ovver a site and a cast warm to touch may indicate tissue hypoxia
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How do you treat severe cases with faciotomy
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Wet sterile saline dressing to cover, woulds closed 3-5 days later, skin graft may be needed, any time a skin graft is discussed, do not disturb it
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