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30 Cards in this Set

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seven p's for perfusion
1. polar temp
2. pallor
3. puffiness
4. pain
5. parathesia
6. paralysis
7. pulselessness
nursing interventions for knee athroplasty
1.empty and record hemo-vac
2.give oxygen 2-3L/min
3. Incentive spirometer/ cough and deep breathing
4.bedrest for 24-48 hours
5.change dressing as ordered
6.neuro checks and vitals q4h
nursing interventions for the area of knee replacement
1. maintain position of operative area
2. physical therapy will initiate ambulation and Rx routine
3.encourage fluid intake
4.antiembolism stockings
5.avoid adduction and hyperflexion of hip
6.use toilet riser to prevent hyperflexion
medical management for hip replacement
place in bucks or russell's traction until surgery
postoperative interventions for hip replacement
1.wound and drain assessment
2.incentive spirometer and turning q2h
3.maintain leg abduction
4.antiembolic stockings; anticoagulation therapy
5.limit wt bearing on affected side
6. chairs and commode seats should raised to prevent flexion of hip beyond 60 degress
patient teaching for open reduction internal fixation(orif)
1.assess ability to understand
2. assist to dangle at bedside
3. no wt on operative side
4. pt will instruct ambulation and weight bearing
5.as pt progresses encourage continuing ambulation only with assistance
patient teaching for a hip prosthetic implant
1.avoid hip flexion beyond 60 degrees for approximately 10 days; beyond 90 degrees for 2-3 months
2.avoid adduction of the affected leg beyond midline for 2-3 months(maintain abduction)
3.maintain partial wt bearing for approx 2-3 months
4.avoid postioning on the operative side
etiology of angina pectoris
cardiac muscle deprived of oxygen, increased workload on the heart
etiology of MI
occlusion of a major coronary artery or one of its branches with subsequent necrosis of myocardium; most common cause is atherosclerosis; ability of the cardiac muscle to contract and pump blood is impaired
etiology of htn
vasoconstriction,a sustained elevated systolic blood pressure greater than 140 and or a sustained elevated diastolic bp greater than 90
essential primary htn
90-95% of all diagnosed cases
secondary htn
attributed to an identifiable medical diagnosis;
arteriosclerosis
thickening, loss of elasticity and clacification of arterial walls, resulting in decreased blood supply
artherosclerosis
narrowing of the artery due to yellowish plaques of cholesterol, lipids in the inner layers of the walls of large and medium sized arteries, is a type of arteriosclerosis
arterial assessment(PATCHES)
P=PULSES
A=APPEARANCE
T=TEMPERATURE
C=CAPILLARY REFILL
H=HARDNESS
E=EDEMA
S=SENSATION
venous assessment
1.first symptom usually edema
2.dark pigmentation
3.drynes and scaling
4. ulcerations
5. pain, aching and cramping
6. usually relieved by rest or elevation`
signs and symptoms for benign prostatic hypertrophy
frequent urination, difficulty starting urination, dysuria, frequent uti, hematuria, oliguria, nocturia
turp post op
bladder irrigations, urine will be pink to cherry red, suprapubic or abdominal dressing
urinary retention signs and symptoms
distended bladder, discomfort in plevic region, voiding frequent, small amounts
interventions for urinary retention
warm shower or sitz bath, natural voiding position if possible, urinary catheter, surgical removal of obstruction, analgesics
signs and symptoms of neurogenic bladder
infrequent voiding, incontinece, diaphorese, flushing, nausea prior to reflex incontinence
interventions for neurogenic bladder
bladder training, intermittent catherization
endstage renal failure
headache, lethargy, anorexia, pruritus, anuria, muscle cramps or twitching, dusky yellow tan or gray skin color, disorientation and mental lapses, anemia
3 p's for DM type I II
polyuria polydipsia polyphagia
hyperthyroidism
also called graves disease cause unknown, exaggeratiion of the metabolic process.
assessment for hyperthyroidism
edema of the anterior portion of the neck, inability to concentrate , memory loss,dysphagia, hoarseness, increased appetite, weight loss, nervousness, insomnia, tachycardia, htn, warm flused skin, fine hair, amenorrhea, elevated temp, diaphoresis, hand tremors`
postoperative care for thyroidectomy
voice rest, voice checks, avoid hyperextension of the neck, tracheotomy tray at bedside, assess for signs and symptoms of interanl and external bleeding, assess for tetany,assess for thyroid crisis
Hypothyroidism clinical manesfestions
hypothermia, intolerance to cold, weight gain, depression, impaired memory, slow thought process, lethargic, anorexia, constipation decreased libido, menstrual irregularities, thin hair, enlarged facial appearance, low hoarse voice, bradycardia, hypotension
acute complications of DM
coma, diabetic ketoacidosis, hyperglycemic hypersomolar nonketotic, hypoglycemic reaction, infection
long term complications of DM
diabetic retinopathy, cardiovascular problems, renal failure,