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87 Cards in this Set
- Front
- Back
osteoarthritis
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occurs when articular cartilage & bone ends of joints deteriorate
S/S: joint deformities - pain - immobility - stiffness |
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When osteoarthritis occurs, the joint space 1_____, 2_____ _____ develop, and the joint may become inflamed. The joints affected most often include those that are 3_____-_____, hands, and the 4_____ _____.
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1) narrows
2) bone spurs 3) weight-bearing 4) vertebral column |
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Heberden's and Bouchard's nodes are . . .
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bony nodes on joints of fingers
caused by osteoarthritis more commen in women than men |
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Three tests used to diagnose osteoarthritis are . . .
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1) x-ray exam
2) computed tomography (CT) scan 3) magnetic resonance imaging (MRI) |
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Mr. Dennis, a 59-yr-old overweight carpenter, visits his physician with c/o of knee & wrist pain. He's noticed it's becoming increasingly difficult to climb a ladder or use a hammer. The physician suspects osteoarthritis.
What risk factors does Mr. Dennis have? |
~ overweight
~ in late middle-age ~ physically demanding job |
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What types of drugs are used to treat the symptoms of osteoarthritis? (5 types listed)
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~ NSAIDS (incl. COX-2 inhibitors)
~ corticosteroids ~ gold therapy ~ immunosuppresives ~ antimalarials |
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Joint pain from osteoarthritis tends to be less severe in the _____. Activities should be scheduled at this time.
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morning
(pain decreases w/rest) |
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The patient with osteoarthritis usually prefers _____ therapy unless the joint is acutely inflamed.
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heat
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arthroplasty
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joint replacement surgery
most common procedure for total joint replacement (TJR) |
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rheumatoid arthritis (RA)
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chronic, progressive, systemic inflammatory disease
destroys synovial joints & other connective tissues (incl. major organs) |
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synovitis
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inflammation of the lining of joint capsule (synovium)
prelude to rheumatoid arthritis |
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The cause of rheumatoid arthritis is . . .
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unknown.
(genetic predisposition likely - those w/family hx are 2-3x more likely to get RA) |
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Early manifestations of RA include . . . (5 s/s listed)
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~ inflammation
~ low-grade fever ~ fatigue ~ weakness ~ anorexia |
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Late manifestations of RA include . . .
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~ deformities
~ pain & morning stiffness ~ osteoporosis ~ severe fatigue ~ anemia ~ weight loss ~ subcutaneous nodules |
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Gold therapy can be used to induce 1_____ _____ in 2_____ _____.
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1) disease remission
2) rheumatoid arthritis |
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Mrs Summers is a 48-yr-old nurse who has had upper extremity joint pain & swelling for about 4 years. She was recently dx w/RA but has no systemic involvement other than extreme fatigue at this time. She is concerned that she will have to give up providing direct patient care on a busy medical unit in the local hospital.
What should you teach her about pain management? |
~ balance rest w/exercise
~ use ice for very hot, swollen joints ~ use heat to decrease stiffness |
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gout
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hyperuricemia causes uric acid deposit in joints & other connective tissues resulting in severe inflammation
primary gout most common & is caused by inherited problem w/purine metabolism |
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hyperuricemia
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excessive uric acid which results in urate crystal formation
(uric acid product of protein breakdown) |
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Diagnosis of gout is based on the 1_____ _____ _____ level. Any result above the maximum normal level of 2_____ mg/dL should be further evaluated.
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1) serum uric acid
2) 7.5 mg/dL |
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The preferred drug for treatment of chronic gout is _____ (_____). It decreases uric acid production, necessitating several weeks of therapy before the medication becomes effective.
a. acetylsalicylic acid (aspirin) b. naproxen (Naproxyn) c. allopurinol (Zyloprim) d. tolmetin (Tolectin) |
c. allopurinol (Zyloprim)
"ALLoPURinol now that the uric acid is gone" |
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Dietary recommendations for patients with gout include . . . (6 suggestions)
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~ avoid high-protein foods
~ avoid alcohol ~ drink plenty of fluids ~ avoid all forms of aspirin ~ avoid diuretics ~ avoid excessive physical or emotional stress |
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systemic lupus erythematosus (SLE)
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an autoimmune disease characterized by spontaneous remissions & exacerbations
S/S: butterfly rash - skin photosensitivity - fever - fatigue - arthralgia - myalgia - malaise - weight loss - mucosal ulcers |
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Treatment for SLE focuses on decreasing 1_____ and preventing life-threatening 2_____ _____. Medications are prescribed according to the patient's needs and may include 3_____, acetaminophen, corticosteroids, antimalarials, 4_____ _____, and immunomodulating drugs.
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1) inflammation
2) organ damage 3) NSAIDs 4) topical cortisone |
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Preventative education for a patient with SLE should include . . . (four suggestions)
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~ avoidance to prolonged exposure to sunlight
~ exercise (to prevent fatigue/weakness) ~ immunizations ~ stress reduction techniques |
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Muscular dystrophy has a _____ origin. However, the exact cause is unknown.
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genetic
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avascular necrosis (AVN)
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condition in which bone tissue dies (usually the femoral head) as a result of impaired blood supply
can be caused by long-term use of steroids |
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Total joint replacement is most often performed for patients who have some type of 1_____ _____ disease in which their joints become severely 2_____. TJR may also be done for patients on long-term 3_____ _____, such as patients with SLE or asthma.
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1) connective tissue
2) deteriorated 3) steroid therapy |
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The most common joint replacement surgeries are the 1_____ _____ _____ (_____) and 2_____ _____ _____ (_____), although any synovial joint can be replaced. Another term used for joint replacement is 3_____.
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1) total hip replacement (THR)
2) total knee replacement 3) arthroplasty |
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The primary goal of total joint replacement is to 1_____ _____ _____ _____ and improve ability to 2_____ _____ _____ when no other treatment is successful.
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1) relieve severe chronic pain
2) carry out ADLs |
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Rheumatoid arthritis (RA) affects women 1_____ more often than men and can occur at any age. The peak onset of RA is 2_____ to 3_____ years old.
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1) 3x
2) 30 3) 60 |
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The most common TJR surgeries are the 1_____ _____ _____ (_____) and 2_____ _____ _____ (_____). Another term used for joint replacement is 3_____. The replacement devices, sometimes referred to as prostheses, are made of metal, ceramic, plastic, or a combination of these materials.
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1) total hip replacement (THR)
2) total knee replacement (TKR) 3) arthroplasty |
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The two-piece device consisting of an acetabular cup inserted into a pelvic acetabulum is used in what type of procedure?
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total hip replacement (THR)
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What is the most common postoperative complication for a patient having a THR?
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subluxation or total dislocation
(femoral component dislodeges from acetabular cup) |
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The surgeon should be notified immediately if any of the s/s of hip dislocation are presented which include . . .
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~ increased hip pain
~ shortening of surgical leg ~ rotation of surgical leg |
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The two primary nursing goals following a total hip replacement (THR) are . . .
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1) prevent hip adduction
2) prevent hip hyperflexion (bending forward > 90 degrees) |
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For any musculoskeletal surgery or injury, frequent neurovascular assessments for 1_____, 2_____, 3_____, and 4_____ are performed when 5_____ _____ are checked.
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1) color
2) warmth 3) circulation 4) movement 5) vital signs |
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Weight bearing to tolerance or full weight bearing ambulation following total hip replacement (THR) is used for what type of prostheses?
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cemented
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The knee is the second most commonly replaced joint. Compared with the hip, it is a much more complicated joint and requires three components for replacement: a 1_____ component, a 2_____ component, and a 3_____ _____.
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1) femoral
2) tibial 3) patellar button |
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continuous passive motion machine (CPM)
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motorized machine w/flexible extremity rest (for arm/leg) for purpose of keeping joint mobile
set at degree of flexion & speed ordered by physician then glides back & forth on a track |
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The main indication for surgical amputations is 1_____ from 2_____ _____ disease in the elderly. The rate of lower extremity amputation is much greater in the 3_____ patient than in the 4_____ patient.
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1) ischemia
2) peripheral vascular 3) diabetic 4) nondiabetic |
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The most common surgical amputation is part of the _____ _____.
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lower extremity
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The loss of any or all of the small toes presents little problem. However, the loss of the great toe is more important because 1_____ and 2_____ are affected.
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1) balance
2) gait |
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If a lower leg amputation must be performed, which procedure is preferred: a below-the-knee amputation (BKA) or an above-the-knee amputation (AKA)?
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below-the-knee amputation (BKA)
(preserves joint function) |
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osteomyelitis
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infection of the bone
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Up to 80% of patients experience this form of discomfort following an amputation . . .
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phantom limb pain
(most often occurs during the first year following amputation) |
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The postop amputee should avoid positions of flexion (such as sitting for long periods) to prevent this complication . . .
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contracture
(limb should be checked periodically to ensure it lies completely flat on the bed) |
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strain
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soft tissue injury occuring when a muscle/tendon is excessivly stretched
can range from mild (minimal inflammation) to severe (separation of muscle from muscle, tendon from muscle, etc) STRain STRetch |
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RICE is an acronym for . . .
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R ... Rest
I ... Ice C ... Compression E ... Elevation |
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sprain
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excessive stretching of one or more ligaments
usually results from twisting movements during sports, exercise, or a fall range from mild (tearing of a few ligaments) to severe (instability of joint - surgery needed) |
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carpal tunnel syndrome
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compression of median nerve within carpal tunnel when swelling in tunnel occurs
can result from edema, trauma, RA, repetative motion, etc. S/S: slow-onset finger, hand, & arm pain/numbness - painful tingling - paresthesias - fine motor deficits - muscle weakness |
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Phalen's test
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numbness with wrist flexion
utilized to dx carpal tunnel syndrome |
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Medical management of carpal tunnel syndrome includes wearing a 1_____, and medications such as 2_____ and 3_____. 4_____ may be injected into the carpal tunnel to decrease pain & inflammation. Surgery may be required.
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1) splint
2) aspirin 3) NSAIDs 4) Cortisone |
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When bone is broken, the body immediately begins to repair the injury. For an adult, within 1_____ to 2_____ hours after the injury a 3_____ forms at the fracture site. In about a week, a nonbony union called a 4_____ develops & can be seen on x-ray examination.
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1) 48
2) 72 3) hematoma 4) callus |
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Young, healthy adult bone completely heals in about 1_____ _____; however, it can take up to 2_____ _____ before the whole process of remodeling is complete. An 3_____ _____ takes longer to heal, and 4_____ tend to heal more quickly.
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1) 6 weeks
2) a year 3) older person 4) children |
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Major factors leading to bone fractures include . . . (four examples)
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~ trauma
~ bone disease (cancer, etc.) ~ malnutrition ~ regular drinking of soda pop |
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greenstick fracture
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bone is bent and fractures on outer arc of bend
often seen in children |
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comminuted fracture
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bone splintered/shattered into numerous fragments
often occurs in crushing injuries |
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impacted fracture
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bone is forcibly pushed together
results in bone being pushed into bone |
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displaced fracture
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bone pieces are out of alignment (one or both pieces)
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pathological fracture
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caused by bone's being weakened due to medical condition
AKA neoplastic fracture |
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closed reduction
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physician manipulates bone ends into realignment by manually pulling on bone
most common treatment for simple fractures |
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traction
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applying pulling force to a part of body to provide fracture reduction, alignment, or pain relief
can be continuous or intermittent |
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skin traction
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used for pain relief
~ Buck's traction (velcro boot) ~ Russell's traction (knee sling) ~ belt (pelvic) ~ halter 5-10 lbs of weight applied |
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Buck's traction
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for pain relief with hip fractures
uses velcro boot |
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skeletal traction
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AKA balanced suspension
involves use of pins, screws, wires, or tongs surgically inserted into bone 20-40 lbs of weight applied |
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open reduction with internal fixation (ORIF)
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bone ends are reduced by direct visualiztion through surgical incision
bone ends held in place by internal fixation (IF) devices (metal plates & screws, prosthesis, etc) |
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Leg exercises, early ambulation, and anticoagulant therapy can help prevent the two most common complications that may develop in patients who are immobile due to trauma or surgery (particularly the elderly). The complications are . . .
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1) deep vein thrombosis (DVT)
2) pulmonary embolism (PE) |
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acute compartment syndrome (ACS)
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pressure within one+ extremity compartments increases, causing massive circulation impairment to the area
S/S: severe, increasing, intractable pain - pain occurs more on active than passive movement - decreased sensation followed by ischemia - pulselessness - paresthesia - pallor |
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Mr. Andrews has suffered a nondisplaced fracture of his right femur. He has a cast from his groin to the middle of his foot. An hour ago he received 10 mg of morphine IV. He is complaining of continuing & increasing pain.
What nursing actions should now be taken? |
~ perform a neurovascular check
~ perform a further pain assessment ~ ask Mr. Andrews to move his limb & see if the pain worsens ~ take vital signs ~ assess for 6 Ps (pulselessness, paresthesia, paralysis, pallor, pain, poikilothermia) |
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Mr. Andrews has suffered a nondisplaced fracture of his right femur. He has a cast from his groin to the middle of his foot. An hour ago he received 10 mg of morphine IV. He is complaining of continuing & increasing pain.
What might be happening with Mr. Andrews? |
He might be experiencing compartment syndrome.
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Mr. Andrews has suffered a nondisplaced fracture of his right femur. He has a cast on from his groin to the middle of his foot. An hour ago he received 10 mg of morphine IV. He is complaining of continuing & increasing pain.
What interventions may be necessary? |
Interventions may include . . .
~ bivalving cast (cutting along cast) ~ possible fasciotomy (incision into fascia that encloses compartment) |
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fat embolism syndrome (FES)
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small fat globules are released from yellow bone marrow into bloodstream
fat travels to lung fields & causes respiratory distress S/S: altered mental status due to low arterial oxygen - tachycardia - tachypnea - fever - high BP - severe SOB - petechiae over upper body |
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Fat embolism syndrome (FES) usually involves the 1_____ _____ or 2_____ _____and can occur up to 3_____ _____after the initial injury/procedure.
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1) long bones
2) multiple fractures 3) 72 hours |
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Actions to be taken should a fat embolism be suspected include . . . (6 actions listed)
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~ promote oxygenation (2L via n/c)
~ maintain bedrest ~ prep pt for chest x-ray ~ administer IV fluids as ordered ~ administer corticosteroids as ordered ~ provide emotional support & calm environment |
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The most important aspect of assessment for the patient with a fracture is frequent monitoring of 1_____ status 2_____ to the fracture site. Any time the patient complains of pain, neurovascular status should be 3_____.
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1) neurovascular
2) distal 3) reassessed |
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osteomyelitis
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infection of bone resulting from invasion of bacteria into bone & surrounding soft tissues
can be acute or chronic S/S: fever - tenderness - redness - heat - pain - swelling |
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A patient with osteomyelitis typically has an elevated 1_____ count and 2_____ _____ rate in addition to a positive 3_____ _____ for infection. MRIs, x-rays, and CT scans can show infected areas.
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1) WBC
2) erythrocyte sedimentation 3) bone biopsy |
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Patients with osteomyelitis often have 1_____ _____ _____ _____ placed for long-term antibiotic therapy. Treatment may require 2_____ _____ _____ of medication.
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1) central venous access devices
2) weeks to months |
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osteoporosis
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bone loses density resulting in fragile bones & possibly fractures (compression)
common metabolic disorder |
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Bone density peaks between 1_____ and 2_____ years of age. After these peak years, the rate of bone breakdown exceeds the rate of bone building.
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1) 30
2) 35 |
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Risk factors for primary osteoporosis include . . . (9 factors listed)
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~ caucasian/Asian
~ postmenopausal ~ sedentary lifestyle ~ low calcium ~ lack of vitamin D ~ excessive alcohol consumption ~ cigarette smoking ~ excessive caffeine intake ~ petite body build |
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Secondary osteoporosis results from an associated medical condition, such as 1_____; long-term drug therapy, especially 2_____; and 3_____ _____, such as that seen with patients who have a spinal cord injury.
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1) hyperparathyroidism
2) steroids 3) prolonged immobility |
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Two lab values that decrease with osteoporosis are . . .
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1) serum calcium levels
2) vitamin D levels |
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Paget's disease
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AKA osteitis deformans
metabolic bone disease in which increased bone loss results in large, disorganized bone deposits throughout the body primarily seen in the elderly |
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The purpose of drug therapy for the patient with Paget's disease is to 1_____ _____ and 2_____ _____ _____. 3_____ (Calcimar) is a thyroid hormone that is often effective in initiating a remission of the disease.
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1) relieve pain
2) decrease bone loss 3) Calcitonin |
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When providing postop care for a patient with a jaw fracture, have 1_____ available at the bedside at all times. If the patient states they feel nauseated, be certain an 2_____ is immediately available.
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1) suction
2) antiemetic |
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When providing preop care, some of the nurse's responsiblities include . . . (4 responsibilities listed)
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~ acting as a witness for consent form
~ taking baseline vitals ~ collecting lab info ~ educating patient |