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LCCC Nursing > Chapter 63: Med Surg > Flashcards

Chapter 63: Med Surg Flashcards

1
Q

sprain

A

injury to a ligamentous structure surrounding a joint, usually caused by wrenching or twisting motion

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2
Q

first degree sprain

A

mild; involves tears in only a few fibers resulting in mild tenderness and minimal swelling, self-limiting with full fx returning within 3-6 weeks

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3
Q

second degree sprain

A

moderate; involves partial disruption of the involved tissue with more swelling and tenderness

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4
Q

third degree sprain

A

complete tearing of a ligament in association with moderate to severe swelling, a gap in the muscle may be apparent, may require surgical repair if it involves the fascia or tendons

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5
Q

strain

A

excessive stretching of a muscle and its fascial sheath usually involving the tendon, mostly occur in large muscle groups

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6
Q

why does edema develop in an injured area?

A

tiny hemorrhages within the disrupted tissues occur along with the local inflammatory response

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7
Q

acute intervention of strains and sprains

A

stopping the activity and limiting movement, applying ice, compressing, elevating, and providing analgesia

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8
Q

compression

A

limits swelling, wrapped starting distally and progressing proximally to encourage fluid return, bandage left in place for 30 minutes and removed for 15 minutes

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9
Q

dislocation

A

severe injury of the ligamentous structures that surround joint evidence by obvious deformity and local pain, tenderness, loss of fx of injured part, and swelling

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10
Q

tx for dislocation

A

prompt attention! must be realigned and immobilized, nurses need to reduce pain and protect injury

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11
Q

subluxation

A

partial or incomplete displacement of the joint surface, less severe than dislocation, may require less healing time

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12
Q

repetitive strain injury

A

cumulative traumatic disorder resulting from repetitive movements, awkward postures, or sustained force causing tiny tears that become inflammed

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13
Q

s/s of repetitive strain injury

A

pain, weakness, numbness, impairment of motor fx

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14
Q

tx of repetitive strain injury

A

precipitating activity, modification of activity, pain management with heat/cold, rest, to type: keep the hips and knees flexed to 90 degrees and feet flat with the wrists kept straight

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15
Q

carpal tunnel syndrome

A

caused by compression of the median nerve caused by pressure from trauma or edema caused by inflammation of tendon

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16
Q

s/s of carpal tunnel

A

weakness especially in thumb, burning pain, tingling, numbness, and + phalen’s test

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17
Q

predisposed to carpal tunnel

A

diabetes, hypothyroidism, women

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18
Q

tinel’s sign

A

tapping over the median nerve as it passes through the carpal tunnel in the wrist and positive response is sensation of tingling

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19
Q

phalen’s sign

A

allow wrists to fall freely into maximum flexion and maintain position for longer than 60 seconds, positive sign is sense of tingling over median nerve

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20
Q

tx of carpal tunnel

A

in acute cases, stop the aggravating motion and let wrist rest with wrist splint, injection of corticosteroid directly into carpal tunnel may relieve, avoid extreme temps, carpal tunnel release

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21
Q

release surgery

A

indicated if symptoms persistent for more than 6 months, open release enlarges carpal tunnel and endoscopic is faster and causes less pain

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22
Q

rotator cuff injury

A

occurs gradually from aging, repetitive stress, or injury from falling, can tear as sudden force of adduction occurs when limb is in abduction, confirmed with MRI

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23
Q

s/s rotator cuff injury

A

shoulder weakness, severe pain when the arm is abducted 60-120 degrees, decreased ROM, drop arm test

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24
Q

drop arm test

A

arm falls suddenly after is has been abducted 90 degrees is a sign of rotator cuff injury

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25
Q

tx rotator cuff injury

A

rest, ice, heat, NSAIDs, corticosteroid injections to joint, physical therapy, surgery indicated when complete tear or no improvement with conservative therapy (arthroscope surgery)

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26
Q

meniscus injury

A

associated with ligament sprains that commonly occur in athletes (basketball, football, rugby, soccer, hockey) exhibited by rotational stress when the knee is in varying degrees of flexion and foot is planted; MRI diagnose

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27
Q

s/s of meniscus injury

A

pain with flexion, internal rotation, and knee extension, no significant edema, localized tenderness, knee clicks or pops, quadricep atrophy is injury has not been tx

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28
Q

tx meniscus injury

A

ice, immobilization, weight bearing as tolerated, knee brace, physical therapy, surgery may be indicated and done with arthroscopy

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29
Q

anterior cruciate ligament (ACL) injury

A

usually occurs from noncontact when the athlete pivots, lands from a jump, or slows down when running, x rays and MRI diagnostic

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30
Q

lachman’s test

A

flex the knee 15-30 degrees and pull tibia forward while femur is stabilized, considered positive for ACL injury if there is forward motion of the tibia with the feeling of a soft or indistinct endpoint

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31
Q

tx for ACL injury

A

if intact: rest, ice, NSAIDs, elevation, ambulation, knee brace; if severe ligament and meniscus injury: surgery, recovery within 6-8 months

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32
Q

bursitis

A

results from repeated or excessive trauma or friction in bursae (synovial fluid)

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33
Q

s/s bursitis

A

warmth, pain, swelling, limited ROM

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34
Q

tx bursitis

A

rest is often the only tx needed

35
Q

greenstick fracture

A

incomplete fracture with one side splintered and other side bent, nondisplaced fracture

36
Q

comminuted

A

more than two fragments, common in osteoporosis pt, displaced fracture

37
Q

fracture healing

A

called union; fracture hematoma, granulation tissue, callus formation, ossification, consolidation, remodeling effected by age, blood supply, infection, hormones, immobilization, and site of fracture

38
Q

s/s of fracture

A

edema, pain, tenderness, muscle spasm, deformity, ecchymosis, loss of fx, crepitation

39
Q

edema

A

can occlude circulation and damage nerves

40
Q

pain and tenderness cause

A

splinting of muscle around fracture with reduction in motion of injured area

41
Q

muscle spasm causes

A

displacement or prevents it from reducing spontaneously

42
Q

crepitation

A

increases the chance for nonunion

43
Q

electrical stimulation

A

can be used in some cases to stimulate bone healing with nonunion or delayed union and causes bone remodeling, electrodes placed on pt while sleeping for 10-12 hours

44
Q

closed reduction

A

nonsurgical, manual realignment of bone, tx following is traction, casts, splints, braces

45
Q

open reduction

A

correction of bone alignment through surgery, wires, screws, or pins placed internally or externally

46
Q

traction

A

prevents or reduces pain and muscle spasms, immobilizes effected limb, reduces a fraction or dislocation, prevents soft tissue damage, promotes active and passive exercise, expands a joint before surgery

47
Q

skin traction

A

used for short term management (48-72 hours), weights are usually 5-10 lbs, nurses do not change weights, but can observe and report when weight is touching ground or different from order

48
Q

skeletal traction

A

in place longer than skin traction, weights are usually 5-45 lbs

49
Q

plaster cast

A

immobilizes above and below injury, bony prominences padded, sets in 15 minutes, strong enough for weight bearing at 24-72 hours, don’t cover while fresh

50
Q

synthetic casts

A

being used more because lightweight, stronger, relatively waterproof, and provide earlier weight bearing

51
Q

short arm cast vs long arm cast

A

short arm used for treatment of stable fractures or metacarpal fractures and long arm casts are for stable forearm or elbow fractures of unstable wrist fractures- be sure to elevate to reduce edema UNLESS used for proximal humerus fracture

52
Q

cast syndrome

A

occurs if body jacket cast is too tight and pt complains of tummy pain, nausea, vomiting, decreased bowel sounds

53
Q

lower extremity cast or jones dressing

A

keep foot elevated above heart for first 24 hours to prevent edema

54
Q

when is external fixation an option?

A

simple fractures, complex fractures with tissue damage, correction of congenital defects, nonunion or malunion, and limb lengthening, salvages extremities that would have otherwise been amputated

55
Q

nursing assessment of fractures

A

pain, pulse, pallor, paresthesia, paralysis, polar

56
Q

what does pallor indicate?

A

arterial insufficiency

57
Q

what does warm, cyanotic indicate?

A

poor venous return

58
Q

absent pulse with dopler indicates

A

emergent! vascular dysfunction and insufficiency

59
Q

hypercalcemia in fractures

A

occurs from demineralization causing a rise in urine pH and stone formation- recommend cranberry juice or ascorbic acid to acidify urine

60
Q

colles fracture

A

fracture of distal radius, pain, swelling, deformity of wrist, usually a cast unless displaced then internal or external fixation

61
Q

fracture of humerus

A

common in young and middle aged people

62
Q

fracture of pelvis

A

benign to life threatening, ecchymosis on tummy, hip spica cast, external fixation, open reduction

63
Q

fracture of hip

A

common in older adults, external rotations, shortening of extremity, surgical repair, place pillow between pt legs when turning, avoid turning on the affected side

64
Q

femoral shaft fracture

A

accompanied by soft tissue damage and lots of blood loss, inability to move hip or knee, stabilize pt and immobilize fracture, open reduction with internal fixation is preferred

65
Q

fracture of tibia

A

much force is required to have a tibia injury, complicated by infections, closed reduction and cast

66
Q

stable vertebral fracture

A

not likely to cause spinal damage, maintain alignment and reduce pain, surgery often done to stabilize fracture until union can be accomplished

67
Q

facial fracture

A

maintain patent airway

68
Q

incidence for amputation

A

greater in men, circulatory impairment, traumatic or thermal injury, malignant tumors, uncontrolled or widespread infection, congenital disorder

69
Q

closed amputation

A

performed to create a weight bearing residual limb

70
Q

disarticulation

A

amputation performed through a joint

71
Q

syme amputation

A

disarticulation of ankle

72
Q

open amputation

A

leaves surface on the residual limb that is not covered with skin, indicated for control of actual or potential infection, usually closed later by a second surgical process or closed by skin traction (guillotine amputation)

73
Q

preoperative management for nurse

A

need to know level of amputation, type of postop dressings, type of prosthesis to be used, begin explaining discharge teaching (phantom limb sensation)

74
Q

postoperative management for nurse

A

monitor individuals who had traumatic or unplanned amputation with care, watch vitals, dressing site for hemorrhage, surgical tourniquet must always be available in case of emergency, if excess bleeding occurs CALL PHYSICIAN, neurovascular assessment, anticoagulant therapy

75
Q

delayed prosthetic

A

may be the best for amputations above the knee or below the elbow, older adults, debilitated individuals, infectious; can bear full weight on prosthetic approximately 3 months after amputation

76
Q

flexion contractures

A

may delay rehabilitation process, most common is hip flexion, to avoid- have pt avoid sitting in a chair for more than 1 hr with hips flexed & do not have pillows under surgical extremity

77
Q

compression bandage

A

supports soft tissues, reduces edema, speeds up healing, minimizes pain, promotes residual limb shrinkage and maturation, worn at all times except physical therapy and bathing, removed and reapplied several times a day

78
Q

osteotomy

A

remove a wedge or slice or bone to change alignment, ineffective in pt with inflammatory joint disease

79
Q

debridement

A

usually performed on knee or shoulder using a fiberoptic arthroscope, outpatient, compression dressing applied, weight bearing permitted after surgery

80
Q

arthroplasty

A

reconstruction or replacement of joint to relieve pain, improve or maintain ROM, and correct deformity

81
Q

hip arthroplasty

A

implant is cemented in place and may become loose over time, so recommended for older, less active pt

82
Q

hip resurfacing

A

femoral head is preserved and reshaped, lower wear and tear, recommended for younger, active pt

83
Q

arthrodesis

A

surgical joint fusion done if articular surfaces are too damaged or infected to allow joint replacement, stable but immobile joint

84
Q

complications of joint surgery

A

infection, thromboembolism (particularly the surgeries involving lower joints), Doppler used to detect DVT, which if absent is indicative of emboli

LCCC Nursing (15 decks)

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