Chapter 68 Flashcards
How is lower back pain assessed?
The initial assessment includes a focused history and physical examination. It includes general observation of the patient, back examination and neurologic testing.
What are some causes of lower back pain?
Lumbosacral strain, unstable lumbosacral ligaments and muscle weakness, osteoarthritis of the spine, spinal stenosis, intervertebral disk problems, and unequal leg length.
What is the medical management of lower back pain?
It mostly resolves in four weeks with analgesic agents, rest and relaxation. Over-the-counter analgesics and prescription muscle relaxants are effective for acute lower back pain and tricyclic antidepressants are effective for chronic back pain.
What is the nursing assessment for lower back pain?
The nurse asks the patient to describe the pain, and if it is recurrent pain what helped relieve it in the past.
What are the major goals for nursing management for lower back pain?
Pain relief, improved physical mobility, improved body mechanics and self esteem, weight loss.
What are bursitis and tendonitis?
Inflammatory conditions that commonly occur in the shoulder.
How are bursitis and tendonitis treated?
Rest of the extremity, intermittent heat and ice to the joint and NSAIDs.
What are loose bodies and how are they treated?
A loose body is a free-floating piece of bone, cartilage, or a foreign object in a joint. The knee is the most common site for loose bodies.
Surgery to remove the loose body or repair the kneecap may be needed if a loose body is causing symptoms.
What is impingement syndrome?
All lesions that involve the rotator cuff of the shoulder.
What is stage I, II and III impingement syndrome?
Stage 1, commonly affecting patients younger than 25 years, is depicted by acute inflammation, edema, and hemorrhage in the rotator cuff. This stage usually is reversible with nonoperative treatment.
Stage 2 usually affects patients aged 25-40 years, resulting as a continuum of stage 1. The rotator cuff tendon progresses to fibrosis and tendonitis, which commonly does not respond to conservative treatment and requires operative intervention.
Stage 3 commonly affects patients older than 40 years. As this condition progresses, it may lead to mechanical disruption of the rotator cuff tendon and to changes in the coracoacromial arch with osteophytosis along the anterior acromion. Surgical l anterior acromioplasty and rotator cuff repair is commonly required.
How is impingement syndrome treated?
Medications used to treat early impingement syndrome include oral NSAIDs or intra-articular injections of corticosteroids. Application of superficial cold or heat may subjectively improve patients’ symptoms; however, a therapeutic exercise program is required to improve outcomes, including reduction of pain and improved shoulder function.
What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is an entrapment neuropathy that occurs when the median nerve at the wrist is compressed by a thickened flexor tendon sheath, skeletal encroachment, edema, or a soft tissue mass.
What are some signs and symptoms of Carpel Tunnel Syndrome?
The patient experiences pain, numbness, paresthesia, and, possibly, weakness along the median nerve distribution (thumb, index, and middle fingers). Night pain and/or fist clenching upon awakening is common. A positive Tinel’s sign helps identify patients requiring intervention (Fig. 42-4).
The patient experiences pain, numbness, paresthesia, and, possibly, weakness along the median nerve distribution (thumb, index, and middle fingers). Night pain and/or fist clenching upon awakening is common. A positive Tinel’s sign helps identify patients requiring intervention.
How is Carpal Tunnel Syndrome treated?
Evidence-based treatment of carpal tunnel syndrome includes oral or intra-articular injections of corticosteroids (e.g., methylprednisolone [Depo-Medrol]). Application of wrist splints to prevent hyperextension and prolonged flexion of the wrist is also effective; however, yoga, laser therapy, and ultrasound therapy are ineffective therapies, as are the use of NSAIDs, diuretics, and vitamin B6 (American College of Occupational and Environmental Medicine, 2011).
Traditional open nerve release or endoscopic laser surgery are the two most common surgical management options. Both of these procedures are performed under local anesthesia and involve making incisions into the affected wrist and cutting the carpal ligament so that the carpal tunnel is widened. Smaller incisions are made with the endoscopic laser procedure, resulting in less scar formation and a shorter recovery time than with the open method. Following either procedure, the patient wears a hand splint and limits hand use during healing. The patient may need assistance with personal care. Full recovery of motor and sensory function after either type of nerve release surgery may take several weeks or months.
What is a ganglion?
Ganglions are among the most common tumors of the hand and wrist. For the most part, they are asymptomatic masses that are primarily cosmetic rather than functional disturbances.
How are ganglions treated?
Treatment may include aspiration, corticosteroid injection, or surgical excision. After treatment, a compression dressing and immobilization splint are used.
What is Dupuytren’s Disease?
Dupuytren’s disease results in a slowly progressive contracture of the palmar fascia that causes flexion of the fourth, fifth, and, sometimes, middle finger, rendering these fingers more or less useless.
How is Dupuytren’s Disease managed?
This condition starts in one hand, but eventually both are affected. Finger-stretching exercises or intra-nodular injections of corticosteroids may prevent contractures. With loss of movement, palmar and digital fasciectomies are performed to improve function.
What are the important nursing management considerations for hand and wrist surgery?
Hourly neurovascular assessment of the exposed fingers for the first 24 hours following surgery is essential for monitoring function of the nerves and perfusion. This is especially important if an intraoperative tourniquet technique was used, which is implicated in neurovascular deficits. . Percutaneous pins may be used to hold bones in position. These pins serve as potential sites of infection. Patient instructions concerning aseptic wound and pin care may be necessary.
What patient teaching is necessary with hand or wrist surgery?
After the patient has undergone surgery, the nurse instructs the patient how to monitor neurovascular status and the signs of complications that need to be reported to the surgeon (e.g., paresthesia, paralysis, uncontrolled pain, coolness of fingers, extreme swelling, excessive bleeding, purulent drainage, foul odor, fever). In addition, the nurse instructs the patient how to elevate the extremity and to apply ice (if prescribed) to control swelling. The use of assistive devices is demonstrated if such devices would be helpful in promoting accomplishment of ADLs
What is plantar fasciitis?
Plantar fasciitis, an inflammation of the foot-supporting fascia, presents as an acute onset of heel pain experienced with the first steps in the morning.
How is plantar fasciitis managed?
Management includes stretching exercises, wearing shoes with support and cushioning to relieve pain, orthotic devices (e.g., heel cups, arch supports, night splints), and corticosteroid injections (Lee, McKeon, & Hertel, 2009). Unresolved plantar fasciitis may progress to fascial tears at the heel and eventual development of heel spurs.
What is a corn?
A callus is a thickened area of the skin that has been exposed to persistent pressure or friction. Faulty foot mechanics usually precede the formation of a callus.
How are corns treated?
Treatment consists of eliminating the underlying causes and having a painful callus treated by a podiatrist.
What is an ingrown toenail?
An ingrown toenail (onychocryptosis) is a condition in which the free edge of a nail plate penetrates the surrounding skin.
How are ingrown toenails treated?
Active treatment consists of washing the foot twice a day and relieving the pain by decreasing the pressure of the nail plate on the surrounding soft tissue (ACFAS, 2010). Warm, wet soaks help drain an infection. A toenail may need to be excised by the podiatrist or primary provider if there are recurrent infections.
What is hammer toe?
Hammer toe is a flexion deformity of the interphalangeal joint, which may involve several toes.
How are hammer toes treated?
Treatment consists of conservative measures: wearing open-toed sandals or shoes that conform to the shape of the foot, carrying out manipulative exercises, and protecting the protruding joints with pads. Surgery (osteotomy) may be used to correct a resulting deformity. There is little evidence to support treatment of hammer toe when the patient does not report pain or other symptoms (ACFAS, 2009).
What is a hallux valgus or bunion?
Hallux valgus (bunion) is a deformity in which the great toe deviates laterally.
What are contributing factors and treatments for bunions?
Factors contributing to bunion formation include heredity, ill-fitting shoes, osteoarthritis, and the gradual lengthening and widening of the foot associated with aging. Treatment depends on the patient’s age, the degree of deformity, and the severity of symptoms. In uncomplicated cases, wearing a shoe that conforms to the shape of the foot, or that is molded to the foot to prevent pressure on the protruding portions, may be the only treatment needed. Corticosteroid injections control acute inflammation. In advanced cases, surgical removal of the exostosis and toe realignment may be required to improve function, appearance, and symptoms.
What is pes cavus?
Pes cavus (claw foot) refers to a foot with an abnormally high arch and a fixed equines deformity of the forefoot.
