Chapter 64: Med Surg Flashcards Preview

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Flashcards in Chapter 64: Med Surg Deck (64)
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1

osteomyelitis

severe infection of bone, usually through the metaphysis and once ischemia occurs, the bone dies

2

indirect entry

frequently affects boys younger than 12 years old and is associated with blunt trauma, if it affects adults most likely has diabetes, GI or respiratory infection

3

direct entry

occurs at any age through an open wound

4

sequestra

devitalized bone separates from living bone

5

involucrum

part of the periosteum that continues to have blood supply and forms a new bone

6

acute osteomyelitis

initial infection or an infection lasting less than 1 month, s/s fever, night sweats, restless, nausea, constant bone pain, swelling, tenderness, warmth at infection site

7

chronic osteomyelitis

bone infection that persists longer than 1 month or an infection that has not responded to therapy, systemic signs not as much, but local signs including constant bone pain, swelling, tenderness, and warmth at infection site more prominent

8

diagnostic studies for osteomyelitis

elevated WBC & ESR, bone or soft tissue biopsy needed to determine causative organism

9

tx osteomyelitis

IV therapy for acute osteomyelitis (Penicillin or Keflex), chronic osteomyelitis responds more to oral therapy with fluoroquinolone (Cipro), response to therapy is watched through bone scans & ESR test

10

what to avoid and watch for with tx osteomyelitis

avoid exercise and warmth because these can accelerate infection, report any signs of toxicity from antibiotic tx and report any whitsh, yellow, curdlike lesions, since the spread of candidiasis is increased with prolonged antibiotic use

11

osteochondroma

benign overgrowth of cartilage and bone near the end of the bone at growth plate, painless, hard, immobile mass, lower than normal height for age

12

diagnosis for osteochondroma

x ray, CT, MRI

13

osteoclastoma

benign, common at the ends of arm and leg bones, reappears frequently after surgery and chemotherapy, "giant cell tumor"

14

endochroma

benign, cartilage tumor found in single hand or foot, common in 10-20 year olds

15

osteosarcoma

primary bone tumor that is extremely aggressive and metastasizes, usually occurs in metaphysis region of long bones, most commonly associated with paget's disease and prior radiation s/s gradual pain and swelling usually around knee

16

diagnosis for osteosarcoma

tissue biopsy, elevated serum alkaline phosphatase and calcium, x ray, CT, PET, MRI

17

chondrosarcoma

occurs in cartilage of bone in arm, leg, pelvis or older generation, surgery usually indicated because does not respond well to chemotherapy

18

ewing's sarcoma

occurs in long bones, children & teens, white people

19

chordoma

tumor in base of skull in older people, tx difficult because involves the spinal cord and nerves

20

overall goals with bone cancers

satisfactory pain relief, maintain preferred activities, demonstrate acceptance of body image, be free of injury, verbalize understanding and realistic idea of disease progression and prognosis

21

acute low back pain

lasts 4 weeks or less, often symptoms do not appear at time of injury but later on because of increased pressure on nerve, straight leg test positive if radicular pain persists

22

planning for low back pain

avoid prolonged bed rest, satisfactory pain relief, avoid constipation, learn back sparing activities, return to previous level

23

things that make back problems worse

leaning forward without bending knees, lifting anything above the elbows, sleeping on abdomen or back or side with legs straight out, smoking (decreases circulation to vertebral disks)

24

chronic back pain

lasts more than 3 months or is a repeated episode, spinal stenosis (narrowing of vertebral canal r/t bone moving into that space), disk herniation

25

disk herniation

compression of nerve roots, associated with stenosis and pain begins in lower back and proceeds to butt and leg, worsens with walking and standing

26

degenerative disk disease (DDD)

degeneration of both the lumbar and cervical disk, normal process of aging, contributes to OA, low back pain

27

herniated intervertebral disk

"slipped disk", natural degeneration or repeated stress/trauma, radicular pain that radiates down buttock and below knee

28

acute nursing management for spinal surgery

place pillows under thighs of each leg when supine and between legs in side lying position to ensure comfort and alignment, watch for CSF (clear or slightly yellow +glucose), movement of extremities should be unaffected postop

29

serious nursing management for spinal surgery

report any new muscle weakness or paresthesias to surgeon immediately, loss of sphincter or bladder tone may indicate nerve damage, donor site usually causes greater pain than fused area, don't twist spine, weight should be on thighs and knees

30

conservative tx for neck pain

soft cervical collars, heat and ice, massage, rest, physical therapy, ultrasound, NSAIDs, acupuncture, most pain resolves without surgical intervention