Exam 2, chapter 41/42 Flashcards
1
Q
A soft tissue injury produced by blunt force such as a blow, kick or fall, that results in bleeding into soft tissues (ecchymosis)?
A
Contusion
2
Q
an injury to a musculotendinous unit caused by overuse, overstretching, or excessive stress.
A
Strain (pulled muscle)
3
Q
A tendon connects?
A
muscle to bone
4
Q
Ligament connects?
A
bone to bone
5
Q
Sprain
A
injury to the ligaments and supporting muscle fibers that surround a joint often caused by a trauma, wrenching, or twisting motion.
6
Q
SXS for strains, contusions and sprains
A
pain edema ecchymosis abnormal joint motion tenderness
7
Q
first degree strain
A
tearing of few muscle fibers
minor edema, tenderness, and muscle spasm
no noticeable loss of function
8
Q
second degree strain
A
tearing of more muscle fibers edema tenderness' muscle fibers ecchymosis notable loss of load bearing strength of the involved extremity.
9
Q
Type of strain that involves complete disruption of at least one musculotendinous unit that involves separation of muscle from muscle, muscle from tendon or tendon from bone.
A
third degree strain
10
Q
SxS of third degree strain
A
significant pain muscle spasm ecchymosis edema loss of function
X-ray to rule out avulsion fracture
11
Q
A break in the continuity of bone caused by direct blows, crushing forces, sudden twisting motions, and extreme muscle contractions?
A
fracture
12
Q
Tenderness at the distal tibia (inner ankle) or fibula (outer ankle) is associated with an inversion or eversion injury may indicate?
A
Fracture
13
Q
Tx of contusions, strains, and sprains
A
Rest to prevent additional injury and promotes healing.
Ice intermittent moist or dry cold packs for 20-30 minutes during the 1st 24-48 hours to produce vasoconstriction (decrease bleeding, edema and discomfort).
Compression: elastic compression banage to control bleeding, reduce edema and provides support.
Elevation controls the swelling.
14
Q
what assessments are important for the nurse to monitor for patients with contusions, strains, and sprains?
A
Neurovascular status
Circulation (pulses, color, temp, cap refill)
Sensation (awareness of light touch)
Movement (ROM) at the most distal digits.
15
Q
How many weeks of immobilization before exercise are initiated for patient with severe sprains and strains?
A
1 to 3 weeks
16
Q
depending on the severity of injury (contusions, strains, sprains), progressive passive and active exercises may begin in?
A
2 to 5 days
17
Q
Spliniting may be used to prevent reinjury in strains and sprains why?
A
because ligaments and tendons are relatively avascular (bloodless).
18
Q
a partial dislocation of articulating surface.
A
subluxation
19
Q
What happens when a dislocation is not treated promptly?
A
Avascular necrosis (AVN)
20
Q
what are some signs and symptoms of a traumatic dislocation?
A
acute pain
change in contour of the joint
change in lenght of the extremity (shortening of the affected limb)
loss of normal mobility
change in the axis of the dislocated bones.
21
Q
what should the nurse be alert for when there is a right rib fracture 6 through 12?
A
liver injuries
22
Q
which organ will be injured when there is a left rib fractures 9 through 11?
A
splenic injuries
23
Q
fractures are described and classified according to?
A
type
communication or noncommunication with external environment.
anatomic location of fracture on involved bone (humerus, femur, tibia).
stable ( transverse, spiral and greenstick) or unstable (comminuted and oblique)
24
Q
A fracuture that involves a break across the entire cross-section of the bone and is frequently displaced (removed from its normal position)?
A
complete fracture
25
a fracture that produces several bone fragments?
comminuted fracture
26
A type of fracture caused by compression of vertebrae and are associated frequently with osteoporosis
compression fracture
27
stress fractures
occurs with repeated bone trauma from athletic activities, most frequently involving the tibia and metatarsals.
28
a type of fracture that runs across the bone at a diagonal angle of 45 to 60 degrees?
oblique
29
fractures that do not cause a break in the skin
closed (simple) fractures
30
Types of fractures in which the skin or mucous membrane extends to the factured bone?
open (compound, or complex) fractures
31
name some types of fractures
```
Avulsion
comminuted
compression
greenstick
stress
transverse
spiral
pathologic
oblique
longitudina
impacted'
```
32
A fracture in which a fragment of bone has been pulled away by a tendon and its attachment
Avulsion
33
comminuted fracture
bone has splintered into several fragments
34
a fracture in which bone has been compressed (seen in vertabral fractures)
compression
35
Greenstick
a fracture in which one side of a bone is broken and the other side is bent
36
A transverse fracture is straight across the bone shaft True or false?
True
37
How will a nurse document as the type of fracture that occurs through an area of diseased bone that can occur without trauma or fall?
pathologic (eg; osteoporosis, bone cyst, Paget;s disease, bony metastasis, tumor).
38
The Dx of a fracture is based on?
pt sympoms
physical signs
X-ray findings
39
clinical manifestations of a fracture
```
pain
loss of function
deformity
shortening
crepitus (grating, crackling or popping sounds)
swelling
discoloration
Do not all need to be present in every fracture.
```
40
The muscle spasms that accompany a fracture begin within?
20 minutes after injury
results in increasing pain intensity
further bony fragmentation or malalignment
41
what are the causes for delayed ossification?
infections
rest
DM
nutriation
42
what should the nurse consider when a patient with injury from fracture must be moved before extrmity splint can be applied
support the limb distal and proximal to the fracture site to prevent rotation as well as angular motion.
43
Stages of fracture union
```
hematoma (0-3 days)
granulation tissue (3-14 days)-osteoid
callus formation (2 weeks)
ossification (3 weeks to 6 month)-cast removal
consolidation (radiologic union)
remodeling (1 year)
```
44
what are the five warning P's of neurovascular impairment?
```
pain
paresthesia (numbness and tingling)
pressure (increase in compartment)
pallor (coolness, paleness )
pulselessness (less than 2 seconds)
paralysis (loss of function)
```
45
what should the nurse do when there is an open fracture?
cover the wound with a sterile dressing to prevent contamination of deeper tissues.
No attempt is to be made to reduce the fracture even if one of the bone fragments is protruding through the wound.
46
what prophylaxis will be administered in the ER for a patient with an open fracture?
Tetanus if the last known booster was over 5 years ago.
47
what is the immediate priority for a patient with fracture?
maintaining hemodynamic stability.
48
The nurse is aware that bleeding is a common problem with fracture therefore?
watch for sxs of hypovolemic shock such as
thirst
elevated HR, anxiety, restlessness, weak pulse (thready)
decreased BP, UO, pulse pressure
cool, clammy skin
delayed capillary refill
rapid shallow respirations
49
What are the Tx for shock in a patient with fracture?
stabilizing the fracture
relieving pain
protection
50
The principles of fracture Tx include
reduction
immobilization
regaining of normal functions and strenght through rehabilitation.
51
restoration of the fracture fragments to anatomic alignment and rotation?
Reduction
52
types of reduction
closed and open reduction
53
nonsurgical, manual realignment of bone fragments to previous anatomic position?
closed reduction
54
Closed reduction
nonsurgical, manual realignment of bone fragments to previous anatomic position.
traction and countertraction manually applied to bone fragments to restore position, lenght, and alignment.
performed while patient is under local or general anesthesia.
55
Can the nurse manipulate protruding bone ends?
No
56
Open reduction
correction of bone alignment through surgical incision.
internal fixation with use of wires, screws, pins, plates, intramedullary rods, or nails.
The internal fixation devices ensure firm approximation and fixation of the bony fragments.
57
open fractures are considered contaminated and carries risk for?
osteomyelitis
tetanus
gas gangrene
58
what is the objectives for managing open fractures?
prevent infection of the wound, soft tissue, and bone.
| promote healing of soft tissue and bone.
59
be alert for signs and symptons of infection with open fracture.
```
Elevated temperature
tachycardia
tachypnea
redness, warth, tenderness, purulent drainage at wound site
leukocytosis (elevated WBCs)
```
60
what is an alternative after fracture reduction?
external fixation
pins are drilled into bone.
held by external metal frame to prevent bone movement.
61
what are the major goals for the patient with a fracture?
knowledge of the treatment regimen
relief of pain
improved physical mobility
achievement of maximum level of self care
healing of any trauma associated lacerations and abrasion
maintenance of adequate neurovascular function
absence of complications.
62
The nurse must never ignore complaints of pain from a patient in a cast because of the possibility of problems such as?
impaired tissue perfusion
| pressure ulcer formation
63
pain associated with underlying condition (eg. fracture) is frequently controlled by?
immobilization
64
pain due to edema that is associated with trauma, surgery, or bleeding into the tissues can frequently be controlled by?
elevation and, if prescribed, intermittent application of cold packs.
place the ice packs on each side of the cast or fixator.
65
what is a significant risk for the immobilized patient?
Deep vein thrombosis (DVT)
66
what should the nurse do to prevent DVT in a patient with fracture?
The nurse encourages the patient to do active flexion-extension foot and ankle exercises and isometric contraction of the claf muscles (calf-pumping exercises) every hour while awake to decrease venous stasis in the unaffected limb.
67
why should the nurse encourage the patient to move digits and joints distal to fracture injury hourly when awake?
to prevent problems related to inactivity.
68
with internal fixation, who determines the amount of movement and weight-bearing stress teh extremity can withstand?
surgeon
69
what are some biologically inert metal devices used for internal fixation?
stainless steel
vitallium
titanium
70
how will the surgeon evaluate the alignment after metal devices for internal fixation have been applied?
X-ray
71
how will the nurse teach a patient to prevent infection when using external fixator?
50/50; hydrogen peroxide and saline
72
what is critical when external fixations are applied?
infection control
73
what are measures that may reduce the incidence of fat emboli?
immediate immobilization of fractures (early surgical fixation.
minimal fracture manipulation.
adequate support from fractured bones during turing and positioning.
maintenance of fluid and electrolyte balance.
74
risk factors for fat embolism syndrome
truama
fracture of long bones or pelvic bones
multiple fractures or crushing injuries
onset is rapid, with 24-72 hours of injury
75
Nursing care for traction
set up by ortho tech
maintain the correct balance between the pulling and counter pull
weighs should be hanging freely.
watch positioning (semi Fowlers, Fowlers).
Do not position pt on affected side
76
what is an example of a skin traction?
Buck's traction
| use to immobilize fractures of the proximal femur before surgical fixation.
77
what should the nurse perform before a buck's traction is applied
inspect the skin for abrasion and circulatory disturbances.
| ensures the skin is dry.
78
what are some complications that may develop as a result of skin traction?
skin breakdown
nerve pressure
circulatory impairment
79
care of the patient in traction
```
TRACTION!!
Temperature (pt and extremity)
Ropes hang freely
Alignment
Circulation checks
Type and location of fracture
Increase fluid intake
Overhead trapeze
No weight on bed or floor
```
80
Assessment for patients on traction
check the amount of weight ordered (usually 5 to 10lbs)
if patients reports severe pain, maybe weights are too heavy.
assess neurovascular status (6 Ps!).
skin
81
Two most common types of traction
skin
| skeletal
82
circulatory impairment in a patient with traction is manifested by
cold skin temperature
decrease peripheral pulses
slow capillary refill time
bluish skin.
83
DVT a serious circulatory impairment may be manifested by
unilateral calf tenderness
warmth
redness
swelling
84
Skin traction
used for short term treatment to control muscle spasms and to immobilize an area until skeletal traction or surgery is possible.
Tape, boots or splints applied directly to skin to maintain alignment assist in reduction.
weights 5 to 10 lbs.
85
how will the nurse assess for correct balance with a skin traction?
weighs should be hanging freely.
| the amount of weight applied must not exceed the tolerance of the skin.
86
How does the skin traction work?
applies a pulling force indirectly onto the bone by pulling on skin.
it short term, light weights (5-10lbs).
87
Examples of skin traction
Buck's
Russell's
Pelvic
cervical
88
skeletal traction
in place for longer periods
used to align injured bones and joints or to treat joint contractures and congenital hip dysplasia.
provides a long term pull that keeps injured bones and joint aligned.
weight ranges 5-45lbs
Too much weights results in delayed union or nonunion.
89
who is responsible for adjusting the clamps on the external fixator frame - skeletal traction?
The physician's responsibility.
Nurse must NEVER make the adjustment.
90
How will the nurse maintain an effective skeletal traction
check the apparatus at least one per shift to ensure the ropes are in the wheel grooves of the pulleys.
Ropes are not frayed.
weights hang freely.
knots in the rope are tied securely.
91
what are the major disadvantages of skeletal traction?
infection
osteomyelitis (bone infection)
immobility.
92
what assessment are the nurse performing on a patient with skeletal traction
skin breakdown
pressure on lower extremity (ischial tuberosity, popliteal space, Achilles' tendon an heels).
6 P's
infections (clean pin with Chlorhexidine solution).
93
which lab may be normal in a patient with chronic osteomyelitis
WBCs
94
what is the dominant finding in osteomyelitis
pain over the affected bone
95
osteomyelitis is caused most commonly by which microorganism?
staphylococcus aureus
96
signs of pin infection
```
edema
purulent drainage
erythema
excessive warmth
tenderness
pin loosening
odor
fever
```
97
type of treatment modality that permit mobilization of patient while restricting movement of a body part?
cast
it a rigid external immobilizing device.
98
risk factors for osteoporosis
```
age
female (caucasian)
small bone structure
postmenopausal
sedentary lifestyle
smoking
COPD
steroid
family history
Ca deficiency
high protein diet
excessive caffeine and alcohol intake
malignancy
hyperthyroidism
Rheumatoid arthritis
diabetes mellitus (DM)
Cushing's disease
gastrectomy
```
99
How should the nurse care for a wet cast?
using a hair dryer on a cool setting.
| Thorough drying is important to prevent skin breakdown.
100
A wet plaster cast appears?
dull and gray
sounds dull on percussion
feels damp
smells musty
101
how will a dry plaster cast appear?
white and shiny
resonant to percussion
firm
odorless
102
Casts
```
use palms of hand during drying period.
edges may be need to be petaled.
plaster sets in 15 minutes
synthetic casts dry in 15 minutes
not strong enough for weight bearing unit 24 to 72 hours.
```
103
fresh plaster cast should never be covered with a blanket why?
To allow maximum dissipation of the heat and facilitate drying (24 to 72 hours).
104
cast use for upper extremities
sugar tong splint
acute writs injuries
injuries that result in significant swelling
posterior splint
Accommodates swelling in fracture extremity post injury.
short arm cast
long arm cast
Body jacket
compresses superior mesenteric artery against duodenum.
sling
105
what is a disadvantage to the use of body jacket cast?
compresses superior mesenteric artery against duodenum.
106
in what position should the hand be? in relation to the elbow when using a sling.
The thumb should be pointing up.
107
injuries to lower extremities are often immobilized by which types of cast?
```
long leg
short leg
cylinder
jones dressing
prefabricated splint or immobilizer
```
108
supporting case during hardening
handle with palms of hands
support on firm smooth surface
DO NOT rest on hard surface or on sharp edges.
avoid pressure on cast.
109
Assessment of the cast
```
assess the skin around the edges
check for hot spots.
wet sports.
be aware of possible pressure points
check for odor
make sure it is not too tight-finger in
may need to bivalve or cut window
```
110
cast care dos
apply ice on fracture site for the first 24 hours.
check with health care provider before getting fiberglass wet.
dry cast after exposure to water.
elevate extremity onto pillows above heat level for first 24 hours.
after initial phase, casted extremity should not be placed in a dependent position because of the possibility of excessive edema.
observe for signs of pressure such as: pain, swelling, compartment syndrome.
move joints above and below cast regularly.
report signs of possible problems.
keep appointment to have fracture and cast checked.
111
Cast care don'ts
```
get plaster cast wet.
remove any padding
insert any objects inside cast
bear weight on new cast or 48-72 hours.
not all casts are weight-bearing
cover cast with plastic for prolonged periods.
```
112
how many meals a day should a patient in body jacket and hip spica cast have?
6 small meals to prevent abdomen distention.
113
dietary requirements for patients in cast
```
ample protein (1g/kg of body weight)
vitamins B, C, D
Calcium
Phosphorus
Magnesium
```
114
what can develop as a result of bone demineralization
Renal calculi
patient should have adequate fluid intake 2500ml/day.
cranberry juice or ascorbic acid -prevents UTIs.
High fiber diet with fruits and vegetables -prevents constipation.
115
what are some nursing diagnoses for patients in cast
impaired physical mobility
risk for peripheral neurovascular dysfunction
acute pain
ineffective therapeutic regimen management
116
A tough connective tissue that surrounds muscle groups, organs, nerves, blood vessels, bones and internal structures? it does not expand readily.
Fascia
117
Elevated intracompartmental pressure within a confined myofascial compartment compromises neurovascular function of tissues within that space?
compartment syndrome
118
type of compartment syndrome resulting from restrictive dressing, splints, casts, excessive traction, or premature closure of fascia?
decrease compartment size
119
increase compartment size
related to bleeding, edema, chemical response to snakebite or IV filtration.
120
what is a hallmark sign for compartment syndrome?
pain that occurs or intensifies with passive ROM.
| If concerned about neurovascular impairment, notified physician immediately.
121
The presence of a pulse does not rule out compartment syndrome True or false?
True
| pulselessness and pallor are late signs of compartment syndrome.
122
what are characteristics of impending compartment syndrome?
paresthesia: numbness and tingling
pain: distal to injury that is not relieved by opioid analgesics and pain on passive stretch of muscle traveling through compartment.
Pressure: increase in compartment
Pallor: coolness, and loss of normal color of extremity.
paralysis: loss of function
pulselessness: diminished/absent peripheral pulses.
123
if a compartment syndrome complication is secondary to a tight bandage or cast, the nurse anticipates that?
The bandage would be loosened or removed and the cast bivalved (cut in half longitudinally).
124
A surgical procedure in which the skin and affected compartments fascia are opened, allowing the pressure to be relieve and circulation restored?
fasciotomy
125
fasciotomy
surgical decompression for compartment syndrome
126
what may be the result for reduction in traction weight?
decrease external circumferential pressure.
127
susceptible site in the lower extremity for pressure (decubitus) ulcers
```
heel
malleoli
dorsum of the foot
head of fibula, tibial tuberosity
anterior surface of the patella.
```
128
The nurse has a high degree of suspicion that a pressure ulcer is developing under a cast or dressing when the patient reports?
pain
tightness in a defined casted area.
Nurse will inspect for drainage, odor, warmth(tissue erythema).
129
which patients are at hight risk for venous thrombosis
patients with fractures of the lower extremities
| pelvis injury
130
Signs of Venous thrombosis
```
can present as shock and loss of consciousness.
sudden-onset SOB.
restlessness
increase respiratory rate
tachycardia
chest pain
low grade fever
pleuritic pain that increase with inspiration (pulmonary infarct).
moderate hypoxemia
productive cough of blood-tinged sputum.
```
131
presence of systemic fat globules from fracture that are distributed into tissues and organs after a traumatic skeletal injury
```
fat embolism (FES)
contributory factor in many deaths associated with fractures.
```
132
why may fat globules diffuse into the vascular compartment at the time of fracture?
because the pressure is greater than the capillary pressure.
| catecholamines elevated by the patient's stress reaction.
133
Risk factors for fat embolism syndrome
```
trauma
fracture of long bones
pelvic bones
multiple fractures
crushing injuries
```
134
fractures most often causing FES
long bones
ribs
tibia
pelvis
135
FES is known to occur following
```
total joint replacement
spinal fusion
liposuction
crush injuries
bone marrow transplantation
```
136
The cerebral disturbance due to hypoxia and the lodging of fat emboli in the brain is manifested by
```
mental status changes varying from
headache
mild agitation
confusion
delirium
coma
```
137
what are signs of systemic fat embolization
patient appears pale
petechiae (transient thrombocytopenia) noted in the buccal membranes and conjunctival sacs on the hard palate over the chest and anterior axillary folds.
138
fat globules transported to lungs cause
hemorrhagic interstitial pneumonitis
139
initial manifestations of FES occur
24-48 hours after injury
140
SxS of acute respiratory distress syndrome (ARDS)
```
chest pain
tachypnea
cyanosis
dyspnea
apprehension
tachycardia
decreased partial pressure of arterial oxygen (PaO2) less than 60 mm Hg-respiratory alkalosis (hyperventilation), later respiratory acidosis (hypoventilation).
```
141
Clinical manifestations of FES
may be rapid and acute
patient expresses a feeling of impending disaster.
in a short time skin color changes from pallor to cyanosis
patient may become comatose.
142
what are the most common causes of death with FES
acute pulmonary edema
| ARDS
143
ARDS
Acute Respiratory Distress Syndrom
144
FES
Fat embolism syndrome
145
what will you do as a nurse to prevent a FES?
immediate immobilization of fractures.
minimal fracture manipulation.
adequate support for fractured bones during turing and positioning.
maintenance of F&E balance.
recognizing early indications and report them promptly.
146
subtle personality changes, restlessness, irritability or confusion in a pt who has sustained a fracture are indication for immediate?
```
reassessment of vitals
O2 saturation
lab date
physical exam
watch out for FES!
```
147
Tx for FES
O2 therapy
mechanical ventilation
positive end expiratory pressure (PEEP)
used to maintain arterial oxygenation
corticosteroids via IV for
inflammatory lung reaction and to control cerebral edema.
vasopressor medication to support cardiovascular function
prevent hypotension, shock and interstitial pulmonary edema
148
bone healing
```
ossification
consolidation
remodeling
intact peripheral circulation
return of skeletal function
```
149
splinting
support the affected body part to avoid fracture displacement and soft tissue injury.
move the injured extremity as little as possible to avoid additional injury.
monitor for bleeding at injury site to plan appropriate intervention.
150
Traction/immobilization care
position in proper body alignment to enhance traction and skeletal function.
maintain traction at all times to prevent misalignment of bone fragments.
monitor circulation, movement and sensation of affected extremity to detect complications of peripheral vascular function.
provide trapeze for movement in bed to reduce complications of immobility.
monitor skin and body prominences for signs of skin breakdown.
administer appropriate skin care at friction points to prevent skin breakdown.
151
Cast care: wet
expose drying cast to air to promote even drying.
support cast with pillows during the drying period to prevent denting and flattening of the cast.
apply plastic to cast if close to groin to prevent soiling of cast.
mark the circumference of any drainage as a gauge for future assessments.
152
cast care: maintenance
instruct patient not to scratch skin under the cast with any objects to prevent skin injury and infection.
position cast on pillow to lessen strain on other body parts.
pad rough cast edges and traction connections to prevent skin irritation and breakdown of cast.
153
positioning
immobilize or support affected body part to prevent pressure and injury.
maintain position and integrity of traction to prevent compression of blood vessels and nerves.
elevate affected limb 20 degrees or greater above the level of the heat to reduce edema by promoting venous return.
if compartment syndrome is suspected elevate extremity no higher than heart level.
154
Application of a pulling force to an injured or diseased part of body or extremity while counter traction pulls in opposite direction
Traction
155
Purpose of any traction
Prevent or decrease muscle spasm
Immobilize joint or part of body.
Decrease a fracture or dislocation.
Treat a pathological joint condition.
156
The removal of a body part, usually an extremity
amputation
157
what are the s&s of PVD prior to amputation
pale color
temperature
hair loss
pain
158
close amputation
creates weight bearing residual limb(stump).
skin flap covers stump (suture line not in area of wt bearing.
skin fold firm as to not allow fluid accumulation and thus infection
159
Open (guillotine) amputation
leaves a surface on limb not covered by skin fold (used for actual or potential infection)
later closed
160
post op care for amputation
```
monitor for bleeding/hemorrhage
sterile dressing changes
avoid flexion
proper bandaging
stump shaping and molding
supports soft tissues
reduces edema and pain
promotes limb shrinkage
healing, and maturation
```
161
immediate prosthesis fitting
gradually increase WBAT
promotes early ambulation
psychological benefits
cast is changed at intervals to permit stump inspection to insure the maintenance of adequate fit.
162
Amputation complications
grieving
phantom limb pain
flexion contractures
163
Amputation pt family teaching
```
DO NOT use lotions, alcohol or powders
DO NOT sit for > 1hr-avoid hip flexion
DO NOT elevate residual limb too high
one pillow only
only for the 1st 24 hours (prevent flexion contractions of the hip)
```
164
surgical excision to gain access to and remove protruding disk
removes entire lamina (bone at the back of spinal canal)
take pressure off the nerve
minimal hospital stay is usually required
Laminectomy
165
Laminotomy
removes a portion of the lamina
part of a disc or bone spur maybe removed
relieves pressure on nerve
minimal hospital stay is usually required.
166
uses microscope to allow better visual of disk and disk space to aid in the removal of damaged portion.
helps maintain bony stability of spine
microsurgical diskectomy
167
Post op spinal surgery
frequently monitor peripheral neurologic signs of extremities.
manage pain appropriately
movement of arms legs and assessment of section should unchanged when compared with preoperative status.
repeat assessment every 2 to 4 hours during 1st 48 hours post surgery.
168
why NO Anticoagulants with patient with spinal surgery
can cause peri-spinal hematoma which can lead to spinal cord injury.
169
S&S of CSF leak in patient with spinal surgery
headache
| check glucose level (CSF is high)
170
Good sources of calcium for osteoporosis
```
milk
yogurt
turnip greens
spinach
cottage cheese
ice cream
sardines
```
171
care for the patient with osteoporosis
supplemental vitamin D and Calcium.
exercise should be encouraged to build up and maintain bone mass.
patient should be instructed to quit smoking and cut down on alcohol intake to decrease losing bone mass.
172
drugs that interfere with calcium.
```
corticosteroids
anti seizure (depakote, Dilantin)
aluminum containing antacids
heparin
certain cancer treatments
parathyroid hormone
```
173
Drug therapy for osteoporosis
bisphosphonates : Alendronate (Fosamax)
Risedronate (Elvista)
Ibandronate (boniva) (stand or sit for 60 minutes)
take in the morning before eating or drinking
take with full glass of water
must stand or sit upright for 30 minutes
cannot eat or drink during this time (can cause esophagitis, muscle pain, or ocluar problems)
