Exam 2, chapter 41/42 Flashcards Preview

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Flashcards in Exam 2, chapter 41/42 Deck (173)
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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
Q

a fracture that produces several bone fragments?

A

comminuted fracture

26
Q

A type of fracture caused by compression of vertebrae and are associated frequently with osteoporosis

A

compression fracture

27
Q

stress fractures

A

occurs with repeated bone trauma from athletic activities, most frequently involving the tibia and metatarsals.

28
Q

a type of fracture that runs across the bone at a diagonal angle of 45 to 60 degrees?

A

oblique

29
Q

fractures that do not cause a break in the skin

A

closed (simple) fractures

30
Q

Types of fractures in which the skin or mucous membrane extends to the factured bone?

A

open (compound, or complex) fractures

31
Q

name some types of fractures

A
Avulsion
comminuted
compression
greenstick
stress
transverse
spiral
pathologic
oblique
longitudina
impacted'
32
Q

A fracture in which a fragment of bone has been pulled away by a tendon and its attachment

A

Avulsion

33
Q

comminuted fracture

A

bone has splintered into several fragments

34
Q

a fracture in which bone has been compressed (seen in vertabral fractures)

A

compression

35
Q

Greenstick

A

a fracture in which one side of a bone is broken and the other side is bent

36
Q

A transverse fracture is straight across the bone shaft True or false?

A

True

37
Q

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?

A

pathologic (eg; osteoporosis, bone cyst, Paget;s disease, bony metastasis, tumor).

38
Q

The Dx of a fracture is based on?

A

pt sympoms
physical signs
X-ray findings

39
Q

clinical manifestations of a fracture

A
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
Q

The muscle spasms that accompany a fracture begin within?

A

20 minutes after injury
results in increasing pain intensity
further bony fragmentation or malalignment

41
Q

what are the causes for delayed ossification?

A

infections
rest
DM
nutriation

42
Q

what should the nurse consider when a patient with injury from fracture must be moved before extrmity splint can be applied

A

support the limb distal and proximal to the fracture site to prevent rotation as well as angular motion.

43
Q

Stages of fracture union

A
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
Q

what are the five warning P’s of neurovascular impairment?

A
pain
paresthesia (numbness and tingling)
pressure (increase in compartment)
pallor (coolness, paleness )
pulselessness (less than 2 seconds)
paralysis (loss of function)
45
Q

what should the nurse do when there is an open fracture?

A

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
Q

what prophylaxis will be administered in the ER for a patient with an open fracture?

A

Tetanus if the last known booster was over 5 years ago.

47
Q

what is the immediate priority for a patient with fracture?

A

maintaining hemodynamic stability.

48
Q

The nurse is aware that bleeding is a common problem with fracture therefore?

A

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
Q

What are the Tx for shock in a patient with fracture?

A

stabilizing the fracture
relieving pain
protection

50
Q

The principles of fracture Tx include

A

reduction
immobilization
regaining of normal functions and strenght through rehabilitation.

51
Q

restoration of the fracture fragments to anatomic alignment and rotation?

A

Reduction

52
Q

types of reduction

A

closed and open reduction

53
Q

nonsurgical, manual realignment of bone fragments to previous anatomic position?

A

closed reduction

54
Q

Closed reduction

A

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
Q

Can the nurse manipulate protruding bone ends?

A

No

56
Q

Open reduction

A

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
Q

open fractures are considered contaminated and carries risk for?

A

osteomyelitis
tetanus
gas gangrene

58
Q

what is the objectives for managing open fractures?

A

prevent infection of the wound, soft tissue, and bone.

promote healing of soft tissue and bone.

59
Q

be alert for signs and symptons of infection with open fracture.

A
Elevated temperature
tachycardia
tachypnea
redness, warth, tenderness, purulent drainage at wound site
leukocytosis (elevated WBCs)
60
Q

what is an alternative after fracture reduction?

A

external fixation
pins are drilled into bone.
held by external metal frame to prevent bone movement.

61
Q

what are the major goals for the patient with a fracture?

A

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
Q

The nurse must never ignore complaints of pain from a patient in a cast because of the possibility of problems such as?

A

impaired tissue perfusion

pressure ulcer formation

63
Q

pain associated with underlying condition (eg. fracture) is frequently controlled by?

A

immobilization

64
Q

pain due to edema that is associated with trauma, surgery, or bleeding into the tissues can frequently be controlled by?

A

elevation and, if prescribed, intermittent application of cold packs.
place the ice packs on each side of the cast or fixator.

65
Q

what is a significant risk for the immobilized patient?

A

Deep vein thrombosis (DVT)

66
Q

what should the nurse do to prevent DVT in a patient with fracture?

A

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
Q

why should the nurse encourage the patient to move digits and joints distal to fracture injury hourly when awake?

A

to prevent problems related to inactivity.

68
Q

with internal fixation, who determines the amount of movement and weight-bearing stress teh extremity can withstand?

A

surgeon

69
Q

what are some biologically inert metal devices used for internal fixation?

A

stainless steel
vitallium
titanium

70
Q

how will the surgeon evaluate the alignment after metal devices for internal fixation have been applied?

A

X-ray

71
Q

how will the nurse teach a patient to prevent infection when using external fixator?

A

50/50; hydrogen peroxide and saline

72
Q

what is critical when external fixations are applied?

A

infection control

73
Q

what are measures that may reduce the incidence of fat emboli?

A

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
Q

risk factors for fat embolism syndrome

A

truama
fracture of long bones or pelvic bones
multiple fractures or crushing injuries

onset is rapid, with 24-72 hours of injury

75
Q

Nursing care for traction

A

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
Q

what is an example of a skin traction?

A

Buck’s traction

use to immobilize fractures of the proximal femur before surgical fixation.

77
Q

what should the nurse perform before a buck’s traction is applied

A

inspect the skin for abrasion and circulatory disturbances.

ensures the skin is dry.

78
Q

what are some complications that may develop as a result of skin traction?

A

skin breakdown
nerve pressure
circulatory impairment

79
Q

care of the patient in traction

A
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
Q

Assessment for patients on traction

A

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
Q

Two most common types of traction

A

skin

skeletal

82
Q

circulatory impairment in a patient with traction is manifested by

A

cold skin temperature
decrease peripheral pulses
slow capillary refill time
bluish skin.

83
Q

DVT a serious circulatory impairment may be manifested by

A

unilateral calf tenderness
warmth
redness
swelling

84
Q

Skin traction

A

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
Q

how will the nurse assess for correct balance with a skin traction?

A

weighs should be hanging freely.

the amount of weight applied must not exceed the tolerance of the skin.

86
Q

How does the skin traction work?

A

applies a pulling force indirectly onto the bone by pulling on skin.
it short term, light weights (5-10lbs).

87
Q

Examples of skin traction

A

Buck’s
Russell’s
Pelvic
cervical

88
Q

skeletal traction

A

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
Q

who is responsible for adjusting the clamps on the external fixator frame - skeletal traction?

A

The physician’s responsibility.

Nurse must NEVER make the adjustment.

90
Q

How will the nurse maintain an effective skeletal traction

A

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
Q

what are the major disadvantages of skeletal traction?

A

infection
osteomyelitis (bone infection)
immobility.

92
Q

what assessment are the nurse performing on a patient with skeletal traction

A

skin breakdown
pressure on lower extremity (ischial tuberosity, popliteal space, Achilles’ tendon an heels).
6 P’s
infections (clean pin with Chlorhexidine solution).

93
Q

which lab may be normal in a patient with chronic osteomyelitis

A

WBCs

94
Q

what is the dominant finding in osteomyelitis

A

pain over the affected bone

95
Q

osteomyelitis is caused most commonly by which microorganism?

A

staphylococcus aureus

96
Q

signs of pin infection

A
edema
purulent drainage
erythema
excessive warmth
tenderness
pin loosening 
odor
fever
97
Q

type of treatment modality that permit mobilization of patient while restricting movement of a body part?

A

cast

it a rigid external immobilizing device.

98
Q

risk factors for osteoporosis

A
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
Q

How should the nurse care for a wet cast?

A

using a hair dryer on a cool setting.

Thorough drying is important to prevent skin breakdown.

100
Q

A wet plaster cast appears?

A

dull and gray
sounds dull on percussion
feels damp
smells musty

101
Q

how will a dry plaster cast appear?

A

white and shiny
resonant to percussion
firm
odorless

102
Q

Casts

A
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
Q

fresh plaster cast should never be covered with a blanket why?

A

To allow maximum dissipation of the heat and facilitate drying (24 to 72 hours).

104
Q

cast use for upper extremities

A

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
Q

what is a disadvantage to the use of body jacket cast?

A

compresses superior mesenteric artery against duodenum.

106
Q

in what position should the hand be? in relation to the elbow when using a sling.

A

The thumb should be pointing up.

107
Q

injuries to lower extremities are often immobilized by which types of cast?

A
long leg
short leg
cylinder
jones dressing
prefabricated splint or immobilizer
108
Q

supporting case during hardening

A

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
Q

Assessment of the cast

A
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
Q

cast care dos

A

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
Q

Cast care don’ts

A
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
Q

how many meals a day should a patient in body jacket and hip spica cast have?

A

6 small meals to prevent abdomen distention.

113
Q

dietary requirements for patients in cast

A
ample protein (1g/kg of body weight)
vitamins B, C, D
Calcium
Phosphorus 
Magnesium
114
Q

what can develop as a result of bone demineralization

A

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
Q

what are some nursing diagnoses for patients in cast

A

impaired physical mobility
risk for peripheral neurovascular dysfunction
acute pain
ineffective therapeutic regimen management

116
Q

A tough connective tissue that surrounds muscle groups, organs, nerves, blood vessels, bones and internal structures? it does not expand readily.

A

Fascia

117
Q

Elevated intracompartmental pressure within a confined myofascial compartment compromises neurovascular function of tissues within that space?

A

compartment syndrome

118
Q

type of compartment syndrome resulting from restrictive dressing, splints, casts, excessive traction, or premature closure of fascia?

A

decrease compartment size

119
Q

increase compartment size

A

related to bleeding, edema, chemical response to snakebite or IV filtration.

120
Q

what is a hallmark sign for compartment syndrome?

A

pain that occurs or intensifies with passive ROM.

If concerned about neurovascular impairment, notified physician immediately.

121
Q

The presence of a pulse does not rule out compartment syndrome True or false?

A

True

pulselessness and pallor are late signs of compartment syndrome.

122
Q

what are characteristics of impending compartment syndrome?

A

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
Q

if a compartment syndrome complication is secondary to a tight bandage or cast, the nurse anticipates that?

A

The bandage would be loosened or removed and the cast bivalved (cut in half longitudinally).

124
Q

A surgical procedure in which the skin and affected compartments fascia are opened, allowing the pressure to be relieve and circulation restored?

A

fasciotomy

125
Q

fasciotomy

A

surgical decompression for compartment syndrome

126
Q

what may be the result for reduction in traction weight?

A

decrease external circumferential pressure.

127
Q

susceptible site in the lower extremity for pressure (decubitus) ulcers

A
heel
malleoli
dorsum of the foot
head of fibula, tibial tuberosity
anterior surface of the patella.
128
Q

The nurse has a high degree of suspicion that a pressure ulcer is developing under a cast or dressing when the patient reports?

A

pain
tightness in a defined casted area.
Nurse will inspect for drainage, odor, warmth(tissue erythema).

129
Q

which patients are at hight risk for venous thrombosis

A

patients with fractures of the lower extremities

pelvis injury

130
Q

Signs of Venous thrombosis

A
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
Q

presence of systemic fat globules from fracture that are distributed into tissues and organs after a traumatic skeletal injury

A
fat embolism (FES)
contributory factor in many deaths associated with fractures.
132
Q

why may fat globules diffuse into the vascular compartment at the time of fracture?

A

because the pressure is greater than the capillary pressure.

catecholamines elevated by the patient’s stress reaction.

133
Q

Risk factors for fat embolism syndrome

A
trauma
fracture of long bones 
pelvic bones
multiple fractures
crushing injuries
134
Q

fractures most often causing FES

A

long bones
ribs
tibia
pelvis

135
Q

FES is known to occur following

A
total joint replacement
spinal fusion
liposuction 
crush injuries 
bone marrow transplantation
136
Q

The cerebral disturbance due to hypoxia and the lodging of fat emboli in the brain is manifested by

A
mental status changes varying from
headache
mild agitation
confusion
delirium
coma
137
Q

what are signs of systemic fat embolization

A

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
Q

fat globules transported to lungs cause

A

hemorrhagic interstitial pneumonitis

139
Q

initial manifestations of FES occur

A

24-48 hours after injury

140
Q

SxS of acute respiratory distress syndrome (ARDS)

A
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
Q

Clinical manifestations of FES

A

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
Q

what are the most common causes of death with FES

A

acute pulmonary edema

ARDS

143
Q

ARDS

A

Acute Respiratory Distress Syndrom

144
Q

FES

A

Fat embolism syndrome

145
Q

what will you do as a nurse to prevent a FES?

A

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
Q

subtle personality changes, restlessness, irritability or confusion in a pt who has sustained a fracture are indication for immediate?

A
reassessment of vitals
O2 saturation
lab date
physical exam 
watch out for FES!
147
Q

Tx for FES

A

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
Q

bone healing

A
ossification
consolidation 
remodeling 
intact peripheral circulation
return of skeletal function
149
Q

splinting

A

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
Q

Traction/immobilization care

A

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
Q

Cast care: wet

A

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
Q

cast care: maintenance

A

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
Q

positioning

A

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
Q

Application of a pulling force to an injured or diseased part of body or extremity while counter traction pulls in opposite direction

A

Traction

155
Q

Purpose of any traction

A

Prevent or decrease muscle spasm
Immobilize joint or part of body.
Decrease a fracture or dislocation.
Treat a pathological joint condition.

156
Q

The removal of a body part, usually an extremity

A

amputation

157
Q

what are the s&s of PVD prior to amputation

A

pale color
temperature
hair loss
pain

158
Q

close amputation

A

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
Q

Open (guillotine) amputation

A

leaves a surface on limb not covered by skin fold (used for actual or potential infection)
later closed

160
Q

post op care for amputation

A
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
Q

immediate prosthesis fitting

A

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
Q

Amputation complications

A

grieving
phantom limb pain
flexion contractures

163
Q

Amputation pt family teaching

A
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
Q

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

A

Laminectomy

165
Q

Laminotomy

A

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
Q

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

A

microsurgical diskectomy

167
Q

Post op spinal surgery

A

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
Q

why NO Anticoagulants with patient with spinal surgery

A

can cause peri-spinal hematoma which can lead to spinal cord injury.

169
Q

S&S of CSF leak in patient with spinal surgery

A

headache

check glucose level (CSF is high)

170
Q

Good sources of calcium for osteoporosis

A
milk
yogurt 
turnip greens
spinach
cottage cheese 
ice cream
sardines
171
Q

care for the patient with osteoporosis

A

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
Q

drugs that interfere with calcium.

A
corticosteroids
anti seizure (depakote, Dilantin)
aluminum containing antacids
heparin
certain cancer treatments 
parathyroid hormone
173
Q

Drug therapy for osteoporosis

A

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)