Exam 3 Flashcards
(47 cards)
Strains are
Sprains are
Treatment
Rotator cuff injury
Management
Joint dislocation
Subluxation
- trauma to muscles or tendons
- trauma to ligament & joint
- RICE
- can’t raise shoulder above head, drop arm test (can’t hold arm up)
- sling the arm, might need surgery
- bone is displaced from joint position
- partial dislocation
Greenstick fracture
Transverse
Comminuted
Complete / incomplete
Spiral
Oblique
- one side is broken & other is bent
- bone fractured straight across
- broken in multiple pieces (fragments)
- separated into 2 parts, partial break
- break encircles the bone
- diagonal break
Assessment of a fracture
Initial care
Closed reduction
Open reduction
- pain, loss of function, deformity, swelling
- immobilize extremity, cover wound, check distal pulse
- manual manipulation, done within 24hrs, cast applied
- surgical intervention, followed by traction or cast
Traction is
Ensure what
Skeletal traction
Bucks skin traction
Dunlop’s skin traction
5 P’s of circulatory checks
Casts interventions
- to maintain proper alignment & prevent muscle spasms
- ensure weights hang freely & don’t touch floor
- includes pins, must do proper pin care & monitor extremity
- lower limb : no more than 5lbs of weight & must hang freely
- traction for humerus fractures
- pain, paresthesia, paralysis, pulse, pallor
- monitor for circulatory impairment, do isometric exercises to prevent atrophy
Fat embolism from
Manifestations
Compartment syndrome is
Early signs
Late signs
Intervention
- fracture of long bone, typically femur
- petechiae rash of chest, AMS, tachycardia, dyspnea
- increased pressure of compartments causing compromised circulation
- severe pain unrelieved by meds
- compromised pulse (paresthesia, pulselessness)
- fasciotomy to relieve pressure
Crutch walking
Canes interventions
- go up step w good leg, go down with crutch & bad leg
- stand at affected side of patient, elbow should be 30 degrees , cane on unaffected side
Hip fracture signs
Interventions
Prevent DVTs
Prevent infection
Total knee replacement interventions
- shortness of affected leg & externally rotated
- keep legs straight & abducted with pillow
- SCDs, SQ heparin, early ambulation
- incentive spirometer Q1H, d/c foley & proper perineal care
- passive ROM for first 24-48hrs on affected leg
C collar used for
Amputation interventions
Stump care
- suspected spine injury or neck pain
- elevated limb for 1st 24hrs to decrease swelling, after 24hrs place the patient prone to stretch muscles
- wash stump with soap & water, don’t apply anything to stump, encourage use of prosthesis, no semi fowlers
Rheumatoid arthritis is
Signs
Boutonnière
Swan neck
Treatment
For chronic pain/ acute pain
- autoimmune systemic inflammatory response in the joints causing destruction of cartilage & joint
- morning stiffness > 30 minutes & swelling of bilateral joints
- flexion of proximal finger join & extension of distal joint
- extension of proximal finger joint & flexion of distal joint
- NSAIDs, salicylates (aspirin), corticosteroids
- apply heat for chronic / apply cold for acute
Osteoarthritis is
Affects what
Manifestations
Heberdens nodes
Bouchards nodes
- degenerative joint disease due to overuse leading to loss of cartilage & inflammation
- weight bearing joints, mostly hips & knees
- pain occurs later in day due to use of affected joint, difficulty getting up after long sitting
- nodes at distal finger joint
- nodes at proximal joint
Osteoporosis is
Interventions
Prevention
Gout is
Interventions
Carpal tunnel syndrome is
Diagnostic test
Treatment
- bone demineralization leading to fragile bones & fractures
- provide safe environment, use a firm mattress
- calcium & vit D, weight bearing exercises
- palpable hard nodules (tophi) due to build up of urate crystals from high uric acid levels
- colchicine for acute attack, allopurinol for maintenance, low purine diet (red meat, shellfish, alcohol, sardines)
- compression of median nerve in wrist causing pain & numbness to 1st 3 fingers
- phalen test: extreme flexion of wrists for 60seconds & assess for numbness or tingling
- bracing to immobilize wrist or surgery to decompress nerve
Respiratory assessment
Rales / crackles
Stridor
Wheezing
Sputum analysis
D-dimer for
- SOB, productive cough (green= immune system working) (yellow/brown = bacterial infection)
- fluid in lungs
- upper airway obstruction
- partial obstruction
- collect early in the morning
- used to rule out clots (<0.5 indicates no clot)
Laryngoscopy & bronchoscope post op
Pulmonary angiography
Thoracentesis & post op
- assess gag reflex, semi Fowler, maintain NPO until gag reflex returns
- iodine allergies, NPO, expect salty taste & flushing
- removal of fluid or air from pleural space / monitor respiratory status, assess trachea & absence of breath sounds for pneumothorax
Obstructive pulmonary disease
Restrictive
Peripheral airway disease
Early signs of hypoxemia
Late signs
- increased airway resistance; can’t exhale (COPD, Asthmatics)
- problems getting air into lungs (rib fracture, neuromuscular disorders, obesity)
- bronchitis, asthma, cystic fibrosis
- agitation, tachycardia, restlessness
- cyanosis, confusion
Flail chest
Open pneumothorax / closed
Spontaneous pneumo
Pleural effusion / hemothorax
Chest tube location
- multiple rib fractures causing paradoxical respiration
- less trachea deviation / tension pneumothorax; tracheal deviation
- tall skinny males, smokers
- fluid in pleural space / blood in space
- tube at bottom for pleural effusion (fluid) / tube at top for pneumothorax (air)
Chest tube water seal should be
Excessive bubbling in water seal
If tidaling stops
Suction chamber should be
- tidaling with respirations
- indicates an air leak
- indicates obstruction or resolved pneumothorax
- gently bubbling
ARDS due to
PEEP for
PEEP contraindicated for
Signs & symptoms of ARDS
ABGs would indicate
Interventions for ARDS
- alveoli filling with water which decreases gas exchange
- used to keep alveoli open for gas exchange
- cardiac patients (decreased cardiac output)
- persistent hypoxia even with oxygen, white out (ground glass) chest x ray
- respiratory acidosis
- corticosteroids to decrease inflammation & bronchodilators to open bronchioles
How long intubated before trach
Indication for mechanical vent
CMV
A/C
SIMV
- ET tube 5-7 days indicates need for tracheostomy
- PaO2 <50 mmHg, PaCO2 >50 mmHg, RR > 35
- machine does everything for patient
- patient can initiate breath, but vent completes the breath with TV
- patient can breath on their own & machine assists in completion of RR
Ventilator alarms
If you don’t know cause of alarm
Low pressure alarm indicates
High pressure
Apnea alarm
- should never be turned off
- start the AMBU Bag
- disconnection, leak
- obstruction (kink, secretions; mucus plug , pneumothorax)
- no spontaneous breathing
CPAP
BiPAP
To give Bipap
Management of mechanical vent
To treat delirium
When patients are fighting vent
- all breaths initiated & ended by pt
- gives inspiratory & expiratory pressure, last source before ventilation
- pt must be cooperative, alert & systolic >90
- sedatives given with analgesics (Benzos, propofol)
- haldol
- give neuromuscular blocking drugs
Asthma is
Symptoms
Test before & after treatment
Asthma severity (symptoms)
Long acting control meds
Short acting rescue meds
Complications of asthma
- reversible airway bronchoconstriction & chronic inflammation
- Wheezing, cough, SOB
- peak expiratory flow
- intermittent <2 days, mild >2days/week, moderate is daily, severe is throughout the day
- ICS (fluticasone), LABA (salmeterol)
- SABA (Albuterol), prednisone (anti-inflammatory)
- absence of wheezing indicates complete closure of airway
Emphysema is
Chronic bronchitis is
Main cause of barrel chest is
COPD diagnostics ABG
COPS treatment
Pt education/ pursed lip for
- loss of elastic recoil, structural defect
- inflammation of upper airway that prevents air from being exhaled
- air trapping
- low PH & High CO2
- give fluids & hydrate patient to loosen & remove mucous
- pursed lip breathing to prevent early bronchiole collapse
Community acquired pneumonia
Hospital acquired
Risk factors for pneumonia
Symptoms
Treatment
- diagnosed within 48hrs of admission
- diagnosed 48hrs after admission
- Atelectasis after surgery, ventilation
- fatigue, SOB, productive cough, crackles & Ronchi, fever
- do blood cultures before antibiotics
Symptoms of TB
Diagnostic tests
Positive in healthy individual
For immigrants & institutional
Immunocompromised pts
Hospital precautions
- low grade fever, night sweats, hemoptysis, weight loss
- sputum culture (gold standard), mantose test (PPD)
- 15mm wide induration
- > 10mm wide
- > 5mm wide
- air borne precaution, negative pressure, adequate nutrition