Test 3 Flashcards
1
Q
What is an injury to the ligament structures surrounding a joint?
A
Sprain
2
Q
How is a sprain normally caused?
A
Wrenching or a twisting motion
3
Q
What is a first degree sprain?
A
tearing of a few fibers
4
Q
What is a second degree?
A
Partial tear/more swelling and tenderness
5
Q
What is a third degree sprain?
A
Complete tearing of a ligament
6
Q
What is the presentation for a sprain?
A
Extreme pain
Palpate gap in joint
Ankle and wrist are common
7
Q
What is the excessive stretching of a muscle and the facial sheath….. TENDON?
A
Strain
8
Q
What is a first degree strain?
A
Mild to moderate pulled muscle
9
Q
What is a second degree strain?
A
Moderately torn muscle
10
Q
What is the third degree strain?
A
Severely ruptured or torn muscle
11
Q
What is the presentation of a strain?
A
Pain
Edema
Decreased ability to function
Bruising
12
Q
What is the complication that involves a ligament pulling loose from a fragment of bone?
A
Avulsion Fracture
13
Q
What is the bleeding into the joint cavities
A
Hemoarthrosis
14
Q
__________ joint can disocate
A
UNSTABLE
15
Q
Sprains and _______ are usually self-limiting with full function returning in - weeks
A
Strains; 3-6 weeks
16
Q
What are the acute care considerations for strains and sprains
A
RICE and analgesia
17
Q
What are nursing care considerations for 48 hours after a strain or sprain
A
Heat
Limited use
Analgesia
18
Q
What is a severe injury of the ligament structures that surround a joint and results in the complete displacement or separation of the articular surfaces of the joint.
A
Dislocation
19
Q
What is a partial or incomplete displacement of the joint surface
A
Subluxation
20
Q
What are the common dislocation sites
A
Thumb, elbow, shoulder, hip, and patella
21
Q
______________ injuries are orthopedic emergencies
A
Dislocations
22
Q
What is the treatment for dislocations
A
Closed or Open Reduction
23
Q
What are two common complications from dislocation injuries?
A
Avascular Necrosis
Compartment Syndrome
24
Q
What is the nursing care after a joint reduction
A
Immobilize
Pain management
Rehab to prevent contractures
25
What is the compression of the midean nerve
Carpal Tunnel Syndrome
26
What are common causes for Carpal Tunnel Syndrome
Tendonitis
Mass
Rheumatoid disease
Repititive motions
27
What are clinical manifestations for Carpal Tunnel Syndrome
Weakness
Burning
Impaired sensation
Atrophy with hand dysfunction
28
What are the 2 tests for Carpal Tunnel
Phalen's sign
Tinel's sign
29
Treatment options for Carpal tunnel
Pain alleviation
Remove cause
Stop aggravating motion
Remove mass
Corticosteroids
Srugery
30
Nursing Care for Carpal Tunnel
Splints to dorsiflex and relieve pressure
Avoid extreme temp. post steroid injection
Rehab for 7 weeks post op
31
What are the 4 muscles in the rotator cuff?
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis
32
What injury is caused when there is a tear in the rotator cuff and humeral head is no longer stabalized?
Rotator Cuff Injury
33
What are common causes of rotator cuff injuries?
Aging
Stress
Trauma
34
What is the presentation of a Rotator Cuff Injury?
Shoulder Weakness
Pain
Decreased ROM
35
What is the treatment of Rotator Cuff Injuries?
NSAIDS
Corticosteroids
PT
36
What are possible complication after a rotator cuff injury?
Scar tissue
Athrofibrosis after surgery
37
What is the damage of the shearing of the Menisci?
A knee injury
38
What are causes of menisci injuries?
Rotational stress with knee and foot fixed
Blow to Knee
39
Manifestations of a Meniscus injury?
Locational Pain
Knee clicks or pops
Pain with abduction and adduction
Quad atrophy
40
What is the treatment of Meniscus Injury?
Immobilize, Ice, and crutches
Surgical repair
Pain management
PT, ROM, exercises, knee immobilizer
Education r/t pre-activity warm up and stretches.
41
What is a disruption or break in the continuity of the structure of the bone?
Fracture
42
What is a fracture that involves tendons pulling off part of the bone
Avusion
43
What is a fracture when there is more than two fragments within the smaller pieces appearing to be floating?
Comminuted
44
What is a fracture that involves one piece of the bone displaced to the side of the other?
Displaced
45
What fracture that is not all the way through?
Greenstick
46
What fracture is comminuted with more that 2 fragments driven into each other?
Impacted
47
What fracture extends to the articular surface of the bone?
Interarticular
48
What is the incomplete fracture that runs longitudinally?
Longitudinal
49
What is the line of the fracture extends in an oblique direction?
Oblique
50
What is the spontaneous fracture at the sight of bone disease?
Pathological
51
What fracture extends in a spiral direction along the bone?
Spiral
52
What fracture may occur in normal or diseased bone after repeated stress?
Stress
53
What is a fracture line that extends across the bone?
Transverse
54
What is stages of bone healing
Fracture hematoma
Organization into fibrous network
Invasion of Osteoblasts
Callus Form
Remodeling
55
What is the bleeding and edema surrounding bone fragments?
Fracture Hematoma
56
When does a fracture hematoma initiatie?
72 hours after injury
57
What is the local necrosis and when the clot turns into a granulated tissue?
Granulation stage and occurs a few days after injury
58
What is the formation of bone network and appears after the second week of injury?
Callus formation
59
What is it called when the callus is hardened and can start to have some mobility?
Ossification and occurs 3-6 weeks after the injury
60
Over time, bone fragments move closer into proximity, this is called?
Consolidation
61
What is it when excessive tissue is absorbed and there is gradual shaping of the bone?
Remodeling
62
What is the Non-surgical, manual realignment of bone fragments to their previous anatomic positions.
Closed reduction
63
What is the correction of the bone alignment through surgical incision.
Open Reduction
64
What is the application of pulling force to an injured or diseased part of the body while counter traction pulls in the opposite direction.
Traction
65
What is the purpose of traction?
- Prevent or reduce muscle spasms
- Immobilize a joint or part of the body
- Reduce a fracture or dislocation
- Treat a pathological joint condition
- Prevent soft tissue damage
- Expand a joint space before major joint reconstruction or during arthroscopic procedures
66
How long is skin traction allowed?
48-72 hours
67
What is the taping, booting, or splinting attached to the skin until skeletal traction is available?
Skin Traction
68
What is the purpose of skin traction?
Maintain alignment
Assists with reduction
Decreases muscles spasms
69
What is the weight limit for skin traction
5-10 lbs
70
What are other nursing care of skin traction
Asses Q4
Neuro checks
Assess for vascular impingment
71
What is traction is used to align injured bones and joints or to treat joint contractures and congenital hip dysplasia.
Skeletal traction
72
Weight for skeletal traction
5-45 lbs.
73
Never disrupt ________ traction unless life threatening emergency!
Skeletal
74
Nursing Care for Skeletal Traction
Cap refill
Sensation and motor function
Assess pin sites
Check Q4 hours
75
What is a temporary circumferential immobilization device?
Cast
76
A _____ is commonly used after closed reduction
Cast
77
Casts normally incorporate the joint ________ the affected bone
ABOVE
78
A body jacket cast is used for what kind of fractures?
Thoracic and Lumbar
79
What is the nursing care of a body jacket cast?
Repositiion Q2-3 hours to let cast dry
Watch for cast syndrome
80
What is the compressing of the mesenteric artery?
Cast syndrome
81
What is the presentation of cast syndrome?
Abd. pain
Increased Abd. pressure
Nausea and vomitting
Bowel sounds
82
What is the treatment for cast syndrome?
NG to suction- relives pressure
Remove splint or cast- releases pressure
Monitor RR, bowel, bladder and pressure
83
What casts are used for pediatric patients with femoral fractures?
Hip Spica
84
What is the nursing care for a hip spica cast?
Do not lie on abdomen while the cast is drying
Support with pillows
Never use space bar to turn a patient who has a hip spica cast
Skin care under cast edge
85
A fiberglass cast is full strength in minutes and is _______ resistant
water
86
A plaster cast is less costly and is more compliant to molding. But you cannot bear weight for 24-__ hours and must turn Q2
72; Sets within 15 minutes but no weight for 2-3 days
87
What are some nursing care for casts
Handle a new cast with palm of hands
Once dry, smooth rough edges
Put ice on the cast for the first 24 hours
88
What are the 5 P's
Pain- unrelieved pain = compartment
Pulses
Pallor
Paresthesia
Paralysis
89
Complication of Immobilization?
Kidney stones
Constipation
Skin breakdown
Orthostatic Hypotension
90
If a patient gets an infection after an open reduction, what would the nursing care be?
Surgical debridement
Wound management
IV ABX 7-10 days
91
What are complications r/t a bone infection?
Contaminated tissue
Osteomyelitis
92
What is a condition in which elevated intra-compartmental pressure within a confined myofascial compartment compromises the neurovascular function of tissues within that space.
Compartment Syndrome
93
What are the causes of compartment syndrome?
tight cast
edema
94
Types of injuries that can lead to compartment syndrome?
Soft tissue damage
Crush of an extremity
Forearm and lower leg injuries
Severe burns
Venomous bites
Revascularization procedures
95
two most common sites for compartment syndrome?
Upper Arm and Lower Leg
96
Compartment syndrome in the upper arm is called
Volkman’s Ischemic Contracture
97
Compartment syndrome in the lower leg is called
Anterior tibial compartment syndrome
98
Manifestations of CS?
Increased pressure on tissues
Venous occlusion which increases edema
Arterial obstruction and ischemia
Destruction of muscle and nerve cells
Fibrotic tissue replaces normal tissues
Potential for Myoglobinuria
Contractures and loss of function
The 5 + Pressure around the compartment
99
Treatment for compartment syndrome?
- Early detection
- Remove cast
- No RICE
- Fasciotomy
100
What is the nursing care after a fasciotomy?
Leave open for a few days
Infection
Amputation
101
What is the etiology of DVT?
Inappropriate cast or traction
Pressure to a vein
Inactivity
102
What is the nursing care for a DVT?
SCD
TED stockings
Heparin
Wiggle toes and fingers of affected extremities.
103
What is the presence fat globules from fractures that are distributed into tissues and organs after a traumatic skeletal injury.
Fat Embolism Syndrome
104
Where is FES most common?
Long bones like the tibia, ribs, and pelvis
105
What is the clinical manifestation of FES?
12-72 hours after injury
ARDS
Chest pain, high HR, cyanosis, dyspnea, apprehension, high RR, ***low O2***
106
What are more s/sx of FES?
Memory loss
Confusion
Restlessness
Elevated temperature
Headache
Continued change in LOC
***Feeling of impending doom***
Skin change from pale to cyanosis
Petechiae located around the neck, anterior chest,
axilla, buccal membrane and conjunctiva of the eyes
107
Labs to look for in suspected FES?
***Decreased PaO2 < 60***
Fat cells in the blood, urine or sputum
Prolonged PTT
ST segment changes on EKG
CXR (pulmonary infiltrate or consolidation)
Decreased platelets and Hematocrit
108
How is FES prevented?
Careful immobilization of a long bone fracture is the most important factor in the prevention of fat embolism.
109
Nursing Care for FES
Management is symptom related
O2 for hypoxia
Coughing / Deep breathing
Hydration to prevent hypovolemic shock
Correct Acidosis
Replacement of blood loss
Intubate if needed – positive pressure
110
An open book pelvic fracture is caused by what?
External force pulling the pelvis apart?
111
An closed book fracture is caused by what?
lateral force compression
112
What are complication from a pelvic fracture?
Hemorrhage
Paralytic Ileus
Laceration of the bladder, colon, urethra
FES/DVT/Sepsis
113
Upon assessment a pelvic fracture would look like what?
Local swelling
Tenderness
Unusual pelvic movement
Eccymosis
114
Treatment for a pelvic fracture
Bed rest from a few days to 6 weeks
May not be full weight bearing up to 3 months
Casts, External Fixator, IF with screws/wires/plates
Move only on physician order – move with caution
Monitor bowel, bladder and distal neurovascular function
115
Clinical Manifestations for a hip fracture?
EXTERNAL rotation
Muscle spasms
Shortening of an extremity
Severe Pain
116
Nursing Care of Hip (PREOP)
Stabilize other health conditions
Muscle relaxants and pain meds for spasms
Pre-op teaching
117
Nursing Care of Hip (POSTOP)
VS, I&O, respiratory status
Pain meds
Observe dressing for bleeding, sight for infection
Monitor for signs of dislocation (Pain, Lumb on buttock, limb shortening, and external rotation)
118
HIP DO NOTS POST OP
DO NOT force hip >90 degrees flexion
DO NOT force hip into adduction
DO NOT force hip into internal rotation
DO NOT CROSS LEGS
DO NOT put on own shoes or stockings
DO NOT sit on chairs without arms or stand without assistance
119
Hip DOS for at least 6 weeks
Use bedside toilet
Sit in shower chair while bathing
Keep hip in neutral straight position when walking, sitting or lying
Use pillows between knees when lying on “good” side
Notify surgeon of severe pain or visible deformity
***Prophylactic ABX before dental surgery***
Prevent both external and internal rotation with pillows between legs and lateral to effected leg
120
What is when a movement is not likely to cause damage to the spinal cord?
Stable Vertebral Fractures
121
All vertebral fractures are considered _______ until proven other wise
UNSTABLE
122
Other Nursing Considerations for Stable Vertebral Fractures?
Support / Heat/ Traction
Maintain good alignment until healed
May use halo vest and or body jacket cast
Use log rolling
Pain management
Common treatment includes either vertebroplasty or kyphoplasty
123
Facial fractures always assume cervical trauma,,,,
Until proven otherwise
124
Nursing Considerations for Facial Fractures?
Have suction ready to use
Airway – Keep wire cutters taped to head of bed!
Oral HYGEINE
Communication
Pain Management
Nutrition
125
Amputation in the young is normally r/t ________
Trauma
126
Amputation in the middle to older age is r/t ________
Peripheral Vascular Disease
127
Reasons for amputation
PVD
Trauma
Thermal Injuries
Malignant tumors
Uncontrolled Infections
128
Pre-op amputation care
Warn about phantom limb sensation
Type of prosthesis to be used
129
Post-op for amputation
Surgical tourniquets must be available to emergency use.
130
Discharge info for Amputation
Residual limb care
Ambulation
Exercises
Stop using prosthesis if irritation develops
Lie on abdomen for 30 minutes 3-4 times per day
131
What is the chronic progressive loss of bone mass
Osteoporosis
132
_____ and _______ increases bone loss
ETOH and smoking
133
Preg, breastfeeding, menopause all _______ the risk of osteoporosis
INCREASE
134
Treatment options for osteoporosis
Good nutrition
Ca and Vit. D supplements
1200 Ca daily for pt. > 51
Low impact exercise
Calcitonin
Bisphosponates
135
What is severe infection of the bone, bone marrow and surrounding soft tissue either through direct or indirect entry.
Osteomyelitis
136
Clinical Manifestations of Osteomyelitis
Fever / Chills / Night sweats
Restlessness
Nausea
Malaise
Constant bone pain that is unrelieved with rest and worsens with activity
Swelling, tenderness and warmth at the site
Restricted movement of affected part
137
Chronic osteomyelitis lasts for more than
One month
138
Treatment options for osteomyelitis
Aggressive IV ABX therapy
Immobilization of affected limb
Surgical removal of dead tissue/bone with chronic
Pain management
Negative pressure wound VAC
Hyperbaric oxygen therapy
139
Complications for osteomyeltis
Septicemia
Septic Arthritis
Pathologic Fractures
Amyloidosis
140
Benign Bone Tumors
Osteocondroma, Osteoclastoma & Endocroma
141
Malignant Bone Tumors
Osteosarcoma, Chondrosarcoma & Ewing’s Sarcoma
142
Osteosarcoma and Ewing’s Sarcoma require ___________ treatment modalities (surgery, chemo & radiation)
Multiple
143
Chondrosarcoma requires wide _________ resection; typically responds poorly to chemo or radaition
Surgical
144
What is a primary bone tumor that is extremely aggressive and can metastasize quickly
Osteogenic sarcoma
145
sign of Osteogenic sarcoma?
Gradual onset of pain and swelling in kids and young people
146
How is osteogenic sarcoma diagnosed
Alkaline phosphate and Ca levels
X-ray, CT, MRI, PET
Tissue biopsy
147
Treatment for Osteogenic Sarcoma
Pre surgical chemotherapy
Limb salvage if 6-7 cm margin around lesion
Amputation if major neurovascular involvement, pathologic fracture, infection or extensive muscle involvement
Chemo + amputation = 5 year survivability rate
148
What is a primary bone tumor that can occur any time during childhood and young adulthood, but usually develops during puberty. It can cause early metastasis to lungs and other bones (approx 1/3 of diagnosed will have metastasis)
Ewing's Sarcome
149
What are treatment options for Ewing's Sarcoma?
Aggressive chemo
Surgical resection
Radiation
150
What is the most common arthritis, with slow progressive non-inflammatory disease of the synovial joints?
Osteoarthritis
151
What are some manifestations of OA?
Localized pain with activity
Stiffness after rest – usually resolves with movement
May develop HEBERDEN’s Nodes in hands
Crepitation if cartilage integrity is lost
DX – CT, MRI, X-Rays
152
What are treatment options for OA?
Balance rest and activity
Application of heat and cold
Healthy weight
NSAIDS , Acetaminophen, Ointments…
153
What is an important education point for a patient with OA?
Rest, Ice, Compression, and Elevate
***THEY SHOULD NOT WORK THRU THEIR PAIN***
154
What is chronic, systemic autoimmune disease with periods of exacerbation and remission
Rheumatoid Arthritis
155
What is an important education point for patient's with RA?
They ***NEED*** to work thru their pain for flexibility
156
What are some systemic effects of RA?
Sjogren's syndrome
Rheumatoid nodules
Felty syndrome
157
What are diagnostic factors for RA?
+ RF
High ESR and ANA
XR changes and physical assessment
158
What are some treatment considerations for RA?
DMARDs, immunotherapy, corticosteroid injection, NSAIDs, balanced diet, alternating rest and activity to minimize stiffness and fatigue .
Joint protection, heat/cold therapy, ROM exercises, relaxation techniques, biofeedback, TENS
159
What is the increase in uric acid production or under excretion of uric acid in the kidney?
Gout
160
Gout is common in what population?
Middle Aged Men
161
What is the end product of purine catabolism and deposits uric acid crystals?
Uric acid
162
Acute gout effects how many joints?
1-4 joints
163
Acute gout is normally triggered by what?
Trauma, ETOH, infection leading to sudden onset of pain
164
Chronic gout is how many joints
More than 4 joints with visible deposits called tophi and can lead to renal disease
165
What are precipitating factors for gout?
Too many calories
Too many purines in diet
ETOH and drugs
166
What are medication considerations for Gout?
Colchicine, NSAIDS, steroids, ACTH during attacks and allopurinol for chronic
167
Other treatment considerations for Gout?
Adequate fluid volume (2-3L)
Decrease foods high in purines
168
What is the autoimmune inflammatory disease where there are chronic flare ups and remission
Systemic lupus Erythematosus (SLE)
169
What are some triggers for SLE?
Onset of menarche
During/After pregnancy
Sun exposure and infections
170
What are some common manifestations of SLE?
Butterfly rash
ANA
Anti-DNA antibodies
171
What are medication considerations for SLE?
NSAIDS
Immunosuppressants
Steroid sparing drugs
Antimalarials and corticosteroids for flare ups
172
What is the chronic musculoskeletal syndrome that is not understood
Fibromyalgia
173
What are important considerations for Fibromyalgia
It is NONPROGRESSIVE
NON-DEGENERATOVE
NON- INFLAMMATORY
174
What are some physical signs of Fibromyalgia
Widespread burning sensation, poor pain discrimination, non-restorative sleep/ fatigue, IBS, depression, and anxiety (constant pain = poor sleep)
175
What are some treatment considerations for fibromyalgia?
Rest, analgesics, heat, massage, stretching, biofeedback, stress management, antidepressants, Lyrica.
***TREAT PAIN AND SLEEP symptom diary on what triggers pain***
176
What is an infection of Borrelia burgdorferi transmitted by a deer tic?
Lyme Disease
177
What is the hallmark of Lyme Disease
BULLSEYE
178
What are s/sx of Lyme Disease?
Fever
Chills
Stiff neck and HA
Swollen lymph nodes
179
How is Lyme Disease diagnosed?
Assessment and serology
180
How to remove a tic?
Remove with tweezers and wash site with an antiseptic
181
What med is given for Lyme Disease and for how long?
Doxycycline for 20-30 days
182
If Lyme disease is not treated, what can it lead to?
Bells Palsy
Poor motor coordination arthritis
Coagulation problems
183
What kind of breast changes are benign and are the most common breast disorder?
Fibrocystic Conditions
184
What is the basic patho of fibrocystic changes?
Excess fibrous tissue, hyperplasia of the epithelial lining of the ducts, and cyst formation
185
Fibrocystic breast changes ________ and ______ with the menstrual cycle
Enlarge and shrink
186
What is a common cause of benign masses due to increased estrogen sensitivity in a localized area of the breast?
Fibroadenoma
187
What are the manifestations of a fibroadenoma
Small, painless mass, well delineated (circular), mobile, usually solid firm and rubbery (not hard), slow growth/ stops at 2-3 cm, and dramatic growth with pregnancy
188
How is a fibroadenoma diagnosed?
Biopsy
189
What is the treatment for a fibroadenoma?
Surgical Excision
190
What is patient education for a fibroadenoma
Lower caffeine
Teach about herbals
Tumors can reoccur
191
What is a benign wart like growth in the mammary ducts usually near the nipple?
Intraductal Papilloma
192
What are some manifestations of Intraductal Papilloma?
Bloody nipple discharge
Palpable mass
193
What is the treatment for intraductal papilloma?
Excision of the papilloma and the duct
194
What is the benign disease involving the swelling of several bilateral ducts (affects peri/ post menopausal women)
Ductal Ectasia
195
What is the manifestations of ductal ectasia?
Multicolor, sticky nipple discharge, can be itching, burning, and painful around nipple, swelling around areola, discharge may present as bloody later on
196
What is a treatment for ductal ectasia?
Surgical excision of the ducts
197
What are risk factors for breast cancer?
Hereditary: history of breast ca (BRCA 1/2 genes autosomal dominant )
Hormonal involvement: is the tumor hormone sensitive (is it fed by estrogen)
Inactivity and obesity
Smoking and Alcohol
Environmental (chemical or radiation exposure)
First full term pregnancy > 30 y/o or nulliparous (no children)
Long menstrual history (<12 >55 y/o)
>50 years old
198
What is the main risk for hormone replacement therapy?
Risk: hormonal regulation related to breast cancer development (mechanisms are poorly understood)
199
Combines hormone therapy increases the risk of.....
Risk of breast CA
Increased tumor size at diagnosis
Increased tumor stage at diagnosis
200
Breast CA usually arise from epithelial tissue of the _____
Ducts (Called ductal carcinoma)
201
Prognosis of breast CA depend on what factors:
- size of nodule
- axillary node involvement ( more nodes involved, worse prognosis)
- tumor differentiation (tumor board grades the tumor- TNM staging)
- estrogen, progesterone, HER2 receptor status (triple test – ***do NOT want a triple negative***/ triple test: Estrogen-receptor (ER), Progesterone-receptor (PR), & HER2
- cell type has little impact once the tumor is invasive
202
Tamoxifen is used for _____ positive tumors
ER +
203
Herceptin is used for _______ positive tumors
HER 2 +
204
What are the two noninvasive breast cancers
Ductal Carcinoma IN SITU
Lobular Carcinoma IN SITU
205
What is the treatment for non-invasive breast CAs
Lumpectomy
Bilateral masectomy
206
What is an inflammatory process leading to intraductal?
Paget's Disease
207
What are the manifestations of Paget's Disease
Rare, see persistent nipple/ areola lesion, may/ may not feel mass but have excoriation that won’t heal, itching/ burning/ bloody discharge, erosion that leads to ulceration
208
What is the treatment of Paget's Disease
Mastectomy
209
What are the manifestations of Inflammatory breast cancer
Skin looks red and feels warmer
Orange peel looking
Hair follicles enlarge
Skin thickens
210
What is the treatment for inflammatory breast cancer?
Radiation and Chemo
211
What is the removal of tissue with the preservation of pectoralis muscle and axillary node dissection
Mastectomy
212
What are pre-op teaching for a mastetomy
chest wall tightness, phantom breast sensation, arm swelling (lymphedema), sensory lost, Post-op exercises to strengthen arm, chest to decrease lymphedema
213
What is a lumpectomy?
Wide excision of a tumor, axillary node dissection, followed by radiation therapy
214
What are some considerations for a lumpectomy?
There may be breast soreness and swelling, skin reactions to radiation, arm swelling, sensory changes in breast and arm, fatigue, discomfort
215
Primary radiation therapy is for not a surgical candidate and lasts for how long?
5-7 weeks
216
Palliative radiation is what?
Aimed at distant met sites to help shrink tumor and reduce pain
217
What is internal radiation?
Brachytherapy (5 days)
218
There are normally good results if there is a combo of ____
chemo
219
What are some SE of chemo?
Anorexia
N/V
Weight loss
Hair loss
BMS
220
Nursing care for Restoring arm function on affected side after mastectomy and axillary lymph node dissection is one of the most important goals
- Place patient in semi-Fowler’s position with affected arm elevated on a pillow
- Flexing and extending fingers should begin in recovery room, and progressive increase in activity should be encouraged
- Postoperative arm and shoulder exercises are instituted gradually at surgeon’s direction
- Exercises are designed to prevent contractures and muscle shortening, maintain muscle tone, and improve lymph and blood circulation
221
Nursing care for acute lymphadema
- Complete decongestive therapy (CDT) – massage
- Elevation of arm (level with heart)
- Diuretics
- Isometric exercises
- Wearing a fitted compression sleeve during waking hours
- Lifelong protection s/p mastectomy side:
***NO IV sticks, BP cuffs, injections on affected side.***
222
Infection of the pelvis, fallopian tubes, ovaries, and peritoneum?
PID
223
PID begins are ________ and moves upward
Cervicitis
224
What is the common cause of PID?
Chlamydia and gonorrhea
225
Who is at risk for PID?
Females < 24 y/o, multiple sex partners, new sex partners
226
Clinical Manifestations for PID?
- Lower abdominal pain
- Walking and intercourse increase pain
- Spotting after intercourse and vaginal discharge
- Fever and chills
- bilateral adnexal tenderness (ovaries/ovarian ligaments) and pain on manipulation of cervix
- foul smelling/ green vaginal discharge
227
Possible complications from PID?
Fitz-Hugh-Curtis Syndrome – PID causative agent spreads to liver causing acute peri-hepatitis (see RUQ pain but LFTS are normal with this.)
- ovarian or tubular abscesses
- adhesions and stricture of fallopian tubes
- increased ectopic pregnancies / infertility
228
Nursing Care for PID?
Nursing Care:
- Education regarding decreasing STD risk
- Allow expression of feelings (fear, regret, shame etc)
- Monitor VS
- Document color, amt, odor of vaginal discharge
- Increase fluids
- Semi-fowlers – facilitates drainage (HOB 30 degrees)
- Assess abdomen to evaluate drug therapy
- Heat to abd and sitz bath if ordered ( if no abscess)
- Analgesics
- Abx therapy, corticosteroids, no intercourse 3wks
- Test partner for chlamydia/ gonorrhea.
229
What is the slow cell change over time and a change in hormones levels?
BPH
230
What are clinical manifestations of BPH? ***early***
narrowed stream, hesitancy initiating a stream, dribbling after voiding (urinary retention), feel as if not emptied, nocturia, urgency
231
What are clinical manifestations of BPH? ***LATE***
bladder dysfunction, abnormally distended ureters, destruction of kidney tissue, pyelonephritis
232
How is BPH diagnosed?
- Abnormal physical findings (feels nodular, hard or boggy by DRE- all men after age 50)
- Signs of infection (WBC, hematuria, bacteria in urine)
- May see elevated BUN and serum creatinine if long standing problem
- PSA count ( prostate-specific antigens) can rise with BPH
233
What medications can be used for BPH?
Proscar and Cardura
234
What are non-surgical options for BPH treatment?
coil/ stent, prostatic balloon dilation, transurethral needle ablation
235
What is Transurethral resection of the prostate?
TURP
236
What are the basics of TURP?
- no incision, excise and cauterize prostatic tissue
- 18-22 French 3-way catheter with a 30 cc balloon containing 30-60 cc sterile water inserted to apply pressure
- bladder irrigation for first 24 hours- strict I & Os.
237
What is nursing care for TURP?
For bladder spasms - opiate suppositories, push fluids to 2-3 liters per day, assess for hyponatremia and fluid excess, maintain patency of catheter, pain management, mobilize pt - roll side to side – worry about clots in bladder, may have order for continuous irrigation to prevent clot formation
238
What is transurethral cutting/incision of the prostate?
TUI (for mild obstructions and high risk pts.)
239
What procedure is used if there is an extremely large mass?
Suprapubic resection
240
Post-op care for BPH?
- Maintain patency of catheter
- irrigate for clots - CBI
- analgesics
- watch VS etc for infection
- I&O
- avoid lifting > 10 lb or straining
- increase fiber, increase fluids, stool softeners
- Kegel exercises
- watch for hemorrhage
