Thermoreg and Mobility

Question 1

Normothermia

Answer 1

(Attributes to thermoregulation) 
36.5-37.2 degrees C
97.7-99 degrees F
F=9/5C+32
C=F-32* 5/9

Question 2

Antecedents to Thermoregulation

Answer 2

Normal hypothalamus, sweat gland, and skeletal muscle functions.
Chemical Thermogenesis occurs
Sufficient blood flow
brown fat in a newborn

Question 3

CBC with differential, when ordered and what do the results mean?

Answer 3

Order whenever there is fever.
More segmented- older WBCs - new infection
Not as segmented- younger WBCs older
infection
send out mature WBCs first, send younger immature ones when infection persists and out of mature

Question 4

therapeutic hypothermia (when and why?

Answer 4

after cardia arrest with return of spontaneous circulation, but not regaining consciousness. to decrease the inflammatory process. cool to 32-34 degrees C and maintain for up to 24 hours.

Question 5

If rewarm pt too quickly during rewarming after therapeutic hypothermia

Answer 5

can cause hyperkalemia

Question 6

To avoid and control shivering during therapeutic hypothermia

Answer 6

provide adequate sedation and counter warming of extremities

Question 7

to prevent skin breakdown in pts receiving therapeutic hypothermia, the nurse should

Answer 7

use a low air loss bed surface and turn the pt at least every one to 2 hours

Question 8

to prevent ventilator associated pneumonia (VAP) during therapeutic hypothermia, the nurse should

Answer 8

keep the HOB higher than 30 degrees

Question 9

Extremely high body temperature

Answer 9

Hyperpyrexia

Question 10

physiological changes to keep homeostasis of body temperature are controlled by the

Answer 10

hypothalmus

Question 11

hypothermia mild, moderate and severe

Answer 11

mild- 34 to 36 degrees C (93.2-96.8)
moderate 30-34 degrees C (86-93)
severe less than 30 degree C (

Question 12

Symptoms of hyperthermia

Answer 12

Vasodilation- flushed skin that is warm or hot, increased respiratory rate,
dry mucous membranes, decreased urine prodxn, and electrolyte imbalance signs of dehydration. could be excess sweat or inability to sweat.
High Fever, may have seizures.
cognition- slightly confused to delirious to coma

Question 13

Fever

Answer 13

Hypothalamus changes set point to a higher temperature because of tissue destruction, pyrogenic substances or dehydration.

Question 14

How is a fever produced when there is infection and how is resolved?

Answer 14

macrophages release endogenous pyrogens (proteins) (make cut warm) and signal hypothalamus that temperature needs to be reset to a higher temp to fight the infection. high temps damage parenchyma (cell tissue) and the cause of high temp is removed (infection) and the hypothalamus sets the temp set point back to normal

Question 15

Defense mechanism in children in response to rapid temperature rise from acute illness

Answer 15

febrile seizures

Question 16

preferred antipyretics for children

Answer 16

Acetaminophen and Ibuprofen

Question 17

Diagnostic test when pt presents with a fever

Answer 17

** CBC WITH DIFFERENTAL to diagnose type of infection
-Imagining Studies:
Car wreck and fever- get that CTC to see if head trauma
Chest x ray for pneumonia
Abdominal sonogram for peritoneal inflammation
Urinalysis , especially for elderly population or sexually active young women

Question 18

Use of hypothermia blanket is recommended when?

Answer 18

temperature is above 104 F and cannot be controlled with antipyretics or if the high temp is related to a disorder of temp regulation

Question 19

Malignant Hyperthermia

Answer 19

An inherited reaction to inhaled anesthetics that requires immediate action to prevent death. Can develop during surgery or PACU. Sx: increased end-title carbon dioxide levels, Rapid rise in temp, hypertension and increased muscle contractions

Question 20

Malignant hyperthermia tx

Answer 20

immediately terminate the inhaled gas and start 100% O2. push Dentrolene Sodium which will reset the hypothalamus, administer quick cooling with ice.

Question 21

Heatstroke at risk

Answer 21

Medical emergency caused by failure of the heat regulating mechanism of the body most commonly caused by prolonged exposure to an environmental temp greater than 102.5 F. At Risk: Elderly, Very young, individuals not acclimated to heat, unable to care for self, or with chronic and debilitating disease (cardiovascular disease), or on certain medications: Tranquilizers, anticholinergics (dry you up for surgery), diuretics, or beta blockers (mess with dilation/constriction mechanism)

Question 22

Clinical manifestations of heat stroke

Answer 22

Profound CNS dysfunction manifested by confusion, delirium, bizarre behavior, coma
Temp of 105, hot, dry skin, anhidrosis (absence of sweating), tachypnea, hypotension, tachycardia

Question 23

Management of Heatstroke

Answer 23

Reduce body temp as quickly as possible and constantly monitor. Stabilize oxygenation, Establish IV access and administer NS. Remove clothing, circulating fan and one of the following:
Cool sheets and towels or continuous sponging with cool water, ice packs applied to neck, groin, chest and axillae, cooling blankets or immersion of the pt in a cold water bath

Question 24

Heat Exhaustion

Answer 24

persons temp may be normal to 104. Weakness, hypotension, increased HR, increased thirst.

Question 25

Induced hypothermia, why and how?

Answer 25

reduces metabolic rates and lowers cellular demand for 02. used to reduce neurological damage, lessen anoxia. Usually initiated with ice pack and cool saline with a goal of 33 degrees. Hold at 33 for max of 24 hour and the rewarm over a 12-24 hour period. Use sedation, anticonvulsant to inhibit shivering and paralytic meds

Question 26

During rewarming phase after induced hypothermia, make sure to stop administration of__

Answer 26

potassium. huge intracellular shift of electrolytes during hypothermia and all shift back extracellularly during rewarming.

Question 27

Newborns and thermoreg

Answer 27

Large body surface area in relation to mass so lose 4 times more heat than an adult. Shivering is rare, don't have the glycogen stores for the necessary energy. Non shivering thermogenesis (NST) from Brown Adipose Tissue (BAT) is primary source of heat. Largest threat is environmental exposure- put on a hat! NICU has Polyethylene wrapping for low birth weight babies

Question 28

Frostbite

Answer 28

As tissue freezes − Ice crystals form − Small vessels vasoconstrict then vasodilate Continued exposure  vasoconstriction Superficial frostbite − Numbness, itching, prickling sensation − Cyanotic, reddened, white Deeper frostbite  paresthesias and stiffness

Question 29

Thawing frostbite

Answer 29

``` Thawing of tissues − Skin white or yellow − Loses elasticity − Burning pain − Edema, blisters − Necrosis, gangrene Start immediately, but go slow, put in warm water, not hot!! ```

Question 30

mild hypothermia symptoms

Answer 30

```  Fatigue  Slurred speech  Poor coordination and clumsiness  Confusion and poor judgment  Inappropriate behavior  Shivering  Tachycardia and tachypnea ```

Question 31

Moderate hypothermia symptoms

Answer 31

```  Depressed mental state  No shivering  Depressed respirations  Slow pulse or irregular heart rate  Hypotension  Pale or cyanotic skin  Hallucinations  Coma ```

Question 32

severe hypothermia symptoms

Answer 32

Absence of respirations and pulse  Ventricular fibrillation  Dilated and unresponsive pupils  Coma

Question 33

Primary prevention hypothermia

Answer 33

Reduce Risk Factors * Educate regarding avoidance to exposure and extreme temperatures * Provide adequate resources - Environmental control and shelter - Appropriate clothing - Physical activity - Social services – assess parent’s ability to meet needs, financial constraints, homelessness - Free clinics - Manufacturing prescription programs - Schools

Question 34

secondary prevention hypothermia

Answer 34

Identify underlying cause - Provide comfort - Monitor vital signs closely - Cardiorespiratory monitor - Temperature regulation - Prevent complications

Question 35

tertiary prevention hypothermia

Answer 35

Remove from cold - Provide warm environment – dry clothes - Warming blankets - Administer warm oral fluids - Keep limbs close to body - Cover scalp with blanket or cap - Apply warming pads to axillae, groin, forehead, and nape of neck - Supply warm oral or intravenous fluids - Warm fluid gastric lavage Rapidly rewarm affected areas in circulating warm water, 104°-105° F (40-40.5°C) for 20 to 30 minutes - Following rewarming, keep on bedrest with affected areas elevated - Avoid rubbing or massaging affected areas - Heated humidified oxygen - Administer analgesics and anti-inflammatory agents - Debride blisters - Whirlpool therapy to clean skin and debride necrotic tissue - Support respiratory and cardiac function - Reduce handling to decrease risk of cardiac fibrillation - Hemodialysis and/or peritoneal dialysis

Question 36

Cold stress in newborns

Answer 36

chilling causes respiratory distress s/sx.Increased movement, respirations - Decreased skin temperature, peripheral perfusion - Development of hypoglycemia • Result of metabolic effects of cold stress • Glucometer values

Question 37

Rewarming after therapeutic hypothermia

Answer 37

Stop potassium and warm very slowly (over 12-24 hours, 1/3-1 degree a min) to avoid hyperkalemia. Biggest thing to watch for is arrhythmia, also monitor: urine output, fluids, platelets, cardiac output, electrolytes, hypotension, insulin resistance, shivering and coagulation problems

Question 38

Risk factors for osteoporosis

Answer 38

smoking- highest risk factor!!Female gender Increasing age Low body weight White or Asian ethnicity Family history Early menopause Excess alcohol intake, Sedentary lifestyle Insufficient calcium intake Long-term use of corticosteroids, thyroid replacement, antiseizure drugs Low testosterone levels in men

Question 39

Assessment for mobility

Answer 39

observe balance, gait and posture-unable to walk, limp, hesitant or jerky? Inspect joints and muscles-swollen, stiff, unable to move? Assess muscle strength- cannot prevent nurse from pushing leg or arm? unable to squeeze fingers?

Question 40

Arthrography:

Answer 40

the x-ray examination of a joint space. During arthrography, a contrast material is injected to enable the radiologist to study the joint space that appears on the x-ray image. Xray only works on bone. If it is a real bad sprain, could have torn ligaments. If xray okay, may need to get an mri

Question 41

Arthroscopy

Answer 41

Arthroscopy (ahr-THROS-skuh-pee) is a procedure for diagnosing and treating joint problems. During arthroscopy, a surgeon inserts a narrow tube containing a fiber-optic video camera through a small incision — about the size of a buttonhole. The view inside your joint is transmitted to a video monitor.

Question 42

Electromyography

Answer 42

Electromyography (EMG) is a diagnostic procedure to assess the health of muscles and the nerve cells that control them (motor neurons).

Question 43

Mobility primary prevention

Answer 43

regular physical activity, optimal nutrition, maintaining optimal body weight, and getting adequate rest. Also, taking measures to prevent injury and trauma. Protection against injury Wearing a helmet when riding a bicycle, skateboard, etc. Wearing padding when riding a skateboard Optimal nutrition Education: Exercise a minimum of 30 minutes 3 times a week Wear a helmet when riding a bicycle, skateboard, etc Optimal nutrition- blood sugar drops when you exercise. Why try to get diabetics to exercise. Eat healthy meals Assess the home and yard for potential items that may cause you to trip

Question 44

Tertiary prevention- mobility

Answer 44

``` Visiting nurse, physical therapist or family member helping pt post surgery to live as normally as possible: Checks environment for potential falls Loose carpet, Remove area rugs Don’t forget the outside Loose or chipped Sidewalk, Driveway, Veranda ```

Question 45

mobility secondary prevention

Answer 45

older woman getting and osteoporosis check

Question 46

problems from immobility

Answer 46

``` DVT (deep vein thrombosis) Pulmonary problems Pneumonia Hypoxia Bone demineralization Muscle contractures Skin breakdown (decubiti) Disuse syndrome ```

Question 47

osteoporosis

Answer 47

Chronic, progressive metabolic bone disease characterized by: Porous bone, Low bone mass, Structural deterioration of bone tissue, and Increased bone fragility At least 10 million people in the United States have osteoporosis. One in two women and one in eight men over 50 will sustain an osteoporosis-related fracture

Question 48

Diseases associated with osteoporosis

Answer 48

``` Intestinal malabsorption (Chromes disease or really bad IBS) Kidney disease Rheumatoid arthritis Hyperthyroidism Chronic alcoholism (malabsorption, may lead to cirrhosis of the liver) Cirrhosis of the liver Hypogonadism (low testosterone) Diabetes mellitus ```

Question 49

Drugs that interfere with bone metabolism

Answer 49

``` Corticosteroids Antiseizure drugs (e.g., valproate [Depakote], phenytoin [Dilantin]) Aluminum-containing antacids Certain cancer treatments Excessive thyroid hormones ```

Question 50

osteoporosis prevention

Answer 50

Regular weight-bearing exercise Fluoride Calcium Vitamin D

Question 51

collaborative care for osteoporosis would look like?

Answer 51

working with the healthcare team combo of dietitian (proper nutrition), physical therapy(weight bearing exercise, prevention of fractures, gait aid to prevent falls), pharmacist (drug therapy, calcium supplements)

Question 52

Adequate calcium intake?

Answer 52

1000 mg/day premenopausal and postmenopausal taking estrogen 1500 mg/day postmenopausal without estrogen Supplemental calcium Must be taken in divided doses with food to enhance absorption Vitamin D necessary for calcium absorption/function; bone formation Sunlight for 20 minutes adequate Supplemental (800-1000 IU/day) Postmenopausal Older adults Homebound Minimal sun exposure

Question 53

Calcium rich foods:

Answer 53

``` Milk Yogurt Turnip greens Cottage cheese Ice cream Sardines and anchovies (canned with bones) Spinach ```

Question 54

*Bisphosphonates*

Answer 54

Inhibit bone resorption Side effects: anorexia, weight loss, gastritis Proper administration Take with full glass of water while sitting up or standing! Take 30 minutes before food or other meds. Remain upright for at least 30 minutes. Never crush med. Rarely can cause jaw bone death.

Question 55

Calcitonin

Answer 55

is secreted by the thyroid gland and inhibits osteoclastic bone resorption by directly interacting with active osteoclasts. Salmon calcitonin (Calcimar) is available in intramuscular, subcutaneous, and intranasal forms. Administration of the intramuscular or subcutaneous form of the drug at night has been shown to decrease the side effects of nausea and facial flushing associated with this drug. Nausea does not occur with the nasal spray. If patients are using the nasal form, teach them to alternate nostrils daily. Nasal dryness and irritation are the most frequent side effects. When calcitonin is used, calcium supplementation is necessary to prevent secondary hyperparathyroidism.

Question 56

osteoarthritis

Answer 56

Caused by direct damage or instability, regular exercise can help prevent.Inflammation is NOT a characteristic! Usually recommend acetemetaphin over nsay because nsay treats inflammation. Can have inflammation of synovial fluid- but not considered an inflammatory diseaseLocalized Joint Cartilage (localized, not systemic!) Usually occurs after 50* Usually overweight Stiffness in AM subsides after 30 minutes; then worsens, relieved with rest Synovial fluid WBC’s

Question 57

osteoarthritis risk factors

Answer 57

``` Age Estrogen reduction at menopause Obesity Injury Frequent kneeling and stooping ```

Question 58

rheumatoid arthritis

Answer 58

``` Systemic manifestation Immune system Can occur at any age Usually loses weight Stiffness lasts 1 hr to all day, may decrease with use, rest does not improve sx WBC > 20,000 mostly neutrophils ```

Question 59

osteoarthritis planning goals

Answer 59

Maintain or improve joint function Use joint protection measures Achieve independence in self-care and maintain optimal role function Use drug and nondrug strategies to manage pain

Question 60

nursing interventions for osteoarthritis

Answer 60

``` Pain management Drugs Nondrug strategies (exercise, heat, cold, relaxation, yoga) Splints Physical therapy for exercise program Tai chi Warm-up to prevent injury Patient teaching: Nature and treatment of disease Pain management, Body mechanics , Correct use of assistive devices, Joint protection and energy conservation, Nutrition, Weight and stress management, Exercise, Assure deformity is not usual course of OA, Community resources ```

Question 61

osteoarthritis health promotion

Answer 61

Community education Alteration of modifiable risk factors Weight loss Occupational and recreational hazards Safety measures in athletic instruction and physical fitness programs Prompt treatment of traumatic joint injuries

Question 62

open reduction for hip fracture

Answer 62

surgical repair

Question 63

closed reduction for hip fracture

Answer 63

called a buck's traction. only used if no surgeon available. when removing, remove weight first and inspect skin for breakdown

Question 64

pos operative care

Answer 64

``` Following the A-B-C’s Airway Breathing Circulation Observe for complications Bleeding Dehiscing (wound breaks open) Nausea & or Vomiting Pain control Special positioning ```

Question 65

posterior hip replacement (versus anterior)

Answer 65

More of a chance of dislocation Most keep legs abducted (separated) Abduction pillow or wedge Must be careful re: positioning

Question 66

behavioral scale for scoring pain in a nonverbal patient

Answer 66

FLACC

Question 67

acute pain

Answer 67

Sudden onset Less than 3 months time for normal healing to occur Mild to severe Generally a precipitating event or illness can be identifiedCourse of pain decreases over time and goes away as recovery occurs. Includes postoperative and trauma pain Treatment goal Pain control with eventual elimination Manifestations reflect sympathetic nervous system activation: Increased heart rate Increased respiratory rate Increased blood pressure

Question 68

chronic pain

Answer 68

Persistent pain Gradual or sudden onset More than 3-month duration; may start acute but continues past normal recovery time Cause may be unknown. Does not go away; characterized by periods of waxing and waning Behavioral manifestations Decreased physical movement/activity Fatigue, Withdrawal from others and social interaction.Can be disabling and accompanied by anxiety and depression Treatment goals Control to the extent possible Focus on enhancing function and quality of life

Question 69

Non drug pain therapy

Answer 69

Massage, Exercise TENS or PENS, Acupuncture Heat or cold therapy,Transcutaneous electrical nerve stimulation (TENS)- Delivery of an electrical current through electrodes on the skin,Acupuncture,Traditional Chinese medicine,Cognitive therapies: Distraction,Hypnosis, and Relaxation

Question 70

General care guidelines for immobilized patient

Answer 70

``` Frequent turning, positioning, alignment Skin assessment and skin care Range of motion Deep breathing Weight bearing (if possible) Measures to optimize elimination Nutrition Exercise therapy Ambulation Joint mobility Stretching Balance Pharmacologic agents Anti-inflammatory agents Analgesics Nutrition supplementation ```

Question 71

Disuse syndrome

Answer 71

can be prevented by moving for 5 minutes 2 times a day. Reverse by increasing activity as pt progresses. collaborative care will include nurse, physician, physical therapist, occupational therapist, dietitian and social worker

Question 72

Hoyer lift

Answer 72

allow a person to be lifted and transferred with a minimum of physical effort. Can typically lift 400-600 max pounds, but some can go up to 1,000

Question 73

muscle wasting from inactivity

Answer 73

Increased nitrogen in the urine Protein loss of 8 grams a day Calcium wastage (1.54 grams per day)

Question 74

Cardiovascular problems from inactivity

Answer 74

Oxygen intake decreases Cardiac output decreases Systolic blood pressure rise Orthostatic hypotension common problem

Question 75

Occurrences in Blood and Lungs from inactivity

Answer 75

Decrease in RBC, Increase in DVTs Increase in secretions (can block brachial) Atelectasis Poor gas exchange

Question 76

Occurence in GI from inactivity

Answer 76

Mucosal atrophy | Liver atrophy

Question 77

genitourinary system from inactivity

Answer 77

Myoglobin being destroyed, goes out into the bloodstream, myoglobin is very toxic to kidneys. Can put into complete renal failure. Elevated potassium from degenerating muscles. Potassium is in your muscles, can cause the heart to stop.

Question 78

Reproductive and endocrine systems from inactivity

Answer 78

Decrease serum androgen levels Decrease spermatogenesis Irregular menstrual cycles Thyroid and adrenal gland function decreases.

Question 79

Other consequences of inactivity

Answer 79

Body temperatures fall, andCircadian rhythms desynchronize Breakdown of feedback-The body loses the ability to communicate with itself immune system breaksdown. Stagnation -body fluid prime place for bacteria and fungi to grow, Infection follows, May lead to sepsis Cardiovascular vulnerability, Obesity, Musculoskeletal fragility, Depression, and Premature aging

Question 80

Respiratory therapy for immobile patient

Answer 80

``` Ventilator Breathing treatments Chest Physiotherapy Chest percussion Nursing Care Keep Airway open Suctioning endotracheal tube (after percussion) Medications to improve oxygenation Monitoring pulse ox ```

Question 81

Mobility Primary prevention

Answer 81

regular physical activity, optimal nutrition, maintaining optimal body weight, and getting adequate rest. Also, taking measures to prevent injury and trauma.