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What is the cause of dysplasia of the hip?
variety of conditions in which the femoral head and the acetabulum are improperly aligned
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What can cause dysplasia of the hip?
- dislocation
- subluxation
- acetabular dysplasia
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what are risk factors to developing dysplasia of the hip?
- females>male
- 1st degree relative
- intrauterine postioning
- maternal increased estrogen levels
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What will be seen in a child with dysplasia of the hip?
- limited abduction
- affected hip can not be pressed back to hit the table
- knee is lower
- "click" heard as femoral head slips into acetabulum under gentle pressure
- asymmetry gluteal and thigh fat fold
- telescoping or pistoning of the thigh
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What is the overall management of a child with dysplasia of the hip?
attempt to form a normal joint
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What type of treatment can be done at attempting to form a normal joint for a dysplasia hips?
- keeping the head of the femur within the hip acetabulum
- constant pressure to enlarge & deepen the acetabulum
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In order to try to correct dysplasia of the hip in a newborn what will be done?
abduct the hips by using a Pavlick harness for 24 hours/day
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In order to try to correct dysplasia of the hip in a 3 months-3 years old what will be done?
- Bryant traction for 20 hours/day for 3-4 weeks
- stretches the soft tissue to allow the hip to be placed in the acetabulum
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In order to try to correct dysplasia of the hip in a 3 year old or older what will be done?
- if its dislocated its reduced under general anesthesia
- and spica cast to hold abduction for 5-9 months and changed every 6 weeks and may wear a brace after for 1-2 months
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What are factors of a congenital club foot?
- boys>girls
- bilateral or unilateral
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What will a child foot look like in a congenital club foot?
- foot is directed downward, inward, forefoot adducted
- foot is shorter with a shortened Achilles tendon
- lower leg muscle atrophy
- child walks on toes & outer borders of the feet
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How is congenital club foot treated at birth?
long leg cast for 12 weeks and change every 1-2 weeks
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In mild cases of congenital club foot how is it treated?
proper shoe to correct
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In sever cases of congenital club foot how is it treated?
- surgery in 4-12 months followed by casting and corrective shoes
- surgery to cut tendon and add pins in bones
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What are the responsibility of the nurse for a patient after surgery to correct club foot?
- assessments (VS)
- elevation
- ice
- pain manamgement
- emotional support
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What is the manifestations of scoliosis?
lateral, curvature, flexing laterally and rotating around it longitudinal axis
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Who is more likely to develop scoliosis?
- 2-4% adolescents
- girls>boys
- 10-13 years of age
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What is the cause of scoliosis?
- soft tissue shortening
- vertebral shape and disk space abnormalities
- fixed rotational deformity
- thoracic curvature
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How might the ribs on the convex side of a patient with scoliosis be seen as?
displaced posteriorly and widely spaced
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How might the ribs on the concave side of a patient with scoliosis be seen as?
displaced anteriorly and narrowly spaced
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What are the main problems that can occur with a patient with scoliosis?
- hips
- knees
- feet
- heart
- lungs
- chronic pain
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How do we treat mild scoliosis curvature <20 degrees?
- frequent evaluations
- exercise program
- may or may not wear brace
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How do we treat moderate curvature scoliosis 20-45 degree?
- Milwaukee brace worn for 23 hrs/day
- taken off for one hour to bathe or swim
- Lateral electrical surface stimulation (LESS)
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How do we treat severe curvature scoliosis >45 degrees?
- surgery-spinal fusion, done in stages, and Harrington rods in place until fusion is solid
- after surgery wear a body cast for 6-9 months
- after body cast wear a brace
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What happens when an individual has back pain?
disk's central portion slips through the surrounding annulus fibrosus into the spinal canal, putting pressure on the nerve root
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What are causes of a patient having back pain?
- lifting
- twisting
- direct injury
- degenerating disk due to old age
- weakened anulus
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Where is the most common back pain located at?
L4-L5
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What are the risk factors for developing back pain?
- increased age
- Lumbar herniation 20-45 yrs
- Cervical herniation over 50 yrs
- male>women
- pregnant women
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What type of symptoms might a patient state they have with back pain?
- pain worsening with activity, subsides with rest
- unilateral or bilateral pain
- sciatic never pain radiating down the leg
- muscle spasms
- weakness
- sensory deficit (losing bladder control)
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How can we diagnose back pain?
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What is the best way to prevent back pain?
- Prevent back pain
- good body mechanics
- core conditioning
- flexibility
- normal body weight
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What can you tell a patient to do to help treat their back pain?
- bed rest with body alignment
- muscle strengthening exercise ASAP
- PT
- traction
- ice-inflammation
- heat-pain
- muscle relaxants
- analgesic
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What is the purpose of having a Laminectomy?
- treats bony impingement on the nerve root when neuro involovment
- removes lamina over the nerve root, then removal of the herniated nucleus pulposus
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Where is the incision located if your having a cervical laminectomy?
anterior
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Where is the incision located if your having a lumbar laminectomy?
posterior
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Define osteoarthritis?
- progressive
- non systemic
- non inflammatory
- bone & joint degeneration
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Which joints are affected with osteoarthritis?
weight bearing joints: knee, hip, cervical and lumbar vertebrae & great toe, and also hands
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What are the reasons of having a primary cause of osteoarthritis?
- no predisposing factors
- hereditary
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What are the reasons of having a secondary cause of osteoarthritis?
- trauma
- congenital or developmental defects
- other arthritic types
- diabetes mellitus
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What are risk factors for developing osteoarthritis?
- obesity
- family history
- history of excess use of same joint
- history of joint injury
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What are complications of having osteoarthritis?
- pain
- flexion contractures
- deformity
- bony cysts, gross bony overgrowth
- nerve root compression
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What do we want to tell the patient to do to treat osteoarthritis?
- activity balanced with rest
- physical therapy
- heat/cold
- exercise
- assistive devices
- drug therapy
- surgery for joint replacement
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Define rheumatoid arthritis?
- chronic
- systemic
- progressive inflammatory disease
- immunologic changes
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which patients are more likely to have rheumatoid arthritis?
- 20-50 years old
- women>males
- inherent tendency
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Which joints are most affected in rheumatoid arthritis?
hands most affected bilateral
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What's the difference of how the joints on the hand will look like in rheumatoid vs. osteoarthritis?
- rheumatoid: warm, tender swollen, and decreased ROM
- osteoarthritis: not warm, not swollen
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What is the cause of rheumatoid arthritis?
auto immune response within the synovial tissue inflamed>increased fluid>causing thickening synovia>causing granulated tissue>damages the cartilage, joint tissue, tendons, ligaments, and subcutaneous tissue>causes proteolytic enzymes are released>causing more destruction of the disease
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What are complications of rheumatoid arthritis?
- flexion contractures: fingers flexed, turned laterally
- tendon/muscle weakness
- septic arthritis
- nerve compression
- skin ulceration
- neuropathy
- pericarditis
- pulmonary
- pleural disease
- interstitial fibrosis
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What type of treatment are used for rheumatoid arthritis?
- surgery for joint replacement
- drug therapy: NSAIDs, steroids, gold containing agents, immunosuppressive drugs
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What is the primary cause of Gout?
uric acid over production &/or retention
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What is the secondary cause of gout?
drugs or other disease state
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What types of symptoms will a person with gout be seen having?
- abrupt swelling tenderness & pain in joint that last several weeks
- very painful want nothing to touch
- symptoms worse with each attack
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What are causes of a GOUT flare up?
- surgery
- minor trauma
- excessive alcohol
- foods high in fats/proteind
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which joint is most affected by GOUT?
GREAT TOE
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What type of treatment will be given for a patient with a GOUT attack?
- anti-inflammatory
- colchicine-acute phase
- indomethacin
- corticosteroids
- allopurinol
- sulfinpyrazone
- rest
- heat/cold
- diet change
- weight loss
- hydration
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What is the indication for allopurinol?
reduces uric acid production taken every day
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What is the indication for sulfinpyrazone?
decrease serum uric acid
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Define systemic lupus erythematose?
- chronic collagen vascular disease
- autoimmune disease
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Which type of the body systems does lupus affects?
- multiple body systems affected (changes from individual to individual)
- producing widespread to connective tissues, blood vessels, and serous/mucous membranes
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what type of symptoms would a patient complain of if the have lupus?
- facial erythematic (butterfly rash)
- alopecia
- stiff aching joints
- musculoskeletal deformity/pain
- photosensitivity
- fatigue
- weight loss
- remissions & exacerbations
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What are other complications that can arise from Lupus?
- pleural effusions (lungs)
- heart problems
- Lupus nephritis (kidney)
- arthritis
- Raynaud's phenomenon (fingers)
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What are primary treatments for a patient with lupus?
- NO CURE
- prevent exacerbations
- suppress inflammation
- relieve symptoms
- immunosuppressive medications
- plasmapheresis
- emotional support
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What are the primary cause of hip fractures?
- TIA's (cardiac problem)
- hypotension
- poor vision
- falls
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what are risk factors for a patient of having a hip fracture?
- increased age
- women>males
- osteoporosis
- sedentary lifestyle
- weakened quadriceps
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What type of fracture is a intracapsular fracture and what is the problem with this one?
- fracture of the femurs head and neck
- has slow healing due to limited blood supply
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What type of fracture is a extra capsular fracture and what is the problem with this one?
- fracture in femurs trochanteric region
- has good healing due to good blood supply
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What type of things would you see in a patient with a hip fracture?
- pain in hip, groin, or knee that worse with movment
- affected limb is rotated and shortened
- muscle spasms
- hematoma and ecchymosed
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what tings can we use to diagnose a hip fracture?
- X-ray
- decreased hemoglobin
- elevated enzymes & blood glucose
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What types of treatments are we going to do for a patient with a hip fracture?
- Bucks traction especially before surgery
- surgery (open reduction, internal fixation or replacement)
- pain meds
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What are complications of a patient with a hip fracture?
- pain
- skin & soft tissue injuries
- nerve injuries
- vascular complications
- delayed, incorrect or non union of bone
- secondary infections
- adhesions and joint stiffness
- fat emboli syndrome
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What are the causes of having a joint replacement?
- 1. arthritic or injury induced inflammation
- 2. abnormalities after fracture healing
- 3. physiologic changes from aging
- 4. cartilage degeneration
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What patients are most like to have a hip replacement with a shell mesh replacement and why?
- younger patients
- they work longer
- but patient cant walk for 3 months after surgery
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What patients are most like to have a hip replacement with a glue cup replacement and why?
- older patients
- they can get up and walk next day
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After surgery of a patient with a hip replacement what is the nurse going to mainly focus on?
- pain management
- position patient with abductor pillow & hip rolls
- teach them not to cross legs
- monitor dressing and drains
- ambulation
- monitor for signs of dislocation
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What are signs of a hip replacement being dislocated?
- worsening pain
- shortening of leg
- popping sound
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What types of things are going to be used when a patient has had a total knee replacement?
- CPM
- ICE
- Auto transfusion (during surgery)
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What are the causes of a person getting an extremity amputated?
- trauma
- vascular insufficiency (diabetes)
- cancer
- infection
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After a patient had a amputation what things is a nurse going to teach them?
- elevate extremity for first 24 hours after
- start ROM after 24 hours
- avoid external rotation or abduction
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What are the main complications of having an amputation?
- contractures
- phantom pain
- hematoma
- necrosis
- wound dehiscent
- gangrene
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When should a nurse be most concern with a patient developing compartment syndrome?
2 hours to 6 days following surgery or trauma
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What are signs/symptoms that a patient might experience with compartment syndrome?
- pain
- pallor
- pulselessness
- paralysis
- paresthesia
- cyanosis
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What is the priority treatment for compartment syndrome?
release pressure by doing a surgery to split the fascia envelope
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What are complications of compartment syndrome?
- ischemia (histamine release>edema>blood vessel compression
- neurologic (due to pressed damaged nerves
- contractures (fibrous tissue that replaces ischemic muscles & tendons
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What types of things cause compartment syndrome?
- fractures
- crushing injuries
- internal pressure or bleeding
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What areas are most affected by compartment syndrome?
- lower leg
- forearm
- thigh
- others: shoulder, hand, butt, and foot
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How does compartment syndrome occur?
fascia is unable to expand for the blood and causes muscles to swell pressing occluding nerves & blood vessels
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