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X-Ray
Pregnancy risk also first line and cost effective.
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CT
ask about iodine or shellfish allergy
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MRI
No metal objects, ask about implants such as pacemakers
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Arthroscopy
looking into the joint, monitor site of incision
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5 P
- Pain
- Pulse
- Pallor
- Paresthesia
- Paralysis
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S&S of fractures
- Obvious deformity
- swelling
- pain
- redness
- loss of function
- misalignment
- hematoma
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Bone healing times
- neonatal 2-3 weeks
- early child hood 4 weeks
- later child hood 6-8 weeks
- adolescence 8-12 weeks
- adults 12 weeks
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ABCDE
- Airway
- breathing
- circulation-C1-C4. C3,4,5 Keep the phrenic nerve alive.
- disability
- exposure
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Hemorrhagic shock
Loss of 20% of blood or more will lead to decompensated shock
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H/H Lab
Hemoglobin and Hematocrit
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TDaP
Adults every 10 years. possible prophylaxis booster at 5 years if needed-break in skin.
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Reduction
Realign bones to restore neurovascular function. Under conscious sedation at times.
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Immobilization
Splints, casts, ORIF-Open reduction internal fixation.
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External Fixator
Crush injuries-shattered bone-
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External fixator and pin care risks
Osteomyelitis-Infection of the bone- Proper cleanliness for pins in order to prevent this.
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Tractions
Of major long bones for pain relief and to help neurovascular.
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ESR (erythrocyte sedimentation rate)
Early indicator of widespread inflammatory reaction due to infection or autoimmune disordersUsually normal in OA
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HS-CRP (high sensitivity C-reactive protein)
Non-specific response to acute inflammationIncrease after surgery indicates possible infectionShows inflammation earlier than ESR
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Serum chemistry for bones
- 99% of calcium stored in bones and teeth
- 85% of phosphorous stored in bones and teeth
- Bone disease can lead to an increase in the blood of hypercalcemia and hyperphosephatemia
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Lab values for Muscle
- CK-Creatine Kinase for skeletal and cardiac muscle
- CPK-MM-Creatine phosphokinase for skeletal muscle
- LDH- HS-CRP (high sensitivity C-reactive protein)
- AST (liver, kidney, heart, skeletal muscles)
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Osteoarthritis treatments
- Early treatment-Rx for swelling, PT, Waterarobics, RICE for trauma, Injections of corticosteroid.
- Late treatment-TKA
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Osteoarthritis
OA Nursing care
- Degeneration of the articular cartilage in the joints caused by prolonged wear & tear of joint surfaces
- -Care
- Assess
- Administer
- Apply
- Teach
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Multi_Model_Pain_Protocal
- M2P2
- designed to prevent narcotic overdoses
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DVT post surgery
- increased calf pain
- increased tenderness above or below the knee
- Veins you can see
- Warmth and redness
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Osteoporosis
- Primary-part of aging
- Secondary-Medical conditions, drug therapy-prednisone leads to this condition-prolonged immobility-not weight bearing.
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Test for Osteoporosis
DEXA scan-duel energy x ray measures bones mineral density.
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Nursing care for osteoporosis
Teach importance of wt Bearing exercise
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Risks associated with osteoporsis
- excessive caffeine-calcium loss in urine
- lack of vitamin D for calcium uptake
- high phosphorus intake-low calcium levels
- protein intake too high or too low
- excessive alcohol and tobacco use
- eating disorders and female athletes-triad.
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Calcitonin
stimulates osteoblasts
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vertebroplasty
percutaneous-injection of bone cement into vertebra which reduces pain, increases function, restores strength.
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Osteoporosis
example of a pathologic fracture leading to a fall in a geriatric patient.
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rheumatoid arthritis
- Autoimmune disorder-women more prone
- debilitating
- iritis
- Chronic systemic disease of autoimmune cause with recurrent inflammation involving the synovium or lining of the joints
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rheumatoid arthritis labs
- rheumatoid factor RF
- antinuclear titer ANA
- Erythrocyte sedimentation rate ESR
- High sensitivity C-reactive protein hsCRP
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Nursing Care for RA
- Assess pain and stiffness
- administer anti-inflammatory medications
- aspirin, nsaids,corticosteroids
- implement strategies to protect joints-water aerobics
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Vitamin D importance
- synonym=cholecalciferol=vitamin D3 sunlight
- VIT D +Parathyroid Hormone+Calcitonin regulate calcium metabolism and osteoblasts.
- Ergocalciferol=Vitamin D2 absorbed from plants
deficiency Leads to increase risk of heart attack, fractures, hypertension and autoimmune diseases.
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Gout
- Deposit of urate (uric acid) crystals in & around joints; hereditary error in purine metabolism
- S&S
- Tophi (deposits of crystals on skin) present near joints & on outer ear; renal calculi
- Meds to treat Uric acid build up.
- Colchicine for acute treatment
- NSAIDS for inflammation
- Allopurinol for chronic treatment
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Gout Lab tests
- Serum Uric acid Levels
- 20% of patients develop kidney stones
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Pediatric conditions
- club foot-congenital twisting of the foot
- developmental dysplasia of the hip DDH- Congenital hip-Spica cast
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Legg-Calve-Perthes
Avascular necrosis of the femoral heads occurs in childhood
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Osteomalacia and rickets
Softening of the bones due to demineralization-due to a deficiency of calcium and vitamin D. chronic renal failure also a risk factor.
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Avulsion: tearing away by force-ex. skateboard tricks or a sprined ankle.
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Communited: broken into pieces-ex. gunshot wound or crush injury.
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Greenstick: One side of bone, not a complete break. ex-bending a live tree branch vs a dead one.
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Compression: squeezed together leading to Fx.
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Depressed:Below normal level
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Displaced: removed from normal
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Impacted: packed together
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Oblique: slanting/diagonal
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Simple: Closed fracture/ not displaced
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Spiral: like a thread of a screw
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