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List three functions that muscles perform when they contract.
Stimulus, tone, movement
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List the 5 basic functions of the skeletal system.
Support protection, movement, mineral storage, Hematopoieses
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Ankylosis
Fixation of a joint, often in abnormal positions, usually results from destruction of articular cartilage and subchondral bone
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Arthrocentesis
the puncture of a patients joint witha needle and the withdrawl of fluid, which is performed to obtain samples of synovial fluid for diagnostic purposes
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Arthroplasty
To repair or refashioning of one or both sides, parts, or specific tissue within a joint
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Blanching
to whiten or pale
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Compartment syndrome
a pathologic condition caused by the progressive development of arterial wessel compression and reduced blood supply to an extremity
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Kyphosis
a rounding in the thoracic spine, hump backed appearence
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Lordosis
an increase in the curve at the lumbar space region that throws the shoulders back, making a lordly or kingly appearance
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Paresthesia
any subjective sensation as of pricks of pins and needles
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Your client has just returned from an application of a long leg cast to her right leg. She fell while hanging wallpaper in her kitchen and broke her right tibia. Explain the correct method of determining adequate circulation, possible nerve damage and infection in her right leg.
- the seven P's
- Pain, Pallor, Paresthesia, puffiness, pulseslessness, polar(cold)
- also: look for loss of function, obvious deformity, signs of shock, ecchymosis, warmth
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Rheumatoid arthritis
- a chronic, systemic degenerative joint diesease
- s/s: periods of remission and exacerbation
- inflammation, pain, stiffness, and edema
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Osteoarthritis
- DJD- is a nonsystemic, inflammatory disorder that progressively causes bones and joints to degenerate.
- Primary causes- unknown
- secondary caused by trama, infection, previouse fractures, stress on weight bearing joints, obesity.
- s/s: localized pain, stiffness, bony knobs (Heberden's knobs) in end joints of fingers, edema, discoloration, elevated temp.
- tophi(seen in ear lobes, fingers, hands and toes)
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Gouty arthritis
- a metabolic disease resulting from an accumulation of uric acid in the blood
- s/s: pain, edema, inflammation, in the effected joints
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nursing interventions that would be appropriate for rheumatoid:
Pain related to joint inflammation
- administer prescribed NSAIDS
- Encourage patient to rest inflammed joints
- teach patient to avoid external rotation of extremities
- encourage ADL's
- encourage patient to alternate sitting and standing
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nursing interventions that would be appropriate for rheumatoid:
Pain related to disease process:
- maintain position of comfort
- Keep pressure off joints
- discuss the importance of diet
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nursing interventions that would be appropriate for rheumatoid:
Self esteem, chronic low, related to negative self-evaluation about self or capabilities:
- Encourage patient to expres feelings
- Encourage patient to explore ways to remain active
- be supportive and kind but firm in setting goals
- Encourage independance
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nursing interventions that would be appropriate for rheumatoid:
Knowledge deficit related to lack of information concerning medication and home care management:
- stress the importance of activity and rest, provide exercise schedule
- take recommended medicatin and provide schedule
- maintain healthy diet
- encourage followup visits
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List 4 healthy life style measures a person can practice to reduce the risk of developing osteoporosis.
- maintain a healthy diet low in protein and high in calcium
- dont consume coffee in excess
- get plenty of exercise
- don't smoke
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A client recently had a lumbosacrael laminectomy to repair a herniated disc. Discuss the proper technique to use when repositioning the client, and provide the rationale.
- Log rolling for changing positions
- Elevate HOB no more than 30 degrees
- use stabilizing devices for Head and back
- **aimed at maintaining the stability of the fracture fixation
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Discuss the rationale for the use of traction. Discuss the difference between skin and skeletal traction.
Traction is used to stabilixe a fracture, prevent deformities, reliece pressure on nerves
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Skin traction
is wieghts that are attached to the skin using sponge, rubber, moleskin, elastic bandage with adherent, or plastic just below the site of fracture with pull exerted on the limb
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Skeletal traction
is applied directly to the bone using wires and surgical pins. The pins protrude through the skin on both sides of the extremity and weghts are attached to a rope that is tied to a spreader bar for the purpose of traction
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Discuss what classification of medication Prednisone is, what it is used for and nursing interventions related to it’s use.
- adreno Corticosteroid
- Anti- inflammatory
- used to decrease inflammation; interferes witht he body's normal inflammatory response
- nsg intervention
- monitor I&O- because of fluid retention
- Check Blood sugar r/t false positive with steriods use
- give with food, milk or antacid
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Your client has decided to take the primary care providers advice, and have a total knee replacement. Next to each of the topics list the specific nursing action needed to provide care to your client after surgery.
Positioning:
Wound care:
Activity:
ain control: Pain :
- *Positioning: elevate on pillow for the first 24 hours
- turn patient from side to back to side
- *Wound care: assess for loss of blood
- care of drains
- remove bulky dressign before passive movement
- *Activity: Encourage patient to wear resting knee splint(immobilizer)
- sit in chair with leg elevated
- light weight bearing w/ assisted devices as soon as the 1st post op day as tolerated.
- *Pain control: encourage patient to use K-Kooler at 40 degrees continuously
- administer pain meds as ordered
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List 4 potential complications of a fracture. Include the S/S of each.
- Compartment syndrome- decreased or no pulse to the area, pain, numbness tingling, muscle ischemia(decreased blood supply.
- Fat embolism- anxiety, brain hypoxia, lethargy, weakness, change in LOC, HTN, Tachycardia, tachpnea, hypothermia.
- Infection(gas ganggrene)- Tachycardiam tachpenea, edema, elveated temp, necrosis, fould order from wound.
- Thromboembolus- tha area will tingle, become cold, numb, cyanotic
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Define the acronym R-I-C-E, when it is used and the rationale.
- Rest
- Ice
- Compression
- Elevate
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Define Osteomyelitis, discuss the medical treatment and nursing care.
- Definition:local or generalized infection of bone and bone marrow
- Medical treatment: Intravenous antibiotic therapy(broad spectrum- Keflin). Parenteral antibiotics for several weeks and bed rest. Some may have surgery to remove mecrotic bone
- Nursing Care: Absolute bed rest, wound care for irrigation, teaching s/s of infection
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A client reports that, after exercising for the first time in months, he has begun to experience pain and stiffness in his thigh muscles. Based on your knowledge, do you anticipate his diagnosis will be strain or a sprain? Why? What would you include in his plan of care.
- Strain- hyperextension of a joint, tearing of capsule and ligaments
- Because a strain is a small tear in the muscle or overstretching of the tendon. Whereas, a sprain is caused by a twisting of the joint.
- s/s: hemarthrosis, swelling and paim
- Restrict movement
- Intermittent (15-20 mins on/ off) ice
- Elevate limb
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abducting
Away from the midline
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adducting
in towards the body
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Flexion
decrease the angle
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extend
increase the angle
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supine
flat on back face up
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dorsaflexion
toes towards nose
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colles Fx
wrist, osteoporosis
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oblique Fx
- Break runs along a slant to the lenght of the bone
- slanted cause by forsce from one direstion
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Commuted Fx
- Bone is splintered into three or more fragments
- Crushing- many little pieces
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Segmented Fx
little pieces of bone broken off- leaving an extra pieces
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Spiral Fx
twist and then break- common in child abuse
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Impacted Fx
Force-called a telescope fracture because one is forcibly wedged into another
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Potts Fx
usually occurs at the distal end of the fibula. chippng off of a piece of the bone and displacement of the foot outward
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ankylosing spondylitis (AKS)
- a chronic, progressive disorder of the sacroiliac and hip joints, synovial joints of the spine and the adjacent soft tissue.
- Causes: ankylosis, also ligaments to become ossified (hardened)
- can also cause kyphosis and cause problems with respirations(difficulty expanding rib cage)
- s/s: inflammation in tendons and ligaments and does not affect the synovial fluid. can cause vision loss in chronic cases
- neck, jaw shoulders, knees, hips
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Glucosamine
- Found in the body as a lubricant and shock absorber, necessary for healty joint function.
- Can be given as a suppliment to reduce joint pain, joint tenderness.
- People allergic to shellfish should not take without consulting a Dr.
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NSAIDS used for RA
- Motrin-Ibuprofen
- mobic
- tolectin
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Anti inflammatory
- Prednisone
- Slow acting- plaquenil
- Gold Salts - IM injection
- folex- rheumatrex - po-or- injection
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Analgesic
- celebrex- cardiac complication
- dolobid
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Disease modifying antirheumatiod drugs
- Enbrel- subcut 2x a week
- Remicade (synovial responce) IV med
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Osteoporosis-
med- fosamax is a bone resorption inhibitor
Calcium suppliments (1000mg)
Weight bearing excercises
- disorder that reesults in reduction in the mass of bone per unit voulme.
- is 2.5 standard deviations of the young adult average.
- occurs in women between ages 55-65.
- postmenopausal
- decrease in estrogen
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Normal bones
have a bone mineral density(BMD) within 1 standard deviation of the young adult average.
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Osteopenia (low bone mass)
is 1 standard deviation of the young adult average.
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Fibromylgia syndrome (FMS)
- is a musculoskeletal chronic pain syndrome of unknown etiology that causes pain in the muscles, bones, or joints.
- ages 20-50
- cause unknown- no permanent damage
- aggitation: cold or humid weather, physical or mental fatigue, stress, anxiety, excessive physical activity
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FMS drugs
antidepressants, anti inflammatory, muscle relaxants, pain inhibitors(analgesics?)
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Arthrodesis
surgical fusion of a joint
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Gas Gangrene
- a severe infection of the skeletal muscle caused by gram-positive bacteria, which may occur in a compound fracture and lacerated wounds
- sudden onset occurs 1-14 after injury
- inspect skin for gass bubbles
- Crepitation- crackling sensation when the skin is touched.
- s/s: elevated temp, tachycardia, tachypnea, edema around the wound
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Bucks traction
is a temporary traction used to provide support and comfort to a fractured extremity until a more definite treatment is initiated. Pull
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Russell's
knee sling to provide support. allows for flexion
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Subluxations
- Partial or incomplete dislocation(seperation)
- causes: congenital, disease process, trauma
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Hypoesthesia (carpal tunnel syndrome)
decreased sensation in responce to stimulation of the sensory nerves
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Herniation of intervertebral disk
Herniated Nucleus pulposus
- caused suddenly by lifting, twisting, or trauma; or gradually from djd, osteoporosis, aging, and chronic disease.
- s/s: sciatica- pain in the back radiating down the leg
- treatment: laminectomy, spinal fusionm disectomy
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Osteogenic Sarcoma
- is a primary milignant bone tumor seen most often in young people.
- can metastasize in the lungs.
- fast growing and aggressive that effects long bones
- cause anemia,effect men
- s/s: pain when weight bearign ages10-35 more than females
- treatment- amputation,radiation, chemotherpy
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Osteochondroma
- common type of benign tumor
- seen most often in males 10-35
- do not spread
- s/s: pain when weght bearing
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