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Texas State - NURS 3440 - Study Guide - Final

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Texas State - NURS 3440 - Study Guide - Final

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background image Lifespan Final Exam Study Guide-Regina Jillapalli Main Points on Blueprint  Sub-points of Blueprint  Answer from notes/textbook Key Definitions Musculoskeletal and Connective Tissue Manifestations and Complications of Immobility- Skin breakdown, pneumonia,  constipation, blood clots, osteoporosis, muscle atrophy.  Casts- casts are applied after swelling has decreased, and may be cut if they are too  tight. Elevate extremity with cast when possible. You must be able to fit one finger 
under cast. Handle wet cast with palms and keep dry (no water, feces, urine).
Infection- patient and nurse can feel a “hot spot” and smell musty odor.\ Impaired circulation- Assess cap refill, pain, numbness, movability Immobilization effects- see top Report  ↑in drainage Traction- continuous is for fractures (before setting in a cast). Intermittent is to  relieve muscle spasms. Skin traction pulls on extremity with wrapping. Skeletal 
traction pulls on extremity by pins in the bone. 
Upper extremity traction stretches bones in two directions-humerus away from core 
and radius/ulna at right angle to humerus
Lower extremity traction-Buck’s extension traction (leg extended), Russell’s traction 
(leg extended with sling to support knee), or balanced traction (knee slightly flexed 
with tibia/fibula being pulled away from body
Spinal column traction-cervical halter stretches neck, pelvic belt pulls pelvis away 
from core, pelvic sling lifts pelvis off bed
Nursing care of traction: Skin traction must be 5-10lbs, Skiletal can be 15-30lbs. Check equipment frequently for balance, prescribed weights If patient has pain or muscle spasms, check for body alignment or request 
decreased weight
Teach everyone to NOT touch the weights. No weights on floor! Assess skin q8h, assess circulation q1h for first 24 hrs, then q4h. Assess neurovascular status: is there pain, pressure, ability to move, pulse, 
numbness, tingling, color change
Crutches- Proper fit: 2-3 fingerbreaths between axilla and crutch, 6 inches diagonally in front of foot, elbow flexed no more than 30 degrees
background image Walking: weight should be on hand more than armpits. 2 point gate: R crutch w/ L ft;
L crutch w/ R ft. Three Point gate: strong foot, then both crutches with weak foot.  
Four point gate: one movement at a time: R crutch, L ft, L crutch, R ft. Stairs, up: 
strong leg, weak leg, crutches. Stairs, down: crutches, weak leg, strong leg.
Disease process of MSK and CTD Osteoarthritis - Is the non-systemic and non-inflammatory degeneration of cartilage  in weight bearing joints. (Commonly effects neck [C4-C6], lower back[L3-L4], knees 
and hands.) Typically unilaterally affected joints. Bone protrudes through cartilage 
and causes crepitis. Painimmobility, contractures and muscles spasms. Relieved by
rest, worsens with movement.
Rheumatoid Arthritis- Is the chronic, systemic, inflammatory autoimmune disease  that causes body to make antibodies (rheumatoid factor) that causes inflammation. 
Vascular granulation (healing process) actually destroys synovial cartilage and 
bone. Typically affects bilateral joints, starting with small bones of hands, wrists and
feet, and progressing to larger joints (knee, shoulder, hips, cervical spine, jaw). 
Other symptoms include nodules on eyes, joint deformities (ulnar deviation) and 
↓ROM and muscle due to pain. Relieved by gentle movement, worsens with rest
Systemic Lupus Erythematosus (SLE)- autoimmune disorder causing chronic  inflammation of connective tissue. Connective tissue around all organs and joints 
inflamed and/or infected. Kidney failure is leading cause of death. Butterfly rash on 
face, photosensitivity.
Scleroderma- another autoimmune disorder causing systemic inflammation of  connective tissue. Symptoms include Calcium deposits under skin, Raynauds 
phenomenon (first symptom), Esophageal dysmotility, Sclerodactyl (hardening of 
finger skin) and Telangiectasia (hemangiomas on skin). Death occurs due to 
hypertension or lung fibrosis.
Stress or pathologic fractures- Closed (skin not broken), Open (skin pierced),  Transverse (fracture at right angle to long axis of bone), Greenstick (fracture on one 
side of bone, other side bent), Comminuted (three or more bone fragments), 
Oblique (fracture diagonal to long axis of bone), spiral fracture (bone has been 
BONE HEALING PROCESS 1. Hematoma formation: large pool of blood clots, around break, connective 
tissue stem cells come into clot
2. Fibrocartilaginous callus formation: soft callus of hyaline cartilage forms, 
hematoma is replaced by vascular connective tissue granulation
3. Bony callus formation: blood vessels invade soft callus, then osteoclasts 
break down soft callus and osteoblasts build hard callus matrix around the 
blood vessels
background image 4. Bone remodeling: Osteocytes remodel hard callus into proper regions of 
medullary cavity, spongy and hard bone
Broken bones effect breathing (rib bones), posture (shoulder/upper arm/pelvis) and 
mobility (leg).  Crepitis may be heard on examination.  
Complication of fracture: myoglobinuric renal failure (this is acute cx, evidenced by 
red urine. Fat embolism (obstruction of lung vessels by fat). Signs/symptoms of fat 
embolism: altered LOC, dyspnea, chest pain, petechiae over neck, upper arms or 
chest (unique to fat embolism). Need surgery to remove clot
Osteoporosis- “Silent Disease”: chronic loss of bone density. Osteoclastic activity  (destruction) greater than osteoblastic activity (building). Bones break much easier. 
(Pathologic fractures). Osteoporosis can be primary (due to age and loos of 
hormones) secondary (due to disease or medication) or regional (due to immobility 
or gravity-free environment).
Diagnostic procedures of MSK and CTD Osteoarthritis- x-rays, MRI, CT scans, slightly elevated ESR Rheumatoid arthritis- positive for anti-CCP (specific test to detect early RA),  rheumatoid factor will be positive (does not prove RA), anemia, ELISA will be high 
late in disease. Synovial fluid analysis-RA↑turbidity and protein, ↓viscosity (NOT 
thick).  Care of patient after synovial fluid withdrawal-ice and rest joint for 24 hrs. 
Notify NCP if bleeding or synovial fluid comes from site
SLE and Scleroderma use mostly the same lab tests-  Pancytopenia, increased  rheumatoid factors and ANA titers. Skin biopsy for discoid lupus. Osteoporosis-  BMD (bone mineral density) T-score of osteoporosis is ≤ -2.5. BMD T- score of osteopenia is between -1 and -2.5. Low serum calcium, vitamin D, 
phosphorus and protein indicate risk for  osteoporosis. Increased biochemical 
markers indicate risk of osteoporosis. Also must r/o hyperthyroidism or medication 
impact on bone density
Nurse caring strategies for MSK and CTD Osteoarthritis Medications o  drug of choice for pain is acetaminophen (Tylenol). Nursing  implications(NI): ≤4000mg/day. ≤2500mg/day for elderly.  o NSAIDS if Tylenol insufficient. NI: low dose for short timeSE: bleeding,  kidney failure o Celecoxib. Cx are HTN, CV disease
o Topical lidocaine. NI: must have patch on only 12 hrs/day
Intra-articular injections
background image o Glucocorticoids 4 times/year
o Replacement of synovial fluid
General pain management o Joint immobility/rest. (splint or naps!)Cane on strong side of body.  Gentle exercise (avoid stressing joints) o Moist heat application, glucosamine supplements (check with doctor  first, increases BG and HTN o Decrease stress that increases pain Rheumatoid arthritis Medications o Start with NSAIDS, Celecoxib, H2 blockers
o Then DMARDS (disease-modifying anti-rheumatic drugs) These slow 
progression. Methotrexate ↓immunity (avoid crowds and ill people). 
Also is teratogenic
o BRMS (biological response modifiers). Ex: etanercept, infliximab,  adalimumab, anakinra, abatacept o Other immune suppressants and anti-inflammatory drugs General management o Rest, proper positioning, ice/heat application, energy conservation
o Plasma exchange, gene therapy
o ↑Calcium, fish oil (natural anti-inflammatory agent), antioxidants
o PT/OT for self-care, coping strategies and home adjustment for 
disabilities Joint replacement (commonly knee and hip) Pre-surgery-Must have NOT active infection, and have advanced osteoporosis.
Must shower with antiseptic soap before sx. 
Post-surgery o Neurovascular assessment q2-4h for 12 hrs
o Vital signs start out at q15min for one hr, q30min for 2 hrs
o Positioning of hip-For posterior approach place abduction pillow 
between legs and prevent legs from crossing midline. Do not bend hip 
>90°. For anterior approach do not rotate leg out or hyperextend.
o Other care-ice, rest and analgesics, cautious ambulation. Knee replacement-does NOT use general anesthesia o S/sx of systemic absorption of nerve block: metallic taste, tinnitus,  slurred speech, ↓HR, ↓BP, ↓RR, seizures o CPM (continuous passive motion) machine-joint must be in neutral  position, not rotated. New nurses CANNOT apply a CPM machine Scleroderma- Mostly care centered around improving eating (soft food, small meals,  keep upright) and comfort measures (keep warm, maintain skin integrity)

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School: Texas State University
Department: Nursing and Health Science
Course: Nur Care Lifespan
Professor: Regina Jillapalli
Term: Spring 2018
Name: Final Lifespan Exam Study Guide
Description: This study guide covers musculoskeletal, connective tissue, reproductive, transgender and neurological systems
Uploaded: 05/05/2018
18 Pages 70 Views 56 Unlocks
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