Exam #4 Study Guide
Exam #4 Study Guide Nurs 3310
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This 16 page Study Guide was uploaded by Christie Kepler on Sunday March 27, 2016. The Study Guide belongs to Nurs 3310 at Western Michigan University taught by Bergman in Winter 2016. Since its upload, it has received 22 views. For similar materials see Nurs Med Surg in Nursing and Health Sciences at Western Michigan University.
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Date Created: 03/27/16
Study Guide Exam #4 Nursing Management: Strains & Sprains 1.) Stop the activity and limited movement 2.) Applying ice compresses to the injured area 3.) Compressing the involved extremity 4.) Elevating the extremity 5.) Providing Analgesic RICE- (Rest, Ice, Compression, Elevation), decreases local inflammation and pain. Movement is restricted and the extremity rest as soon as pain is felt. Cold- causes vasoconstriction and reduces pain, Shouldn’t exceed past 20-30 minutes. Compression- Start distally and move proximally only for 30 min and remove 15 min. Bones 206 bones o Long Bones: characterized by a central shaft(diaphysis) and two widened ends Ex: Femur, humerus, and tibia o Short Bones: composed of cancellous bone Ex: Carpals in the hand and Tarsals in the foot o Flat Bones: two layers of compact bone separated by a layer of cancellous bone Ex: Ribs, skill, scapula, and sternum o Irregular Bones: appear in a variety of shapes and sizes Ex: sacrum, mandible, and ear ossicles Gross Structure: o Each bone consists of epiphysis, diaphysis, and metaphysis Epiphysis: the widened area found at each end of a long bone, is composed primarily of cancellous bone. Diaphysis: main shaft of the bone. It provides structural support and is composed of compact bone. Metaphysis: flared area between the epiphysis and diaphysis, composed of cancellous bone. Lewis et al. (2014). Medical-surgical nursing: Assessment and management of clinical problems(ted.). St Louis: Elsevier Epiphyseal plate: growth zone, is the cartilaginous area between the epiphysis and metaphysis. Periosteum: composed of fibrous connective tissue that covers the bone. Image: Opencirriculum.org Muscle Structure: Epimysium: enclosed skeletal muscle Fasiculi: connective tissue surrounding and extending in the muscle divided into fiber bundles Perimysium: covers fiber bundles Endomysium: innermost connective tissue Muscle Fibers: o Myofibrils Sarcomere: contractile unit of the myofibril Myosin (thick) filament Actin (thin) filament Ligaments: connect bones to bones Tendons: attach muscles to bones as an extension of the muscle sheath that adheres to the periosteum. Fascia: layers of connective tissue with intermeshed fibers that can withstand limited stretching. Provides strength to muscle tissue. Bursae: Small sacs of connective tissue lined with synovial membrane and containing viscous synovial fluid. Ex: found between the patella and the skin. Osteoporosis: Risk factors: Advancing Age > 65 y.o. Current Cigarette Smoking Female Gender Non-traumatic Fracture Low Body Weight Sedentary lifestyle White or Asian Ethnicity Post-menopausal problems(ted.). St Louis: Elseviercal nursing: Assessment and management of clinical Family Hx: osteoporosis Low Testosterone level in Diet low in calcium or vitamin Men D deficiency Long Term use Excessive use of alcohol (>2 corticosteroids, thyroid drinks/day) replacement, heparin, long- acting sedatives, or anti- seizure. Diagnostic Studies: Hx and physical Examination o Most common in Spine, hips, and wrists Gradual loss of height and a humped back known as kyphosis, or “Dowager’s Hump”. Lab Values o Serum Calcium, Phosphate, alkaline phosphatase, and Vitamin D levels Bone Mineral Density (BMD) o Dual-energy x-ray absorptiometry (DXA) T-scores >= -1 normal BMD <-2.5 Osteoporosis o Quantitative Ultrasound Treatment: Diet High in Calcium o 1000 – 1500 mg/day Food High in Calcium o Milk, Cheese, Yogurt, Ice Cream, Seafood- Sardines, Oysters, Broccoli, Spinach, Almonds Vitamin D supplement o 20 minutes/day – Sunlight o 800-1000 IU/day Regular Exercise o Weight bearing o Walking 30 min/day Drug Therapy: o Biphosphate- increase total Bone mass and BMD problems(ted.). St Louis: Elseviercal nursing: Assessment and management of clinical Fosamax o Calcitonin o Selective Estrogen Receptor Modulators Evista o Teriparatide (Forteo) recombinant form of PTH o Denosumab (Prolia) used for postmenopausal women Influences of Bone Healing: Displacement and site of fracture Blood supply to area Immobilization Internal Fixation Devices Infection or poor nutrition Age Smoking Cast care: Do: o Apply ice over site for first 24 H o Don’t get cast wet o Dry after exposure to water Blot dry with towel Use hair dryer to dry cast o Elevate extremity above heart for first 48 Hour o Move joint above and below cast regularly o Use hair dryer on cool setting for itching o Report signs of problems: Increasing pain Swelling Pain during movement Burning or tingling under cast Sores or foul odor under cast o Keep appointments Don’t: problems(ted.). St Louis: Elseviercal nursing: Assessment and management of clinical o Get cast wet o Remove any padding o Insert objects inside cast o Bear weight on cast for 48 hours o Cover with plastic for long periods of time. Traction: 1. Prevent or reduce pain and muscle spasms with low back pain or cervical pain. 2. Immobilize a joint or a part of a body 3. Reduce a fracture or dislocation 4. Treat a pathologic joint condition (Tumor or infection) 2 Common Types of Traction: Skin traction- short term use , 48-72 hours A Buck’s Traction- immobilize a fracture, prevent hip flexion contractures, and reduce muscle spasms Management: Maintain continuous traction Keep weights off the floor Assess skin, movement, and sensation Cast Temporary treatment for closed reduction Immobilization above and below joint restricts tendon and ligament movement. Should never be covered cause air cant circulate, heat builds up and can burn and delay drying process External Fixation Apply traction or to compress fracture fragments and immobilize reduced fragments Salvage extremities that otherwise might require amputation Long-term process o Assess for pin loosening and infection Infection problems(9ted.). St Louis: Elsevieral nursing: Assessment and management of clinical Exudate, erythema, tenderness, and painful removal of the device Meticulous pin care Soap and water Internal Fixation Proper alignment is done by x-rays on regular intervals Assessment: Peripheral Neurovascular o Peripheral Vascular pulses Color Edema Temperature o Peripheral Neurologic Sensation Capillary Refill Motor Function Pain Compartment syndrome Swelling and increased pressure within a limited space Signs and Symptoms: o Six Ps Pain- not controlled by drugs Pressure Paresthesia Pallor Paralysis Pulselessness Management: o Evaluate location, quality, and intensity of pain o Assess Urine output- myoglobin o DON’T elevate above heart o DON’T cold or compress o Split cast in half o Reduce Traction Weight o Fasciotomy Table 63-10 – Problems associate with musculoskeletal injuries problems(ted.). St Louis: Elseviercal nursing: Assessment and management of clinical Problem Description Nursing management Muscle Atrophy Decreased muscle mass- Isometric muscle prolonged immobilization strengthening Contracture Abnormal condition of Frequent position changes, joint characterized by correct alignment, ROM, flexion and fixation gradual stretching FootDrop Plantar flexion of the foot Supporting foot in neutral position High-top athletic shoes may help Pain Frequently associate with Incorrect positioning, fracture, edema, and alignment of extremity, muscle spasms device is applied to tightly. Incorrect position of constrictive dressing, and motion occurred at fracture sit Muscle Spasms Involuntary contraction Determine cause of pain after fracture, muscle Reduce intensity of strain, or nerve injury and muscle spasm. Don’t may last several weeks. massage can stimulate Intense lasting from muscle tissue contraction several seconds to minutes and pain. Thermotherapy heat, may reduce muscle spasm. Pages 125-130, general knowledge of management of these special types of fracture. Drug Therapy: Morphine Moderate to severe pain Stimulate histamine release -> pruritus Dilaudid Shorter duration than morphine Moderate to severe pain Lewis et al. (2014). Medical-surgical nursing: Assessment and management of clinical problems(ted.). St Louis: Elsevier Fentanyl Immediate onset IV used with benzos for analgesic and sedation Hydrocodone Moderate to severe pain Short term management of acute pain Tramadol Dual mechanism Used for moderate pain Talwin May cause psychotomimetic effects and withdrawal Buprenorphine Lower abuse potential than morphine Acute low back pain Low back pain that lasts 4 weeks or less Often symptoms don’t appear at time of injury but develop in 24H Management : o Assess body mechanics o Advise maintain appropriate body weight o Sleep Supine or on side with pillows o Stop smoking Intervention: o NSAIDS and Muscle Relaxants o Massage and back manipulation o Bed Rest 1-2 Days o Refrain from aggravating activities Chronic low back pain More than 3 Months Spinal Stenosis Narrowing of the spinal canal Treatment: Antidepressants o Help with pain and sleeping Anti-seizure Neurontin o Improve walking and relieve leg symptoms problems(ted.). St Louis: Elseviercal nursing: Assessment and management of clinical Core Strength Bend knees Hips Potential complications of fracture Venous Thromboembolism Inactivity of the muscle that normally assist in the pumping action of venous blood returning to the extremities o Drugs: Warfarin Low-molecular Heparin Compression hose Compression devices Dorisflex and Plantar flex fingers and toes against resistance ROM excercises Fat Embolism Syndrome Presence of systemic fat globules from fracture that are distributed into tissues and organs after a traumatic skeletal injury Fat enters the systemic circulation where it embolizes to other organs such as the brain o Signs and Symptoms: 24-48 hours after injury Fat in Lungs: Hemmorrhagic interstitial pneumonitis Respiratory distress Change in LOC Petechiae around neck, anterior chest, axilla, buccal membrane, conjunctiva Impending doom o Treatment: Directed at prevention Fluid Restriction Correction of acidosis and blood loss Reposition as little as possible Oxygen treats hypoxia Chest x-ray white out Osteomyelitis problems(ted.). St Louis: Elseviercal nursing: Assessment and management of clinical Severe infection of the bone, bone marrow, and surrounding soft tissue. Staphylococcus aureus is common cause Infect Microorganisms o Invade directly and indirectly. o Occurs in 12 y.o. boys indirectly o Direct Entry at any age with open wound. o Microorganisms grow →increase pressure in bone →ischemia and vascular compromise o Infection spreads through bone →cortex de-vascularization and necrosis Local manifestations o Pain unrelieved by rest; worsens with activity o Swelling, tenderness, warmth o Restricted movement Systemic manifestations o Fever o Night sweats o Chills o Restlessness o Nausea o Malaise o Drainage (late) Treatment: o Vigorous and prolonged IV therapy 4-6 weeks and long as 3-6 months o Surgical Removal of tissue o Antibiotic-Impregnated polymethyl methacrylate bead chains o Intermittent or constant irrigation o Negative- Pressure therapy o Hyperbaric Oxygen Therapy o Bone grafts- help restore blood flow Cerebral lobes Frontal Lobe: problems(ted.). St Louis: Elseviercal nursing: Assessment and management of clinical Controls higher cognitive function, memory retention, voluntary eye movements, voluntary motor movement, and speech (Broca’s Area) o Broca’s Area: regulates verbal expression Temporal Lobe: Integrates somatic, visual, and auditory data, contains Wernicke’s Speech area o Wernicke’s Speech area: integrates auditory language (understanding of spoken words) Parietal Lobe: Interprets spatial information and contains sensory cortex Occipital Lobe Processing of sight Cerebellum: Coordinates voluntary movement and maintains trunk stability and equilibrium o Test: Observe stature, Finger-to-nose test, and Heel-to-shin Test Cranial nerve functions I:Oflactory : Smell II: Optic : Vision III: Oculomotor: Eye movement IV: Trochlear: Eye V: Trigeminal: Touch forehead and cheek, clench teeth VI: Abducens: Eyes, Look side to side VII: Facial: Smile, taste 2/3 of tongue VIII: Vestibulococchlear: Hearing and Equilibrium IX: Glossopharyngeal: Posterior 1/3 of tongue, speech X: Vagus: Digestion, Defecation, slowed heart rate XI: Accessory: Shoulder Shrug XII: Hypoglossal: Tongue Movement Seizures: Generalized Seizures: Involve both sides of the brain Bilateral synchronous epileptic discharges problems(ted.). St Louis: Elseviercal nursing: Assessment and management of clinical Loss of consciousness Tonic-Clonic Seizure Loss of consciousness and falling to the ground Tightening of the body (Tonic phase) 10-20 seconds Subsequent jerking of the extremities (Clonic Phase) 30-40 seconds Cyanosis, excessive salivation, and tongue or check biting Absence Seizure (Petit Mal) Only occurs in children “Daydreaming” only a few seconds Untreated can happen 100xday Atypical Seizure Starting spell with other signs and symptoms o Brief warning o Peculiar/ Confusion during seizure o Loss of postural tone Myocolonic Seizure Sudden, excessive jerking Atonic Seizure “Drop attack” Tonic episode/paroxysmal loss of muscle tone person falls to the ground Tonic Sudden onset of maintained increased tone in extensor muscle Clonic Loss of consciousness and sudden loss of muscle tone Followed by limb jerking which may or may not be symmetric Focal Seizure Parital or partial One hemisphere of the brain Simple Focal Seizure Remain conscious Unusual feelings or sensations Feel things that aren’t real problems(ted.). St Louis: Elseviercal nursing: Assessment and management of clinical Complex focal seizure Loss of consciousness Dreamlike experience Lip smacking and repetitive movements “Automatisms” Few Seconds Psychogenic seizures Also called pseudoseizures, non-epileptic seizure Psychiatric in origin Resemble epileptic seizures Accurate diagnosis usually requires use of video-EEG monitoring to capture a typical episode. Complications: Status epilepticus A state of constant seizure or condition when seizures recur in rapid succession without return to consciousness between seizures Most serious complication of epilepsy Neurologic emergency Can involve any type of seizure Can be sub-clinical (no obvious seizure) Nursing Care: Drug Therapy: Generalized Seizures o Phenytoin (Dilantin) o Carbamazepine (Tegretol) o Phenobarbital o Divalproex o Primidone (Mysoline) Absence and Myoclonic o Ethosuximide (Zarontin) o Divalproex o Clonazepam (Klonopin) Side Effects: o Drowsiness o Ataxia o Mental Slowness problems(ted.). St Louis: Elseviercal nursing: Assessment and management of clinical Multiple Sclerosis Chronic progressive degenerative disorder of the CNS 20-50 years old 5 times more prevalent in temperate climates Cause is unknown Signs & Symptoms: o Progressive deterioration in neurologic function o Motor, sensory, cerebellar, and emotional problems o Bowel and Bladder function can be impaired Nursing Care: o Immunosuppressive therapy o Muscle relaxants o CNS Stimulants o Anticholinergics o Trycyclic Antidepressants o Antiseizure Drugs Parkinson’s Disease Slowing down in the initiation and execution of movement Increase muscle tone Tremor at rest Gait Disturbance Cause is lack of dopamine Sign & Symptoms o Tremor o Rigidity o Bradykinesia o Pill rolling: finger and thumb move in a rotary fashion Nonmotor symptoms: o Depression – Diagnose medication o Anxiety o Fatigue o Pain o Constipation problems(ted.). St Louis: Elseviercal nursing: Assessment and management of clinical o Sleep problems o Short-term memory loss- Louis body dementia Complications: o Motor Symptoms o Weakness- orthostatic hypotention o Akinesia o Neurologic problems o Neuropsychiatric Problems o Dysphagia- malnutrition and aspiration o General debilitation Nursing care: o Help with mobility and remove obstacles o Simplify dressing changes Huntington’s Disease Hereditary degenerative brain disease Excess of ACOA Symptoms in 30-0s o Speech o Motor o Sensory o Cognitive decline No Cure, only supportive therapy Myasthenia Gravis Chronic Muscle Weakness and Fatigue Auto-Immune ACOA- decrease amount Cause Unknown – Associated with Thymus Gland: Hyperthyroidism, Thymus Hyperplasia Associated w/ Thymus gland tumors Early Onset Age 20 to 30: Affects More Women Late Onset After Age 50: Affects More Men Pathophysiology: Antibodies to Acetylcholine Interrupt Nerve Impulses at the Neuromuscular Junction Exacerbated by problems(ted.). St Louis: Elseviercal nursing: Assessment and management of clinical o Infection o Stress o Fatigue o Heat Myasthenic Crisis - Undermedication Increased HR, BP Respiratory Distress Increased Secretions Can be caused from intercurrent infection Cholinergic Crisis –Overmedication Weakness, Difficulty Swallowing, Speaking Abdominal Cramps, Diarrhea Blurred Vision Increased Secretions Treatment Medications o Anticholinesterase o Pyridostigmine (Mestinon®) o Neostigmine (Prostigmine®) o Steroids o Plasmapheresis o Reduces Circulating Antibodies Amyotrophic Lateral Sclerosis (ALS) Disease of the nerve cells of the brain and spine Causes progressive muscle weakness and is fatal when the weakness includes respiratory muscles (death most often around 3-5 years) Usually starts with arm weakness No cure Riluzole can be used to help control symptoms but does not stop the process Control of the symptoms Degenerative Nerve disease, muscle follows the nerves Same as above for delirium, dementia, Alzheimer’s. problems(ted.). St Louis: Elseviercal nursing: Assessment and management of clinical
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