1
Q
alkaline phosphatase (ALP)
A
-increased in bone cancer, healing fractures, rheumatoid arthritis, and osteoporosis
2
Q
Calcium (Ca)
A
- increased in bone cancer and multiple fractures
- monitor Ca levels and detect imbalances
3
Q
Phosphorus (P)
A
-increased with bone tumors and phosphate healing fractures
4
Q
Rheumatoid factor (RF)
A
-diagnose RA; also increased in lupus and scleroedema
5
Q
Uric acid
A
-diagnosis and monitor treatment of gout
6
Q
Creatine kinase (CK)
A
- diagnose muscle trauma or disease
- increased in muscular dystrophy and traumatic injuries
7
Q
Sedimentation rate (ESR)
A
-measures inflammation in the body
8
Q
What do you assess when assessing pain?
A
-descriptors, location and nature
9
Q
Strength - muscle grading scale 1-5
A
0- paralysis; no visible contraction 1- can feel contraction; no movement of limb 2- movement with gravity eliminated 3- full ROM against gravity 4- full ROM with some resistance 5- full ROM with full resistance
10
Q
Morse fall scale
A
0-24 (no risk)
25-50 (low risk)
>50 (high risk)
11
Q
Radiologic examinations
A
X-rays
CT scan
MRI
bone scans
12
Q
Bone density tests
A
DXA or DEXA gold standard
-evaluates degree of osteoporosis
13
Q
Arthroscopy
A
- fiber-optic endoscope to examine joint interior, to diagnose diseases, and to perform surgery
- arthrocentesis- withdraws fluid from a joint by needle aspiration
14
Q
Electromyogram (EMG) and somatosensory evoked potential (SSEP)
A
-tests of the electrical activity of skeletal muscle
15
Q
Conditions that effect mobility
A
- Cardiovascular
- neurological
- respiratory
- musculoskeletal
- infection
- peri operative
- psychological
16
Q
Short term mobility goals
A
- prevent further injury
- control pain
- prevent falls
- ROM
- safe mobility
17
Q
Long term mobility goals
A
- Optimal function
- restore normal function
18
Q
Caring interventions
A
-rehabilitative nursing-process of restoring a persons ability to live and work in as normal a manner as possible; involves the prevention and correction of alterations in the musculoskeletal system
19
Q
preservative methods
A
- interventions needed to maintain normal mobility
- exercises and assisted ambulation
- used with EVERY client
20
Q
Restorative methods
A
- interventions to achieve level of mobility prior to illness
- crutch walking and splinting
- used with clients who have decreased mobility caused by factors such as debilitating illness or major surgery
21
Q
Client education for mobility
A
- encourage participation
- instruct on importance of movement/ambulation/exercise
- proper nutrition
- maintain proper body alignment
- safety related to mobility, environment, and use of devices
22
Q
Potential complications with mobility issues
A
- tissue integrity
- DVT/blood clotting
- falls/fractures
- functional decline
- pneumonia
23
Q
Manifestations of back pain
A
- lower back pain that radiates across the buttocks and down the posterior leg
- SCIATICA-lumbar back pain that radiates down the posterior leg to the ankle and is increased by sneezing or coughing
- posterior deformity
- motor deficits
- sensory deficits
- changes in reflexes
- pain in shoulder neck and arm
- paresthesia
- muscle spasms
- stiff neck
- decreased or absent arm reflexes
- lower extremity weakness
- unsteady gait
- urinary elimination problems
- altered sexual function
- hyperactive lower extremity reflexes
24
Q
Diagnostics to diagnose back pain
A
- X rays and CT scans of lumbosacral and cervical area
- electromyography (EMG)- measures electrical activity of skeletal muscle at rest and during voluntary contractions. May be done to specify which muscles are affected
- myelogram- illustrates area of hernias
25
CONSERVATIVE Treatment of back pain
- goals of treatment are to relieve pain and healing the involved disk by fibrosis
- usually prescribed by for 2-6 weeks
- client is advised to continue with normal activities while taking prescribed meds for pain
- meds include nonnarcotic analgesics, anti-inflammatory drugs (NSAIDS), muscle relaxants, sedatives
26
SURGERY treatment for back pain (LAMINECTOMY)
- removal of part of the vertebral lamina
- relieves pressure on the nerves
- often combined with removal of the protruding nucleus pulposus
27
Diskectomy surgery treatment for back pain
-removal of nucleus pulposes of an intervertebral disk
28
Spinal fusion surgery for back pain
- insertion of a wedge-shaped piece of bone or bone chips between the vertebrae to stabilize them
- bone usually taken from iliac crest of client
29
Foraminotomy surgery for back pain
-enlargement of the opening between the disk and the facet joint to remove bony overgrowth compressing the nerve
30
Intradiscal electrothermal therapy (IDET) surgery treatment for back pain
- thermal energy used to treat pain from bulging spinal disk
- special needle inserted into the disk and heated to high temperature.
- heat thickens and seals the disk wall and decreases bulging of the disk
31
Microdiskectomy surgery treatment for back pain
-microsurgical techniques are used and performed through very small incision
32
Complimentary and Alternative therapies for treatment of back pain
- chiropractic therapy
- massage therapy
- acupuncture
33
Nursing implementations for acute pain (back pain)
- assess degree of pain and identify contributing and relieving factors
- use a firm mattress or place a board under the mattress
- teach client to avoid turning or twisting the spinal column and to assume positions that decrease stress on the vertebral column
- provide analgesic meds around the clock
34
Nursing implementations for chronic pain (back pain)
- treat clients reports of pain with respect
- do not refer to client as being addicted to pain meds
- monitor client carefully for any changes in condition
- maintain individualized written plans of care for pain management and ensure continuity of care
- teach the client alternative methods of pain management
- develop effective methods of improving rest and sleep
- refer client to PT for exercise program
- assess need for referrals for client who is depressed or anxious
35
Nursing implementations for constipation (R/T back pain)
- assess clients usual bowel routine, including diet, fluid intake, and the use of laxatives or enemas
- encourage fluid intake of 2500-3000 mL/day
- increase fiber and bulk in the diet
36
Manifestations of hip fracture
- unable to walk, stand, or bear weight on effected side
- acute pain
- extreme pain prevents any movement
- force of gravity and pull of muscles cause affected leg to appear shortened and externally rotated
37
Diagnosis of hip fracture
- bone mineral density test
- bone and joint radiography and CT
- magnetic resonance imaging
- bone and joint scanning
38
treatment for nondisplaced subcapital and femoral neck fractures
-internal fixation with multiple pins
39
Treatment for displaced fractures of subcapital and femoral neck
-ORIF with rod, pins, prosthesis, or fixed sliding plate
40
Total hip replacement is done only when...
Severe arthritis is present
41
Implementations for acute pain
- monitor vitals
- ask client to rate pain
- apply bucks traction
- administer pain meds
42
Implementations for peripheral neurovascular dysfunction (R/T hip fracture)
- assess 5 p's every 1-2 hours (pain,pallor, pulses, paresthesia, paresis)
- monitor the extremity for edema and swelling
- assess for deep, throbbing, unrelenting pain
- administer anticoagulant
43
Implementations for risk of infection (R/T hip fracture)
- monitor vitals and lab reports of WBCs
- use sterile technique for dressing changes
- assess wound for size, color, and presence of drainage
- administer antibiotics
44
Implementations for impaired physical mobility (R/T hip fracture)
- teach or assist client with ROM exercises of unaffected limbs
- teach isometric exercises and encourage client to perform every 4 hours
- encourage ambulation when client is able
- teach and observe clients use of assistance devices
- turn client on bed rest every 2 hours
45
Implementations for risk of disturbed sensory perception: tactile (R/T hip fracture)
- assess every 1-2 hours ability to differentiate between sharp and dull touch and presence of paresthesia and paralysis
- support injured extremity above and below fracture site when moving client
46
Manifestations of osteoarthritis
- pain and stiffness in one or more joints
- deep ache
- aggravated by motion of joint and relieved by rest
- ROM decreases
- crepitus during movement
- joint enlargement
- flexion contractures
- bony hard, cool on palpation
47
Diagnostics for osteoarthritis
- x-rays of joints
- synovial fluid from joints can help identify type of arthritis
- blood level of hyaluronic acid (lubricating substance in cartilage and joint synovial fluid) indicates presence and severity of OA
48
Treatment of osteoarthritis (pharmacological)
- topical medications; counterirritants, salicylates, and capsaicin
- analgesics and anti-inflammatories; NSAIDs, TYLENOL, Celebrex
- lidocaine injections (do NOT use more frequently than every 4-6 months)
49
Nonpharmacological therapies for OA
- weight loss
- exercise- stretching muscles, active ROM for all joints, low intensity isometric exercises, resistive exercises twice a week, aerobic exercises, isotonic exercises
- rest- adequate sleep at night and frequent, short rest periods, use of assistive devices
- apply heat to painful joints- moist heat
- cold applications to reduce pain and swelling- mild cold; swelling, deeper cold; pain
- canes, crutches, walkers
- assistive technology- better compliance when adequately taught
50
Surgical treatment for OA (arthroscopy)
- arthroscope is inserted into a joint
- smoothing rough cartilage and flushing out the joint to remove debris
- not proven effective in knee OA
51
Surgical treatment of OA (osteotomy)
- incision into or transaction of the bone
- realigns affected joint
- shifts joint toward areas of less severely damaged cartilage
52
Surgical treatment of OA (arthroplasty)
- total joint replacement
| - pain is virtually eliminated
53
Treatment for OA- physical therapy and rehabilitation
-builds strength and regains joint flexibility
54
Complementary and alternative therapies for OA
- bio magnetic therapy
- acupuncture
- elimination of nightshade foods such as potatoes, tomatoes, peppers, eggplant, and tobacco
- nutritional supplements
- herbal therapy
- massage therapy
- osteopathic manipulation
- vitamin therapy
- yoga
55
Nursing interventions for chronic pain (R/T OA)
- monitor level of pain (intensity, location, quality, aggravating and relieving factors)
- take prescribed analgesic or anti inflammatory meds as needed
- encourage rest of painful joints
- suggest applying heat to painful joints
- emphasize importance of proper posture and good body mechanics for walking, sitting, lifting, moving
- lose weight
- use nonpharmalogic pain relief
56
Nursing interventions for impaired physical mobility (R/T OA)
- assess ROM of affected joints
- perform functional mobility assessment
- teach active and passive ROM exercises as well as isometric, progressive resistance, and low-impact aerobic exercises
57
nursing interventions for self-care deficit (R/T OA)
- perform a functional assessment of the upper and lower extremities
- assess the home setting to determine the need for assistive devices such as handrails, grab bars, a walk-in shower stall, or a shower chair and handheld showerhead
- assist in obtaining other assistive devices such as long handled shoehorns, zipper grabbers, long-handled tongs or grippers, jar openers, and special eating utensils
Nursing II
flashcards
Decks in class (6)
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