med surg test 1 pp, Rasmussen: Nursing 1 Exam 1, Nursing 1 Exam #1 naomi, Rasmussen: Nursing 1 Exam 1 naomi
Immobility of the Integumentary System
- Pressure - Shearing - Bony prominences - Pressure ulcers
Prevention of Immobility
- Turning the client every 2 hours to prevent ulcers - Use assistive devices to help them get out of bed and to move around - Perform ROM - Helping the client to use the bathroom
Immobility of the Genitourinary System
- Urinary Stasis / Retention - UTI - Renal Calculi
Osteoporosis Treatment
- Weight-bearing and strengthening exercises - walking, jogging, resistance. - Vitamin D and Calcium supplementation - .Screening for bone density if age 65 or older. - Drink moderately and no smoking.
Organizational culture of safety
-Historically, a culture of blame has existed; identify the clinical at fault, followed by disciplinary measures. -Now: the focus is on what when wrong rather than who to blame. -Culture of safety is needed to address errors and to prevent a re-occurrence.
What diseases/disorders can increase the risk for falls and why?
1. Decreased visual acuity 2. Generalized weakness 3. Urinary frequency 4. Gait and balance problems (MS, CP) 5. Cognitive dysfunction
When pushing or pulling loads, what should nurses do to prevent injury?
1. Widen the base of support 2. Pull objects towards the center of gravity rather than pushing away. 3. If pushing, move the front foot forward and if pulling move the rear leg back to promote stability. 4. Use body as a counterweight 5. Avoid twisting the spine and bending the back while the hips and knees are straight 6. Sliding, rolling, and pushing require less energy than lifting and offer less risk for injury.
What is the treatment for CO poisoning?
100% humidified oxygen
What is an angiogram?
A catheter is inserted in the femoral, brachial, subclavian, or carotid artery and a contrast dye is injected to visualize the vessels.
Just Culture
A health care system's value is in reporting errors without punishment. Seeks to find a balance between the need to learn from mistakes and the need for disciplinary action against employees.
Nursing diagnoses related to safety
Risk for falls Risk for injury A fall is an unintentional change in body position that results in the patient's body coming to rest on the floor or ground. A recent history of falling is the single most important predictor for falls.
emergency and disaster preparedness disaster
A mass casualty incident in which the number of casualties exceeds the resource capabilities of a particular community or hospital facility. event in which illness or injuries exceed resource capabilities of a health care facility or community due to destruction and devastation can be either internal to a health care facility or external from situations that create casualties in the community. Both internal and external disasters can occur simultaneously, such as when Superstorm Sandy incapacitated several hospitals on the Atlantic Coast of New York and New Jersey in late October 2012
Strains & Sprains Pathophysiology
A sprain is a stretching or tearing of ligaments, the tough bands of fibrous tissue that connect two bones together in your joints. A strain is a stretching or tearing of muscle or tendon. A tendon is a fibrous cord of tissue that connects muscles to bones.
Amphiarthroses
Allow for limited movement. (e.g. the joints between the vertebrae and the pubic bones
Specimen collection
Always take the specimen to the lab to get evaluated. Urine must be kept on ice for 24 hour urine collection. Take stool immediately.
What are the treatments of atrophy?
An exercise program
Immobility on DVT formation
Assess with Homan's sign - passively dorsiflex the foot feeling for clonus with slight involuntary pushing, while asking if patient has pain in the calf. Positive=extreme pain with or without clonus means DVT. Do not massage or elevate.
Elimination Problem Prevention
Avoidance of environmental contamination Regular toileting practices Adequate Fiber Regular exercise Hydration
Gout Pathophysiology
Body can't metabolize uric acid so it accumulates in the blood and tissues. Urate salts form needlelike crystals that form deposits especially in the smaller bones of the feet. Extremely painful.
Osteosarcoma Complications
Bone fractures may occur Limited range of motion Limping from pain and discomfort Swelling, Tenderness and Redness at the site Limb Removal Spread of Cancer to Lungs Side Effects related to Chemotherapy
Osteosarcoma Pathophysiology
Bone tumor that can occur in any bone, but usually occurs in the long bones near metaphyseal growth plates. The most common bones are femur, tibia, humerus, skull/jaw, and pelvis.
Scoliosis Complications
Breathing problems may occur in severe cases Low back pain or persistent pain Lower self-esteem Spinal infection after surgery Spine or nerve damage from an uncorrected curve or spinal surgery Curvatures worsen as child ages.
Diverticulitis Diagnosis
CT Scan, Barium, Colonoscopy, antibiotics, analgesics, and anticholenergics to reduce bowel spasms. Increased WBCs. Bulk forming laxatives, and possibly surgery.
Crohn's Disease Diagnosis
CT scan, X-ray, Barium enema, Colonoscopy, Biopsy, Occult blood. Hemoglobin (Hb), hematocrit, WBCs, erythrocyte sedimentation rate, serum potassium, calcium, magnesium, and Hb levels Vitamin B12 and folate deficiency may occur.
Scope of errors - Latent
Care coordination Documentation Electronic records
Irritable Bowel Syndrome Signs and Symtpoms
Chronic constipation and/or diarrhea Lower abdominal pain Small stools with visible mucus or pasty Dyspepsia, Abdominal bloating, Heartburn, Faintness and weakness Contributing psychological factors, such as a recent stressful life change. Anxiety and fatigue.
Urinary Retention Complications
Complications include urinary tract infections (UTIs), bladder damage, and chronic kidney disease
Appendicular section
Connected to axial skeleton by bones of upper and lower extremities a. Shoulder girdle supports arms; humerus is located in upper arm and ulna and radius in forearm b. Each innominate bone (hip bone) consists of 3 parts—ileum, ischium, and pubis; innominate bones unite with sacrum and coccyx of vertebral column to form pelvic girdle, which supports legs
Constipation Pathophysiology
Constipation is broadly defined as an unsatisfactory defecation characterized by infrequent stools, difficult stool passage or both
Crohn's Disease Medications
Corticosteroids, Immunosuppressant, Sulfonamides, Anti-inflammatories, Antibacterials and antiprotozoals, Antidiarrheal, Opioids, Vitamin supplements, Antispasmodics. Surgery -- Indicated for acute intestinal obstruction colectomy with ileostomy
Bowel Obstruction Signs and Symptoms
Crampy abdominal pain that comes and goes Loss of appetite Constipation Vomiting Inability to have a bowel movement or pass gas Swelling of the abdomen
Rheumatoid Arthritis Treatment
DMARDSs - Disease-modifying antirheumatic drugs like methotrexate and sulfasalazine, NSAIDs, Prednisone, Celecoxib, Abatacept and infliximab. Alternative medicines: Fish oil, plant oils, tai chi Surgery: to help repair joint damage Synovectomy, Tendon repair, Joint fusion, Total joint replacement
Urinary Tract Infection Complications
Damage to the urinary tract lining Infection of adjacent organs and structures
Immobility on decreased cardiac contraction
Decreased contractibility, blood pooling in distal areas; monitor vitals, promote activity, elevate the feet, turn patient onto left side, use TED hose, SCD's
Back Pain Signs & Symptoms
Difficulty moving that can prevent walking and standing. Achy, dull pain Muscle Spasms Soreness with Touch Pain that can range from mild to a severely debilitating.
Back Pain Complications
Disability Bladder, Bowel, and intestinal functions- slipped disk can irritate, compress, and damage the spinal nerve which in severe and irreversible Depression Weight Gain
Irritable Bowel Syndrome Complications
Diverticulitis and colon cancer Chronic inflammatory bowel disease
Toddler (1-3years)
Drowning (second to MVA) Falls (primary cause of non-fatal injury) Cuts Concussions Guns and weapons (locked and unloaded) Escape from home Poison (Poison Control # on fridge) Suffocation and choking Child mistreatment
How can you prevent mercury poisoning?
Eliminate mercury containing items from workplace.
Near miss
Error of commission or omission that could have harmed a patient, but harm did not occur as a result of chance
Renal Calculi Signs and Symptoms
Extreme pain Changes in frequency, color and smell Hematuria (blood in urine) Abdominal distention Costovertebral tenderness on palpation, Tachycardia Elevated blood pressure
What is the leading cause of death in the older adult?
Falls
What is the leading cause of injury in preschoolers?
Falls
Pyelonephritis Signs and Symptoms
Fever and chills, costovertebral angle pain (flank pain), nausea and vomiting, urge/frequency, blood in urine, loss of appetite, fatigue, cloudy, dark, strong smelling urine. In elderly mental status changes.
What are CT scans used for?
For long bones and joints, CT scans can allow for a detailed examination of cross-sections of the areas examined. Defects that can be seen include tumors and fractures.
Never Events - Senital Events
Foreign object left in patients after surgery Administering the wrong type of blood Symptoms resulting from bad blood sugar levels Air embolism Severe pressure ulcers Falls and trauma Infections from urinary catheters Infections from intravenous catheters Surgical site infections Deep vein thrombosis or pulmonary embolism
What are some important interventions for patients that have an internal radioactive implant?
General guidelines include: 1. assigning the patient to a private room 2. placing post-radiation precaution signage 3. limiting the amount of time in the room, observing a distance of at least six feet from the source when possible 4. prohibiting pregnant staff, family, visitors, and children from interacting or visiting with the patient 5. provide specific instructions to the patient and family 6. all health care staff should be required to wear personal dosimeter badges to record their total personal exposure to radiation.
Cane
Handgrip at greater trochanter Elbow flexed 15-30 degree Use on UNAFFECTED side Place cane 4-6" to side stronger foot Move cane and affected leg at same time when walking, then unaffected leg
Walker
Handgrip at greater trochanter Elbow flexed 20-30 degree Walker followed by affected side then unaffected side.
What is a never event
Healthcare acquired complications that can cause serious injury or death to a patient that should never happen in a hospital.
Constipation Complications
Hemorrhoids Anal fissures Rectal prolapse Fecal impaction
Treatment of Osteoarthritis
I 2 tan w If function is completely lost joint replacement surgery would then have to be explored *2 main goals are to provide comfort & maintain function/mobility TENS unit Application of heat Nonpharmacological techniques for pain relief Weight loss
Gout Client Teaching
Ice, weight loss, excercise. Drink plenty of fluids. Restrict aspirin , diuretics, excessive physical or emotional stress can exacerbate the disease Eat a low purine diet, no pork, lamb, red meats & seafood
Immobility on urinary stasis
Incomplete bladder emptying, dehydration, UTI; increase patients fluids and encourage them to empty bladder fully
Arthrography
Injection of air or contrast medium into a joint, which is then examined using X-ray, CT or MRI
Urinary Retention Pathophysiology
Ischuria - inability to completely empty the bladder. External sphincter does not open for release of urine or blockage of urethra.
Irritable Bowel Syndrome Pathophysiology
Large intestines. No cellular change so can't detect with lab testing. Can be induced by stress or anxiety related and women are more commonly affected. A change occurs in bowel motility, reflecting an abnormality in the neuromuscular control of intestinal smooth muscle.
Factors affecting mobility and activity
Lifespan Nutrition Lifestyle Stress External environment Disease
Gout Complications
Limited range of motion Joint damage Kidney stones
Ulcerative Colitis Signs and Symptoms
Liquid stools with visible pus, mucus, and blood Possible abdominal distention Abdominal tenderness Perianal irritation, hemorrhoids, and fissures Jaundice Joint pain
Risk for falls - Goals/outcomes
Long term: -Client will not experience any falls during stay -Client will make necessary physical changes in environment to ensure increased safety within first week of returning home Short term: -Client will identify factors that increase potential for injury by the end of the day -Client will remain free of falls per shift
Controll
Loss of control can lead to skin breakdown, changes in daily activities and changes in social relationships.
Falls causing a hip fractures are classified as what?
Low energy trauma
Immobility related to impairments in intracranial regulation
May become immobile as a result of unsteadiness and imbalance
If a patient is moderately dependent, what type of transfer device should be used?
Mechanical lift with full sling, or if transfer is manual, more than one helper might be needed.
Mobility
Mobility is a state or quality of being mobile or movable. Other terms: Immobility Disuse syndrome Deconditioned
Paget's Disease Signs and Symtoms
Most of the time no symptoms, but if there are the most common is bone pain. Mental changes may occur due to compression of the spinal cord- known as small hat syndrome bone pain, joint pain, stiffness, may be severe and constant, other signs include deformities, enlargement, fractures, headaches, hearing loss, back pain.
Scoliosis Teaching
Most of the time the cause is unknown, or idiopathic. No one did anything wrong to cause scoliosis, and it can't be prevented. Scoliosis usually occurs in early adolescence and becomes more noticeable during a growth spurt. Girls and boys are affected equally by idiopathic scoliosis, but girls are more likely to develop curves big enough to require treatment.
What is the leading cause of death in the school-aged child?
Motor vehicle accidents
What is passive range of motion (PROM)?
Moving joints through the range of motion when the patient is unable to do so for himself.
Back Pain Medications
NSAIDs and Analgesics Muscle Relaxant- baclofen, cyclobenzaprine, carisoprodol Narcotics- Tramadol Medical procedures - electrical nerve stimulation, epidural steroid injection, or surgery. Other treatments - joint manipulation, stretching, physical therapy and massage.
Osteoarthritis Pathophysiology
Non-inflammatory degenerative joint disease that affects the whole joint. Cartilage at the ends of bones wears down. Caused by repetitive movements and is not systemic. Occurs gradually and worsens over time. Most commonly affects the hands, neck, lower back, knees or hips.
What treatments are used for hip fractures?
ORIF and hip replacements
Diarthroses aka synovial
Or synovial joints. Freely movable because of the amount of space between the articulating bones. or synovial joints, are freely movable because of the amount of space between the articulating bones. Synovial joints are filled with synovial fluid, and the joint surfaces of the articulating bones are covered with smooth
How does poisoning occur in older children and adolescents?
Overdosing with drugs or experimenting with recreational or prescription drugs intended for adults.
How do you use a fire extinguisher? (PASS)
P - pulls the pin A - Aim at the base of the fire S - Squeeze the levers S - Sweep the extinguisher from side to side
Osteosarcoma Signs and Symptoms
Pain - Pain in affected bone, worse at night, increases with activity Swelling - May start weeks after pain develops. May feel like a lump or mass Bone fractures - Osteosarcoma can weaken the bone it develops in and can cause fractures
Appendicitis Signs and Symptoms
Pain in the periumbilical area that descends to the right lower quadrant. Rebound tenderness and abdominal rigidity Low-grade fever Elevated WBC Anorexia, nausea and vomiting Constipation or diarrhea
Acute Abdominal Pain Treatment
Pain meds Surgery Antibiotics if infection related
Gout Signs and Symptoms
Painful, Erythema of joints or bursa May have the appearance of cellulitis or septic joint Fever Leukocytosis (high WBC) Usually occur in the coldest areas on the body Common in the distal joints, bursa , pinnae of ears
Adolescent (12-20 years)
Piercing & Tattoos Driving (distracted driving)..texting especially Firearms Suicide Drugs and Alcohol and Tobacco Sexuality and STIs Sexual abuse Use of Internet Risk taking (diving into unfamiliar water)
Poisoning
Poisoning-household chemicals, lead, medicines, cosmetics. Prevention- cabinet locks, store poisons high, keep poison control number available. Treatment depends on the poison ingested - antidotes most often activated charcoal. Do NOT induce vomiting for acidic material ingested
Dual energy x-ray absorptiomentry
Preferred technique for measuring bone mineral density, mainly spine, hip, forearm, minimal radiation exposure.
Goals of Treatment for Strains & Sprains
Proper muscle, tendon or ligament healing and proper pain management.
X-ray
Quick, painless test that produces images of structures inside your body, minimal risk of radiation exposure, bones show up white
Fire Precautions
R.A.C.E Rescue Alarm Contain Extinguish
Immobility causing decreased muscle mass and strength:
ROM is decreased, atrophy & contractures To prevent, do ROM exercises, turning, bring in PT and nutrition
Back Pain Goals of Treatment
Reduce acute symptoms and prevent future problems. It is debatable as to whether or not a herniated disk can ever completely heal.
Immobility of the Musculoskeletal System
- Decreased muscle endurance/strength/mass - Impaired balance - Atrophy of muscles - Decreased stability - Osteoporosis - Contractures - Foot drop - Altered joint mobility
Immobility of the Gastrointestinal System
- Decreased peristalsis - Decreased fluid intake - Constipation/fecal impactions/diarrhea - Anorexia
Diverticulitis Complications
- Infection, Inflammation and Sepsis - Abscess, which occurs when pus collects in the pouch. - Blockage in your colon or small intestine caused by scarring. - Peritonitis, which can occur if the infected or inflamed pouch ruptures, spilling intestinal contents into your abdominal cavity. Peritonitis is a medical emergency and requires immediate care.
Immobility of the Cardiovascular System
- Orthostatic hypotension - Less fluid volume in the circulatory system - Stasis of blood in the legs, - Diminished autonomic response, - Decreased cardiac output - Increased oxygenation requirement - Increased risk of thrombus development. - Deep Vein Thrombosis
What is the most common reason for burns in children younger than 3?
Scald injuries from hot water, steam or grease.
Immobility Interventions - Decreases stressors / strengthen lines of defense
Set up consultation with multidisciplinary care team (PT, OT, social worker, etc) Perform ROM (passive, passive/active, active, etc) Work with PT to recover body rhythm and muscle control (lessens fatigue)
Immobility on pressure ulcers
Skin breakdown; do skin assessments, turn and move, watch bony prominences closely
Osteoarthritis Complications
Sleep disruption Brittle bones, contractures, muscle weakness, atrophy and foot drop. Weight Gain Gout because of biuldup of uric acid crystals Chondrocalcinosis is a build up of calcium crystals due to osteoarthritis, which resembles gout.
Urge Incontinence
Sometimes referred to as " overactive bladder" or "spastic bladder," urge incontinence is an involuntary loss of urine that usually occurs when a person has a strong, sudden need to urinate.
What are the leading causes of injury in adolescents?
Sports and recreation injuries including diving and drowning incidents especially when drinking and drug use are involved.
If a patient as limited dependence, what type of transfer device should be used?
Stand/assist lift or friction reducing device
Adults
Stress Domestic Violence MVA Industrial accidents and exposure Drugs and alcohol abuse Accidental poisoning is number one cause of death from age 34-54
Stress Incontinence
Stress incontinence happens when physical movement or activity — such as coughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder. Stress incontinence is not related to psychological stress.
What is the leading cause of death in infants younger than one year?
Suffocation by smothering, drowning or choking on a foreign object or inhaling gas or smoke.
Elimination Assessment
TACO - Time, Amount, Character, Odor
safety exemplers
Tear Fired cw PM Dc Team system Environmental systems analysis systems regulatory system-- natl' quality benchmarks fall precaution invasive procedures recognition of/action on adverse events error reporting documentation/ electronic records communication with pts/fam/other hcp work process prevention of decubitus ulcer medication administration diagnostic procedures care coordination
What is the morse fall scale?
The Morse Fall Scale uses the following questions to assess a person's risk for falls: 1. Does the patient have a history of falling? 2. Does the person have more than one medical diagnosis? 3. Does the person use ambulatory aids, such as crutches or a walker? 4. Does the person have an IV line or a saline lock? 5. Is the person's gait normal or stooped or otherwise impaired? 6. What is the person's mental status (e.g., disoriented, forgetful)?
What is the base of support?
The base of support is what holds the body up (your feet). Greater stability and balance occur when the base of support is broader (spreading the feet apart)
How is the line of gravity, center of gravity and base of support related to the risk for falls?
The body achieves balance when it is in alignment. For it to be balanced, the line of gravity must pass through the center of gravity, and the center of gravity must be close to your base of support.
How is base of support related to the risk for falls?
The broader the base of support, the lower the center of gravity and the easier it is to maintain balance.
What is center of gravity?
The center of gravity is the point around which mass is distributed (pelvis). When an individual shifts the center of gravity shifts. The lower the line of gravity is to the center of the base of support, the more stable the individual is. This can be done by bending the hips and knees.
Athrography
The injection of air, contrast medium, or both into a joint, which is then examined either by plain X-rays, CT scan, or MRI. Once considered the mainstay in diagnosing cartilage lesions or damage, plain radiographic (X-ray) arthrography is SELDOM used today.
Reason's Swiss Cheese Model of Accident Causation
The model shows how errors occur when situational factors align, despite multiple layers of safeguards for the prevention of errors.
Osteoporosis Pathophysiology
The most common bone disease, Osteoporosis is a progressive and chronic. It is systematic and caused by low bone mass and bone tissue deterioration. This break down leads to fragile and brittle bones; making them more susceptible to fractures. In healthy bones, the relationship between absorption and bone formation is equal. In osteoporosis, there is an imbalance. The body can't maintain homeostasis, the bone becomes less and less and the ratio is uneven.
What is active range of motion (AROM)?
The movement of the joint through the entire ROM by an individual without assistance
What is a bone scan?
The patient is injected with an isotope because radioisotopes are used in the bone scan. Depending on the type of isotope used, the scan may take two to four hours to complete. Once the isotope is injected and has been distributed in the body, the body is scanned for hot spots. Dark spots on the scan indicate areas where the radioisotope uptake is greater, usually indicating an abnormality in that region.
Paget's Disease Pathophysiology
The second most common type of bone disease, after osteoporosis. Most commonly affecting older males and causing thickening and hypertrophy of the long bones and deformity of the flat bones Normal bone remodeling: New bone is formed and bold bone is absorbed Paget's disease: New bone is placed where it is not needed and old bone is removed where it is needed.
Bowel Obstruction Complications
Tissue death and infection.
If patient can assist with a transfer and has limited mobility, what type of transfer device should be used?
Transfer belt or gait belt
osteoarthritis medications
Tylenol and/or narcotics, NSAIDs Cortisone and lubrication injections Vitamin D, phosphorus, calcium, selenium, proteins, and iron are basic needs for joints Celebrex Occasionally joint replacement surgery
Sentinel event
Unexpected occurrence involving death or serious injury **Always signals the need for immediate investigation and response
Adverse event
Unintended harm by an act of commission or omission rather than as a result of disease process
What is the most common reason for burns in infants and young children?
Warming food or formula in the microwave causing food to become hotter than intended.
Preventing of harm to client and self
Wash hands! Complete fall risk assessment Follow hospitals policies and procedures Check equipment regularly Actually assess your patients Proper body mechanics Proper disposal of sharps Radiation precautions Environmental Awareness
Diagnostic test for Lyme disease
Western blot test to confirm positive ELISA (enzyme-linked immunosorbent assay) test
Who is more likely to sustain a hip fracture?
Women
Scoliosis Diagnosis
X-ray or MRI
When to screen for Prostate Cancer
You should get a digital rectal exam and PSA test every year starting at age 45 to check for prostate cancer if you are African American or have a family history (father, brother, son) of prostate cancer.
skeletal disease osteoporosis s&S
bdd f cd back pain Decrease in height accompanied by kyphosis dowagers hump- hump back Fractures: forearm, femur, ribs, and spine constipation decreased bone mass
Acute Abdominal Pain Diagnosis
blood and urine tests X-ray, ultrasound, CT scan
safety** nurses attend to safety needs of
clients in all healthcare settings healthcare workers, including themselves safety is a basic human need
eat
evaluate assess teach
safety hazard - community pollution
example/ cause air, water, noise, soil prevention- c pe pe car pool public transportation ear plugs proper disposal and recycling of solid waste environmental safe products
safety hazard - community community- acquired pathogens
example/ cause food-borne prevention: c-pap cleaning cooking surfaces proper storage attention to folk remedies?? proper cooking and cleaning of foods Vector-borne Prevention: drain standing water; insect repellents; protect skin contact with insects; wipe out breeding areas
muscle fibromyalgia meds
fans for fibromyalgia treatment - pregabalin Lyrica antidepressants nsaids- ibuprofen skeletal muscle relaxants- cyclobenzaprine
Maslow's - Safety and Security Needs
fh perm b pe family health property employment resources morality body Physical safety and security means being protected from potential or actual harm. Emotional safety and security involves trusting others and being free of fear, anxiety, and apprehension.
PN concepts
he c healthcare organization/disparaties ethics clinical judgement
skeletal disease pagets dz dx procedure
increase in serum- alkaline phosphate is the first indicator x-ray bone scan
Osteoporosis xl
is a decrease in total bone density, which occurs when osteoclast activity outpaces that of the osteoblasts. The internal structure of the bone diminishes, and the bone col- lapses in on itself. Normally bone mass continues to increase up to the third decade of life. After age 30, bone loss begins. Women experience a rapid decline in bone mass at menopause. In men, a gradual loss continues. As bones become porous, they become weak, leading to vertebral collapse or fractures of the long bones of the arms and legs. Fractures may occur spontaneously or with very slight trauma. The best treatment for osteoporosis is prevention. Teach adolescents to eat a diet high in calcium, fluoride, and other minerals, and to start an exercise program they can continue throughout their lives. Advise older women that weight- bearing exercise can help decrease the rate of bone loss, and advise them to ask their provider about medications to reduce bone mineral loss. The National Osteoporosis Foundation recommends cal- cium intake for adults age 50 and older to be 1,200 mg/day and vitamin D 800 to 1,000 IV/day to prevent bone loss. The
Functional incontinence
is a form of urinary incontinence in which a person is usually aware of the need to urinate, but for one or more physical or mental reasons they are unable to get to a bathroom. The loss of urine can vary, from small leakages to full emptying of the bladder.
Overflow Incontinence
is a form of urinary incontinence, characterized by the involuntary release of urine from an overfull urinary bladder, often in the absence of any urge to urinate.
Exercise therapy
jabs Joint mobility Ambulation Balance Stretching
arthritis dz: osteoarthritis risk factors
jog ao joint injury occupation - athletes that use the same joints continuously genetics aging obesity
individual factors affecting safety
lc begs siips mv lifestyle cognitive awareness Balance Emotional health gait Safety awareness sensory and perceptual status impaired communication impaired mobility physical and emotional well-being safety awareness mobility Visual acuity
developmental factors affecting safety preschool 3-5 years
leading cause of death/ accidents mva, drowning, fires, poisoning *falls are the primary cause of non-fatal injuries* risk factors play extends to outdoors more adventurous
skeletal disease pagets dz tx
lmn pwp Limiting disability Meds- calcitonin & biophoshonates- analgesics No cure, so focus is aimed at *symptom management* prevent complication Worst cases: Surgery pt- weight bearing exercises
joint and connective tissue dz: gout foods low in purine
megn mc sicc f milk eggs gelatin nuts most veges citrus juice sugar increase fluids cheese cherries fats
skeletal disease scoliosis tx
mild curvature- exercise and braces sx is needed for curvature greater than 40 degrees
skeletal disease osteoporosis
mc mostly affects wrist- hip- vertebral column chronic dz in which bone loss causes decreased density and fracture. *book* The patient may have back pain, which often occurs after lifting, bending, or stooping. The pain may be sharp and acute in onset. Pain is worse with activity and is relieved by rest. Back pain accompanied by tenderness and voluntary restriction of spinal movement suggests one or more compression vertebral fractures (i.e., the most common type of osteoporotic or fragility fracture). Movement restriction and spinal deformity may result in constipation, abdominal distention, reflux esophagitis, and respiratory compromise in severe cases. The most likely area for spinal fracture is between T8 and L3, the most movable part of the vertebral column. Fractures are also common in the distal end of the radius (wrist) and the upper third of the femur (hip). Ask the patient to locate all areas that are painful and observe for signs and symptoms of fractures, such as swelling and malalignment. Pathophysiology Osteoporosis is a chronic disease of CELLULAR REGULATION in which bone loss causes significant decreased density and possible fracture. (See Chapter 2 for a concept review of cellular regulation.) It is often referred to as a silent disease or silent thief because the first sign of osteoporosis in most people follows some kind of a fracture. The spine, hip, and wrist are most often at risk, although any bone can fracture. Euro-American postmenopausal women have a 50% chance of having an osteoporotic-related (fragility) fracture in their lifetime (National Osteoporosis Foundation [NOF], 2017). A woman who experiences a hip fracture has a four times greater risk for a second fracture. Fractures as a result of osteoporosis and falling can decrease a patient's MOBILITY and quality of life. The mortality rate for older patients with hip fractures is very high, especially within the first 6 to 12 months, and the debilitating effects can be devastating (Fitton et al., 2015). Osteoporosis is a major global health problem. In less affluent or famine countries, many individuals have both osteoporosis and osteomalacia as a result of dietary deficiencies. **nutrition The nutritional considerations for the treatment of a patient with a diagnosis of osteoporosis are the same as those for preventing the disease. Teach patients about the need for adequate amounts of calcium and vitamin D for bone remodeling. Instruct them to avoid excessive alcohol and caffeine consumption. People who are lactose intolerant can choose a variety of soy and rice products that are fortified with calcium and vitamin D. In addition, calcium and vitamin D are added to many fruit juices, bread, and cereal products. A variety of nutrients are needed to maintain bone health. The promotion of a single nutrient will not prevent or treat osteoporosis. Help the patient develop a nutritional plan that is most beneficial in maintaining bone health; the plan should emphasize fruits and vegetables, low-fat dairy and protein sources, increased fiber, and moderation in alcohol and caffeine
Consequences of immobility
mj pu pigs radd cov Muscle atrophy Joint dysfunction Paralytic ileus Urinary tract infection Pressure ulcers Increased coagulability Glucose intolerance Sleep disturbances Renal calculi Atelectasis/pneumonia Depression Disorientation Constipation Orthostatic hypotension Venous stasis
older adult factors affecting safety restraints xl
mr. bob jacc jacc jt rap pda but rlr ccccccc Ambularms and bed alarms are another alternative for restraints with patients who climb out of bed and are in danger of falling. must be prescribed by the healthcare provider Reduce risk of injury to others by an agitated client Bedside rails Are considered restraints Order must include reason for restraint and time period; PRN restraint orders are prohibited Bedside rails- Half or three-quarter rails may be better than full length rails for confused or agitated clients who may be injured climbing over rail Jacket, belt, or extremity restraints- Use a half-bow knot for easy release when attaching restraint to bed or chair Assess and document condition of a restrained client HOURLY Creative nursing measures to prevent use of physical or chemical restraints- Orient client to surroundings Creative nursing measures to prevent use of physical or chemical restraints- Encourage family, friends, or a sitter to stay with client Jacket, belt, or extremity restraints- Check for adequate circulation when using restraints; maintain TWO finger widths between client and restraint A nurse may apply physical restraints; however, healthcare provider must evaluate client within an Creative nursing measures to prevent use of physical or chemical restraints- Keep confused clients near nursing station Creative nursing measures to prevent use of physical or chemical restraints- Provide confused clients with diversionary activities Jacket, belt, or extremity restraints- Apply only as specified by manufacturer; never tie them to a movable part of a bed or chair types of chemical restraints-- antipsychotics--antianxiety--antidepressants-- sedative ( diazepam or lorazepam.)- hypnotics Reduce risk of client injury from falls A written order is needed to restrain a client Prevent interruption of therapy such as traction or IV infusions Prevent a confused or agitated client from removing life support device or drug that prevents the client from moving freely- limit client mobility alternative to restraints should always be used first Bedside rails- Keep bed in lowest position use least restrictive device - turn, reposition, toilet, hydrate/ nutrition - release restraint every 2 hours limit client mobility/freedom remove restraints, assess skin, and allow or assist client to re position per agency policy Can be physical or *chemical* The most potent group of psychoactive drugs is the antipsychotics. These drugs are appropriate only for the control of certain behavioral problems such as delusions, acute psychosis, and schizophrenia. Typical antipsychotic drugs include haloperidol (Haldol, Peridol) and thiothixene (Navane). These drugs should not be used to treat anxiety or induce sedation. check client every 30-60 min. *every 15min for the first hour* check for vitals, skin breakdown, physical comfort, rom Creative nursing measures to prevent use of physical or chemical restraints- Maintain frequent toileting routine Creative nursing measures to prevent use of physical or chemical restraints- Reposition or ambulate frequently if appropriate Creative nursing measures to prevent use of physical or chemical restraints- Evaluate client medications for undesirable effects Creative nursing measures to prevent use of physical or chemical restraints- Use relaxation techniques such as music, aroma therapy, and books on tape If a restraint is applied, use the least restrictive device (e.g., mitts rather than wrist restraints, a roller belt rather than a vest).
Psychological effects of immobility
monitor for signs of depression, promote activity, create achievement goals, encourage support groups, validate their feelings
qsen comp
pets IQ patient centered care evidence based practice teamwork and interprofessional collaboration safety informatics quality improvement
nurses must have the ksa to be
tap ccl transition manager advocate for patient and family patient educator care giver care coordinator leader
Immobility Interventions - Teach
tee Teach family to modify home environment (rugs, steps, shower, etc.) Explore regular activity schedule (work, volunteer, etc) Explore energy conservation techniques (activity during energetic time and scheduled rest periods, etc)
Acute Abdominal Pain Pathophysiology
three major pathological processes, inflammatory, obstructive, and vascular, can produce acute abdominal pain.
Immobilization
tss cpb Traction Slings Shoulder immobilizers Casts and splints Pillows Braces
Back Pain Diagnosis
X-ray, CT, MRI
skeletal disease osteomalacia tx
prevention sunlight exposure vit d supplements when dx- ERGOCALCIFEROL and ca is prescribed
What are the causes of food poisoning?
1. Improper food storage 2. Improper food preparation 3. Poisonous chemicals in the environment
What is the leading cause of injury in adults ages 35 to 54?
Workplace injury or lifestyle, stress, carelessness, abuse, and decline in strength and stamina.
Osteoarthritis Diagnosis
X Rays- show cartilage loss specifically, joint damage and spurs. (Spacing between bones decreases as cartilage degrades) Also identify fluid build up. MRI- soft tissue damage and changes in bone density. Used for tracking progression (cartilage, tendons, ligaments). Blood and urine- Mostly used to rule out other forms of arthritis. Joint fluid analysis- aspiration of synovial fluid from joint space.
Angiogram
X-ray of blood or lymph vessels with barium. Catheter inserted into vein and injects dye. Then watch to see where dye moves and if there is a blockage.
Paget's Disease Diagnosis
X-ray, bone scan or Alk-phos blood test Bone biopsy: rarely done.
What is an X-ray?
X-rays are the gold standard of diagnosis in the assessment of skeletal complaints. X-rays assist in the diagnosis of fractures, abnormal fracture healing, tumors, arthritic conditions, and osteomyelitis.
Safety hazards for healthcare workers
-Back injury -Needle stick injury -Radiation injury -Workplace violence Prevention: -Body mechanics -Sharps awareness; proper disposal -Radiation precautions -Environmental awareness of personal safety
Safety hazards in a home
* Poisoning - medication, household chemicals, lead, cosmetics. * Carbon monoxide poisoning - treatment- 100% humidified oxygen. * Scalds and burns * Fires * Falls - age >65 at highest risk * Firearms injuries * Suffocation/Asphyxiation- drowning, choking, smoke/gas inhalation, children 0-4yrs at highest risk. * Take home toxins- pathogenic microorganisms, asbestos, lead, mercury, arsenic.
emergency and disaster preparedness
* nursing role in healthcare facility* pcpcp prior to disaster- contribute to developing internal and external emergency response plans collaborate with medical command physician to meet patients needs personal emergency preparedness plan creativity and flexibility are essential personal readiness supplies " go bag" * nursing role in the community* test- f triage emergency response shelter assistance teaching first aid
Crohn's Disease Signs and Symptoms
Fatigue, weakness, fever, flatulence, nausea, diarrhea, abdominal pain that usually occurs in the right lower abdominal quadrant, weight loss.
Scoliosis Signs and Symptoms
"S" curve of the spine - uneven shoulders and uneven waist.
What is dyskinesia?
Abnormality or impairment of voluntary movement
What is the leading cause of injury in the school-aged child?
Falls or injuries related to sports, skateboarding, bicycle riding, and playground injuries.
Categories of errors
Diagnostic Treatment Preventive Communication
What is a Dexa scan?
Dual energy X-ray absorptiometry scans measure bone density.
Osteomalacia Complications
Fracture of the bones Widespread bone pain, especially in the hips Skin integrity due to impaired perfusion, Impaired physical mobility, bone cell mineralization problems.
What is the major cause of hip fractures?
Osteoporosis
Gout goals of treatment
Reduce painful attacks and lower amount of uric acid in patients blood and tissues.
Bowel Obstruction Diagnosis
X-ray, CT or Ultrasound Air or barium enema
Crutches
are the most commonly used ambulatory aid for many types of lower-extremity musculoskeletal trauma (e.g., fractures, sprains, amputations). In most agencies, the physical therapist or emergency department/ambulatory care nurse fits the patient for crutches and teaches him or her how to ambulate with them. Reinforce those instructions and evaluate whether the patient is using the crutches correctly. Walking with crutches requires strong arm muscles, balance, and coordination. For this reason, crutches are not often used for older adults; walkers and canes are preferred. Crutches can cause upper-extremity bursitis or axillary nerve damage if they are not fitted or used correctly. For that reason, the top of each crutch is padded. To prevent pressure on the axillary nerve, there should be two to three finger-breadths between the axilla and the top of the crutch when the crutch tip is at least 6 inches (15 cm) diagonally in front of the foot. The crutch is adjusted so the elbow is flexed no more than 30 degrees when the palm is on the handle (Fig. 51-7). The distal tips of each crutch are rubber to prevent slipping. Sizing Crutches To measure a patient for an axillary crutch, follow these guidelines: ■ Ask the patient to lie down wearing the nonskid shoes that will he use when walking. ■ Measure the distance between the heel and the anterior fold of the axilla, then add 2.5 cm (1 in.). ■ Select a crutch that can be adjusted to this height. ■ Have the patient stand, and position the crutch tip 10 to 15 cm (4 to 6 in.) to the side of the heel.Adjust the axil- lary crutch pad three fingerbreadths below the axilla. ■ Adjust the handgrips so that the patient can comfortably grasp the bar while the elbow is slightly flexed.The patient's axilla should not rest on the crutchpad. pt teaching After ensuring the crutches are the proper size (refer to Clinical Insight 33-5), do the following: ■ When first teaching crutch walking, instruct the patient to stand near a wall with a chair behind him. Help the patient to stand and grip the crutches. Ask the patient to sway from side to side on the crutches to become accustomed to weight-bearing by the arms. ■ Tripod position is the basic crutch gait standing position. Place crutches 15 cm (6 in.) in front of the feet, with the crutch point 15 cm from the patient's center. In this position, a triangle is formed by the crutches and the body. ■ Five crutch gaits exist (see accompanying chart): 2-point gait, 3-point gait, 4-point gait, swing-to gait, and swing- through gait. ■ To teach the patient how to go down stairs, instruct him to hold his injured leg in front and hop down each stair on his good leg, one step at a time.When going up stairs with no handrail, he should lead with his good leg by standing close to the first step with weight on the crutches, and lift the uninjured leg, landing it solidly on the step.Then bring the crutches up to that same step, and repeat. If there is a handrail, then patient holds the crutches in one hand and handrail with the other. He then brings the good leg up one step, while the injured leg bears no weight. Navigating stairs with crutches can be dangerous. When possible, have the patient practice this technique before dis- charge.When having a patient practice, someone should always stand below the patient on the stairs to prevent falling. If this is too difficult, he should try sitting on the stairs and inch down each step slowly and carefully. ---- Crutches are commonly used for rehabilitation of an in- jured lower extremity. The purpose of using crutches is to limit or eliminate weight-bearing on the leg(s) by forcing the user to rely on strength in the arms and shoulders for support. Two forms of crutches are available. The forearm support crutch is more likely to be used by a patient with permanent limitations. It is usually constructed of lightweight aluminum with a hand hold and a forearm support (Fig. 33-18A). Axillary crutches are for both short- and long-term use (Fig. 33-18B). Properly fitted axillary crutches support the body weight in the hands and arms, not the axilla. For guide- lines on how to measure a patient for an axillary crutch, see Clinical Insight 33-5. Crutch walking taxes the arms and hands and may cause discomfort to the axillae, arms, and palms where the patient is bearing weight. There are five crutch gaits: two-point gait, three-point gait, four-point gait, swing-to gait, and swing- through gait. Two-point and four-point gait are used for par- tial weight-bearing, whereas three-point gait is used when weight-bearing must be avoided. Swing-to and swing- through are used when weight-bearing is permitted. For basic gaits and guidelines for teaching patients to use crutches, refer to Clinical Insight 33-6
Treatment for Lyme disease
wave l When synovitis accompanies arthritic symptoms, a synovectomy aka sx may be used to reduce edema and pain in the joint. Antibiotics (type and route are dependent on the stage). Vaccine is no longer available Early illness is usually treated with oral drugs, for example, doxycycline (Vibramycin), amoxicillin, or cefuroxime axetil. Later illness such as nervous-system disease might require intravenous drugs such as ceftriaxone (Rocephin) and penicillin G.
skeletal disease Osteomyelitis tx
wip wound debridement IV antibiotic therapy for 4-6 weeks- type depends on culture pain meds
CAGE
• Have you ever tried to cut down on your drinking? • Have people annoyed you by criticizing your drinking? • Have you ever felt bad or guilty about your drinking? • Have you ever had a drink first thing in the morning to settle your nerves to get rid of a hangover (eye-opener)?
Teaching Care of a Cast at Home
➤ Always keep the cast clean and dry. ➤ Before bathing, cover the cast with a plastic bag and tape the opening shut or use a special cast cover with Velcro straps. Do not place the cast into water unless it is made of water-repellent material. Keep in mind that waterproof casts are not for all types of fractures.They can't be used for recently manipulated fractures or when skin pins are used. ➤ If the cast gets wet enough that the skin gets wet under the cast, it may break down and infection may occur. Dry it immediately with a blow dryer on the cool setting. Be careful—skin can be burned using the hot setting. If you have any trouble getting the cast dry, the cast may need to be replaced. Call the healthcare provider if the cast doesn't dry properly. ➤ Sweating under the cast enough to make it damp may cause mold or mildew to develop. Call the healthcare provider if you notice odor coming from the cast. ➤ Never put anything inside the cast. Do not try to scratch the skin under the cast with any sharp objects, such as a hanger or pencil.This may break the skin under the cast and cause it to become infected. Do not use powders, ointments, or lotions inside the cast. foundation also urges people of all ages, but particularly postmenopausal women, to avoid smoking because tobacco reduces the absorption of calcium in the intestine. In addition, more than two drinks of alcohol per day decreases the matrix of the bone and reduces the body's ability to absorb calcium ("Management of Osteoporosis," 2010). Osteomyelitis (infection of the bone) may develop after bone injury or surgery. It can be difficult and expensive to treat and can leave the patient with permanent disability. Bone con- tains microscopic channels that are impermeable to most of the natural defenses of the body. Once bacteria enter these channels, they multiply rapidly. Bone tumors may also affect form and function. Tumors in the bone cause considerable pain and severely limit activity. Nursing responsibilities for patients with osteomyelitis or bone tumors include collaborative treatments, patient educa- tion about the treatment plan, and providing comfort. Trauma Trauma can affect the entire musculoskeletal system. One of the most significant forms of trauma is a fracture, or a break in the bone. Signs and symptoms of a fracture include tender- ness at the site, loss of function, deformity of the area, and swelling of the surrounding tissues. However, x-ray is required for definitive diagnosis. Fractures are classified according to the extent of damage. The type and severity of fracture determine whether casting, traction, or surgical repair is necessary. To learn about caring for a cast in the home, refer to the accompanying Home Care box, Teaching Care of a Cast at Home. For a classification and description of several types of fractures, Go to Chapter 33, Tables, Boxes, Figures: ESG Figure 33-1, Types of Fractures, on DavisPlus. ➤ Sometimes when swelling goes down, the cast can become loose and rub on the skin. If this is the case, advise your patient to call the primary provider to look at the cast. ➤ Check the circulation by gently squeezing a finger or toe below the cast. It should blanch (turn lighter) and quickly return to a pink color.The fingers and toes should be warm to the touch, able to move freely, and not tingling or numb. ➤ Do not trim the cast or break off any rough edges.This may weaken or break the cast. If a fiberglass cast has a rough edge, use a metal file to smooth it or call the healthcare provider. ➤ A sling may be needed for support if the cast is on the hand, wrist, arm, or elbow. It is helpful to wrap soft sheepskin or padding behind the neck to protect the skin and make it feel more comfortable. ➤ If the cast is on the foot or leg,do not walk on or put any weight on the injured leg, unless the doctor allows it. ➤ If the primary provider allows walking on the cast, be sure to wear the cast boot.The boot is to reduce wear and tear on the bottom and has a tread to prevent slipping and falling. ➤ Crutches may be needed to walk if a cast is on the foot, ankle, or leg. Make sure the crutches are adjusted properly before leaving the hospital or the doctor's office
Appendicitis Medications
Antibiotics for infection, pain relief and surgery to remove.
Elimination Problems
Control, Retention, Discomfort
**safety patient harm & errors generally occur as a result of
LLL LIE LIE Lack of clear or adequate communication lack of attentiveness & patient monitoring lack of clinical judgement lack of mandatory reporting inadequate measures to prevent health complication errors in medication administration lack of professional accountability n pt advocacy inability to carry out interventions in an appropriate & timely manner errors in interpreting authorized provider prescriptions
Gout Medications
Nsaids and corticosteriods to reduce inflammation Allopurinol - Reduces uric acid. Doesn't relieve acute gout attacks. Increase fluid intake May cause hypoglycemia. Colchicine - Used for initial prevention and chronic attacks. Decreases WBCs response to urate crystals. Avoid grapefruit juice.
Urinary Tract Infection Signs and Symptoms
Pain or tenderness over the bladder Hematuria Fever Cloudy, foul-smelling urine Mental changes
What past medical history can increase the risk for falls and why?
Parkinsons, Cognitive disorders, unstable gait, assistive devices, arthritits
Renal Calculi Medications
Percutaneous ultrasonic lithotripsy Extracorporeal shock wave lithotripsy Vigorous hydration (more than 3 qt [3 L]/day) Antibiotics, Analgesics, Diuretics, Methenamine mandelate, Allopurinol (for uric acid calculi), Ascorbic acid, Nonsteroidal anti-inflammatory drug ketorolac (Toradol), Desmopressin (DDAVP) Surgery: Cystoscopy, Ureteral stent, Percutaneous nephrostomy
Acute Abdominal Pain Complications
Peritonitis is a medical emergency caused by an infection in the abdominal cavity. This condition, which can result from a ruptured organ often causes sudden, severe abdominal pain, hardness of the abdomen, and fever. Bleeding, Bloating, Changes in bowel habits, Fatigue, Fever, Constipation, Loss of appetite, Pain, Weight loss, Vomiting.
older adult factors affecting safety impaired mobility
need to focus on functional ability
skeletal disease scoliosis dx procedures
standing spinal x-ray curvature measured
What is the leading cause of death in adults ages 35 to 54?
Unintentional poisoning.
Pyelonephritis Diagnosis
Urinalysis to detect bacteria and WBCs in urine. Gram stain, urine culture, CBC, ESR, C-reactive protein, blood culture, creatinine, BUN. Check for obstructions using ultrasound or CT.
Renal Calculi Diagnosis
Urinalysis, 24 hour urine collection, Xray, KUB (kidney ultrasound bladder), CT scan
Urinary Tract Infection Diagnosis
Urinalysis, Ultrasound, MRI, CT scan to check for obstructions.
Elimination Laboratory Testing
Urinalysis, blood urea nitrogen (BUN), Creatinine, Culture, Occult blood. Glomular Filtration Rate - test to see if kidneys are functioning properly. Loss of volume can cause kidney failure. Unrelieved retention can cause kidney damage.
Urinary Retention Diagnosis
Urinalysis, blood urea nitrogen (BUN), creatinine, culture, occult blood X-rays, CT or Ultrasound Direct observation tests Colonoscopy, cystoscopy, uroscopy Bladder stress testing, urine flow studies
car seat
*Infants younger than age 1 yr* "Infant-only" (These are small and may have carrying handles or be part of a stroller system.) Use rear-facing seats until the infant is age 1 yr and weighs at least 20 lb *Toddlers and preschoolers* "Convertible" (can be used rear facing, then converted to forward facing) or "forward facing Rear-facing seats are safer for toddlers until they are age 2 yr. It is best to ride rear facing as long as possible (until they reach the height and weight maximum specified by the seat manufacturer) *School-age children* Booster seats After outgrowing their car safety seat, children should stay in a booster seat until the car seat belts fit properly (usually at about 4 ft 9 in. tall and ages 8 to 12 yr). Booster seats are safer than a seat belt alone. *Older children* Car lap and shoulder belts Children who have outgrown their booster seats should ride in the back seat until age 13 yr. Some experts recommend that anyone weighing less than 110 lb, regardless of age, ride in the back seat. Riding in the back seat is associated with a 40% reduction in the risk of fatal injury, and up to 46% in cars with airbags
Concept Attributes of Safety
*Knowledge Focus of safety is on the execution of skills, as well as on technology and systems level. *Skills Nurses need to use tools to contribute to safer systems. *Attitudes Nurses and other health care professionals need to value their roles in safety and collaboration.
OSTEOPOROSIS n OSTEOMALACIA defferences
*osteoporosis* Decreased bone mass caused by multiple factors Primary etiology Lack of calcium and estrogen or testosterone Radiographic findings Osteopenia (bone loss), fractures Calcium level Low or normal Phosphate level Normal Parathyroid hormone Normal Alkaline phosphatase Normal *OSTEOMALACIA* Bone softening caused by lack of calcification Primary etiology Lack of vitamin D Radiographic findings Fractures Calcium level Low or normal Phosphate level Low or normal Parathyroid hormone High or normal Alkaline phosphatase High Vitamin D and calcium are needed to form and maintain bone. Deficiencies lead to porous bones. In children, prolonged deficiencies can cause the long bones of the legs to become bowed, retard growth, and lead to frequent fractures.
quality improvement models
*plan do study act (pdsa)* identify and analyze the problem, develop and test an evidence based solution analyze effectivness of the test solution, implement the improved solution to positively impact care 1. Identify and analyze the problem (Plan). 2. Develop and test an evidence-based solution (Do). 3. Analyze the effectiveness of the test solution, including possible further improvement (Study). 4. Implement the improved solution to positively impact care (Act). *focus-pdca* *f*ind a process to improve *o*rganize a team *c*larify the current process *u*nderstand variations in current process *s*elect the process to improve *p*lan the improvement *d*o the improvement *c*heck for results *a*ct to hold the gain *dmaic* *d*efine the issue/problem *m*easure the key aspects of the current process for the issue --collect data-- *a*nalyze the collected data *i*mprove the current process by implementing and evidence based interventions/solution *c*ontrol the future state of the intervention to ensure continuity of the process
Osteoporosis Medications
- Alendrontate: take in am, empty stomach with water. Remain upright for 30 min - Calcium & Vitamin D Supplementation; - - Bisphosphonates- increase bone mass and reduce fractures - SERMs - selective estrogen receptor modulators - Calcitonin - naturally occurring hormone, can slow rate of bone loss - Raloxifene - acts like estrogen, reduces fractures, can increase risk of blood clots and hot flashes - Parathyroid Hormone or teriparatide- helps body build new bone faster than the old bone is broken down - Testosterone for men- increase bone mass
Paget's Disease Medications
- Bisphosphonates (osteoporosis drugs) are the most common treatment for Paget's disease - Calcitonin (Miacalcin), a naturally occurring hormone - Alendronate or Cholecalciferol to help relieve pain and keep disease from progressing - Calcium supplements
Carbon Monoxide Poisoning
- Carbon monoxide (CO) is a colorless, tasteless, odorless toxic gas. Exposure can cause headaches, weakness, nausea, and vomiting; prolonged exposure leads to seizures, dysrhythmias, unconsciousness, brain damage, and death. - Do not use unconventional heating inside such as grill, or gas range - Use of detectors and change batteries every 6 months.
Immobility of the Metabolic/Endocrine System
- Decreased appetite and altered nutritional intake, - Decreased protein - muscle and weight loss - Alterations in calcium/fluid/electrolytes, - - Reabsorption of calcium from bones - Decreased Metabolic Rate - Negative Nitrogen Balance - Negative Calcium Balance
Communication
- Educate patients - Communicate specifics to tech - Shift-to-shift report - Use SBAR - specifically with physicians - Use patient names - more specific - Follow-up - if you say an hour, do it! - Never walk past a call light - Document accurately
Bone Functions
- Enable movement - Protect vital organs - Store minerals - Blood production - Support body structure - Provide form
Aging and Muscles
- Lean muscle mass decreases - Osteopenia - bone loss - Muscle contraction time is decreased - Fatigue often increased - Endurance decreased - Ligaments and tendons lose elasticity/resiliency - With trauma or repetitive stress, ligaments and tendons shorten - results in stiffness, loss of flexibility and ROM - During the reparative phase, calcium can be deposited in muscle, tendon and ligamentous structures, creating pain and further decreasing function.
Osteoarthritis Signs and Symptoms
- Pain, stiffness and tenderness in relation to activity and weather. - Limited ROM especially after rest. - Crepidus when joint moves - Numbness and tingling which indicate bone changes that interfere with nerves. - Enlarged finger joints Heberden's or Bouchard's nodes. - Raynaud's phenomenon of the hand - Shiny, taut skin with or without nodules
How can immobility affect the GI system?
1. Constipation 2. Paralytic ileus 3. Diminished appetitie 4. Slow digestion 5. Muscle wasting as a decreased calorie intake does not meet the protein demands therefore muscle is used as a fuel source.
Prevention of choking
- Suffocation by smothering is the leading cause of death for infants younger than 1 year. - Suffocation may be caused by drowning, choking, or inhaling gas or smoke. - Beware of small foods with small children, including hot dogs, raw vegetables, popcorn, hard candies, nuts, and grapes. They are responsible for most non-fatal choking. - Nonfood items, such as latex balloons and plastic bags, cause the majority of suffocation deaths in young children. - Suffocation of infants is often related to bed or crib hazards, such as excess bedding or pillows, or toys hung from long ribbons inside the infant's crib.
Osteomalacia Pathophysiology
- The adult counterpart of rickets. -Metabolic disease in which the patient has inadequate mineralization of bone and a defect in the bone building process. -Typically caused by a deficiency of vitamin D, Calcium or phosphorus. -Can also be caused by celiac disease, chronic pancreatitis, renal disease, lactose intolerance and certain medications. -Soft bones are more likely to bow or fracture Osteomalacia is not the same as osteoporosis, another bone disorder that also can lead to bone fractures. Osteomalacia results from a defect in the bone-building process, while osteoporosis develops due to a weakening of previously constructed bone.
Fall assessment screening
-What are common screening tools? **Morse Falls Score sheet When should these be used? **Upon admission - meeting **Ongoing as conditions change
Mobility screening
-What are common screening tools? **Timed Get-up-and Go test **Performance-oriented mobility assessment
Osteoporosis screening
-What are the national guidelines for screening? **Women 65 and older AND/OR younger who have increased fracture risk -Test? DEXA of the hip and spine
What are some nursing diagnoses related to immobility?
1. Activity intolerance 2. Impaired physical mobility 3. Risk for disuse syndrome 4. Sedentary lifestyle 5. Risk for injury 6. Risk for falls 7. Acute confusion 8. Knowledge deficit
What actions can be taken to minimize the risk for suffocation in infants and toddlers?
1. Always place infants on back to rest 2. Keep plastic bags out of reach 3. Make sure crib mattress fits snugly and that crib slats are no more than 2 3/8 inch apart. 4. Remove mobiles from over the bed as soon as the infant begins to push up. 5. Avoid latex balloons 6. Fence swimming pools 7. Keep toilet lids down and bathroom doors closed.
What are the safety hazards for infants and toddlers?
1. Aspiration/choking 2. Suffocation 3. Poisoning 4. Falls 5. Motor vehicle injury 6. Burns 7. Drowning
How do you manage patients that are agitated to prevent it from escalating?
1. Assess for factors that lead to aggression and signs of anxiety. 2. Use a "public safety room" for patients that have risk factors for violence 3. Intervene to relieve anxiety as it can lead to violent behavior. 4. Treat underlying medical conditions or administer sedatives 5. Use a calm nursing approach 6. Avoid using threatening or aggressive body language 7. Don't respond to anger with anger 8. Don't defend when the patient is verbally aggressive 9. Don't wear a stethoscope around your neck 10. Remove objects from the room that could be used as a weapon 11. Keep the room door open
What are the general rules nurses should follow when their patient has a restraint?
1. Assess skin integrity usually every 2 hours 2. Provide a means for hygiene and elimination 3. Always explain the need for the restraint to the client and family. Obtained signed consent if necessary. 4. Use a quick release knot to tie the restraint to the bed frame. This provides for easy removal where it will not tighten when bed is raised or lowered. 5. Two fingers must fit between the device and client to prevent injury. 6. Regularly assess the need for the continued use of the restraint.
What are the appropriate principles of body mechanics when transferring a patient?
1. Assess the patients ability to assist in the transfer 2. Use a wide base of support 3. Squat to lift heavy objects from the floor 4. Use the muscles in your legs when lifting 5. Keep objects close to your body 6. Use both hands and arms 7. Raise the height of the bed 8. When possible, keep elbows bent 9. Push, slide, or pull heavy objects 10. Maintain a good grip on the patient or object 11. Get help 12. Use assistive devices
What should nurses do to prevent needlestick injuries?
1. Avoid recapping contaminated needles 2. Use a swoop method if you must recap a sterile needle. 3. Never carry syringes in uniform pocket 4. Place sharps container near work area if it is moveable. 5. Place sharps containers at eye level; do not overfill container
What actions can be taken to prevent drowning in preschoolers and school aged children?
1. Be sure child knows how to swim 2. Fence fools 3. Supervise near pools and water
What other ROM can be done with the hip?
1. Circumduction - Circle the leg keeping the knee straight 2. Internal rotation - turn the foot and leg inward toward the other leg 3. External rotation - Turn the foot and leg outward pointing the toes as far as possible away from the other leg
What are some important considerations for external beam radiation?
1. Common complications are enteritis, fatigue, and skin irritation 2. Signs of enteritis are diarrhea, gas, cramping, bloating, urgency, bleeding, and rectal soreness. The nurse should determine usual pattern of bowel movements and ask the patient to log the pattern of diarrhea, including when it started; how long it has lasted; and frequency, amount, and type of stools. 3. Treatment of acute enteritis includes treating the diarrhea, loss of fluids, poor absorption, and stomach or rectal pain. 4. Nurse should perform a nutrition assessment including height and weight, usual eating habits, any change in eating habits, amount of fiber in the diet, and signs of dehydration (such as poor skin tone, increased weakness, or fatigue) are important to determine the severity of nausea and vomiting. 5. Fatigue may be caused by the increased energy needed to repair damaged skin tissue and the GI issues. In addition to discussing and preparing the patient for the possibility of extreme fatigue, suggestions for dealing with it include limiting unnecessary activities, maintaining good nutrition, maintaining a regular sleep schedule, and relying on friends and family to assist with activities of daily living. 6. To prevent skin breakdown, the patient should be taught to use only creams or lotions approved by the radiation oncologist and to avoid sun exposure. Binding clothing at the radiation site should be avoided to limit skin irritation. Changes the nurse and patient look for include thinning, altered pigmentation, ulceration or necrosis, and other reactions. An effective skin regimen can be developed and individualized to the patient.
What are the conditions that can affect mobility?
1. Developmental stage 2. Nutrition - obesity, inadequate protein stores causing muscle wasting and fatigue 3. Lifestyle - lack of exercise 4. Stress - high levels of stress can produce fatigue 5. Environmental factors - weather, pollution, neighborhood conditions, finances, support systems 6. Diseases and abnormalities - arthritis, paget's disease, osteoporosis, trauma, disorders of the CNS
How should you position yourself with a patient that is agitated?
1. Don't let the patient get between you and the door 2. Remain at least an arm's length away from the patient 3. Do not turn your back on patient 5. do not touch the patient without permission.
What are the safety concerns for preschoolers and school aged children?
1. Drowning 2. Motor vehicle injuries 3. Firearms 4. Play injury 5. Burns 6. Poison
Axial section
1. Each vertebra is constructed like a ring, one on top of another, with a padding of cartilage between; vertebral rings are studded with bony projections called processes, which function as attachments for muscles and points of articulation with bones 2. Twelve pairs of ribs attach to thoracic vertebrae; upper 7 opposing pairs attach at front to sternum; 3 of remaining 5 pairs attach to rib immediately above by cartilage, and lowest 2 pairs are unattached
What ROM can be done with the foot?
1. Eversion - turning the sole of the foot laterally 2. Inversion - turn the sole of the foot medially
When performing PROM, what should be kept in mind?
1. Explain the purpose of ROM 2. Observe the patient as you perform PROM for energy level or pain 3. Support the patient's limb above and below the joint that is to be exercised 4. Move the joint in a slow, smooth, rhythmic manner. Avoid fast movements 5. Never force a joint 6. Perform PROM at least 2 x daily. Move each joint through ROM 3-5 times. 7. Consider incorporating ROM in care activities such as bathing or turning the patient 8. Return the joint to neutral when complete 9. Encourage active exercise whenever possible.
What ROM can be done with the ankle?
1. Extension (plantar flexion) - point the toes and foot downward 2. Flexion (dorsiflexion) - Pull the toes and foot upward
What ROM can be done with the shoulder?
1. Flexion - arm raised to to alongside of head 2. Extension - Arm put back a neutral position at the side of the body 3. Hyperextension - Move the arm behind the body 4. Abduction - Raise arm out to the side of the head 5. Adduction - Move arm down from side of head to across the front of the body as far as possible 6. Conduction - circle the arm from the shoulder 7. External rotation - Keeping elbow up move hand up 8. Internal rotation - keeping elbow up move hand down
What ROM can be done with the trunk?
1. Flexion - at the waist, bend forward 2. Extension - straighten the trunk 3. Hyperextension - bend the trunk backward 4. Lateral flexion - bend the trunk to the side 5. Rotation - turn the upper body from side to side
What ROM can be done with the elbow?
1. Flexion - bend at the elbow to move the forearm from a straight position up toward the shoulder 2. Extension - straighten the arm by lowering the arm forward and down 3. Rotation (supination) - move the hand and forearm so that the palm is facing upward 4. Roration (pronation) - move the hand and forearm so that the palm is facing downward.
What ROM can be done with the fingers?
1. Flexion - bend the fingers into a fist 2 Extension - straighten the fingers 3. Hyperextension - bend the fingers back 4. Abduction - Spread the fingers apart 5. Adduction - bring the fingers together
What ROM can be done with the wrist?
1. Flexion - bend the fingers of the hand toward the inner aspect of the forearm 2. Extension - straighten the wrist so that it is one the same plane as the forearm 3. Hyperextension - bend the wrist as far back as possible 4. Abduction - Bend wrist laterally toward the thumb. 5. Adduction - bend the wrist laterally toward the pinky
What ROM can be done with the knee?
1. Flexion - bend the knee bringing the heel back 2. Extension - straighten the knee returning the leg back to its original position
What ROM can be done with the toes?
1. Flexion - curl the toes downward 2. Extension - straighten the toes 3. Abduction - spread the toes apart 4. Adduction - bring the toes together
What ROM can be done with the neck?
1. Flexion - head to chin 2. Extension - Head is upright 3. Hyperextension - Head is back 4. Lateral flexion - Head tilted from shoulder to shoulder 5. Rotation - Rotate head from side to side
What ROM can be done with the hip?
1. Flexion - move the leg forward and up 2. Extension - move the leg back down beside the other 3. Hyperextension - move the leg back behind the body 4. Abduction - move the leg laterally 4. Adduction - sweep the leg inward across the midline
What ROM can be done with the thumb?
1. Flexion - move the thumb across the palm of the hand toward the pinky 2. Extension - move the thumb laterally away from the fingers 3. Opposition - touch the thumb to the top of each finger of the same hand.
What are some examples of never events?
1. Foreign objects left in patients after surgery 2. Air embolism 3. Medication error 4. Administering the wrong type of blood 5. Falls and trauma 6. Catheter UTI 7. IV catheter infections 8. Surgical site infections 9. DVT or PE post op
What education should a patient need to prevent recurrence of a hip fracture?
1. Gait training 2. Long term exercise program 3. Review of medications 4. Teach proper use of assistive devices 5. Assess patient environment and remove hazards including removing rugs and clutter 6. Place non skid mats on shower flower 7. Install grab handles near toilet and shower 8. Installing handrails on both sides of the stairs 9. Improving lighting 10. Have vision checked regularly 11. Have regular check ups and bone density scans
What should be included in developing a fitness program for older adults?
1. Get at least 30 minutes of endurance activity every day. This is exercise that makes you breathe hard, builds strength and staying power. 2. Incorporate resistance into your exercise: weights or isometric activity. 3. Work on your balance - such as standing on one foot. 4. Stretch daily to promote flexibility and prevent injury
How should the nurse educate clients on avoiding carbon monoxide poisoning?
1. Install CO detectors 2. Ensure gas or wood-burning appliances are vented 3. Repair rush holes or defects in vehicles that could allow exhaust fumes to enter passenger compartment 4. Never use a kerosene heater, gas oven, or gas range to heat a house 5. Never operate gasoline-powered engines near open doors or windows in confined spaces 6. Never burn charcoal inside a home, cabin, recreational vehicle, fireplace, or tent
What nursing interventions can be taken to prevent the risk for falls and injuries?
1. Instruct clients with orthostatic hypotension to get up slowly and sit on the side of bed. 2. Instruct use of call light and put it within reach 3. Use fall risk alerts such as ID wristbands, bright colored socks, or signs on door. 4. Provide regular toileting 5. Orientate client to room and surroundings 6. Ensure adequate lighting 7. Ensure client knows how to use all assistive devices 8. Place clients at risk for falls near nursing station 9. Ensure bedside tables and frequently used items are within reach 10. Maintain bed in low position 11. Keep bed rails up for patients who are sedated or unconscious 12. Avoid use of full side bedrails for clients who get out of bed without assistance 13. Provide client with nonskid footwear or bath mats 14. Use gait belts and other equipment when moving clients 15. Keep floor free from clutter 16. Review medication side effects with client 17. Perform hourly rounds on clients 18. Communicate fall risk during handover 19. Document!
How can immobility affect the respiratory system?
1. It decreases the strength of all the muscles involved in ventilation 2. Depth of respiration decrease 3. Pooling of secretions in airways 4. The ability to cough and expectorate diminishes 5. Decreased oxygen and carbon dioxide exchange 6. Pneumonia
How can immobility affect the cardiovascular system?
1. It increases the workload of the heart 2. Promotes venous stasis 3. Heart rate and stroke volume increase to maintain BP 4. Blood pools causing edema 5. Blood clots 6. Orthostatic hypotension
What actions can be taken to avoid poisoning in infants and toddlers?
1. Keep cleaning agents out of reach and lock chemicals, medications 2. Remove sources of lead 3. Dispose of medications no longer in use
What actions can be taken to avoid falls in infants and toddlers?
1. Keep crib rails up 2. Never leave infant unattended on changing table 3. Use gates on stairs and screens on windows 4. Place in low bed when toddler starts to climb
What actions can be taken to prevent firearms injuries in preschoolers and school aged children?
1. Keep firearms unloaded, locked, and out of reach 2. Teach never to touch a gun 3. Store bullets in separate place
What actions can be taken to minimize the risk for aspiration/choking in infants and toddlers?
1. Keep small objects out of reach 2. Do not feed infant hard candy, peanuts, popcorn, or whole/sliced pieces of hot dog 3. Do not place infant in supine position while feeding from bottle. 4. Do not place pacifier on a string and it should be kept in one piece.
What are causes of medication errors?
1. Lack of knowledge - of drug, of patient, wrong route 2. Faulty communication - illegible prescription, misunderstood abbreviations, poor documentation 3. Equipment errors - equipment malfunction or wrong equipment used to administer 4. Calculation errors - confusion about unit of measurement, or dose is calculated wrong 5. Improper handling/storage 6. Not identifying patient 7. Nurse fatigue/distraction 8. Inadequate lighting
What precautions should be taken when caring for a patient with an internal radioactive implant?
1. Limit the amount of time with the patient by organizing nursing care 2. Perform near the patient only the nursing care that is absolutely necessary 3. Wear protective shielding and wear film badges
How can immobility affect the musculoskeletal system?
1. Loss of muscle strength 2. Stiff joints 3. Contractures or fusion of the joints 4. Bone formation decreases causing osteoporosis 5. Increase excretion of calcium causing kidney stones
What are the risk factors for falls?
1. Medications 2. Past medical history 3. Current medical treatments or conditions 4. Diseases/disorders 5. Age
What are the safety hazards for adolescents?
1. Motor vehicle injuries 2. Burns
What is the risk to patient during a transfer?
1. Patient falling 2. Friction or shear 3. Injury from misuse of equipment
What methods can be used to assess the risk for falls and injuries?
1. Perform a risk assessment in the initial assessment 2. Reassess a risk for falls every 8 hours 3. Identify medications that increase risk for falls 4. Use testing methods such as the morse fall scale, get up and go test, and comprehensive fall evaluation
What are some considerations nurses should take when promoting exercise in patients?
1. Personalize the benefits of physical activity - what motivates your patient? 2. Set personal goals for physical activity - make them simple and realistic 3. Include a variety of activities to keep patient from feeling bored. 4. Remind your patient to recognize and appreciate success. 5. Suggest strategies to achieve patient goals 6. Provide encouragement
What actions can be taken to avoid motor vehicle injuries in infants and toddlers?
1. Place in a rear facing car seat until two years of age or until they exceed height and weight limit of car seat. 2. Use a five point harness 3. Place car seat in back seat
What are some interventions for patients that are immobile?
1. Position the patient to allow for lung expansion and to prevent atelectasis and pneumonia 2. Provide a healthy diet to prevent loss of muscle mass 3. Prevent orthostatic hypotension by having patient sit on edge of bed before moving. 4. Turn that patient every 2 hours to prevent pressure on the skin and minimize edema
How should restraint use be documented?
1. Precipitating events and behavior of the client prior to seclusion or restraint 2. Alternative actions taken to avoid seclusion or restraint 3. The time restraints were applied and removed (if discontinued) 4. Type of restrain used and location 5. Client's behavior while restrained 6. Type and frequency of care (ROM, neurosensory checks, removal, integumentary checks) 7. COndition of the body part being restrained 8. Client's response when restraint is removed 9. Medication administration
Muscles
1. Primarily function as a source of power and pull against bones to move body 2. Three primary types of muscle: -skeletal muscle (striated, voluntary) moves extremities and external areas of body- moves the skeleton. -cardiac muscle (striated, involuntary) is found in heart--- is a unique form of muscle that has the abil- ity to contract spontaneously. It is responsible for the beating of the heart. -smooth muscle (nonstriated, involuntary) is found in walls of arteries and bowel- occurring in the digestive tract and other hollow structures, such as the bladder and blood vessels, pro- duces movement of food through the digestive tract, urine through the urinary tract, and blood through the circulatory system. Muscles span a joint and attach by tendons to two different bones.
What actions can be taken to prevent burns in preschoolers and school aged children?
1. Reduce setting on water heater to no higher than 120 degrees F 2. Teach dangers of playing with matches, fireworks 3. Teach how to use microwave and other cooking instruments
What should the response be in the event of a fire (RACE)?
1. Rescue the patient(s) 2. Alarm: activate the alarms 3. Contain: Close doors and windows and turn off oxygen or electrical devices. 4. Extinguish: Extinguish the fire if possible
Joint articulations
1. Result when two bones are joined together; categorized according to type of motion 2. Composed of fibrous connective tissue and cartilage (dense avascular connective tissue) that covers ends of bones making movement smooth 3. Joint cavity secretes synovial fluid, which lubricates joint and reduces friction *book* A joint is a space in which two or more bones come together. This is also referred to as articulation of the joint. The major function of a joint is to provide movement and flexibility in the body. There are three types of joints in the body: • Synarthrodial, or completely immovable, joints (e.g., in the cranium) • Amphiarthrodial, or slightly movable, joints (e.g., in the pelvis) • Diarthrodial (synovial), or freely movable, joints (e.g., the elbow and knee) Although any of these joints can be affected by disease or injury, the synovial joints are most commonly involved
What are the rights of medication administration?
1. Right patient 2. Right medication 3. Right dose 4. Right time 5. Right route 6. Right documentation
What actions can be taken to prevent motor vehicle or injuries in adolescents?
1. Set rules on number of people allowed to ride in cars, seat belt use and to call for a ride home if driver is impaired. 2. Protective equipment for sports 3. Alert to signs of depression 4. Firearm safety 5. Water safety 6. Check water depth before diving
Crew Resource Management Six critical components:
1. Situational awareness 2. Problem identification 3. Decision making by generating alternative acceptable solutions 4. Appropriate workload distribution 5. Time management 6. Conflict resolution
Bone marrow xl
1. Soft, spongy, highly cellular blood-forming tissue that fills cavities of bones and is site for hematopoiesis (red blood cell or RBC production) and storage of RBCs. 2. Responsible also for production of white blood cells (WBCs), and platelets. 3. Becomes predominantly fatty with age, particularly in long bones of limb. The short, flat, and irregular bones contain red bone marrow that produces red blood cells.
What should nurses do to prevent radiation injury?
1. Take precautions to avoid excessive radiation exposure during x-ray procedures.
What actions can be taken to prevent poisoning in preschoolers and school aged children?
1. Teach child about alcohol, cigs, prescription and illegal drugs 2. Keep dangerous substances out of reach
What can nurses do to promote client safety for young and middle aged adults?
1. Teach clients to drive defensively and not drink and drive 2. Reinforce teaching of long term effects of drinking 3. Ensure home safety with smoke and CO detectors, fire alarms 4. Signs of depression or suicide 5. Diving and water safety 6. Safety in the workplace 7. Hazards of excessive sun exposure and use of sun block
What actions can be taken to prevent play injuries in preschoolers and school aged children?
1. Teach not to run with objects in mouth 2. Teach playground safety 3. Teach to play in safe areas 4. Teach to never swim alone and wear life jackets in boats 5. Wear protective helmets and elbow and knee pads 6. Teach stranger danger
What nursing interventions can prevent poison intervention?
1. Teach parents to keep the poison control center phone number easily accessible. 2. Teach parents to call 911 immediately if a poisonous substance is ingested even if symptoms are not present 3. Teach clients to use a medication organizer for older adults to prevent accidental overdose. 4. Teach parents to use careful words and actions, store medications carefully, dispose of medications carefully, and evaluate environment for poisonous substances.
What education should a patient need following hip surgery?
1. Teach patient correct usage of assistive devices - raised toilet seats, dressing sticks, long handed shoe horns, walkers, and canes. 2. Provide tools to aid in dressing 3. Encourage patient to increase mobility slowly 4. Physical therapy will be needed to regain mobility. 5. Monitor for evidence of incisional infection 6. Educate on how to care for incision - clean daily with soap and water 7. Monitor for deep vein thrombosis (redness, swelling, pain in calf) and pulmonary embolism (shortness of breath, chest pain) or bleeding if patient is on anticoagulant 8. Prevent dislocation by using elevated seating/raised toilet seats, use straight chairs with arms, use an abduction pillow between legs while in bed, and externally rotate the toes 9. Do not cross legs or internally rotate your toes
What actions can be taken to avoid burns in infants and toddlers?
1. Test temperature of formula or bath water 2. Place pots on back burner and turn handle away from front of stove 3. Supervise use of faucets 4. Keep matches and lighters out of reach.
What should be included in the teaching of patients on how to use crutches?
1. The axilliary crutch pad should be three fingerbreadths below the axilla. 2. Place crutches 6 inches in front of the feet forming a triangle 3. When going up stairs, lead with the good leg. 4. Position crutches on the unaffected side when sitting or rising from a chair.
If a patient is completely immobile and can provide no assistance, what type of transfer device should be used?
A mechanical lift with full sling
What should be included in the teaching of patients on how to use a walker?
1. The walker should extend from the floor to the hip joint so the patient can maintain a 30 degree flexion of the coat. 2. Pick up the walker and advance it as you step ahead. 3. If one leg is weaker, move it forward as the walker moves forward 4. Pic up rather than slide the walker (unless it has wheels)
What should be included in the teaching patients how to use a cane?
1. Top of cane should reach the top of the hip joint 2. Patient should be able to maintain a 30 degree flexion of the elbow 3. Hold the cane on the stronger side 4. Advance the cane 6-10 inches then move then weaker leg. Next, bring the stronger leg through 5. Avoid leaning over or on the cane 6. Maintain 2 points of support on the ground at all times.
Classifications of bones xl
1. Two major classifications are based on structure: -compact bone (dense) -cancellous bone (spongy) 2. A central shaft (diaphysis) and two end portions (epiphyseals) characterize long bones (e.g., humerus and radius) *book* Long bones, such as the femur, are cylindric with rounded ends and often bear weight.
What guidelines should a nurse follow to prevent injury?
1. Two or more personnel should assist with positioning 2. Remove obstacles prior to any procedure or ambulating patient 3. Use smooth movements when lifting and moving clients 4. When standing for long periods of time, flex the hip and knee through use of foot rest. 5. When sitting for long periods of time, keep the knees lightly higher than the hips. 6. Avoid repetitive movements of hands wrists, and shoulders. 7. Avoid twisting the spine or bending at the waist.
What actions can be taken to prevent motor vehicle injuries for preschoolers and school aged children?
1. Use booster seats for children who are less than 4 feet 9 inches and weigh less than 80 lbs. 2. If air bag, place children under 12 in the back seat 3. Use protective equipment when riding a bike, participating in sports 4. Teach child safety rules of the road and not running into the road 5. Teach stranger danger 6. Begin sex education for school aged child
What actions can be taken to prevent burns in adolescents?
1. Use sunblock or protective clothing 2. Teach dangers of sunbathing and tanning beds 3. Educated hazards of smoking, alcohol, legal and illegal drugs, and unprotected sex.
When lifting heavy objects or patients what should nurses do to prevent injury?
1. Use the major muscle groups to prevent back strain 2. Tighten the abdominal muscles to increase support to the back muscles 3. Distribute the weight between the large muscles of the arms and legs 4. When lifting from the floor, flex the hips, knees, and back. Get the object to thigh level, keeping the knees bent and the back straight. Stand up while holding the object as close as possible to the body, bring the load to the center of gravity. 5. Use assistive devices when possible.
What are important considerations when obtaining a written order for a restraint?
1. You must have an order from a physician to apply restraints. The order must be ordered for the shortest duration necessary. 2. In an emergency situation when there is immediate risk to the client or others, restraints can be applied. But a prescription must be obtained within one hour. 3. The prescription must include the reason, type, location, duration of restraint, and type of behavior demonstrated that warranted the use of the restraint. 4. Prescriptions are limited to 4 hours for adults, 2 hours for 9 to 17, and one hour under 9 years of age. 5. PRN prescriptions are not allowed.
CT Scan
100 times more sensitive than normal x-rays. Can be done with or without contrast dye. For long bones and joints CT scans can allow for a detailed examination of cross-sections of the areas examined. Defects that can be seen include tumors and fractures. Contrast may be used in joint examination.
What is atrophy?
A decrease in the size of muscle tissue due to lack of use or loss of neural innervation. It can also be related to osteoarthritis or rheumatoid arthritis.
Treatment of Strains & Sprains
A partial tear can usually heal with rest, but a complete tear often requires surgery to stabilize the joint. Initial treatment almost always includes RICE therapy - rest, ice, compression and elevation. Adaptive devices, physical therapy and pain management.
What is a sentinel event?
A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury. Serious injury specifically includes loss of limb or function. Such events are called sensitive because they signal the need for immediate investigation and response.
When to get Occult Blood
A test whereby stool is examined for minute amounts of blood loss (possibly from polyps or cancer) by way of a chemical reaction resulting in a color change. While FOBT is not a test to examine the colon, it is recommended annually to individuals over age 50. If occult blood is found in the stool, a follow up colonoscopy will be necessary.
X-ray
Assist in the diagnosis of fractures, abnormal fracture healing, tumors, arthritic conditions, and osteomyelitis.
Ulcerative Colitis Pathophysiology
Autoimmune disease. Ulceration of the colon that causes inflammation of the digestive tract. Innermost lining of the large intestine that may lead to ulcers, which may bleed and interfere with digestion. Exact cause unknown, may be related to an abnormal immune response in the GI tract, possibly associated with genetic factors.
Malabsorption/Celiac Disease Pathophysiology
Autoimmune disorder that causes gluten to damage to small intestines. Gluten can be found in wheat barley and rye.
Ligaments
Bands of rigid connective tissue that HOLD JOINTS TOGETHER, allowing for movement and stability Have a relatively poor blood supply, which significantly prolongs healing process after injury *book* ligaments, which attach bones to other bones at joints. Ligaments are flexible to allow freedom of movement, but strong and tough so they do not yield under force of movement.
Body mechanics
Bend at knees, spread feet apart to lower your center of gravity (shoulder width apart) & broaden base support (greater stability and support), use leg/arm muscles to lift, not back, carry things close to you.
Immobility related to perfusion
Are less able to be mobile because of reduced oxygenated blood reaching peripheral tissues Those who are immobile, perfusion is less effective because of reduced venous return Decreased peripheral perfusion most often occurs in the lower extremities. The distal legs become cool and pale or cyanotic. Pedal pulses may be diminished or absent. If not treated, inadequate perfusion can result in skin ulcers (see tissue integrity later in this chapter) or cell death such as gangrene. Decreased central perfusion can result in life-threatening systemic events such as acute myocardial infarction, stroke, and shock as a result of decreased blood flow to major organs.
Crutches
Arms/hands bear weight Up stairs=good first Down stairs=bad first When walking crutch goes 6-10" in front Crutches go to affected side when sitting Pad 2 inches below axilla, 4 inches to side of heel Elbow flexed 20-30 degree when walking
Retention
An inability to completely empty the bladder. Can be caused by obstruction, inflammation & lack of nerve stimulation.
Adverse reaction
An undesired effect of a prescribed medication, whether a severe side effect or a toxicity
Idiosyncratic reaction
An unusual response to a drug that may be unrelated to dose; reaction may or may not reoccur if medication is given again
Crohn's Disease Complications
Anal fistula Perineal abscess Fistulas of the bladder or vagina or to the skin in an old scar area Intestinal obstruction Perforation Nutritional deficiencies caused by malabsorption and maldigestion
Urinary Tract Infection Treatment
Antibiotic - bactrum must be taken with water, analgesic for discomfort. Sitz bath, warm compress, Cranberry juice, proper cleaning after toileting, wear cotton underwear, no bubble baths, wipe front to back
Pyelonephritis Treatment
Antibiotics. Fluids ,antipyretic or analgesic for fever and pain. Narcotics are complimentary. Sometimes requires hospitalization.
Irritable Bowel Syndrome Medications
Anticholinergic, antispasmodic drugs, Antidiarrheals, Laxatives, Antiemetics, Simethicone, Mild tranquilizers, Tricyclic antidepressants
Back Pain Treatment
Self Care- Heating Pad and exercise Preventing pain by maintaining good posture, using a firm mattress, using good body mechanics, and exercising.
Passive xl ROM
Accomplished with assistance of a caregiver who supports client's body part while moving it t involves moving joints through their ROM when the patient is unable to do so for himself. is move- ment of the joints through their range of motion by another per- son. Both AROM and PROM improve joint mobility, increase circulation to the area exercised, and help maintain function. However, AROM also improves muscle strength and tone, as well as respiratory and cardiac function. For an explanation of how to perform
What are the treatments for hemiparesis?
Active and passive range of motion exercises or electrical stimulation.
Immobility related to pain
Acute or chronic pain may interfere with mobility Some conditions associated with immobility cause pain
What are the side effects of celebrex?
Adverse reactions are gastric bleeding, ulcers, and cardiovascular events. It should not be used by persons with asthma or sensitivity to sulfa or aspirin. It is under investigation for its adverse side effects. It has the highest risk for heart attacks compared to other NSAIDs.
Paget's Disease Teaching
Bisphosphonates don't cure, but can help slow progression of disease, important to stick to medication regiment. More common in men
Appendicitis Diagnosis
Blood and urine tests X-ray, CT scan or Ultrasound
Rheumatoid Arthritis Diagnosis
Blood tests: Erythrocyte sedimentation rate (ESR or sed rate), C-reactive protein (CRP): test for inflammation. Rheumatoid factor and anti-cyclic cirtullinated peptide (anti-CCP) antibodies Imaging: X-Ray, MRI and Ultrasound
Immobility causing stasis of bronchial secretions
Bronchial stasis, atelectasis; educate the client, use incentive spirometer, deep breathing technique and coughing exercises/hold cough
Immobility effect on the Neurological System
Changes in emotional status: depression, alteration in self-concept, anxiety, behavioral changes: withdrawal, altered sleep/wake pattern, hostility, inappropriate laughter and passivity, altered perception, ineffective coping.
What are the acute signs and symptoms of mercury poisoning?
Chills, nausea, malaise, chest tightness and pain, dyspnea, coughing, stomatitis, gingivitis, excess salivation, and diarrhea. It can also cause respiratory irritation, digestive disturbances and severe renal damage.
What are the 4 Cs of food safety?
Clean, Cook, Combat cross-contamination, Chill
Osteosarcoma Teaching
Client teaching will include when to seek medical attention for a possible advancement in your disease. If you experience any of the following, you will need to contact your physician immediately:
Drug Alert
Closely monitor older adults receiving antipsychotics for adverse drug events (ADEs). Assess patients for: • Anticholinergic effects, the most common problem, causing constipation, dry mouth, and urinary retention • Orthostatic hypotension, which increases the patient's risk for falls and fractures • Parkinsonism, including tremors, bradycardia, and a shuffling gait • Restlessness and the inability to stay still in any one position • Hyperglycemia and diabetes mellitus, which occur more with drugs such as risperidone (Risperdal) and quetiapine (Seroquel) If any of these ADEs occur, notify the primary health care provider immediately.
Fall risks and prevention
Cognition, balance, gait, mobility, vision, peripheral neuropathy, awareness, medications. Toddlers, elderly most at risk. Bed to lowest point, only 2 guardrails left up, non-slip socks, remove throw rugs, remove clutter, orient to room, make sure patient knows how to use canes/walkers/crutches, call light within reach, prepare a fall assessment, clean, dry floors
Skeleton
Consists of bones, joints, and cartilage; provides framework for body and protects soft tissue and vital organs Composed primarily of calcium (as Ca++ phosphate and Ca++ carbonate) Provides points of attachment for muscles
Hip fractures that occur in people younger than 50 are a result of what?
Contact sports, vehicle accidents, or industrial accidents. This is classified as a high energy trauma.
CT Scan
Series x-ray images at different angles, computer then processes and creates cross sectional images of bones, vessels, soft tissues
Safety hazards in the home - Fires
Cooking fires, smoke inhalation, home heating equipment Prevention: -Smoke alarms -Caution with cigarettes -Fire extinguisher -No candles unattended -Safety with holiday lights -Care with electrical cords Home fires are a major cause of death and injury. Older adults and children under age 5 have the greatest risk of fire death. Most fatal home fires occur while people are asleep, and most fire-related deaths occur from smoke inhalation. The following are common causes of fire in the home: ■Cooking fires are the number one cause of home fires and home fire injuries. ■Smoking (e.g., cigarettes) is the leading cause of fatal home fires, but during the winter months heating equipment is equally responsible. ■Home oxygen administration equipment is also a hazard. In 75% of the home fires involving oxygen, smoking materials are the ignition source; cooking and candles are other common factors. When more oxygen is in the air, items such as hair, plastic, skin oils, clothing, and furniture catch fire at lower temperatures. Any fire that starts will burn hotter and faster. Other causes of fire include unsupervised children playing with matches, improper use of candles, and faulty wiring.
Ulcerative Colitis Treatment
Corticotropin and adrenal corticosteroids, Sulfasalazine, Mesalamine, Antispasmodics and antidiarrheals, Fiber supplements Surgery --Treatment of last resort -- Proctocolectomy with ileostomy, Pouch ileostomy, Ileoanal reservoir with loop ileostomy, Colectomy (after 10 years of active disease).
Assistive devices
Crutches Canes Walkers Wheelchairs- Patients who sit for prolonged periods in a wheelchair need to be repositioned at least every 1 to 2 hours. Each patient is evaluated by the physical or occupational therapist for the best seating pad or cushion that is comfortable yet reduces pressure on bony prominences. Patients who are able are taught to perform pressure relief by using their arms to lift their buttocks off the wheelchair seat for 20 seconds or longer every hour or more often if needed (sometimes referred to as wheelchair push-ups) Prostheses
Renal Calculi Pathophysiology
Crystals in urine that accumulate in the kidneys and cause stones.
Surgical interventions
Curative versus palliative curative care involves treatment in an effort to extend the patient's overall length of life palliative care involves treatment that will hopefully improve the patient's quality of life
Immobility on the GI system
Decreased motility/peristalsis: get them walking, increase fiber and fluids
Immobility of the Respiratory System
Decreased respiratory movement resulting in atelectasis, hypostatic pneumonia, and decreased cough response.
Malabsorption/Celiac Complications
Developmental delays and cognitive impairment Anemia Gallstones or Kidney stones Osteoporosis or Osteomalacia Itchy/blistery skin rash Damage to dental enamel or mouth ulcers Headaches and fatigue Nervous system injury Joint pain Reduced functioning of the spleen Acid reflux and heartburn.
Malabsorption/Celiac Signs and Symptoms
Diarrhea, fatigue, weight loss, bloating and anemia, Orthostatic hypotension, abdominal distention, hyperactive bowel sounds, pallor, ecchymosis, peripheral edema.
Malabsorption/Celiac Treatment
Diet - barley, wheat and rye free Gluten-free to stop progression of celiac disease and malabsorption Lactose-free to treat lactase deficiency Dietary supplementation and Vitamin B12 injections
Seizure precautions
Do not attempt to insert anything into mouth of client during seizure bite-stick, airway instead remove objects that could lead to client harm Do not attempt to restrain or limit movement during a seizure use oxygen mask after seizure activity has ceased Keep suction and oxygen equipment near bed Explain purpose of seizure precautions Pad head and side-rails of bed with blankets and linens to prevent injury
Preschooler (3-6 years)
Drowning Falls Cuts Firearms Strangers Burns Motor Vehicles Poisoning
Safety hazards in the home - Suffocation/Asphyxiation
Drowning, choking, smoke/gas inhalation Children 0-4 years old high risk Prevention -Watch for small, removable parts -Cut food into tiny pieces -Pay attention to mobiles, strings, cords, plastic bags -Apply a barrier to pool -Know Heimlich maneuver Suffocation by smothering is the leading cause of death for infants younger than 1 year. Suffocation may be caused by drowning, choking on a foreign object, or inhaling gas or smoke. Drowning is an important cause of accidental death in children age 1 to 18 years. Food items, including hot dogs, raw vegetables, popcorn, hard candies, nuts, and grapes, are responsible for most nonfatal choking incidents. Nonfood items, such as latex balloons and plastic bags, cause the majority of suffocation deaths in young children. Suffocation of infants is often related to bed or crib hazards, such as excess bedding or pillows, or toys hung from long ribbons inside the infant's crib. Infants can become entangled in cords from win- dow blinds or in the ribbon or string used to hang a pacifier around an infant's neck.
Osteoporosis Diagnosis
Dual X-ray absorptiometry (DXA): most common, uses the lumbar spine and hip Quantitative Computerized tomography (QCT): used if pt has lots of arthritis in back, which makes DXA less reliable; uses standard CT scanner. Lateral radiographs: thoracic and lumbar spine used. increased creatinine, decreased calcium, increased TSH, bone density: -2.5 or lower
What are the signs and symptoms of apraxia?
Individuals know what words they want to say, but their brains have difficulty coordinating the muscle movements necessary to say all the sounds in the words. As a result, they may say something completely different or make up words (e.g., "bipem" or "chicken" for "kitchen"). The person may recognize the error and try again—sometimes getting it right, but sometimes saying something else entirely.
Urinary Tract Infection Pathophysiology
Infection of the urinary system; kidneys, bladder or urethra. More common in women.
Appendicitis Pathophysiology
Inflammation of the appendix. When the appendix becomes inflamed or infected, rupture may occur within a matter of hours leading to peritonitis and sepsis.
Urinary Retention Treatment
Treatment for urinary retention includes catheterization, treating prostate enlargement, and surgery.
Dual Energy X-ray Absorptiometry Scan (DEXA)
Dual energy X-ray absorptiometry (DEXA) scans measure bone density. These scans assist in the early diagnosis of osteoporosis. (DXA or DEXA) A type of radiographic scan that measures bone mineral density in the hip, wrist, or vertebral column; used as a screening and diagnostic tool for diagnosis and for follow-up evaluation of treatment of osteoporosis. Using a computer analysis, the scans can determine size, thickness, and mineral content of the bone. The most commonly used screening and diagnostic tool for measuring bone mineral density (BMD) is dual x-ray absorptiometry (DXA). The spine and hip are most often assessed when central DXA (cDXA) scan is performed. Many health care providers recommend that women in their 40s have a baseline screening DXA scan so later bone changes can be detected and compared. DXA is a painless scan that emits less radiation than a chest x-ray. It is the most commonly test currently used but has limitations. First, BMD alone explains only part of the bone change and provides no information on cellular activity. Second, there are variations among different DXA systems. In addition, the DXA scanner does not account for very tall or very obese patients. Finally, it is not safe for patients to have frequent scans because of radiation exposure (Fitton et al., 2015). Tell patients that their height is taken before having a DXA scan. The patient stays dressed but is asked to remove any metallic objects such as belt buckles, coins, keys, or jewelry that might interfere with the test. The results are displayed on a computer graph, and a T-score is calculated. No special follow-up care for the test is required. However, the patient needs to discuss the results with the primary care provider for any decisions about possible preventive or management interventions.
Osteomalacia Signs and Symptoms
Early in the disease there may be no symptoms. Muscle weakness and dull/achy bone pain, decreased ROM and unsteady gait. weakness and achy bones Numbness around the mouth Numbness of the arms and legs Spasms of the hands or feet o Patient presents a history of generalized skeletal pain and tenderness without a history of an injury including back pain, pain in the ribs, feet, hands, and hips. Patient may be waddling
Pyelonephritis Teaching
Encourage increased fluid intake, apply heating pad to lower back. Female - wipe from front to back, void every 2-3 hours. No NSAIDs.
Constipation Treatment
Exercise, high fiber diet, drink more fluids Medications: Bulk-forming agents- Citrucel, FiberCon Osmotic agents-Milk of Magnesia, Miralax Stool softeners- Colace, docusate Lubricants-Fleet, Zymenol Stimulant laxative- Dulcolax Surgery
Infants (1month- 1 year) Safety
Falls SIDS (back to sleep) Injury from toys Burns Suffocation and choking Electrocution Ingestion of foreign bodies Child mistreatment
Safety hazards in hospital/care giving environment
Falls Equipment-related accidents Fires/electrical hazards Restraints Side rails Mercury poisoning Infection Spills Back injury - poor body mechanics Needle stick injury Combative patients Poor staffing
Elderly
Falls #1 Elder abuse and neglect MVA Sensorimotor changes Fires (candles, heaters)..forgetfulness Burns (electric blankets, hot water, heating pads) Accidental overdosing and polypharmacy
Acute Abdominal Pain Signs and Symptoms
Fever. Inability to keep food down for more than 2 days. Any signs of dehydration. Inability to pass stool, especially if you are also vomiting. Painful or unusually frequent urination. The abdomen is tender to the touch. The pain is the result of an injury to the abdomen
Diverticulitis Treatment
Fiber diet containing no seeds, indigestible roughage, nuts or popcorn Antibiotics, analgesics, and anticholinergics to reduce bowel spasms. Bulk-forming laxatives Surgery
Tendons
Fibrous tissue that attaches muscle to bone *book* tendons (bands of tough, fibrous tissue that attach muscles to bones) Tendons are fibrous connective tissues that attach muscles to the bone.
What is an angiogram used for?
For patients with musculoskeletal disorders, angiogram is most often used after trauma or surgery to confirm a diagnosis of a DVT or a pulmonary embolism or to assess damage in an injured area.
Osteoporosis Complications
Fractures: most commonly: hip , wrist, and spine Side Complications: UTI's, Blood clots in legs or lungs, pneumonia, and bedsores Mobility issues Joint stiffness Chronic pain and weakness Dental disease: due to many medications used to treat osteoporosis
Immobility on Orthostatic hypotension
Get up slowly, sit before standing, increase fluids
Safety hazards in the home - Scalds & burns
Hot water, grease, sunburn, cigarettes Prevention: -Guardrails by fireplace -Turning pot handles -Care with candles -Sunscreen -Care when warming food in microwave The following are common causes of scalds and burns: Scald injuries (e.g., from hot water, steam, or grease) are the most common cause of burns in children younger than age 3. Scalding burns (especially on both feet or both hands) and cigarette burns in children and vulnerable older adults should always prompt you to assess for abuse. To assess for abuse, refer to Procedure 9-1 Warming food or formula in the microwave may cause the food to become hotter than intended, leading to burns in infants and young children Sunburn can cause a first- or second-degree burn Contact burns may occur from contact with metal surfaces and vinyl seats when cars are parked in the sun. The risk of contact burns in all age groups is greater in the presence of heating devices such as kerosene heaters, wood-burning stoves, and home sauna heating elements. People may use these as heat sources when they cannot afford the cost of traditional furnace fuels. Chemical agents, such as acid, alkali, or other organic com- pounds, can also cause localized burns.
Safety hazards at home - Poisoning
Household chemicals, lead, medicines, cosmetics Prevention: cabinet locks, store poison high, keep Poison Control telephone number available Treat: depends on type of poison ingested; antidotes, charcoal, etc. the most effective intervention is professional administration of activated charcoal orally or via gastric tube. However, charcoal is not effective for ethanol, alkali, iron, boric acid, lithium, methanol, or cyanide. Depending on the situation, other options for medical treatment include gastric lavage, dialysis, administration of antidotes, and forced diuresis.
Malabsorption/Celiac Diagnosis
If you start a gluten free diet before your test, it may alter your results. Serology testing looks for antibodies in your blood. Elevated levels of certain antibody proteins indicate an immune reaction to gluten.
Osteosarcoma Diagnosis
Imaging tests - X-ray, MRI, CT, Bone scan, PET Biopsy - Only certain way to diagnose osteosarcoma. Needle biopsy or surgical biopsy. Lab tests - Pathology for biopsy Blood tests - Helpful after diagnosis if disease is more advanced than appears
Synarthroses
Immovable joints (e.g. the sutures between cranial bones). In youth these joints have some flexibility to allow growth but they gradually become rigid. are immovable joints (e.g., the sutures between the cranial bones). In youth, these joints have some flexibility to allow growth, but they gradually become rigid.
How does poisoning occur in young children?
Improper storage of household chemicals, medicines and vitamins, and cosmetics. Lead paint in older homes, soil, and toys increase risk of lead poisoning.
When should a comprehensive fall evaluation be used?
In any of the following situations, you should refer the patient to a practitioner with advanced skills and experience for a comprehensive fall evaluation: 1. The patient is seeking care because of a fall. 2. The patient or family reports recurrent falls in the past year. 3. The patient's gait or balance is abnormal.
Urinary Retention Signs and Symptoms
Increased urine volume and bladder distention Back-flow to the upper urinary tract Dilation of the ureters and renal pelvis Pyelonephritis and renal atrophy
Consequences of Urinary Retention
Increased urine volume and bladder distention. Back-flow to the upper urinary tract. Dilation of the ureters and renal pelvis. Pyelonephritis and renal atrophy.
What is the get up and go test?
Initial Check. The Get Up and Go test is simple. Seat the patient in a chair and observe as he follows these instructions: 1. Stand up without using your arms for support as you rise and stand. 2. Walk several paces, turn, and return to the chair. 3. Sit back in the chair without using your arms for support. Those who can do this with steadiness need no further assessment. If the person is unsteady or has difficulty per- forming this test, perform the follow-up assessment below. Follow-Up Assessment. Ask the person to follow these instructions: 1. Sit. 2. Stand without using your arms for support. 3. Close your eyes for a few seconds while standing in place. 4. Stand with your eyes closed while I push gently on your chest (sternum). 5. Walk a short distance(specify) and come to a complete stop. 6. Turn around and return to the chair. 7. Sit in the chair without using your arms for support.
Strains/Sprains Medications
Initial treatment almost always includes RICE therapy - rest, ice, compression and elevation. Pain & inflammation can be managed by an over the counter NSAIDs (ibuprofen) or acetaminophen (Tylenol) Ibuprofen - take with full glass of water and to remain upright in an upright position for 15-30 min after administration
Bowel Obstruction Pathophysiology
Intestinal obstruction is a blockage that keeps food or liquid from passing through your small intestine or large intestine (colon).
Bowel Obstruction Treatment
Intravenous (IV) line for fluids. Nasogastric tube to suck out air and fluid and relieve abdominal swelling. Catheter to drain urine Low fiber diet for partial bowel obstruction Surgery
Active xl ROM
Isotonic exercises of each joint in body that are performed by client Can maintain or improve muscle strength Prevent deterioration of joint movement and subsequent contractures Active range of motion (AROM) is defined as the movement of the joint through the entire ROM by the individual. Full ROM is part of being physically fit; for that reason, stretching exercises are included in a comprehensive exercise program. Active range of motion (AROM) occurs when the patient independently moves his joints through flexion, extension, abduction, adduction, and circular rotation. Patients recovering from illness, injury, or surgery often perform this exercise as a rehabilitation procedure.
What is a hip replacement?
It involves the replacement of the acetabular cup, the femoral head, and the femoral stem.
What is celebrex?
It is a COX-2 inhibitor that is commonly used for severe arthritis that requires high doses of an anti-inflammatory drug.
What is fosamax?
It is a biphosphonate drug used for the prevention and treatment postmenopausal osteoporosis. It is also used to treat bone loss for glucocorticoid drug use.
What is a CT scan?
It is a radiographic study that is 100 times more sensitive than normal X-rays. Contrast may be used in joint examination.
What are the causes of mercury poisoning?
It is a result of the inhalation, ingestion or absorption of mercury through the skin. It accumulates in muscle tissue. Products that contain mercury include thermometers, thermostats, batteries, fluorescent light bulbs, blood pressure devices, and electrical equipment and switches.
What is apraxia?
It is a speech disorder that is caused by damage to the parts of the brain that control coordinated muscle movement. Often it is a result of a stroke.
What is line of gravity?
It is an imaginary vertical line drawn from the top of the head through the center of gravity. The closer the line of gravity is to the base of support, the more stable the individual is.
What is range of motion (ROM)?
It is the maximum movement possible at a joint.
What are bone scans used for?
It is used to detect early bone disease, bone metastasis, and bone response to therapeutic regimens. Bone scans assist in detecting fractures, abnormal healing of fractures, and degenerative bone diseases.
What is an arthrography used for?
It is used when more specific evaluation of cartilage surface lesions, subchondral changes, or evaluation of cartilage structure is needed. Knees and shoulders are the joints most commonly assessed using this method.
What is hemiparesis?
It is weakness on one half of the body. Usually caused by a stroke.
What is the cause of dyskinesia?
It often occurs as a side effect of long-term therapy with levodopa. But it can also result from prolonged use of certain antipsychotics.
What is an arthrography?
It the injection of air, contrast medium, or both into a joint, which is then examined either by plain X-rays, computed tumography (CT) scan, or magnetic resonance (MR) imaging.
How should you determine which method of transfer to use?
It will depend on the patient's level of dependence
Crohn's Disease Pathophysiology
One of the most common types of inflammatory bowel disease - the other is Ulcerative Colitis. Bowel inflammation, irritation and swelling. Can affect any part of the colon, both the small and large intestines. Thickens the lining of the digestive tract causing fissures and ulcers.
Rheumatoid Arthritis Signs and Symptoms
Joint pain, deformity, loss of function, fever, fatigue, weakness, weight loss. RA usually seen in fingers, wrists, elbows, ankles and knees
Pyelonephritis Pathophysiology
Kidney infection. Bacteria reach the kidney by ascending from the lower urinary tract.
What other factors contribute to hip fractures?
Lack of physical exercise, impaired vision and a fall within the last year year.
Diverticulitis Signs and Symptoms
Left lower quadrant abdominal pain that increases with coughing, straining, or lifting. Fever, gas, cramp like pain, abdominal distention and tenderness, blood in stools.
Osteopenia
Low bone density - the step between normal bone density and osteoporosis
Constipation Signs and Symptoms
Lower abdominal discomfort A sense of incomplete evacuation (the feeling that you still have to "go") Straining to have a bowel movement Hard or small stools Rectal bleeding and/or anal fissures caused by hard stools
What are the treatments for dyskinesia?
Lowering dosage of medications or stress reducers and relaxation techniques.
MRI
Magnetic resonance imaging, powerful magnetic field, radiowaves and computer used to produce detailed pictures of inside the body.
Osteoarthritis Client Teaching
Maintain weight Exercise Increase Vitamin D and Calcium Heat and cold for pain management, Avoid repetitive bending and stress on joint. Capsaicin/ OTC creams Assistive devices and taping joints
Immobility related to nutrition
May be unable to purchase, prepare, and/or consume adequate nutrition Individuals with inadequate nutrition may have decreased mobility because of excessive fatigue Older adults are the largest population at risk for malnutrition as a result of acute and chronic diseases, poor oral health, and social isolation. Obesity is a common problem in people who have type 2 diabetes mellitus and metabolic syndrome. In addition to these high-risk populations, other common risk factors for decreased nutrition in adults include lack of money to purchase healthy food and substance use. Adults with anorexia or bulimia nervosa are also malnourished. These disorders are discussed in textbooks on mental and behavioral health. Table 2-4 summarizes common risk factors for decreased nutrition.
Immobility related to impairments in gas exchange
May become immobile because of excessive fatigue. Are at risk of developing complications associated with gas exchange, such as stasis pneumonia. Decreased gas exchange results in (1) inadequate transportation of oxygen to body cells and organs; and/or (2) retention of carbon dioxide. Inadequate oxygen results in cell dysfunction (ischemia) and possible cell death (necrosis or infarction) (Fig. 2-5). An excessive buildup of carbon dioxide combines with water to produce carbonic acid. This increase in acid causes respiratory acidosis and lowers the pH of blood. is the process of oxygen transport to the cells and carbon dioxide transport away from the cells through ventilation and diffusion. This process begins with ventilation triggered by neurons in the brain sensing the need for gas exchange.
Immobility related to elimination
May have changes to their pattern of elimination or be at risk of experiencing problems such as constipation or urinary retention. Incontinence of either the bowel or bladder can occur as a result of aging when pelvic floor muscles become weaker. It may also occur in adults who have neurologic disorders such as stroke, dementia, and multiple sclerosis. Excessive use of laxatives may also cause fecal (diarrheal) incontinence. Diarrhea also results from acute GI infections such as gastroenteritis and chronic inflammatory bowel diseases such as Crohn's disease. Irritable bowel syndrome causes frequent diarrhea, constipation, or intermittent episodes of diarrhea and constipation. Urinary retention is often a problem in older men who have benign prostatic hyperplasia (overgrowth). This overgrowth blocks the bladder neck and prevents urination or complete bladder emptying. Retention of stool, or constipation, is also common in older adults who have decreased peristalsis and/or lack of adequate dietary fiber and fluids to promote fecal passage. Lack of exercise and use of certain medications such as opioids, diuretics, and psychoactive drugs can contribute to constipation in adults of any age. Spinal cord and brain injuries or diseases often cause involuntary control or retention of both bowel and bladder. Renal and urinary health problems can alter urinary elimination, depending on the type of disease or disorder. For example, urinary tract obstructions such as ureteral stones may prevent urine from reaching the bladder. Chronic kidney disease can cause changes in the amount of urinary output, depending on the stage of the disease. In the end stage the patient experiences oliguria (scant urine) or anuria (absence of urine) because the kidneys have lost their ability to make urine.
Restraint Rules/Regulations
One-on-one viewing of patient in restraints/seclusion, document episodes in detail and void when possible. Remove restraints every 2 hours to provide skin care. Re-evaluation is every 4 hours. Reapplication of restraints can be delegated to an AP. Anew order for restraints must be given at least every 24 hours.
What is ORIF?
Open reduction and internal fixation. Open reduction is the realignment of bone segments under direct visualization through an incision. Internal fixation involves surgery in which the surgeon implants metal wires, plates, rods, pins, screws, or nails to support the bone directly.
Immobility related to tissue integrity
May have diminished tissue integrity or be at risk of experiencing such problems, like skin breakdown Changes in tissue integrity can occur at any age, but older adults are at an increased risk. The skin and underlying tissues of older adults become thinner, drier, and more likely to bruise because of increased capillary fragility. Arterial blood flow is often decreased. Certain medical conditions also increase the risk of impaired tissue integrity and include malnutrition, neurologic disorders, diabetes mellitus, peripheral vascular disease, urinary and bowel incontinence, and immune suppression. The most common tissue impairment is pressure injuries, which account for a significant number of hospital and long-term care admissions.
Arthrometry
Measures and documents cruciate ligament laxity of the knee both passively and actively. The arthrometer measures the distraction forces on the knee. These measurements are taken passively, actively, and manually. Measurements are taken on both the noninjured and injured knee. **Surgeons use this method to diagnose anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) tears.
Restraint Definition
Mechanical device/material/equipment such as cloth vests or side rails Chemical restraint such as medication- sedatives and psychotropic. Avoid when possible, use the lowest level of restraint available for the least amount of time needed
If a patient is dependence but can hold on to a device with minimal strength, what type of transfer device should be used?
Mechanical lift with full sling or stand/assist life
Arthroscopy
Most often performed in the knee joint, an arthroscopy is an endoscopic procedure used to diagnose and repair meniscal, patellar, extrasynovial, and synovial diseases. Biopsies can also be performed. *book* Arthroscopy may be used as a diagnostic test or a surgical procedure. An arthroscope is a fiberoptic tube inserted into a joint for direct visualization of the ligaments, menisci, and articular surfaces of the joint. The knee and shoulder are most commonly evaluated. In addition, synovial biopsy and surgery to repair traumatic injury can be done through the arthroscope as an ambulatory-care or same-day surgical procedure.
Angiogram
Most often used after trauma or surgery to confirm a diagnosis of a DVT or a pulmonary embolism or to assess damage in an injured area. An angiogram is an invasive procedure that can have serious complications. A catheter is inserted in the femoral, brachial, subclavian, or carotid artery and a contrast dye is injected to visualize the vessels. The most serious complication is an embolus forming due to catheter clot formation.
What is the leading cause of death in children ages 1 to 3?
Motor vehicle accidents followed by drowning.
What is the leading cause of death in adolescents?
Motor vehicle accidents followed by homicide both of which are associated with alcohol and drug use.
What is the leading cause of death in preschoolers?
Motor vehicle injuries along with drowning, fires, and poisoning.
What medications can increase the risk for falls and why?
Narcotics, opioids, sedatives, antipsychotics, neuro drugs, diurectics, cadiac meds, muscle relaxants, calcium channel blockers
Bone scan
Nuclear medicine test uses small amount radioactive substance called a tracer, tracer injected into vein, areas where too much is absorbed or too little may indicate area of cancer.
What are the chronic signs and symptoms of mercury poisoning?
Numbness or tingling of the hands, lips, and feet. Changes in personality of behavior. Fatigue, weakness, weight loss, and GI disturbances.
Ulcerative Colitis Complications
Nutritional deficiencies, sepsis, anal fissure, anal fistula, abscesses, perforation of the colon, hemorrhage, anemia, toxic megacolon, cancer, coagulation defects, cirrhosis, ankylosing spondylitis, strictures, pseudopolyps, stenosis, toxemia, arthritis.
Scoliosis Treatment
Observation until skeletal muscle maturity has been achieved. When it's needed due to severity: Bracing - painful, time consuming, self image affected. The younger the age, the more likely for future curvature Surgery and Exercises also options for treatments Pain and inflammation medication therapies
Toxic reaction
Occurs when prescribed medication dosage is excessive or poisonous to an individual; this may be due to client's size, health condition, or other medications being taken
What are the age factors that increase the risk for falls and why?
Older adults are at a higher risk for falls due to physiological changes such as reduced muscle strength and joint mobility, slowing of reflexes, decreased ability to respond to multiple stimuli, and sensory loss (vision and hearing).
Paget's Disease Complications
Osteoarthritis. Broken bones or fractures. Nervous System problems. Hearing loss, tinnitus, headache, dizziness, trouble with walking and balance and numbness in an arms or leg Heart Failure. Bone Cancer (osteogenic sarcoma). Kidney stones and/or calcium deposits
Rheumatoid Arthritis Complications
Osteoporosis Rheumatoid nodules Dry eyes and mouth Infections Carpel tunnel syndrome Hardened and blocked arteries Inflammation and scarring of the lung tissue Lymphoma
Complications of Strains & Sprains
Pain, recurring swelling and possible surgery. Sometimes ligaments can heal incorrectly leaving them permanently stretched.
Safety hazards in the home - Take-home toxins
Pathogenic microorganisms, asbestos, lead, mercury, arsenic Prevention: -Be aware of workplace preventive measures -Remove work clothing -Shower if appropriate -Use gloves Take-home toxins are hazardous substances transported from the workplace to the home. The National Institute for Occupational Safety and Health (NIOSH) reports that path- ogenic microorganisms, asbestos, lead, mercury, arsenic, pesticides, caustic farm products, and dozens of other agents cause significant morbidity and mortality in workers' homes (NIOSH, 2003, 2004). These toxins are most likely transported to workers' homes on the workers themselves,on their clothing, or on objects brought from the workplace. In the home, contamination occurs via any of three sources: ■Direct skin-to-skin contact, or direct contact with contami- nated clothing ■Arthropod vectors, such as ticks that are responsible for Lyme disease ■Transmission on dust particles that are inhaled (e.g., anthrax spores, arsenic in mine and smelter dust)
Osteomyelitis Treatment
Pharmacology is 4-6 weeks of IV antibiotic therapy for acute, and 6-8 weeks of oral antibiotic for chronic. Localized wound debridement will be necessary.
Strains/Sprains Diagnosis
Physical Exam, X-ray, MRI Grade One: - Strain - Stretch on muscle fibers, less than 10% of muscle fibers involved. - Sprain - Stretched ligament, 0-20% torn Grade Two: - Strain - Partial tear in muscle. Palpation reveals defect. 10-50% of muscle fibers involved. - Sprain - Ligament 20-75% torn. Grade Three: - Strain - Extensive tear or complete rupture. 50-100% of muscle fibers torn to complete rupture of the muscle. - Sprain - 75-complete rupture of ligament.
older adult factors affecting safety.. test types of abuse
Physical abuse is the use of physical force that results in bodily injury, especially in the "bathing suit" zone (abdomen, buttocks, genital area, upper thighs). Examples of physical abuse are hitting, burning, pushing, and molesting the patient. Sedating the older adult is also abusive. Financial abuse occurs when the older adult's property or resources are mismanaged or misused; this is more common than physical abuse. emotional- intentional use of threats, humiliation, intimidation, isolation Carefully assess the patient for signs of abuse such as bruises in clusters or regular patterns; burns, commonly to the buttocks or the soles of the feet; unusual hair loss; or multiple injuries, especially fractures. If the older adult is too weak or has no other resources or support systems, he or she may not admit that abuse is occurring. ***Examples of Elder Abuse Screening Tools • Elder Abuse Suspicion Index • Elder Assessment Instrument • Indicators of Abuse Screen • Questions to Elicit Elder Abuse • Hwalek-Sengstock Elder Abuse Screening Tool • Caregiver Abuse Screen • Brief Abuse Screen for the Elderly • Vulnerability to Abuse Screening Scale
Osteoarthritis Treatment
Physical therapy Exercise Weight Management Vitamin D and Calcium Ice packs and heating pads Assistive devices Joint taping
Safety hazards in the home - Falls
Prevalent in those older than 65 years Slippery floors, stairs, tubs; low toilet seat; high bed Prevention: -nonskid shoes -tidy clothes -proper lighting -grab bars/rails -no scatter rugs For clients at risk for falls, repeat the risk assessment every 8 hours, and monitor the patient more frequently. Falls are the third leading cause of injury-related deaths—the leading cause for older adults. An average of 4 in 100 people experience a nonfatal fall for which they seek medical advice. The rate triples for adults older than 75 years (Adams, Barnes, & Vickerie, 2007). More than half of all falls occur in the home, and about 80% of home falls involve people age 65 years and older. Health issues that increase the risk for falls include poor vision, hypotension (low blood pressure), a history of falls, dizziness, pain, alcohol use, cognitive impairment, polypharmacy, arthritis, gait or balance deficits, and age greater than 80 years medications that increase the risk for falling (e.g., opioid analgesics, sedatives ( diazepam or lorazepam.), and antihyperten- sives). Most institutions have policies, guidelines, and special forms for assessing risk for falls.
Safety hazards in the home - Carbon Monoxide poisoning
Produced by burning fuel: gas, wood, oil, kerosene Prevention: carbon monoxide detector Treat: 100% humidified oxygen Carbon monoxide (CO) is a colorless, tasteless, odorless toxic gas. Exposure can cause headaches, weakness, nausea, and vomiting; prolonged exposure leads to seizures, dysrhyth- mias, unconsciousness, brain damage, and death. Each year in the United States, CO poisoning causes approximately 500 unintentional deaths (King & Bailey, 2007). It accounts for a majority of deaths at the scene of fires, and is also a rela- tively common method of suicide. Many CO deaths occur during cold weather among older adults and the poor who seek nonconventional heat sources (e.g., gas ranges and ovens) to stay warm. Prevent Carbon Monoxide Poisoning If carbon monoxide (CO) intoxication is suspected, the person should be treated with 100% humidified oxygen. A simple blood test may be done to confirm CO levels in the blood. Nursing interventions include teaching prevention measures, such as the following: ■Buy, install, and maintain a home CO detector. ■Ensure that gas or wood-burning appliances are adequately vented to the outside. ■Repair rust holes or defects in vehicles that could allow exhaust fumes to enter the passenger compartment. ■Never use a kerosene heater, gas oven, or gas range to heat a house, even for a short time Never operate gasoline-powered engines (e.g., automobiles, generators, lawn mowers) near open doors or windows or in confined spaces, such as garages or basements. ■Never burn charcoal inside a home, cabin, recreational vehicle, or tent—not even in a fireplace.
Mercury Poisoning
Products containing mercury include thermometers, thermostats, batteries, fluorescent light bulbs, blood pressure devices, and electrical equipment and switches. To prevent have yearly facility training and follow facility policy
Principles of body mechanics To move your body without causing injury
Proper alignment Wide base of support Avoid bending and twisting Squat to lift Keep objects close when lifting Raise beds Push vs. lift Get help
Irritable Bowel Syndrome Treatment
Reduce anxiety and stress Dietary factors, such as fiber, raw fruits, coffee, alcohol, and foods that are cold, highly seasoned, or laxative in nature Regular exercise
What are the leading causes of injury in the older adult?
Reduced muscle strength and joint mobility, slowing of reflexes, decreased ability to respond to multiple stimuli, sensory loss (hearing and vision). These factors increase risk for falls, burns, car accidents.
Osteomalacia Medications
Replenishing low levels of vitamin D and Calcium through supplementation and sun exposure. Treating any underlying disorders that may be causing the deficiencies.
Ulcerative Colitis Client Teaching
Rest periods during exacerbations Can cause developmental delays in children. Ileostomy care if necessary. Importance of diet change.
Rheumatoid Arthritis Teaching
Rest when needed Use ice and heat to decrease swelling and pain Diet, Weight, Excercise Do not smoke Get physical and occupational therapy as directed Crutches, cane, walker
Consequences of Bowel Retention
Retention of stool in the rectum. Stool dries and hardens. Constipation Impaction
Rheumatoid Arthritis vs Osteoarthritis
Rheumatoid arthritis is autoimmune and is always on both sides. May begin at any time, rapid progression, joints are painful/swollen/stiff. Osteoarthritis is due to wear and tear, and is only on a specific joint. OA=One Arm. Occurs later in life, slow progression, joints ache and are tender with little to no swelling
Appendicitis Complications
Ruptured appendix. A rupture spreads infection throughout your abdomen (peritonitis). Possibly life-threatening. A pocket of pus that forms in the abdomen. Tube placed in abdomen to clear the infection.
Scoliosis Pathophysiology
Scoliosis is condition that causes side to side curving of the spine. For example, one hip or one shoulder may stand higher than the other. This is a progressive condition, so if it is left untreated it can cause major complications and chronic pain due to the constant pressure on the nerves and spinal cord. More common in girls.
When to get a Colonoscopy
Screening at the age of 40. Screening for colon cancer for an average risk individual includes a colonoscopy every 10 years or a sigmoidoscopy every 5 years, in addition to a hemacult (blood in the stool) test every year. History of colon cancer, polyps, or IBS.
Osteomyelitis
Serious infection of the bone that often is difficult to treat, Can be acute or chronic. Chronic lasts longer than 3 months. Periods of remission and exacerbations, pain, and soft tissue abscesses and draining wounds may occur in those with chronic osteomyelitis
School-Age (6-12)
Sexual abuse Burns Broken bones Concussions Drowning Guns and weapons Use of Internet Sports injuries (cognitive rest) Abduction Bullying (cyber bullying) Child Mistreatment
What are the side effects of fosamax?
Side effects of oral bisphosphonates include gastrointestinal problems such as difficulty swallowing, inflammation of the esophagus, and gastric ulcer. Side effects of intravenous bisphosphonates include flu-like symptoms, fever, pain in muscles or joints, and headache. These side effects can occur shortly after receiving an infusion and generally stop within 2 to 3 days. There also have been rare reports of osteonecrosis of the jaw and of visual disturbances in people taking oral and intravenous bisphosphonates.
Constipation Diagnosis
Sigmoidoscopy or colonoscopy Colorectal transit studies-Colorectal transit studies are tests that show how well stool moves through your colon. Anorectal function tests- Anorectal function tests can show problems in your anus or rectum. X-Ray, MRI or CT scan to check for obstructions
Irritable Bowel Syndrome Diagnosis
Stool examination is negative for occult blood, parasites, and pathogenic bacteria. Complete blood count, serologic tests, serum albumin, and erythrocyte sedimentation rate are normal. Barium enema reveals colonic spasm and a tubular appearance of the descending colon. Sigmoidoscopy may disclose spastic contractions.
Ulcerative Colitis Diagnosis
Stool specimen to check for blood or pus, colonoscopy.
Scoliosis Goal of Treatment
Straightening of spine, increased self esteem, and pain management if necessary. Often goal of surgery is simply to allow a child to be able to sit upright in a wheelchair.
Crohn's Disease Treatment
Stress reduction Avoidance of foods that worsen diarrhea such as raw fruits and vegetables. Adequate caloric, protein, and vitamin intake, parenteral nutrition, if necessary Reduced activity
Human factors
Study of the interrelationships among people, technology, and the work environment. Consider the ability or inability to perform tasks while attending to multiple things at once. Work of nurses in acute care environment is very complex. Focus is on supporting health professionals and eliminating hazards.
Appendicitis Treatment
Surgery to remove the appendix. If your appendix has burst and an abscess has formed around it, the abscess may be drained by placing a tube through your skin into the abscess. Appendectomy can be performed several weeks later after controlling the infection.
Paget's Disease Treatment
Surgery: Total knee or hip replacement Help fractures heal Replace joints damaged by severe arthritis Realign deformed bones Reduce pressure on nerves Paget's disease of bone often causes the body to produce too many blood vessels in the affected bones, increasing the risk of serious blood loss during an operation.
Osteosarcoma Medications
Surgery: amputation, bone grafting, wide local excision), Chemotherapy: methotrexate, carboplatin, cisplatin, doxorubicin, and ifosfamide Radiation Therapy:
Rheumatoid Arthritis Pathophysiology
Systemic autoimmune disease involving chronic inflammation of the joints and surrounding connective tissue. There is no cure and is more common in females.
What is the pathophysiology of a hip fracture?
The classification of hip fractures is based on the anatomical location of the fracture within the hip. The fracture may occur in the femoral head, femoral neck, intertrochanter, subtrochanter, or acetabular area. Treatment depends on the location of the fracture. With a femoral neck fracture, blood supply to the femoral head may be disrupted, placing the patient at risk for avascular necrosis (AVN) and degenerative changes to the femoral head, especially if the fracture is displaced. Therefore, this type of fracture is treated with a hemiarthroplasty. With a hemiarthroplasty, the entire head and neck of the femur is replaced with an implant. If the fracture is not displaced, internal fixation with a cannulated screw is the treatment of choice (Altizer, 2005). Intertrochanteric fractures are usually repaired with nail fixation. Subtrochanteric fractures are usually treated with intramedullary nailing.
drugs to treat or prevent osteoporosis
The evidence shows that drug therapy should be used for postmenopausal women and men age 50 and older when the BMD T-score for the hip or lumbar spine is below or equal to −2.5 with no other risk factors, or when the T-score is below −1.5 with risk factors or previous fracture. Anyone age 50 or older who had a hip or vertebral fracture should also be treated (NOF, 2017). The health care provider may prescribe calcium and vitamin D3 supplements, bisphosphonates, estrogen agonist/antagonists (formerly called selective estrogen receptor modulators), parathyroid hormone, RANKL inhibitor, or a combination of several drugs to treat or prevent osteoporosis (Chart 50-2). In addition, calcitonin may be used for some patients. Estrogen and combination hormone therapy are not used solely for osteoporosis prevention or management because they can increase other health risks such as breast cancer and myocardial infarction.
What current medical treatments or conditions can increase the risk for falls and why?
Tubing, IVs, catheters
What are the types of medication errors?
The most common errors are confusion caused by similar drug names, lack of knowledge of the drug (e.g., incorrect dosages), and lack of information about the patient (e.g., allergies, lab results). A fairly high percentage of medication errors involve anticoagulants (blood thinners), with nearly 3% of those resulting in patient harm or death.
Strains & Sprains Signs and Symptoms
The most common location for a sprain is in your ankle. Strains often occur in the lower back and in the hamstring muscle in the back of your thigh. Sprain- Pain, Swelling, Bruising,Limited ability to move the affected joint, At the time of injury, you may hear or feel a "pop" in your joint Strain- Pain, Swelling, Muscle spasms Limited ability to move the affected muscle
What are the treatments of apraxia?
The patient will work with a speech language pathologist on exercises to regain ability to speak.
What are DEXA scans used for?
They assist in the early diagnosis of osteoporosis
Gout Diagnosis
Urine - Urinary uric acid levels Blood - Serum Uric acid levels Xray, CT, Ultrasound Joint Fluid Test - Synovial Fluid Aspiration-synovial fluid drawn from joint and tested for high levels uric acid. Kidney function test
MRI
Used to confirm the diagnosis of musculoskeletal dysfunction and infection by orthopedic surgeons. Similar to CT images; however, the ability to see tissue is much clearer, without contrast Bone, joint, and soft tissue injuries can be seen without bone artifact and can distinguish whether a tumor is within or adjacent to a bone *book* MRI, with or without the use of contrast media, is commonly used to diagnose musculoskeletal disorders. It is more accurate than CT and myelography for many spinal and knee problems. MRI is most appropriate for joints, soft tissue, and bony tumors that involve soft tissue. CT is still the test of choice for injuries or pathology that involves only bone. The image is produced through the interaction of magnetic fields, radio waves, and atomic nuclei showing hydrogen density. Simply put, the radio waves "bounce" off the body tissues being examined. Because each tissue has its own density, the computer image clearly distinguishes normal and abnormal tissues. For some tissues, the cross-sectional image is better than that produced by radiography or CT. The lack of hydrogen ions in cortical bone makes it easily distinguishable from soft tissues. The test is particularly useful in identifying problems with muscles, tendons, and ligaments. Ensure that the patient removes all metal objects and checks for clothing zippers and metal fasteners. Although joint implants made of titanium or stainless steel are usually safe, depending on the age of the MRI equipment, pacemakers, stents, and surgical clips usually are not. Large facilities and those focused on sports medicine may have orthopedic-type MRI machines that are open design and vertically oriented (upright) to make the examination more comfortable. These machines are most useful for viewing extremity injuries but cannot be used for abdomen, brain, or spine studies because of their size and shape. Chart 49-3 lists questions that the nurse or technician should consider in preparing the patient for MRI.
joint and connective tissue dz: gout meds
Used to decrease the production of uric acid and promote the production of it acute- colchicine- colsalide and an nsaid ibuprofen--Motrin-- chronic-allopurinol zyloprim The health care provider typically prescribes a combination of colchicine (Colcrys) and an NSAID such as indomethacin (Indocin, Novomethacin image) or ibuprofen (Motrin, Amersol) for acute gout. IV colchicine works within 12 hours. The patient takes oral medications until the inflammation subsides, usually for 4 to 7 days. For patients with repeated acute episodes or chronic gout, the health care provider prescribes drugs on a continuous, maintenance basis to promote uric acid excretion or reduce its production. Allopurinol (Zyloprim, Purinol) or febuxostat (Uloric) is the drug of choice. Febuxostat may cause a greater risk to cardiovascular health than allopurinol (Lilley et al., 2014). As xanthine oxidase inhibitors, these drugs prevent the conversion of xanthine to uric acid. Teach patients to take them after meals and drink a glass of water with each dose to prevent GI distress. Drinking at least eight glasses of water each day helps prevent renal dysfunction. Remind patients that periodic follow-up laboratory tests, including liver enzymes, kidney function studies, and complete blood count, are important because xanthine oxidase inhibitors cause liver dysfunction and bone marrow suppression. Probenecid can also be effective as a uricosuric drug in gout because it promotes the excretion of excess uric acid. Combination drugs that contain probenecid and colchicine (e.g., ColBENEMID) are also available. The primary health care provider and nurse monitor serum uric acid levels to determine the effectiveness of these medications. Aspirin should be avoided because it inactivates the effects of the drug.
Myelogram
Used to diagnose defects in and around the spinal column. Using fluoroscopy and radiography, a contrast dye is injected into the subarachnoid space of the spinal canal. Defects are revealed when a smooth flow of contrast is not seen. Herniated discs, tumors, and spinal nerve root injury are examples of defects that may be seen.
Myelogram
Uses a contrast dye and X-rays or computed tomography (CT) to look for problems in the spinal canal, including the spinal cord, nerve roots, and other tissues.
What must you consider when delegating the application of restraints?
You can delegate the application of restraints to NAP including removing and reapplying restraints to provide skin care and supervised movement and observing skin excoriation under or around restraint location and report it to you. You cannot delegate the assessment of the patient's status or response to the restraints.
Safety hazards in the home - Firearm injuries
Youth suicides; domestic violence Prevention: -firearms safety education for parents and children -proper locked storage, keep ammunition separate Gun ownership is a controversial issue. Some people keep guns in the home for protection and/or recreation (e.g., hunting, target shooting). However, guns are a source of unintentional injury and death. Gun safety and security are especially important when there are children or someone with a substance abuse problem in the home. Household access to firearms has been implicated as a risk factor for youth suicide and domestic homicide, as well as unintentional injury .Because of the frequency and severity of unintentional firearm injuries involving children, the American Academy of Pediatrics and other groups have mounted efforts to educate parents about firearm safety.
older adult factors affecting safety.. test neglect
a caregiver fails to provide for an older adult's basic needs such as food, clothing, medications, or assistance with ADLs. The caregiver refuses to let other people such as nursing assistants or home care nurses into the home. Whether intentional or unintentional, neglect accounts for almost half of all cases of actual elder abuse. Neglect may be manifested by pressure injuries, contractures, dehydration or malnutrition, urine burns, excessive body odor, and listlessness. Depression and dementia are common in community older adults who are abused or neglected.
joint and connective tissue dz: gout
ac accumulation of uric acid deposits in the joints results from the body inability to metabolize purine foods causes of attacks- fad starvation diets, stress, illness is an inflammatory response to high levels of uric acid. Crystals form in the synovial fluid, and small white nodules, or tophi, form in the subcutaneous tissues. Gout pro- duces painful joints and severely limits activity during acute flare-ups. Nursing activity for patients with joint mobility problems focuses on assisting with movement, providing comfort, and teaching about medications. If mobility is severely restricted, you will also assist patients with activities of daily living (ADLs).
Immobility Interventions - Assessment (immobility)
aca Asses ability to walk - assess environment at home Complete assessment of ROM, muscle strength, pain, fatigue, etc. Assess ability to carry out functional activities (ADLS, etc)
skeletal disease osteoporosis at risk
access A = alcohol use C = corticosteroid use C = calcium is low E = estrogen is low (especially postmenopausal) S = smoking S = sedentary lifestyle *book* People with eating disorders such as anorexia nervosa and bulimia nervosa are also at risk for osteoporosis related to decreased intake of calcium and vitamin D.
Osteomalacia Diagnosis
blood: serum calcium, phosphate, alk-phos, parathyroid hormone, Vit D, bun, and creatinine x-ray and bone density scan - X-Ray, blood and urine to detect vitamin D deficiency, bone biopsy (not usually done).
Short bones xl
characterized by cancellous bone covered by a thin layer of compact bone (examples: carpals and tarsals) *book* Short bones, such as the phalanges, are small and bear little or no weight.
ethics 1536
according to the american nurses association ANA, ethics is a theoretical and reflective domain of human knowledge that address issues and questions about mortality in human choices, actions, character, and ends ana code of ethics 6 essential ethical prinipiles that nurses and health care professional should use as a guide for clinical decision making 1533/34 Autonomy- self-determination- person's right to choose and ability to act on that choice. right to make own decisions---is also referred to as self-determination or self-management. When the patient is not capable of self-determination, you are ethically obligated to protect him or her as an advocate within the professional scope of practice, according to the American Nurses Association (ANA) Code of Ethics for Nurses (ANA, 2015). 1534 beneficence- duty to do or promote good. benefit to others... which promotes positive actions to help others. In other words, it encourages the nurse to do good for the patient. 1534 nonmaleficence- twofold duty to do no harm and to prevent harm. Respect for Dignity...emphasizes the importance of preventing harm and ensuring the patient's well-being. Harm can be avoided only if its causes or possible causes are identified. As described earlier in this chapter, patient safety is currently a major national focus to prevent deaths and injuries. 1535 fidelity- Fidelity (faithfulness) is the duty to keep promises. The duty to keep a promise is the same regardless of its level of importance. keeping promises...refers to the agreement that nurses will keep their obligations or promises to patients to follow through with care. 1535 veracity- Veracity is the duty to tell the truth. be culturally sensitive in order to act on the family's values, not the dominant cultural values. Key Point: Always consider the context... is a related principle in which the nurse is obligated to tell the truth to the best of his or her knowledge. If you are not truthful with a patient, his or her respect for you will diminish, and your credibility as a health care professional will be damaged. 1536-1543 social justice- is the obligation to be fair. equal treatment of all patients... the last principle, refers to equality and fairness; that is, all patients should be treated equally and fairly, regardless of age, gender identity, sexual orientation, religion, race, ethnicity, or education. For example, a patient who cannot afford health care receives the same quality and level of care as one who has extensive insurance coverage. An older patient with dementia is shown the same respect as a younger patient who can communicate. A Hispanic patient who can communicate only in Spanish receives the same level of care as a Euro-American patient whose primary language is English.
skeletal disease osteoporosis tx and safety
aka u deann avoid throw rugs keep areas free from clutter adequate lighting use app. assistive devices diet-- high in ca- vit d- fiber- protein Exercise - walking, swimming, and water aerobics are recommended to increase muscle avoid alcohol n smoking note** excessive caffeine can cause excretion of ca through the urine non-skid socks n shoes meds: bed n bm vc boniva estrogen for post-menopausal women didronel NSAIDS for discomfort/pain biophosphonates aka fosamax muscle relaxers vit d supplements Calcium supplements (1000 mg to 1500 mg daily) foods high in ca: camms bsb cac cereal apricots molasses milk dairy esp yogurt spinach breads sardines beans carrots asparagus collard greens ***Intake of calcium alone is not a treatment for osteoporosis, but calcium is an important part of any program to promote bone health. Most people cannot or do not have enough calcium in their diet; therefore calcium supplements are needed. NOF (2017) supports the National Academy of Medicine's research recommendation of 1000 mg daily for all postmenopausal women and men between ages 50 and 70, and 1200 mg for both women and men 71 years of age and older (NOF, 2017). Calcium carbonate, found in over-the-counter (OTC) drugs such as Os-Cal, is one of the most cost-effective supplement formulas. Teach women to start taking supplements in young adulthood to help maintain peak bone mass. Instruct patients of any age to take calcium supplements that also contain a small amount of activated vitamin D (D3), such as Os-Cal Ultra. Because vitamin D is needed for calcium absorption by the body, vitamin D3 supplementation is also indicated. This drug is also available as an OTC medication. NOF (2017) recommends a daily dose of 800 to 1000 units for women and men age 50 or over. Up to 4000 units daily may be taken for patients who have severe bone loss or multiple nonmodifiable risk factors. Laboratory tests to measure serum calcium and vitamin D3 are done to monitor the effectiveness of these supplements.
Pharmacologic agents
ana Anti-inflammatory agents Nutrition supplementation Analgesics
older adult factors affecting safety skin breakdown
anni rc avoid friction and shearing national patient safety goal: must have program to prevent agency associated pressure injuries nutrition support: protein- zinc- vitamin a&c increase mobility and activity when appropriate reposition and provide support surfaces clean skin use moisture barriers
Emergency response - Primary survey
at pa caca Assess quality of ventilation (rate, color, auscultate lungs) Take blood pressure Primary survey focuses on airway, breathing, circulation, and neurological disability/deficits (ABCD) Assess level of consciousness and pupillary response, weakness or paralysis of extremities Clear and open the airway Assess for respiratory distress Check pulses for quality and rate Assess for external bleeding
muscle fibromyalgia
au hs A clinical syndrome or condition involving chronic widespread diffuse musculoskeletal pain, stiffness, and tenderness. usually affects women of child-bearing age and has no known cause healthcare provider will rule out everything else first syndrome of fatigue and chronic pain is a chronic pain syndrome, not an inflammatory disease. Pain, stiffness, and tenderness are located at specific sites in the back of the neck, upper chest, trunk, low back, and extremities. These tender points are also known as trigger points and can typically be palpated to elicit pain in a predictable, reproducible pattern.
Lyme disease
bm Bacterial infection that occurs after the bite of an infected deer tick, once the tick is attached it must remain in place for 36-48 hours for the infection to be transmitted Multisystem inflammatory process with devastating long-term effects if left untreated is a reportable systemic infectious disease caused by the spirochete Borrelia burgdorferi and results from the bite of an infected deer tick, also known as the black-legged tick. It is the most common vector-borne disease in the United States and Europe. Most cases of the disease in the United States are seen in New England; the mid-Atlantic states, including Maryland and Virginia; the upper Midwest, including Wisconsin and Minnesota; and northern California, especially during the summer months.
skeletal disease Osteomyelitis dx procedures
bnb be cc bone biopsy culture needle aspiration of affected area bone scan bone x-ray ESR (will be elevated) CBC (elevated WBC's) CRP (will be elevated)
Accident prevention - Older adult
bo fml cc ss f fb dnh be careful with use of space heaters; be sure older adults have fans or air conditioners in summer heat Older adults may be prey to strangers and criminals who can inflict physical and financial injury frequent assessment of driving ability is required Motor vehicle accidents are of concern for older adults loss of driving privileges can mean a loss of independence Clients taking some medications may have decreased cognitive abilities or impaired judgment; encourage them to ask for assistance with activities of daily living caution them against letting strangers into their homes or responding to telephone calls, e-mails, or letters asking for money or personal information Stairwells should be well lit Small scatter rugs, runners, and mats should not be used Furniture, floors, and passageways should be free of clutter Falls are the leading cause of accidents in older adults Bathrooms and showers/tubs should have grab bars Decrease in temperature regulation may increase risk of hyperthermia or hypothermia Neighbors, police, and fire officials should be made aware of older adults with disabilities living alone Home modifications may be necessary to accommodate safe use of wheelchairs or walkers
skeletal disease kyphosis tx
braces and spinal infusion if cardiopulmonary problems or pain occur
Bone marrow aspiration and biopsy
butt Bone marrow is aspirated using a needle that is inserted into the cancellous bone. Used to examine the bone marrow for abnormal tissue growth or to monitor the progress of bone marrow disease. This procedure is performed under local anesthesia. The aspiration can be performed at the ILIAC CREST or the STERNUM.
skeletal disease osteomalacia dx procedures
bx cvs bp bone densitometry x-ray creatinine vit d serum ca bun phosphate
emergency and disaster preparedness multi- casualty
can be managed by a hospital using local resources
Flat bones xl
characterized by two layers of compact bone separated by a layer of cancellous bone (e.g., skull, ribs, scapula, and sternum) *book* Flat bones, such as the scapula, protect vital organs and often contain blood-forming cells.
skeletal disease pagets dz
chronic bone disorder that begins with an increase in bone absorption, in compensating for this bone formation increases along with bone remodeling leading to deformities and fractures is a metabolic bone disease in which increased bone loss results in pain, pathological fractures, and deformi- ties. This disorder usually affects the skull, vertebrae, femur, and pelvis.
arthritis dz: osteoarthritis
cn changes are associated with increasing age and trauma nonsystemic, non inflammatory progressive disorder of movable joints The most prevalent type of degenerative joint disease is osteoarthri- tis (OA). OA involves a loss of articular cartilage in the joint, with pain and stiffness as the primary symptoms. Patients may also have decreased ROM and crepitus, a creaking or grating sound, with joint motion. Symptoms are aggravated by weight- bearing and joint use and are relieved by resting the affected joints. OA is more common in women, older adults, and people who are overweight is the progressive deterioration and loss of cartilage and bone in one or more joints. Articular cartilage, also known as hyaline cartilage, contains water and a matrix of: • Proteoglycans (glycoproteins containing chondroitin, keratin sulfate, and other substances) • Collagen (elastic substance) • Chondrocytes (cartilage-forming cells) As people age or experience joint injury, proteoglycans and water decrease in the joint. The production of synovial fluid, which provides joint lubrication and nutrition, also declines because of the decreased synthesis of hyaluronic acid and less body fluid in the older adult (McCance et al., 2014). In patients of any age with OA, enzymes such as stromelysin break down the articular matrix. In early disease the cartilage changes from its normal bluish white, translucent color to an opaque and yellowish brown appearance. As cartilage and the bone beneath the cartilage begin to erode, the joint space narrows, and osteophytes (bone spurs) form
If the patient has difficulty chewing or swallowing,
coordinate a plan of care with the speech-language pathologist and dietitian
special consideration and population
cultural & spiritual consideration consideration for older adult 65+ gender--veteran health consideration
skeletal disease pagets dz s&s
cv he is bb mm ss check for family occurrence and hz of previous fractures- disease is genetic vision hearing enlarged scalp- The skull is often enlarged with the bone becoming soft and thick. in advanced cases may see khyphosis or scoliosis skin over affected area maybe warm to touch balance deficiencies Bowing of the long bones of the arms and legs. most common symptom is pain the hips and pelvis which is often described as deep aching pain that worsens with weight bearing movement of the eye and facial muscle swallowing speech
skeletal disease osteomalacia at risk
dam rl diet deficient in vitamin d low endogenous production of vitamin d bc lack of sunlight exposure anticonvulsant therapy malabsorption renal tubule disease liver, pancreatic, billliary system dz *billliary-autoimmune disease
informatics and technology
definition- the acsess and use of information and electronic technology to communicate, manage knowledge,prevent error, and support decision-making purpose: safety quality of health retrieval of data for ebp & quality improvement
emergency and disaster preparedness the life safety code
published by the national fire protection asso. requires every health care facility to practice at least 1 fire drill or actual fire response annually The Life Safety Code® published by the National Fire Protection Association (2016) provides guidelines for building construction, design, maintenance, and evacuation.
delegation
definition- the process of transferring to a competent person the authority to perform a selected nursing task or activity in a selected client care situation the nurse is always accountable for the task or activity that is delegated! 5 rights of delegation • Right task: The task is within the UAP's scope of practice and competence. • Right circumstances: The patient care setting and resources are appropriate for the delegation. • Right person: The UAP is competent to perform the delegated task or activity. • Right communication: The nurse provides a clear and concise explanation of the task or activity, including limits and expectations. • Right supervision: The nurse appropriately monitors, evaluates, intervenes, and provides feedback on the delegation process as needed. --> supervision is guidance or direction, evaluation, and follow-up by the nurse to ensure that the task or activity is performed appr. You may delegate the application of the restraints; however, you may not delegate the assessment of the patient's status nor the evaluation of the patient's response to the restraints. You may assign the NAP to (1) remove and reapply restraints to provide skin care and allow for supervised movement and (2) observe for skin excoriation under or around restraint location and report it to you. (3) you can expect the NAPs to remove clutter and spills in patient rooms, to provide patients with nonskid slippers, and to lock beds and wheelchairs. Examples of delegated tasks are turning and positioning, vital signs, and intake and output measurements. Urinary and bowel ELIMINATION issues vary in type and severity and may be caused by many factors, including acute or chronic disease-------Place the patient on a toileting schedule or a bowel or bladder training program, if appropriate. Delegate this activity to unlicensed assistive personnel and supervise them
care coordination
deliberate organization and communication about client care activities b/t 2 or more members of health care team, including patient in order to facilitate app. and continuous health care to meet client's needs care coordination: case manager aka discharge planner who is a nurse or social worker
arthritis dz: osteoarthritis s&S
dice hbp deformities immobility of joint and limb due to pain and joint changes crepitation enlarged nodular joints Heberden's nodules- (bony nodules at the distal interphalangeal [DIP] joints) Bouchard's nodules- bony nodules at the proximal interphalangeal [PIP] joints) pain and stiffness, esp in the morning
health care disparities
differences in patient access to or availability of appropriate health care services a major focus of the u.s *healthy people 2020* intiative is to decrease healthcare disparities caused by: poor communication healthcare access health literacy health care provider biases and discrimination
older adult factors affecting safety drug use and misuse
dipped dm fhp dz interaction intolerance to standard drug dosages physiologic changes affect absorption polypharmacy- the simultaneous use of multiple drugs to treat a single ailment or condition. excretion distribution drugs metabolism food herb polymedicine
emergency and disaster preparedness psychological response of survivers
disaster experience can produce immediate and long lasting effects life-style, roles, routines may be altered coping ability may be severely stressed nurses communicate and provide a sense of safety monitor signs for pstd ies- r questionnaire????
Diverticulitis Pathophysiology
diverticulosis- is a herniation of the intestinal mucosa. This disorder can occur in any part of the intestine but is most common in the sigmoid colon. diverticulitis- is inflammation of intestinal mucosa.
skeletal disease bisphosphonates: alendronate fosamax
dm m d dose: 40 mg once daily for 3 months MUST be taken on an empty stomach with 6-8 oz of water may be taking any time during the day, as long as there is no food for 30 min after dose do not lie down for 30min after dose
Implementing a fall prevention program after fall assessment
do u beak kkk Do not use full-length bed side-rails for confused clients; do not leave confused client alone—evaluate need for constant companion Orient client to nurse call system and encourage use Use a bed or chair monitoring device if necessary for clients at risk for falls Be sure nurse call system is within reach Encourage use of nonskid footwear Assess ability to ambulate and transfer Keep room tidy and free of clutter Keep bedside table and chair near bed Keep hospital bed in low position Keep crib side-rails up when child is unattended
General care guidelines for immobilized patient
dr.mn sfw -Deep breathing -Range of motion -Measures to optimize elimination -Nutrition -Skin assessment and skin care -Frequent turning, positioning, alignment -Weight bearing (if possible)
renal calculi (kidney stones)
due to increased excretion of calcium. These changes place the patient at risk for pathological frac- tures with minimal trauma.
Osteoporosis Signs and Symptoms
early shows no signs and symptoms, later = back pain, fractured or collapsed vertebrae, loss of height, kyphosis, compressed fractures
Accident prevention - Adult
emt hearr fame Encourage working adults to participate in occupational health programs offered in workplace musculoskeletal injury is most frequent workplace injury teach that homes should have smoke detectors, a fire extinguisher in the kitchen, and a fire evacuation plan Hazardous conditions and toxic substances may occur in workplace educate employees in OSHA (Occupational Safety and Health Administration) regulations and guidelines for use of safety devices and handling hazardous substances Alcohol consumption is involved in 40% of deaths from motor vehicle accidents Residents in some neighborhoods may be at risk for crime and injury Residential fires account for the majority of fire-related injuries Firearms in the home may lead to accidental injury or death assess for access to police and fire services making it important to have community education programs about hazards of drinking and driving; other drugs that cause impairment pose similar risks encourage owners to attend firearm safety class and store all firearms and ammunition in a locked cabinet
Nerve conduction studies
ene Electromyography (EMG) measures electrical activity of skeletal muscle at rest and during voluntary muscle contraction. Needles are inserted into the muscle to detect electrical activity, which is printed as a graph. This procedure may be uncomfortable for the patient. EMG is used to diagnose neuromuscular diseases and nerve damage. The EMG can be used to differentiate between muscle and nerve damage.
safety hazard - community mva
example/ cause fan-p failure to use seat belts alcohol non-deployment of airbags pedestrian accidents prevention-- pauu proper age- dependent restraints for children avoid distractions in cars-- cell phone txt message- loud music use designated driver use seat belts, proper age-dependent restraints for children As mentioned in the beginning of the chapter, motor vehicle accidents (MVAs) are the leading cause of accidental death in American adults and children older than 1 year. They account for about 34% of all accidental deaths (CDC, n.d.b). Failure to use seat belts and proper child car seats continues to be the major contributing factor. Severe injuries and death also occur from air bag deployment when young children are improperly placed in the front passenger seat. Many of the fatal MVAs dur- ing adolescence involve abuse of alcohol or other substances (CDC, 2007, 2010c; Miniño, Heron, Murphy, et al., 2007). The risk of being injured or killed in a car crash increases for older adult drivers. Every day, on average, 500 people over age 65 are injured in an automobile accident.
safety hazard - community electrical storms
example/ cause lightning prevention-- dd s during a storm seek lowest point possible do not use metal objects seek shelter in a large building away from water According to the National Weather Service, deaths from lightning strikes lead all other categories of storm-related fatalities, exceeded in some years only by floods (Cooper & Kulkarni, 2011). Weather conditions play a major role in outdoor recreation programming. It is important for professionals, participants, and outdoor recreation providers to understand severe weather conditions, specifically thunderstorms and lightning, and the dangers associated with them.
older adult factors affecting safety substance abuse
excessive use alcohol and illicit drugs impairs cognition isolation depression delirium can result *** national institute on alcohol abuse and alcoholism recommends no more than 1 drink per day, or 7 drinks per week for people over 65 short Michigan alcohol screening test cage test • Have you ever tried to cut down on your drinking? • Have people annoyed you by criticizing your drinking? • Have you ever felt bad or guilty about your drinking? • Have you ever had a drink first thing in the morning to settle your nerves to get rid of a hangover (eye-opener)?
Elements of a musculoskeletal assessment
far pp los pfc rfr Fatigue Altered gait or imbalance Reduced functional ability Problem-based history Pain (0-10) Lifestyle behaviors Occupation Social environment Past medical history Family history Current medications Reduced joint movement Falls (history of) Reduced sensation or loss of sensation
emergency and disaster preparedness hospital incident command system
fd remi ht facility- level organizational model for disaster management debriefing- critical incident stress debriefing and administrative review roles- formally structured under hospital or long term care facility incident commander with clear lines of authority and accountability for specific resources emergency operations systems medical command physician incident commander determines when to *stand down* hospital incident commander triage officer The facility-level organizational model for disaster management is the Hospital Incident Command System (HICS), which is a part of the National Incident Management System (NIMS) implemented by the Department of Homeland Security and FEMA to standardize disaster operations. In this system, roles are formally structured under the hospital or long-term care facility incident commander with clear lines of authority and accountability for specific resources (FEMA, 2016). Officers are named to oversee essential emergency preparedness functions such as public information, safety and security, and medical command. Chiefs are appointed to manage logistics, planning, finance, and operations as appropriate to the type and scale of the event. In turn, chiefs delegate specific duties to other departmental officers and unit leaders. The idea is to achieve a manageable span of control over the personnel or resources allocated to achieve efficiency.
joint and connective tissue dz: gout foods high in purine
fl loop pads fish esp sardines liver lobster oatmeal oyster peas poultry asparagus dried beans spinach
Clinical Management: Primary Prevention
for p Fall prevention measures -Optimal nutrition -Regular physical activity -Protection against injury
Fulmer SPICES
framework was developed as part of the NICHE project and identifies six serious "marker conditions" that can lead to longer hospital stays, higher medical costs, and even deaths. These conditions are: • Sleep disorders • Problems with eating or feeding • Incontinence • Confusion • Evidence of falls • Skin breakdown
skeletal disease osteomalacia s&s
generalized skeletal pain and tenderness without a hz of injury *hips are the most common site* reluctant to walk low back pain pain in the ribs, feet, and other areas waddling gate
identify the common causes of patient falls
hss tl high bed slippery floors stairs tubs low toilet seat
Accident prevention - Infant
i c bp in pr hl Infants may be trapped by crib slats spaced too far apart Carefully select infant furniture paying special attention to current safety standards Because of their inability to communicate, infants are at risk for burns from applications of heat to skin, such as from a hot water bottle or other heated device Place infants riding in a car in a rear-facing car restraint system in back seat; use a rear-facing restraint system until child is 1 year old and at least 20 pounds Infants or young children may be poisoned by lead paint on antique furniture normal serum lead level is < 10 mg/dL Place infants on back after eating and while sleeping; this will not increase risk of aspiration and will reduce risk of sudden infant death syndrome (SIDS) Rapid changes in development and acquisition of new motor skills put infants at increased risk for injury from falls from tables, beds, high chairs, infant seats, and so on higher levels require treatment to reduce or prevent neurological deficits lead level 10-19 mg requires environmental history
Nursing interventions for impaired mobility - Explain benefits of exercise
i dip Improves tone and strength of muscles, joint flexibility and range of motion (ROM) Decreases bone loss of calcium, which helps maintain acidic urine to decrease risk for renal calculi Improves GI motility and tone, thereby improving digestion and elimination Promotes good pulmonary ventilation, which prevents pooling of secretions in lungs and reduces risk of pneumonia
Isotonic exercise
iee Increase muscle tone and maintain joint flexibility Exercises that shorten muscle to produce contraction and active movement with no significant change in resistance, so force of contraction stays stable Examples are using a trapeze to lift body or pushing body into a sitting position *involves movement of the joint during the muscle contraction. A classic example of an isotonic exercise is weight training with free weights. As the weight is moved throughout the ROM, the muscle shortens and lengthens. Calis- thenics, such as chin-ups, push-ups, and sit-ups, all of which use body weight as the resistance force, are also isotonic exercises.*
older adult factors affecting safety impaired cognition
if an older adult is not legally competent, a guardian may be appointed examples: depression ptsd dementia delirium
safety hazard: healthcare facility
in case of fire race (R)emove clients from danger--Remove the patient from immediate danger. Move patient(s) into the corridor, and close doors to the affected area. (A)ctivate the fire alarm-- Report the location and kind of fire, and identify yourself. Activate the nearest alarm. (C)ontain the fire.---Close all doors and windows. Turn off all oxygen valves after coordinating with the charge nurse. (E)vacuate the area (horizontal evacuation should be done before vertical evacuation if possible).---Use the proper extinguisher. Stay between the fire and the path to safety. Keep low. You should try to extinguish (the E step) the fire only after the R-A-C steps are completed, and only a small fire that is contained to one area, such as a trash can. If the fire gets out of control, leave the area immediately. to use fire extinguisher: pull pin aim hose squeeze handle sweep from side to side Extinguisher Classifications You should know where the extinguishers are located in your facility and know how to use them. Most agencies use multipurpose (Class ABC) extinguishers. Class A Wood, paper, rubber, textiles, plastics Class B Flammable liquids, gases, oils, solvents, paints, or greases Class C Live electrical wires or equipment Class D Combustible metals (e.g., potassium, magnesium, titanium) Class K Kitchen fires involving cooking oils and fats If you would like to read journal articles about evacuating patients
teamwork & interprofessional collaboration
in order to provide patient and family centered care, the nurse functions effectively within nursing & interprofessional teams, fostering open communication mutual respect shared decision-making to achieve quality patient care *interprofessional education collaborative competencies* tire teams and teamwork interprofessional communication role- responsibilities ethics/ values for interprofessional practice
skeletal disease Osteomyelitis
infection has invaded bone area may develop after bone injury or surgery. It can be difficult and expensive to treat and can leave the patient with permanent disability. Bone con- tains microscopic channels that are impermeable to most of the natural defenses of the body. Once bacteria enter these channels, they multiply rapidly.
The pQUS
is an effective and low-cost screening tool that can detect osteoporosis and predict risk for hip fracture. The heel, tibia, and patella are most commonly tested. This procedure requires no special preparation, is quick, and has no radiation exposure or specific follow-up care (Pagana et al., 2017). Both tests are commonly used for screening at community health fairs, skilled nursing facilities, and women's health centers.
walker
is most often used by the older patient who needs additional support for balance. The physical therapist assesses the strength of the upper extremities and the unaffected leg. Strength is improved with prescribed exercises as needed. A walker is a lightweight metal frame device with four legs that provides a wide base of support as a patient ambulates (Fig. 33-17A). Various forms of walkers are available. Some models have wheels that allow the walker to be rolled for- ward; others have a seat that allows the patient to rest period- ically (Fig. 33-17B). These walkers are best for patients whose mobility problems are related to fatigue or shortness of breath rather than gait instability. Sizing Walkers ■ Ask the patient to stand erect, holding onto the walker. ■ The walker should extend from the floor to the hip joint so that the patient can comfortably hold the walker with 30° flexion of the elbo pt teaching Walkers After ensuring the walker is the proper size (refer to Clinical Insight 33-5), instruct the patient to do the following: ■ Stand between the back legs of the walker. Do not stand too far behind the walker. ■ Pick up the walker, and advance it as you step ahead. Do not advance it so far as to lose balance. ■ If one leg is weaker, move it forward as the walker moves forward. ■ Pick up, rather than slide, the walker (unless it has wheels).
cane
is sometimes used if the patient needs only minimal support for an affected leg. The straight cane offers the least support. A hemi-cane or quad-cane provides a broader base for the cane and therefore more support. The cane is placed on the unaffected side and should create no more than 30 degrees of flexion of the elbow. The top of the cane should be parallel to the greater trochanter of the femur or stylus of the wrist. Sizing Canes ■ Ask the patient to stand erect, and place the cane tip 20 cm (4 in.) to the side of the foot. ■ The top of the cane should reach the top of the hip joint so that the patient can hold the cane with her elbow flexed 30°. pt teaching Canes After ensuring the cane is the proper size (refer to Clinical Insight 33-5), instruct the patient to do the following: ■ Hold the cane on the stronger side. ■ Distribute weight evenly between the feet and cane. ■ Advance the cane and weaker leg simultaneously, then bring the stronger leg through. ■ Avoid leaning over or on the cane. ■ Maintain the integrity of the rubber tip for traction
joint and connective tissue dz: gout s&s
k rr s tp kidney stones Rapid development (within hours) of pain and edema in the one affected joint. renal abnormalities Swelling, pain, and decreased range of motion in the affected joint Tophi- growths of urate crystals- Tophi may be seen on external ears, hands, feet, the olecranon process, and prepatellar bursas. tophi, or deposits of sodium urate crystals (Fig. 18-10). Although tophi are rarely seen today, they may appear on the outer ear, arms, and fingers near the joints. The tophi are hard on palpation and irregular in shape. When the skin over the tophi is irritated, it may break open, and a yellow, gritty substance is discharged. Infection may result. progressive joint damage n deformaties
Joint aspiration
ptt Performed to examine the synovial fluid in the joint cavity. It is also used to relieve pain in the joint resulting from edema and effusion. The procedure involves inserting a needle into the joint space and withdrawing fluid using a syringe. The fluid is then sent to the laboratory to be analyzed for infection or abnormal cells. The procedure is generally done under local anesthetic in the health care provider's office.
Accident prevention - Toddler
kd bats kua paw h keep handles of pans on stove tops facing inward *Drowning is a leading cause of death in toddlers* Burns in toddlers occur because of chewing on electrical wires, pulling hot liquids from tables or stove tops, and touching space heaters assess toys for small parts Toddlers explore all objects with their mouths- choking is highest between 6 months and 3 years of age. Store medications, cleaning supplies, and poisons in locked cabinets to prevent poisonings in a curious toddler keep electrical outlets covered use car restraint systems until child's shoulders are above the harness or ears have reached top of seat accompany children at all times when in and around water in bathtub, wading pool, or swimming pool Place car restraint systems for toddlers in back seat and may be forward-facing after toddler has reached 1 year of age and 20 pounds avoid giving foods such as hard candy, peanuts, and chewing gum to prevent choking and aspiration when a child outgrows system, a booster seat with a lap/shoulder belt is required have poison control phone number readily available to caregiver and posted on telephone
developmental factors affecting safety infants- Birth- 1 year toddlers- 1-3 years
leading cause of death/ accidents motor vehicle accident is the leading cause of death for toddlers. * dcf is m* drowning choking falls ingestion of poisons SIDS mva risk factors can't recognize danger Tactile exploration of environment-- curious totally dependent
developmental factors affecting safety school age 6-12 years
leading cause of death/ accidents mva (fatal) and falls(non-fatal) risk factors -try new activities without practice -more time outside of the home-bone and muscle injuries are common. -stranger danger-risk for injury inflicted by people outside the home (e.g., abduction).
older adults 65 +
leading cause of death/ accidents is fam br jss falls are the most common cause of accidental deaths joint mobility sensory lossess- hearing and vision decreased ability to respond to multiple stimuli slowing reflexes ** all of which increase risk for falls mva burns car accidents risk factors loss of muscle strength
developmental factors affecting safety adult 18-65
leading cause of death/ accidents is 35 mw sl 35-54 leading cause of death is unintentional *poising* mva workplace injury risk factors some decline in strength and stamina-others maintain fitness-excessive alcohol use) lifestyle choices impact health- work and family responsibilities often leave little time for regular physical activity, increasing the risk of musculoskeletal injury in the so-called weekend athlete.
developmental factors affecting safety adolescent 13-18
leading cause of death/ accidents is --hams-- homicide- leading cause of death alcohol and drug use mva- leading cause of death sports and recreational injuries risk factors false confidence feel industructable risk-taking behaviors most lack adult adult judgement
emergency and disaster preparedness mass- casualty
local medical capabilities overwhelmed may require collaboration of multiple agencies and health care facilities to handle overwhelms local medical capabilities and may require the collaboration of multiple agencies and health care facilities to handle the crisis. State, regional, and/or national resources may be needed to support the areas affected by the event. Trauma centers have a special role in all emergency preparedness activities because they provide a critical level of expertise and specialized resources for complex injury management. mass casualty event such as a bus crash, tornado, chemical plant incident, or building collapse has been greatly improved in many communities.
Osteoarthritis Medications:
maca meloxicam acetaminophen cortisone (orally, injections) arthritic rubs
emergency and disaster preparedness emergency preparedness plan
mandated by the joint commission- that is tested through drills or actual participation in a real event at least twice a year. Common to all mass casualty events, the goal of emergency preparedness is to effectively meet the extraordinary need for resources such as hospital beds, staff, drugs, PPE, supplies, and medical devices such as mechanical ventilators. The U.S. government stockpiles critical equipment and supplies in case they are needed for a pandemic influenza outbreak and organizes large-scale vaccination programs (see Chapter 23 for more information on emerging infections). Each state has its own specific emergency preparedness plan for pandemic influenza, including who would receive vaccines in a mass casualty event. A personal emergency preparedness plan developed by each nurse can help in such situations. It should outline the preplanned specific arrangements that are to be made for child care, pet care, and older adult care if the need arises, especially if the event prevents returning home for an extended period.
skeletal disease osteomalacia
metabolic dz that causes poor and delayed mineralization of the bone cells in mature bones main cause is a vitamin d deficiency *book* Osteomalacia is loss of bone related to lack of vitamin D, which causes bone softening. Vitamin D is needed for calcium absorption in the small intestines. As a result of vitamin D deficiency, normal bone building is disrupted, and calcification does not occur to harden the bone. Table 50-1 compares these two bone diseases caused by impaired cellular regulation.
Isometric exercise
ms tm Muscle tension or resistance is produced without a change in muscle length Strengthen muscle groups that will be used later in ambulation Teach client to push or pull against a stationary object Muscles exercised are abdominal, gluteus, and quadriceps *Isometric exercises involve muscle contraction without motion. They are usually performed against an immovable surface or object, for example, pressing the hand against a wall. The muscles of the arm contract, but the wall does not move. Each position is held for 6 to 8 seconds and repeated 5 to 10 times. Isometric training is effective for developing total strength of a particular muscle or group of muscles. It is often used for rehabilitation because the exact area of muscle weakness can be isolated and strengthening can be adminis- tered at the proper joint angle. This kind of training requires no special equipment, and there is little chance of injury.*
R.I.C.E.
o Rest, ice, compression, evaluation o No longer than 30 minutes, check every 15 min, wait at least 1 hour between applications o Check for erythema, cyanosis, or blanching
rice
o Rest, ice, compression, evaluation o No longer than 30 minutes, check every 15 min, wait at least 1 hour between applications o Check for erythema, cyanosis, or blanching
Bone scan
o bat Once the isotope is injected and has been distributed in the body, the body is scanned for hot spots. Dark spots on the scan indicate areas where the radioisotope uptake is greater, usually indicating an abnormality in that region. Bone scans assist in detecting fractures, abnormal healing of fractures, and degenerative bone diseases. A nuclear scan used to detect early bone disease, bone metastasis, and bone response to therapeutic regimens. The patient is injected with the isotope because radioisotopes are used in the bone scan. *book* Nuclear Scans. The bone scan is a radionuclide test in which radioactive material is injected for viewing the entire skeleton. It may be used primarily to detect tumors, arthritis, osteomyelitis, osteoporosis, vertebral compression fractures, and unexplained bone pain. Bone scans are used less commonly today as more sophisticated MRI equipment becomes more available. However, it may be very useful for detecting hairline fractures in patients with unexplained bone pain and diffuse metastatic bone disease.
Back Pain Pathophysiology
one of the most common reasons people go to the doctor or miss work and a leading cause of disability worldwide. Disc degeneration due to age or trauma. Decrease in the disc height causes a shift in the load bearing in weight distribution. Impaired healing of the intervertebral disc due to poor peripheral blood supply.
skeletal disease Osteomyelitis nursing interventions
pad pait perform sterile dressing changes admen pain meds diet high in protein and vit c *perform neurovascular checks* antibiotics ASAP immobilize the body part teach importance of antibiotics completion
Patient teaching regarding Lyme disease
pd dl t Properly using insect repellents containing DEET is recommended *Daily tick checks* should be conducted after coming in from the outdoors. *If found, the tick should be properly removed by using fine-point tweezers to take away the ENTIRE creature.* *Dress appropriately for the outdoors when going out in a tick-laden environment*: Light-colored clothing should be worn to make ticks more visible. Tuck pants into socks when going into areas that could harbor ticks.
muscle fibromyalgia tx
pf pt- exercise with swimming & water exercises being recommended focus on clients symptoms
define and describe actions to prevent falls from occurring
pg nn proper lighting grab bars/rails *no scatter rugs* non-skid shoes
skeletal disease Osteomyelitis at risk
pico rem poor blood supply Injection/needle drug use chronic illness- diabetes, cardio-vascular dz overweight recent trauma elderly Malnourished patients
muscle fibromyalgia s&s
pif pain- increase with stress- weather conditions insomnia fatigue
attributes of patient- centered care
pita rice physical comfort information, communication, education transitional and continuity access to healthcare respect for patients values preferences needs involvement of family and friends coordination and integration of care emotional support- free from fear and anxiety
Procedure for incident reporting
pits pin dd bfd person filing report may or may not be the person responsible for or involved in incident Identify client, visitor, employee, and all witnesses to event The policy for incident reporting is unique to each health care agency; review and follow specific agency policy for incident reporting State objective facts of incident Prevent further injury and provide care for client, visitor, or employee Is an agency record of an accident or other event in the health care agency that is not consistent with hospital policy; may also be called unusual occurrence report or variance report. Notify health care provider immediately and take orders for interventions that may limit further harm Document facts of incident in client's record do not document in client record that an incident report was filed Be specific—list name of medication or equipment involved File report as soon as possible do not draw conclusions or lay blame
Scope of errors - Active
pm cdif -Prevention of decubitus ulcers -Medication administration: *10 Rights *Components of an physician med order -Diagnostic workup -Invasive procedures -Fall prevention -Recognition of/action on adverse events -Communication
Major complications of immobility
po padd pk Pressure ulcers Orthostatic intolerance (postural or orthostatic hypotension) Psychological effects: powerlessness and possible reduced self-esteem Atrophy and contractures Disuse osteoporosis Deep vein thrombosis Pneumonia 8. Decrease in peristalsis (paralytic ileus) Kidney stones
skeletal disease kyphosis
posterior curvature of the thoracic spine greater than 45 degrees often results from osteoporosis "hunchback"
Client teaching for renal calculi
prescribed diet and importance of compliance drug therapy ways to prevent recurrences how to strain urine for stones immediate return visit to hospital for fever, uncontrolled pain, or vomiting
quality improvement
process in which nurses and the interprofessional healthcare team use indicators --data-- to monitor care outcomes and develop solutions to change and improve care
medical- surgical nursing
promote restore maintain optimal health for patients 18 years of age or 100 years old
skeletal disease Osteomyelitis prevention
prophylactic antibiotics and sterile technique during and after sx Acute and Chronic Osteomyelitis Acute Osteomyelitis • Fever; temperature usually above 101° F (38.3° C) • Swelling around the affected area • Possible erythema and heat in the affected area • Tenderness of the affected area • Bone pain that is constant, localized, and pulsating; worsens with movement Chronic Osteomyelitis • Foot ulcer(s) (most commonly) • Sinus tract formation • Localized pain • Drainage from the affected area
case management
provides quality and cost effective services and resources to achieve positive pt outcome ex- The nurse and case manager coordinate *in-patient* and community- based care before discharge from facility in order to prevent readmission
skeletal disease Osteomyelitis s&s
ps fmp tt purulent drainage from infected site swelling fever malaise pain of affected area tenderness of infected area tachycardia
healthcare organizations
purposely designed and structured systems in which healthcare is provided by members of nursing and interprofessional teams. an healthcare organization is characterized by its mission and philosphy organizational structure workforce( health care & ancillary) patients services provided: these characteristics allow the agency to provide safe, quality patient care that the public or local community can trust
older adult factors affecting safety stress, loss and coping
rapid environmental changes lifestyle changes acute and chronic loneliness loss of significant other financial hardship
emergency and disaster preparedness test mass casualty triage
red "CLASS ONE"- emergent needing immediate attention-Priority I or emergent care is needed for victims who need immediate treatment, such as those with cardiac or respiratory distress, trauma and bleeding, or neurological deficits; these victims should be labeled with a RED TAG yellow" CLASS TWO"- can wait short time for care- Priority II or urgent care is needed for victims who need treatment within 30min to 2 hours, such as clients with simple fractures, lacerations, or fevers; these victims should be labeled with a YELLOW TAG and reevaluated every 30 to 60 minutes----*Yellow-tagged patients have major injuries such as open fractures with a distal pulse and large wounds that need treatment within 30 minutes to 2 hours*. green "CLASS THREE"- non- urgent or "walking- wounded" - Priority III or non-urgent care is needed for victims who need treatment that can wait for hours; those with sprains, rashes, and minor pain should be labeled with a GREEN TAG and reevaluated every 1 to 2 hours---*Green-tagged patients have minor injuries that can be managed in a delayed fashion, generally more than 2 hours. Examples of green-tagged injuries include closed fractures, sprains, strains, abrasions, and contusions.*--- Green-tagged patients are often referred to as the "walking wounded" because they may actually evacuate themselves from the mass casualty scene and go to the hospital in a private vehicle. *Green-tagged patients usually make up the greatest number in most large-scale multi-casualty situations*.--- green-tagged patients who self-transport may unknowingly carry contaminants from a nuclear, biologic, or chemical incident into the hospital environment with potentially disastrous consequences. ORANGE TAG indicates a client who has a non-emergent PSYCHIATRIC condition black" CLASS FOUR IV"- expected to die or dead --Typical examples of black-tagged patients are those with massive head trauma, extensive full-thickness body burns, and high cervical spinal cord injury requiring mechanical ventilation. The rationale for this very difficult decision is that limited resources must be dedicated to saving the most lives rather than expending valuable resources to save one life at the possible expense of many others.
Osteoporosis Teaching
reposition every 2 hr or as needed, ROM, assist with transfer and ambulating, encourage exercise, balanced diet. More common in women.
Nursing Process - Goals and outcomes related to immobility
ridi -Report more control over muscles during ambulation -Increase ambulation (distance and time) daily -Describe modifications to daily routine to reduce stress and promote relaxation -Identify ways to conserve energy to manage fatigue
transition management
safe seamless movement of clients among health care setting, health care providers- community for *ongoing care* to meet cts needs joint commission recommendation for effective care coordination n transition management LEO MU. K list of community and *outpatient*--ambulatory care-- resources and referalls explanation of self care activities ongoing or emergency care information medication reconciliation-- joint commission national patient safety goal understandable discharge instruction for client in family knowledge of the clients language, culture and health liteacy
Nursing Process - Nursing diagnoses (related to immobility)
sari rari Self-care deficit (bathing/hygiene, feeding, dressing/grooming, toileting Acute pain / chronic pain Risk for disuse syndrome Ineffective health maintenance Risk for ineffective peripheral tissue perfusion Activity intolerance Risk for injury / risk for falls Impaired physical mobility
communication
sbar- formal method of hand off communication b/t 2 or more healthcare team members s- situation: describe what is happening at the time to require the communication. b- background: explain any relevant background information that relates to the situation A: assessment: provides an analysis of the problem or client need based on assessment data r: recommendation/ request: state what is needed or what the desired outcome is *team stepps* STEPPS stands for Strategies and Tools to Enhance Performance and Patient Safety. cus words: state "im concerned: im uncomfortable- I don't feel safe check backs- restate what a person said to verify understanding by everyone call outs- shout out important info for all team members to hear at one time (such as vital signs two challenged rule: state a concern twice if needed, if ignored follow facility chain of command
Accident prevention - School age child
sc tbs pi tnt swimming lessons and life jackets are necessary for boating and swimming children should never swim without adult supervision Teach and model pedestrian and bicycle safety to children at this age bicycle helmets can prevent head injury to children biking, rollerblading, or skateboarding school-age children can participate in implementing a school or home fire escape plan; teach to "stop, drop, and roll" if clothing catches fire Place children under 12 years or under 4 feet 9 inches in rear seat of a car with a lap/shoulder seatbelt Include in safety education for children to play in safe areas, avoid strangers, recognize unwelcome touch, and obey traffic signals Teach school-age children principles of fire safety; injury can occur from experimentation with matches, lighters, and fireworks never allow children to ride in the bed of a pickup truck or open, unsecured area of an automobile, such as a station wagon or van Teach school-age children principles of water safety
Symptoms of Lyme disease
spf 90 Symptoms can begin as soon as three days after the bite or as late as 30 days: Patient usually reports being active outside in the last 2-4 weeks, may or may not report bite...but most present in 7 to 14 days. In the early and localized stage I, Flu-like symptoms (low grade fever, fatigue, muscle and bone aches, chills, and malaise) 90% of cases report erythema migrans (which is the circular rash that continues to grow often resembling a bullseye) Stage II (early disseminated stage) occurs 2 to 12 weeks after the tick bite. The patient may develop carditis with dysrhythmias, dyspnea, dizziness, or palpitations and central nervous system disorders such as meningitis, facial paralysis (often misdiagnosed as Bell's palsy), and peripheral neuritis. For severe disease, IV antibiotics (e.g., ceftriaxone or cefotaxime) are given for at least 30 days. If Lyme disease is not diagnosed and treated in the earlier stages, later chronic complications (e.g., arthritis, chronic fatigue, memory/thinking problems) can result. This late stage III (chronic persistent stage) occurs months to years after the tick bite. For some patients the first and only sign of Lyme disease is arthritis. In some cases the disease may not respond to antibiotics in any stage, and the patient develops permanent damage to joints and the nervous system. Prevention is the best strategy for Lyme disease.
skeletal disease scoliosis
spinal deformity characterized by lateral curve, spinal rotation causing asymmetry, and less than normal curvature in the thoracic spine is a lateral curvature of the spine. Scoliosis can result from congenital bone disorders, neuromuscular impairment, or trauma, but approximately two-thirds of cases have no known cause and are termed idiopathic scoliosis. Idiopathic scoliosis is classified as infantile, juvenile, or adolescent depending on the age at onset.
safety hazard: healthcare facility
sr mwf fr ben pecc side-rails restraints mercury poising workplace violence *falls risk assessment* fires/electrical hazards radiation injury back injury equipment related accidents needles stick injury Prevention: yearly facility training; following facility policy environmental safety clean, dry floors client education
Risk for falls - Nursing interventions
t u pms gem bt -Transfer the patient to a room near the nurses' station. -Use side rails on beds, as needed. For beds with split side rails, leave at least one of the rails at the foot of the bed down. Provide signs or secure a wristband identification to remind healthcare providers to implement fall precaution behaviors. -Move items used by the patient within easy reach, such as call light, urinal, water, and telephone. -See to it that the beds are at the lowest possible position. If needed, set the patient's sleeping surface as adjacent to the floor as possible. -Guarantee appropriate room lighting, especially during the night. -Encourage the patient to don shoes or slippers with nonskid soles when walking. -Make the primary path for walking clear and as straight as possible. Avoid clutter on the floor surface. -Bed and chair alarms must be secured when patient gets up without support or assistance. -Teach client how to safely ambulate at home, including using safety measures such as handrails in bathroom. The Ambularm is worn on the leg and signals when the leg is in a dependent position, such as over the siderail or on the floor. Another type of alarm is an integral bed alarm, which beeps if the patient's weight is off the mattress for more than a few seconds. For specific instructions about using alarms,
Emergency response - Secondary survey
td mira The secondary survey is initiated after initiating lifesaving interventions Do a complete health history and physical examination Measure and record a full set of vital signs Identify family members Remove all of client's clothing Administer comfort measures or pain medication if appropriate
Accident prevention - Adolescent
tease ra Teach adolescents dangers of alcohol and substance use Encourage courses in driver's education Adolescents may be injured in sports-related accidents seatbelt regulations should be role modeled and enforced by parents encourage protective sporting gear for organized and impromptu sporting events Review water safety principles because adolescents can overestimate endurance when swimming Adolescents benefit from information about sexual health, including information about sexually transmitted infections and pregnancy prevention birth control
safety definition
the ability to keep the client and staff free from harm and minimize errors in care prevention of health care errors and the elimination or mitigation of patient injury caused by health care errors.
evidence based practice
the integration of the best current evidence and practice to make decisions about client care things to consider clients preference and values one's on clinical expertise for the delivery of optimal health care the best source of evidence is research promotes safety for clients, families, staff, health care system bc it is based on reliable studies, guidelines, consensus, expert opinion The highest levels of evidence are systematic reviews and integrative or meta-analysis studies.
patient- centered care
the patient- designee is the source of cntrl and full partner in providing compassionate coordinated care based on respect for pts needs, preferences, values nurse culturally competent joint commission family- centered care right of pt and family to make informed decisions
clinical judgement
the process that nurses and other members of the interprofessional team use to make decision based on interpretation of the patient's needs or problems. critical thinking skills and the nursing process - tanner - - assessment- noticing - analysis- interpreting - planning and implementation - responding - evaluation- reflection *rapid response teams*: save lives and decrease the risk for harm by providing care before a medical emergency occurs by intervention rapidly when needed for patients who are beginning to clinically decline who is rapid response?
the joint commission- national patient safety goal 2018
tjc requires that healthcare organizations create a culture of safety: bs p blame- free approach serious- sentinal events must be reported patient and families are encoraged to become safety partners with healthcare providers and organizations *2018 national patient safety goal* u pp iii u use alarms safely prevent infections prevent mistakes in surgery identify patient safety risk identify patients correctly improve staff communication use medicines safely
triage
to rapidly sort ill or injured patients into priority categories based on their acuity and survival potential. Triage functions may be performed by EMS providers in the field such as: • Emergency medical technicians (EMTs) and paramedics • Nurse and physician field teams who are called from the hospital to a disaster scene to assist EMS providers • Nurse and physician hospital teams to assess and reassess incoming patients Triage concepts in a mass casualty incident differ from the "civilian triage" methods discussed in Chapter 8 that are practiced during usual emergency operations (Table 10-1). Although disaster triage practices can vary widely based on local EMS protocols, some concepts are fairly universal. Most mass casualty response teams in the field (at the disaster site) and in the hospital setting use a disaster triage tag system that categorizes triage priority by color and number:
Somatosensory Evoked Potentials (Evoked Potentials)
u tiie Used to measure time in meters per second from the stimulation of a peripheral nerve through the response. This measurement documents axonal continuity when sensory potential cannot be measured due to nerve trauma. **It is used when EMG is not appropriate. It is useful in the evaluation of radiculopathies and peripheral nerve function and the diagnosis of Charcot-Marie-Tooth disease. Electrodes are placed on the skin, stimulus is applied, and time intervals are calculated based on the time it takes from the stimulus to be given at one electrode and reach the next electrode along the peripheral nerve pathway.
Nursing interventions to prevent medication errors
u's bad bk vcr Use standard hours and times for medication administration Stop and double- check medication if client questions appearance or dose Be familiar with side effects or possible adverse reactions; observe for these on an ongoing basis Ask a nurse colleague to double-check complex dosage calculations Do not interrupt nurses giving medications, which can lead to errors during administration Be familiar with medication resources at agency c. ensure client information e.g., height, weight, allergies is accessible to healthcare providers, clinicians, and pharmacists Know agency medication administration system; follow protocols Verify medication orders; do not transcribe orders that contain unapproved or nonstandard abbreviations until clarified Check client identification bracelet before administering medication; ask client to verbalize name and date of birth (or other method of checking two unique identifiers) according to agency policy; additional measures are needed with blood administration Report and document any error or variation in medication administration process
skeletal disease scoliosis s&s
uneven pants and shirt length pain is not an issue until the deformity has progressed Adams bending forward test- test done in schools to help observe curvature in the spine
joint and connective tissue dz: gout dx procedure
uu less Urine albumin will be greater than 100 mg/24 hours Urinary uric acid will be elevated-750 mg/24 hr Leukocytosis will be present ESR will be elevated serum uric acid greater than 7mg/dl synovial fluid analysis- will show uric acid crystals
older adult factors affecting safety impaired nutrition and hydration
vd lp fit cg vitamins a/c/d diminished taste and smell loneliness poor dentures fiber increased need for ca tooth loss constipation geriatric failure to thrive-gftt