Test 3 NSG 210
post op knee rehab
- PT will start mobility within 24 hours - pain meds before PT, what pain they can tolerate - pre op ROM to prepare muscles - moving post op will cause pain, prepare PT for it - drains are used to remove drainage and blood from knee (monitor for post op bleeding) - pre op ice to reduce edema
Treatment of hyperthyroidism
- Radioactive iodine (I131) works by destroying the thyroid gland - Surgery to remove all or part of the thyroid gland - Lifelong thyroid hormone replacement will be needed (watch for s/s of hypothyroidism)
treatment for osteoporosis
- bisphosphanates: alendronate, risedronate, ibandronate, zoledronic acid (can cause break or crack In thigh bone), Fosamax - monoclonal drugs: Denosumab (given under the skin every 6 months via a shot) can have increased spinal fracture when stopping, need to take FOREVER - selective estrogen receptor modulators: - muscle relaxants (baclofen, dantrolene, diazepam) **dental exams should be done before these meds**
pituitary gland is divided into two lobes ?
Anterior lobe: (TSH, adrenalcortical trophis, ACTH and stimulates adrenal glands to secrete glucocorticoids) LH hormone, FSH, and GH hormones posterior lobe: antidiuretic hormone, oxytocin
expected finding of DKA
Blood glucose over 300, weight loss, deep labored breathing (kussmauls respirations), increased urine output
multiple sclerosis
CHRONIC disease of the central nervous system marked by damage to the myelin sheath. Plaques occur in the brain and spinal cord causing tremor, weakness, incoordination, paresthesia, and disturbances in vision and speech. autoimmune CT and MRI (white gray matter and lesions on myelin sheath)
Addison's disease: adrenal hypofunction
Causes = autoimmiune, TB, bilateral adrenalectomy, abrupt withdraw of long term corticosteroid S/S = wt loss, craving for salt, bronze skin, weakness, fatigue, nausea, vomiting, abd pain, constipation, diarrhea, dizziness w/ orthostatic hypotension, dehydration, hyponatremia, hyperkalemia, hypoglycemia, hypercalcemia Addison crisis - shock, change in LOC, profound fatigue, vascular collapse low BP, renal shut down, dehydration restore fluid and corticosteroids
expected findings of hyperthyroidism (graves disease, thyroid storm)
LABS = TSH decreased, T3 & T4 increased s/s= weight loss, heat intolerance, diaphoresis, bulging eyes, insomnia, increased HR , BP, and DTRs, finger clubbing, enlarged thyroid, tachycardia
expected findings of hypothyroidism (myxedema, thyroiditis- hashimotos)
LABS = TSH increased, T3 and T4 decreased s/s = weight gain, fatigue, cool, dry skin, cold intolerance, hypotension, bradypnea, bradycardia, puffy face (hands, feet, eyes), temp and HR decrease, numbness and tingling of fingers, goiter (palpated on neck)
treatment fir hypothyroidism
Levothyroxine, Armur, Synthroid **take 1st thing in morning before breakfast, lifelong therapy, monitor s/s of hyperthyroidism**
Hip fracture older adults, women, osteoporosis
Most common type of fracture; may cause shortening or external rotation of the leg (The leg appears to be shortened and is adducted and externally rotated.) 2 types: intracapsiular and extracapsiular
post op hip replacement rehab
PT or go to rehab facility? walkers, anticoagulants, Teds and SCDs to prevent clots pain control abduction pillow may be used
pt teaching: crutches
Prevent damage to axialla, put weight in hands and arms not armpit. Place crutch tip diagonally 6" in front of foot. Adjust so elbow <30 degrees.
comminuted fracture
bone breaks into many fragments. caused by crushing action, car crashes, gun-wound shot. risk factors: osteoporosis, older age. complete fracture and a lot of the time open
complete fracture
bone is broken all the way through
incomplete fracture
bone is not broken all the way through (hairline)
avulsion fracture
broken bone in which the site of muscle, tendon, or ligament insertion is detached by a forceful pull. commonly seen in athletes, children, or dancers. s/s: intense and sudden pain where the trauma occurred. swelling, bruising, trouble moving the bone/joint, prevention: wearing protective gear
when getting a vanillylmandelic acid test to screen for pheochromocytoma you will want to avoid?
coffee, tea, bananas, chocolate, vanilla, citrus fruits, aspirin for 2 to 3 days prior to the test
closed fracture
doesn't go through skin
hip replacement postop education
don't need to bend more than 90 degrees have raised toilet seat, dont bend down
what hormone dilates systemic arteries, increases cardiac output, and increases blood flow to the kidneys causing urinary output?
dopamine
nursing management for closed fracture
edema management, pain management, exercise unaffected part, use of assistive devices, fall risks assessments, cast care
a nurse caring for a pt with pheochromocytoma should?
elevate the head of the bed, monitor for hypertension, place pillows behind the neck,
S/S of multiple sclerosis
fatigue, weakness, numbness, difficulty in coordination, loss of balance, pain and visual disturbances, spasm, tingling, burning, pins and needles, nystagmus, diplopia, frequent urination or incontinence, sudden slurring or stuttering in speech
risk factors for hip dysplasia
female baby, first pregnancy, large baby, family hx, baby in breech postion, has foot deformities, asymmetry, pain, incorrect swaddling (not too tight, get 2-3 fingers between baby and swaddle) or baby wearing (baby's legs should not hang straight, knees should be up )
Epinephrine : fight or flight
fight
What bones heal fast?
flat bones
Noreepinephrine : fight or flight?
flight (no fight)
FSH hormone
follicle stimulating hormone. stimulates the growth of the ovarian follicle, production of estrogen in females, and production of sperm in males
impacted fracture
fracture in which one bone fragment is pushed into another
What insulin is not compatible with others?
glargine
Intraarticular fracture
goes into joint surfaces, can lead to arthritis (MRI or arthroscopy to diagnose)
treatment for hip dysplasia
harnesses surgery casting
A pt with an adrenal insufficiency will have?
high calcium (4.5-5.5) weight loss low sodium (135-145)
pituitary gland is regulated by the?
hypothalamus
antidiuretic hormone (ADH)
influences the absorption of water in the kidneys
pt teaching for cast care
its warm when it is first being applied. don't get wet, don't stick anything down cast to scratch, no small toys that can go down in it.
Splinting
joints distal and proximal to the suspected fracture site must be supported and immobilized. neuro checks before and after. open fracture = cover with sterile dressing
when a pt has a thyroidectomy you want to report what to the provider postop?
laryngeal stridor (a harsh, high pitched sound with inspiration the indicates respiratory obstruction. The nurse should take immediate action to preserve the client's airway)
the parathyroids help regulate?
level of calcium in the blood
pt teaching Addisons disease?
lifelong cortisone therapy, need a medical alert bracelet, keep emergency kit of hydrocortisone
What bones take longest to heal?
long bones
LH hormone
luteinizing hormone, stimulates maturation in ovulation and stimulation production of testosterone
treatment for multiple sclerosis
muscle relaxants (drowsiness) EX.) baclofen, dantrolene, diazepam (valium), tizanidine
oblique non displaced fracture
occurs at an angle across the bone (diagonal),
transverse fracture
occurs straight across the bone, complete and closed
compression fracture
occurs when the bone is pressed together (compressed) on itself. causes osteoporosis, trauma, tumors.
compartment syndromes
ongoing deep pains or aches, numbness, tingling, light shocks, "pins and needles", low BP, trouble urinating,
ORIF
open reduction internal fixation orthopedic surgery (go in and repair bone)
Neurovascular checks: 5 Ps
pain (Can they feel the pain?), pulse, pallor (white), paresthesia (can you feel this?), paralysis (can you move this?) (pressure)
manifestations of fracture?
pain, loss of function, deformity, shortening, crepitus (trapped air, felt on palpation), swelling, and discoloration
Which gland regulates calcium?
parathyroid gland
what gland produces the growth hormone?
pituitary gland
what is the master gland of the body?
pituitary gland
nursing management for open fracture
prevent infection of wound, tissue, bone iv therapy, edema management, pin care, enhance bone healing, monitor for complications
pt teaching: cane
put on affected side
reduction of a fracture external : twist or pull bone back into place open : ORIF (surgery)
realignment of the broken bone
describe the reaction of thyroxine hormone has on the body?
regulates metabolism by increasing the metabolic rate
5 functions of hormones
regulation of metabolism, growth & development, reproduction, stress response, and cell permeability
expected findings of hyperparathyroidism (over production of parathormone)
renal calculi (kidney stones), hypercalcemia, muscle weakness, bone decalcification
R I C E: stands for?
rest, ice (20 min at a time, not on bare skin use pillow case or something between skin, compression (check 5ps), elevation
complications of fractures include?
shock, fat embolism, compartment syndrome, delayed union/nonunion, avascular necrosis (blood supply gone. dislocation), reaction to internal fixation devices, complex regional pain syndrome (severe burning, stiffness, discoloration), heterotrophic ossification (formation of bone near bones or muscles in response to trauma)
growth hormone
stimulates protein synthesis and growth in cells (muscle and bone)
adrenalectomy
surgical removal of one or both adrenal glands
expected findings of hypoparathryoidism
tenant (tingling around mouth, feet), dry skin and fingernails, hypocalcemia positive trousseau sign- upper arm compressed positive chvosteks sign- tapping over facial nerve, spasm of mouth GIVE = calcium gluconate To decrease tetany diet modifications
What is an indication of hypocalcemia?
tetany (numbness and tingling of hands and feet)
open/compound fracture
the broken ends of the bone protrude through the skin grades = 1-11
the most common location for a strain is?
the lower back or hamstrings
the adrenal glands help?
trigger fight or flight response
traction
use of pulling force to promote and maintain alignment of injured area.
with a fracture you want to immobilize the extremity. you can have issues such as?
- delayed or non union (not healing the way it needs to, takes longer than expected to heal) - angulation (axis of bone has been altered, distal points in different direction) - Infection - acute compartment syndrome (a cast is applied and developed from fracture due to pressure of cast or skin. a lot of pressure that can cause neurologic defects of limb. not allowing blood flow. want to cut off cast or stop what is causing pressure) - venous stasis (pooling of blood in vein) - thrombus (blood clot, can move and become embolus) - fat embolism (when fat globules released into blood stream and occurs 24-72 hrs after trauma. get straight to ER s/s shortness of breath, confusion, rash)
complications of fractures
--Fat emboli- (long bones) fat globules move into bloodstream. --Hemorrhage --Delayed union- healing is slowed; caused by infection or distraction of fractured fragments; Bone pain will increase --Malunion- Improper alignment of fractured fragments. May develop with premature weight-bearing --Nonunion-Healing has not occurred 4-6 months after fracture. Why? Insufficient blood supply, repetitive stress on fracture site, infection, inadequate internal fixation --Sepsis --Compartment syndrome: High pressure within a muscle compartment of an extremity compromises circulation. Pressure may be internal (bleeding) or external (casts). If left untreated neuromuscular damage occurs within 4-6hrs; Limb can become permanently useless within 24-48 hrs --Peripheral nerve damage cut off casts, decrease that pressure.
femoral shaft fracture rehabilitation
-Lower leg, foot, and hip exercises to preserve muscle function and improve circulation -Early ambulation stimulates healing -Physical therapy, ambulation, and weight bearing are prescribed -Active and passive knee exercises are begun as soon as possible to prevent restriction of knee movement
Diet for osteoporosis
-eat more foods with calcium and vitamin D -do not drink lots of caffeine.
the most common location for a sprain is? treatment includes?
-the ankle -RICE (rest, ice, compression, elevation)
Normal TSH levels
0.4-6.15 U/mL
nursing interventions for hyperthyroidism
1. Provide a cool and calm restful atmosphere 2. Observe for signs of thyroid storm 3. Explain to client the recommended diet: high-calorie high-protein low-caffeine low-fiber diet if diarrhea is present 4. perform eye care 5. prepare client for hyperthyroid treatment
Osteoporosis
A condition in which the body's bones become weak and break easily. uncontrollable risk factors: gender, age, body size, ethnicity, bone fractures modifiable risk factors: lack of exercise, nutrition (low calcium, vit D, high phosphates) lack of sunlight, smoking, caffeine, alcohol, medication intake, comorbidities.
spiral fracture
A fracture that twists around the bone. twisting tool, twisting arm, child abuse, etc
hip replacement
A surgical procedure in which the hip joint is replaced by a prosthetic implant. Done to relieve pain or restore function of those with arthritis, joint disease, or fracture can be total or just the femoral head
the adrenocorticotropic hormone (ACTH) stimulation test is to assess for?
Addisons disease
what should the nurse do to a postop pt with acute adrenal insufficiency?
Administer IV hydrocortisone sodium (To replace the cortisol deficiency that occurs with adrenal insufficiency)
Cushing disease; adrenal hyperfunction
Causes = pituitary hypersecretion of corticotrophin, corticotrophin secreting tumor (pancreatic carcinoma), administration of synthetic glucocorticoids, adrenal tumor S/S = muscle weakness, buffalo hump (fat deposits), moon face, thin extremities, thin and fragile skin, broad purple striae, males- gynecomastia, edema (sodium and water retaining) Test = low dose, overnight, dexomethosne suppression test, 24 hr urine, cortisol levels high night time cortisol levels confirms Cushing Treatments: drug therapy, radiation, surgery Teaching : daily weights, diet high in potassium but low in calories, carbs and sodium
oblique displaced fracture
Diagonal break across bone, not attached. complete and open
Skin traction (Buck's traction)
For hip and knee contractures, muscle spasms, and alignment of hip fractures. Uses a boot or brace to apply weights. Weight used during skin traction should not be more than 5 to 10 pounds to prevent injury to the skin. free hanging weights, skin integrity.
green stick fracture (incomplete fracture) often seen in children
bone breaks incompletely, bends s/s: pain, tenderness
knee replacement
Replacement is done to increase mobility and relieve pain. common causes include arthritis, and trauma. replaces parts of knee that bears weight drain will be applied risk of DVT issues with infection or anesethia post op use walker, crutch or cane post op
Adrenal glad hormones : SSS
Sugar (glucocorticoids) Salt (mineralcortoids) Sex (Androgens)
skeletal traction
The most effective means of traction, pins or screws placed so weight is placed directly to the bone. pin care (asses once every shift), ensure free handing weights
Pheochromocytoma
a benign tumor of the adrenal medulla that causes the gland to produce excess epinephrine. *TRIAD- headache, diaphoresis, palpitations *5 Hs- hypertension, headache, hyperhidrosis, hypermetabolism, and hyperglycemia *24 hour urine collection - discard first morning void and collect after that *clonidine suppression test = medication supresses release of catecholamines MEDS: calcium channel blockers, alpha blockers, may remove adrenal gland (adrenalectomy)
linear fracture
a fracture running parallel to the length of the bone, incomplete and closed
hip dysplasia
a hip socket that doesn't fully cover the ball portion of the upper thighbone. allows hip joint to become dislocated. most people are born with it. Barlow tests (dislocation test) Ortolani test (reduction test)
hairline fracture
a small fracture that developed overtime due to repeated stress of the bone. causes include repeated activity. commonly sorts
what gland triggers fight or flight?
adrenal gland
nursing intervention for hypothyroidism
allow rest periods, provide blankets, pt teaching (meds are lifelong therapy), monitor for s/s of hyperthyroidism
a strain is?
an overextending or tearing of muscles or tendons. mimics a fracture, only X-ray can confirm its not.
a sprain is?
an overextension or tearing of ligaments. mimics a fracture, only X-ray can confirm its not. s/s bruising, signs of edema (fall, twist, get hit) graded 1-3 3 = most severe, painful, no weight bearing
open fractures require treatment to prevent infection:
antibiotics, tetanus prophylaxis, cleaning and debridement of wound
prevention for osteoporosis
balanced diet high in calcium, Vit D. use of calcium supplements, regular weight bearing exercises, BMD (bone mineral density). avoid sustained use of corticosteroids (COPD)
recommended screenings for osteoporosis
baseline DEXA testing, bone mineral density, fracture risk. serum calcium, phosphate, alkaline phosphate, calcium excretion,
