H&I Test 5

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mowgli
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214362
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H&I Test 5
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2013-04-25 08:25:44
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Renal muscu
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Renal/Musculoskeletal
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  1. Labs and Dx tests for urinary / renal d/o
    Serum creatinine.  .  AC elevation.  Serum electrolyte; ↓Ca,↑Na, K. Commonly have hypertention. X-ray.  Flat plate of abd. KUB (outline of kidney), Ultrasound (need full bladder).  Injecting dye. (assess for iodine allergy)
  2. What type of lab is best for kidney function
    creatnin clearance
  3. what can creatnin clearance show
    drop in kidney function
  4. What does BUN tell
    ability of kidney to excrete urea /nitrogetn
  5. when could BUN be elevated
    • if eating lots protein
    • can be related to drugs/ steroids
  6. what does serum creatnin tell
    • wasting of muscle
    • ability of kidney excretion

    certain kidney d/o will be elevated better indicated
  7. what can serum creatinin be influenced by
    • dehydration
    • prob w/ liver function

    look at BUN-creatnine ratio
  8. *what is the norm BUN-creatnine ratio
    10-1
  9. what can be checked by BUN
    • acute kidney failure/
    • nephrities ?
  10. BMP ?
    ?
  11. what will they do if they can't confirm Dx w/ kidney d/o
    will do Bx of kidney if can't confirm Dx
  12. What will happen if someone has kidney failure
    will have changes in electrolyte low Calcium, high sodium
  13. what health problem is common for kidney pt's
    HTN
  14. ......flat plate of abd///
  15. what tool is used in Dx of kidney problems

    what do you need for exam
    ultrasound---see more today vs xray

    need to have full bladder
  16. who can't get an IV pylogram
    those w/ allergy to iodine and  shellfish
  17. what does nephrostamy tube do
    create wider opening to allow for overflow
  18. what condition is nephrostamy tube put in for?
    obstructed uriter
  19. how is nephrostamy tube put in
    • through flack back
    • goes directly into kidney
  20. what do you check for pt w/ nephrostamy tube
    • ..... tube
    • conditon of dressing
    • ... insertion site
    • amount/color of drainage
  21. what kind of dressing is used
    • sterile dressing on insertion
    • and dressing change as ordered
  22. What is urethral stricture
    congen or aquired
  23. what does urethral stricture cause
    • surge scarr
    • urinary diverstion scar
    • urine/ gall stones
  24. what are s/s of urethral stricture
    • varied usually
    • high urination after lots of cafine
    • look at urinary stream will have weak stream
    • urinary retention
    • pt constant dribbling of urine
  25. what group gets urethral stricture
    • very common d/o
    • high occurance in elderly men
    • --bc elarged prostate
  26. what is Tx of urethral stricture
    • insertion to urethra lidocane
    • insert boggy (balloon) each time make larger
    • dilititon in hospital -can be done at bedside
  27. What is renal calculi
    • ural lythasis
    • stones in urithra
  28. who gets renal calculi

    how many people
    • common in males
    • high reoccurance
    • 500 thousand people infected
  29. what causes renal calculi
    • linked to family
    • chronic dehydration
    • infection
    • urinary stasis
    •  altered pH
  30. what are the types of renal calculi based on
    food
  31. what are the differant types of renal calculi
    • calcium oxilate
    • calcium phosphate
    • magnesium amonia
    • uric acid stones
    • sistine stones
  32. how do you treat calcium oxilate
    restrict protein to 60g/day
  33. how do you Dx renal calculi
    send stones to pathology to ID type
  34. what are s/s of renal calculi
    • excrutiatig pain or
    • dull flank pain
    • if in...

    • urethral stones- exrutiatig esp in abd radate/refer to
    • cholic-pain from spasm
    • hemateria, -once stone starts moving tairs in
    • n/v
    • classic s/s of UTI
  35. how can you dx renal calculi?
    • KUB
    • ultrasound
    • urinalysis
    • c&s
  36. how is renal calculi treated
    • lythotripsy-use electro shock waves pulverize stones (electro coparal)
    • very painful use conscious sedation

    can use laser lithotripsy
  37. what should you do for any lithotripsy
    • have nephrostamy tube to flush out
    • iv & force fluid
    • have pt strain urine-stone can be pinhead sized
  38. what can you do for ingebudshap
    can do gen anasthegia

    to help pass lift behind or for future-put in stents
  39. how long does it take for pulverized stones to pass
    1-4wks
  40. what should you do if you put in stent for renal calculi
    w/in several wks take out
  41. what should you teach w/ lithotripsy
    initial urinatin ma be bright red for the 1st 24hrs
  42. what is done if stones & all byproducts of lythotripsy aren't passed
    surgery
  43. what kind of surgery is done for renal calculi
    • endoscopy using ......oscopy
    • or may need to open up
  44. what is called if you cut into kidney
    renal pelvis
    bladeder ?
    nephro..

     py

    urial
  45. what are complications of surgery for renal calculi
    • bleeding
    • hemaraging
    • bruising
    • infections
  46. what should you teach for renal calculi treatment

    how much
    • intitial-if urine becomes cloudy or foul may be getting UTI
    • main teach-prevention-
    • --foods to avoid that cause stones
    • ---exs calc also chocolate/nuts/tea/spinich

    ofte
  47. what is main complicatio of renal calculi
    • if stones move can cause obstruction
    • damage to kidney
    • urine retention
  48. what is hydronephrosis
    kidney retai water
  49. what are causes of hydronephrosis
  50. What are complications of hydronephrosis
  51. what are Tx of hydronephrosis
  52. What are s/s of hydronephrosis
  53. what is the %age for cancer of urinary system
    • 3% of all cancer
    • of these 55% are adno carcioma
  54. what groups have a high insidence for urinary CA
    males b/w 55-60yrs
  55. who gets squamos cell CA in pelvis
    equaly seen in males and females
  56. does urinary cancer tend to metasise

    where
    yes

    • usually
    • liver
    • kidney
    • long bones
    • when spread fustho-direct extention to uriters
  57. s/s of urinary cancer
    • anemia
    • weakness
    • weight loss
    • ..
    • w/this type when palpate flank may feel mas
    • way do excreting
  58. Dx for urinary CA
    • electrogram pylogram
    • ultrasound
    • ct scan
    • renal Bx
  59. when do surgical treatment for urinary CA
    • esp if find tumor in kidney
    •  best if incapsulated
  60. what is choice surgery for incapulated renal carcinoma
    radical nephrectomy
  61. what may be done prior to renal/urinary CA
    chemo/radiation-- to shrink tumor
  62. nurse care if had chemo/radiation
    • chemo/radiation teaching/care etc
    • do protective measures-reveres isolation, etc
    • lots emotional support
    • emotional assessment

    asses s/e of radiation/chemo
  63. what should you asses for w/ chemo/radiation for urinary/renal CA
    • weakness
    • fatigue
    • changes in urine
    • ---decrease i urie w/ large tumor
    • ---blood in urine
    • change in urinary pattern
  64. what kind of care do you give for Urinary CA surgery
    • pre/post op teaching
    • usually surg care
    • monitor I& O--esp w/ nephrectomy
    • admin meds-look for theraputic effect

    assess airway/bleeding
  65. what labs are given for radiation for Urinary CA
    • CBC
    • WBC
    • platelets

    explain all prcedures
  66. why may lots of tests be given for urinary CA
    to r/o
  67. what should be done before radical renal surgery
    • always check to makesure other kidney functioning
    • assess for chang in bleeding
    • s/s infection

    • if drain  --where, type, drainage
    • docu each separate
  68. after renal CA surgery
    • help w/ splintin, T/C/D
    • listen to lung souds
    • pain
    • meds
    • passive ROM-prevent 2ndary like DVT
  69. what is bladder CA
    one of most common uriary CA
  70. who is most likely to get bladder CA
    men b/2 60 & 70 have highest incidence
  71. what part of bladder usually gets bladder CA
    • in neck
    • urithral
  72. underlying causes of bladderCA
    • chemicals-carcinagens
    • tar
    • dyes (industrial compouds, etc)
  73. what should you do for bladder CA
    • look at s/s
    • ask Hx
    • ask...
  74. common s/s of bladder CA
    painles intermittent hemouria
  75. other s/s of bladder CA
    • irritablity of bladder
    • infection w/ dysuria
    • frequet urgency
    • low stream
  76. Dx of bladder CA
    • s/s one indscator
    • urinanalysis
    • CT scan
    • IVP (intravenous pylogram)
    • CYSF (cystoscopy of bladder-can do 8x at same time
  77. Tx for bladder CA
    • 1st chemo therapy
    • then surgery
  78. Tx of choice for bladder CA
    surgery
  79. if have small tumor
    • can instill chemo through catch
    • also do systemic chemo
  80. how can help reoccurance of bladder CA
    • vaccine
    • VSG
  81. what may do before extensive surgery for bladder CA
    • electro
    • --current to try to destroy tumor (electrofurgeration)
  82. alt med to try to radicate bladder CA tumor
    laser
  83. what is resection of tumor for bladder CA
    • remove tumor & some tissue still leave portion in place
    • idealy like to remove bladder
  84. 2 surgical procedures for bladder CA
    segmental bladder resection-
  85. when is segmental bladder resection done
    w/ pt w/ single primary tmor kow primarey sitetoo large to remove through systoscope--remove tmore & some extra tissue--will shrink bladder--do lots
  86. when is radical systectomy done
    • reserved for untreatable CA
    • under more conservative Tx
    • remove as much tissue as possible
    • will do radiation /chemo prior

    BCG vaccine
  87. how is radical sysetectomy done
    • remove all bladder & some other tissue
    • need to do urinary diversion-several types
  88. when is urinary diverstion done
    after bladder removal
  89.  differant types of urinary diverstion
    • illeal Conduit
    • Sigmoid Conduit
    • uritherostomy
    • nephrostomy
    • orthopstic bladder substitution
  90. how is illeal coduit done
    • take part of illium
    • restect/cut from small bowel
    • get uriters attached
    • stoma for illeal coduit--a little flatter than colonostomy stoma
    • will see collection bag
  91. is common to see in illeal conduit
    • see mucus--usually after surgery
    • after increased intake of fluids w/ decrease
  92. how is sigmoid conduit done
    same way as illeal conduit except simoid
  93. how is nephrostomy done

    what do you worry of w/ this
    tube directly into kidney--

    kidney infection
  94. what is orthopstic bladder substitution
    • create bladder
    • take section of intestine of...
  95. nursing care for bladder CA
    • assess s/s
    • tiredness
    • unexplained wtloss
    • good health Hx-smoke
    • emotional support
    • explain procedure
    • do good teaching
    • assess coping skills
    • psy --if have stomy, diverstion -- big impact
    • intestinal prep as oredered -- going into lower intestine--bladder prep several days
  96. what kind of diet should be given for bladder CA
    • low residue diet
    • neomyocin--oral
  97. post op for bladder CA
    • airway
    • breathing
    • i&O
    • get up ASAP
    • teach self care esp w/ stoma
    • protect skin
  98. what should all surgery get
    pai meds
  99. post op care for stoma
    • assess it & skin around it
    • t/c/db
  100. Post op care for drainage tubes
    • -make sure patent
    • assess bowel sounds-- asses of parlyitic illiaus
  101. What are causes of Renal Failure
    • HTN
    • dehydration
    • meds
    • NSAIDS--if take NSAIDS drink lots fluid
  102. what is needed for kidneys to function properly
    lots of blood flow
  103. w/ kideney failure mortality rate high
    35-65%
  104. what one prob w/ kidney problems
    • probubly don't know the have kidney problems
    • --tur to renal failure
    • acute or chronic
  105. how long does it take for syp of acute renal failure to show up
    1-7 days
  106. prerenal causes of acute renal failure
    • low blood flow i glomaruli
    • sudden drop in BP <70
    • no renal perfusion
  107. intrarenal causes of acute renal failure
    • taken in nephrotoxic agents )meds, any type nephrotoxic)
    • repeated kidney infections
    • occlusion of intra renal arteries
    • HTN
    • DM
    • any direct kidney trauma
    • heavy metals (ex.-mercury)
    • antibiotics--myocin can be nephrotoxic
    • lots of chem can lead to rf-cleaning compounds, pesticides...
    • pyloeglymarial eiater stitial nephrites
  108. what may happen if acute renal failure is caused by meds
    some times if it is med if stop taking- will go back to normal state
  109. what do you look at for post renal failure
    obstruction in kidney
  110. **Stages of Renal Failure
    • Onset
    • olyguric stage
    • diuretic stage
    • recovery stage
  111. What is the onset stage of renal failure
    • can be 1-7 days
    •   usually 1-3 days
    • creatin & BUN
    • output low or normal
    • no problem if not filtering

    • look at urine-- depends on underlying
    • problem
  112. what is the main goal of the onset stage of renal failure
    reverse-can be reveresed usually w/ acute renal failure
  113. what is the olyguric stage of renal failure
    • lower urine output   <400mL/day
    • elevated BUN, creatinine/K/phosphate
    • decreased-Na/Cal/sodium bicarbinate
    • specific gravitgy



    inability of kidney to concentrate urine-stasis hypervolemic-retain too much fluid/blood will back up
  114. how long does the olyguric stage of kidney failure usually last
    up to 14 days
  115. what is the urine output of the diuretic stage of renal failure
    >400 mL/day can go over 4 L/day
  116. what is happening w/ diuretic stage of renal failure
    • kidneys putting out large volumes ot filtering
    • loosing lots of fluid retaining lots of waste products

    • when get to end of diuretic stage start to excreate BUN, creatnine, K, phosphate
    • retain calcium, sodium bicarbinate

    opposite of oliguric
  117. what happes in recovery stage in renal failure
    • BUN, Creatnine go back to normal
    • lasts 1-12 mo
    • if doesn't fully recover after 12 months is now in chronic RF
  118. Tx of acute RF
    • 1st find cause--may have same/simliar cause as chroic
    • fluid/dietary restrictions
    • prevent further damage may still have residual damage
  119. care for acute RF
    • do BMP
    • replace electrolyes as needed
    • some pt may require dialysis-try to stimulate urinary output-wake up kidney
    • IV fluids,
    • dopamine-to raise renal perfusion diuretics/lasiks-kickstart kidneys
    • --if give diuretics and get nothing kow not working
    • osmotic diuretic
  120. what is choice osmotic diuretic for acute RF

    why
    manitol

    • hypermolarity type
    • hypertonic draws fluid out--hope to wake up kidneys
  121. what should you do for acute RF w/ lower serum glucose

    high serum glucose
    give hypertonic serum glucose

    • give kenselate--,,,,,, laxative
    • --oral or rectal
  122. What is continuous renal replacement therapy
    meds w/dialysis-get rid of waste

    controled removal of waste products

    creat axis fro hemodyalysis
  123. what kind of access (shunts) for hemodialysis can you do
    venus or atrial
  124. what ca hemodyalysis cause in pt w/ cardiac problems
    cardiac arrest
  125. What is done in hemodialysis
    • attach filter to access
    • filters will catch any particles

    this is hard procedure for pt
  126. what is chronic renal failure
    end stage renal disease

    come on gradually
  127. what usually happens when Dx w/ chronic renal failure
    90-95% kidney function lost-- irreversible
  128. causes for chronic renal failure
    • HTN
    • DM
    • glumerulor nephrities
    • can be caused by autoimmune disease
  129. s/s of chronic renal failure
    • azotemia-waste products in blood---can't concentrate urine
    • large amounts of dilute urine
    • acidbase imbalance
    • fluid imbalance
  130. what is dilute urine of chronic renal failure pt
    fluid/ no wate

    eventually go to little/ o urie
  131. what does it mean if chronic renal failure pt excretes dark
    pt i trouble
  132. how is chronic renal failure Dx
    BUN
  133. What is normal BUN level

    What does BUN do
    10-20mg/dL

    estamate of glumarular function
  134. What does it mean when BUN goes to 70mg/DL
    pt need dialysis
  135. labs for chronic renal failure
    high BUN/ Creatinine/ potassium (hyperkatremia)

    low Calcium (hypocalcemia)
  136. What is normal Creatnine level
    0.5-1.5mg/dL
  137. what is the relation to creatnine level and kidney function
    when lvl 2x norm-lost 50% kidney function

    when lvl 10x norm-lost 90% kidey function
  138. what is the best indicator for renal function
    creatnine
  139. what is normal level of potassium
    3.5-4.5mEq
  140. what is the Tx for hyperkalemia
    kestcalate / sodium bicarbinate
  141. what causes hypocalemia
    • decreased enzymes that activate vitD -> lower calcium absorption
    • calcium then pulled from bones to blood and be.....
  142. what is normal calcium levels
    • 9-11 mg/dL
    • 4.5-5.5 mEq/L
  143. what are s/s of hypocalemia
    tetni-irritability, mucsle twitching
  144. Tx for hypocalemia
    • calcium suppliments
    • phosphate binders -given alone
  145. what causes  chronic renal failure fluid imbalance
    • hypernetriemia
    • hypervolemia
  146. what should you watch for w/ fluid imbalance
    • edema
    • look at ankles---usually st noticable area
  147. s/s of chronic renal failure fluid imbalance
    • hypervolemia
    • hypertension
    • CHF
  148. tx of fluid imbalance
    • fluid restrictions
    • diuretics
    • probably dialysis
    • insuline resistance
  149. What fluid inbalance related insuline resistance
    • -high glucose levels (hyperinsulineism)
    • liver stimulated to produce more try glycerines rise LDL-....
    • cause hyperlipidemia
    • arthosclerosis
  150. Chronic RF related anemia
    produces less.... pioten
  151. Tx for chronic RF anemia
    • put on iron supplements or ....
    • put on sialysis may need to be given ....
  152. other areas affected by chronic renal failure
    • skin,
    • urin
    • may get frost in mouth
    • very brittle nails, hair
    • skin turns tan- high lvl of bilirubin
    • high levels of amonia-may have indigestion
    • may have skeletal demineralization
    • emotional
    • reproductive system
  153. what happens in chronic RF if amonia levels too high
    ?
  154. what happens in skeletal demineralization
    loose bone mass/density
  155. how long is the average wait time for a kidney replacement
    3-5 yrs
  156. what do they not do today for chronic RF
    take out diseased kidney
  157. how is the reproductive system affected by chronic RF
    • lower
    • --sex hormones
    • --labido
    • --drive
  158. what is Tx of chronic renal failure based on

    what happens once determined
    • s/s
    • lab results

    will out
  159. what are chronic RF restricted diets based on
    Dx tests & labs
  160. what kind of meds/problems do most chronic RF pt's have
    HTN

    may start off on one med than switch
  161. what do you monitor for w/ chronic RF related HTN

    what may they need
    complications

    IV Budcos --is hypertensve by nature
  162. what do pt w/ chronic renal disease take

    what does this cause them to need
    sodium bicarbinate

    always need gases lab 1st
  163. many ESRD  retain potasium what do you give them
    kexcitale --laxitive
  164. do you monitor for ESRD why
    • Calc levels
    • often low
  165. what is the normal average lab calcium level
    60mg
  166. what labs do you need to cardfully monitor for chronic renal failure

    why
    electrolytes

    want to make sure they...
  167. what if ESRD still urinating
    probably won't be on fluid restrictions
  168. why do ESRD pt get anemia
    • paritially b/c not eatin properly
    • partially b/c pH
  169. what are the advantages of folic acid for ESRD (chronic RF)
    • lower # of transfusions
    • maintain more consistant blood pH levels
  170. What do ESRD need if not filtering
    dialyis
  171. what happens if nonfiltering ESRD don't get dialysis
    • don't wash blood out
    • get horrible dath
  172. how often is dialysis needed

    what type of fluid used
    3-4x/day

    special hypertonic dialysis fluid....
  173. what do RF symptoms start w/

    what does it mean if retaining fluid
    fluid excess in extremeties

    fluid beds not filtering
  174. what do ESRF pts 1st get
    acidosis  -->
  175. what is a problem of hemodialysis w/ cardiac pt's
    very hard on heart

    always have pt well prepared
  176. cardiac s/s for dialysis
    • chest pain
    • cardiac dysrthymia
  177. who orders heperine to lower clots on dialysis
    DR
  178. what are perminant dialysis accesses
    atriovenus shunt-join vain & artery w/tubing
  179. What is a AV fistula?

    what is the perfered site for this
    arm--can use
  180. where shouldn't you take Bp on a dialysis pt
    on the arm w/ the shut
  181. what should you palpate dialysis shunt for

    why
    thrill

    if none =bid trouble
  182. how is the type of dialysis best used for pt decided
    • how active pt is
    • found by asking ?'s
  183. what part of the body is used for parataneal dialysis
    abdomen
  184. how often is parataneal dialysis repeated
    3-4x/wk
  185. when do you chech veuro vasc
    if had surgery or fracture
  186. What is very important in orthopedic assesments
    • color of extremeties, temp
    • neuro vasc if had surgery or fracture
  187. what causes stiffness
    --aquard gait in ortho pt

    what do you do for them
    ortho or other problems

    r/o other problems
  188. what can tell you if pt is in pain
    • difficulty getting up
    • facial expressions
    • guarding

    if have change in facial expressions w/movement=in pain
  189. what is numbness

    what causes it
    perasthesia

    • damage to nerve ending-is ofting reversable
    •   change in sensation
  190. how are orthopedic problems Dx
    • testing
    • xray
    • ct scan
    • MRI
    • arthoscopy
    • look at joint capsel for damage/tear
    • bone density
    • DEXA-
    • bone scan
    • EMG-look at electrical potential of muscle & electric reserve of nerve
  191. what will arthoscopic pt's have
    ace wrap

    sump drain
  192. what do you look at in arthoscopy pt
    • bleeding
    • edema
    • circulation
    • pulse in posteriar tibial

    • may have continuous antibiotic solution
    • --(to keep infection down)

    have them wiggle toes
  193. what kind of procedure is arthoscopic procedure

    why
    strict aseptic

    if you get micro organism in bone-get major infection
  194. what are some major complications of arthoscopic surgery
    • -blood clot
    • fat embolism--common in bone fractures
    • fluid accumulation under surgery site
  195. Bone Bx
    • look for bleeding
    • painful
    • huge risk of infection
  196. what is any surgical pt at high risk for or actually get
    infection
  197. what are some orthopedic labs
  198. blood & urine
    • alk phosphitase-often found in many bone d/o/CA metasis
    • CPK MM-muscle
    • RA factor
  199. what should you be anytime you move ortho pt's
    gentile
  200. what should you be sure to do when lifing or turning pt
    • provent cotractures
    • keep affected extremity in good anatomical position
    • usually have gradual mobilization
    • lots of teaching
  201. complications of lifting & turning
    • contractures
    • loss of movement
    • anbulosis
    • perm ...  of joint
  202. what do you watch for w/ cast or brace
    soft spot discoloration
  203. what shouldn't you do w/ casts
    scratch w/ anything under cast
  204. how should you handle wet casts
    • w/ palm of hand
    • -not fingers until dry
  205. what kind of casts have opening for
    • long/short leg casts
    • bivalve casts
  206. how fast do fiberglass casts usually dry?
    w/in 30 min
  207. what should you check for casts
    • swelling
    • circulation
    • temp
  208. what do braces & splints provide
    suport
  209. are casts usually put on for
    • congenital problems
    • fractures
  210. braces and casts apply removal ease
    easy to apply easy to remove
  211. what does traction do

    what will you have
    pulls to maintain bone alignment/ imobalization (not 100%)

    • weights
    • over bed trapese
    • pullies
  212. what do you need to make sure of w/ weighted traction
    weights are hanging freely
  213. who usually sets up traction
    what does nurse assure of
    pt

    weights are where they need to be
  214. what should you do if traction has pins
    • asses pin sites
    • for infection
    • do site care
  215. where can traction be applied
    • cervical spine
    • extremeties
  216. what does mechanical traction do
    pull on body parts
  217. what do skeletal traction have
    • pin
    • wires
    • ~10lbs
  218. what ca happen if there is too much weight on bone in skel traction
    can pull out of allignment
  219. what do you need to know w/ skeletal traction
    weight of pt to find how much weight to use
  220. what is used for skin traction

    what can you do
    mole skin

    have ace wrap around mole skin
  221. what should be checked w/ any traction / orthopedic pt
    neurovaso

    assess site of fracture
  222. weight for skin traction

    how can it be used
    7-10 lbs

    intermittent or continuous
  223.  Brian's traction info
    • > 20lb pt
    • use body as counter weight
    • treat congenital hip displasia
    • ot often used b/c circulation problems
  224. Bucks traction
    • used to treat some types of fractures
    • skin traction
    • used for hip d/o
    •  --muscle spasms
    •  --contractures
  225. Russel tractio info
    • try to immobalize femur
    • continuous
    • slightly flexed knee
  226. cervical traction info

    --skeletal
     
     --suspention
    • used to treat irritation
    • usually is continuous

    • need to maitain body in very straight allignment
    •   --worry of cerv spine

    • hip/fibula/femer/leg supported
    • imobalize  / splint elevated / supports leg ad
  227. thomas splint info
    padded ring fits around upper leg
  228. Halo traction info
    drill bur hole in skull

    rods go in leather jacket

    don't put pillow behind head-causes rise in pressure-pain
  229. nurse care for splints / brace /cast
    • neurovasc assess
    • look for skin break down
    •    edema
    •    abrasion

    assess pain
  230. to Tx orthopedicpain
    • can lower w/ ice pack
    • intermitent elevation
  231. ROM on affected & unaffected side
    • on affected side--as ordered
    • on unaffected side -- very important
  232. what are the 5 P's of orthopedic care
    • pain
    • palor
    • pulse
    • paralasys
    • paresthesia - sensation
  233. what is compartment syndrome
    • effects extremeties
    • vascular insefficiencies
    • rise in tissue pressure in confined/limited space
  234. main s/s of compartment syndrom
    unrelieved pain

    pain meds don't relieve pain
  235. what Tx for compartment syndrome
    • elevate extremeties-no higher than heart-for tissue perfusion
    • if pt in cast put in whole bivalve cast--allow for swellilng

    if doesn't work doe surgery--ephiotomy
  236. disuse syndrome Tx
    • isonetric exercises are good
    • teach of self care
  237. worry of what w/ disuse syndrome
    insitiions if had incisions

    often go home w/ Q pump
  238. what do you teach about for disuse syndrome
    • swelling
    • to elevate
  239. what assistive divices may be used for disuse syndrome

    what do you need to be careful w/
    • cruches
    • walker

    be careful w/ ambulition
  240. w/ disuse syndromept what shuld you do if they've been in bed for long periods of time
    have them sit up slowly
  241. when is external fixation used
    usually when had fracture-esp bone fracture
  242. what kind of fracture often get external fixation
    • femur
    • long bone
    • humerus
    • compicated fracture
  243. spika cast
  244. what should be checked for external fixation
    circulation Q2-3 h initially then pro protocal
  245. what should you look for w/ any orthopedic device

    assess for
    pressure areas

    • circulatio
    • infectio
  246. what should you teach pt w/ orthopedic device
    • assess circulation/infection
    • keep clean & dry
    • specific site care
  247. how should orthopedic pinheads be cleaned
    • separately
    • one swab per pin
  248. what should be coordinated w/ any ortho pt
    • movement w/ pain meds
    • -be gentile
  249. nurse care for pt w/ traction
    • always check traction
    • -monitor for complicatios
    • assess skin & dressings
    • assure no skin break down

    skin traction can cause nerve damage if not properly applied
  250. what can be damaged/caused w/ traction
    peroneal nerve-->footdrop
  251. what should you do if ortho pt starts complaiing of burning
    • ck area STAT
    • makesure sheets don't impede movement of toes --foot drop
  252. when should cir on skin tractio 1st be checked
    no more than 30 min after initial
  253. how should sheets be changed for pt in traction
    head to toe
  254. what is anyone o prolonged bed rest at higher risk of
    DVT
  255. s/s of DVT
    • lower puls o toe
    • cool if blood flow is lower
    • diameter is higher compared to other side
  256. what should you moitor for w/ pt on bed rest
    complications
  257. what complications can pt imobalized for prolonged amount of time high risk of
    • pneumoina - esp w/ surgery
    • adolexsis
    • skin breakdown
    • muscle loss
    • constipation
    • anorexia
    • UTI
    • venus thrombosis
  258. how many pt w/ orthopedic problems need surgery
    not many
  259. what is ORIF
    open reduction internal fixation--surgery for fracture
  260. what is bone grafting
    • //// may not occur
    • bone need to be taken out--can graft
    • have bone banks
  261. what can bone grafts be used for
    • to pack wouds
    • to lenthen bone
  262. joint replacement
    • almost any bone can eb replaced
    • done for severe joint problems
  263. what are some joint problems joint replacements are used for
    • osteo arthrits
    • joint disease
    • joint degeneration
  264. main reason for joint replacement
    • lower pain
    • improve movement
    • some times used to correct deformaties or malignent
    • if have any type of fracture that impedes circulation
    • avascular necrosis-bone die
    • removal of hard ware--put in screws/pins
  265. what material used for pins/screws
    • metal
    • polyurithane
  266. what does healing time of ortho surgeries depend on
    area of surgery
  267. nurse interventions for ortho surgeries
    • preop
    • -good assessment
    • -lots teaching
    • -pt needs to be stable /cleared prior to surgery
    • always do full syst assesement
    • -assess extremeties for edema
  268. what kind of anesthesia do most ortho pt go under
    general
  269. what to look for /at w/ ortho surgery
    • overal funtion
    • renal/veus syst
    • GI/renal syst affected by anesthetia
    • infection-report STAT
  270. what can happen to ventilated COPD pt
    may not come of vent
  271. what do pt w/ vericose veins have high risk of
    • DVT
    • pulmonary embolism
  272. what happens the longer pt on ortho operating table
    higher risk of blood clots
  273. how log should ortho pt be free of ay s/s of infectio before surgery
    at lest 5wk rior
  274. what happens once infection gets in orthopt
    • long term problem
    • high risk amputatio
  275. when are profolactic antibiotics givin to ortho pt
    • before
    • during
    • after
  276. what is osteomyloitis
    • most severe bone infection
    • gets in bone marrow

    hard to treat
  277. post ortho op care
    • neuro vasc check
    • assess site or profery
    • check drains
  278. w/ ortho surgery drains what should be monitored and documented
    • typ drain
    • amount drainage
    • color
    • location

    empty PRN --docu I/o each drain seperatly
  279. what does post ortho surgery ambulation depend on
    • type of surgery
    • spec weight baring
  280. how are most orthopedic prosthetics put in
    glued in w/ special cement
  281. what will post knee surgery pt be put on

    what should be checked
    CPM machine

    circulation

    ambulation is progressive
  282. total hip replacement
    replace damaged hip w/ artificial joint

    very painful
  283. what d/o can hip replacement be used for
    • wear/ tear
    • disease
    • selment
  284. how long is total hip replacement incision
    from tropnear to mid thigh
  285. what should be checked for hip replacement pt
    • assess circulation distal to insicion
    • monitor for complications
    • worry of thrombosis
  286. what to assess /monitor in total hip replacement
    • circu distat to insicion site
    • monitor for complicatios
    • DVT
    • bleeding
    • worry of thrombosis
  287. what is main problem of total hip replacement
    dislogeing of prosthetic
  288. what needss to be done if hip replacement prosthetic is dislodged
    need to go back in
  289. what to worry about w/ total hip replacement
    infection/ healing pressure
  290. w/ total hip prosthetic what should the leg be kept from doing
    inernally rotatin
  291. what can be used to keep leg from twisting outward w/ t hip replacement
    trocanter roll
  292. what is the #1 consideratin in total hip replacement
    dislocation of prosthesis
  293. in what position do you want hip in hip replacement
    • abduction
    • can use abducter pillow(s)
  294. info for turning hip replacement pt
    • any time turn pt keep pillows in place-
    • -to keep leg from falling down & prosthesis from comming out
  295. what do you want to teach hip replacement pt
    not to flex hip > 90o

    • not to bend at waist
  296. Why is it important to read Dr order for hip replacement
    • Dr make specif orders for positioning/turning
    • Dr will determine if pt can lay on op side

    activity upon Dr order
  297. voiding care for hip replacement pt
    will have elevation over toilet to prevent >90o flextion

    • if need bed pan-fracture pan w/ trapese for pt to hold
    •   --can bend unaffecteed leg to help lift
  298. What do you want to prevent in hip replacement pts'

    what do you want to maintain
    • aduction-bringing legs together
    • rotation

    proper leg alignement
  299. s/s dislodge of hip replacement
    • pain at surg site
    • acute/sudden onset of groin pain
    • afraid to move leg
    • felt pop
    • leg looks shorter

    REPORT STAT
  300. what means if drain doesn't have any drainage and Dr expected drainage
    drain may not be working properly
  301. drain loosing suction ability means

    when do you recharge drain
    prob w/ drain

    when empty
  302. how much drainage should hip replacement drain have 1st 24 hr

    48hr after surgery
    200-500mL

    no more than 30mL per 24hr
  303. what should you do if drainage amount increases
    report to Dr ASAP
  304. assoc complications of hip replacement
    • DVT-calf pain, tenderness, swelling
    •   may start anticoag therapy
    • excess bleeding under skin--s/s hemorrhaging

    may screen for thrombosis w/ doppler if high concern or risk
  305. self care to teach hip replacement pt
    • movement
    • turn abd pillow
    • no flextion
    • not to cross leg-pop out
    • avoid long trips
    • no tub baths-infection
  306. what are total knee replacements for
    • injury
    • degeneration
    • joint disease
    • war tear
    • joint damage
    • pain
  307. musculoskeletal intervention/monitor/asses for
    • bleeding
    • infetion
    • circulation
  308. where important to do ROM for replacement surgeries
    unaffected limb/side
  309. post op for tot knee replace
    • compression bandage
    • may not have drain
  310. post op care for t knee repl
    intermittent ice pack

    • CPM device -check flesion er dr
    •   --faster recovery

    • get pt up ASAP (same/next day)
    • progressive ambulation/mobil per Dr order

    maintain norm neuro vaso
  311. drainage amount for knee replacement drain
    • 200-400mL
    • 48hr after <25ml in 48h
  312. preop knee replacement skin prep
    germisidle solution
  313. important in knee replacement surgery
    protect veins of leg

    • pain management
    •   -elevate lower portion of leg on pillow-help alleviate some discomfort/pain
  314. pain PCA for knee replacement
    • initial epideral or Q pump
    • -have lock out doses
    • -initially start w/ bolus

    docu amount pt had / shift

    • pt can't change setting 
    • -pt supposed to be one to push button

    after get over initial acute pain- move to IM/PO 
  315. Potential complications/worry of w/ knee replacement
    • atelectasis- collapse of lung
    •   -insentive sperometer used for most post op
    • dehydration -should hydrate before surgery

    osteomyolitis
  316. w/o complications how soon do knee replacement pt's go home
    w/in 3-4 mo
  317. what is Duptren's contractor
    • slowly progressive contracture d/o
    • affects palmor fastia
    • flexion of 4th & 5th finger (pinky & ring)
    • --become useless
  318. s/s of Dupuyten's disease
    • in affected fingers
    • -dull aching discomfort
    • -cramps
    • -morning numbness
    • -stiffness
  319. underlying causes of Dupuyten's disease (contracture)
    • arthritis
    • alcoholism
    • autosomal dom trait
    • DM
    • gout
    • cigarette smok
  320. post surgery nurse care of Dupuyten's disease
    • neuro vasc -assess 1st 24hr
    • corticosteroids
    • pain meds-look at effectiveness
    • elevate arm over heart-lower edema
    • give antibiotices-assess post op infection
  321. only Tx for Dupuyten's disease
    • cut tendens to release
    • fasciectomies- release contracture
  322. Gangion cyst

    Tx
    collection of genlatinous material near tendon sheaths near dorsal wrist

    • aspiration
    • corticosteroid injection/surgical excision
  323. Gangion cysts most often affect

    s/s
    women <50yrs

    • locally tender
    • aching pain
  324. post Gangion surg tx
    • compression dressing
    • immobalization splint
  325. Bursitis & tendinitis

    Tx
    inflammatory conditions-often in shoulder

    Bursae-fluid filled sacs-painful when inflamed


    • RICE
    • extracorporeal shcok wave therapy
    • arthroscopic synovectomy-if persists
  326. impingement syndrome

    usual cause
    all lesioins that involve rotator cuff


    • repetitive overhead movement of arm
    • acute trauma
    •   -irritatino -> inflammation of rotator cuff tendons/subacromial bursa
  327. what do stages of chronic kideney disease depend on
    glomerular filtartion rate (GFR)
  328. what ca renal fluid balance defect lead toin elderly
    • constipation
    • falls
    • med toxicity
    • UTI & RespTI
    • delirium
    • seizures
    • electrolyet imbalance hyperthermia
    • delayed wound healing
  329. what labs indicated underlying kidney disease
    • elevated serum creatinine levels
    • decreased erythropoietin-anemia
    • metabolic acidosis
    • fluid retention AEB edema/CHF
  330. Nursing assessment of urinary system
    • Start with history with urinary problem,
    • I&O,
    • bladder palpation,
    • labs (BUN,creatinine),
    • Urine (frequency (diabetes, hypertension),
    • urgency/color/odor/clarity,
    • medication,
    • uremic froth (white froth on skin from uric acid accumulation),
    • V/S,
    • edema, weight, age related changes
  331. what do you check for in urinalysis for urinary d/o
    • ketone,
    • blood,
    • WBC,
    • glucose,
    • protein,
    • color, pH,
    • specific gravity,
    • billirubin,
    • crystal,
    • sediment,
    • culture and sensitivity,
    • creatinine clearance (best test for kidney function).
    • Urine creatinine
    • 24 hr urine collection.
  332. lumbar laminectomy
    remove a small portioin of the bone  to give the nerve root space

    used to alleveiate pain from lumbar stinosis

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