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5 P’s of Neurovascular checks
- Pain: (location, severity)
- Pallor: (paleness, coolness, discolor)
- Paralysis: (deficit in movement, strength)
- Paresthesia: (changes in sensation)
- Pulse: (distal to injury decreased/absent)
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Cast care- pt. teaching
- Instruct importance of reporting any signs of impaired
- circulation
- Teach the 5 P’s
- Teach pt. to wiggle extremities, elevate if s/s of impaired circulation continues call Dr.
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Volkmann’s Contracture
- Due to obstructed arterial blood flow to the end of the forearm and hand
- s/s: pain, inability to straighten fingers, cyanosis,
- swelling
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S/S of peroneal nerve palsy/injury
- Numbness
- Burning in foot
- Foot drop
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Symptom of a fat embolism
- *Cough produces large amounts of thick white sputum
- Chest pain
- Increased heart & respiratory rate
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Symptom of compartment syndrome
*Unrelieved pain following analgesics
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How to prevent dislocation after total hip replacement…
Prevent internal rotation of the affected leg
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RICE tx of sprain/strains
- Rest
- Ice
- Compression
- Elevation
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SE of estrogen for management of osteoporosis (Rx Evista)
- Spotting
- Weight gain
- Increased risk for DVT
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Effect of discontinuing corticosteroids of bone loss
Halts progression of disease but will not restore lost bone
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Osteoarthritis (OA)
- Idiopathic secondary to trauma to joint
- *Non-inflammatory joint disease
- Generally a part of aging
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Manifestations of osteoarthritis
- Pain
- Crepitus (sounds)
- Herberdens Nodes
- Stiffness (most common)
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What will X-rays show with osteoarthritis?
- Joint deformities
- Bone spurs
- Narrowing of joint spaces
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High risk pt.s for Osteomyelitis
- Poorly nourished
- Elderly
- Obese
- Impaired immune systems
- Chronic illnesses
- Long-term corticosteroid tx
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Manifestation of osteomyelitis
Sepsis
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Rheumatoid Arthritis
- Systemic inflammatory disease that affects the synovial lining of joints
- *Inflammation*
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Medications for Rheumatoid Arthritis
- NSAID (ASA can cause tinnitus)
- Prednisone
- Corticosteroid injection into joint
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Manifestation of systemic lupus erythematosis (SLE)
- Red butterfly rash across the cheeks and bridge of the nose
- Early AM joint stiffness
- Malaise & weakness
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What is affected by antigen/antibody complexes associated with SLE
- Blood vessels
- Mucous membranes
- Joints
- Skin
- Kidneys
- Muscles
- Brain
- Heart
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Scleroderma
- Excess collagen causing stiff skin, small blood vesseldamage
- Early symptom is Raynauds phenomenon
- CREST
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CREST associated with scleroderma
- Calcinosis (Ca deposits on skin)
- Raynauds phenomenon
- Esophageal dysfunction (acid reflux & decreased motilityof esophagus)
- Sclerodactyly (thickening/tightening of skin on fingers&hands)
- Telangiectasias (dilation of capillaries causing red markson skin)
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What causes Gout?
Excessive accumulation of Uric acid causing crystal formations
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Test for Gout
- Microscopy of synovial fluid
- Uric acid > 7mg/dL
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Medications used for Gout
- Uricosuric agents (Probenecid)
- Antigout agents (allopurinal) *can cause decreased platelets*
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Decreased WBC indicative of
- Inflammation
- Chronic infection
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Complications from casts
- Impaired circulation (5 Ps)
- Pressure sore
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What exercises can be used to prevent atrophy while on bedrest?
Isometric and ROM exercises
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What is elevated creatine Kinase (CK) indicative of?
- Muscle damage
- Non-specific to which muscle
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Polymyalgia Rheumatica
- Pain in multiple muscles
- Corticosteroids have dramatic decrease in pain & inflammation
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Polymyositis
Multiple muscle inflammation
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Ankylosing Spondylitis
Bent spine
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Sick-day rules related to diabetes mellitus:
- Monitor blood glucose q3-4hrs
- Continue medications as usua
- lDiet of easily digested foods and liquids
- Call provider is blood glucose >300 or unable to retain fluids
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Intervention for chemical burn to eye
Irrigate eye for at least 10 min
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Dumping Syndrome
SE of gastric surgery causing rapid stomach emptying into the duodenum when high carbs and liquids are consumed.
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Nutritional therapy for diverticulitis
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Pt. teaching about ulcerative colitis
- Reduce anxiety
- Teach pt. to about appropriate diet (bland, high protein, vit. & calories, low residue)
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Diet for inflammatory bowel disorders
- Bland
- High protein, vit. & calories
- Low residue
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Clinical manifestation of thyroid storm
- Cardiac dysfunction
- Fever
- Neuro impairment
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Foods that contain iodine
- Seafood
- Iodine salt
- Dairy products
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Pt. teaching about barium swallow
Explain procedure and why it’s performed
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What s/s post cataract surgery need to be reported/why?
- Increase in “floaters”, flashing lights, pain
- s/s of retinal detachment
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Risk r/t Menieres disease
Risk of falls r/t vertigo
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Asthma-
Chronic inflammatory disease of the airways
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Cheyne stokes-
Abnormal pattern of breathing characterized by progressively deeper & faster breathing followed by gradual decrease resulting in temporary stop of breathing
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Types of breath sounds
- Rales- small clicking, bubbling, or rattling
- Rhonchi- resembles snoring
- Stridor- wheeze-like sound
- Wheezing- high-pitched sounds produced by narrow airways
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What causes angina?
Atherosclerosis and increased demand for O2 causing pain from insufficient coronary blood flow
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R-sided heart failure s/s
- Fluid retention
- Jugular distention
- Cyanosis
- Enlarger liver
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How does Basel
cell cancer develop?
Usually extensive exposure to sun
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What labs must be monitored for pt. on Aldactone?
- Diuretic
- Monitor potassium lvls
- Monitor for dehydration (BUN, creatinine, electrolytes)
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