MS 2 Midterm

osteoarthritis RF

• Aging, obesity, female sex

• Diet low in calcium/vit d, longterm steroid/PPI/epilepsy meds

  • Smoking, long term alcohol use, DM, joint injury, joint deformities

OA findings

• Hands, hips, knees, vertebrae

• Progressive degeneration of cartilage, noninflammatory

• Pain improves with rest, hurts when actively using joints 

• Crepitus, excess fluid, gait changes, limited ROM, bony projections, heberdens/bouchards nodes (knuckle deformities)

OA tx

• Tylenol is drug of choice

  • Make sure not taking other meds that have tylenol in them, dont exceed max dose

• NSAIDs/opioids- use if we have to

• Heat for joint tenderness, cold for inflammation

• Acupuncture, massage, tai chi, dietary supplements

• Low impact activity

osteoporosis causes

• Primary- genetic or environmental factors 

• Secondary- medical conditions or chronic medication use

• Decrease in estrogen that maintains bone density

  • overuse of steroids/PPI/levothyroxine

  • low calcium

osteoporosis rf

• Alcohol use, smoking, female, low body weight, corticosteroid use, low estrogen, sedentary lifestyle, RA, CKD, some PPIs, older age >65, postmenopausal, caffeine

osteoporosis prevention

• Weight bearing exercise

• Calcium 1,000-1,200 mg/day, calcium carbonate with meals, citrate w or w/o food, vitamin D 600-800 IU/day

• No smoking, limit alcohol, reduce fall hazards

• bisphosphonates

  • 
    

high calcium foods

• -dairy products, green leafy veggies (kale/spinach), fortified orange juice, fortified foods like rice/white beans, canned fish with bones

low back pain- pain reduction

• Ergonomics, correct posture, avoid prolonged sitting/standing, healthy weight, strong core, supportive shoes

• Stretch, NSAIDs, no smoking, heat or ice, firm mattress, williams back pain exercises, mckenzie protocol

• NSAID, mild opioids, narcotics, muscle relaxants, topical pain relievers, corticosteroids, anticonvulsants, antidepressants

• Spinal manipulation, acupuncture, tai chi, yoga, progressive muscle relaxation

• TENS

  • laminectomy

exercise recommended for LBP

routine, good posture, stretch, low impact (walking/swimming)

total hip pre op

• Complete blood count (CBC), urinalysis, electrolytes, blood urea nitrogen (BUN), and creatinine: Assess surgical readiness, and rule out anemia, infection, or organ failure. Epoetin alfa can be prescribed several weeks preoperatively to increase hemoglobin (Hgb) for a client who has mild anemia.

total hip post op precautions

• Weight bearing status depending on provider, assistive devices/raised toilet seats, don't cross legs, avoiding flexion >90 degrees, no internal rotation, anticoags, early mobility, SCDs

total hip post op complications

• DVT/PE, joint dislocation, infection, anemia, neurovascular compromise

manifestations of open fractures/complications

• Pain at site, swelling, tenderness, bruising, shortening of limb, deformity, displacement

• Open is surgical, use pins 

• Risk of infection with the pins, pressure ulcers, atelectasis 

priority action following fiberglass cast application

• Dont get wet, dont stick stuff in cast, elevate above heart level 24-72hr, wiggle fingers/toes

  • Increase pain/tightness, numbness/tingling, pale/cool/blue, drainage, cracked cast

• Cap refill, temp

• Checking for tightness and (pulselessness, pallor, paresthesia, pain, paralysis)- compartment syndrome 

recognizing fracture complications

• Compartment syndrome: 

  • high pain levels, not relieved with opioids, pain with passive stretch, tense, firm compartment, paresthesia

  • Pallor, pulseless, paralysis, pain, paresthesia

  • Keep limb at heart level, no elevation, no ice, take off cast, prepare for fasciotomy 

• Hypovolemic shock- pelvic/femur fractures

• DVT/PE- early mobility compression, anticoags

• Delayed union, nonunion, malunion

• Avascular necrosis

• Complex regional pain syndrome- burning pain, swelling, color/temp change

  • DIC

traction weights

• Reduce muscle spasm, reduce/align/immobilize fractures, reduce deformity, increase space between surfaces

• Skeletal traction is continuous

• Weight hangs freely, ropes in pulley tracks

• Check for color, sensation, motion, temp, cap refill 

• Check skin under straps/boots or pin sites

• DVT signs, lung sounds, bowel pattern

• Assistive devices

  • fluids/fiber, incentive spirometry 

different fracture types… open/compound, closed, complete, stress, impacted, compression, pathological, greenstick

• Open/compound- disrupts skin integrity→ open wound

• Closed- doesn’t break through the skin

• Complete- goes through the entire bone, dividing into 2 distinct parts

• Stress- from athletic activities

• Impacted- fractured bone wedged inside an other bone fragment

• Compression- older adults, loading force presses on bone

• Pathological- bone weakENED from disease

  • Greenstick-usually w kids

fat embolism

• Usually happens with big bone breaks, fat globules from bone marrow enter the circulation and lodge in the pulmonary or cardiovascular 

• 24-72hrs after fracture

• Most common in young adult males

• Respiratory distress, decreases o2/tachy; confusion, restless, decreased LOC; petechiae on chest, axillae, conjunctivae (triad)

• To prevent- early mobilization and surgical fixation

  • Tx: 02, supportive care, rapid response  

[pain reduction fibromyalgia

• Meds: SSRIs/SNRIs- to help regulate the mental aspects of it

• NSAIDS for pain and inflammation 

• PT recommended 

• Limit caffeine, alcohol, other substances that impact sleep

• Sleep routine

• Regular low impact exercises- walking, swimming

  • CAT therapy- acupuncture, tai chi, hypnosis 

gout dietary recommendations

• Low purine diet- no organ meats or shellfish

• Limit alcohol, aspirin, diuretics

• Increase fluids

  • No starvation diets, stress reduction

cushings sx

• Moon face, purple striae, buffalo hump, alopecia or hirsutism

hypothyroidism labs

t3/t4 down, TSH up

nursing care Addisons crisis

• IV fluids and corticosteroids, treat hyperkalemia, monitor VS/electrolytes, vasopressors to increase bp, prevent circulatory shock, treat underlying cause (infection/trauma)

• Monitor for shock- decreased loc/ uo <30ml/hr

  • Monitor for dysrhythmias, quiet environment 

DI expected findings

• Excessive voiding, 5-15 L/day, specific gravity < 1.015, polydipsia, dehydration, very dilute, low ph/osmolality of urine, urine sodium/potassium decrease

  • Blood becomes more concentrated (osmolality goes up)

acromegaly sx

• Coarse facial features, enlarged distal extremities, hepatomegaly, loss of color discrimination

metabolic acidosis, expected labs/causes

• DKA, starvation, lactic acidosis, ethyl/methyl alcohol poisoning, asprin poisoning, ESRD, pancreatitis, diarrhea, hyperkalemia

• pH <7.35, CO2 >/= 35-45, HCO3 <22

  • Chronic kidney disease is metabolic acidosis

resp acidosis labs

• pH <7.35, CO2 >45, HCO3 </= 22-26

resp alkalosis labs

• pH >7.45, CO2 <35

• HIV/AIDS complications

• Thrush: can progress to esophagus/stomach

•  herpes, tb, pneumonia, 

• kaposi sarcoma: cutaneous lesions but may involve multiple organ systems, lesions cause discomfort, ulceration, potential for infection

• HIV encephalopathy: progressive cognitive, behavioural and motor decline

• Cryptococcus neoformans: meningitis

• Progressive multifocal leukoencephalopathy (PML)

• wasting syndrome: 10% weight loss, chronic diarrhea, weakness, fever, protein malnutrition

• Pneumocystic carinii pneumonia (PCP): most common life threatening infection, only occurs in severely immunosuppressed pts, non productive cough, fever, chills, dyspnea, must be dealt with quickly or can cause death 

  • Mycobacterium avium complex (MAC)- CD4 <100

thyroidectomy precautions Airway obstruction

• Airway obstruction

  • Hypocalcemia- tingling around mouth

hypoparathyroid findings

• Muscle spasms, tremors, tetany, positive chevosteks/trousseaus

• Hair loss brittle nails scaly skin

  • Abd cramps, dysrhythmias, numbness and tingling, irritability, psychoses

dka tx manifestations

• Blood glucose above 250mg/dl, ketones and glucose in urine

• Polyphagia, polydipsia, polyuria, weight loss, fruity breath, kussmul respirations, dry, warm, n/v

  • Insulin and NS, monitor electrolytes

hypoglycemia sx

• Shakiness, anxiety, chills, diaphoresis, hunger, nausea, low energy, fatigue, confusion, dizzy, headache, vision problems

• Tx: 15g of fast acting carbs and recheck bs in 15 min

  • administer IV, SQ, IM glucagon if cant take by mouth

SIADH causes

• Meningitis, malignant tumors, pulmonary disorders, increased intrathoracic pressure, genetics, head injury, hemorrhage, infection, mental illness, surgery, hormone imbalance, certain medications

  • Excessive secretion of ADH

SLE manifestations

• Butterfly rash, weight loss, fatigue, arthritis, fevers, emotional lability, anemia, neurologic disorders, Raynaud's and Sjogren's, malaise, blurred vision, joint pain

• Rash to areas exposed to sunlight, photosensitivity

• Kidney dysfunction → blood or protein in urine

  • Pericarditis, pleural effusion

late signs RA

joint deformities

manifestations delayed hypersensitivity reactions

• Happens 1-3 days after 

• Redness, swelling, itchy, rash