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N103 test 3 (GRCC)
N103 test 3 (GRCC): Activity/Excercise
| Question | Answer |
|---|---|
| Strain | Abnormal muscoskeletal disorder where more force is put on a muscle or tendon and its more than what it can handle; found in low back pain from strain. |
| Contusions | Bleeding into soft tissue resulting from blunt force (i.e. hit with baseball bat, etc) |
| Hematoma | contusion with large amount of bleeding. |
| Tumor-like made of blood | Hematoma |
| Abnormal musculoskeletal disorders | Such disorders have bruises -a big bruise. AKA tumor made of blood |
| Strain | Stretching injury to a muscle or muscle-tendon caused by mechanical overloading. |
| Sprain | Injury to a ligament surrounding a joint |
| Sprain | Overstretch ligaments tear and joint not stable. Common place of sprain is ankle, then the knee. |
| Abnormal musculoskeletal disorders | Contusion, hematoma, strain, sprain. |
| Rest and immobilization, ice for 1st 24 hours | Treatment for abnormal musculoskeletal disorders. |
| Compression dressing, elevate with leg extended. | Treatment for abnormal musculoskeletal disorders. |
| More severe injuries may require PT, surgery | Treatment for abnormal musculoskeletal disorders including torn cartilage, soft tissue injury, ankle ligament torn. |
| R.I.C.E | Rest Immobilization Compression Elevation |
| Rest | Treatment for musculoskeletal disorders (contusion, sprain, strains, & hematoma) |
| Immobilization | Treatment for musculoskeletal disorders (contusion, sprain, strains, & hematoma) |
| Ice and immobilization will help with these | Pulled, overstretched and bleeding within 24 hours |
| Soft tissue injury wrapped in soft wrap or splints depends on extent of injury. | Compression |
| In order to decrease pain and swelling. | Elevate |
| Proper method to elevate legs. | Foot is raised higher than the knee- may need 3 pillows |
| In diagnosing soft tissue injuries, could they be a fracture? | Yes, soft tissue injuries could be a fracture. |
| What medical equipment is used to rule out fractures? | X-Ray |
| What medical equipment is used to determine if there are torn ligaments? | MRI |
| Meds given for abnormal musculoskeletal disorders | Tylenol #3 |
| Is it okay to give NSAIDS within 24 hours of injury? | No. It is preferred to give NSAIDS 24 hours after injury to limit the risk of excess bleeding. |
| Acute Pain | Nursing Diagnosis for abnormal musculoskeletal disorders (Sprain, Strain, Hematoma, Contusion) |
| Impaired physical ability, limited mobility | Nursing Diagnosis for abnormal musculoskeletal disorders (Sprain, Strain, Hematoma, Contusion) |
| Self Care Defecit | Nursing Diagnosis for abnormal musculoskeletal disorders (Sprain, Strain, Hematoma, Contusion) |
| Loss of articulation of bone ends in the joint following sever trauma | Dislocation |
| Dislocation is where a joint comes apart or tears open? T or F | True. |
| Any break in continuity of bone | Fracture |
| Occurs when bone is subjected to more kinetic energy than the bone can absorb | Fractures or dislocations |
| What is the result when bones snap? | Fracture |
| What is the result when joints tear apart? | Dislocation |
| People always know when they have a fracture? T or F | False. People don't always accept that they may have a fracture....they tend to down play the severity (closed fractures) |
| Simple Fracture | AKA Closed fracture. Skin is intact over fracture site and end of bone(s) are not sticking out through skin. |
| Compound Fracture | AKA Open fracture. Sharp edges of bone stick though skin (splint as they lay) usually go to surgery to clean out dirt. |
| Osteomyelitis | Infection of the bone. Ineffective debridement on a compound fracture may cause this. |
| IV antibiotics, debridement, fractures and screws | Typical of surgery on compound fractures. |
| Stable fractures | AKA non-displaced fracture ends of bones are lined up - via cast - and heals and aligns within 6-8 weeks. |
| Unstable fractures | AKA Displaced fractures (bones have moved out of correct alignment due to muscle pull...usually requires surgery. |
| Pt may have is soft Tissue injuries | This manifestation of a fractured bone could tear up arteries, veins, nerves due to fracture. Usually surgery is done. |
| An alteration of circulation, sensation,etc. | Manifestation of a fracture or dislocation. |
| May have obvious deformity or shortening of extremities. | Manifestation of a fracture or dislocation. |
| May have felt cracking or popping sound | Manifestation of a fracture or dislocation. |
| Inflammation lasts 10 to 2 weeks due to bleeding around fracture site. | Phase 1 of fracture/dislocation healing. |
| Blood comes from the fracture site and forms a hematoma around fracture forming a callous | Phase 1 - inflammatory phase (lasts 10 days to 2 weeks) |
| The blood filled callous around fracture site (formed form the blood supply from the bone)eventually fills in with bone and becomes more solid. | Phase II - Repairative phase. |
| Age, condition, type of fracture (i.e. spiral fracture) | Healing of fractures influenced by these. |
| Healing time for arm and feet | 6-8 weeks |
| Healing time for spiral | 10-12 weeks |
| Healing time for hips | 4 months or longer |
| During an emergency care where there is uncontrolled bleeding, search for a sterile cloth to place on bleeding wound. T or F | False. During an emergency, the cloth you use to stop bleeding doesn't have to be sterile as pt will be put on antibiotics. |
| During emergency care, what is the best method to maintain tissue perfusion. | Assess pulse below site of fracture. |
| During emergency care, which methods are best for immobilization? | Elevate if possible, and use splint because it maintains and supports bone by keeping it aligned. |
| History of incident & assessment | Diagnostic tests for fracture and dislocation. |
| Why is it important to know history as part of the diagnostic test for fracture and dislocation. | Knowing history of injury is important because, the biggest injury gets taken care of before small injuries - usually doesn't seem as severe and may not be treated right away. |
| X-Ray of bones | Detects fractures. |
| Additional diagnostic tests for fractures and dislocations | CBC, electrolytes, and may need to order other tests. |
| When diagnosing a fracture or dislocation, what test will be done first, and then what would be done as a follow up as needed? | X ray and then MRI |
| Pain Meds- Narcotics | Given to patient recovering from fracture/dislocation. |
| What do you teach pt if they go home from hospital with narcotics? | Fiber use. |
| Nsaids | These are given to help with inflammation as a result of fractures and dislocation. |
| When does patient get antibiotics? | When a patient has a compound fracture. |
| If patient is admitted to hospital what other drugs are ordered? | Stool softners, etc |
| Where do you check pulse if the knee is dislocated? | Check the pulse below the knee, typically at the ankle. If no pulse, then pt needs surgery. |
| Displaced fractures | Injuries require surgery |
| Soft tissue damage involving nerves | Injury that requires surgery. |
| Blood vessels | Injury that requires surgery |
| ORIF | Open Reduction Internal Fixation |
| Internal fixation | Screw, pins and plates |
| ORIF | Incision to bone and screws, pins, plates used to align bone. |
| straightening or pulling force to maintain or return fracture bones to normal alignment | Traction application. |
| Used to overcome muscle spasms | Traction used for what? |
| Used long enough for callous to form at fractured site. | Traction used for what? |
| The nurse can remove/change traction weights as needed? T or F | False. Never remove or change traction weights as this requires doctors permission. |
| Traction weights | Used to maintain necessary force. |
| Traction is used for? | Fractured hips |
| Straight traction | Applies a pulling force in a straight line to the injured body part. |
| Most common type of straight traction | Bucks traction |
| The pulling force is applied to the skin of the affected leg. | Bucks traction |
| Type of traction that uses more than one force of pull to raise & support the injured extremity off the bed & maintain its alignment. | Balanced suspension traction |
| Balanced suspension traction advantages | Helps increase mobility and makes it easier to change linen and to perform back care. |
| Type of traction where rod is applied directly to the bone. | Skeletal traction |
| Can patient be turned while in tractions | Assess for complications with traction. |
| Increase risk of skin breakdown, especially heel. | Assess for complication with traction. |
| Traction and kidney stones | While in traction, pt is prone to kidney stones due to immobility and decrease need of calcium. Excess calcium is processed by kidney causing stones. |
| Type of traction used for hip fractures until surgery starts | Bucks traction |
| Rigid device applied to immobilize bones and promote healing. | Casting |
| Plaster casts | Comes in rolls and impregnated with plaster of paris. |
| Warmer water causes this type of cast to hardens quick- gives off heat, takes 24-42 hrs to dry. | Plaster cast |
| Type of casting when opened to air start dry immediately smooth with hand & fix rough edges. | Fiberglass cast |
| Which cast is stronger? plaster or fiberglass | Fiberglass |
| Excessive swelling and pressure due to limited space, resulting in decreased circulation to muscles, etc. | Compartment syndrome - complication of casting |
| Complication of casting may result in need of amputation. | Compartment syndrome |
| Aschemia- a complication of casting | No pulse distal to sight where it is occurring; amputation may be needed. |
| When do complication from casting occur? | Complications occur within 48 hours. |
| Sign and symptoms of complications | Increased pain, decreased sensation, loss of movement, decreased distal pulses, cyanosis. |
| Pt arrives in the emergency room and is complaining of pain, decreased sensation, loss of movement in the leg he had casted 48 hours earlier, what do you do? | Check distal pulse & circulation test (cap refill). If decreased pulses & or cap refill is greater than 3 seconds, then contact doc ASAP. Elevate leg. |
| What would be a major symptom of blood flow interruption towards injury after it is casted? | Increased pain distal to injury due to areas not getting blood flow. |
| B-Valving Cast | Cuts cast in half allowing leg to swell. |
| Fasciotomy | Make incision over calf or thigh with a knife blade, where the fascia is cut to relieve tension or pressure- reducing the risk of tissue death. |
| To prevent too much bleeding after performing a faciotomy on a pt's thigh, a nurse will stitch up the incision w/in 5-10 minutes. T or F | False. Despite lots of bleeding, the incision needs to be kept open allowing expansion of muscle as it swells. Eventually will be closed, but no set time limit. |
| Where does a fasciotomy usually take place? | Will be done in bed @ bedside. Eventually stop the bleeding. |
| Fat embolism | Occurs in fractures of long bones, tibias, femur. |
| Yellow part of the bone is made of fat, and when there is a fracture of long bone, tibias, or femurs, then fat molecules get into system. | Fat embolism (FES) |
| Confusion, restlessness, cyanosis, dyspnea, petechia on chest, axila | Signs and symptoms of a fat embolism |
| Neurological dysfunction | Signs and symptoms of fat embolism. |
| FES | Fat embolism syndrome |
| What results from fat embolism syndrome? | ARDS - Acute respiratory distress syndrome - causes pulmonary edema or atelectasis |
| Preventing fat embolism syndrome | How you splint them. Stabilize fracture and monitor pt. Splint as pt lies instead of moving them. |
| Petechia | Little tiny pin point embolism on chest, inside mouth occurs w/in hours to a day or so after surgery. |
| DVT | Blood clot in legs |
| A DVT can break loose can lodge into pulmonary & could lead to what? | Pulmonary embolism |
| What can be done to prevent a DVT? | Early immobilization following fracture and early ambulation. |
| Anticoagulants and Ted hose | Treatment if pt has DVT |
| When is infection most common? | It is most commone with compound (open fracture) that could lead to osteomyelitis |
| osteomyelitis | Chronic bone infection that may never go away. Result from infection from compound fracture. |
| Delay or non-union of a fracture or dislocation | Prolonged healing that last longer than it should or doesn't heal at all. |
| Poor nutrition | Risk Factor that may cause delay or non-union of a fracture/dislocation. |
| Inadequate immobilization or improper alignment of fracture. | Risk Factor that may cause delay or non-union of a fracture/dislocation. |
| Infection | Risk Factor that may cause delay or non-union of a fracture/dislocation. |
| Necrosis- one side of the bone doesn't get enough blood supply - causing dead bone. | Risk Factor that may cause delay or non-union of a fracture/dislocation. |
| Immunosuppressed (i.e. lupus, osteoarthritis) | Risk Factor that may cause delay or non-union of a fracture/dislocation. |
| Age- people don't heal up as fast (i.e. hip is usually replaced) | Risk Factor that may cause delay or non-union of a fracture/dislocation. |
| Severe bone trauma | Risk Factor that may cause delay or non-union of a fracture/dislocation. |
| Pt will be brought back to surgery multiple times. | Treatment for delay or non-union of fracture/dislocation. |
| Surgery to help delayed/non-union fracture | Graph bone onto fractured bone. |
| Electrical stimulation across fracture fragment stimulating then to grow fast. | Treatment for delay or non-union of fracture/dislocation. |
| Debridement | Treatment for delay or non-union of fracture/dislocation. |
| Poorly understood condition where something goes wrong with nerves. | Reflex sympathetic dystrophy |
| Person has persistent pain | Reflex sympathetic dystrophy |
| Hyperastesia result from reflex sympathetic dystrophy | Little touch causes severe pain (i.e. lower extremity wear shoes is too painful) |
| Swelling in extremity - skin color and texture will change. | Reflex sympathetic dystrophy |
| Narcotics don't touch pain. | Reflex sympathetic dystrophy |
| Will try nerve blocks, neurontin, cut nerves | Treatment for reflex sympathetic dystrophy |
| Nursing care management for pain | Always ask pt to describe pain, location, level. It's important to know if it has changed in any way. |
| Instruct pt to rest | Nursing care management for pain |
| Apply to the ice of injury (causes vasoconstriction & decrease swelling) | Nursing care management for pain |
| Maintain compression dressing, such an Ace bandage. | Nursing care management for pain |
| Elevate the extremity 2 inches above the heart. This promotes venous return and decreases swelling. | Nursing care management for pain |
| Teach the acronym RICE to remember acute injury care: rest, ice, compression, elevation. | Nursing care management for pain |
| Apply heat if pain continues over several days. Increases blood flow and venous return, decreasing edema and pain. | Nursing care management for pain |
| Advise to take aspirin or NSAID's on a regular basis. | Nursing care management for pain |
| Instruct to take analgesics to maintain comfort, preventing pain from becoming severe. | Nursing care management for pain |
| Teach correct use of crutches, canes, or slings if prescribed. | Nursing care for impaired physical mobility - ADL impairment. |
| Remind to rest injured extremity. | Nursing care for impaired physical mobility - ADL impairment. |
| Encourage follow-up with primary care provider. | Nursing care for impaired physical mobility - ADL impairment. |
| Check for poor pulses, poor cap refill, numbness and tingling. | Nursing care for impaired tissue perfusion. |
| Nursing care for neurovascular compromise. | Assess if patient has numbness/tingling in extremities or when the wiggle their toes or fingers |
| Nursing care's Assessment of client's response to trauma | Ask how is pt dealing with trauma psychologically? |
| Maintain good bone health by doing weight bearing exercises. | Health promotion techniques/teaching opportunities. |
| Adequate calcium intake from teens, 20's, 30's | Beyond this won't matter much because your body can't absorb calcium efficiently. |
| Acute pain | Nursing diagnosis for fracture or dislocation. |
| Risk for peripheral neurovascular dysfunction - increase numbness, tingling- then notify doctor asap. | Nursing diagnosis for fracture or dislocation. |
| Impaired physical mobility - nursing dx for fracture or dislocation | Crutches require balance and upper strength. Keep in mind, elderly aren't strong and should try walkers or canes. |
| Risk for infection- especially with compound and open fractures, also abrasions, and put in cast (docs tend to splint such injury) | Nursing diagnosis for fracture or dislocation. |
| Risk for disturbed sensory perception : tactile | When you touch cast, you can't feel anything. |
| Cast care: home care- client and family teaching. | Keep cast dry, edges should be smooth. Keeping edges smooth prevents pressure sores, and also ruins clothes. |
| Cast care: home care - client and family teaching. | Odor or drainage from cast required to contact doctor. |
| Following orders re: weight bearing - home care for client and family teaching. | Even if pt is feeling better, no wt bearing cuz doctor said so. |
| Pay attention to doctor orders | with regards to weight bearing, ROM and unaffected joints. |
| Elevation to decrease swelling and pain. | Home care for client and family teaching. |
| Discharge planning - needed equipment, PT | Walkers, social worker contacts, med supply company, walker delivery, wheelchairs. |
| Provide leads on where to get med supplies/equipment if needed. | Discharge planning - needed equipment, PT |
| Amputations; partial or total removal of body part. | resulting from traumatic event or chronic condition. |
| Amputations causes | PVD & trauma |
| Difference between PVD & Trauma | Trauma typical in warzone and PVD is typical in areas like West Michigan. |
| Majority of amputation are due to? | PVD |
| Elderly people don't typically get prothesis? | They don't get prothesis due to medical issues such as right sided weakness. |
| Trauma is major cause of | Upper extremity amputation. |
| PVD & PAD major cause for | lower amputation. |
| Underlying cause of amputations | Interruption in blood flow, frost bite, burns or electrocution. |
| Goals of amputations | Alleviate symptoms R/T chronic infections, chronic pain |
| Maintain healthy tissue (i.e. gangrene limbs need to be taken off, needs to be done above knee) | Goals of amputations |
| Limbs always taken off above the knee? | The knee has poor circulation and incisions will not heal. |
| Increase functional outcome after amputation. | Goals for amputation |
| Site healing for amputations. | Assess stump due to poor circulation |
| Site healing for amputation- prevent infections | Assess dressing in incision every day |
| Amputated limb should not be elevated | With an above the knee amputation cuz stump tends to stick up if left elevated. |
| ROM on stump prevents contractors? T or F | True |
| why would the stump be assessed within first 24 hours after an amputation? | Complication of an Infection |
| What would cause delay healing of amputation? | Complication of an amputation as a related to poor circulation. |
| Pain at bottom of stump | Chronic stump pain is a complication of an amputation. |
| Pain in leg that is not there. | Phantom limb pain is a complication of an amputation |
| Contractures are a complication of amputations. | These are associated with above knee amputation. |
| What needs to be done to decrease the risk of contractures following an amputation? | Pt needs to lie prone, ROM (Hyperextension) in amputated leg. Quadracep excercises to keep stump from stiffening up. |
| Using certain extremeties over and over again causes this type of injury? | Repetitive Use Injury |
| Compression of median nerve in wrist. Over use, tissues swell squeezing median nerve - numbness, tingling sensation, weak hand and hard to manage pain. | Carpal Tunnel Syndrome |
| Pockets of fluid surrounds joint and become inflamed. | Bursitis |
| Bursitis | Most bursas in hips, knees and elbows. |
| Joint tendon, hot, red, swollen at joints or whenever bursa is upon pain with flexion | sx of bursitis |
| Collaborative care r/t repetitive use injuries | Pt wants to be able to increase mobility. |
| Meds used to help with repetitive use injuries | First they will give pt NSAIDS, and then steroid injection of joints. |
| 1st type of treatment for repetitive use injuries. | Will first try to place pt injured area by immobilizing with splint. |
| 2nd type of treatment to try for repetitive use injuries. | If splint doesn't work ,then try alternating heat and ice, and takes 3-4 weeks to recover |
| 3rd type of treatment to try for repetitive use injuries | Surgery where they can do things like remove a bursa. |
| Nursing Care for repetitive injury for acute pain | Encourage use of splint, teach safe application of heat and cold, instruct about using nsaids. |
| Nursing care for repetitive injury for impaired physical mobility. | Refer to PT for appropriate exercises, suggest OT. |
| Recommendation for home care for repetitive use injuries | What can be changed to improve, avoid activity that risk re-injury. |
| Osteoarthritis | Degenerative joint disease and is the most common form of arthritis. |
| Osteoarthritis age related | Common among aging men at 55 years old, and women are 2 x more common to have this. |
| Osteoarthritis risk factors | Age, genetics, fractures, excessive wt (lower extremities), inactivity, strenuous activity, repetitive exercise sports |
| Pathophysiology of osteoarthritis | Cartilage lining the joint disinergrates causes joint pain- body works to destroy |
| Boney overgrowth in joints get bigger (enlarged joints) | Signs and symptoms of osteoarthritis |
| Onset is gradual- slowly progressive- pain stiffness, in one or more joints | Signs and symptoms of osteoarthritis |
| First joints that have been overused, are effected by osteoarthritis, then other joints will eventually follow. | Signs and symptoms of osteoarthritis |
| Immobility causes stiffness when 1st getting up in the am, resulting decrease ROM. Unable to hear creaking, clumsy | Signs and symptoms of osteoarthritis |
| Crepitus | describe the grating, crackling or popping sounds and sensations experienced under the skin and joints. |
| Pt working with doctor, PT, OT to maintain function mobility. | collaborative care for degenerative disorders. |
| Osteophites | Bone spurs develop. |
| pharmocological tx for osteoarthritis 1st method | Stat with tylenol (less side effects, can get over the counter and it is cheaper) |
| pharmocological tx for osteoarthritis 2nd tier method | Give nsaids (person can't be on coumadin)- usually prescription strength works best. |
| pharmocological tx for osteoarthritis 3rd tier method | Steroid injection into joint. Not commonly done due to complications. |
| complication of steroid injections | Will cause premature joint degeneration, and most docs would only prescribe this up to 2 x/year. |
| Lifelong PT (exercise to strengthen muscles around joints, | Conservative tx for degenerative disorders such as Osteoarthritis. |
| Teach stretch exercises and heat applications. | Conservative tx for degenerative disorders such as Osteoarthritis. |
| For particular joints, they may recommend use of ambulation devices (i.e. cane, walker) | Conservative tx for degenerative disorders such as Osteoarthritis. |
| Which side do you teach a pt on how to use a cane? | The unaffected side. |
| When conservative tx for degenerative disorders such as Osteoarthritis doesn't work. | Then patient may try surgery. |
| THA | total hip arthroplasty- total hip replacement with prothesis. |
| TKA or TKR | Total Knee arthroplasty or Total Knee Replacement. |
| Most common replacement? | Knees and hips replacement |
| Most common concern following hip surgery? | Dislocation of joint if there is too much mobility. |
| Knee rehab takes how long? | 6-8weeks |
| Can also replace? | Ankles, elbows and shoulders. |
| Herbal remedies, mega vitamin doses, osteopathic, chiropractor, yoga. | Example of complementary therapies for degenerative disorders such as osteoarthritis. |
| Night shade foods: potatoes, tomatoes, pepper, eggplant and tobacco | Example of complementary therapies for degenerative disorders such as osteoarthritis. |
| Nursing care for degenerative disorders such as osteoarthritis. | Promote comfort |
| What can a nurse do to promote comfort for a pt suffering from osteoarthritis? | Provide warm mattress pad, electric blanket (warmth prevents pain), showers, stretching exercises, ambulation devices, and adaption of lifestyle changes. |
| Nursing diagnosis for degenerative disorders such as osteoarthritis | Chronic pain- on meds get hostile while in hospital cuz nsaids were taken away from the pt. |
| Nursing diagnosis for degenerative disorders such as osteoarthritis | Impaired physical mobility leads to another nursing dx: Self care deficit. |
| 80% adult population suffer from this. | Low Back Pain |
| Muscle strain and tendons of back caused by abnormal stress or overuse. | Main cause for low back pain |
| Abnormal stress or overuse | Doing activity that pt normally doesn't do (i.e. movingboxes) |
| Pulled muscles and herniated disc | abnormal stress that can cause low back pain. |
| Local pain | Pathophys of low backpain |
| overstrain torn fibers | Pathyphys of low back pain |
| irritating nerves | Muscle spasms as a response to limited mobility. |
| DX tests for low back pain | X- rays can't detect soft tissue |
| Meds for low back pain | nsaids are usually given |
| T or F. narcotics are effective medication to give for low back pain? | False. Narcotics give pt false sense of ability. When they have low back pain, they should rest, alternate heat and cold, walk, and see a PT |
| Best position for pt with low back pain. | Pillow underneath knees and elevate head of bed. |
| If pt with low back pain has a saggy bed. | Recommend plywood and place underneath mattress for firm support. |
| Recovery time for low back pain | 2-3 weeks as long as pt follows instructions. |
| Leg muscles get stronger? | They compensate for bad back and leg muscles get stronger than back muscles. |
| Rupture of intervertebral disc c protrusion of nucleus pulposus | Back pain with herniated disc |
| Herniated disc | Hole, tear, rip in the cartilidge surrounding disc. |
| Radiating or ridicular pain cr/t herniated dis | Caused by back injury. |
| Most common sites for back pain | L4-5, L5-S1, C5-6 |
| Pathophys for herniated disc | Protrusion occurs, abrupt herniation or gradual herniation. |
| Protrusion - pathyphy for herniated disc | Gushing out of jelly like sbustance that occurs spontaneously- causing pressure on nerves- caused by microtrauma. |
| Abrupt herniation - pathophys of herniated disc | Intense pain and muscle spasms with radiating pain down leg. |
| Gradual herniation - pathophys of herniated disc | There may be no herniation at all- disinergration causes bones spurs to develop- since this is gradual, expect to see arthritic changes. |
| Re-current episodes of pain in lower back with radiation from butt to leg. | Sx-lumbar pain due to herniated discs |
| Motor defecits, weakness in one leg have sensory defecits | Sx-lumbar pain due to herniated discs |
| Paratesia | Pins and needls sensations. |
| Motor defecits, weakness in one leg have sensory defecits | All pain sensation is in the leg, not the back. |
| Ruptured or Herniated disc | Pulp in center of disc (HNP)gushing out from a spore and through the cartilage. |
| Herniated disc | Material bulges against the outer rings. The bulging may press against one of the nearby nerves passing through the vertebrae |
| Free fragment | Occurs when disk material separtes from and moves outside of the outer rings through a tear. The fragment may irritate a nearby nerve. |
| Sciatica | Occurs when a damaged disk presses on one of the nerves forming the sciatic nerve. |
| t or f. Doctors can ID which disk is involved based on location of back pain? | True. |
| Parasthesias, muscle spasms within cervical | numbness, tingling, and pt can't pick up things. Muscle spasm causes head to be one one side. |
| Pt complains of pain in shoulder, arm and neck | sx of cervical pain. |
| dx lumbar and cervical pain | Xray - ineffective in detecting tissue problems. |
| CT Scan | dx lumbar and cervical pain |
| MRI | Detects soft tissue injury and can see much better than a CT & uses less radiation. |
| Removal metal from body-watch, rings, jewelry, glasses earrings | Requirements before MRI |
| Pt must wear hospital gown cuz it doesn't have metal. | Requirement before MRI |
| Problems with claustrophobia. | Disadvantages with using an MRI |
| Best diagnostic tool but can't be used for everyone | Disadvantages with using an MRI. |
| T or F. An exception can be made for pt who have braces or pacemakers for an MRI> | False. No metal can be present on pt during mri. |
| T or F. Can have an MRI if pt has hip replacement? | True. |
| Length of time an MRI lasts | 30 mmin to 2 hours |
| Pt goes head first into which dx machine? | MRI |
| A disk may be injured by degeneration? | True. it may eventually wear out. |
| What happens to a disk that degenerates? | Become flat that the vertebrae above and below it touch or slip back and forth. |
| What happens when disk wear out? | Abnormal bone growth occurs, bone spurs that can form on the vertebrae and in the foramina, causing narrowing (stenosis) |
| Narrowing | Stenosis. |
| meds to take for herniated disks | Analgesics, nsaids, and muscle relaxants. |
| Analgesics are best to give for patient with herniated disks. | Incision pain. |
| Muscle relaxants | Flexeral, roboxin (methocarbonal), valium (diazepam) |
| Ask pt what they were taking at home for the back pain. | this helps to determine what meds work best and what dosage they were taking. |
| Treatment for herniated disk - conservative approach | Last for 2-6 wks, cuz insurance co doesn't want to pay for surgery, so doc will instruct pt to decrease activity, take meds, apply heat and stretch. |
| Treatment if the conservative approach to fix a herniated disk. | Laminectomy, diskectomy, decompressive laminectomy |
| T or F. Different types of laminectomy effects legnth of hospital stay? | True |
| Fusion | requires pt to wear brace for 3 months at least and is a longer hospital stay. |
| Decompressive laminectomy | Remove pressue on chord removal of arthritic bone spurs. Drain is put in and is removed 2nd day after surgery. Pt is in more pain due to extensiveness of this surgery. |
| Acute pain | Nursing diagnosis for back pain. |
| Chronic pain - osteoarthritis | Nursing diagnosis for back pain. |
| Constipation - Complication from taking narcotics for back pain. | Nursing diagnosis for back pain. |
| Limited mobility - pt shouldn't be bending over and needs help. Leads to another nsg dx. | Nursing diagnosis for back pain and leads to selfcare deficit. |
| Pt has limited mobility and can't take care of themselves. | Nursing dx for pt with back pain. |
| Aloe graft | bone used from bone bank for anterior cervical fusion. |
| auto graft | Bone taken from pt for anterior cervical fusion. |
| What should happen before surgery? | pt should be fitted for brace. |
| What typically happens 2 weeks after back surgery? | Pt pain has decreased and is tired of wearing the brace, and refuses to wear it. 2nd injury may occur. |
| Following surgery, pt refuses to wear back brace against doctors orders, and re-injury occurs requiring 2nd surgery. | Insurance may not pay for the 2nd surgery as the pt went against docs orders and the injury was a direct cause of pts refusal to listen to doc orders. |
Created by:
Wends1984
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