Term
| largest organ in the body |
|
Definition
|
|
Term
| what is the integumentary system composed of? |
|
Definition
| skin, hair, nails, and glands |
|
|
Term
| what are the 3 layers of the integumentary? |
|
Definition
epidermis
dermis
subcutaneous tissue |
|
|
Term
| the thinner, avascular layer of skin that "sheds" |
|
Definition
|
|
Term
| the thicker, vascular layer of the skin with vessels, nerves, and hair bulbs |
|
Definition
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|
Term
| layer of skin that connects the dermal layer to the deeper tissues such as the fascia, muscle and bone |
|
Definition
|
|
Term
|
Definition
1. protection: from invasion of microbes
2. sensation: through efferent and afferent nerves in dermis
3. thermoregulation
4. blood pressure control: vasodilation and constriction
5. secretion of sebum and sweat
6. excretion of water
7. vitamin D activation
8. body image |
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Term
|
Definition
|
|
Term
|
Definition
| temperature above 100.5-101 |
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|
Term
| aging change in the integumentary system |
|
Definition
DECREASE
-decrease in sub Q fat and muscle laxity
-decrease in extracellular water and surface lipids
-decrease proliferative capacity of cells
-decrease blood flow
-decreased immunocompetence
INCREASE
-elastic fiber degeneration
-collagen stiffening
-increased turgor
-sagging tissue
-increase capillary fragility/ permeability: easily bruise
-increase melanocytes: senile lentigines |
|
|
Term
| excessive redness in the skin could be due to |
|
Definition
| carbon monoxide poisoning |
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|
Term
| excessive blue pigmentation of the skin could be |
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Definition
|
|
Term
| excessive yellow pigmentation of the skin could be |
|
Definition
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|
Term
| excessive black pigmentation of the skin could be |
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Definition
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Term
|
Definition
|
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Term
|
Definition
| the bruising disperses, the blood is within the vessels |
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Term
|
Definition
| hematoma; the bleeding is within the tissues |
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Term
| good hair distribution and no alopecia indicates |
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Definition
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|
Term
| circumscribed, flat area with a change in skin color, less than 1 cm in diameter such as freckles, petechiae, measles, and a flat mole or nevus |
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Definition
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|
Term
| a freckle is an example of a |
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Definition
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Term
|
Definition
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Term
|
Definition
| a flat mole; is an example of a macule |
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Term
| elevated, solid lesion, less than 1 cm in diameter such as a wart (verruca), elevated moles |
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Definition
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Term
|
Definition
| is a wart and is an example of a papule |
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Term
| an elevated mole is an example of a |
|
Definition
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|
Term
| a wart is an example of a |
|
Definition
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Term
| circumscribed, superficial collection of serous fluid, less than 1 cm in diameter such as varicella (chickenpox), herpes zoster (shingles), second degree burn |
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Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| chicken pox and shingles are examples of what type of skin lesion? |
|
Definition
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|
Term
| circumscribed, elevated superficial solid lesion, greater than 1 cm such as psoriasis, seborrheic and active keratoses |
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Definition
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|
Term
| psoriasis produces lesions that are examples of |
|
Definition
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|
Term
| firm, edematous, irregularly shaped are, diameter varies such as an insect bite and urticaria |
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Definition
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|
Term
| an insect bite and uritcaria are examples of what type of lesion? |
|
Definition
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|
Term
| the only skin lesion that varies in size |
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Definition
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|
Term
| elevated, superficial lesion filled with purulent fluid such as acne and impetigo |
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Definition
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|
Term
| acne and impetigo are examples of what type of skin lesion? |
|
Definition
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|
Term
| a linear crack or break from the epidermis to the dermis, dry or moist such as athletes foot or cracks at the corner of the mouth |
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Definition
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|
Term
| athlete's foot is an example of what type of lesion? |
|
Definition
|
|
Term
| excess, dead epidermal cells produced by abnormal keratinization and shedding such as in flaking of the skin after drug reaction or scarlet fever |
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Definition
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|
Term
| abnormal formation of connective tissue that replaces normal skin such as a surgical incision or healed wound |
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Definition
|
|
Term
| excess collagen formation in a healed wound that has a "shiny" appearance is a |
|
Definition
|
|
Term
| is a keloid normal? painful? who does it occur mostly in? |
|
Definition
it is abnormal
is can be painful
occurs mostly in darker skinned individuals |
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|
Term
| assessment inspection of a wound |
|
Definition
-size with paper ruler
-depth with sterile Q-tip
-color
-edema or erythema
-drainage
-pain |
|
|
Term
| terms used for describing wound drainage |
|
Definition
serous
sanguineous
serosanguineous
purulent |
|
|
Term
|
Definition
| clear to yellowish drainage or serum blood plasma |
|
|
Term
|
Definition
| blood, red, thick, and viscuous |
|
|
Term
|
Definition
| mix b/t serous and sanguineous, so appears pick |
|
|
Term
|
Definition
| pus, creamy, yellow drainage |
|
|
Term
|
Definition
-sclera and conjunctiva
-nail beds
-palms and soles
-lips and mucous membranes
-keloids are more likely |
|
|
Term
| palpation of the skin reveals: |
|
Definition
-temperature
-turgor (should be resilent, 2-3 sec)
-tenting is seen in elderly and dehydrated patient
-moisture and texture |
|
|
Term
|
Definition
|
|
Term
|
Definition
-skin exposure
-poor nutrition and dehydration
-medications
-co-morbidities
-poor rest and sleep habits
-tobacco and ETOH abuse
-trauma
-poor or excessive hygiene |
|
|
Term
medication stressors to the integumentary:
anticancer |
|
Definition
|
|
Term
medication stressors to the integumentary:
antidepressants |
|
Definition
|
|
Term
medication stressors to the integumentary:
antiarrythmics |
|
Definition
|
|
Term
medication stressors to the integumentary:
antihistamines |
|
Definition
|
|
Term
medication stressors to the integumentary:
antimicrobials |
|
Definition
tetracycline
cipro
zithromax |
|
|
Term
medication stressors to the integumentary:
diuretics |
|
Definition
HCTZ (hydrochlorothiazide)
lasix |
|
|
Term
medication stressors to the integumentary:
hypoglycemics |
|
Definition
orinase
glucotrol
diabinese |
|
|
Term
medication stressors to the integumentary:
NSAIDs |
|
Definition
|
|
Term
co-morbidity stressors to the integumentary:
DM |
|
Definition
| causes microvasculature changes which decreases oxygenation, perfusion, and increases healing time |
|
|
Term
co-morbidity stressors to the integumentary:
cystic fibrosis |
|
Definition
| thickening of the fingernails (clubbing) |
|
|
Term
|
Definition
| thickening of the pulmonary tissue |
|
|
Term
co-morbidity stressors to the integumentary:
peripheral vascular disease (PVD) |
|
Definition
| change in pigment, darkening of distal areas |
|
|
Term
co-morbidity stressors to the integumentary:
liver disease/ cirrhosis |
|
Definition
| jaundice of sclera and skin due to buildup of bilirubin |
|
|
Term
co-morbidity stressors to the integumentary:
Crohn's disease/ ulcerative colitis |
|
Definition
| can develop ulcers from mouth to rectum |
|
|
Term
| Crohn's disease/ ulcerative colitis |
|
Definition
| autoimmune GI disorders. patients can develop ulcers from mouth to rectum |
|
|
Term
co-morbidity stressors to the integumentary:
Cushing's syndrome |
|
Definition
|
|
Term
|
Definition
|
|
Term
co-morbidity stressors to the integumentary:
scleroderma |
|
Definition
| collagen disorder; stiffening of the collagen looks like they have had 5 face lifts because their face is pulled so tight. fingers may become contracted |
|
|
Term
|
Definition
stiffening of the collagen
is autoimmune and is progressively fatal |
|
|
Term
co-morbidity stressors to the integumentary:
lymphoma |
|
Definition
|
|
Term
co-morbidity stressors to the integumentary:
hyperthyroidism |
|
Definition
| weight loss, thinner, intolerant to heat, more sweating, more metabolism |
|
|
Term
co-morbidity stressors to the integumentary:
hypothyroidism |
|
Definition
| heavier, gain weight, intolerant to cold, hair loss |
|
|
Term
|
Definition
|
|
Term
co-morbidity stressors to the integumentary:
lupus |
|
Definition
| butterfly rash on the face |
|
|
Term
|
Definition
| abnormal connection between 2 closed systems |
|
|
Term
| loss of epidermis with exposure of dermis, abrasion or scratch |
|
Definition
|
|
Term
| depression of skin, thinning of epidermis and dermis as in aged skin |
|
Definition
|
|
Term
| crater like irregular shape, loss of epidermis and dermis as in a cold sore |
|
Definition
|
|
Term
|
Definition
red
sloughing
beginning stages of a wound |
|
|
Term
| your patient has a reddened wound that you believe is superficial. what should you do? |
|
Definition
| apply skin protectant such as the proshield to prevent further breakdown |
|
|
Term
|
Definition
| includes epidermis and dermis |
|
|
Term
| describe what you would see in a partial thickness wound |
|
Definition
|
|
Term
| a partial thickness wound would need a |
|
Definition
| dressing change and to be covered to avoid infection |
|
|
Term
|
Definition
| down into muscle and bone |
|
|
Term
| a full thickness wound requires |
|
Definition
|
|
Term
|
Definition
| healthy tissue, good perfusion and oxygenation |
|
|
Term
| what type of dressing would you want for a red wound? |
|
Definition
wet to moist dressing NOT wet to dry.
wet gauze with normal saline before pulling it off to avoid debriding |
|
|
Term
|
Definition
| infection and purulent drainage |
|
|
Term
| how to dress a yellow wound |
|
Definition
| wet to dry to debride infectious tissues |
|
|
Term
| when dealing with dressing changes for a yellow wound, keep in mind that it may be |
|
Definition
| painful for the patient. you may need to give pain medication before doing the dressing change |
|
|
Term
| debriding agents for a yellow wound |
|
Definition
surgical
whirpool
medications
dressing changes (wet to dry) |
|
|
Term
|
Definition
| necrotic tissue, eschar, must be surgically debrided |
|
|
Term
| will medication or wet to dry dressings debride a black wound? |
|
Definition
| no, only surgical debridment would be effective |
|
|
Term
| necrotic tissues that deepens further into tissues can lead to |
|
Definition
| osteomyelitis which can lead to amputations |
|
|
Term
|
Definition
|
|
Term
|
Definition
a stage in the wound healing process where there is same type cell replacement, it is rapid, no scars.
can occur in labile cells:
skin
lymphoid organs
bone marrow
GI mucous membrane
urinary tract
reproductive |
|
|
Term
|
Definition
| is a more complex process where cells are replaced with connective tissue (scar formation). occurs in 3 phases: primary, secondary, tertiary |
|
|
Term
|
Definition
-takes 3-5 days (about 1 week)
-blood clots are formed
-inflammation reaction
-fibrin clot
-capillary growth and epithelial cell migration |
|
|
Term
| phase 2 of the wound healing process |
|
Definition
granulation
-takes about 5 days to 1 month
-fibroblast migration/ collagen secretion
-is pink and vascular
-fragile
-risk for dehiscence |
|
|
Term
| phase 3 of the wound healing process |
|
Definition
scar contracture
-can take 7 days to months
-collagen remodeling
-scar strengthening |
|
|
Term
| best prognosis for wound healing |
|
Definition
| wound healing by primary intention |
|
|
Term
| primary intention wound healing |
|
Definition
-surgeon makes an incision and closes with sutures, staples, or glue
-best prognosis
-no infection/dehiscence
-thin scar
-cover with a dry dressing
-no complications |
|
|
Term
| what type of dressing do you want to use for a primary intention wound? |
|
Definition
| a dry dressing to keep the wound completely covered to absorb any post-op bleeding. the dressing is usually removed after 24-48 hours to allow the wound to air dry and heal |
|
|
Term
| secondary intention wound healing |
|
Definition
-has lost incision edges and is not well approximated
-tissue is lost
-there is an open wound that now must be healed on its own from the inside out and bottom to up.
-there will NOT be manual closure with sutures or staples |
|
|
Term
| what are the different ways a wound can heal? |
|
Definition
primary intention
secondary intention
tertiary intention |
|
|
Term
| what type of dressing is used for a wound healing by secondary intention? |
|
Definition
| wet to moist OR wet to dry depending on if it a red or yellow wound |
|
|
Term
| wound healing by tertiary intention |
|
Definition
| -wounds that are surgically closed at a later date |
|
|
Term
|
Definition
-nutrition deficiencies: diet, hydration, minerals, vitamins
-inadequate blood supply: poor perfusion and oxygenation: hypo/hypervolemia, DM, PVD, arterial insufficiency
-medications: such as steroids
-infections: can turn a wound healing by primary intention into a secondary intention
-obesity: pulling forces on wound
-DM
-anemia
-mechanical friction
-advanced age |
|
|
Term
|
Definition
-hypertrophic scars/keloids
-contracture
-adhesion: thickening or scar formation within GI tract in the mucus membranes, causing inflammation and narrowing of the lumen of the GI tract
-dehiscence
-evisceration
-infection
-fissure
-fistula |
|
|
Term
|
Definition
| can occur with wounds that are near a joint area and if there is not continuous ROM exercises performed; causes joint to become immobile or contracted causing a loss in ROM |
|
|
Term
|
Definition
| thickening or scar formation within GI tract in the mucus membranes, causing inflammation and narrowing of the lumen of the GI tract. causes N/V/D. may have to be surgically repaired |
|
|
Term
|
Definition
| crack from the epidermis to the dermis usually secondary to dry skin like in athletes foot |
|
|
Term
| abnormal connection between 2 closed systems like the vagina and the rectum |
|
Definition
|
|
Term
| does a fistula require surgical intervention? |
|
Definition
|
|
Term
| what usually causes a fistula? |
|
Definition
|
|
Term
|
Definition
| separation of a well approximated wound, wound will be healing by secondary intention |
|
|
Term
| how would a wound that has dehisced be healing after the fact? |
|
Definition
| secondary intention, healing from the inside out and from bottom to top |
|
|
Term
| nursing interventions for dehiscence |
|
Definition
cover wound with a sterile dressing to prevent infection
-lie patient back in reclining patient to remove pressure off wound
-call MD |
|
|
Term
|
Definition
| occurs on the abdominal wall and is a full thickness wound causing the bowels to be exposed |
|
|
Term
| nursing interventions for evisceration |
|
Definition
| cover patient with moist sterile dressing, recline patient, notify MD STAT!!!!!!!!!!!!!!!!!!!!! and prepare patient for OR ASAP |
|
|
Term
| what type of infections do those involving antibiotic resistant organisms tend to be? |
|
Definition
| nosocomial rather than community acquired |
|
|
Term
| causes of antibiotic resistant organisms |
|
Definition
inappropriate antibiotic use
poor hand washing and the spread |
|
|
Term
| list some antibiotic resistant organisms |
|
Definition
-MRSA: methicillin resistant staphylcoccus aureus
-VRE: vancomyocin resistant enterococci
-PRSP: penicillin resistant streptococcus pneumonia |
|
|
Term
|
Definition
-is methicillin resistant staphylcoccus aureus
-requires contact precautions: hand washing, gown, and gloves regardless
-common in skin wounds
-contact precautions are to protect immunocompromised patients |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
-vancomyocin resistant enterococci
-contact precautions |
|
|
Term
| PRSP is what type of infection? |
|
Definition
|
|
Term
|
Definition
-penicillin resistant streptococcus pneumonia
-droplet precautions |
|
|
Term
|
Definition
|
|
Term
|
Definition
-wash hands
-wear mask before entering and at room entrance and discard prior to leaving |
|
|
Term
what type of cultures would you need for:
-MRSA
-VRE
-PRSP |
|
Definition
-MRSA: wound cultures
-VRE: stool cultures
-PRSP: sputum cultures |
|
|
Term
| nursing interventions for treatment of a antibiotic resistant organism |
|
Definition
1. administer sensitive antibiotics
2. monitor C&S results
3. apply appropriate dressings on wounds
4. use right isolation
5. prevent/education
6. wash hands |
|
|
Term
diagnostic test: biopsy
purpose: |
|
Definition
|
|
Term
diagnostic test: patch testing
purpose: |
|
Definition
|
|
Term
diagnostic test: wood's lamp
purpose: |
|
Definition
| tell if patient has a fungal infection |
|
|
Term
diagnostic test: mineral oil studies
purpose: |
|
Definition
| test for infestations such as scabies or lice |
|
|
Term
diagnostic test: KOH
purpose: |
|
Definition
| potassium hydroxide; tells if has a fungal infection |
|
|
Term
| what 3 diagnostic tests can tell if patient has a fungal infection? |
|
Definition
| wood's lamp, KOH, and C&S |
|
|
Term
|
Definition
| -inflammatory process involving both the epidermis and dermis |
|
|
Term
|
Definition
|
|
Term
|
Definition
-inflammation of the skin secondary to contact with an irritant
-delayed skin reaction leading to hypersensitivity
-erythema, swelling, papules, vesicles |
|
|
Term
| common irritants that cause contact dermatitis |
|
Definition
-poison ivy
-rubber
-nickel
-chemicals |
|
|
Term
| when does the substance that caused contact dermatitis cause a reaction |
|
Definition
| upon exposure and the it becomes antigenic and then the body develops antibodies |
|
|
Term
| is contact dermatitis itchy or painful? |
|
Definition
|
|
Term
| management of contact dermatitis |
|
Definition
-ID irritant and avoid contact
-meds
-lubricate skin to prevent fissures and cracking
-cool moist compresses and cool baths
-prevent secondary infection and heal without delay |
|
|
Term
| medications for contact dermatitis |
|
Definition
-antihistamines: benedryl, claritin, clarinex, allegra and zyrtec to prevent histamine from the site to eliminate itching
-topic corticosteroids- apply in a thin layer directly on site |
|
|
Term
| why should corticosteroids only be used short term? |
|
Definition
| when used long term can cause atrophy |
|
|
Term
| atopic dermatitis is also called |
|
Definition
|
|
Term
|
Definition
-also called eczema
-genetic link
-etiology unknown
-often seen in infancy
-commonly seen with allergies |
|
|
Term
| contributing factors to the severity of atopic dermatitis |
|
Definition
-increased water contact (very drying)
-decreased itch threshold
-stress |
|
|
Term
| exacerbating factors to atopic dermatitis |
|
Definition
-extreme temperautre and humidity changes
-exercise: increases body temp
-stress
-fibers that are irritating: wool, furs, nylon
-detergents, perfume, dyes, lotions |
|
|
Term
| what type of clothing would you encourage your patient with atopic dermatitis to wear? |
|
Definition
|
|
Term
| management of atopic dermatitis |
|
Definition
1. identify and eliminate irritant
2. keep skin moist
3. meds
4. phototherapy: controlled sunlight therapy by a in house lamp
5. cool moist compresses/baths
6. prevent secondary infection |
|
|
Term
| meds for atopic dermatitis |
|
Definition
1. antihistamines
2. systemic or topical steroids |
|
|
Term
| phototherapy and nursing considerations |
|
Definition
controlled sunlight therapy by an in house lamp, is not tanning.
considerations: it is immunosuppresive |
|
|
Term
| why are cool moist compresses helpful in dermatitis? |
|
Definition
| they cause vasoconstriction to decrease swelling, prevent more histamine from reaching site and decrease itching to prevent secondary infection |
|
|
Term
| patient education for eczema or atopic dermatitis |
|
Definition
1. bathe 1x a day
2. not a long shower or bathe to prevent drying to the skin
3. use NON-drying soaps such as dove, cetaphil, and aveeno
4. pat skin dry
5. apply emolient or moisturizer when the skin is moist to increase absorption
6. avoid extreme temps
7. non-irritating clothing such as cotton
8. avoid certain food products that are triggers |
|
|
Term
|
Definition
-inflammation of the skin that is secondary to the stasis of blood flow
-acute inflammation
-often in lower legs with edema
-red or brown due to stasis of blood
-possible exudative as skin begins to crack leading to infections
-high risk for 2nd infection
-common in older adults |
|
|
Term
| management of stasis dermatitis |
|
Definition
-increase blood flow
-elevate dependent extremities
-compression stockings and TEDS
-wet dressing if weeping
-topical corticosteroids |
|
|
Term
| meds for stasis dermatitis |
|
Definition
|
|
Term
| what type of dressing should be used for stasis dermatitis? |
|
Definition
|
|
Term
|
Definition
| an infection of the epidermis, dermis, and subQ from entrance of bacteria into the skin and requires antibiotics |
|
|
Term
| cellulitis usually follows |
|
Definition
| skin trauma or opening of the skin |
|
|
Term
| common bacteria that cause cellulitis |
|
Definition
| staph aureus and streptococci |
|
|
Term
|
Definition
| redness, edema, swelling, irritation, painful, inflammation in local area secondary to infection |
|
|
Term
|
Definition
-immobilization
-elevation of extremity to decrease edema
-systemic antibiotics: PO is community, IV is hospital |
|
|
Term
|
Definition
| severe allergy reaction that causes swelling of the lips |
|
|
Term
| what is your major concern when dealing with angioedema? |
|
Definition
| maintaining a patent airway |
|
|
Term
| is angioedema an emergency? |
|
Definition
|
|
Term
|
Definition
-prevent and ID allergen
-monitor ABCs
-maintain circulation
-isotonic IV fluids
-give corticosteroids IV
-give antihistamines IV |
|
|
Term
| medications for angioedema |
|
Definition
corticosteroids
antihistamines
isotonic fluids
all IV |
|
|
Term
| non-melonoma skin cancer examples |
|
Definition
| basal and squamous cell cancers |
|
|
Term
| both the basal cell and squamous cell cancers originate in which layer of the skin? |
|
Definition
|
|
Term
| can squamous cell and basal cell skin cancer be malignant? |
|
Definition
|
|
Term
| what is the prognosis for basal and squamous cell skin cancer? |
|
Definition
| good if it they are caught and excised early |
|
|
Term
| where are basal and squamous cell skin cancers most likely to occur? |
|
Definition
| the areas of the body that receive the most sunlight |
|
|
Term
| which cancer is the most common yet the least fatal? |
|
Definition
|
|
Term
| which cancer is more aggressive and has more potential to metastasize? |
|
Definition
| squamous cell skin cancer |
|
|
Term
| which type of skin cancer involves a small and small enlarging papule with a pearly and transluscent border, and an overlying erosion and ulceration with a depressed center? |
|
Definition
|
|
Term
| which type of cancer involves a firm nodule with indistinct border, scaling, and ulceration? |
|
Definition
| squamous cell skin cancer |
|
|
Term
| squamous cell cancer is common where? |
|
Definition
| on the lips and mouths of smokers of tobacco and sun damaged skin |
|
|
Term
| basal cell skin cancer is common on |
|
Definition
|
|
Term
| management of non-melonoma cancers |
|
Definition
-surgical excision: Moh's procedure
-cryosurgery
-chemotherapy
-electrosurgery |
|
|
Term
| what is the cure rate for non-melonoma cancers? |
|
Definition
| high if detected and excised early |
|
|
Term
|
Definition
| neoplastic growth of the melanocytes |
|
|
Term
| where are melanocytes found? |
|
Definition
-epidermis
-meninges
-lymph nodes
-digestive tract |
|
|
Term
| do melanomas only occur in the skin? |
|
Definition
no, there are melanocytes in a variety of locations:
-epidermis
-meninges
-lymph nodes
-digestive tract |
|
|
Term
| can melanoma metastasize? |
|
Definition
|
|
Term
| where can melanoma metastasize to? |
|
Definition
|
|
Term
| when dealing with melanoma, the thicker the lesion is |
|
Definition
| the deeper the cancer invades and it will metastasize to systemic organs |
|
|
Term
|
Definition
any abnormality in the tissue of an organism.
simple is damage caused by disease or trauma |
|
|
Term
| risk factors developing malignant melanoma |
|
Definition
-UV radiation exposure
-skin sensitivity
-genetic and hormonal predisposition |
|
|
Term
| if you have malignant melanoma in your family, what should you do? |
|
Definition
| begin skin screening early |
|
|
Term
| management of malignant melanoma |
|
Definition
-surgery is REQUIRED. entire melanoma and depth must be removed
-chemotherapy and radiation
-early detection and prevention
- |
|
|
Term
| assessment of a malignant melanoma |
|
Definition
| ulcerated in middle, irregular borders, color variations |
|
|
Term
| "hints" to melanoma: ABCD |
|
Definition
A: asymmetry
B: border that irregular
C: color
D: diameter: greater than 6 mm or larger than a pencil eraser |
|
|
Term
| small, pinpoint purplish hemmorhagic spots on the skin |
|
Definition
|
|
Term
|
Definition
|
|
Term
| thick, dry, necrotic black tissue |
|
Definition
|
|
Term
| weeping discharge from the tissue the |
|
Definition
|
|
Term
corticosteroids
-use
-action
-adverse reaction
-admin
-drug interactions |
|
Definition
corticosteroids
-use: manage inflammatory and allergic conditions
-action: suppress immune response and inflammation
-adverse reaction:
1. depression
2. nausea
3. weight gain
4. increased appetite
5. GI bleed
6. PUD: peptic ulcer disease
7. petechiae
8. delayed wound healing
9. immunosuppression and growth suppression
10. skin atrophy
11. HYPOKALEMIA
12. Na retention
13. edema
14. hyperglycemia
15. leukocytosis
-admin: PO, IV, IM, rectal, topical
-drug interactions
1. increase insulin
2. watch K+ and cardiac meds
3. oral contraceptives or BCP may block metabolism |
|
|
Term
| if topical steroids are used for a long time what can happen? |
|
Definition
|
|
Term
| are steroids for long term or short term use? |
|
Definition
| SHORT TERM!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! |
|
|
Term
| applying topical corticosteroids |
|
Definition
apply in a thin layer
do not apply to broken skin |
|
|
Term
| in a more severe reaction would the patient be on PO or IV (systemic) steroids? |
|
Definition
|
|
Term
| systemic corticosteroids: |
|
Definition
prednisone
decadrone
solumedrol
solucortef |
|
|
Term
antihistamines
-use
-action
-adverse reaction
-admin
-drug interactions |
|
Definition
antihistamines
-use: relieve allergic symptoms
-action: blocks histamine effects of: vasodilation, hypotension, tachycardia, smooth muscle contraction, N/V, HA
-adverse reaction: drowsiness, respiratory depression, dry mouth, anorexia
-admin: PO, IM, IV, topical
-drug interactions:
1. anything that is a CNS depression: ETOH, benzodiazepines, analgesics, anticholinergic effects |
|
|
Term
| actions of histamine response |
|
Definition
| vasodilation, hypotension, tachycardia, smooth muscle contraction, N/V, HA |
|
|
Term
| antihistamines are metabolized by the |
|
Definition
|
|
Term
| 1 generation antihistamines such as benedryl |
|
Definition
sedating
more effective
no operating equipment
no driv |
|
|
Term
| 2nd generation antihistamines like claritin, clarinex, allegra, zyrtec |
|
Definition
generally NON sedating
normal ADLs can be performed |
|
|
Term
| the ears are involved in what |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
-part we can see
-receives and transmits sound waves to tympanic membrane
-conducts and amplifies sound |
|
|
Term
| what separates the external ear from the middle ear? |
|
Definition
| the tympanic membrane (ear drum) |
|
|
Term
| what can we find in the external ear that help to trap particles? |
|
Definition
| cilia and the production of cerumen (ear wax) |
|
|
Term
| the middle ear is filled with |
|
Definition
|
|
Term
| the middle ear is connected to the nasal pharynx by the |
|
Definition
|
|
Term
|
Definition
| air equalization between the middle ear and throat when you sneeze and swallow |
|
|
Term
| 3 bones in the middle ear |
|
Definition
|
|
Term
| the 3 bones of the middle ear: the incus, malleus, and the stapes are collectively called the |
|
Definition
|
|
Term
| as the tympanic membrane (TM) vibrates it causes what? |
|
Definition
| the ossicles to vibrate causing the transmission of sound |
|
|
Term
| when the TM vibrates, it causes the ossicles ro move causing the transmission of sound into the |
|
Definition
|
|
Term
|
Definition
| open up into the inner ear and maintains fluid balance in the inner ear |
|
|
Term
|
Definition
| is a bony maze that protects the membrane that functions in hearing and balance |
|
|
Term
| the cochlea is located where? and involved in what? |
|
Definition
| located in the inner ear and is involved in hearing |
|
|
Term
| the semicircular canals/vestibule are located where? and are involved in what? |
|
Definition
| located in the inner ear and involved in balance |
|
|
Term
| where do the brain pathways meet with sound? |
|
Definition
|
|
Term
| where do brain pathway meets with sound and assign meaning to them |
|
Definition
|
|
Term
| describe how sound waves reach the brain |
|
Definition
1. sound waves are picked up in the external ear and pass through the canal to the tympanic membrane
2. sound waves strike TM, causing the malleus to move
3. as they move they cause transmission of sound to the stapes which moves back and forth and pushes the oval window in and out
4. sound then reaches the liquid in the inner ear
5. sound waves then are picked up by tiny nerve sensors in the cochlea which create nerve impulses that travel to the 8th cranial nerve |
|
|
Term
| issues with the external ear are known as what type of hearing problem? |
|
Definition
|
|
Term
| any problems from the inner ear to the 8th cranial nerve is known as a |
|
Definition
|
|
Term
| in a sensoneural hearing loss the patient will have difficulty hearing |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what drugs can cause ototoxicity? |
|
Definition
| lasix (furosemide) and bumex |
|
|
Term
| when pushing lasix IV, what precautions should be taken? why? |
|
Definition
| it should be pushed slowly since lasix is known to cause ototoxicity and tinnitus (ringing in the ears) |
|
|
Term
|
Definition
-feel like the room is spinning
-feel dizzy
-feel off balance when they walk
-symptoms go away when they lay down and become worse when they sit up or stand up |
|
|
Term
| vertigo results from problems where? |
|
Definition
| in the inner ear where balance is controlled |
|
|
Term
|
Definition
-problems in the inner ear, inflammation
-cold
-problems in brain stem or cerebellum |
|
|
Term
| what exacerbates the s/s of vertigo? |
|
Definition
| symptoms go away when they lay down and become worse when they sit up or stand up |
|
|
Term
| ringing in the ears sensation |
|
Definition
|
|
Term
|
Definition
-ringing in the ears
-hairs in the ears are bent or broken and they leak random impulses |
|
|
Term
|
Definition
-bent or broken hairs in the ear that leak random impulses
-cerumen that blocks TM
-normal aging process: causing thickening of the cilia and drier cerumen |
|
|
Term
| patient observation with hearing trouble |
|
Definition
| patient tilts head, ask you to repeat things often, gives inappropriate responses |
|
|
Term
| to view the ear canal in a child less than 3 you would |
|
Definition
|
|
Term
| to view the ear canal in some older than 3 you would pull |
|
Definition
|
|
Term
| normal assessment of an auditory canal and tympanic membrane |
|
Definition
| no excessive wax build up and their is a light reflection off of the TM at around the 5 o clock position |
|
|
Term
| different tests to test patient hearing |
|
Definition
|
|
Term
|
Definition
stand behind the patient
have them occlude one ear
and whisper
ask them to repeat
do this to other ear |
|
|
Term
| what does the rhine test assess? |
|
Definition
| air conduction and bone conduction |
|
|
Term
|
Definition
| the normal way our ears hear through sound waves traveling to TM |
|
|
Term
|
Definition
| sound vibration from to skull to the inner ear |
|
|
Term
|
Definition
| ac should be greater than bc |
|
|
Term
| what instrument do you need for a rhine test? |
|
Definition
|
|
Term
| how do you conduct a rhine test? |
|
Definition
1. activate tuning fork by striking it
2. place it on the mastoid bone
3. activate tuning fork
4. place is 1/2-1 inch in front of ear canal
5. ask at which position did patient hear the best or the loudest
6. if normal, the ac should be better head than bc |
|
|
Term
| would instrument do you need for a weber's test? |
|
Definition
|
|
Term
| what two hearing tests use a tuning fork? |
|
Definition
|
|
Term
| a normal assessment in the weber's test would be |
|
Definition
|
|
Term
|
Definition
1. activate the tuning fork
2. place it midline between the ear on the forehead
3. ask them where they hear it best
4. normal: no lateralization of sound, it is heard equally by both ears |
|
|
Term
| if when conducting a weber's test your patient states that they heard the sound louder in their left ear, what could this mean? |
|
Definition
| they have a bone conduction or conductive hearing loss in the left ear |
|
|
Term
| hearing louder in 1 ear during a weber's test could mean what? |
|
Definition
|
|
Term
| hearing best in the left ear during a weber's test could mean |
|
Definition
| sensioneural hearing loss in the right ear |
|
|
Term
| a normal TM should look like: |
|
Definition
shiny
transluscent
pearly- gray
light shining at 5o' clock |
|
|
Term
| a bulging TM would look like... |
|
Definition
|
|
Term
| why would a TM be bulging out? |
|
Definition
-could be due to a fluid filled middle ear
-infection in middle ear (otitis media) |
|
|
Term
|
Definition
| infection of the middle ear |
|
|
Term
| too much pressure on the TM can causes |
|
Definition
|
|
Term
| after a TM rupture secondary to increased pressure what happens to the pain level? |
|
Definition
|
|
Term
| do we want to prevent a TM from rupturing? |
|
Definition
|
|
Term
|
Definition
chronic infections
-chronic otitis media
-mastoiditis |
|
|
Term
| normal hearing loss from aging |
|
Definition
|
|
Term
| normal aging changes to the external ear: |
|
Definition
-enlarged auricles
-pendulous earlobes
-loss of elasticity in the pinna
-leads to conductive and sensorineural hearing loss |
|
|
Term
| normal aging changes to the middle ear: |
|
Definition
-atrophy of the apocrine gland causes drier cerumen and decreased hearing
-sclerotic change in the TM
-increased deposits of bone cells in the ossicles
-cilia becomes more course and stiff so it doesn't conduct sound as well |
|
|
Term
| normal aging changes to the inner ear: |
|
Definition
| -cilia becomes more course and stiff decreased hearing acuity |
|
|
Term
|
Definition
-with age cerumen becomes thicker, drier
-thicker course cilia
-use of Q-tip that jams it further |
|
|
Term
|
Definition
-complaint of hearing loss
-tinnitus
-vertigo
-having a cough |
|
|
Term
|
Definition
| use of an otoscope, cannot see through to TM due to build up of cerumen (wax) |
|
|
Term
| nursing interventions for ceruminosis |
|
Definition
-irrigate with body temp fluids
-instill lubricating drops to lossed cerumen
-refer to MD if unsuccessful |
|
|
Term
| patient education for ceruminosis |
|
Definition
| -do NOT use Q-tips to clean your ears only a washcloth and finger to avoid packing |
|
|
Term
| assessment of a patient with a foreign body in the external ear |
|
Definition
-may be protruding
-pain
-decreased hearing
-tinnitis
-swelling, redness, drainage |
|
|
Term
| diagnosis of a patient with a foreign body in the external ear |
|
Definition
| view w or without otoscope |
|
|
Term
| interventions for a patient with a foreign body in the external ear |
|
Definition
-stabilize object
-DO NOT pull out!!!!!
-keep patient still
- |
|
|
Term
| what if your patient has an insect in their ear? |
|
Definition
| MD may order ear drops to numb the canal and immobilize the insect such as lidocaine |
|
|
Term
| who will most likely remove an object from an ear? |
|
Definition
| the MD unless her determines that it can be removed through irrigation |
|
|
Term
| what causes otitis media? |
|
Definition
| fluid accumulation in the middle ear like pus pushing against the TM |
|
|
Term
| assessment for otitis media |
|
Definition
-usually unilateral
-very painful (infant may pull at ears)
-infant may not want to eat or swallow due to pressure buildup in ear
-drainage after rupture of TM which causes relief of pain, but requires surgical intervetion
-may have a fever
-may beed surgery: myringotomy |
|
|
Term
|
Definition
| otoscope would show bulging and red TM |
|
|
Term
|
Definition
-antibiotics
-pain meds like antipyretics: tylenol
-auralgan:numbs ear canal to reduce pain |
|
|
Term
| antipyretic analgesic that numbs the ear canal to relieve the pain of otitis media. is very sticky and gooey |
|
Definition
|
|
Term
|
Definition
| cutting a small incision into the TM and placing a little tube in it to allow the drainage of excess fluid while it heals. the tube will heal on its own and the tube is pushed out. takes about 9 months |
|
|
Term
| how long will it take a TM to heal after a myringotomy? |
|
Definition
|
|
Term
| nursing interventions for otitis media |
|
Definition
-prevention
-avoiding second hand smoke since it irritates the structures in the ear and can causes more severe ear infections
-proper hand washing
-take abx as prescribed or prophylactically
-see MD with ear pain |
|
|
Term
| is otitis media contagious? |
|
Definition
| no, but the bacteria that led to it can still spread |
|
|
Term
|
Definition
| slow formation of abnormal spongy bone in the middle ears, causing the ossicles to become "one mass" decreasing sound conduction leading to progressive hearing loss. is usually bilateral |
|
|
Term
| assessment of otosclerosis |
|
Definition
-progressively worse hearing loss
-tinnitus
-red/orange TM |
|
|
Term
|
Definition
-CT scan of temporal bone
-negative rhine/weber (bc>ac and lateralization)
-use of audiometry: difficulty in hearing certain tones |
|
|
Term
| interventions of otosclerosis |
|
Definition
-sodium fluoride: to help slow bone reabsorptoin and calcification
-hearing aid: to amplify sound waves
-surgery: stapedectomy |
|
|
Term
|
Definition
| removal of the stapes with possible replacement with a plastic prosthesis |
|
|
Term
| post surgery for a stapedectomy |
|
Definition
N/V/D
dizzy
decrease sudden movement to avoid vertigo
no straining that would increase pressure in ears: sneezing, coughing, lifting
-administer abx |
|
|
Term
|
Definition
| disrupted fluid balance in the inner ear |
|
|
Term
| what is the cause of Meniere's disease? |
|
Definition
|
|
Term
| what is the cure to Meniere's disease? |
|
Definition
|
|
Term
| assessment of Meniere's disease |
|
Definition
-looks very ill, pale, diaphoretic
-N/V
-vertigo
-lying down does NOT help!
-will hold on to something to avoid "spinning out of control"
-tinnitus
-sense of fullness
-decreased hearing
-s/s are SUDDEN which is very disruptive
-may have surgery |
|
|
Term
| in a person with Meniere's disease does laying down help? |
|
Definition
|
|
Term
|
Definition
-nurse must do good neuro exam to rule out
-CT scan to rule out other neuro problems like a stroke |
|
|
Term
| interventions for a patient with Meniere's disease who is having an attack |
|
Definition
-safety: lock bed, raise rails, lower bed
-minimize stimuli: lights & sounds, TV, radio, ask family to quiet or leave until attack is done
-give fluids to help with fluid balance
-meds for N/V
-antivert for dizziness and vertigo |
|
|
Term
| with Meniere's disease what can stimuli do? |
|
Definition
| initiate and aggravate an attack |
|
|
Term
| what types of medications would you give for an acute attack of Meniere's disease |
|
Definition
-meds for N/V
-antivert for dizziness and vertigo
-fluids to help with fluid balance |
|
|
Term
| preventative interventions for Meniere's disease attacks |
|
Definition
-low Na diet to avoid fluid retention
-avoid dehydration: exercise, being in heat, beach
-no stimulants that are triggers: caffeine, coffee, smoking, nicotine |
|
|
Term
|
Definition
| area in the inner with the cochlea (for hearing) and vestibular system (for balance) |
|
|
Term
|
Definition
-inflammation of the labyrinth
-often caused by infection
- |
|
|
Term
| lets you know the difference between up and down even with your eyes closed |
|
Definition
|
|
Term
|
Definition
-can start from an URI
-often caused by infection
-often unknown |
|
|
Term
| assessment of labyrinthitis |
|
Definition
-vertigo
-tinnitis
-sensorineural hearing loss due to decreased ability of cochlea to transmit sound waves to the brain
-unilateral |
|
|
Term
|
Definition
-based on s/s
-eliminate other causes: hearing and balance testing |
|
|
Term
| if s/s that mimic labyrinthitis are really due to a virus what will happen? |
|
Definition
| it will go away on its own and then give meds to treat N/V and vertigo |
|
|
Term
| if s/s that mimic labyrinthitis are really due to a bacteria what will happen? |
|
Definition
|
|
Term
| nursing interventions for labyrinthitis |
|
Definition
| -educate pt when call MS: fever, decreased hearing in 1 ear, vertigo, vomiting, |
|
|
Term
| is there a way to prevent labyrinthitis? |
|
Definition
|
|
Term
| a patient with bacterial labyrinthitis should be constantly checked for |
|
Definition
| mental status and LOC changes because of risk of meningitis |
|
|
Term
|
Definition
-disorientation
-confused
-lethargic
-agitated |
|
|
Term
| if as a result of labyrinthitis the patient has permanent damage, what must be done? |
|
Definition
| call PT to help them control balance and sensory interpretation |
|
|
Term
|
Definition
| benign tumor that forms on vestibular nerve (controls balance) that connects inner ear to the brain |
|
|
Term
|
Definition
|
|
Term
| the balance nerve runs parallel to the |
|
Definition
| auditory (hearing) nerve and facial nerve (controls facial muscles) |
|
|
Term
| assessment of acoustic neuroma |
|
Definition
-unilater, progressive, sensorineural hearing loss
-decreased sense of touch in the posterior ear canaldue to the tumor compressing
-ear and facial numbing |
|
|
Term
|
Definition
|
|
Term
| best way to Dx an acoustic neuroma |
|
Definition
|
|
Term
| interventions for acoustic neuroma |
|
Definition
-surgery
-radiation
if tumor increases in size to greater than 2 cm |
|
|
Term
| after surgery for acoustic neuroma the patient would have |
|
Definition
-may have permanent hearing loss in the ear
-be in the hospital up to a week
-no work for 1 month
-facial paralysis
-numbness |
|
|
Term
| will radiation cure acoustic neuroma? |
|
Definition
| no it will only shrink the tumor |
|
|
Term
| hearing loss that involves the outer and middle ear |
|
Definition
|
|
Term
| hearing loss that involves the inner ear |
|
Definition
| sensorineural hearing loss |
|
|
Term
| causes of sensorineural hearing loss |
|
Definition
-ototoxic meds: lasix and bumex
-trauma
-Menier's disease and acoustic neuroma |
|
|
Term
| anything that decreases the brain's ability to interpret the sound waves it receives |
|
Definition
| sensorineural hearing loss |
|
|
Term
| both conductive hearing loss and sensorineural hearing loss would be |
|
Definition
|
|
Term
|
Definition
|
|
Term
| a hearing aid would be best for what type of hearing loss? |
|
Definition
|
|
Term
| why would a hearing aid NOT be helpful for a patient with a sensorineural hearing loss? |
|
Definition
| because in this case the inner ear is having trouble transmitting the sound waves to the brain to be interpreted |
|
|
Term
| in patients with sensorineural hearing loss what pitches are harder to hear? |
|
Definition
|
|
Term
| this type of hearing loss is normal with age |
|
Definition
| sensorineural hearing loss |
|
|
Term
| patient education for a hearing aid |
|
Definition
-begin use in a quiet environment
-learn to adjust volume |
|
|
Term
| when talking to a patient with a hearing aid, how should you speak? |
|
Definition
| slowly but normally using lower tones because higher tones are harder to understand |
|
|
Term
| administering otic medication |
|
Definition
-straighten auditory canal
-tild head in opposite direction |
|
|
Term
|
Definition
|
|
Term
|
Definition
| anethetic used to paralyze insects |
|
|
Term
| how many bones are in the body? |
|
Definition
|
|
Term
| how are bones classified in the body? |
|
Definition
|
|
Term
| long bones are located where in the body? |
|
Definition
|
|
Term
| long bones are known to develop what condition? |
|
Definition
|
|
Term
| examples of short bones in the body |
|
Definition
|
|
Term
|
Definition
|
|
Term
| irregular bones include the |
|
Definition
|
|
Term
| what are the 3 types of muscle? |
|
Definition
1. cardiac
2. skeletal
3. smooth |
|
|
Term
|
Definition
striated
found in the heart
there are spontaneous contractions that allow for blood to travel
is involuntary |
|
|
Term
|
Definition
striated
voluntary
allows us to ambulate, sit, and contract muscle |
|
|
Term
| which types of muscle are striated? which are voluntary? |
|
Definition
striated: skeletal & cardiac
non-striated: smooth
voluntary: skeletal
involuntary: smooth and cardiac |
|
|
Term
|
Definition
nonstriated, involuntary
found in the walls of hollow structures: airways, arteries, GI tract, bladder, uterus and is its contraction causes peristalsis which is involuntary |
|
|
Term
| functions of the musculoskeletal system |
|
Definition
-protects internal orgnas
-spurrpot and framework
-voluntary movement
-blood cell production: RBC & WBC
-mineral storage: Ca+ and PO3= |
|
|
Term
| where are blood cells produced? |
|
Definition
|
|
Term
| in response to hypocalcemia, how will your body respond? |
|
Definition
| the parathyroid gland will release parathyroid hormone (PTH) which will help bones to give up Ca and put it into the blood and helps the kidney hold on to Ca rather than excreting it |
|
|
Term
| in response to hypercalcemia, how will your body respond? |
|
Definition
| the thyroid gland will release calcitonin which helps the bones to absorb Ca+ to decrease blood levels of Ca and helps kidneys to excrete Ca from the blood |
|
|
Term
| vitamin D is necesscary for the absorption of |
|
Definition
|
|
Term
| weight bearing excerises have what affect on bone formation? |
|
Definition
| it positively affects bone formation |
|
|
Term
| what type of hormones are needed for bone and muscle development particularly in the young and growing years? |
|
Definition
|
|
Term
| negative influences on the bones |
|
Definition
1. long term steroid use that is longer than 3 months can decrease bone strength and lead to osteoporosis
2. inflammation and infection would impede bone formation |
|
|
Term
| what types of patients would need medication long term to decrease inflammation? what are they putting themselves at risk for? |
|
Definition
| patients who would need a long term medication to decrease inflammation are patients such as those with ulcerative colitis, Crohn's disease, arthritis, lupus, skin conditions. these patients would need corticosteroids to suppress their inflammation long term. however the use of steroids for longer than 3 months would cause a decrease in bone strength and could lead to osteoporosis |
|
|
Term
| expected aging changes in the musculoskeletal system |
|
Definition
-decreased: elasticity in the ligaments and cartilage, decreased agility and dexterity, muscle cells causing decreased overall strength, decreased bone density which may cause osteoporosis. lose H2) between the discs, have a narrowing in the intervertebral spaces, and height
-increased: in the rigidity of the cartilage causing stiffness and pain, posturing changes
-impaired osteoblastic activity: do not produce bone as well and do not recover and replae bones during injury as fast |
|
|
Term
|
Definition
| shrinking of a muscle that could be due to lack of use |
|
|
Term
| when palpating to assess the musculoskeletal system it is important to do in what order? |
|
Definition
| TOP to BOTTOM or superficial to deep to avoid causing pain first |
|
|
Term
| grinding feeling or noise when a joint is being moved or used |
|
Definition
|
|
Term
| ROM is either what or what? |
|
Definition
|
|
Term
|
Definition
| patient can actively move their muscles themselves |
|
|
Term
|
Definition
| nurse of PT or passive ROM machine is moving muscle for patient |
|
|
Term
| in order to truly assess if one extremity is weaker than its opposite counterpart how must you assess the strength of extremities? |
|
Definition
| bilaterally at the same time for each extermities: have patient squeeze your hands with BOTH of their hands and the SAME time |
|
|
Term
muscle strength scale score of:
0/5
what does this score indicate?
who is most likely to have this score? |
|
Definition
there is no movement, it is flaccid and if you lift up the extremity, it drops
those patients who have suffered a stroke |
|
|
Term
muscle strength scale score of:
1/5
what does this score indicate? |
|
Definition
| movement is barely detectable, you touch the muscle and there may be a twitch or contraction |
|
|
Term
muscle strength scale score of:
2/5
what does this score indicate? |
|
Definition
| active movement without gravity such as in a whirlpool; they cannot move in a normal environment with gravity |
|
|
Term
muscle strength scale score of:
3/5
what does this score indicate? |
|
Definition
| active movement against gravity sitting in a chair or laying down but NOT against resistance or strength |
|
|
Term
muscle strength scale score of:
4/5
what does this score indicate? |
|
Definition
| active movement against gravity and SOME resistance. there is mild weakness |
|
|
Term
muscle strength scale score of:
5/5
what does this score indicate? |
|
Definition
| active movement against full resistance, normal, active ROM |
|
|
Term
| a simple and single view that is a flat plane used to view bone and fractures of bone |
|
Definition
|
|
Term
| more advanced than x-ray and has 3-D views, can identify fractures, massess, tumors, soft tissues, muscle trauma, MVA, so for bones and soft tissue |
|
Definition
|
|
Term
| most detailed diagnostic test for MS system, shows best detial in soft tissue details, best test for evaluating soft tissue and looking for injury. contraindicated for any patient with a mental implants since it uses a magnetic field |
|
Definition
|
|
Term
| what types of metal objects would be contraindicated for the use of an MRI? |
|
Definition
| pace-makers, staples,clips,metal implants |
|
|
Term
| what types of MRIs are there? |
|
Definition
|
|
Term
| what do you want to be aware of with closed MRIs? |
|
Definition
| if your patient is claustrophobic, may need an anxiolytic such as a benzo |
|
|
Term
| would a claustrophobic patient have issues with an open MRI? |
|
Definition
|
|
Term
| precautions for use of IV contrast |
|
Definition
-have no allergy to IV contrast
-have normal renal function: creatinine that is less than 2 |
|
|
Term
| why would a patient with a creatinine level higher than 2 not be able to recieve IV contrast? |
|
Definition
| because their kidneys may not be able to excrete the IV contrast after the procedure |
|
|
Term
|
Definition
BMD: bone mineral density scans or DEXA: dual energy x-ray absorptiometry
used to measure bone mass and density
are noninvasive |
|
|
Term
| what can BMD or DEXA scans be used to diagnose? |
|
Definition
osteoporosis
osteopenia
bone disease |
|
|
Term
| how is a bone scan different from a BMD or DEXA scan? |
|
Definition
| a bone scan is different from a bone mineral density scan (BMD) because a bone scan requires the injection of a radioisotope |
|
|
Term
| what does a bone scan measure? |
|
Definition
| measures the uptake of isotope from the blood flow to the bone |
|
|
Term
| increased uptake of isotope in a bone scan can indicate: |
|
Definition
osteomyelitis
osteoporosis
malignancy |
|
|
Term
| decreased uptake of isotope in a bone scan can indicate: |
|
Definition
|
|
Term
bone serological lab:
alkaline phosphatase
what is it:
normal value:
hypo:
hyper: |
|
Definition
bone serological lab:
alkaline phosphatase
what is it: an enzyme produced by the osteoblasts of bone and is needed mineralization of organic bone matrix
normal value: 20-90
hypo: n/a
hyper:
1. during healing fractures as the osteoblasts work to create more bone that was damaged or lost
2. bone Ca
3. Paget's disease |
|
|
Term
bone serological lab:
calcium
what is it:
normal value:
hypo:
hyper: |
|
Definition
bone serological lab:
calcium
what is it: electrolyte stored in the bone to provide bone strength
normal value: 9-11
hypo: hypocalcemia
1. hypoparathyroidism
2. renal disease
hyper: hypercalcemia
1. hyperparathyroidism
bone tumors |
|
|
Term
bone serological lab:
phosphorus
what is it:
normal value:
hypo:
hyper: |
|
Definition
bone serological lab:
phosphorus
what is it: electrolyte stored in the bone that is inversely proportional to the amount of Ca in the blood
normal value: 2.8-4.5
hypo:
1. osteomalacia
hyper:
1. renal disease
2. healing fractures
3. bone tumors |
|
|
Term
bone serological lab:
ESR
what is it:
normal value:
hypo:
hyper: |
|
Definition
bone serological lab:
ESR
what is it: erythrocyte sedimentation rate, nonspecific index of inflammation. is indicative of inflammation and measure how rapidity of RBC sediment
normal value: <20
hypo: n/a
hyper: where there is an inflammatory process occuring:
1. rheumatoid arthritis
2. rheumatic fever
3. osteomyelitis |
|
|
Term
bone serological lab:
uric acid
what is it:
normal value:
hypo:
hyper: |
|
Definition
bone serological lab:
uric acid
what is it: end product of metabolism. excreted through the urine
normal value: <5.5-6.5
hypo: n/a
hyper:
1. gout |
|
|
Term
|
Definition
| an accumulation of uric acid causes pain in the great toe |
|
|
Term
bone serological lab:
CRP
what is it:
normal value:
hypo:
hyper: |
|
Definition
bone serological lab:
CRP
what is it: C-reactive protein; an inflammatory marker
normal value: negative
hypo: n/a
hyper:
1. elevates 24 hours after tissue damage: MVA, fracture |
|
|
Term
bone serological lab:
CK
what is it:
normal value:
hypo:
hyper: |
|
Definition
bone serological lab:
CK
what is it: creatinine kinase; found in skeletal muscle, after muscle damage or trauma it will be elevated; non-specific
normal value: <35-55
hypo: n/a
hyper:
1. increased muscle injury
2. MI
3. runner in marathon |
|
|
Term
|
Definition
| scope inserted into joint to view |
|
|
Term
|
Definition
| puncturing of the joint capsule and aspiration of fluid to analyze synovial fluid for |
|
|
Term
|
Definition
| evaluates the electrical potential within the skeletal muscle during contraction. tells if muscle is contracting |
|
|
Term
|
Definition
|
|
Term
|
Definition
| injury to the ligaments around a joint caused by a twisting motion usually in the ankles and wrist |
|
|
Term
|
Definition
| excessive stretching of a muscle, often involves tendons, overuse or poor stretching prior to exercise |
|
|
Term
| clinical manifestations of a strain and sprain |
|
Definition
-edema and swelling
-pain
-decreased function
-loss of ROM
-ecchymosis: bruising |
|
|
Term
| most important priority with a soft tissue injury: |
|
Definition
|
|
Term
| nursing care for soft tissue injuries: |
|
Definition
RICE:
Rest: allow time for healing and cell turnover and to prevent further injury
Ice: causes vasoconstriction to decrease swelling
Compression: stocking and ACE wraps to decrease swelling and complications
Elevation: decreases swelling AND healing time |
|
|
Term
|
Definition
-very common
-caused by compression of the median nerve which is below the carpal ligament
-associated with overuse: typing, blow-drying |
|
|
Term
| clinical manifestations of carpal tunnel syndrome: |
|
Definition
numbness
tingling
pain
loss of motion and movement
weakness
burning
dropping things
losing grasp |
|
|
Term
| two signs used for the diagnosis of carpal tunnel syndrome: |
|
Definition
-phalen's sign:
1. place arms in front
2. bend wrist and push together for 30 seconds
3. +sign= numbness, tingling, and pain
-tinels sign:
1. tap the median nerve
2. +sign= numbness, tingling, and pain |
|
|
Term
| management of carpal tunnel syndrome |
|
Definition
1. BEST: prevention
2. identify and alleviate
3. use wrist devices to alleviate compression on nerve
4. keyboard pads
5. NSAIDs: motrin, ibuprofen, aleve
5. oral steroids like prednisone: NO MORE THAN 3 months to avoid osteoporosis and gastric ulcers.
6. corticosteroid injections: later treatment after simpler treatments have been tried, short term to decrease inflammation. only last several months
7. surgical decompression: last resort to remove tissue that is compressing the nerve; can have good/bad results |
|
|
Term
| why should NSAID's be taken on a full stomach? |
|
Definition
|
|
Term
|
Definition
| disruption or break in the structure of the bone |
|
|
Term
| fractures are often secondary to |
|
Definition
| trauma or disease process |
|
|
Term
| classifications of fractures |
|
Definition
1. traumatic (trauma) or pathologic (osteoporosis or cancer, etc)
2. stable (tranverse, greenstick and spiral) or unstable (go to OR ASAP: comminuted or oblique)
3. closed vs open (through the skin) |
|
|
Term
|
Definition
transverse
greenstick
spiral |
|
|
Term
|
Definition
comminuted
oblique
go to OR ASAP!!!!!!!!!!!!!!!!!!!!! |
|
|
Term
| with an unstable fracture it is important to |
|
Definition
| go to OR ASAP!!!!!!!!!!!!!!!!!!!!! |
|
|
Term
| which type of fracture are most at risk for infection? |
|
Definition
|
|
Term
| how to diagnose a fracture |
|
Definition
|
|
Term
| clinical manifestations of a fracture |
|
Definition
pain
swelling
loss of function
physical deformity
crepitation
discoloration and bruising
decreased sensation |
|
|
Term
|
Definition
1. immobilize
2. realign
3. may need a cast and tract
4. elevate to decrease swelling
5. make sure they have circulation: check pulses bilaterally, temperature, any paresthesia (numbness) or paralysis
6. cast care: dry and clean and prevent infection |
|
|
Term
| things that will slow healing process of a fracture |
|
Definition
1. inadequate reduction
2. inefficient immobilization
3. excessive swelling
4. excessive bone loss
5. infection
6. bone necrosis
7. osteomyelitis
8. DM and endocrine problems
9. poor dietary intake
10. medications: steroids and chemotherapy |
|
|
Term
|
Definition
| realignment of fractured bones |
|
|
Term
| closed fracture reduction |
|
Definition
| is nonsurgical, the manual realignment of bone |
|
|
Term
| types of fracture reduction |
|
Definition
|
|
Term
|
Definition
| surgical realignment, internal fixation with tools, higher risk for infection |
|
|
Term
| which type of fracture reduction leaves patients more at risk for infection? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
done before the OR
noninvasive and uses weights and ropes to align the bone
good for limiting muscle spasms |
|
|
Term
|
Definition
post surgery
invasive
pins put into the bones that come out of skin and uses weights; higher risk for infection |
|
|
Term
| which type of traction leaves patients more at risk for infection? |
|
Definition
| skeletal since it is invasive |
|
|
Term
|
Definition
TRACTION:
T: toleration and pain managment: should alleviate pain and muscle spasms
R: reassess and rinsing pins every shift to avoid infection, note drainage and foul odor; reposition every 2 hours
A: alignment of body
C: circulation check
T: tool check: make sure rope is not frayed and it pulley and that the weight is hanging freely with NO weights on the bed or floor
I: increase fluid intake, monitor I and O, BMs
O: overhead trapeze: helps to reposition patient and bedsore prevention
N: NO weights on bed, floor, or hanging freely. NEVER remove weights unless OR. |
|
|
Term
| ways of immobilization of a fracture |
|
Definition
casts
external fixation
internal fixation |
|
|
Term
| when a patient has an immobilization device what is important to tell them? |
|
Definition
| to not move that extremity to the best of their ability |
|
|
Term
| patient education with cast care |
|
Definition
-cast is wet when it is applied to the body
-it then dries
-they may feet heat and warmth
-edema is normal
-cannot wet cast
-no lotions, creams, or oils under cast
-ROM to exposed extremities to avoid contractures |
|
|
Term
| pharmacological management in fractures |
|
Definition
-muscle relaxants: flexeril, robaxin, soma
-analgesics: NSAIDs, tylenol, narcotics
-tetanus-diptheria toxoid: anyone that has a wound that was created with a metal object; if they haven't had it in the past 5 years
-antibiotics |
|
|
Term
| adverse reactions to muscle relaxants used to reduce muscle spasms in fractures |
|
Definition
| drowsiness, HA, fatigue, respiratory depression, GI upset |
|
|
Term
| side effects of narcotics |
|
Definition
| RESP DEPRESSION, drowsiness, constipation |
|
|
Term
| nutritional intake for fractures |
|
Definition
-increased caloric intake
-protein: 1 gm/kg
-vitamins C, B, D
-calcium
fluid intake: 2-3 L to prevent constipation
-fiber and vegetables |
|
|
Term
|
Definition
| increased intracompartment pressure within any confined myofascial compartment. compromises neurovascular function and can be life/limb threatening, increased pressure causes swelling that can damage nerves and vessels |
|
|
Term
| causes of compartment syndrome |
|
Definition
anything that causes too much swelling in an area:
restrictive dressings
splints
casts
excessive traction
bleeding
edema
IV infiltration |
|
|
Term
| key to save a life/limb from compartment syndrome |
|
Definition
early detection
knowing who is at risk |
|
|
Term
| clinical manifestations of compartment syndrome |
|
Definition
the six Ps:
1. parathesia
2. pain
3. pressure
4. pallor/pale/cool
5. pulselessness
6. paralysis |
|
|
Term
| what to do if you assess the six P's in a patient and you believe it is compartment syndrome |
|
Definition
| alert the MD and charge nurse IMMEDIATELY |
|
|
Term
| nursing response to compartment syndrome |
|
Definition
1. place extremity at heart level, do NOT elevate
2. remove cold compresses and ice packs
3. loosen restrictive dressings and casts
4. notify MD may have to go to surgery for fasciotomy |
|
|
Term
|
Definition
| done in cases to relieve compartment syndrome: remove tissue to allow room for swelling to take place |
|
|
Term
|
Definition
deep vein thrombosis:
-a peripheral blood clot
-very common after fractures, surgeries, immobilzation, venous stasis, clotting disorder or lower extremities fracture, local pressure on vein (cast) |
|
|
Term
|
Definition
prevent pulmonary embolic:
-antiembolism stockings, TEDSs and SCD
-early ambulation
-medication
-active ROM |
|
|
Term
| medications to prevent PE |
|
Definition
aspirin
plavix
trental
coumadin
heparin
lovenox/arixtra |
|
|
Term
|
Definition
| used to decrease platlet aggregation and are all oral |
|
|
Term
| labs to check for coumadin use |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| lab to check for heparin use |
|
Definition
|
|
Term
| low molecular weight heparin |
|
Definition
|
|
Term
|
Definition
|
|
Term
| labs to check for lovenox |
|
Definition
| platelet count should not be below 100,00 |
|
|
Term
| what is important to know about the "bubble" in lovenox? |
|
Definition
|
|
Term
|
Definition
| prescence of fat globules in the tissues and organs after a traumatic skeletal injury. most commonly associated with fractures of long bones |
|
|
Term
| fat emboli syndrome is most associated with what type of bone fracture? |
|
Definition
| long bone fractures or trauma |
|
|
Term
| clinical manifestations of fat emboli syndrome |
|
Definition
1. acute respiratory distress syndrome (ARDS): chest pain, tachypnea, decreased O2 sat, dyspnea, anxiety, cyanosis
2. petechiae: neck and chest ant wall
3. altered mental status/confusion
4. follow H&H/PLT/PT/INR
5. O2, fluid resuscitation, shock prevention
6. be sure there is a patient IV! |
|
|
Term
| in ARDS, what is seen first? |
|
Definition
| in acute respiratory distress syndrome the first sign is anxiety |
|
|
Term
| in ARDS, what is the priority |
|
Definition
| this is an emergency, may even need a code, treat the symptoms as quickly as possible |
|
|
Term
| hip fractures are common in |
|
Definition
|
|
Term
| pre op care for hip fracture patients |
|
Definition
-stabilize patient: may take time due to comorbidities: DM, HTN, CAD, COPD
-hydrate
-muscle spasm management: align the hip and administer muscle relaxants
-pain management: narcotics: monitor neuro and resp status
-exercises: wiggle toes
-use trapeze: reposition and move on bed, reduce pressure
-hydration to prevent constipation due to narcotics and immobility
-safety: call light, side rails, trapeze
-consent: risk, benefits, alternatives; make sure it is signed |
|
|
Term
| best method for the best prognosis for a hip fracture |
|
Definition
| open reduction internal fixation (ORIF) |
|
|
Term
| post op care for a hip fracture |
|
Definition
H: hydration
I: incision care: assess site for redness, drainage monitor for infection
P: pain management
F: fiber supplementation
R: respiratory care- pulmonary toileting: C&DB, IS for 30 min-1 hr to prevent pneumonia and atelectasis
A: abductor pillow: wedge pillow to keep hip in abducted position. in place while lying down, straps below and above kneecap NOT on knee
C: circulation checks |
|
|
Term
| risk factors for hip fractures |
|
Definition
-increased age
-increased in females, but both sexes are affected
-history of osteoporosis |
|
|
Term
| clinical manifestations of hip fractures |
|
Definition
-pain
-unable to bear weight
-leg shortened
-adduction of lef
-external rotation
-deformity along lateral side of the hip if fracture is displaced
-ecchymosis |
|
|
Term
| nursing care for hip fractures |
|
Definition
-turn q2h to unoperative side
-pulm. toileting
-monitor I and O
-exercise when ok
-education and emotional support
-self care promotion
-diversional activity |
|
|
Term
|
Definition
-circulatory impairment
-PVD
-trauma
-malignant tumor
-infection, ischemia, necrosis
-congenital disorders
-frostbite |
|
|
Term
| types of amputation surgery |
|
Definition
-closed or flap method
-open method |
|
|
Term
|
Definition
-is a type of amputation surgery
-used when there is no infection
-tissue from anterior is a flap that closes over amputation site |
|
|
Term
| open method of amputation |
|
Definition
used for for anyone with an infection
being tissue together and staple it and insert drains |
|
|
Term
|
Definition
| below knee and above knee amputation |
|
|
Term
| post op amputation management |
|
Definition
A: assess site for hemorrhage/infection due increased bleeding risk
M: monitor Hgb/Hct
P: prevent hip flexion contracture, elevate stump on a pillow first 24 hours ONLY then prone 30 min TID-QID
U: U have pain? treat phantom pain is normal that may last 1 year, give psychological support |
|
|
Term
| prosthetic device for closed flap vs open flap amputation |
|
Definition
closed flap: can be fitted
open flap: have to wait for site to heal |
|
|
Term
| stump care after wound has healed |
|
Definition
-assess for skin breakdown
-wash, rinse, and dry stump daily
-don not apply anything to stump no alcohol or lotion |
|
|
Term
|
Definition
circulation
motor
sensation |
|
|
Term
| osteoporosis is common in the |
|
Definition
|
|
Term
|
Definition
-chronic progressive disease
-loss of bone mass, strength, and density
-structural deterioration of bone tissue leading to fractures |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| after what age does the chance of developing osteoporosis increase? |
|
Definition
|
|
Term
| risk factors for developing osteoporosis |
|
Definition
-female
-over 50
-white, European, Asian
-tobacco/ETOH use
-early menopause
-family history
-small stature
-anorexia
-sedentary lifestyle
-insufficient Ca+ intake
-long term steroid use, longer than 3 months |
|
|
Term
| clinical manifestations of osteoporosis |
|
Definition
-is a silent disease and patient is usually unaware
-decrease height
-may or may not have pain
-thoracic kyphosis (hump in upper back) |
|
|
Term
| diagnosis of osteoporosis |
|
Definition
-BMD/Dexascan
-follow 1-2 years after |
|
|
Term
| pharmacological treatment of osteoporosis |
|
Definition
1. estrogen replacement therapy (HRT): believed to inhibit osteoclast activity or the breakdown of bone
2. biphosphanates:
fosamax
actonel
boniva: once a month
3. calcitonin (myacalcin): inhibits bone resorption or breakdown of bone by taking Ca from the blood and into the bone. May have to give oral Ca to prevent hypocalcemia
4. SERM: selective estrogen reuptake modifiers: evista
-reduces bone resorption
5. parathyroid hormone derivative
-forteo
-stimulate production of new bone
-sub Q injection qDay |
|
|
Term
| what is one important consideration when dealing with estrogen replacement therapy? |
|
Definition
| it is not to be used in patients with breast cancer |
|
|
Term
| while fosamax and actonel are given _________, boniva is given _________. these 3 drugs are examples of ______________ which are used in the treatment of _________. |
|
Definition
| while fosamax and actonel are given WEEKLY, boniva is given MONTHLY. these 3 drugs are examples of BIPHOSPHANATES which are used in the treatment of OSTEOPOROSIS |
|
|
Term
| nursing considerations for administering biphosphanates: |
|
Definition
1. taken in AM
2. empty stomach
3. full glass of H20
4. sit upright for 30 min after taking it
5. no food for 30 min after
6. avoids espohageal damage |
|
|
Term
| biphosphanates like estrogen (HRT) work to inhibit |
|
Definition
| osteoclast activty, slow down breakdown of bones |
|
|
Term
|
Definition
|
|
Term
| your patient is hypercalcemic, what dug would you expect the MD to order? |
|
Definition
|
|
Term
| adverse reaction to SERM drug: evista would include |
|
Definition
| leg cramps and hot flashes |
|
|
Term
| management of osteoporosis |
|
Definition
-prevent further bone loss
-decrease risk of fractures
-nutrition and Ca
-supplement (1500 mg of Ca a day)
-Vitamin D
-weight bearing exercises |
|
|
Term
| the only drug that increases the formation of bone |
|
Definition
|
|
Term
| how much Ca should someone be getting daily? |
|
Definition
|
|
Term
| how much vitamin D should someone be getting daily? |
|
Definition
|
|
Term
| is swimming a weight bearing exercise? |
|
Definition
|
|
Term
| Paget's disease (osteitis deformans) |
|
Definition
-increased bone destruction
-rapid unorganized bone fromation/repair
-bone pain
-etiology is unknown
-may be genetic
-increased incidence in males |
|
|
Term
| clinical manifestations of Paget's disease |
|
Definition
-bone pain
-deformities and bony enlargements
-bow legs and spinal curvature
-fatigue
-alkaline phosphatase will be elevated
-may develop kidney stones from increased Ca deposits |
|
|
Term
| management of Paget's disease |
|
Definition
-treat symptoms
-analgesics
-prevent fractures
biphosphanates and calcitonin
dexamethasone (steroid)
NSAIDs: ibuprofen, motrin, aleve, advil, NOT tylenol
-assistive devices due ambulatory difficulty |
|
|
Term
|
Definition
-chronic disorder
-non joint/non-articular musculoskeletal pain
-fatigue and multiple tender points
-major cause of disability
-associated with: anxiety, depression, sleep disorder, IBS, morning stiffness
-unknown etiology
-more in women than in men |
|
|
Term
| clinical manifestations fibromyalgia |
|
Definition
-widespread burning pain
-head, facial pain, migraines
-tmj
-fatigue
-insomnia
-difficulty concentrating
-point tenderness in 11 or more sites
-parathesia |
|
|
Term
| management of fibromyalgia |
|
Definition
-rest
-heat and massage
-nutrition: avoid muscle irritants: sugar, caffeine, ETOH
-support groups, families, friends
PATIENT IS NOT ALONE! |
|
|
Term
| muscle irritants that patients with fibromyalgia should avoid |
|
Definition
|
|
Term
| pharmacological management of fibromyalgia |
|
Definition
-analgesics: NSAIDs, Tylenol
-antidepressants: elavil
-muscle relaxants however be careful they may become addictive: flexoril, robaxin, soma
-sleeping pills due to insomnia: ambien
-benzodiazepines HIGHLY addictive: to decrease anxiety: valium, ativan, xanax |
|
|
Term
| precautions for the use of muscle relaxants such as flexoril: |
|
Definition
| they may become addictive |
|
|
Term
| precautions for the use of sleeping pills such as ambien |
|
Definition
| they may become addictive |
|
|
Term
| precautions for the use of benzodiazepines |
|
Definition
| they are HIGHLY addictive |
|
|
Term
|
Definition
NSAIDS: tylenol
narcotics: percocet, tylenol with codeine, darvocet, oxycontin/oxycodeine: MONITOR neuro and respiratory |
|
|
Term
| priority for open fracture to avoid serious infection |
|
Definition
| give tetanus diptheria vaccination if they have not had it in the last 5 years |
|
|
Term
|
Definition
| acute bone infection that is difficult to treat and locate |
|
|
Term
| medications for Tx of acute osteomyelitis |
|
Definition
-IV antibiotics: 4-6 weeks: PCN, amoxicillin, augmentin, cephalosporins
-if not healed proceed to oral abs
-aminoglycosides: getamycin, tobramycin |
|
|
Term
| before you hang an antibiotic you always want to ask your patient |
|
Definition
|
|
Term
| if a patient is allergic to PCN they may also be allergic to |
|
Definition
|
|
Term
| cephalosporins are at a risk for crossover with |
|
Definition
|
|
Term
| some examples of cephalosporin antibiotics |
|
Definition
cephalexin (keflex)
cefazolin (ancef) |
|
|
Term
| examples of aminoglycosides. what are they used for? |
|
Definition
antibiotics for the treatment of acute osteomyelitis.
aminoglycosides: getamycin, tobramycin |
|
|
Term
| precautions when using aminoglycosides |
|
Definition
| they are very potent so you MUST check peaks and troughs of blood levels |
|
|
Term
| adverse effects of the use of aminoglycosides |
|
Definition
ototoxicity
renal toxicity |
|
|
Term
| medications for the prevention of DVT |
|
Definition
|
|
Term
|
Definition
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