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med surgical
skeletal disorders and gi
139
Medical
Professional
09/09/2007

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Term
inflammatory condition of the pancreas
Definition
pancreatitis
Term
what is the cause of acute or chronic pancreatitis
Definition
alcohol, trauma, damage to the bilary tract, infectious disease
Term
what are the two factors most commonly associated with pancreatitis
Definition
1. acohol
2. biliary tract disease
Term
in pancreatitis the enzymes cannot flow out of the pancreas due to
Definition
stones, scarring, edema
Term
what is a serious development of pancreatitis
Definition
abscess and psuedocysts
Term
what is the CM of pancreatitis
Definition
severe abdominal pain radiating to the back. Jaundice is also noted
Term
how can the pain be decreased from pancreatitis
Definition
flexing the trunk, leaning foward from a sitting position, or b sitting in a fetal position
Term
how can the pain be decreased from pancreatitis
Definition
flexing the trunk, leaning foward from a sitting position, or b sitting in a fetal position
Term
what are some other complaints of pancreatitis
Definition
nausea, anorexia, malaise, retlesness
Term
objective ataincludes
Definition
noting the presence of low grade fever, vomiting in 70 - 90 % of pts. jaundice, wt loss steatorrhea and tachycardia
Term
how do you diagnose pancreatitis
Definition
there will be increased amalyse an lipds

CT or ultrasound
Term
how do you diagnose pancreatitis
Definition
there will be increased amalyse an lipds

CT or ultrasound
Term
what is the tx of pancreatitis
Definition
NPO and NG tube, pain meds

surgery may be indicated if the biliary tract disease is present

TPN
Term
what type of diet should a person on pancreatitis have
Definition
bland, low fat, high protein, high carb

no alcohol, no coffee
Term
what is the nursing interventions
Definition
bed rest, pain meds
Term
disorders of the biliary system are common in the US and are responsible for the hospitilization of more than a half million people a year
Definition
cholecystitis and cholelithiasis
Term
who do you see cholecystitis and cholelithiasis
Definition
women than men, american indians and whites in obese people, pregnant women, people with diabetes
Term
cholecystitis is
Definition
inflammation of gallbladder
Term
cholelithiasis
Definition
presene of gallstones
Term
cholecystitis can be caused by
Definition
obstruction of a gallstone or a tumor
Term
clinical manifestation of cholecystitis is
Definition
sudden onset of n/v and severe , colicky pain in the RUQ of the abdomen, hx of fat intolerance
Term
subjective data includes c/o
Definition
indegestion after eating foods high in fat.

anorexia, flatulence, vomiting, nausea,
Term
what is the objective data
Definition
low grade fever and an elevated leukocyte count, mind jaundice, stools that contain fat (steatorrhea), clay colored stools, urine is dark amber or tea colored
Term
dx tests for cholecystitis
Definition
fecal studies, serum bilirubin test, US, HIDA scan, oral cholecystogram
Term
if the attack is mild cholecystitis the pt is treated
Definition
conservatively, bed rest, NG tube is inserted and low suction, NPO
Term
what type of diet should the person have with cholecystitis
Definition
low in fat and cholesterol, avoidance of spicy foods
Term
what is the tx of choice for cholecystitis
Definition
cholecystctomy - removal of the gallbladder
Term
an endscopic examination that enables direct visualizing of a joint.
Definition
arthroscopy
Term
type f disease in which there is an inflammation of a joint
Definition
arthritis
Term
most serious form of the disease and leads to severe crippling. it is a chronic systemic disease that affects 3% of the population
Definition
RA
Term
who does RA affect
Definition
75 % of women
Term
RA is thought to be an
Definition
autoimmune disease
Term
RA can affect many what
Definition
organ systems
Term
RA is characterized by
Definition
chronic inflammation of the synovial membrane of the diathroses joint
Term
RA is characterized by
Definition
chronic inflammation of the synovial membrane of the diathroses joint
Term
RA is characterized by
Definition
chronic inflammation of the synovial membrane of the diathroses joint
Term
what is the objective data collected
Definition
joint edema, tenderness, subcutaneous nodules, limited ROM, especially morning stiffness, symmetrical joint involvement, fever
Term
what are the dx tests for RA
Definition
ESR, Latex agglutination test, RF, Red cell count, synovial fluid aspiration
Term
Medical treatment early is most beneficial, tx is aimed at
Definition
administering NSAIDs
pain relief
prolonging joint function
slowing progression of joint damage- daily exercise, PT, wt management
Term
what are some nursing interventions and pt teaching
Definition
rest most imp. 8 - 10 hours and 2 hour naps

exercise- quiet 10 - 15 min two to three times a day

heat lamps, paraffin wax

rehab
Term
most important about pt teaching is
Definition
teach a person about the disease process
Term
osteoarthritis is also called
Definition
degnerative joint disease
Term
this disease is an almost inevitable consquence of aging and is a major cause of severe chronic disability
Definition
osteoarthritis
Term
it is anonsystemic noninflammatory disorder that progressively causes bones and joints to degenerate
Definition
osteoarthritis
Term
nearly all people over ____ will show show osteorarthritic changes
Definition
60
Term
objective data for osteoarthritis will reveal
Definition
joint edema, herberdens nodes appear on the distal side
bouchards nodes - appear on the proximal joints of fingers
pts gait will reveal a limp
Term
the doctor will order what for osteoarthritis
Definition
rest periods with excercise, PT, gait enhancers, heat applications, drug therapy
Term
what else can be done for osteoarthritis
Definition
osteotoy,arthroplasty of the hip and knee is the most common
Term
what is the nursing intervention
Definition
help pt maintain ADLs
Term
metabolic disorder resulting from an acumulation of uric acid in the bood. it is an acute inflammatory condition associated with ineffective metabolism of purines
Definition
gout
Term
who does gout effect
Definition
men more than women
Term
85% of people will develop
Definition
tophi
Term
what is tophi
Definition
calculi containing sodium urate deposits that develop in periarticular fibrous tissue,
Term
what is the clinical manifestation of gout
Definition
excruciating pain that occurs at night, mainly occurs in the big toe
Term
tophi are seen around the
Definition
ear, fingers, hands,toes
Term
data collectioon involves a dietary history with specific questions concerning coonsumption of
Definition
alcohol, foods high in purine
Term
what are some foods high in purine
Definition
organ meats, brain, kidney, liver, heart, anchovies, yeast, herring, mackeral, scallops
Term
nurse should notice signs of
Definition
edema in the big toe, redness, purple, hypertension, tachycardia, tachypnea
Term
what are the lab tests for gout
Definition
serum and urine uric acid levels
Term
what is the medical management for gout
Definition
several drugs
Term
what is an important nursing intervention for gout
Definition
administration of 2000 m daily helps eliminate the excess urinary urates
Term
hip replacement is commonly perormed when arthritis involves the
Definition
head of the femu and acetabulum
Term
in hip replacement how should the leg be kept
Definition
abducted
Term
pt should limit hip flexion to _____ degrees for approx. 2 - 3 months
Definition
90
Term
what is the most common fx treated in the hospital
Definition
hip fx
Term
hip fx is involved in either
Definition
intracapsular fx or extracapsular fx
Term
what is the CM of hip fx
Definition
pain at site, inability to move the leg voluntarily, shortening or external rotation of the leg
Term
the most important thing the nurse can do is keep the injured part at
Definition
rest because movement of a fxbone can cause additional damage and may cause a closed fx
Term
treating what takes presidence over treating the fx
Definition
shock
Term
what is the preferred method of managing hip fx
Definition
surgery
Term
what is some pt teaching for hip fx
Definition
pt should not elevate the leg while sitting, dont cross legs , HOB should be at 45 degree angle,use abduction pillow for 7 - 10 days,
Term
complications of hip fx are the most common cause of death after the age of
Definition
75
Term
first fx are described as eiter
Definition
open (compound) or closed (simple)
Term
incomplete fx in which the fx line extends only partially through the bone. bone is broken and bent but stilled secured on one side. most commonly seen in children
Definition
green stick fx
Term
fracture line extends entirely through the bone. with the periosteum disrupted on both sides of the bone
Definition
complete fx
Term
bone is splintered into three or more fragments at the site of the break. there is more than one fx line
Definition
comminuted fx
Term
sometimes called a telescope fx, one bone fragment is forcibly wedged into another bone fragment, it can create a shortening of the extremity
Definition
impacted fx
Term
sometimes called a telescope fx, one bone fragment is forcibly wedged into another bone fragment, it can create a shortening of the extremity
Definition
impacted fx
Term
breakruns directly across the bone, it is at a right angle of the bones axis
Definition
transverse fx
Term
breakruns directly across the bone, it is at a right angle of the bones axis
Definition
transverse fx
Term
break runs along a slant to the length of the bone, it is approx at a 45 degree angle to the shaft of the bone
Definition
oblique fx
Term
break coils around the bone. sometimes called a torsion fx and results from a twisting force
Definition
spiral fx
Term
fx of the distal portion of the radius within 1 inch of the joint . this occurs when the person attempts to break the fall with there hands
Definition
colles fx
Term
occurs at the distal end of the fibula characterized by chipping of the medial malleolus with a displacement of the foot outward
Definition
potts fx
Term
pathological condition caused yb the pregressive development of arterial vessel compesson and reduced blood supply to affected extremity
Definition
compartment syndrome
Term
compartment syndrome can be caued by
Definition
tight casts or dressing, muscle ischemia
Term
irreversible muscle ischemia can occur within
Definition
6 hours
Term
paralysis can occur in
Definition
24 - 48 hours
Term
subjective data for compartment syndrome is
Definition
severe pain that can not be alleviated with pain meds. numbness or tingling of extremities
Term
subjective data for compartment syndrome is
Definition
severe pain that can not be alleviated with pain meds. numbness or tingling of extremities
Term
objective data of compartment syndrome includes
Definition
inability to flex fingers or toes, coolness of the extremity and absence of pulsation in the affected extremity

skin will have pallor , or cyanosis capillary refill will be slow
Term
what is the treatment for compartment syndrome
Definition
fasciotomy - to relieve pressure, it is done immediately within 30 minutes. the incision is left open to heal by granulation
Term
nursing interventions for compartment syndrome
Definition
pain medication administration
keep affected limb elevated no higher than heartlevel
cold packs - removal of constricting material
purulent drainage is sign of infection
Term
what is a permanent contraction tha can occur becasue of compartment syndrome
Definition
volkmanns contracture - permanent contracture, (with clawhand, flexion of wrist and fingers, and atrophy of the forearm)
Term
involves the embolization of tissue fat with platelets and circuating free fatty acids within the pulonary capillaries
Definition
fat embolism
Term
when should you expect a fat embolism
Definition
person has multiple fx of long bones and the pelvis
Term
what is the most serious complcation of long bone fx
Definition
fat embolism
Term
the onset of a fat embolism usually occurs within
Definition
48 hours
Term
subjective data includes assessment of
Definition
mental disturbances, irritability, restlessness, disorientation, stupor, coma
Term
collection of objective data includes assessing the pt for
Definition
hypoxemia, auditory crackles, dyspnea, tachypnea, wheezes
Term
the dr will order what with fat embolism
Definition
iv fluids, steroid therapy, digoxin, oxygen, IS
Term
what is the most common cause of death in fat embolism
Definition
respiratory failure
Term
form of traction used as temprorary measure to provide support and comfort to a fx extremity until a more definite tx is initiated. . traction pull s in a horizontal plane with affected extremity. freq used to treat muscle spasms and monor fx of the lowe
Definition
bucks traction
Term
a knee sling is used to provide support of the affected leg. it allows more movement in bed and permits flexion of hte knee joint. usually used to treat hip and knee fx
Definition
russel fx
Term
used in pediatrics for small children with fx femurs. both legs are suspended ata 90 degree angle to the runk of hte body, and the w of hte lower body pulls the bone fragments of hte fx leg into alignment
Definition
bryants traction
Term
painful disorder of the wrist or hand, induced by compression on the median nerve between the inelastic carpal ligament and other structures in the carpal tunnel
Definition
carpal tunnel syndrome
Term
carpal tunnel syndrome results from pressure on the median nerve on the wrist symptoms of
Definition
paresthesia (sensation of pins and needles) and hypoesthesia (decrease in sensation
Term
there is a higher incidence of this in
Definition
women who are obese, middle aged women involving repetitious motions of hte fingers and hands
women in there last trimester
Term
the affected hand has alterred ability to
Definition
grasp or hold small objects
Term
subjective data includes
Definition
c/o burning pain or tingling in the hands relieved with vigoruos shaking or exercising of hte hands, numbness, inability to grasp or hold objects
Term
objective data includes assessment of the
Definition
hand, wrist, or fingers for edema, muscle atrophy or a depressed appearance of hte soft tissue at the base of hte thumb onthe palmar surface
Term
dx tests for carpal tunnel syndrome are
Definition
physical exam
electromyogram
MRI
handheld electroneurometer
Term
medical management for carpal tunnel syndrome is
Definition
splint if you have mild symptoms
hydrocortisone acetate suspension injections - mild sx
surgery for severe sx
Term
if surgery is required the post op intervetions are as follows
Definition
1. elevate hand and arm for 24 hours
2. implementing and evaluating active thumb and finger motion
3. administer meds
4. monitor v/s
5. check fingers for circulation, sensation, movement every 1 - 2 hours for 24 hours
Term
amputation can be done for
Definition
trauma, diabetes, tumors, impaired circulation
Term
if replantation takes place the severed limb should be kept sterile and placed
Definition
in a moist plastic bag filled with ice water. keep away from ice, do not use dry ice
Term
subjective data in an amputation includes
Definition
assessment of pain
level of orientation
neuro impairment
Term
objective data include what in an amputation
Definition
assess v/s
assess bilateral pedal pulses and doppler pressure measurements
assess wound drainage for color, amount and presence of odor
evaluate upper body strenght and nutritional status
Term
dx tests include
Definition
cbc, bun, K levels, ECG
Term
post op care of pt w/amputation includes noting subjective data such as
Definition
phantome pain
Term
collection of objective data after amputation includes
Definition
observing for hemorrhage
monitoring suction drainage and documenting
assesing and protecting the remaining extremety
observe for nero impairent - done hourly in the immediate post period
Term
flexion hip contractures can be prevented postop by
Definition
raising the foot of the bed slightly to elevate the residual eextremity (do not elevate the stump on a pillow)
Term
what are the risk factors for duodenal ulcers
Definition
H. pylori infection, NSAIDS, cigarette smoking, and coffee
Term
what is the characteristic symptoms of duodenal ulcers
Definition
pain, symptom are described as dull, burning, burning, and gnawing, it is located in the midline of the epigstric region
Term
when GI bleeding occurs what are some signs
Definition
vomiting (hematemesis) coffee grounds

also, melena (tarlike, fetid - smelling sgtool containing undigested blood
Term
gastric outlet obstruction is a complication of a
Definition
peptic ulcer
Term
what is done for relief of a person with gastric outlet obstruction
Definition
constant NG aspiration
Term
what type of diet should the pt with ulcers have
Definition
smaller more frequent meals throughout the day
Term
what surgery is performed for ucers
Definition
vagotomy
Term
what is a vagotomy
Definition
removal of the vagal innervation to the funds, decreasing acid produced by the parietalcells of the stomach. usually done with the bilroth I and II procedure
Term
ulcerative colitis and crohns disease occur more often in
Definition
women, in the jewish population
Term
ulceratrive colitis is confined to the mucosa and submucosa of hte colon
the disease usually starts on the
Definition
left side of the colon and go to the right
Term
what is the CM of ulcerative colitis
Definition
diarrhea - up to 15 - 20 loose stools a day containing pus and blood and mucus
Term
what is a complication of ulcerative colitis
Definition
toxic megacolon
Term
subjective data for ulcerative colitis is
Definition
c/o rectal bleeding and abdominal cramps. lethargy, sense of frustration and loss of control
Term
objective data includes
Definition
wt loss, abdominal distention, fever, tachycardia, leukocytosis, stool changes
Term
med tx of ulcerative colitis
Definition
medication, diet intervention, stress reduction
Term
diet should exclude
Definition
milk products, spicy foods
Term
ileostomy
Definition
surgical formation of an opening of hte ileum onto the surface of hte abdomen, through fecal matter is emptied
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