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151 Cards in this Set

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What decreased the amount of swelling in the joints

Anti-inflammatory Corticosteroids
What conditions would use Anti-inflammatory Corticosteroids
Rheumatoid Arthritis, Busitis, and Tendonitis
Side Effects of Anti-inflammatory Corticosteroids
Muscle weakness, osteoporosis, immunosuppression, ployuria, polydipsia, abnormal fat distribution, growth retardation in children, weight gain, mood swings such as depression, edema
Common Anti-inflammatory Corticosteroids
Cortisone (Cortone), Prednisone (Deltasone), Betamethasone (Celestone), Hydrocortisone, Methylprednisolone (Solu-Medrol)
What drug is used to treat symptoms associated with gout
Anti-gout agents
What and Anti-gout agents can cause what adverse conditions
skin reactions and kidney impairment
What drug helps PREVENT an attack of gout (it does not relieve the pain)
Allopurinol (Zyloprim)
What is used to treat the pain of gout
Colchicine or an NSAID
Commone Anti-gout agents
Probenecid (Benemid), Sulfinpyrazone (Anturane)
What type of drug is used to decreased muscle spasm or muscle spasticity which occures in many different disorders
Musculoskeletal Relaxants
What do Musculoskeletal Relaxants act on
they are mostly central acting drugs
What is the only Musculoskeletal Relaxant that is peripherally acting medication primarly used to treat neuroleptic malignant syndrome
Dantrolene (Dantrium)
Which Musculoskeletal Relaxant may also be given as a continous infusion into the spine via an implanted pump
Baclofen (Lioresal)
Which Musculoskeletal Relaxant can cause the urine to become green, brown, or black
Methocarbarnol (Robaxin)
Common Musculoskeletal Relaxants
Carisoprodol (Soma), Chlorphenesin (Maolate), Cyclobenzaprine (Flexeril), Diazepam (Valium), Metaxalone (Skelaxin), Orphenadrine citrate (Norflex), Quinine sulfate (Quinamm), Tizanidine (Zanaflex)
What is the most worrisome side effect of aspirin
gastrointestinal bleeding
What do you never give to a person who has a possible viral illness
Aspirin and never give aspirin to children
What will decrease inflammation at a site of an injur without the more severe systemic side effects of steroids
Nonsteroidal anti-inflammatory drugs (NSAIDS) and Acetaminophen (Tylenol)
Primary side effects of concern with NSAIDS
gastrointestinal bleeding and perforated ulcers
NSAIDS adverse effects are
possible decrease in kidney function due to inhibition of prostaglandins
How can I minimize the stomach upset experienced by taking NSAIDS
take with food or milk
What is the main use of Acetaminophen
analgesic and antipyretic
What analgesic/antipyretic causes the least GI discomfort in those with stomach problesm of history of ulcers
Acetaminophen
What is the principle feature of Tylenol overdose
hepatic toxicity treat with mucamist
Which NSAID can be hepatotoxic and nephrotoxic and can alter coagulation studies
Ibuprofen (Motrin)
If GI discomfort with Ibuprofen
may take misoprostol (Cytotec) to help with the discomfort
Indomethacin (Indocin) is to be taken on a schedule to relaive pain associated with
gout
Additional NSAIDs
Kertolac (Toradol), Phenylbutazone (Butaxolidin), Piroxicam (Feldene), Diclofenac sodium (Voltaren), Diclofenac potassium (Cataflam), Etodolac (Lodine), Fenoprofen calcium (Nalfon), Flurbiprofen (Ansiad), Ketoprofen (Orudis, Oruvall), Meloxicam (Mobic), Nabumetone (Relafen), Naproxen (Aleve, Anaprox, Naprosyn), Oxaprin (Daypro), Sulindac (Clinoril), Tolmetin sodium (Tolectin), Tramadol (Ultram)
COX-2 inhibitors
decrease inflammation in thos with arthritis
COX-2 inhibitors can cause what adverse reaction
gastritis and upper gastrointestinal bleeding
There is only one COX-2 inhibitors on the market what is it
Celecoxib (Celebrex)
Selective estrogen receptor modulators (SERMS) are used for
treat osteoporosis in postmenopausal women
Selective estrogen receptor modulators (SERMS) have increased risk of
blood clots
Common Selective estrogen receptor modulators (SERMS)
Raloxifene (Evista)
Oral biphosphonates and calcitonin (Miacalcin) is used to
prevent and treat osteoporosis, think of Sally Fields
Oral biphosphonates and calcitonin (Miacalcin) adverse reactions
increased risk of infection.
Oral biphosphonates and calcitonin (Miacalcin) are contraindicated in clients with a history of
gastroesophageal reflux disease
Common Oral biphosphonates and calcitonin (Miacalcin)
Alendronate (Fosamax), Ibandronate sodium (Boniva), Resedronate (Actonel)
What is used to treat moderate to severe pain
Opioids
What do Opioids work on
the central nervous system to give a therapeutic effect
Lab effects of Opioid use
Increased amylase, lipase, liver enzymes, and CPK
Side effects of Opioids
Respiratory depression, Hypotension, Palpitations, Constipation, Urinary retention
Common Opioids
Alfentanil (Alfenta), Buprenophine (Buprenex), Butophanol (Stadol), Codeine, Fentanyl (Duragesic, Sublimaze), Hydromorphone (Dilaudid), Meperidine (Demerol, Pethidine), Metadone (Dolophine), Morphine sulfate, Nalbuphine (Nubain), Oxycodone (OxyContin), Oxymorphone (Numorphan), Pentazocine (Talwin), Tramadol (Ultram)
Anti-rheumatoid agent/gold compounds side effects
Decreased WBC and Hgb, Proteinuria, Hematuria, Nephrotic Syndrome, Increased Liver function studies, Jaundice, N & V
Common Oral Anti-rheumatoid agents
Hydroxychloroquine (Plaquenil), Leflunomide (Arava), Methotrexate (Rheumatrex, Trexall), Penicillamine (Cuprimine, Depen), Sulfasalazine (Azulfidine)
Common Oral Gold Compound
Auranofin (Ridaura)
Common Injectable Gold Compound
Aurothioglucose (Solganol), Gold sodium thiomalate (Aurolate), IV formulation is Infliximab (Remicaid)
Painful form of arthritis caused by a build up of uric acid
Gout
Diet for Gout
decrease consumption of food with purines such as liver, dried beans, shell fish, or the inability to excrete uric acid
Crystals formed in joints as a result of high uric acid levels is
Gout
Lab effects of Gout
Increased WBC, Uric Acid, and ESR
What is a sudden, involuntary, painful muscle contraction which may occur after injury
muscle spasms
What is an increse in muscle tone which produces stiff muscle movements
Muscle Spasticity
Tx for Muscle Spasms and Muscle Spasticity
stretching
Most common form of arthritis leading to degeneration and destruction of the cartilage of any joint, but most often the hands, knees, hips or spine
Osteoarthritis
Wear and tear disease is
Osteoarthritis, enlargement of the joints occurs, in the hands, nodes have been identified at the joint
Herberden nodes with Osteoarthritis
Distal joints of hands
Bouchards nodes with Osteoarthritis
Proximal joints of hands
Tx for Osteoarthritis for severe pain
joint replacements
Pain and swelling caused by inflammation of the synovial tissue. It is an inflammatory disorder, not degenerative. Considered autoimmune and can become systemic in severe cases
Rheumatoid Arthritis
Lab Effects with Rheumatoid Arthritis
Increase ESR and positive RA factor, note the ESR is normal in Osteoarthritis
Can Rheumatoid Arthritis go into remission
YES, early diagnosis is essential
Assessment for Rheumatoid Arthritis includes
inspection, palpation, strength testing DO NOT DO ROM BECAUSE IT WILL BE ALTERED AND WILL CAUSE PAIN
Age group for Rheumatoid Arthritis
may occur in children between 2-5 and 9-12 years and carry it throughout life
What happens to cartilage with Rheumatoid Arthritis
it thins and spurs form
Will see marked immobility, pain and muscle spasms with
Rheumatoid Arthritis
Treatment for Rheumatoid Arthritis
Corticosteroids, Immobilizaiton and rest, NSAIDS and aspirin for pain
Do’s with Rheumatoid Arthritis
exercise slowly and smoothly, exercise to increase mobility, take a hot bath or shower in the morning, lie in the prone position to exten hips and knees, sit in a straight back chair, change position every 20 minutes, slide objects rather then lift them.
Donts with Rheumatoid Arthritis
Do not exercise painful, swollen joints, do not exercise to the point of pain, Do not put pressure on the joints, Do not jerk joints with movements
Joint replacements activity restrictions may include
do NOT sit longer than 1 hour, do NOT turn them onto the operative hip, do NOT lift leg upward from lying or sitting position, do NOT lean forward in the chair when trying to get up, do NOT drive for 6 weeks after surgery unless allowed by the surgeon.
If bedpan is needed immediately after a hip replacement how do you teach the patient to move
fles the unaffected knee and use the trapeze bar to raise their hips.
Joint replacements care of support stockings
put support stockings on the unaffected leg and ACE bandage on the affected leg until the swelling has resolved
What are the most common complications with joint replacements
DVT in affected leg and infection, know that both are late complications
Decrease in bone mineral density leading to an increased risk of fracture
Osteoporosis
What is the most common cause of fractures in the elderly
Osteoporosis, especially women, fractures occur due to loss of bone mass
Most common fractures due to Osteoporosis
Vertebral fractures may occue due to the loss of bone mass, Hip fractures, Colle’s fracture of the forearm.
Dietary for Osteoporosis
High calcium, tums are good but they are high in sodium
Risk factors for Osteoporosis
Caucasion or Asion descent, Slender body build, Early estrogen deficiency, Nulliparity, Smoking, Sedentary lifestyle, Family history of osteoporosis
Chronic autoimmune disease that can be fatal
Lupus
What does the immune system attack with Lupus
bodys cells and tissues, resulting in inflammation and tissue damage which can affect any part of the body, but most often arms, heart, joints, skin, lungs, bood vessels, liver, kidneys, and nervous system.
Lab effects with Lupus
ESR increased
Lupus teachings
Reduction of stress, avoid sunlight, treatment is with steroids, HEAT for joint pain, Raynauds is often present with Lupus.
Chronic disease characterized by excessive deposits of collagen in the skin and other organs
Scleroderma
What disorder can be localized to the skin or it may be the systemic type which can be fatal due to involvement of the heart, kidney, lung and intestines
Scleroderma
With Scleroderma is swallowing difficult
YES
With Scleroderma is Raynaud’s commonly associated
YES
Teaching with Scleroderma
keep the skin well lubricated
What can decrease the risk of a fat embolism
gentle handling and maintain in the position the extremity is found in.
What are these symptoms of, tachycardia and petechiae over the chest
fat embolism remember chest pain is NOT a common complaint with a fat embolism
Is a greenstick fracture an incomplete fracture
YES
With any fracture assess for
blood vessel injury
What type of fracture is across the entire shaft with some possible displacement
Simple fracture
What can a compound fracture also be called
Open fracture
What type of fracture is where the bone has broken into several fragments
Comminuted Fracture
What do you see with a spiral fracture
twisting, may be related to abuse in infants
Does a intracapsular fracture heal quickly and easily
NO the fracture is cut off from the blood supply and necrosis can occur
What can long bone fracture lead to
Anemia so check hematocrit every 3-4 days to monitor
What does the initials ORIF stand for
Open reduction internal fixation
Infection of bone or bone marrow, usually caused by bacteria
Osteomyelitis, may do surgery and place in a cast to immobilize
Condition when all or part of the soft center of a spinal disk is forced through a weakened part of the disc
Herniated disk
Why is there pain with Valsalva maneuver with a Herniated disk
because it puts pressure in the central nervious system canal
Most common areas for spinal fractures
Cervical 5th, 6th, and 7th, Thoracic 12th, Lumber 1st
How many people do you need to log roll after spinal surgery and spinal fusion
two or more people after surgery with a fusion
Teaching with spinal surgery and spinal fusion
no prolonged sitting, stair climbing restricted intially, back brace is generally applied before getting out of bed after spinal surgery
What can I used for transfering patient from stretcher to bed after surgery
use a transfer board and the assistance of four people
What is it called when an amputee has itching, warmth, and cold felt in the area due to intact peripheral nerves in the area
Phantom limb sensation
Is Phantom limbe pain lifelong
YES , it is not well understood
How can I prevent hip contraction after amputation
elevation of limb for 24 hours on a pillow, then periodically afterwards, position on the abdomen for 30 minutes periods every 4-6 hours
Care of surgical site for an amputee
wear a clean woolen sock each day, clean daily with a gentle soap and water and dry carefully, oil and creams are avoided.
Teaching with Prosthesis
use it early to encourage a normal walking pattern, darkened skin edges around the residual limb indicate the prosthesis is a correct fit
Why does an amputee get darkened skin around the residual limb
the pressure of the prosthesis causes the release of hemosiderin, an iron-rich pigment, which causes the discoloration
Where is a bone marrow biopsy usually done
normally the illiac crest
What is used to clean the area of the bone marrow biopsy
povidone-iodine (Betadine) to cleanse the site, chloraprep is also acceptable
Teaching with bone marrow biopsy
local anesthetic will be used, mild pain expected afterwards (note causes of SEVERE PAIN early – bleeding, late – infection), Monitor for swelling, bleeding, or hemotoma formation, vital signs will be taken every 4 hours for 24 hours.
What test will be elevated in inflammatory disorders
ANA and erythrocyte sedimentation rate
Rheumatoid factor is positive in
Rheumatoid Arthritis
What is injected with a bone scan
low radioactive substance injected into the vein with a bone scan, the scan detects where the substance is deposited, can detect bone fractures
How often do I do Circulation and neurovascular checks for musculoskeletal issues
every hour initially
What are the five Ps when monitoring for signs of ischemia
Pain, Paresthesia, Paralysis, Pulselessness, Pallor
What will be used with an ORIF of the hip or after a knee replacement
a drain, a frequently a Jackson Pratt drain
Expected blood loss with a Jackson Pratt drain on a ORIF on the 1st day
200-500 mL in 24 hours
Expected blood loss with a Jackson Pratt drain on a ORIF on the 2nd day
100 mL in 24 hours
Expected blood loss with a Jackson Pratt drain on a Knee Replacement on the 1st day
200 in first shift
What would stop the knee from moving during the initial post op period
a knee immobilizer which may be ordered for client when getting them up to protect the joint
What is used to treat fractures and decrease muscle spasms experienced after an injury
Traction
What does TRACTION stand for
T = Temperature of the extremity and oral to monitor for infection, R=Ropes hang freely, A= Alignment of the extremity and the set up, C= Circulation checks for the 5 Ps, T=Type and location of the fracture determins need for traction, I=Increase fluid intake because of limited movement, O=Overhead trapeze to increase independence and muscle strength, N=No weights on the bed or the floow, do not release once established.
Once traction is applied can it be released periodically
NO
Is Bucks traction is skin traction
Yes
Is Russells traction skin traction
Yes, it is two weights pulling 2 different directions
Is Bryants traction skin traction
Yes
Is Pelvic traction skin traction
Yes
Does skeletal traction have pins or wires in place distal or proximal to the fracture
Distal
How many finger widths below the anterior axillary fold do you measure for crutches
2-3 finger widths below the anterior axillary fold to a point lateral and slightly in front of the foot
What angle should the elbow flexion when the handgrip is properly placed
30 degrees
How many inches in front and to the side of the clients toes should the crutches be for walking
6-10 inches
What does the rule three point gait with crutches mean
Three points touch down at once
How do you climb stairs with crutches
Good leg up bad leg and crutches down “Heaven up, Hell down”
What side do you use a cane on
strong side held six inches lateral to the fifth toe
Advance the cain with what side
the weak side
How do you use a walker
pick it up, set it down 2 feet ahead on all 4 points and walk to it
Where do belongings go on a walker
on the side of the walker, not in front due to it obstructs vision
How do you treat soft tissue injuries
with RICE for the first 24 hours after injury R=Rest, I=Ice, C=Compression, E=Elevation
Cast care teaching
elevate and ice the decrease swelling, swelling may occure after case removal, spica cast covers the lower extremity (will need bed rest, use fracture pan), Petal the edges of the cast to help with skin irritation
How often should Neurovascular checks for compartment syndrome
every hour whenever something is first done
How do you check brachial plexus and stutus of the ulnar nerve
spread all fingers wide and resist pressure
How do you check median nerve function
client should grasp the nurses hand, weakness of the grasp may indicate compromise
How do you check radial nerve function
move the thumb toward the palm and back to neutral position
How do you check the peroneal nerve
Flex the ankle and exten the toes
How do you check the tibial nerve
flex the foot downward
What are signs of compartment syndrome
increased pain and loss of sensation, buring pain ovver a site and a cast warm to touch may indicate tissue hypoxia
How do you treat severe cases with faciotomy
Wet sterile saline dressing to cover, woulds closed 3-5 days later, skin graft may be needed, any time a skin graft is discussed, do not disturb it