Med Surg A - Exam 4

Estrogen: Influence on Bone - induces osteoclasts to self-destruct and slow rate of bone destruction, menopause = prone to bone loss Calcitonin/TSH: Influence on Bone - inhibits osteoclast activity PTH: Influence on Bone - promotes activity and # of osteoblasts Growth Hormone: Influence on Bone - initiates growth of bone until adult size is reach Muscles - structures that contract and help produce movement Skeletal muscle - conscious, voluntary control of movement of body Supination - movement that turns the palm up Pronation - turning the palm downward Flexion - decreases the angle of a joint Extension - increases the angle of a joint Abduction - movement away from the midline Adduction - movement toward the midline Circumduction - circular movement of a limb at the far end Inversion - turning inward Eversion - turning outward Protraction - moving a body part forward and parallel to the ground Retraction - moving a body part backward and parallel to the ground Elevation - raising a body part Depression - lowering a body part Smooth Muscle - involuntary/under control of ANS, which controls contraction of organs & blood vessels Cardiac Muscle - contracts without neural stimulation due to automaticity, which allow heart to set rhythm thru pacemaker cells Joints - union between 2+ bones, permit mobility, provide support Nonsynovial Joints - joined by fibrous tissue/cartilage, immovable Synovial Joints - freely movable Cartilage - avascular structure that receives nutrients from synovial fluid & provides additional cushion to joints Ligaments - fibrous connective tissue present at joints which helps to stabilize them; made of collagen; bone to bone connection which stops undesired movement Tendon - fibrous connective tissue that connects muscle to bone and facilitates movement Fascia - layer of interconnected fibers of connective tissue with elastic properties that enclose, stabilize, and separate muscle/organ Bursa - cushion between tendons & skin or ligaments & bone Assessment: PMH/History of Present Illness - o Pain: location, quality, time frame, exacerbating factors, things that improve it o Swelling: presence of it, time it was first noticed, any increase/decrease o Stiffness: location, duration, degree o Deformity: any change from uninjured state or affected area o Weakness: presence, degree, increased/resolved since injury o Instability: presence, degree, level of functioning o Loss of function: inability to function in a manner that it previously did o Color or temp changes o Altered sensation: numbness, tingling o Associated symptoms o Response to treatment Assessment: Physical - posture, gait, joint mobility, sensation, pulses, muscle tone & strength Diagnostic Studies - labs (calcium, vit D, hormones), x-ray, CT, MRI, arthrogram, DXA, bone scans, EMG, arthroscopy, arthrocentesis Arthrogram - § series of images taken of a joint after contrast medium has been injected. After administration of local anesthetic, a radiologist or orthopedic provider uses fluoroscopy or ultrasound to accurately inject the appropriate quantity of contrast into the joint. This procedure allows for visualization of soft tissue structures of a joint: the tendons, ligaments, muscles, cartilage, and joint capsule DXA Scan - bone mineral density test Indications: osteoporosis, postmenopausal state, baseline tests, client presents with loss of height/bone pain/fractures Preprocedure: not recommended during pregnancy, remove metallic objects Postprocedure: f/u to discuss supplements and medications EMG - § diagnostic test that assesses the health of motor neurons and muscle. Motor neurons transmit electrical signals to the muscles that make them contract. Using tiny needle electrodes that are strategically placed on the muscles, the EMG machine translates these signals into graphs or numbers that the practitioner interprets. This test takes approximately 30 to 60 minutes and is done to distinguish nerve dysfunction, muscle dysfunction, or problems with nerve-to-muscle signal transmission Arthroscopy - allows visualization of internal structures of a joint through use of an endoscope; most common for knees/shoulders Indications: joint swelling, pain; can diagnose injury; can repair torn ligament or meniscus; can perform biopsy Preprocedure: ensure consent is signed Postprocedure: Postop care, Assess neurovascular status and dressing every hour, Mild analgesia/opioids Complications: infection Strain - injury to muscle or tendon Sprain - injury to ligament Diagnosis: Sprain/Strain - H&P, radiography, US, MRI Treatment: Sprain/Strain - RICE Complications: Sprain/Strain - Chronically unstable joints, Bursitis, Tendinitis, Frequent recurrence Nursing Diagnoses: Sprain/Strain - acute pain, altered peripheral tissue perfusion, impaired physical mobility Assessment: Sprain/Strain - inspection, palpation, history of injury Education: Sprain/Strain - immediately report worsening symptoms Fracture - disruption or break in the continuity of a bone Diagnosis: Fracture - H&P, radiography, CT Treatment: Fracture - nonsurgical (closed reduction), surgical (open reduction - internal/external fixation) Complications: Fracture - Neurovascular compromise Venous thromboembolism Fat embolism Traumatic rhabdomyolysis: clinical and biological syndrome secondary to lysis of striated muscle fibers resulting in extended musculoskeletal damage Hypovolemia Infection Malunion, nonunion Compartment syndrome: occurs when the pressure within a compartment increases, restricting the blood flow to the area and potentially damaging the muscles and nearby nerves Nursing Diagnoses: Fracture - acute pain, activity intolerance, impaired mobility, impaired skin integrity Assessment: Fracture - vitals, physical, proper positioning, labs, urine appearance, I&Os Interventions: Fracture - Maintain pulmonary hygiene Administer analgesics Administer medications Wound/pin care Elevation Ice ROM exercises Repositioning Hydration, nutrition Positive feedback & encouragement Education: Fracture - Treatment Healing process Importance of consuming adequate calories Appropriate analgesia Wound care Exercise, ambulation Slings, splints, casts, traction Self-care Goals: Fracture - Remain free from infection Using analgesia as ordered No neurovascular compromise Compliant with nutrition, activity, exercise Stable vitals, I&Os, perfusion Myasthenia Gravis - autoimmune neuromuscular disorder characterized by weakness of voluntary muscles Myasthenia Gravis: Epidemiology - men women onset in men is 60-80, onset in women is 20-30 most patients are over 50 no known risk factors Myasthenia Gravis: Clinical Manifestations - ocular: ptosis, diplopia bulbar: involve cranial nerves, difficulty with chewing/swallowing and phonation generalized trunk/limb weakness respiratory deterioration Myasthenia Gravis: Diagnosis - serological testing, repetitive nerve stimulation, single-fiber electromyography, tensilon test, CT scan Myasthenia Gravis: Assessment - comprehensive neuro assessment with detailed cranial nerve assessment motor strength vital capacity & lung sounds dysphagia nutrition dysarthria Myasthenia Gravis: Nursing Diagnoses - risk for ineffective breathing risk for aspiration fatigue Myasthenia Gravis: Surgical Management - thymectomy Myasthenia Gravis: Interventions - meds as ordered, elevate HOB, establish communication method, plan meals when meds are peaking, offer soft foods/thickened liquids, plan for rest Myasthenia Gravis: Medications - first line = anticholinesterase drugs: pyridostigmine, neostigmine second line = immunotherapy/prednisone, azathioprine, cyclophosphamide third line = plasmaphoresis, IV immunoglobulin Myasthenia Gravis: Education - o Meds as prescribed/adherence o Keep medication with you at all times o Medic alert bracelet o Avoid public places (infection risk) o Obtain vaccines to prevent flu/pneumonia o Prevent fatigue through frequent rest periods o Referrals as needed Myasthenia Crisis - exacerbation of weakness that provokes acute episode of respiratory failure that is often caused by respiratory infection tachy, flaccidity, cool and pale skin tensilon test will improve strength managed with immunoglobulin IV or plasmapheresis Cipro can bring on, lack of anticholinergics, trauma, stress, altitude, neuro muscular blocking meds (sedatives, opiates), surgery Cholinergic Crisis - caused by excess anticholinesterase meds brady, fasciculations, sweating, pallor, excess secretions, small pupils tensilon test won't improve strength managed by temporarily discontinuing anticholinesterase meds Osteomyelitis - invasion of bone & surrounding tissue by bacterial pathogen (commonly staph aureus); involves bone necrosis & sinus tract formation Osteomyelitis: Clinical Manifestations - pain not relieved by rest, swelling, tenderness & warmth, fever, chills, malaise Osteomyelitis: Diagnosis - WBC, ESR, CRP, x-rays Osteomyelitis: Assessment - o Vitals o Pain o Wound o Neurovascular o Laboratory tests