lOMoARcPSD|26582732
Medical
surgery Exam 1
study guide
2025
medical surgery 2 (florida state college at jacksonville)
all the doctor with compartment syndrome→ perry ch 48
• Compartment syndrome occurs when tissue pressure within a confined body space
becomes elevated and restricts blood flow. The resulting ischemia can lead to tissue damage
and eventually tissue death.
A. Compartment syndrome is a serious complication that results from compression of
nerves, blood vessels, and muscle inside a closed space.
• Compartment syndrome evaluation→ assess the extent of injury—”the 6 ps”
1. Pain: severe pain that is not relieved by analgesics or elevation of the limb, movement that
increases pain
2. Pulselessness: inability to palpate a pulse distal to the fracture or compartment
3. Pallor: pale-appearing skin, poor perfusion, capillary refill greater than 3 s
4. Paresthesia: tingling or burning sensations
5. Paralysis: inability to move extremity or digits
6. Pressure: involved limb or digits may feel tense and warm; skin is tight, shiny; pressure
within the compartment is elevated
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post hip surgery care: hydration, q2 repositioning, neurovascular checks, abduction pillow → iggy ch
46
A. Early ambulation, leg exercises, and compression stockings/devices promote venous return and
peripheral circulation which helps prevent deep vein thrombi.
A. Anticoagulants such as subcutaneous low–molecular-weight heparin are used for all
clients who have a total lower extremity joint arthroplasty.
A. The nurse would encourage fluids to expand blood volume and promote circulation; fluids would
not be restricted.
surgery may be indicated when conservative measures and/or drug therapy no longer
provide pain control.
A. The most common surgical procedure for oa is total joint arthroplasty (tja)--> a surgical creation of a
functional [synovial] joint using implants),
A. Total hip arthroplasty→ if the patient has a joint replacement for the first time, it is referred to as
**primary arthroplasty.** →if the implant loosens or fails for any reason, a revision arthroplasty
may be performed to replace the previous one.
A. Tja is a procedure used most often to manage the pain of oa and improve mobility.
These disorders include rheumatoid arthritis (ra), congenital anomalies, trauma,
and osteonecrosis.
A. Use an abduction pillow or splint (rather than bed pillows) to keep their legs apart
and prevent adduction, especially if the patient is very restless or has an altered
mental state. Hip adduction can cause the surgical hip to become partially or
completely dislocated.
A. Be alert to decreasing mental status and/or elevated white blood cell count as
indicators of infection→ especially older adults, they will experience delirium.
• Osteonecrosis→ bone death secondary to lack of or disruption in blood supply to the
affected bone, usually from trauma or chronic steroid therapy.
1. Contraindications for tja are active infection anywhere in the body and rapidly progressive
inflammation. Severe medical problems, such as uncontrolled diabetes or hypertension,
put the patient at risk for major postoperative complications and possible death
• Post-op care for hip surgery→ the patient and joint coach learn postoperative exercises,
transfer and positioning techniques, and ambulation with a walker or crutches, depending
on the patient’s age and stability.
manage pain - distraction , medication , opioids, non-opioids , adjuvant analgesic →perry ch 30,
Mccuiston ch 6-7
pain is often associated with fear, anxiety, and stress. A number of nonpharmacologic
techniques, such as distraction, relaxation, guided imagery, and cutaneous stimulation, can
help with pain control.
Distraction
A. Involve the parent and child in identifying strong distractors.
A. Involve the child in play; use radio, tape recorder, cd player, or computer game; have child sing or
use rhythmic breathing.
A. Have the child take a deep breath and blow it out until told to stop.
A. Have child blow bubbles to “blow the hurt away.”
A. Have child concentrate on yelling or saying “ouch,” with instructions to “yell as loud or soft as you
feel it hurt; that way i know what’s happening.”
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A. Have the child look through a kaleidoscope (type with glitter suspended in a fluid-filled tube) and
encourage him or her to concentrate by asking, “do you see the different designs?”
A. Use humor, such as watching cartoons, telling jokes or funny stories, or acting silly with the child.
A. Have the child read, play games, or visit with friends.
• Other forms of non-pharmacologic pain management→
containment/swaddling, non-nutritive sucking, kangaroo care.
• Principles for pharmacologic pain management should include:
a. Using a two-step strategy
A. Dosing at regular intervals
A. Using the appropriate route of administration
A. Adapting treatment to the individual child
A. Consider around the clock dosing
Non-opioids →acetaminophen (tylenol, paracetamol) and nsaids (antipyretic/anti inflammatories) are
suitable for mild to moderate pain.
A. Acetaminophen (tylenol) → nonprescription→ a higher dosage range may provide increased
analgesic→ antipyretic
A. Indomethacin→ nsaid→ used for patients who have osteoarthritis and rheumatoid arthritis.
A. Ibuprofen (children’s motrin, children’s advil)--> nonprescription
A. Naproxen (naprosyn) → prescription→ used for dental pain, muscle aches, and menstrual cramps.
They have a ceiling effect→ taking more than needed/supposed to will not produce a greater pain relief
effect.
Opioids→ opioids are needed for moderate to severe pain→ opioids also have a ceiling effect and are
imposed by side effects.
• Morphine remains the standard agent used for comparison to other opioid agents.
• When morphine is not a suitable opioid, drugs such as hydromorphone hydrochloride (dilaudid) and
fentanyl citrate (sublimaze) are used.
A. Hydromorphone is a potent opioid, and significant differences exist between oral and iv dosing. Use
extreme caution when converting from one route to another.
A. Methadone initially should be titrated like other strong opioids.
A. Administer iv opioids over 3 to 5 minutes.
• The optimum dosage of an analgesic is one that controls the pain without producing undesirable side
effects→ requires titrating the drug down instead of abruptly stopping it.
• Morphine sulfate→ opioid
Contraindications: hypersensitivity, cns or respiratory depression, status asthmaticus, increased intracranial
pressure, shock, alcohol use disorder, ileus, hypovolemia, dysrhythmias
• Caution: respiratory insufficiency, seizures, renal or hepatic disorders, urinary retention, sleep
apnea, older adults
therapeutic effects/uses : to relieve moderate to severe pain
Mechanism of action: depression of the cns; depression of pain impulses by binding with opiate receptors in
the cns.
Side effects: anorexia, dry mouth, nausea, abdominal pain, diarrhea, constipation, flatulence, fever,
drowsiness, dizziness, agitation, anxiety, dysgeusia, confusion, depression, urinary retention, rash, blurred
vision, miosis, weakness, flushing, euphoria, peripheral edema, paresthesia, diaphoresis, pruritus, infection,
back pain, insomnia, erectile dysfunction
Downloaded by NELSON KIIRU ()
Medical
surgery Exam 1
study guide
2025
medical surgery 2 (florida state college at jacksonville)
all the doctor with compartment syndrome→ perry ch 48
• Compartment syndrome occurs when tissue pressure within a confined body space
becomes elevated and restricts blood flow. The resulting ischemia can lead to tissue damage
and eventually tissue death.
A. Compartment syndrome is a serious complication that results from compression of
nerves, blood vessels, and muscle inside a closed space.
• Compartment syndrome evaluation→ assess the extent of injury—”the 6 ps”
1. Pain: severe pain that is not relieved by analgesics or elevation of the limb, movement that
increases pain
2. Pulselessness: inability to palpate a pulse distal to the fracture or compartment
3. Pallor: pale-appearing skin, poor perfusion, capillary refill greater than 3 s
4. Paresthesia: tingling or burning sensations
5. Paralysis: inability to move extremity or digits
6. Pressure: involved limb or digits may feel tense and warm; skin is tight, shiny; pressure
within the compartment is elevated
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
post hip surgery care: hydration, q2 repositioning, neurovascular checks, abduction pillow → iggy ch
46
A. Early ambulation, leg exercises, and compression stockings/devices promote venous return and
peripheral circulation which helps prevent deep vein thrombi.
A. Anticoagulants such as subcutaneous low–molecular-weight heparin are used for all
clients who have a total lower extremity joint arthroplasty.
A. The nurse would encourage fluids to expand blood volume and promote circulation; fluids would
not be restricted.
surgery may be indicated when conservative measures and/or drug therapy no longer
provide pain control.
A. The most common surgical procedure for oa is total joint arthroplasty (tja)--> a surgical creation of a
functional [synovial] joint using implants),
A. Total hip arthroplasty→ if the patient has a joint replacement for the first time, it is referred to as
**primary arthroplasty.** →if the implant loosens or fails for any reason, a revision arthroplasty
may be performed to replace the previous one.
A. Tja is a procedure used most often to manage the pain of oa and improve mobility.
These disorders include rheumatoid arthritis (ra), congenital anomalies, trauma,
and osteonecrosis.
A. Use an abduction pillow or splint (rather than bed pillows) to keep their legs apart
and prevent adduction, especially if the patient is very restless or has an altered
mental state. Hip adduction can cause the surgical hip to become partially or
completely dislocated.
A. Be alert to decreasing mental status and/or elevated white blood cell count as
indicators of infection→ especially older adults, they will experience delirium.
• Osteonecrosis→ bone death secondary to lack of or disruption in blood supply to the
affected bone, usually from trauma or chronic steroid therapy.
1. Contraindications for tja are active infection anywhere in the body and rapidly progressive
inflammation. Severe medical problems, such as uncontrolled diabetes or hypertension,
put the patient at risk for major postoperative complications and possible death
• Post-op care for hip surgery→ the patient and joint coach learn postoperative exercises,
transfer and positioning techniques, and ambulation with a walker or crutches, depending
on the patient’s age and stability.
manage pain - distraction , medication , opioids, non-opioids , adjuvant analgesic →perry ch 30,
Mccuiston ch 6-7
pain is often associated with fear, anxiety, and stress. A number of nonpharmacologic
techniques, such as distraction, relaxation, guided imagery, and cutaneous stimulation, can
help with pain control.
Distraction
A. Involve the parent and child in identifying strong distractors.
A. Involve the child in play; use radio, tape recorder, cd player, or computer game; have child sing or
use rhythmic breathing.
A. Have the child take a deep breath and blow it out until told to stop.
A. Have child blow bubbles to “blow the hurt away.”
A. Have child concentrate on yelling or saying “ouch,” with instructions to “yell as loud or soft as you
feel it hurt; that way i know what’s happening.”
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
A. Have the child look through a kaleidoscope (type with glitter suspended in a fluid-filled tube) and
encourage him or her to concentrate by asking, “do you see the different designs?”
A. Use humor, such as watching cartoons, telling jokes or funny stories, or acting silly with the child.
A. Have the child read, play games, or visit with friends.
• Other forms of non-pharmacologic pain management→
containment/swaddling, non-nutritive sucking, kangaroo care.
• Principles for pharmacologic pain management should include:
a. Using a two-step strategy
A. Dosing at regular intervals
A. Using the appropriate route of administration
A. Adapting treatment to the individual child
A. Consider around the clock dosing
Non-opioids →acetaminophen (tylenol, paracetamol) and nsaids (antipyretic/anti inflammatories) are
suitable for mild to moderate pain.
A. Acetaminophen (tylenol) → nonprescription→ a higher dosage range may provide increased
analgesic→ antipyretic
A. Indomethacin→ nsaid→ used for patients who have osteoarthritis and rheumatoid arthritis.
A. Ibuprofen (children’s motrin, children’s advil)--> nonprescription
A. Naproxen (naprosyn) → prescription→ used for dental pain, muscle aches, and menstrual cramps.
They have a ceiling effect→ taking more than needed/supposed to will not produce a greater pain relief
effect.
Opioids→ opioids are needed for moderate to severe pain→ opioids also have a ceiling effect and are
imposed by side effects.
• Morphine remains the standard agent used for comparison to other opioid agents.
• When morphine is not a suitable opioid, drugs such as hydromorphone hydrochloride (dilaudid) and
fentanyl citrate (sublimaze) are used.
A. Hydromorphone is a potent opioid, and significant differences exist between oral and iv dosing. Use
extreme caution when converting from one route to another.
A. Methadone initially should be titrated like other strong opioids.
A. Administer iv opioids over 3 to 5 minutes.
• The optimum dosage of an analgesic is one that controls the pain without producing undesirable side
effects→ requires titrating the drug down instead of abruptly stopping it.
• Morphine sulfate→ opioid
Contraindications: hypersensitivity, cns or respiratory depression, status asthmaticus, increased intracranial
pressure, shock, alcohol use disorder, ileus, hypovolemia, dysrhythmias
• Caution: respiratory insufficiency, seizures, renal or hepatic disorders, urinary retention, sleep
apnea, older adults
therapeutic effects/uses : to relieve moderate to severe pain
Mechanism of action: depression of the cns; depression of pain impulses by binding with opiate receptors in
the cns.
Side effects: anorexia, dry mouth, nausea, abdominal pain, diarrhea, constipation, flatulence, fever,
drowsiness, dizziness, agitation, anxiety, dysgeusia, confusion, depression, urinary retention, rash, blurred
vision, miosis, weakness, flushing, euphoria, peripheral edema, paresthesia, diaphoresis, pruritus, infection,
back pain, insomnia, erectile dysfunction
Downloaded by NELSON KIIRU ()
