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this is for the LPN course @ CONA. Second mid-term exam. Objesctives 4,5,6

what are wet dressings used for?

used to apply solution to skin lesions, left in place until debridement used

what tempuature should a therapeutic bath be ?

tepid

what is the purpose of using a therapeutic bath?

relives inflammation, itching, also aids in removal of crusts and scales

what is surgical excision?

excision of tissue by, laser therapy, cryosurgery, electrodesication

acne vulgaris

ifammation due to affected hair follicles and sebaccous glands

what is a furuncle?

boil

carbuncle

furuncle with purulent drainage

signs and symtoms of psoriasis?

patches of erythema covered with silvery scales

treatment for psoriasis?

corticosteroids, coal tar extracts and in extreme cases Photochemotherapy

it is important to pt teaching for photochemothereapy____________

to avoid sunlight for 8hr after receiving treatment

scabies

common and infectious

Signs and symptoms of scabies?

sever itching, especially at night. Mostly affects webs of fingers, elbows, armpits......etc.

treatment for scabies?

topical scabicide. Apply in think layer, leave on for 8-12 hrs and then wash off. wash all clothing/linens in HOT water

Shingles (herpes Zoster)

virus lays dormant in nerve root, migrates to cranial or spinal nerve root)

signs and symptoms of shingles

vesticles follow along nerve pathway

what is pediculosis

Lice

treatment of pediculosis?

nix shampoo

what are the major complications of a burn?

Edema, fluid loss, low blood pressure, SHOCK, electrolyte deficits

characteristics of a 1st degree burn?

superficial, epidermis injured, painful

characteristics of a 2nd degree burn?

+3 wks to heal, may need debridement, may require skin graphs

characteristics of a 3rd degree burn?

destroys all layers of the skin, needs debridement and grafting, may involve muscle and bone

the main thing to look for in a burn pt?

inhalation injury, hypovolemic shock

initial Tx of a burn?

Lay pt flat, assess respiratory status

what do you NOT do for burns?

do not apply anything to the burn, do not remove clothing, nothing by mouth, so not immerse burn in cold water

Acute care for burns would include the following:

ventilation, fluid resuscitation, analgesics for pain, inserting catheter, monitor input and output, prevention of shock

wound management for burns would include:

remove foreign material, shave hair around burn, open or closed method of Tx

nsg care for burns:

Assess for respiratory distress, maintain airway, monitor breathing: maintain fluid balance

When assessing for pain for a burn injury the Pt may need ____________

freq. sedation, esp for a dressing change

when assesing a burn Pt for infection you should :

be aware of sepsis, reverse isolation, monitor temp, keep Pt warm

in preventing dangers of immobilization be aware of:

proper alignment,keep the skin surfaces from touching, use turning frames and cradles

inhance tissue repair in burn Pt's by :

increase calorie intake to 6000cal/day, diet high in protein

Common diagnostic tests include:

arthroscopy, arthrocentesis, bone densitometry, and bone scan

Arthroscopy is:

a surgical procedure to view inside a joint

arthrocentesis

surgical puncture of the joint space to remove synovial fluid

bone densitometry

x-ray to measure bone density & compare to known standards for age & gender

bone scan

uptake of a radioactive substance is measured in bone

traumatic injuries include:

strain, contusion, sprain

sprain:

a painful injury to a joint caused by a sudden wrenching of its ligaments

strain

muscle stretched beyond capacity

contusion

soft tissue injury from blow or blunt trauma

dislocation

a displacement of a part (especially a bone) from its normal position (as in the shoulder or the vertebral column)*may disrupt blood supply, hear a Popping sound!

Nsg for dislocation

elevate and immobilize, perform neurovascular checks every 30min

Fracture

a break in a bone

signs and symptoms of a fracture

severe pain, pain increases with movement , deformity, crepitus

crepitus

Crackling sound produced when ends of bone rub against each other or against roughened cartilage.

Closed reduction (dealing with fracture)

bone is restored to normal position by external manipulation, used bandage or traction

Open reduction (dealing with fractures)

Surgery to realign bones, internal fixation may be used

cast

rigid mold, hip spica, cylindar and body cast

External fixation

pins inserted into bones from outside skin

internal fixation

bones secured with metal screws, rods, nails, pins

traction

(orthopedics) the act of pulling on a bone or limb (as in a fracture) to relieve pressure or align parts in a special way during healing

Signs and symptoms of a fractured femur

severe pain, ecchymosis (bruising), connot move hip/knee,

Tx for fractured femur?

skeletal traction, SPICA CAST

Nsg for fractured femur?

pin site care, prevention of pressure ulcers, constapation, pneumonia, blood clots etc.

Asses for shock by?

assessing Loss Of Consciousness, and mental status, monitor pulse and BP

assessing for anxiety by?

involve Pt's , encourage contact w/ family

What are some signs and symptoms of a broken hip?

pain radiating to the knee, affected leg shorter and externally rotated

Nsg care for a broken hip would be?

place trochanter roll beside affected when in recumbent position, this prevents the hip from rolling outward. Also elevate; flexion no more then 90 degrees

open method exposure involves this:

reverse isolation, Escher removal by debridement

Closed method involves more then ____ ___ ___ ______ .

one type of dressing

what is envolved in surgical management of a burn?

debridement

What are some of the benifit of skin grafting?

decreased the chance of infection, as well as decrease fluid loss

autograft

tissue that is taken from one site and grafted to another site on the same person

allograft

tissue or organ transplanted from a donor of the same species but different genetic makeup

heterograft

tissue from an animal of one species used as a temporary graft (as in cases of severe burns) on an individual of another species

skin substitute or synthetic skin is applied when?

after cleansing and debridement

how is synthetic skin grown?

from the clients own cells

some complications of fractures include?

shock, pulmonary embolism, compartment syndrome avascular necrosis

what is compartment syndrome?

tissue profusion into muscle compartment compromised by tissue swelling, hemmorage, or a cast that is to tight

how could compartment syndrome be prevented?

elevation of extremity, application of ice, neurovascular checks

avascular necrosis

bone tissue death due to interruption of blood supply

rheumatoid arthritis

a chronic autoimmune disease with inflammation of the joints and marked deformities

what are some signs and symptoms of rheumatoid arthritis?

Acute onset with blateral and symmetrical joints affected, decrease in mobility, the joint become spongey, nodules over joints

what are some systemic signs of rheumatoid arthritis?

Anorexia and weight loss, muscle weakness, extremities appear smooth and glossy as well as they may be cold and clammy

Tx for rheumatoid arthritis may include?

although there is no real treatment, gold therapy may be used

Nsg care for rheumatoid arthritis could include?

Transcutaneous electrical nerve stimulation (TENS), teaching about the disease, medications and heat and cold therapy

osteoarthritis

chronic breakdown of cartilage in the joints

Characteristics of osteoarthritis

limited to one or two joints, degenerative, common in the elderly and obese

early signs of osteoarthritis include:

joint stiffness, pain after inactivity

later signs of osteoarthritis may include:

pain unrelieved by rest, develop herberden/ bouchard nodes

herberden / bouchard nodes

Hard and tender bumps and lumps, crepitus

Tx of osteoarthritis includes

NSAIDS, TENS, heat, rest

Nsg care for osteoarthritis

medication teaching, encourage good posture, keep head of bed 45 degrees or less

Gout

a painful inflammation of the big toe/foot or hand/fingers caused by defects in uric acid metabolism resulting in deposits of the acid and its salts in the blood and joints

characteristics of gout include:

attacks last 1-2 weeks, swelling and tenderness may last longer

Tx for gout includes

try to control attacks in two ways 1) anti-gout meds, decrease amount of ingested purines

Temporomandibular D/O

malocclusion of teeth, bruxism (grind teeth)meniscus displaced from fossa of temporal bone, jaw pain form muscle spasm

Systemic Lupis Erythematosus

Connectice tissue disease, Affects multiple body systems, most prominent sig being red butterfly rash on face

fibromyalgia

a chronic disorder characterized by widespread aching and stiffness of muscles and soft tissues and fatigue

bursitis

inflammation of a bursa

S&S of bursitis include

painful movement of joint, distinct lump at joint

Tx fro bursitis

rest, mild ROM exercises, salicytates, NSAIDS

ankylosing spondylitis

chronic, progressive arthritis with stiffening of joints, primarily of the spine

S&S of ankylosing spondylitis

flattened lumbar curve, aortic regulation, permanently flexed neck, reduced lung sounds

Tx for ankylosing spondylitis

medications, back brace

Osteomalacia

bone pain, waddling gait caused form insufficient calcium deficiency

pagets diseas

abnormal bone remodeling, skeletal deformity

osteomyelitis

bone infection, treated by antibiotics and immobilization

Lyme disease

an infection caused by the bite of an infected tick; symptoms vary but may include a rash at the site of the bite and flulike symptoms such as fever, headache, joint pain, and fatigue

Benign tumors

An abnormal growth of tissue confined to a particular area; not considered to be cancer.

Malignant tumors

mass of cells that invade the surrounding tissue. Caused by radation exposure, toxic chemicals

Primary

Originating from bone,

Secondary

metastatic, originating from somewhere else in the body

Amputation

a surgical removal of all or part of a limb

some compilactain of an amputation may include:

hematoma, hemorrhage, infection, "phantom Limb"

1-2 days after amputation surgery Nsg should:

encourage self care, assist with walk/crutches, assist with active isometric exercise, no put a pillow btwn the legs

It is important aftet amputation to

keep the stump elevated only for the first 24-48 hours, after this DO NOT ELEVATE THE STUMP.

colloid solutions

consists of water molecules of undissolved substances

1U whole blood contains

475ml bld cells and plasma, 60-70ml added preservatives and anticoagulants

albumin

a simple water-soluble protein found in many animal tissues and liquids

cryoprecipitate

deficient in clotting factors, hemophilia A&B

What complications can occur when giving a blood transfusion?

Allergic, hemolytic, febrile, anaphalatic, circulatory

what is the NSg for an allergic reaction when transfusing blood?

decrease infusion rate, report, give antihistamine

what are the main characteristics of a hemolytic reaction when transfusing blood?

back pain, chest pain, shock . this is the most deadly and most rare of all reactions

hemolytic

Transfusion reaction caused by incompatibility

Nsg for a hemolytic reaction include

Call for help, Stop transfusion, infuse normal saline and a increased rate in a lower port

febrile reaction is

allergy to proteins in donor blood, it is also the most common

Tx for a febrile reaction is

stop transfusion and start normal saline

anaphylactic reaction

caused by sensitivities to immune globulins passed from donors blood

Signs and symptoms of anaphylactic reaction during a blood transfusion

respiratory distress, dyspnea, cyanosis

Tx for anaphylactic reaction during transfusion

STOP transfusion, do not restart, administer meds,

Circulatory over load during a transfusions is ?

a rapid transfusion in a short period, a sign of this is hypertension, dyspnea, and bounding pulse

Nsg for circulatory over load would be

Stop transfusion, notify Dr, give Oxygen and elevate head of bed

before obtaining blood products/ component from the blood bank you must verify:

client availability, client ID band affixed properly, written or verbal order documented, clients vital signs are acceptable, IV access established

what should the infusion start at

50-120ml /hr for the first 15 min, if there are no adverse reactions then increase the rate to 150ml/hr

how long is the time frame for each unit of blood given

2hrs, you should also stay with the Pt for the first 15min of the infusion

what is the MAX time acceptable blood can be hung for a transfusion

4 hours

what percentage of people are RH positive>

85%

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