week 4 & 5 & 6 principles med surg II

while tendons connect muscle to bone; injury to either structure impairs movementligaments hold articulating bones togethersupport bone formationweight baring activities , sex hormones, calcitonin, and calcium intakeadults over 50 require 800-1000 IU of vitamin Dinstruct on the importance of calcium ( 1,200mg) and vitamin D ( 600 IU) intake along with sources ( Low fat milk,yogurt,cheese) ;while vit D is essential for calcium absorptioncalcium helps to maintain bonecould lead to osteoporosisexcessive cortisol and thyroid hormone production increase bone resorption andinhibits osteoclastic (bone resorption) activity ; thus menopause increases the risk for osteoporosisestrogen stimulates osteoblastic (bone formation) activity andresult in a loss in heightvertebral fractures and a loss in vertebral cartilage typicallylaboratory monitoring of bleeding timeslow molecular weight heparin does not requireto prevent atelectasisinstruct clients to perform coughing and deep breathing every 2 hourswhile plaster casts are heavy, can not get wet and take up to 3 days to completely dry ; both casts give off heat when drying so prepare client for this feelingfiberglass casts are light , water resistant and dry within 30 minutescasts that cover the heels and elbows are allowed to get wetskin maceration could occur ifindents which could cause skin breakdownhandle plaster casts with the palms of the hands to preventavoid placing on plastic ( heat is retained and drying is impaired)place plaster casts on a firm surface while drying andthe application of a cast, splint, or brace, to limit edemaelevate the limb above the level of the heart for the first 24-48 hours followingneurovascular status ( pallor, pain, paralysis, paresthesia, polar, pulselessness) immediatelyreport signs of impairedpain, pallor , paresthesias, paralysis, polkilothermia/polar, pulselessness and capillary refilldetermine change sin arterial blood flow by assessing fora pressure ulcerpain, tightness, and a localized feeling of heat over a bony prominence, in the setting of a cast, could suggestwhich could lead to necrosis and irreversible neuromuscular damagecompartment syndrome is a medical emergency and must be identified immediately; pressure within the muscle compartment or cast increases as perfusion to the area decreasessevere unrelieved pain that worsens with movementcompartment syndrome is marked byedema to the extremity, warmth , tenderness or fullness in the legclassic signs of DVT includeanticoagulants, anti-embolism stockings and/or sequential tedsprevent pulmonary embolism or DVT by usingDVT and infectionorthopedic surgery increases the risk ofvenous thromboembolismlow molecular weight heparin -enoxaparin- may be prescribed to preventperform pin site care using aseptic technique -use chlorhexidine 2mg/ml solution unless contraindicated -external fixators increase the risk for osteomyelitis socleaning with a circular motion from the inner to the outer region and cleaning each site separatelyperform pin care bycomplications related to painprovide patient controlled analgesia to help reducesome fractures due to loss of blood to the bone so the clients must be closely monitored for increased pain and decrease in mobilityavascular necrosis can occur followingabducting legs, prevent internal rotation of leg, turn to the unaffected side while maintaining abduction , avoid flexing the hip more than 90 degrees , keep leg in a neutral position , keep head of bed < 60 degrees , and avoid crossing the legsprevent hip dislocation following total hip arthroplasty byfollowing hip precautions for a minimum of 4 months -used raised toilet seats , avoiding crossing the legs, no bending at the waste, and sit with hips higher than the knees-instruct the client following total hip arthroplasty to prevent dislocation bylimb shortening , acute groin pain, external or internal rotation, limb deformity , crepitus and reduced mobilitysigns of hip dislocation includelimiting fluid accumulation and hematomasurgical drains help to reduce pain byinstructing the client on isometric exercisesprevent disease from immobilization byperoneal nerve damage and could result in foot drop - neurovascular assessments is a priority -pressure on the back or side of the knee increases the risk forpneumonia , decubiti , constipation and DVTimmobility increases the risk fortotal knee arthroplasty; the rate and joint extension and flexion are ordered by the surgeoncontinuous passive motion devices promote movement followingso the risk for flexion contractures increases when voluntary muscles control is lostflexor muscles are stronger than extensor musclesavoiding pillows behind the knee or not using the knee gatch on the bedprevent flexion contractures to the knee byto decrease pain from muscle spasmstraction helps to maintain bone alignment andensuring traction is continuous and uninterrupted , weights hang freely , knots are away from the pulley and the clients body is in proper alignmentcare for the client with traction byre positioning - while maintaining a supine position- , using pressure relieving mattresses, inspecting the skin three times a day and assessing from tendernessprevent skin breakdown from skin traction byweight reduction , strengthening exercises , lift objects using a wide base of support and use the leg and arm muscles - not the back - bend at the knees, avoid twisting the back , keep objects close to the body , push don't pullinstruct on proper body mechanics and strategies to prevent low back pain;bone demineralization and pathological fracturesconditions that increase PTH secretion could contribute tobone and contribute to pathological fracturesbone tumors can weakenmeasure bone density and diagnose osteoporosis - T score of -2.5 -dual energy x-ray absorptiometry (DEXA) scan is used tosuper infections - oral or vaginal candidiasis , pseudomembranous colitis -long term antibiotic use increases the risk forosteoclastic activity and promote calcium deposition into bonebiophosphonates - alendronate- inhibitbisphosphonates so encourage yearly dental evaluationsosteonecrosis of the jaw is a potential risk withand to sit upright for at least 30-60 minutes - risk for esophageal ulcers -instruct patients to take oral bisphosphonates on an empty stomach , with 8 ounces of waterphysical modalities , mind-body methods, biologic and energy based therapiesprovide non-pharmacological pain management strategies such asbones become porous and brittle - osteoporosis -when osteoclastic activity is greater than osteoblastic activitytypically requires weight-bearing restrictionsosteomyelitis weakens the bone andpain, swelling, warmth , elevated erythrocyte sedimentation rate, and leukocytesosteomyelitis is marked bypainful vertebral compression fractures and reductionosteoporosis could lead toosteoporosisthin, Asian or Caucasian women have the greatest risk foran increase in blood pressure, heart rate and respiration'spain stimulates the sympathetic nervous system and could result induration, -when it started - type - includes intensity, associated factors, influencing factors -what makes it better or worse and locationa comprehensive pain assessment includeslocal anesthetics, non opioids or opioidsmanage noceceptive pain withand supine position without pillows under the knees following a below the knee amputation - except first 24 hours-prevent flexion contractures following amputations; prone position to prevent hip contractures following an above the kneeinstruct on not sitting for prolonged periods of time - hip flexion-extend the limb following an amputation to prevent flexion contractures , keep legs close together and avoid hip or knee flexion;reduce limb edemaapply uniform compression to the amputation tocrepitus , deformity , edema , loss of function, limb shortening and painfractures are marked byhypovolemic shock( hemorrhage) , fat embolism ( long bones) and compartment syndromecomplications following fractures includechest pain, cough , dyspnea, hypoxemia, tachycardia, tachypnea, petechiae, and restlessnessclinical manifestations of pulmonary embolism consist ofconfusion , restlessness, and irritability occur in the setting of a fractureobtain an ABG ifa wrist fractureencourage range of motion to the fingers and shoulder followingperfusion and leads to unresolved ischemiaavascular necrosis may follow joint dislocation's if the bone injury impairswhich is actual pain that is felt after an amputationuse opioids to manage phantom limb pain,during the first 72 hours to limit inflammation and promote healingtreat tissue injury with rest , ice,compression and elevationand immobilize fracturebuck's traction helps to decrease pain and muscle spasmsthe parts of your immune system that you are born withnatural ( innate) immunity aredetermine the effectiveness of chemotherapytumor markers ( fro ex: CEA, CA 125) are monitored to helpalcohol and caloric intake and increasing activity level, using sunscreen with a minimum spf 5 , limiting sun exposure and using condomseducate on avoiding carcinogens ( smoking ) limitingannual fecal occult blood test , at age 50, prostate specific antigen at age 50, pap test every 3 yearsscreen for cancer; annual mammogram starting at age 40, colonoscopy at age 50 every 10 years ,communicate the size of the tumor, if lymph nodes are involved and if there is metastasisstaging of a tumor is done toso never use the hand or wrist and prevent extravasation by confirming patency of I.V deviceextravasation of a vesicant could result in tissue necrosisbland foods and small, frequent meals are used to decease nausea and vomitingseratonin receptor blockers ( ondansetron, granisetron) , dopaminergic receptor blockers ( metoclopramide, prochlorperazine) ,increases the risk for infection , bleeding and fatiguemylosuppression , induced by chemotherapy , results in pancytopenia andprotect the bladder with I.V hydration and diuresissome chemotherapy agents could induce hemorrhagic cystitis which could lead to a life threatening hemorrhage soblood return is absent or there is burning pain or swelling to the sitesuspect an increase risk for extravasation if resistance is met while flushing I.V catheter ,neurovascular assessments of the affected extremity should be performedfollwing a extravasation ,blistering skin rash, diffuse inflammation to the G.I tract with massive diarrhea or hepatomegalygraft verses host disease could presentbone marrow transplantation until new marrow engraftment occurssepsis and bleeding are major complications followinginfection so a temp >100.4 for an hour is significant and should be reportedbeing immunocompromised reduces clinical manifestations ofavoiding rectal or vaginal procedures , using electric razors , avoid using stagnant water and reduce exposure to sources of infectionreduce the risk for infection by implementing neutopenic precautions ( WBC <1,000)they dry the mucosa , use a soft toothbrush , avoid rough , hot or spicy foods and remove dentures unless eatingadvise the client with stomatitis to avoid mouthwashes that contain alcohol or tobacco becauseserving cold foods since they are less odorous , encouraging oral hygiene , provide small frequent meals, and make sure pain managedimprove oral intake in the setting of nausea bypetechiae and eccymosiscommon signs of thrombocytopenia includeare thrombocytopenicavoid rectal route for medication administration for patients whoincreased dyspnea, facial and neck edema, jugular vein distention, visual disturbances, and headachesigns of superior vena cava syndrome includelevel of consciousness , hyporeflexia, ileus, constipation, polyuria, and polydipsiahypercalcemia is an oncologic emergency and is marked by a progressive change inhyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia; bradydysrhthmias, wide QRS complexes, tented T waves, tetany, seizures, and flank painclinical manifestations of tumor lysis syndrome includetumor lysis syndromepreventing renal failure and achieving electrolyte balance is a priority in the setting ofwhile benign tumors do not metastasizemalignant neoplasms invade other areas ( metastasis ) and branch offdestroy abnormal cellscancer develops when the immune system fails to recognize andor delayed -several courses after the medication - and stop the medication immediatelymonitor for hypersensitivity reactions which could be acute -within 15-30 minutes -or stimulate neutrophil production to decrease the risk for infection ( neupogen)colony - stimulating factors stimulate RBC production decreasing the need for blood transfusions -erythropoietin-complications related to painprovide patient controlled analgesia to help reduceis typically prescribed with folic acidmethotrexate contributes to folic acid deficiency and results in cell deathduration( when it started) type ( intensity , associated factors) influencing factors ( better or worse) and locationa comprehensive pan assessment includesphysical modalities , mind body methods, biologic and energy based therapiesprovide non-pharmacological pain management strategies such asbed rest, in a private room , provide low-residue foods , give anti-diarrheal agents to prevent dislodgement of device, and insert a foleyprevent dislodgement of intracavitary low dose radiation by maintaining the client onlimiting time with the client, wearing dosimeter badges, keeping pregnant staff or visitors and children out of the room, limiting visits to 30 minutes and keeping 6 feet away from the radiation sourceradiation safety precautions ( brachytherapy) includea radioactive device dislodgeskeep a lead container in the room in caseincreased irritation, obtain an order for a cream or ointment and use a nonadhesive pad over the areatreat wet desquamation by leaving blisters intact and notify primary care provider , avoid frequent washing of the area because ofvoid after intercourse, pneumococcal and influenza vaccine , cough and deep breathing exercises , sit up while eatingreduce the risk for infection with elderly ; drink plenty of fluids unless contraindicated, use lotion, assessing for signs of skin breakdown, change incontinence pads frequentlythe immune system and help to destroy organismsCD4 cells ( helper T cells) stimulatean inflammatory response and chemicals ( all are used to remove or destroy pathogens )natural immunity allows the body to resist infection by responding to foreign substances with WBC,respond to pathogens either actively or passiveacquired immunity is the type of response that allows the body tosince your immune system will actively generate antibodies in response to the antigena vaccine or prior exposure to a disease provides active immunityantibodies that are given to you . ( note you have immediate protection although the duration of protection is shorter than active immunity )breastfeeding and immune globulin are types of acquired immunity since they containinfections from organisms that do not typically cause a problem, poor treatment response and chronic diarrheaimmunodeficiency is marked by frequent infections that could be severe,an increase in lymphocytes indicate a viral infection ( although lymphocytes are also elevated in some bacterial infections as well)all increase in neutrophils indicates bacterial infection whileinfectionprotein deficiency increases risk foropportunistic infectionsthe reduction in T cells increases the risk forexcess alcohol consumption , poor nutrition, smoking, glucocoticosteroids , and diabetes mellitusinstruct on factors that increase the risk for infection;organism is resistant to the prescribed antibioticnotify the provider if a culture and sensitivity reveals that theinfectionredness , swelling , tenderness, purulent drainage fever and chills and an elevated WBC count are classic signs ofadministration of iodinated contrast mediummetformin should be stopped 48 hours before and after thedecrease in Pa02 ( <50 mm hg) and an increase in paco2 (>50mm/hg) with respiratory acidosisacute respiratory failure is manifested by ametabolic acidosis and electrolyte imbalances ( specifically hypernatremia and hypokalemia)diarrhea could lead toand avoid nicotine which could also stimulate bowel motilityencourage clients who have diarrhea to avoid foods that stimulate peristalsis ( fiber rich foods, lactulose)the individual has antibodies and has been infected with the virusa positive human immunodeficiency virus test shows thatautoimmune deficiency , lambskin is not effectiveinstruct on the use of latex condoms to decrease the risk ofblood , breast milk, semen and vaginal secretions and is also found in urine , saliva and tearshuman immunodeficiency virus is primarily transmitted throughimmunity which could lead to life threatening opportunistic infectionshuman immunodeficiency (virus targets CD4+ cells ( T cells) and impairsfever, chills, night sweat , weight loss, lymphadenopathy and fatiguetypical clinical manifestations of H.I.V arethe most common life threatening infection that individuals with autoimmune deficiency will encounterpneumocystis pneumonia is caused by the bacteria P. jiroveci and ispainful and could extend from the mouth to the esophagus and stomach if left untreatedoral candidiasis could make swallowing difficult andkaposi's sarcoma and non hodgkins lymphomaautoimmune diseases increase the risk for cancerblindness when individuals have autoimmune deficiencycytomegalovirus attacks the retina and is the leading cause ofmonitoring serum albumin, protein and transferrin level along with food intakeassess nutritional status byfever, chills , night sweat , weight loss, lymphadenopathy and fatiguetypical clinical manifestations of H.I.V arethe risk of bloodborne pathogens -hepatitis B , H.I.Vimplement standard precautions for all clients to help decreasedyspnea , tachypnea , crackles, tachycardia , labored breathing, dullness on percussion, and a decrease in oxygen saturation'sclients with pneumonia may present withprophylactic therapy to prevent pneumocystis pneumonia and is started with T-cells count less than 200 cells/mm3trimethropin -sulfamethoxazole (TMP-SMZ) is used astreat oral candidiasisantifungal agents ( clotimazole, ketoconazole or fluconazole) can be used toantiviral medication ( acyclovir, famciclovir or valacyclovir)herpes simplex or zoster is typically treated with anminimize fatigue which could decrease appetiteencourage the client to rest before meals help tospiritual therapy , guided imagery , positive affirmations, reflexology and yogaCAM extends beyond the use of nutritional therapies and includesoccur after re-exposure to an allergen that the body has been sensitized tohypersensitivity reactions ( type I-IV) typicallysudden allergic reactionanaphylaxis is a life threateningdiseases like myasthenia gravis can occurwhen the body mistakenly creates antibodies that attack the tissue of the host ( type II hypersensitivity )active allergic responseeosinophils are typically elevated in annot be performed if bronchospasms are presentskin testing for allergies shoulddeposited into tissue or vascular endothelium ( rheumatoid arthritis , systemic lupus erythematosus )a hypersensitivity reaction (type III) occurs when the immune complex isdecreases the risk of systemic reactionthe radioallergodorbent test (RAST) uses serum to measure allergen-specific IgE whichanaphylaxis could result in angioedema, anxiety, bronchospasms, cough, dyspnea , dysphagia, dizziness, edema, hypotension, pruritis and wheezingdepending on the severity and system involved,when clients have allergieseducate on the importance of informing health care providers and wearing medical IDwhile leukotrienes trigger bronchial constriction; increase in mucus production and skin reactionshistamine contributes to bronchspasms , wheezing , pruritis and localized edematypically followed by phagocytic clearingthe formation of immune complexes isphagocytic clearing typically followsafter immune complexes are formed( urticaria, pruritis , flushing) epinephrine , corticosteroids and vasopressors for severe reactions ( bronchospasms, hypotension, shock, laryngeal edema)prepare to give antihistamines ( diphenhydramine) for mild allergic reactionspreventing the development of new symptoms ( this drug does not stop the release of histamine from mast cells so administer early)antihistamines (H1 Blockers ) prevent histamine from binding to receptor sites thusepinephrine is readily availableallergen injections could induce systemic reactions and should only be given whereepinephrine, antihistamines, and corticosteroidstreatment for anaphylaxis includesseek medical attention following the use of this medication since a rebound or delayed reaction could occur several hours laterinstruct clients who are prescribed an EPIpen auto injector tobuttocks and to call 911 after injecting into the thigheducate on the importance of never injecting an EpiPen into thebecause of the risk for rebound congestionlimit adrenergic agents ( vasoconstriction ) to a few daysand could mask infectioncorticosteroids inhibit inflammatory response, suppress adrenal gland activity, increase the risk of hyperglycemia and hypernatremia, and hypokalemiametered dose inhalerrinse mouth after using corticosteroidaddisonian crisis ( acute adrenal failure)long term use of corticosteroids (prednisone) contributes to adrenal atrophy and hypofunction and abrupt cessation of corticosteroids could lead tolimit production or block the inflammatory effects of leukotrienesleukotriene modifiers ( zafirlukast, montelukast, zileuton)nasal decongestants ; nasal mucosa is more edematous with medication use prompting the use of more medicationrhinitis medicamentosa is a rebound rhinitis that occurs with overuse ofalcohol ingestion , foods high in purines ( shellfish , organ meats) or illnessinstruct clients that gout attacks can be triggered bypain and edema to the joint of the big toegout is typically marked bythat there is an infection or inflammationan increase in erythrocyte sedimentation rate suggeststhis disease affects nearly every organ in the bodyin systemic lupus erythematous the immune system creates antibodies to a part of the cells nucleusheberden's nodes ( distal interphalangeal joint ) and bouchards nodes (proximal interphalangeal joint) pain, loss of function, ambulating with a limp and crepitus in the affected jointclinical manifestations of osteoarthritis includepain, joint swelling with limited movement , stiffness, weakness and fatiguetypical manifestations of rheumatic disease isacetaminophenosteoarthritis is initially treated withsuppress inflammation and prevent joint erosion; however these drugs increase the risk for infection so monitor closelybiological disease modifying antirheumatic drugs help toapplying splints to the area and allowing the joint to restmovement to inflammed joints can be limited byare key goals in the management of rheumatic diseasemaintaining or improving functional status and joint mobility ; reducing inflammation and controlling painexercise , joint protection, relaxation, foam mattress , splints and the application of heat or coldmanage pain in the setting of rheumatic disease withosteoarthritis is a noninflammatory degeneration of articular cartilage marked by joint pain that lasts < 30 minutes and resolves with restRA is marked by symmetrical joint pain and swelling involving the small joints ( hands, wrists, and feet) that lasts more than 1 hour;make swallowing difficultdrying of the mucus membranes in sjogrens syndrome could

week 4 & 5 & 6 principles med surg II

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