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med surg exam 2

Terms in this set (179)

X-rays - most commonly used
CT - assess allergies to iodine-based contrast.
Bone scan (nuclear scan): involve IV injection of radioisotope
Prior to scan: assess allergies to radioisotope and contraindications (e.g.pregnancy, breast-feeding); empty the bladder before scanning the pelvic bones. May have contraindications in renal compromised patients. All patients should drink 32oz of water to filter isotope.
May experience hot flushes from isotope during the procedure
After scan: encourage fluids intake; No precautions required in handling the excreta.
Arthrography: involve injection of radiopaque contrast or air into the joint cavity
After arthrogram, a compression bandage applied; rest joint for 12 hrs; avoidstrenuous activity; mild analgesia; ice for comfort; clicking or crackling in the joint is expectedfor 24-48 hrspost the procedure.
MRI
Ensure all metal objects are removed.
Contraindications include pregnancy, pacemakers, stents, electronic or metal implants, clips, claustrophobic.
Bone Densitometry: Remove metal objects
Ultrasonography/ Fluoroscopy
Biopsies - bone biopsy, muscle biopsy; ice application; watch for bleeding and infection post procedure.
Arthrocentesis- analgesics for pain during procedure; ice application 24-48 hrs post-procedure; monitor for complications (e.g. infection, bleeding)
Electromyography (EMG)
Evaluate muscle weakness; discontinue muscle relaxants (e.g. cyclobenzaprine) before the procedure.
Contraindicated for patients on anticoagulant therapy, extensive skin infections.
Not to use any lotions or creams on the day of the test.
Ice application to hematoma after the procedure. Warm compresses may relieve residual discomfort after the procedure
Arthroscopy - diagnostic test or surgical procedure, most commonly used for knee & shoulder evaluation.
The patient must be able to flex the knee, no infection.
Preventing hip dislocation (major complication) - correct positioning at all times
Supine with head slight elevated, the affected leg in a neutral position & an abduction splint/ pillows placed between legs to prevent adduction beyond the midline of the body.
Avoid flexing the hips more than 90 degree. Hips should be higher than knees while sitting.
Do not sit or stand for prolonged period. Do not bend forward when seated in a chair. Do not cross legs beyond the body midline. Do not bend at the waist to put on shoes & stocks or pick up an object.
Do not twist body when standing.
Avoid stresses to the new hip joint for the first 8-12 weeks, when the risk of dislocation is greatest.
Keep the operative hip in abduction when turning the ptin bed to the unaffected side
Avoid turning the ptto the affected side unless specified by the surgeon.
Use assistive/adaptive devices (e.g. high-seat chairs, semi-reclining wheelchairs, raised toilet seats).
Preventing DVT and PE - intermittent compression devices at all times; oral warfarin or subcutaneous enoxaparin, early mobilization
Preventing Infection - monitor for altered conscious status; Do not rely on fever as a sign of infection.
Preventing pressure ulcers for all older adult pts - pressure-relieving mattress & heels off the bed with cradle boot.
Monitoring wound drainage: assessing for bleeding (200-500 mL in the 1st24 hrs; by 48 hrs= < 30mL/8 hr) and managing anemia
Assessing for neurovascular compromise
Managingpain with NSAIDs, acetaminophen, oral opioids
Promoting mobility and activity - out of bed day of or within a day after surgery (limited flexion must be maintained);
Use of assistive/adaptive devices (walker, crutches) to help ADLs. Can resume routine ADLs by 3 months.