Med Surg 1 Exam 7

• Amputation


  • Lose circulation in limb
  • Tissue dies, becomes infected
• Nursing Interventions


  • Training, conditioning of limb in rehab
  • PT, OT, Emotional, Physical training
  • Reduce edema
  • Elevation
  • Range of motion, especially in hip
  • Lay prone at times a day
  • Handle limb gently
  • Measure for edema
  • Pressure to reduce edema
  • Nutrition
  • Figure 8 wrap
  • Rigid pressure dressing
  • Negative pressure dressings when lots of drainage or infection
• Nursing Interventions - Prosthesis

  • Avoid placing residual limb on pillows when in bed
  • Shape stump with elastic bandages
  • Condition the limb as prescribed
  • Massage limb
  • Skin care
  • Exposure to sunshine 20-30 mins daily
  • Practice position changes, standing
  • Learn new center of gravity, how to balance
  • Specialized wheelchair for double amputees
  • Discharge instructions, outpatient rehab, prosthesis fitting and training, support groups
• Disease


  Osteoarthritis (OA)
• FthronicPain


  Chronic pain
• DisturbedsleepPatter


  Disturbed sleep pattern
• ImpairedPhysicalMobility


  Impaired physical mobility
• SelfCareDeficit


  Self-care deficit
• ActivityTolerance


  Reduced ability to tolerate activity
• Pharmatologcmanagementcont


  Pharmacological management
• knowledgeDeficit


  Lack of knowledge
• Health Promotion


  • Eliminate excessive strain on joints
  • Reduce trauma on joints
  • No acute strenuous repetitive exercise or activity
  • Keep active without overexertion
• Osteoarthritis (OA)
• Disease


  • Pathophysiology
  • Risk Factors
  • Signs
  • Symptoms
  • Diagnostics/Labs
  • Nursing Interventions
  • Potential Complications
  • Patient Education
• Intervertebral Disc Disease
• Degenerative disc


  Disc stops being cushiony
• Nucleus pulposus


  Jelly-like center of disc
• Intervertebral discs


  • Separate the vertebrae and absorb shock for the spine
  • Discs lose elasticity, flexibility, and shock-absorbing capabilities
• Disc degeneration


  Can lead to herniated discs, spinal stenosis
• Herniated Disc


  Nucleus pulposus pushes through crack in annulus fibrosus
• Spinal Stenosis


  Space around spinal cord narrows, putting pressure on cord and nerves
• Diagnostic Tests


  • X-ray
  • Myelogram
  • CT or MRI
  • Vertebral Venogram
  • Electromyography (EMG)
• Non-Operative Therapy


  • Medications (NSAIDs, muscle relaxants, anticonvulsants, antidepressants)
  • Complementary/alternative medicine
  • Good body mechanics
  • Back strengthening exercises
  • Rest
  • Ice/heat application
  • Physical therapy
  • Epidural corticosteroid injections
• Elective Therapy


  • Laminectomy
  • Discectomy
  • Spinal fusion
• Laminectomy


  • Removes lamina (back part of vertebra) to open up spinal canal
• Discectomy


  • Relieves pressure on spinal cord or nerves by removing herniated disc
• Spinal Fusion


  • Adjacent vertebrae are fused together with bone graft, often with metal rods/plates/screws
• Post-Op Assessment & Interventions

  • Early mobility
  • Neurologic assessment
  • Pain control
  • Proper body mechanics
  • Maintain spinal alignment
• Musculoskeletal Trauma
• Types of Musculoskeletal Injuries

  • Contusion
  • Sprain
  • Strain
  • Dislocation
• Contusion


  • Soft tissue injury produced by blunt trauma, causing pain, swelling, discoloration, bruising
• Sprain


  • Injury to ligaments supporting a joint, causing pain, swelling, decreased function
• Strain


  • Injury to the musculotendinous unit, causing pain, swelling, muscle spasm, decreased function
• Dislocation


  • Articular surfaces of a joint are not in contact
• Nursing Interventions


  • RICE (rest, ice, compression, elevation)
  • Anti-inflammatory medications
  • Immobilize and rest the injured area
• Types of Fractures


  • Closed
  • Open/Compound
  • Comminuted
  • Compression
  • Avulsion
  • Impacted
  • Intraarticular
  • Oblique
  • Pathologic
• Open/Compound Fracture


  • Skin is broken, bone is exposed
• Comminuted Fracture


  • Bone has splintered into several fragments
• Compression Fracture


  • Vertebral fractures where bone is compressed
• Avulsion Fracture


  • Fragment of bone has been pulled away by a tendon or ligament