MED-SURG 3 Final Exam Review
MUSCULOSKELETAL
o Invasiveo Check consent o Renal function!!! o Increase fluids o Ask patient for Allergies!!!! o Monitor
... [Show More] Bun and Creatinine -
o NOT indicated for:
PACEMAKER PATIENT, any
metal in body, HIP
REPLACEMENT PATIENT, MECHANICAL VALVES
PATIENTSo Noisy
o Takes30to90minuteso
Weight the patient o Prosthetic Heart valve
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- When you give a patient a dye, tell them to drink a lot of fluids for 1-2 days, encourage fluids!
- Ask about allergies to the dye
- Visualizes the joint, it might have swelling (arthroscopy- visualization of the joints to
diagnose joint disorders)
- The fluid should be straw-colored, not red !!!!!(athrocentesis- joint aspiration)
- Assess and document the findings
- For Arthroscopy – compression dressing to control swelling - Apply ice and elevate to
reduce swelling
- How do you care for the patient? NPO?
o Not NPO, but cannot take calcium supplements the day of the test 24
hours before the exam
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CT SCAN:
MRI:
Arthroscopy/Athrocentesis
Bone Densitometry
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- This test measures the bone density - DXA for osteoporosis BMD
A DEXA scan is a special type of X-ray that measures bone mineral density (BMD).
DEXA stands for "dual energy X-ray absorptiometry". This type of scan is also often known as DXA, or "dual X-ray absorptiometry". It's also sometimes referred to as a bone density scan or a bone densitometry scan.
DEXA scans are often used to diagnose osteoporosis (when the bones become weak and fragile, and are more likely to break).
They can also be used to assess the risk of osteoporosis developing in women aged over 50 and in men over 60.
As well as being quick and painless, a DEXA scan is more effective than normal X-rays in identifying low bone mineral density.
- The nurse asks the patient about any allergies to the radioisotope, pregnancy
- Tell the patient to drink plenty of fluids to excrete the dye
- The patient must empty the bladder!!! Before the test because it interferes with
visualization of the pelvic bones
o As the nurse, perform a neurovascular assessment, ask them to move the fingers and toes, depending on where the cast is
o Bivalve: the patient can’t move, the doctor will cut the cast straight down (when the cast is on too tight) to relieve pressure!!! o Splints are for short term use, braces are for longer-term use
o A cast is used to immobilize a part of the body, if the skin itches, apply ice, but do not put anything inside the cast!
o Cast= If blood, circle- date, time, initials -
o Blood vessels get compressed o Use a doppler to assess for pulses (edema) o Maintain extremities at heart level
o Skin is pale and the peripheral pulse is weak or gone, hallmark: pain with Passive ROM
o Cut cast in half BIVALVE
o Pressure not relieved & circulation not restored, fasciotomy (cut skin) o 5 P’s
Pain-Pallor-Pulselessness- Paresthesia-Paralysis
Bone Scan
Cast, splint, or brace:
Compartment Syndrome:!!!!!
External Fixator:
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o Why is it used and the purpose? How do you take care of the patient? o The patient will have drainage so know how to clean it (it’s expected for there to be drainage)
o Take care of it by cleaning the pin sites, 1 or 2 times a day with cotton applicators or a specific solution
o Monitor the neurovascular status every 2-4 hours o Watch for infection o Screw becomes loose? Call Ortho
o Do pin care; keep it as aseptic as possible.
o Bone infection – occurs 30 days after surgical procedure
o Do infection protocol o IV antibiotic for at least 4-8 weeks, then 4-6
weeks PO antibiotics. Always worry about kidneys! AE of antibiotic ( ototoxicity and nephrotoxicity (aminoglycoside) , hepatotoxicity (cephalosporins)
o Surgery Debridement if it’s too severe (if infection of bone is extensive)- (Debridement is the medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue.
o Area has to be immobilized o Elevate to reduce pain and swelling!!!!
o CPM machine (know what it is used for) is very painful!!! Medicate the patient for pain before! Keep it on for 8 hours. Remember to check for BM because the patient is getting pain medications plus bed rest, which causes constipation, used after knee replacement surgery
o Look out for DVT for the patient with total knee replacement o You have a patient with a hip replacement: you need to assess, the patient is unable to move the toes, look for swelling, always do assessments on the patient, even if you have other patients, because complications can occur at any time
o Abductionpillow,topreventhipflexionaftertotalhipreplacemento Don’t sit at 90 degree angle!!!! o Don’t sit on the side of surgery
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o Long bone fractures because there is fat in bone marrow. o Symptoms? [Show Less]