Exam 2 Blueprint MDC1, with notes! PDF

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Great study guide for mdc2 exam 2! Includes allot of note taking....

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NUR2356 Multidimensional Care 1 – Examination Blueprint – Exam 2 Pain A. Assessment: P: provocation & Palliation- What causes it, what makes it better, What makes it worse. Q: Quality & Quantity: How does it feel, look, or sound. How much of it is there? R: Region& Radiation: Where is it? Does it spread? S: Severity& Scale: Does it interfere with activities? How does it rate on a scale1-10 T: Timing & Type of onset: When did it begin? How does it occur? Is it sudden or gradual? B. Interventions a. Non-pharmacological: exercise, meditation, relaxation techniques, cutaneous stimulation such as hot/cold therapies, repositioning, rubs b. Pharmacological: NSAIDS (Ibuprofen, aspirin), opioids Joints A. Body mechanics 1. Techniques for proper body mechanics: Avoid standing in one position for long periods of time, do not lock knees when standing, keep core tight, do not bend at waist or neck, do not slump when sitting, sleep on firm mattress. Allows bones to be aligned.

2. Safe client handling: transfer board assist with moving the patient, mechanical lift, transfer belt 3. Devices for client transferring/ambulation 4. Positioning terms- Fowler’s: Sitting: Semi-fowler’s: sitting 30 degrees (promotes respiratory function), High Fowler: 45–90-degree (helps with cardiac dysfunction) Orthopneic: patient leans forward to help with respiration. Used in shortness of breath. Lateral position: Lying sideways: Lateral recumbent: side-lying with legs in line. Oblique position: lying semi to the side with legs slightly bent. Prone: Lying on the stomach: Sims’ position: lying semi lateral and semi on the stomach. Supine position: lying on the back. 5. Fitness programs: Ability to carry activities of daily living without fatigue and weakness. Musculoskeletal A. Bunions: The great toe shifts laterally, and the first metatarsal head of the great toe enlarges. Pain especially when shoes worn.

B. Carpal tunnel syndrome: Compression of the median nerve in the wrist resulting in pain and numbness. a. Assessment: History: hand pain, numbness, pain worse at night, paresthesia (painful tingling), wrist swelling, skin condition (redness), nail changes (thickening, fissuring), Several test (Phalen’s maneuver, Tinel’s sign) b. Treatment: NSAIDS, corticosteroids, splint the hand, surgery c. Client Education: After surgery keep arm elevated about heart level for several days, Check the neurovascular status of the fingers every hour C. Plantar fasciitis: Inflammation of the fascia located in the arch of the foot a. Assessment: b. Treatment: rest, ice, stretching exercises, strapping of the foot to maintain the arch, shoes with good support, and orthotics, NSAIDS, endoscopic surgery remove the inflamed tissue c. Client Education D. Bone Cancer a. Assessment b. Treatment c. Client Education

Fractures A. Emergency care 1. What are initial stabilization interventions? Assess ABC (Airway, breathing, circulation), expose area to assure accurate assessment, control and bleeding, position patient supine (flat on back), splint for support, manage pain. B. Assessing for neurovascular compromise (this is a priority assessment): Skin color distal to the injury, skin temperature (with dorsum of hand), movement, sensation(assess paresthesia), pulse (assess distal to injury), capillary refill, pain assessment. C. Stages of bone healing: 1: within 24 hours a hematoma forms at site of fracture. 2: 3days-2 weeks, granulation tissue begins to invade hematoma. Promotes the formation of fibrocartilage, providing foundation for bone healing. 3: result of vascular & cellular proliferation. Within 3-6 weeks the fracture site is surrounded by new vascular tissue (callus is the beginning of nonbony union) 4: 3-8 weeks, callus is gradually reabsorbed & transformed into bone. 5: Consolidation and remodeling of bone continue to meet mechanical demands. Process can start 4-6 weeks after fracture and continue for up to one year. D. Osteoporosis: decreased bone mass caused by multiple factors 1. Assessment: Nonmodifiable risk factors: Older age, parental history, history of low-trauma fracture after age 50. Modifiable: low body weight, thin build, chronic low calcium and or vitamin D, Estrogen or androgen deficiency, current smoker, high alcohol intake, lack of physical exercise.

Menstrual & menopause history, genetic considerations, nutrition, endocrine history (parathyroid dysfunction) 2. Treatment: calcium and vitamin D, medications: bisphosphonates, estrogen 3. Client Education: encourage client to eat foods with vitamin D, avoid alcohol, exercise program, physical therapy, walking, avoid tobacco E. Osteomyelitis 1. Assessment: pain-constant, localized pulsating sensation that is worse with movement. 2. Treatment: 4-6 weeks of antibiotic therapy for acute case. May be placed in contact precaution if area is draining. May require wound irrigation and medication. Hyperbaric oxygen therapy. Surgery: wound debridement and bone excision. Followed by bone graft. Amputation. 3. Client Education: Educate about medications, signs and symptoms, assist in ADL’s, coordinate physical therapy. F. Closed versus Open: The skin surface over the broken bone is disrupted in a compound fracture, which causes an external wound. These fractures are often graded to define the extent of tissue damage. A simple fracture does not extend through the skin and therefore has no visible wound. 1. Assessments: medical history, assess all major body systems first for lifethreatening complications, including head, chest, and abdominal trauma. Some fractures can cause internal organ damage resulting in hemorrhage. Assess vital signs, skin color, and level of consciousness for indications of possible hypovolemic shock. heck the urine for blood, which indicates possible damage to the urinary system. G. Complications 1. Different types- acute compartment syndrome: muscle, blood vessels and nerves being caught within the fascia, leading to increased venous pressure resulting in edema. Unrelieved by pain medication. Appears 6-8 hours after injury or can take up to 2 days. 6P’s: Pain, Pressure, Paralysis, Paresthesia, Pallor, Pulselessness, DVT: Deep vein thrombosis, infection: wound, osteomyelitis, hospital acquired infection (HAI) 2. Nursing interventions for complications H. Cast Care 1. Client education: handle with palm of hands, report “hot spots”, never put anything into the cast, smell the area for mustiness or unpleasant odor. 2. Nursing care: prevention of neurovascular compromise, neurovascular checks every hour for the first 24 hours, 1-4 hours after that depending on the injury, monitor for complaints of increased pain that is not relieved by analgesia, elevate above the heart level to decrease the amount of edema, apply ice to the area to reduce edema. I. Types of Traction: Skin traction (Bucks): boot attached to 5-10 lbs weights, used to relieve muscle spasm pain from hip or proximal femur fracture. Skeletal traction: screws directly into the bone which allows for heavier weights (15-30lbs). Client immobile 1. Nursing assessment-normal and abnormal findings:

2. Potential problems: patient reports severe pain, realign, and reposition, if this does not relieve the discomfort the weights may be too heavy. Monitor site for infection. J. Medications K. Amputation 1. Assessment 2. Client education Immobility A. Terms 1. Examples: paraplegia B. Effects on the body systems 1. Nursing interventions to address negative effects on each system C. Nursing interventions to promote mobility/adaptability Sensory/Perception A. Blindness/Impaired vision a. Risk factors b. Assessment c. Nursing interventions d. Client education (health promotion) B. Glaucoma a. Pathophysiology b. Diagnostic tests c. Treatment and treatment goals C. Cataracts a. Pathophysiology: A cataract is a lens opacity that distorts the image. With aging, the lens gradually loses water and increases in density. Lens density increases with drying and compression of older lens fibers and production of new fibers and lens crystals. With time, as lens density increases and transparency is lost, visual sensory perception is greatly reduced. b. Treatment and treatment goals: Surgery is the only “cure” for cataracts and should be performed as soon as possible after vision is reduced to the extent that ADLs are affected c. Post-surgery care: Immediately after surgery, antibiotic and steroid ointments are instilled i. Abnormal signs/symptoms: Bleeding or increased discharge, Green or yellow, thick drainage, Lid swelling, Reappearance of a bloodshot sclera after the initial appearance has cleared, Decreased vision, Flashes of light or floating shapes ii. Client education: wear dark glasses outdoors or in brightly lit environments. Teach how to instill the prescribed eyedrops. creating a written schedule for the timing and the order of eyedrops

administration. Stress the importance of keeping all follow-up appointments. iii. Medications/eyedrops D. Terms: tinnitus: continuous ringing or noise perception in the ear) is a common ear problem that can occur in one or both ears. Myopia: (nearsightedness) occurs when the eye overbends the light and images converge in front of the retina. Near vision is normal, but distance vision is poor. E. Types of hearing loss and risk factors for each CONDUCTIVE HEARING LOSS: Cerumen, Foreign body, Perforation of the tympanic membrane, Edema, Infection of the external ear or middle ear, Tumor, Otosclerosis. SENSORINEURAL HEARING LOSS: Prolonged exposure to noise, Presbycusis, Ototoxic substance, Ménière's disease, Acoustic neuroma, Diabetes mellitus, Labyrinthitis, Infection, Myxedema Dosage Calculation A. Review the basic conversions that were learned in Intro to Nursing...