MDC1 EXAM 2 YOUTUBE NOTES

Paraplegia & Fluidity

• Paraplegia: paralysis of the lower trunk and legs.
• Fluidity: reduced or absent muscle tone, often following cast removal.

Helix Valgus Deformity & Bunionectomy

• Helix valgus: lateral shift of the big toe at the metatarsal joint, bunion formation.
• Bunionectomy: 6-12 weeks non-weight-bearing recovery, use a foot elevation pillow.
• Immobility complications: venous stasis, skin breakdown, muscle discomfort, and contractures. Increased oxygen demand, altered self-concept, withdrawal, sleep disturbances, and passivity are also possible.

Psychosocial Aspects of Immobility

• Encourage visitors, pet therapy, and mentally stimulating activities.

Effects of Exercise on Systems

• Isometric: muscle contraction without movement (bedridden patients).
• Isotonic: joint movement with muscle contraction (e.g., weights, push-ups).
• Isokinetic: variable resistance with specialized equipment (physical therapy).
• Aerobic: oxygen-dependent energy use with large muscle groups (e.g., jogging, cycling).
• Anaerobic: oxygen-independent energy use (e.g., heavy lifting, sprinting).

Exercise & Independence

• Exercise maintains strength and independence.

Osteoporosis

• Cause: Changes in calcium metabolism leading to potential kidney stones. Decreased bone mass due to factors like calcium/estrogen/testosterone deficiency, nutritional deficiencies, or others. Kyphosis is common.
• Non-modifiable risk factors: older age (men and women), family history, low-trauma fractures after 50, ethnicity (e.g., Caucasian, Asian), eating disorders.
• Modifiable risk factors: low body weight, chronic calcium/vitamin D deficiency, hormone deficiency, smoking, excessive alcohol consumption (≥3 drinks/day), lack of exercise/prolonged immobility.
• Treatment: estrogen antagonists to mimic/block estrogen effects.

Range of Motion (ROM)

• PROM: passive range of motion (dependent, assisted movement).
• AROM: active range of motion (independent movement).

Kyphoplasty & Vertebral Plasty

• Kyphoplasty: minimally invasive procedure to restore vertebral height by inflating a balloon.
• Vertebral plasty: bone cement injected directly into the fracture site.

Osteosarcoma

• Bone cancer originating in osteoblast cells.
• Primary: originates in the bone.
• Secondary: originates outside the bone.

Carpal Tunnel Syndrome

• Neurological disorder: median nerve compression at the wrist.
• Common in rheumatoid arthritis and diabetes patients.
• Diagnosis: Phalen maneuver and Tinel's sign.
• Treatment: transverse carpal ligament release (surgery).

Imaging Tests

• Ultrasound: uses sound waves to create images of internal structures.
• MRI: most accurate for bone quality assessment.

Medications for Osteoporosis

• Reclast: increases bone density, reduces reabsorption, and lowers fracture risk (not for women with thromboembolism history).

Syndactylism & Atelectasis

• Syndactylism: fused fingers.
• Atelectasis: diminished breath sounds; orthopneic position prevents this.

Ischial Tuberosities & Plantar Fasciitis

• Ischial tuberosities: common site of breakdown in wheelchair users.
• Plantar fasciitis: inflammation of the plantar fascia; treat with ice and NSAIDs, supportive shoes, instead of heat.

Joint Movements

• Joint extension: strengthening a hinge joint to 180°.
• Adduction: lateral movement towards the body midline.
• Flexion: moving the head to the chest.

Fracture Symptoms & Treatment

• Late fracture symptoms: tenderness, swelling, deep aching pain, inability to bear weight.
• Treatment focuses on healing and pain management.

Increasing Appetite

• Strategies for increased appetite: rest, light exercise before meals, enjoyable foods/aroma, pre-planned meals, hydration, frequent meals/snacks.

Anti-Embolism Stockings & DVT

• TED hose: compression stockings to improve circulation and prevent DVT.
• DVT signs: pain, redness, swelling, tenderness, extremity swelling.

Osteogenesis Imperfecta (OI)

• Brittle bones that fracture easily.
• Treatment: bag baths, no-rinse pH-balanced cleanser, avoid soap, moisturize, clean immediately after soiling.

Gas Exchange Improvement

• Upright posture/elevated bed head: optimizes lung expansion and ventilation, improving gas exchange.

Self-Care Deficit & Neuromuscular Assessment

• Self-care deficit: inability to perform ADLs (activities of daily living).
• Neuromuscular assessment: the 5 P's (pain, pallor, paresthesia, paralysis, pulselessness).

Pre-Transfer Client Assessment

• Pre-transfer assessment of client is crucial.

Nutrition & Strength Assessment

• Importance of nutrition.
• Manual muscle testing (MMT).

Additional Conditions & Treatments

• Abduction pillow: prevents total hip joint dislocation.
• COPD & activity intolerance: potential nursing diagnosis for COPD patients with reduced mobility.
• Chest pain assessment: palpate chest wall to rule out muscular pain.
• ORIF (Open Reduction Internal Fixation): surgical stabilization of fractured bones (e.g., screws, plates). Hip fractures are common in older adults (osteoporosis is a major risk factor).
• Fat Embolism Syndrome (FES): fat globules released into blood vessels after fracture (common in hip/pelvis fractures); symptoms include hypoxemia and respiratory distress followed by headache, lethargy, agitation, seizures, and rash.
• Phantom pain: pain in an amputated limb. Somatic pain: deep/superficial bone/tendon/muscle pain (e.g., aching, cramping). Neuropathic pain: nerves affected, pain signals to the brain.
• Bisphosphonates: for osteoporosis, taken on an empty stomach, 3 years, repeat DEXA scan in 2-3 years (empty stomach). Dual-Energy X-Ray Absorptiometry (DEXA scan) is used to diagnose osteoporosis.
• RICE treatment: Rest, Ice, Compression, Elevation.
• Ambulation readiness: assessment of active ROM in all extremities. Clarify unclear orders.
• Occupational therapist: for patients with mental, physical, developmental, or emotional disabilities; assists with daily living/working skills.
• Rib fracture symptoms: severe pain, worsened by deep breaths, can impede breathing. Airway assessment.

Cast Care

• Keep cast clean and dry; cover with plastic before bathing. Do not insert anything into the cast.

Body Mechanics

• Body mechanics: coordination between musculoskeletal/nervous systems; involves alignment, balance, coordination, and joint mobility.

Normal Lab Values

• Serum calcium: 9.0-10.5.
• Vitamin D: 25-80.
• Strain: injury to a muscle/tendon.
• Sprain: injury to a ligament.
• Exercise: any physical activity that burns calories.

Cultural Variations & Cell Production

• Amish: higher prevalence of dwarfism.
• Red blood cell creator: red bone marrow.

Ganglion Aspiration

• Ganglion cyst fluid removal with a needle; emergent if nerve damage is suspected.

Dosage Conversions

• Kilograms to pounds: multiply by 2.2.
• Milliliters to ounces: 30 mL = 1 ounce.
• Micrograms to milligrams: 1000 mcg = 1 mg.
• Tablespoons to milliliters: varies, but often 15 mL per tablespoon.

Eye Conditions

• Trauma to the eye leads to cataracts.
• Conductive hearing loss: tympanic membrane/Eustachian tubes/ossicles damage; often due to otitis media (ear infections).
• Sensorineural hearing loss: damage to inner ear/auditory nerve (e.g., noise exposure).
• Otitis media: ear infection; conductive hearing loss; common in children; purulent exudate.
• Myringotomy: surgery to insert tubes for drainage.
• External otitis media: lymph node involvement; worsening infection sign.
• Therapeutic communication: open-ended questions encourage elaboration; closed-ended questions require no explanation.
• Hearing-impaired patient interaction: face the client, allow for lip reading.

Restraints

• Mechanical restraints: cloth vests, side rails.
• Chemical restraints: sedatives, psychotropics to control behavior.

Foreign Body in Ear

• Mineral oil for treatment.

Meniere's Disease

• Meniere's: fluid buildup in inner ear; symptoms: tinnitus, vertigo.
• Non-pharmacological interventions: avoiding activities worsening vertigo (stairs, ladders), slow head movements.
• Pharmacological interventions: diuretics, antiemetics to manage symptoms.

Presbycusis

• Presbycusis: progressive sensorineural hearing loss in older adults; reduced high-frequency hearing, difficulty in noisy environments.

Vision Conditions

• Myopia: nearsightedness.
• Hyperopia: farsightedness.
• Glaucoma (angle-closure): emergency; increased intraocular pressure; peripheral vision loss or blindness; common type is open-angle glaucoma.
• Gonioscopy: visualization to determine glaucoma type (open or closed angle).
• Intraocular pressure increase: retina blood vessel and photoreceptor compression leads to tissue hypoxia and vision loss.

Eye Drop Administration & Irrigation

• Eye drop administration: tilt back head, pull lower lid down, administer into conjunctival sac, apply pressure to tear duct afterwards.
• Ocular irrigation: pour/syringe fluid from ≈5cm distance, assessing upper conjunctiva including under eyelids.

Opioid Effects & Prevention

• Opioid effects: pneumonia risk, constipation, drowsiness, nausea, slow breathing.
• Constipation prevention: fluids, fiber, movement.

Dressing Changes & Calcium Supplements

• Wound dressing with drainage: reinforce and assess skin for padding needs.
• Calcium supplements: discuss options with the provider.

Normal Lab Values (continued)

• Hematocrit: 43-49% males; 38-44% females. Hemoglobin: 13.2-17.3 males; 11.7-15.5 females. Platelet count: 150,000-400,000. Minimum urine output: 30 mL/hour.

Fracture Assessment & Care

• ESR (Erythrocyte Sedimentation Rate): reflects soft tissue damage (x-ray does not show soft tissue damage).
• Hematocrit/hemoglobin check for femur fractures.
• Spinal anesthesia numbness: 20 hours.
• Absent pulse but warm, good capillary refill: reassess with gentle touch.
• Capillary refill: less than 2-3 seconds normal.

Pain Assessment

• Pain assessment: type, quality, radiation, impact on ADLs, effect of posture/movement.

Meniere's Disease (continued)

• Classic symptoms: episodic vertigo, tinnitus, hearing loss; typically ages 20-60; episodes lasting days or persistent, varying intensity.

Continuous Nerve Block Complications

• Continuous nerve block complications: metallic taste, tinnitus, nervousness, slurred speech, bradycardia, hypotension, decreased respirations, seizures.

Fracture Complications & Shock

• Assess for hemorrhagic shock in patients with fractures.
• RICE for musculoskeletal inflammation.
• Assess pulse before assessing numbness in crushing injuries
• Hypothermia treatment: blankets for post-operative hypothermia.

CNA Assessments

• CNA cannot EAT (Evaluate, Assess, Treat)

Pelvic Fracture Complications

• Pelvic fracture complication: hematuria (bladder puncture risk), hypovolemic shock.

Osteomyelitis

• Osteomyelitis: antibiotics (teach side effects/infection control); elevated WBCs, edema, warmth, fever, pain; 4-6 weeks of IV antibiotics; irrigate surgical wound; hyperbaric chamber; possible amputation.

Hospital Acquired Infections (HAIs)

• Hospital Acquired Infections: prevent them

Arthroscopy

• Arthroscopy: tube for direct visualization; requires joint mobility.

Nursing Process

• Nursing Process: problem-solving method for nursing care.

Complex Regional Pain Syndrome (CRPS)

• Reflex sympathetic dystrophy: dysfunction of central and peripheral nervous systems.