MED SURG MIDTERM STUDY GUIDE / MED SURG MIDTERM STUDY GUIDE : LATEST-2022, A COMPLETE DOCUMENT FOR EXAM
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Course
NURSING NUR2212 (MEDSURG)
Institution
Miami Dade College, Miami
MED SURG MIDTERM STUDY GUIDE / MED SURG MIDTERM STUDY GUIDE : LATEST-2022, A COMPLETE DOCUMENT FOR EXAMMED SURG MIDTERM STUDY GUIDE / MED SURG MIDTERM STUDY GUIDE : LATEST-2022, A COMPLETE DOCUMENT FOR EXAM
MUSCULOSKETETAL: 30 QUESTIONS
1)Sprain: nursing care to include teaching (R.I.C.E)-
-Treatment of a sprain consists of resting and elevating the
affected part, applying cold, and using a compression bandage.
After the acute inflammatory stage (usually 24 to 48 hours after
injury)
RICE: Rest, Ice, Compression, Elevation. Management for pt with
musculoskeletal trauma (contusion, sprain, and strain) elevation
at or above level of heart
Dislocation: ROM, s/s, nursing care ( SPLINTING)
- Signs and symptoms of a traumatic dislocation include acute
pain, change in positioning of the joint, shortening of the
extremity, deformity, and decreased mobility. X-rays of both
the affected and symmetrically unaffected joint confirm the
diagnosis. Pt should be educated on the S/S to look for that
could indicate compartment syndrome.
- *Neurovascular assessment on suspected joint is a priority
,- Affected joint should be immobilized with a stabilization splint as
soon as possible and until diagnosis is confirmed with xray.
2)Traction: types and nursing care( SKIN TRACTION & SKELETAL)
- Traction uses a pulling force to promote and maintain alignment
to an injured part of the body
Two types of traction:
* Skin traction- “Bucks traction”
- Is skin traction applied to the lower leg. Applies a pulling force in
a straight line with the body part resting on the bed
-Nurse must inspect pts skin for abrasions and circulatory
dysfunctions, before traction is applied. ( Skin and circulation
must be in healthy condition to tolerate traction) After applying
traction pts skin should be assessed for skin irritation or
inflammation every 8hrs.
-After skin traction is applied nurse must assess circulation ( 5P’s )
within 15-30mins and then every 1 to 2hrs thereafter. Clinical
manifestations of DVT should also be watched for they include;
calf tenderness, warmth, redness, & swelling.
-In bucks traction extremity is elevated and supported under the
heel & knee while foam boot is placed under pts leg and their heel
is placed In the heel of the boot. Traction is applied by a free-
standing weight.
-No more than 4.5-8lbs of traction can be used on any extremity
in skin traction. (Pelvic traction has a limit of 10-20lbs)
* Skeletal traction ( Balanced traction)- Is used when
continuous traction is desired to immobilize, position, or align a
fracture.
-Greater weights are used with it between 25-40lbs
-Skeletal traction should NEVER be interrupted
,-While skeletal traction is being used the nurse checks the
traction apparatus to assure that all ropes are in grooves of
pulleys, ropes are not unraveled, & that the weights are hanging
freely.
-The nurse must also evaluate pts position is correct, because
slipping down in the bed causes ineffective traction
- Neurovascular assessments (5P’s) comparison to unaffected
extremity must be conducted every 4hrs after traction is applied.
- The nurse also encourages the pt to do calf exercises 10 times
an hr while awake ( to help prevent DVT which is a risk for pt
while in traction)
- Nurse must assess and do pin site care while pt is in traction
atleast every 8hrs!! S/S of infection/reaction at pinsite include:
redness, warmth, purulent drainage, pin loosening, tinting of skin
at pin site, odor, & fever.
-Active exercise for pt in traction includes: pulling up on trapeze,
flexing & extending the feet, ROM and weight resistance
exercises for non-affected joints as well.
3)Total Hip Replacement (THR): teaching, positions to avoid,
discharge instruction, post-op care
Avoid adduction (legs together)
Avoid internal and external rotation, hyperextension, and
acute flexion.
Patient must be in supine position with head slightly
elevated and affected leg in a neutral position.
Maintain abduction by using an abduction splint, a wedge
pillow, or a couple pillows placed between the legs to
prevent adduction. (Keep pillow between legs when initially
assisted out of bed)
A cradle boot may be used to prevent leg rotation and to
support heel off the bed, preventing pressure ulcers.
When turning patient, keep operative hip in abduction
(movement away from center of body).
, Patient should not be turned to operative side. In most cases
side lying is permitted on nonoperative side as long as
abduction pillow is used
When using bedpan, flex unaffected hip and use trapeze to
lift pelvis onto pan
High-seat chairs, semi-reclining wheelchairs, and raised
toilet seats are used to minimize hip joint flexion. When
sitting, the hip should be higher than the knees.
Affected leg should not be elevated when sitting. The patient
may flex at the knee
Never cross legs or bend at the waist (put shoes/socks on)
Never flex hip more than 90 degrees and do not flex affected
hip
Patient Education Upon Discharge for Hip Replacement
Importance of exercises to strengthen hip, physical therapy
will be needed
Stair climbing and swimming a few weeks after surgery is
good exercise
ADL can be continued after 3 months
Avoid crossing legs or flexing hip more than 90 degrees for
first 4 months
Importance of using meds warfarin(Coumadin) & aspirin
Avoidance of low seated chairs & sitting for longer than 45
mins
Wound care as follows: Keep incision clean & dry, cleaning it
daily with soap & water, changing the dressing, Recognizing
s/s of infection. Staples/sutures will be removed 10-14days
after surgery
Driving may resume after 4 weeks; long car rides should be
avoided.
Other activities to avoid include: tub baths, jogging, lifting heavy
loads and excessive bending and or twisting.
* Postop day 1 of hip replacement- Patient should be supine
with head slightly elevated; The affected leg in a neutral position
and an abductor pillow between legs.
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