Nursing Care Lecture Notes

Key Topics: Post-operative Care, Patient Assessment, Nursing Interventions

Total Hip Replacement

Preventing Dislocation

• Action: Place a pillow between the patient's legs when turning.
• Rationale: Prevents legs from crossing, maintains hip in neutral position.
  • Incorrect Actions: Sleeping on operated side, sitting in low chair, crossing legs.

Bone Fracture Care

Diet for Bone Healing

• Type of Diet: High protein.
• Rationale: Proteins aid in tissue repair and collagen formation necessary for bone healing.
  • Incorrect Diets: Low calorie, high carbohydrate, low fat.

Suspected Compartment Syndrome

Symptoms Assessment

• Key Symptom: Pallor and coolness below injury site.
• Rationale: Indicates decreased perfusion due to increased pressure.
  • Incorrect Symptoms: Bradycardia, hypertension, increased range of motion.

Crutch Use Education

Preventing Axillary Nerve Damage

• Instructions:
  • Elbows flexed at 30° angle.
  • Support weight with hands, not armpits.
  • Ensure crutches are 3 inches below armpits.
  • Correct: All of the above.

Medication Administration (Ibuprofen)

For Acute Gout

• Best Action: Contact healthcare provider to clarify the order.
• Rationale: NSAIDs can exacerbate gout symptoms.
  • Incorrect Actions: Administer as ordered, increase dosage, suggest dietary change.

Osteoporosis Care

Appropriate Nursing Intervention

• Intervention: Promote diet rich in calcium and vitamin D.
• Rationale: Essential for bone density and health.
  • Incorrect Interventions: High impact exercises, bed rest, limiting fluid intake.

Suspected Sprain Care

Initial Nursing Intervention

• Action: Elevate the limb above heart level.
• Rationale: Reduces swelling and pain by facilitating venous return.
  • Incorrect Actions: Apply heat, encourage active range of motion, administer muscle relaxant.

Rheumatoid Arthritis (RA) Education

Recommended Exercises

• Type: Gentle stretching exercises.
• Rationale: Maintain joint flexibility without extra stress.
  • Incorrect Exercises: High-intensity interval training, weightlifting, long-distance running.

Spinal Fusion Post-operative Care

Priority Nursing Intervention

• Action: Monitor for signs of deep vein thrombosis (DVT).
• Rationale: Risk of DVT due to decreased mobility.
  • Incorrect Actions: Resume normal activities, perform twisting motions, avoid pain medication.

Chronic Back Pain Assessment

Important Question

• Question: How does your back pain affect your daily activities?
• Rationale: Provides insight into severity and impact on quality of life.
  • Incorrect Questions: Medications for pain, cause of pain, imaging tests done.

Osteoarthritis Management Education

Understanding Non-Pharmacological Interventions

• Correct Statement: Heat application can help decrease joint stiffness.
  • Incorrect Statements: Avoid exercise, high-impact aerobic exercise, lose weight rapidly.

Cane Use Instruction

For Left-Sided Weakness

• Instruction: Hold the cane in your right hand and move it simultaneously with your left leg.
• Rationale: Distributes weight away from the weak side for better balance.
  • Incorrect Instructions: Hold in left hand, keep on left side, use only for long distances.

Knee Surgery Post-operative Care

Patient Statement Needing Further Teaching

• Incorrect Statement: Rest knee all day to prevent pain.
• Rationale: Complete rest leads to stiffness; prescribed exercises are important.
  • Correct Actions: Use ice packs, keep leg elevated, perform daily exercises.

Lower Extremity Cast Care

Priority Nursing Intervention

• Action: Encourage patient to wiggle toes frequently.
• Rationale: Maintains circulation, reduces risk of swelling, detects issues early.
  • Incorrect Actions: Keep cast covered, apply heat, remain seated to reduce swelling.

Lower Back Pain Prevention

Rationale for Healthy Weight

• Correct Rationale: Extra weight puts additional stress on back muscles and spinal column.
  • Incorrect Rationales: Risk of osteoporosis, bone density loss, improved posture.

Osteoporosis Prevention

Dietary Recommendations

• Recommendation: Increase intake of fatty fish and sunshine for natural vitamin D.
  • Incorrect Recommendations: Limit calcium, focus on high protein without dairy, eliminate gluten.

ACL Reconstruction Rehabilitation

Emphasized Instruction

• Instruction: Engage in physiotherapy and controlled knee exercises.
  • Incorrect Instructions: Limit knee flexion, avoid weight-bearing exercises, perform high-impact sports.

Scoliosis Assessment

Common Observation

• Observation: Uneven shoulder blades.
  • Incorrect Observations: Even waistline, symmetrical shoulder height, equal leg lengths.

Cast Care with Intense Pain

Nurse's Best Action

• Action: Prepare to valve the cast to relieve pressure.
• Rationale: Intense pain may indicate compartment syndrome or pressure sores; valving relieves pressure.
  • Incorrect Actions: Advise rest, elevate casted limb, apply heat pad.

Chronic Tendinitis Management

Nurse's Emphasis

• Instruction: Regular application of cold packs to reduce inflammation.
  • Incorrect Instructions: Complete immobilization, start intensive exercise, take NSAIDs only when pain is unbearable.

Post-Laminectomy Care

Critical Postoperative Instruction

• Instruction: Avoid bending, lifting, or twisting for a specified period.
  • Incorrect Instructions: Engage in twisting motions, start lifting weights, perform daily sit-ups.

Fibromyalgia Lifestyle Management

Suggested Modification

• Modification: Maintain a regular moderate exercise program.
  • Incorrect Modifications: High-intensity workouts, increase caffeine intake, restrict sleep.

Below-Knee Amputation Care Plan

Appropriate Goal

• Goal: Manage phantom limb pain effectively using multimodal strategies.
  • Incorrect Goals: Demonstrate mobility within a day, express acceptance within two days, avoid pain medication.

Low Back Pain Ergonomic Advice

Correct Advice

• Advice: Maintain a neutral pelvis and use a chair with lumbar support when sitting.
  • Incorrect Advice: Sit in soft deep couch, sleep on stomach with firm mattress, lift by bending at waist.

Herniated Disc Symptom

Associated Symptom

• Symptom: Decreased reflexes in the affected limb.
  • Incorrect Symptoms: Increased bladder control, absence of pain, improved symptoms when lying flat.

Additional Resources

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