2/23 Flashcards
A patient is scheduled for a contrast computed tomography (CT) of their hip today. Which action by the nurse is most important before the patient’s test?
A. review the patient’s renal func
B. assess for a seafood allergy
C. premedicate the pt for claustrophobia
D. ensure that the client has no metal on the body
Answer: B
Rationale: multiple correct answers; priority; contrast allergy and anaphylaxis that is what kills them first; seafood allergy - contrast contains iodine and most shellfish and fish do; still ask; never had contrast dye but allergy - change dose/type contrast or premedicate - Benadryl
Review pt’s renal func: will do but not priority; Cr: 2.9 and reason doing CT with contrast because fell 3 days ago and could not get to phone, elderly pt, really dehydrated; Cr high - dehydration: elevation BUN at first but over 3 days dehydration do some damage; for this pt give them fluids; CT: fluids and rehydrate ideal overnigh but if cannot bolus with fluids and give lots fluids after; renal protective properties: acetylestine; give med and fluids for renal protective properties; diabetic and need contrast: taking metformin: dye and metformin not good: premedicate and postmedicate and stop if can 48 hours before and after: acetylestine
If on ESRD and dialysis, Cr 7 - give contrast dye; be careful but anticipate dialysis and ideally plan CT and straight to dialysis
Premedicate for claustrophobia - not necessary for CT - donut; in and out of; MRI - might need medicate; small dunnel and in there for long time
Ensure client has no metal - MRI
Which of the following are changes that occur to the musculoskeletal system as a person ages? SATA
A. bone changes lead to potential safety risks
B. increased bone density leads to joint stiffness
C. osteoarthritis occurs due to cartilage degeneration
D. osteoporosis is a universal occurence
E. some muscle tissue atrophy is expected to occur with aging
Answer: A, C, E
Rationale: A - particularly for women; women at higher risk; more kids have more risk - kids suck out Ca; more likely cause bone breaks - problematic
OA - joints hurt and telling when storms coming; more active on joint sooner cartilage where out and likely have issues
Some but not complete atrophy; strength decline - muscles get smaller; gym every single day can combat but is expected finding
Increased bone density - not effect on joint: cartilage
Porosis not universal - anyone can get it but not expected finding
Calcium loss expected finding as age but not osteoporosis
Causes of low Ca: aging, meds, broken bone (esp large bone break - decreased serum Ca), cancers (bone metastasis where eating bone - Ca absorbed into bloodstream - high serum Ca; gone through radiation treatment and bones rebuilding Ca goes low)
A 78 year old woman with diabetes and congestive heart failure is admitted with a leg wound that says is draining a lot, the nurse clarifies what the patient means by “a lot” and is told that the wound soaks through its dressing multiple times a day. The client’s white blood cell count is 38,000/mm. The client is a-febrile. What action does the nurse take first?
A. administer acetaminophen
B. educate the client on amputation
C. place the client on contact isolation
D. refer the client to the wound care nurse
Answer: C
Rationale: all potentially correct; nasty draining wound; put in contact isolation - high chance MRSA/VRE; not know organism; can always take out later if cultures out negative; pre-emptavely put in isolation - priority is that
Wound could go septic - protecting other pts; safety concern
Refer the client - absolutely; but second in priority to safety question; put in wound care consult; not up there shortly; not right away situation
Administer acetaminophen - not says in pain; not febrile
Educate client on amputation - eventually but not jump to there; not enough info but not enough info to go there; multidisciplinary team meetings; fix before go there
An emergency department nurse triages a client with diabetes mellitus who has fractured her arm. Which action should the nurse take first?
A. remove the medical alert bracelet from the fractured arm
B. immobilize the fracture by splinting the affected arm
C. place the client in a supine position and offer a warm blanket
D. cover any area of broken skin with a sterile dressing
Answer: A
Rationale: arm broken: arm will start to swell and bracelet probably metal - cut off circulation; remove metal while can; may have to cut it off if too late after swelling started
Immobilize the fracture - want expert consultation; provider to take look at it before do this; want ensure not doing more harm than good; want do comfy position that promotes adequate blood flow
Supine position - fine; warm blanket not want - heat draw more fluid to area and could increase swelling; ice better but not until someone look at it; nothing warm until someone look at it
Broken skin with a sterile dressing - not want allow push anything further into wound
Bone sticking out - go to surgery
Hold bone, nerves, blood vessels - hold via traction - as a nurse cannot; if specially trained can adjust it; how set up imp; need order; physician/PA set up initially - qualified to ensure proper alignment
A nurse obtains a health history of a client with a fractured femur. Which factor identified in the client’s history should the nurse recongize as an aspect that would most impede healing of the fracture?
A. sedentary lifestyle
B. a 30-pack year smoking hx
C. prescribed oral contraceptives
D. Paget’s disease
Answer: D
Rationale: Paget’s disease - rare; condition where pt’s break bones easily, often big bones: femur, pelvis, sternum, scapula; hx this disease - hard time bone healing; bone healing issue for pt; because way Ca metabolized; bones more frail - takes less hit result in break because bone density is less; bones grow fast but grow weak and not correctly; pain is huge possibility
Bone growing too fast can impinge on nerves
30-year smoking hx - delay healing
Oral contraceptives - issue blood clots
Sedentary lifestyle - not great but not huge indiv risk factor
Background: concerning: SOB; scoliosis not med emergency; progressively SOB; do additional FU - not want get worse; least to most invasive; want bracing and PT; given older age and end growing may need more invasive treatment; towards end growing may need surgical correction
Scoliosis
One immune issues
No cure for it
Trying to control it
Real QOL for pt
Try early diagnosis so med regimen that reduces flare ups; common pts that see joint deformities
Methotrexate - first line
Adding in adalimumab or maubs - works for autoimmune disorders; very expensive
RA
Goal: start out with treatment (chemo or radiation) to try to shrink tumor; to surgery to remove tumor and hopefully lymph nodes surrounding tumor; follow up therapy to get last cancer cell - for solid tumors; depends on level metastasis if catch early
Location of tumor: likely end up with amputation - bone cancers
Pain control is big
Bone tumor
Steri strips - want pull off - but leave in place until fall off on own
Neuro assessment with injury close to spinal column; make sure no long-term spinal deficit; too early to tell when fresh; mean time - lots steroids - bring down inflammation but no idea new baseline will be
Spinal surgery
Anticipating PICC line placement: odds are long-term antibiotics: 3-6 weeks; not get long-term antibiotics: vancomyocin: low pH and hard on blood vessels
Mentions meth prob: not send home with PICC home - not send home with direct IV access; does need IV access; bring in care management, case workers, social workers to figure out good plan; up to ethics board if necessary; compromise where d/c to rehab facility; solutions but make sure HCP knows and know more involved plan of care
Hyperbaric oxygen - great treatment; put in tube and not touch them; N in blood will boil if take them out quickly; not defib fresh out chamber - incredibly flammable - not in room either; if not stable do not send them
Surgical wound infection
Not always but usually if have bacteria going to survive within bone tissue - usually gram-neg: gen anaerobic - not need O2 to survive - harder to kill in gen; heavy hitter antibiotics and long-term; tougher and more aggressive course of treatment
More care do in home better; home assessment is involved
Osteomyelitis
Most of the time is surgical emergency; fasciotomy to relieve pressure
5 P’s - past pallor is cyanosis - cyanosis is worse; can be grouped in with P’s - worsening of pallor - in real danger of death - gone and cannot get it back
Large bone break that can turn into emergency: rhabdomyolysis, fat embolism - hallmark: petichae (pinpoint bruises that do not hurt - area where blood supply that not cut off - mainly on chest)
Heparin - could but not help because fat embolism but not blood clot; TPA not help
Help: BP can tolerate vasdilatory med; usually not roto rooter - usually oily fat; just support most time until body reabsorbs it; not lot can do for big ones
Compartment syndrome
This or spiral fracture - risk for abuse - frequent for abuse; extra screening for abuse; not ask in front of mom and dad that defensive and stories not make sense; take to x-ray
Mandatory report if necessary
Greenstick fracture
See more in older lady
Pts hurt; overuse of any specific muscle group/muscle - see in older people who fell down or in same position
Trauma situations: earthquakes - long time before get them
Myoglobin released then get this
Burns: often as well
Rhabdomyolosis
Traction gets moved expert consultation - not want impinge nerves and mess with blood supply or have acute compartment syndrome
Pin care - not fun do - separate tissue from pins - premedicate - tissue grow over pins and hurt even more when rip all off; separate tissue from pins
Traction
