3rd year semester 2 final exam midterm 1 material Flashcards
how many Canadians are foreign born?
1 in 5
How do we ensure that we provide culturally sensitive and competent care?
self-awareness
Risk of death from a transfusion
1 in 200,000
DIC (Disseminated intravascular coagulation)
diffuse clotting of blood which blocks small arteries creating lack of blood flow
What is the most serious blood transfusion reaction?
acute hemolytic reaction - given wrong blood type
Most common transfusion reaction type (accounts for 90% of reactions)
febrile non-hemolytic
Most common transfusion-related cause of death
Transfusion Related Acute Lung Injury (TRALI)
Potentially fatal reaction
WBCs form and occlude the microvasculature of lungs
things that can be done to prevent or manage high blood pressure
o Lifestyle modification
- reduce sodium, calorie reduced, DASH
- lose weight
- reduce alcohol
- lower “bad” fats – cholesterol
- exercise
- stress management
what is DASH?
diet to reduce hypertension
Dietary Approaches to Stop Hypertension
low fat dairy and lots of fruits and vegetables combined with salt restriction
Tetralogy of Fallot
o Ventricular septal defect
o Pulmonary stenosis
o Hypertrophy of R ventricle
o Overriding aorta
Priority action when someone experiencing chest pain
sit down & rest
what does MONA stand for?
*treatment for MI M - morphine for pain O - oxygen nasal prongs 2-4 L/min N - nitrates A - aspirin
symptoms of L-sided heart failure
o Fatigue o Dyspnea, shallow resp. o Orthopnea (SOB) in recumbent position o Dry, hacking cough o Pulmonary edema o Nocturia, oliguria, anuria o Paroxysmal Nocturnal Dyspnea (PND) -sleep with head propped up on pillows
symptoms R-sided heart failure
o Fatigue ++
o Dependent edema
o Anorexia
o Nausea
most serious arrythmia
Ventricular tachycardia
tx: meds - IV lidocaine
cardioversion
aterial leg ulcer characteristics
Small, round, deep, punched out ulcers
Skin shiny, taut, thin, erythema, dry, cool,
Absent leg hair
*not exhaustive list
what size does an AAA have to be to have surgery?
> 5 cm
very risky surgery
bifurcation graft
Buerger’s disease
young men who have smoked for long time
what is virchow’s triad
*factors leading to thrombosis (re: DVT)
Venous stasis
Damaged endothelium of vein
Hypercoagulability of blood
DVT
women 35 or older who smoke & on birth control
Stasis Dermatitis
*d/t venous insufficiency
erythema, edema, scaling, and weeping of the lower leg and may be intensely pruritic
tx: skin barrier to protect the periwound skin from exudate; Dermatitis, scaling and pruritus can be controlled with zinc oxide i.e. (Viscopaste, Zip Zoc) bandaging; or topical steroids
controlling edema
Elevate feet above heart level Avoid prolonged sitting or standing Do ankle/toe flexion exercises Schedule frequent rest periods “A walk a day keeps the doctor away”
what is the cornerstone of managing venous ulcers?
compression!
what teaching is necessary to client about compression wraps?
Always document teaching provided to pt. & family i.e., “if you have increased pain, or a change in color of toes, take off compression wrap, and contact nurse/doctor”
sensory neuropathy
bilateral, progressive, may have ø pain, high risk for mechanical, thermal & chemical trauma
Hypo or hyper aesthesia
motor neuropathy
changes in muscle/tendon anatomy, clawing of the toes, foot deformity, a change in gait = a change in pressure points = callous
autonomic neuropathy
sympathetic nerve damage, no sweating, dry skin, cracks & fissures develop allowing fungi & bacteria to infiltrate
sprain
injury to ligament (bone to bone)
stretched but not torn (first degree), 2nd (partial tear), 3rd (fully torn, maybe more than one)
avulsion fracture
ligament pulls loose a fragment of bone
subluxation
a partial dislocation
hemarthrosis
bleeding into a joint space or cavity
which is worse - 3rd degree sprain or bone fracture?
3rd degree sprain can be more painful and immobilizing and can take longer to heal
sprain prevention
Stretching & warm up exercises: slow stretching, warming up muscles important.
Use elastic support or adhesive wrapping to support a weak/previous injured joint.
What is the acronym RICE used for and what does it stand for?
*to treat a sprain
R - rest & limit movement of limb
I - ice first 24-48 hrs; then heat 48 hrs on (max 20 min)
C - compression to control swelling & pain
E - elevate above heart level to control swelling & improve circulation
+ analgesics & physitherapy
what is a strain?
Stretching or tearing of muscle or tendon
what is Tinel’s sign?
*test for carpal tunnel
Tap over the location of the median nerve
If tapping produces paresthesias (tingling/burning sensations) in the affected hand, CTS is supported
what is Phalen’s Test?
*test for carpal tunnel
Place back of both hands together and hold the wrists in forced flexion for a full minute (stop at once if sharp pain occurs).
If this produces numbness or “pins & needles” along the thumb side half of the hand, client has median nerve entrapment (CTS).
Torus fracture
buckle fracture
stable fracture
Greenstick fracture
The fracture extends through a portion of the bone, causing it to bend on the other side
Colles fracture
fracture of the distal radius, is one of the most common fractures in adults (we put hand out to break a fall)
what are the most common fractures in children?
forearm & wrist
50% are greenstick or buckle (torus)
what’s involved in pin care?
clean around pin site with sterile saline and Q-tips OD; may apply antibiotic ointment if ordered
*external fixation
zimmer splint
post operative knee immobilizer
A canvas knee support with velcro closures
Locks the knee in extension and prevents motion of the joint
Used after an acute injury to the knee, such as a ligament rupture or a fracture
Crutches or walker are then used to assist with ambulation
compartment syndrome
Progressive development of arterial compression and reduced blood supply within the myofascial compartment
edema creates pressure
a surgeon performs a fasciotomy- long incisions through the skin and fascia layer to reduce the compartment pressure
6 Ps of Impending CS
Pain Pallor Paralysis paresthesia pressure pulselessness
Homan’s sign
positive result when deep calf pain results from abrupt dorsiflexion of the ankle. Pain results from venous thrombosis or inflammation of the calf muscles
clinical manifestations of hip fracture
External rotation of affected leg.
Muscle spasm.
Shortening of the affected leg.
Severe pain and tenderness in the region of fracture site
whats the first thing you assess if unwitnessed fall?
hit head?
neuro assessment
scoliosis
lateral curvature of the spine measuring 10 º or > on x-ray
treatment osteoprosis
calcium; vitamin D; exercise; prevent falls; gain weightl stop smoking
rheumatoid arthritis
systemic autoimmune disease causes inflammation in sinovial joints
non joint symptoms of rheumatoid arthritis
Fatigue, anorexia, wt. loss.
RA (rheumatoid arthritis) nodules - very nobby
Sjogren syndrome 10-15% (dry eyes, mouth, mucus membranes)
Felty syndrome (inflammatory eye disorders, splenomegaly, lymphadenopathy, pulmonary disease & blood dyscrasias )
Humira
Tumor Necrosis Factor (TNF) blocker
for moderate to severe RA
treating inflammation
prevent further damage to bones and joints and improve ability to perform ADLs
which disease is deep rest used for?
Fibromyalgia
what are two things that trigger gout?
excessive alcohol
purines
examples of purine-containing foods
red meat & organ meats game meat shellfish beans mushrooms, spinach, asparagus, cauliflower
what drug is used for acute gout and for recurrent gout?
acute - colchicine
recurrent - allopurinol
what is a butterfly rash a sign of?
systemic lupus erythematosus
what does skin look like with scleroderma?
Hardening, tightening or thickening. Change in color. A shiny appearance. Loss of hair on affected areas. Reduction of skin creases.
can have rheumatoid ulcers characterized by scalloped edge which is unique to this
Sjogren syndrome
*can happen with rheumatoid arhtritis
dry eyes, mouth, mucus membranes
Felty syndrome
*can happen with rheumatoid arhtritis
inflammatory eye disorders, splenomegaly, lymphadenopathy, pulmonary disease and blood dyscrasias
what range should one keep their sodium intake at when reducing sodium in diet?
limit to 1495-2300 mg/day of sodium
what are basic exercise recommendations re: lifestyle mod for lowering HTN?
30-60 min/day 4-7 day/week
