Adult Health II -- Test 2 Flashcards
1
Q
Risk factors – fall
A
occupation contact sports drugs (steroids AEDs thryroid tetracycline, chemos e.g. methotrexate, radiation) Vit A in excess (> 1.5 mg/day) overweight elderly male lack weight-bearing exercise systemic disease diminished senses
2
Q
S/S of fractures
A
loss of function crepitus (don't test ROM) swelling pain deformity discoloration
3
Q
Nerve / Circ check
A
8 Ps pain paresthesias pallor pulses paralysis polar (temp) perception (sensation) pressure (tension)
4
Q
Crutches – basics
A
4-6” below axilla
good going up
bad going down
5
Q
Cast Care Info
A
dry rest on CLOTH pillo turn q 2 r/t drying out the cast use palms not f-tips when wet dry = hard/white/odorless/resonant don't paint or varnish report broken cast will loosen hair dryer (NEVER insert) for itch keep dry report color change if wound beneath report foul smell report excessive pain nerve / circ checks
6
Q
Nx for traction – skin traction
A
usu short term
<10 lbs of weight
check skin underneath
7
Q
Nx for traction – skeletal traction
A
align pts body in center of bed weights are correct and swing freely pulleys aligned and ropes OK ropes knotted properly no feet touching end of bed nerv / circ checks
8
Q
Nx for traction – pin site care
A
per order
NS or 1/2 strength H202
sterile in hospital / clean at home
loose gauze around pin
9
Q
Compartment syndrome – patho
A
progressive muscle necrosis d/t swelling and decreased blood flow
compartment pressure inc / arterial flow occld
impeded venous return
10
Q
Compartment syndrome – contributing Fx
A
burns tight dressings poor position long bone fractures and soft tissue damage hypotension
11
Q
Compartment syndrome – S/S
A
increased pain UNRELIEVED c analgesics ALTERED nerv / circ checks excessive swelling diminished / absent pulses decreased sensation / movement numbness / tingling
12
Q
Compartment syndrome – Tx
A
PROMPT REC = SAVE THE LIMB bivalve cast LMW Dextran or Mannitol decompression fasciotomy monitor CPK -- MM and uring for myoglobin (product of muscle necrosis - damages renal)
13
Q
Osteomyelitis – S/S
A
LOW GRADE SMOLDERING FEVER 99-100
malaise
local tenderness / swelling / warmth
purulent discharge
14
Q
Osteomyelitis – Tx
A
debridement
antibiotics
prophylactic antibios if internal hardware
15
Q
Fat embolism – path
A
fat globules from exposed marrow
into blood and into lungs
high risk < long bone fractures and crushing
16
Q
Fat embolism – S/S
A
PETECHIAE in palate, chest, conjunctive d/t transient thrombocytopenia
chest pain
pulse ox down
dyspnea / tachypnea / crackles
17
Q
Fat embolism – Tx
A
aim at prevention by swift fracture immobilization and repair
02
fluids if hypov / diuretics if edemic
Heparin or LMW dextran = expand vessels
18
Q
DVT – S/S
A
unilateral leg pain / edema / warmth / redness
19
Q
DVT – Prevention
A
TED, SCD, Lovenox
20
Q
DVT – Dx
A
venous doppler
21
Q
DVT – Tx
A
Heparin, Coumadin
22
Q
Hypovolemic shock – S/S
A
extreme blood loss =
pale / cool / clammy
Hgb and Hct <
confused
23
Q
Hypovolemic shock – Tx
A
fluid resuscitation, blood transfusion
vasoconstrictors 02
24
Q
THA – pre-op
TKA also
A
no smoking
no ASA 1-2 weeks, no ibu 1-2 days
lose weight
donate own blood
25
THA -- post-op
```
abductor pillow (NO ADDUCTION)
OOB ON OPERATED SIDE
elevated toilet seat
no squatting etc 3-6 mos
don't lean forward
reachers
PCA
```
26
THA -- post-op monitor
nerv / circ
| Hemovac of JP -- 100/150 mL/4 hrs serosang then sanguinous
27
TKA -- post-op
nerv / circ
PCA
immobilize when OOB
CPM machine -- ALWAYS MOVE PT LEG IN AND OUT IN FULL EXTENSION
28
Coumadin
```
INR 2-3
PT 18-24 secs
fall precautions
monitor: hematuria confusion (CB)
no OTCs with ASA or ibu
no high Vit K foods (unless always)
```
29
Dexa scan
measures BMD in hip, spine, forearm
| = or > T -1
30
Risk factors -- osteoporosis
```
smoking
> 65
inadequate Ca intake
not enough sun
too much Na / protein / ETOH / caffeine
late start or early menopause
small lean frame
Asian and Caucasian
personal and family Hx
> estrogen post-meno
renal / DM
```
31
Risk factors -- osteoporosis -- Rx
steroids
AEDs
chemo
excessive thyroid drugs
32
Rx Tx for osteoporosis
Ca up to 500 mg at a time (nsg c thyroid hormones, tetra, steroids, Fe, antacids)
Calcitronin -- inhibits osteoclasts but SE
Aldendronate / Fosamax inhibit resorption TAKE ON EMPTY STOMACH 1ST IN AM, 30 PRE FOOD, C H20 ONLY, NO ANTACIDS
Evista/Raloxifene -- mimic estrogen on bone S/E = leg cramps and hot flashes
Forteo/Teriparatide -- PTH stimulates osteoblasts S/E = Dz
Prolia/Denosumab -- post-meno
check Vit D and CrC within normal
33
Amputation -- post-op
bleeding -- Tx c tourniquet
flexion traction -- Tx pillow under residual limb
or lay prone 20-30 TID or QID
infection
phantom limb pain
34
IICP -- CT
consent for contrast and assess allergies and Tx c anti-hist and steroids
document evidence of renal Fx BUN Cr WNL -- dye renal damage
NPO midnight c contrast
#20 or greater in AC fossa
hold Metformin
force fluids wash out dye
35
IICP -- MRI
can use Gaudolinium contrast etc
remove all metal
check for prostheses or old tattoos
36
IICP -- PET scan
NPO
no caffeine / ETOH / tobacco 24 hrs
no sedatives no glucose preps/drugs
37
IICP -- angiogram
thru femoral artery to cerebral circ
assess for allergies / CrC WNL / meds vs contrast (AEDs antidep Metformin)
4-6 hrs post rest
pressure dressing, assess bleeding
38
IICP -- LP
subarachnoid below L2
obtain / measure / inject into CSF
Pre need consent / empty bladder / strict asepsis
Post lie flat, force fluids replace CSF H/A
39
Normal ICP
5-15 mm Hg in lateral ventricles
40
Ventriculostomy
aka ICP monitoring
| also drain CSF and admin meds
41
CPP -- range
normal 70-100 mm Hg
| very bad < 50 or > 150
42
CPP -- calculate
MAP - ICP = CPP
MAP = SP + 2 X DP / 3 (normal = 70-110)
43
CPP auto-regulation -- pressure
as SBP goes up, vessels constrict
| as SBP goes down, vessels dilate
44
CPP auto-regulation -- metabolic
O2 CO2 and temp cause constriction or dilation in order to change CBF and bring O2
45
IICP -- Cushing's Triad
Very ominous
1) bradypnea
2) widening pulse pressure SP > and DP <
3) bradycardia
= pressure in cranial vault and attempt to increase cranial blood flow
46
GCS
Eye 1-4
Verbal 1-5
Motor 1-6
severe < 8
mod 9-12
mild 13+
< 7 very ominous
47
Painful pressure -- when no Rs to verbal
gentle shake > nail bed pressure > supraorbital pressure > trap squeeze
localizing >
48
Decorticate
Pigeon in hands and feet
49
Decerebrate -- worse > decorticate
Extend out
50
Cranial Nerve reflexes
```
Gag -- 9 & 10
Corneal -- 5 & 7
Oculocephalic / doll's eyes -- 4 & 6
Oculovestibular / cold H2O -- 4 & 6
Babinski -- motor
```
51
IICP Nx and Tx
```
O2
ICP drain
control hyperthermia > 38
control Sz
limit suctioning < 10 secs
reduce cellular demands -- sedate / paralyze
diuretics
stool softener
elevate HOB
watch opioids -- OK but assess RR
Mannitol -- pulls H2O < brain use filter needle
```
52
Basilar skull fracture
Racoon eyes
Battle's sign
tears dura -- CSF from nose or ears
53
Classification head injury Open / Closed
```
Open = tears dura
Closed = dura intact
```
54
Concussion
Least serious
brain jarring
at home observe for V / LOC / severe H/A / Sz / fever / salty drainage
55
Contusion
> concussion
areas of hemorrhage, necrosis & cerebral damage
coup or contracoup
post amnesia for wks-mos
56
Laceration
traumatic tearing of brain tissue d/t open fracture or penetration
perm brain damage
hemotomas
57
Epidural hematoma
```
b/w skull and dura
MIDDLE MENINGEAL ARTERY IN TEMPORAL AREA
arterial bleed
unconc > conc > unconc
immediate craniotomy
```
58
Subdural hematoma
```
b/w dura and arachnoid
VENOUS BLEED
acute w/i 48 hrs
subacute w/i 2-14 days
chronic wks-mos
elderly fall and hit their head
```
59
Intracerbral hematoma
bleeding into brain tissue
GSW or aneurysm
size and location -- often fatal
60
Post-op craniotomy
```
LOC
VS -- temp and IICB
ABG -- hypoxemia
Sx dressing for blood or CSF
Meds for cerebral edema
electrolytes -- esp Na
Sz / DVT prevent with Hep / TED / SCD
```
61
S/S of IICP
widening pulse pressure
bradycardia
RR <
Temp >
62
Dx CSF leak
```
drain ENT that is salty
glucose positive
halo sign on pillow etc
H/A improves when lying down
Nucal rigidity
```
63
Urine specific gravity
normal -- 1.001 - 1.040
| usu -- 1.015 - 1.025
64
Sz --simple partial
```
no LossOC
< 1 min
motor -- unilateral movement eg arm
sensory -- ringing, metallic
autonomic -- racing HR
```
65
Sz -- complex partial
altered csnss
automatisms but not aware of them
altered memory deja vu
66
Sz -- generalized
whole brain -- LossOC
Absence (petit mal) -- brief loss, often children
Myoclonic -- sudden jerk / stiff / fall
Atonic -- loss of muscle tone / may fall
Tonic Clonic (grand mal) -- tonic stiff / the clonic jerk, cyanosis, salivation, hrs-days to recover
67
DILANTIN
PO or IV
```
THERAP LEVEL = 10-20 mcg/mL
ONLY WITH NS
GIVE SLOWLY
reduces voltage, frequency, and spread of electrical discharges
grand mal / status epilepticus
```
teratogenic / hypersensitivity = Steven Johnsn Syndrome
gingival hyperplasia
68
Sz precautions
1) added side rails up
2) O2 and suction at bedside
3) saline lock in place
4) go glass
5) bed L&L
69
AEDs S/E
```
bone marrow suppression
osteoporosis
gingival hyperplasia
nystagmus
teratogenic
ataxia
DON'T STOP ABRUPTLY = SZ CAUSING
```
70
BMT or HSCT
bone marrow or hemapoietic stem cell trans
leukemia / lymphoma / SC / MM
marrow is eradicated and then "rescued"
71
Types of BM donor
Auto
| Allo -- matches HLA human leukocyte antigen = sygnenic / related / MUD
72
CSF used
make more stem cells in BMT process
73
Allo BMT
may change blood type
| will need re-immnunization
74
BMT complications
infection
GVHD -- graft (marrow) rejects the host (usu host rejects graft = HVGD)
w/i 100 days
75
Rx vs GVHD
methotrexate
cyclosporine
corticosteroids
76
S/S Leukemia
swollen lymph nodes
- fever
- easy bruising
- bone or joint pain
- fatigue/malaise
- anorexia
- weight loss
77
MMyeloma
hypercalcemia
Pamidronate = inhibits osteoclasts
8.5-10.0 SERUM CALCIUM
78
Skin Cancer ABCD
```
A: asymmetry
B: border (irregular)
C: color (uneven)
D: diameter (>6mm)
E: Evolving
```
79
Cancer stages of grief
ABDA
