Exam 3 Flashcards
Strains are
Sprains are
Treatment
Rotator cuff injury
Management
Joint dislocation
Subluxation
- trauma to muscles or tendons
- trauma to ligament & joint
- RICE
- can’t raise shoulder above head, drop arm test (can’t hold arm up)
- sling the arm, might need surgery
- bone is displaced from joint position
- partial dislocation
Greenstick fracture
Transverse
Comminuted
Complete / incomplete
Spiral
Oblique
- one side is broken & other is bent
- bone fractured straight across
- broken in multiple pieces (fragments)
- separated into 2 parts, partial break
- break encircles the bone
- diagonal break
Assessment of a fracture
Initial care
Closed reduction
Open reduction
- pain, loss of function, deformity, swelling
- immobilize extremity, cover wound, check distal pulse
- manual manipulation, done within 24hrs, cast applied
- surgical intervention, followed by traction or cast
Traction is
Ensure what
Skeletal traction
Bucks skin traction
Dunlop’s skin traction
5 P’s of circulatory checks
Casts interventions
- to maintain proper alignment & prevent muscle spasms
- ensure weights hang freely & don’t touch floor
- includes pins, must do proper pin care & monitor extremity
- lower limb : no more than 5lbs of weight & must hang freely
- traction for humerus fractures
- pain, paresthesia, paralysis, pulse, pallor
- monitor for circulatory impairment, do isometric exercises to prevent atrophy
Fat embolism from
Manifestations
Compartment syndrome is
Early signs
Late signs
Intervention
- fracture of long bone, typically femur
- petechiae rash of chest, AMS, tachycardia, dyspnea
- increased pressure of compartments causing compromised circulation
- severe pain unrelieved by meds
- compromised pulse (paresthesia, pulselessness)
- fasciotomy to relieve pressure
Crutch walking
Canes interventions
- go up step w good leg, go down with crutch & bad leg
- stand at affected side of patient, elbow should be 30 degrees , cane on unaffected side
Hip fracture signs
Interventions
Prevent DVTs
Prevent infection
Total knee replacement interventions
- shortness of affected leg & externally rotated
- keep legs straight & abducted with pillow
- SCDs, SQ heparin, early ambulation
- incentive spirometer Q1H, d/c foley & proper perineal care
- passive ROM for first 24-48hrs on affected leg
C collar used for
Amputation interventions
Stump care
- suspected spine injury or neck pain
- elevated limb for 1st 24hrs to decrease swelling, after 24hrs place the patient prone to stretch muscles
- wash stump with soap & water, don’t apply anything to stump, encourage use of prosthesis, no semi fowlers
Rheumatoid arthritis is
Signs
Boutonnière
Swan neck
Treatment
For chronic pain/ acute pain
- autoimmune systemic inflammatory response in the joints causing destruction of cartilage & joint
- morning stiffness > 30 minutes & swelling of bilateral joints
- flexion of proximal finger join & extension of distal joint
- extension of proximal finger joint & flexion of distal joint
- NSAIDs, salicylates (aspirin), corticosteroids
- apply heat for chronic / apply cold for acute
Osteoarthritis is
Affects what
Manifestations
Heberdens nodes
Bouchards nodes
- degenerative joint disease due to overuse leading to loss of cartilage & inflammation
- weight bearing joints, mostly hips & knees
- pain occurs later in day due to use of affected joint, difficulty getting up after long sitting
- nodes at distal finger joint
- nodes at proximal joint
Osteoporosis is
Interventions
Prevention
Gout is
Interventions
Carpal tunnel syndrome is
Diagnostic test
Treatment
- bone demineralization leading to fragile bones & fractures
- provide safe environment, use a firm mattress
- calcium & vit D, weight bearing exercises
- palpable hard nodules (tophi) due to build up of urate crystals from high uric acid levels
- colchicine for acute attack, allopurinol for maintenance, low purine diet (red meat, shellfish, alcohol, sardines)
- compression of median nerve in wrist causing pain & numbness to 1st 3 fingers
- phalen test: extreme flexion of wrists for 60seconds & assess for numbness or tingling
- bracing to immobilize wrist or surgery to decompress nerve
Respiratory assessment
Rales / crackles
Stridor
Wheezing
Sputum analysis
D-dimer for
- SOB, productive cough (green= immune system working) (yellow/brown = bacterial infection)
- fluid in lungs
- upper airway obstruction
- partial obstruction
- collect early in the morning
- used to rule out clots (<0.5 indicates no clot)
Laryngoscopy & bronchoscope post op
Pulmonary angiography
Thoracentesis & post op
- assess gag reflex, semi Fowler, maintain NPO until gag reflex returns
- iodine allergies, NPO, expect salty taste & flushing
- removal of fluid or air from pleural space / monitor respiratory status, assess trachea & absence of breath sounds for pneumothorax
Obstructive pulmonary disease
Restrictive
Peripheral airway disease
Early signs of hypoxemia
Late signs
- increased airway resistance; can’t exhale (COPD, Asthmatics)
- problems getting air into lungs (rib fracture, neuromuscular disorders, obesity)
- bronchitis, asthma, cystic fibrosis
- agitation, tachycardia, restlessness
- cyanosis, confusion
Flail chest
Open pneumothorax / closed
Spontaneous pneumo
Pleural effusion / hemothorax
Chest tube location
- multiple rib fractures causing paradoxical respiration
- less trachea deviation / tension pneumothorax; tracheal deviation
- tall skinny males, smokers
- fluid in pleural space / blood in space
- tube at bottom for pleural effusion (fluid) / tube at top for pneumothorax (air)
Chest tube water seal should be
Excessive bubbling in water seal
If tidaling stops
Suction chamber should be
- tidaling with respirations
- indicates an air leak
- indicates obstruction or resolved pneumothorax
- gently bubbling
ARDS due to
PEEP for
PEEP contraindicated for
Signs & symptoms of ARDS
ABGs would indicate
Interventions for ARDS
- alveoli filling with water which decreases gas exchange
- used to keep alveoli open for gas exchange
- cardiac patients (decreased cardiac output)
- persistent hypoxia even with oxygen, white out (ground glass) chest x ray
- respiratory acidosis
- corticosteroids to decrease inflammation & bronchodilators to open bronchioles
How long intubated before trach
Indication for mechanical vent
CMV
A/C
SIMV
- ET tube 5-7 days indicates need for tracheostomy
- PaO2 <50 mmHg, PaCO2 >50 mmHg, RR > 35
- machine does everything for patient
- patient can initiate breath, but vent completes the breath with TV
- patient can breath on their own & machine assists in completion of RR
Ventilator alarms
If you don’t know cause of alarm
Low pressure alarm indicates
High pressure
Apnea alarm
- should never be turned off
- start the AMBU Bag
- disconnection, leak
- obstruction (kink, secretions; mucus plug , pneumothorax)
- no spontaneous breathing
CPAP
BiPAP
To give Bipap
Management of mechanical vent
To treat delirium
When patients are fighting vent
- all breaths initiated & ended by pt
- gives inspiratory & expiratory pressure, last source before ventilation
- pt must be cooperative, alert & systolic >90
- sedatives given with analgesics (Benzos, propofol)
- haldol
- give neuromuscular blocking drugs
Asthma is
Symptoms
Test before & after treatment
Asthma severity (symptoms)
Long acting control meds
Short acting rescue meds
Complications of asthma
- reversible airway bronchoconstriction & chronic inflammation
- Wheezing, cough, SOB
- peak expiratory flow
- intermittent <2 days, mild >2days/week, moderate is daily, severe is throughout the day
- ICS (fluticasone), LABA (salmeterol)
- SABA (Albuterol), prednisone (anti-inflammatory)
- absence of wheezing indicates complete closure of airway
Emphysema is
Chronic bronchitis is
Main cause of barrel chest is
COPD diagnostics ABG
COPS treatment
Pt education/ pursed lip for
- loss of elastic recoil, structural defect
- inflammation of upper airway that prevents air from being exhaled
- air trapping
- low PH & High CO2
- give fluids & hydrate patient to loosen & remove mucous
- pursed lip breathing to prevent early bronchiole collapse
Community acquired pneumonia
Hospital acquired
Risk factors for pneumonia
Symptoms
Treatment
- diagnosed within 48hrs of admission
- diagnosed 48hrs after admission
- Atelectasis after surgery, ventilation
- fatigue, SOB, productive cough, crackles & Ronchi, fever
- do blood cultures before antibiotics
Symptoms of TB
Diagnostic tests
Positive in healthy individual
For immigrants & institutional
Immunocompromised pts
Hospital precautions
- low grade fever, night sweats, hemoptysis, weight loss
- sputum culture (gold standard), mantose test (PPD)
- 15mm wide induration
- > 10mm wide
- > 5mm wide
- air borne precaution, negative pressure, adequate nutrition
Rhinitis causes
Manifestations
Treatment
Pharyngitis manifestations
Treatment
Airborne precautions
- allergens or viruses/bacteria
- nasal drainage, congestion
- antihistamine, nasal spray
- petechiae in throat, white spots
- Bicillin shot or penicillin
- measles, varicella, TB
Paracentesis is
Liver biopsy post procedure
Liver function tests
- to treat ascites in cirrhosis
- place patient on side to put pressure on puncture site & prevent bleeding
- ALT (liver tissue), AST (toxicity), elevated alkaline phosphate = obstruction
GERD manifestations
Interventions
Hiatal hernia is
Complications
Esophageal varices
Main concern
- heart burn, regurgitation, cough
- PPI (pantorprazole), sit up after eating, don’t eat 2Hr before bed
- portion of stomach goes through diaphragm into thorax
- ulceration, hemorrhage, regurgitation, strangulation
- dilation of veins due to cirrhosis or liver damage (portal HTN)
- hemorrhage from varices (give vit K, blakemore tube)
Peptic ulcer disease due to
Meds
Gastric ulcer manifestations
Predisposing factors
Duodenal ulcer
Gastritis is
- increased acid production or decreased mucous protection
- H2 blocker (-tidine), PPI
- pain after eating
- NSAIDs, smoking, alcohol, steroids
- pain 2-3hrs after eating, Melena
- inflammation of stomach caused by irritating food or H pylori
Gastrectomy complications
Post op intervention
Preventing dumping syndrome
Pernicious anemia
B12 deficiency symptoms
- anemia, dumping syndrome & vitamin B12 deficiency
- Reconnect NGT to suction, assess bowels, maintain NPO until peristalsis returns
- low carb high protein diet, lie down after eating, avoid fluid with meals
- leads to deficiency of B12, only anemia linked to neuro symptoms
- pallor, fatigue, beefy tongue, paresthesias, unsteady gait
Ulcerative colitis is
Manifestations
Crohn’s disease is
Manifestations
Complications for both
Interventions
TPN tips
- continuous ulceration distally in rectum
- bloody stool, anorexia, peritonitis
- patchy ulceration in any part of the intestine
- steatorrhea (fatty stool)
- UC risk for colon cancer, CD risk for fistular abscess & ulceration
- NPO bowel rest, BRAT diet, antidiatrheals (Lomotil, Imodium), steroids
- check glucose, hang Dextrose 10% between TPN bags
Diverticulosis
Diet Management
Diverticulitis
Diet Management
Manifestations
Treatment
- multiple diverticula of colon
- high residue diet w/ no seeds
- inflammation of the diverticula
- NPO, low residue, bland, no seeds
- LLQ pain, N/V, blood in stools
- surgery for rupture, NPO, antibiotics, NGT, stool softeners
Hemorrhoids are
S/S
Interventions
- dilated varicose veins of anal canal
- bright red bleeding with defecation, rectal itching or pain
- high fiber diet & fluids, stool softener, limit sitting, ice packs
Acute pancreatitis & indication
Prognosis good vs poor
Manifestations
Cullens sign & turners sign
Interventions
- inflammation of pancreas indicated by elevated lipase & amylase levels
- good: biliary disease/ poor: ETOH
- epigastric LUQ pain, N/V, peritonitis
- cullens : bruising around umbilicus / turners : brushing of flank
- NPO, give opioids & fluids, pt can eat when lipase & pain decreases
Complications of cirrhosis
Signs & symptoms
Interventions
- portal HTN, Ascites, esophageal varices, coagulation defects, jaundice
- hepatomegaly, fetor hepaticus (fruity, musty breath), Asterixis, delirium, AMS, coma
- rest, I&Os, vitamin K, lactulose to remove ammonia, avoid hepatotoxic meds
Cholecystitis is
Cholelithiasis
Manifestations
How to perform murphys
- inflammation of gallbladder (mostly due to gallstone obstruction)
- acute inflammation due to gallstones
- RUQ pain, N/V, murphys sign
- take deep breath & hold, palpate RUQ & assess for guarding/tenderness
Appendicitis triad manifestations
If suspected appendicitis
Psoas sign
Obturator sign
- RLQ pain, leukocytosis, anorexia
- place pt NPO & prepare for surgery
- push down on right leg
- flex right leg & rotate hip internally
Hepatitis signs
Pre-icteric stage
Icteric stage
Post-icteric stage
- very fatigued, low energy
- flu like symptoms, body aches, elevated bilirubin & enzymes, no jaundice
- appearance of jaundice, tea color urine, clay colored stools
- symptoms decrease
Hep A
Prevention
Hep B
Prevention
Hep C
Prevention
Hep D common in
Complications
- transmitted via fecal route
- hand washing, needle & stool precautions, vaccine 2 weeks before travel
- parenterally transmitted
- hand washing, needle precautions, avoid sexual contact, Hep B vax
- parenterally transmitted
- hand washing, needle precautions, screening blood donors
- Mediterranean & middle eastern areas, only caused with HBV infections
- chronic liver disease
Education for hepatitis
strict handwashing
Separate materials
Don’t share bathrooms
Avoid anything hepatotoxic
High carb, low fat food
Normal MCV
Microcytic anemia
Macrocytic
Anemia symptoms
Causes of anemia
Treatment
Neutropenic patient
- 80-100 (CKD anemia)
- <80 (iron deficiency & thalassemia)
- > 100 (folic acid & B12 deficiency)
- SOB, severe fatigue, weakness, pallor, tachycardia, pain
- bleeding, bone marrow defect, deficiency of iron or folic acid
- blood transfusion, stimulating agent (procrit, avanesp)
- reverse isolation (no flowers, no children, no large crowds)
Iron deficiency anemia
Iron supp teaching
Manifestations
Diagnosis
Sources of iron
- most common
- constipation, black stool / take with vitamin C or orange juice
- pallor, cheilosis, glossitis, fatigue
- low iron & ferritin levels, increased TIBC (total iron binding capacity)
- Beans, protein, greens, legumes
Cobalamin deficiency
Pernicious anemia
Important manifestations
Pt with restraints
Schilling test
- vitamin B12 deficiency
- lacking intrinsic factors
- safety is important due to neuro effects ; AMS, confusion
- requires continuous assessment, never delegate
- give oral B12, check absorption, if negative administer intrinsic factor, if absorbed with intrinsic factor it is pernicious anemia
Aplastic anemia due to
Hallmarks of aplastic anemia
Treatment due to bone marrow
Safety
- typically patients with neoplasms due to chemo & radiation therapy
- anemic, thrombocytopenia, leukopenia (low RBC, Plt, WBC)
- prepare for bone marrow transplant (requires sever immunosuppression)
- prevent from infection or bleeding
Hemolytic anemia type
Sickle cell manifestations
What precipitated sickle crisis
Treatment
- sickle cells
- severe pain, increased blood viscosity (occlusion, ischemia, infarction to vital organs)
- cold, stress, dehydration, illness
- Hydration, opioids (analgesic), oxygen, rest
Polycythemia is
Treatment
Hemophilia main point
Treatment
Thrombocytopenia is
- increased platelets : risk for clots
- phlebotomy, anticoagulants
- prevent injuries; risk for bleeding out
- Fresh frozen plasma in acute episode of bleeding
- decreased platelets resulting in prolonged bleeding time (increased PT & PTT)
DIC is
Typically results from
Manifestations
Diagnostics
Treatment
- excessive clotting, exhausts clotting factors & leads to bleeding disorder
- sepsis
- bleeding, petechiae, ecchymosis, hypotension, multiple organ system dysfunction (high mortality)
- low fibrin, long PT, low platelets
- Platelets, FFP, give blood
Transfusion therapy
Adverse reaction
What to do
Ensure blood matches, 2 nurses sign
Hang blood with NS
- Rxn within 1st 15 min
Flushing, chills, fever, tachy, hypo
- stop infusion, change tubing & send to lab
