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Role Transition > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Strains are
Sprains are
Treatment
Rotator cuff injury
Management
Joint dislocation
Subluxation

A
  • 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
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2
Q

Greenstick fracture
Transverse
Comminuted
Complete / incomplete
Spiral
Oblique

A
  • 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
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3
Q

Assessment of a fracture
Initial care
Closed reduction
Open reduction

A
  • 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
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4
Q

Traction is
Ensure what
Skeletal traction
Bucks skin traction
Dunlop’s skin traction
5 P’s of circulatory checks
Casts interventions

A
  • 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
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5
Q

Fat embolism from
Manifestations
Compartment syndrome is
Early signs
Late signs
Intervention

A
  • 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
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6
Q

Crutch walking
Canes interventions

A
  • 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
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7
Q

Hip fracture signs
Interventions
Prevent DVTs
Prevent infection
Total knee replacement interventions

A
  • 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
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8
Q

C collar used for
Amputation interventions
Stump care

A
  • 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
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9
Q

Rheumatoid arthritis is
Signs
Boutonnière
Swan neck
Treatment
For chronic pain/ acute pain

A
  • 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
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10
Q

Osteoarthritis is
Affects what
Manifestations
Heberdens nodes
Bouchards nodes

A
  • 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
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11
Q

Osteoporosis is
Interventions
Prevention
Gout is
Interventions
Carpal tunnel syndrome is
Diagnostic test
Treatment

A
  • 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
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12
Q

Respiratory assessment
Rales / crackles
Stridor
Wheezing
Sputum analysis
D-dimer for

A
  • 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)
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13
Q

Laryngoscopy & bronchoscope post op
Pulmonary angiography
Thoracentesis & post op

A
  • 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
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14
Q

Obstructive pulmonary disease
Restrictive
Peripheral airway disease
Early signs of hypoxemia
Late signs

A
  • 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
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15
Q

Flail chest
Open pneumothorax / closed
Spontaneous pneumo
Pleural effusion / hemothorax
Chest tube location

A
  • 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)
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16
Q

Chest tube water seal should be
Excessive bubbling in water seal
If tidaling stops
Suction chamber should be

A
  • tidaling with respirations
  • indicates an air leak
  • indicates obstruction or resolved pneumothorax
  • gently bubbling
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17
Q

ARDS due to
PEEP for
PEEP contraindicated for
Signs & symptoms of ARDS
ABGs would indicate
Interventions for ARDS

A
  • 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
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18
Q

How long intubated before trach
Indication for mechanical vent
CMV
A/C
SIMV

A
  • 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
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19
Q

Ventilator alarms
If you don’t know cause of alarm
Low pressure alarm indicates
High pressure
Apnea alarm

A
  • should never be turned off
  • start the AMBU Bag
  • disconnection, leak
  • obstruction (kink, secretions; mucus plug , pneumothorax)
  • no spontaneous breathing
20
Q

CPAP
BiPAP
To give Bipap
Management of mechanical vent
To treat delirium
When patients are fighting vent

A
  • 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
21
Q

Asthma is
Symptoms
Test before & after treatment
Asthma severity (symptoms)
Long acting control meds
Short acting rescue meds
Complications of asthma

A
  • 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
22
Q

Emphysema is
Chronic bronchitis is
Main cause of barrel chest is
COPD diagnostics ABG
COPS treatment
Pt education/ pursed lip for

A
  • 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
23
Q

Community acquired pneumonia
Hospital acquired
Risk factors for pneumonia
Symptoms
Treatment

A
  • 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
24
Q

Symptoms of TB
Diagnostic tests
Positive in healthy individual
For immigrants & institutional
Immunocompromised pts
Hospital precautions

A
  • 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
25
Q

Rhinitis causes
Manifestations
Treatment
Pharyngitis manifestations
Treatment
Airborne precautions

A
  • allergens or viruses/bacteria
  • nasal drainage, congestion
  • antihistamine, nasal spray
  • petechiae in throat, white spots
  • Bicillin shot or penicillin
  • measles, varicella, TB
26
Q

Paracentesis is
Liver biopsy post procedure
Liver function tests

A
  • 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
27
Q

GERD manifestations
Interventions
Hiatal hernia is
Complications
Esophageal varices
Main concern

A
  • 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)
28
Q

Peptic ulcer disease due to
Meds
Gastric ulcer manifestations
Predisposing factors
Duodenal ulcer
Gastritis is

A
  • 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
29
Q

Gastrectomy complications
Post op intervention
Preventing dumping syndrome
Pernicious anemia
B12 deficiency symptoms

A
  • 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
30
Q

Ulcerative colitis is
Manifestations
Crohn’s disease is
Manifestations
Complications for both
Interventions
TPN tips

A
  • 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
31
Q

Diverticulosis
Diet Management
Diverticulitis
Diet Management
Manifestations
Treatment

A
  • 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
32
Q

Hemorrhoids are
S/S
Interventions

A
  • 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
33
Q

Acute pancreatitis & indication
Prognosis good vs poor
Manifestations
Cullens sign & turners sign
Interventions

A
  • 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
34
Q

Complications of cirrhosis
Signs & symptoms
Interventions

A
  • 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
35
Q

Cholecystitis is
Cholelithiasis
Manifestations
How to perform murphys

A
  • 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
36
Q

Appendicitis triad manifestations
If suspected appendicitis
Psoas sign
Obturator sign

A
  • RLQ pain, leukocytosis, anorexia
  • place pt NPO & prepare for surgery
  • push down on right leg
  • flex right leg & rotate hip internally
37
Q

Hepatitis signs
Pre-icteric stage
Icteric stage
Post-icteric stage

A
  • 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
38
Q

Hep A
Prevention
Hep B
Prevention
Hep C
Prevention
Hep D common in
Complications

A
  • 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
39
Q

Education for hepatitis

A

strict handwashing
Separate materials
Don’t share bathrooms
Avoid anything hepatotoxic
High carb, low fat food

40
Q

Normal MCV
Microcytic anemia
Macrocytic
Anemia symptoms
Causes of anemia
Treatment
Neutropenic patient

A
  • 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)
41
Q

Iron deficiency anemia
Iron supp teaching
Manifestations
Diagnosis
Sources of iron

A
  • 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
42
Q

Cobalamin deficiency
Pernicious anemia
Important manifestations
Pt with restraints
Schilling test

A
  • 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
43
Q

Aplastic anemia due to
Hallmarks of aplastic anemia
Treatment due to bone marrow
Safety

A
  • 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
44
Q

Hemolytic anemia type
Sickle cell manifestations
What precipitated sickle crisis
Treatment

A
  • sickle cells
  • severe pain, increased blood viscosity (occlusion, ischemia, infarction to vital organs)
  • cold, stress, dehydration, illness
  • Hydration, opioids (analgesic), oxygen, rest
45
Q

Polycythemia is
Treatment
Hemophilia main point
Treatment
Thrombocytopenia is

A
  • 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)
46
Q

DIC is
Typically results from
Manifestations
Diagnostics
Treatment

A
  • 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
47
Q

Transfusion therapy
Adverse reaction
What to do

A

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

Role Transition (3 decks)

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