Final Exam: SG Material Flashcards
Fractures can lead to what issue? What can this issue lead to?
Fractures can lead to compartment syndrome which can lead to amputation
What are s/s of fractures? (3)
Cool, pallor, numbness
What is used to treat fractures preoperatively? What happens if the patient moves?
- Traction (weights) attached to the patient’s fractures to immobilize the patient; should not touch the floor (removes the traction)
- Can be painful for the patient if they move
Fractures on long bones (eg: lower extremities) have a high risk for? (2)
- pulmonary embolism (fat can break off and move to lungs or brain)
- muscle spasms
Precautions for hip replacement? (2)
- extending body to 90 degree angle
- raise toilet seat to avoid bending
Compound fracture is?
breakage that results in bone protruding through the skin and has a high risk for infection
Complications of broken hip? (2)
- immobility
- chronic health issues with immobility (eg: malnutrition, muscle degeneration, skin breakdown)
Osteoporosis (bone loss) is more common in which gender and why?
In females related to post-menopause (loss of estrogen)
Why are women more susceptible to bone loss than men? How does the loss of estrogen contribute to osteoporosis?
Estrogen combines with calcium and vitamin D to help keep bones working; loss of estrogen makes more osteoclasts (bone reduction) and less osteoblasts (bone formation)
A fracture that occurs because of osteoporosis is classified as?
A pathological fracture (can trace back to the disease process)
What are the main concerns for patients with osteoporosis? (2)
Risk for falls (to prevent breaking bones) and fractures
What are the nutritional causes of osteoporosis? What nutritional supplement can treat osteoporosis?
- lack of calcium/dairy
- take vitamin D to increase calcium bioavailability
Two days after surgery for a crushed pelvis, a CNA reports that the patient is complaining of SOB and demonstrating signs of confusion and restlessness. What should a nurse suspect from these signs alone that the patient has developed?
Fat embolism
What is a serious muscle issue that can result from osteoporosis or a fracture?
Rhabdomyolysis: muscle breakdown
A 78-year-old retired teacher with a hx of osteoporosis has fallen in her bathroom and sustained a sub capital femoral fracture. She is scheduled for an open reduction and internal fixation procedure in the morning. Which type of traction will most likely be implemented?
Bucks’ Traction
Difference between internal vs external fixation?
Internal: patient will be instilled internally with rods and pins
External: bolts and pins are instilled outside the patient
A patient with external fixation needs pin care, the patient teaching should include? (2)
- expectations to feel itchy while healing around the pin sites
- report exudate or drainage that is green or brown that is foul-smelling
A nurse is told that a patient has a compound comminuted fracture. What characteristic of the bone in this type causes the nurse to be concerned?
Broken in two or more pieces, bone fragment protrudes through the skin, leading to a high risk for infection
What action should the nurse implement when caring for a patient dx of a compound fracture?
Assess for pulses distal to the injury (breakage can affect circulation and oxygenation of the tissue distal from the injury, eg: for a knee injury, assess pulses at the pedal and tibial pulse)
What should a nurse who is documenting and reporting the s/s of infection underneath a cast include in the medical record? (5)
- foul odor
- redness
- warmth
- swelling
- elevated temperature
A nurse is teaching an osteoporotic patient taking alendronate (Fosamax). Which instruction should the nurse stress? (2)
Keep patient upright for 30 minutes (patient should keep themselves upright) and take without regard to food
Alendronate (Fosamax) what type of medication and what is it used for? What is a patient at risk for?
Biphosphate medication; at risk for getting other fractures (drug use is to mobilize and decrease bone loss)
Peptic ulcer disease is?
Erosion of stomach lining and ulceration in the small intestine
What digestive enzymes does the stomach secrete (2)
Pepsin and hydrochloric acid
What is the main bacterial cause of peptic ulcer disease?
H. pylori bacteria
What medications propagate peptic ulcer disease?
NSAIDs
Gastric ulcers occur in the stomach and pain occurs when? Foods role?
Pain occurs 1-2 hrs after meal; food aggravates s/s
Duodenal ulcers occur in the duodenum and pain occurs when? Foods role?
Pain occurs 2-5 hrs after meal; food alleviates pain as it buffers acid secretion
What group of medications is used to treat peptic ulcer disease? How long does its effects last?
Antibiotic treatment; effect lasts for weeks
What are side effects of antibiotic treatment? (4)
- GI issues
- superinfection (eg: kills normal flora)
- oral candidiasis
- yeast infection (mostly in women)
What are 5 other groups of medications that treat peptic ulcer disease?
- H2 receptor blockers (eg: ranitidine)
- proton pump inhibitors (eg: ending in -prazole)
- antacids
- magnesium
- aluminum antacids
H2 receptors are used for which patients?
Patients who are in the hospital for a long period of time to PREVENT a peptic ulcer
H2 receptors are?
The second fastest-acting medication and has the most duration
Sucralfate is a medication that does NOT?
Lowers stomach acid; provides a protective covering of stomach lining
Are there medications to physically fix a peptic ulcer?
No
What is the main concern with antibiotic treatment? (2)
C. diff infection and superinfections (eg: oral candidiasis or thrush, yeast infection)
S/S of perforated ulcer?
Bright, red blood in vomit
S/S of internal bleeding ulcer? (3)
- hard, board-like ABD
- hypotension and tachycardia
Where does fecal matter stay when it is expelled in the GI tract?
In the rectum
At what age is it common for the appendix to get inflamed (appendicitis)?
Patients under 25
What are 2 functions of the liver?
- metabolize (CYP450 is the enzyme that metabolizes drugs in the liver)
- makes bile (used to breakdown fat) and glucose
Hepatitis A is?
- route
- causes (2)
- s/s (3)
- prevention
- patient teaching (2)
- ACUTE, inflammation cannot be chronic from hep A
- route: oral-fecal route
- causes: poor handwashing, poorly cleaned vegetables and fruits
- s/s: jaundice, nausea, fatigue
- preventable with a vaccine
- practice good hand hygiene, wash produce thoroughly
A nurse is educating a patient dx with hep A. What should the nurse instruct this patient to avoid sharing?
Food
Hepatitis B is mainly a concern for?
- causes (3)
- chronic or acute?
- prevention?
- treatment (2)
- concern for HCPs especially through a large bore needlestick
- blood, bodily fluid, IV drug abuse
- can convert to a chronic condition
- use standard infection precautions (eg: PPE)
- gamma-ray and interferon
Hepatitis C
- transmission (2)
- requires what type of testing?
- chronic or acute?
- blood-borne, IV drugs
- requires genotype testing
- chronic and slow-damaging to liver overtime
What precaution should a nurse initiate when caring for a patient with hepatitis B?
Standard precautions
Liver function test includes? (2)
AST and ALT
Diverticulosis?
primarily affects the outpouchings of the large intestine, becomes inflamed and starts to rot
What is diverticulosis caused by? (2)
- low fiber diet
- hx of hemorrhoids
What is the difference between diverticulosis and diverticulitis?
Diverticulosis has less s/s and leads to inflammation (diverticulitis)
Treatment for diverticulosis? (2) nutrition
- high-fiber diet
- low-fat/non-fat diet
When is a fat embolism most likely to occur?
24-48 hrs after a fractured tibia
What foods can get stuck in the diverticula? (2)
Nuts and seeds
What should a nurse include in the discharge teaching for a patient after a laparoscopic for a cholelithiasis?
Follow a low-fat diet (not enough bile to break down fat)
S/S of cholelithiasis?
dark, amber-colored urine that may contain blood
Ulcerative colitis is limited to which section of the GI tract? S/S? Surgical treatment for ulcerative colitis?
- colon
- bloody diarrhea
- stoma (eg: ileostomy)
A patient in acute pain is admitted with pancreatitis. A nurse reviews a lab report showing elevation that is diagnostic for acute pancreatitis. Which lab report did the nurse most likely review?
Serum amylase
Causes of pancreatitis (3) Which is the most common?
- gallbladder disease: most common (very painful)
- chronic alcholism
- diabetes
Which gender population is more likely to have gallstones?
Males
Describe pain associated with gallstones? (2)
- radiates to the back
- can be acute or chronic
Functions of the pancreas (2)
Endocrine functions: secretes insulin, glucagon
Exocrine function: digestive enzymes
What can occur if enzymes are not released due to an obstruction in the pancreas?
Enzymes can injure the pancreas itself which can lead to issues in the GI (eg: digestion)
Patient care for pancreatitis? (2)
- administer pain medications
- low-fat diet
Patients with which GI disorder have a GREATER risk for colorectal cancer?
Ulcerative colitis
Precursors to colon cancer? (2)
ulcerative colitis and Crohn’s disease
If a patient does not have first-degree relatives with colorectal cancer, at what age is a patient prone to getting the disease?
Starting at 50 years old
What is the gold standard testing for colorectal cancer?
Colonoscopy (detects polyps)
Diet that can lead to colorectal cancer (2)
- high red meat intake
- fatty diet
What gene is detected in patients with colorectal cancer?
APC gene (increased risk for colorectal cancer)
Endoscopy goes through which tract?
Oral tract
Cirrhosis is?
An ongoing inflammatory process in response to hepatocyte (liver cell) death
A common cause of CHRONIC cirrhosis?
Alcohol consumption
ACUTE cirrhosis is caused by?
Hepatitis A (eg: ingesting uncooked meat/unwashed produce)
If a patient eats a poisonous vegetable and requires a liver transfer, is this acute or chronic cirrhosis?
Acute
3 possible causes of cirrhosis?
- excessive drinking
- hepatitis C
- non-alcoholic fatty liver disease (NAFLD)
S/S of ascites? (2)
- striae
- spider anginoma
Which liver disease process is a result of cirrhosis?
End-stage liver disease
What actions should a nurse implement to correctly assess the progress of ascites on a daily basis? (2)
Daily weight (fluid retention) and ABD girth measurements
Why do I&Os not have to be assessed on a daily basis for a patient with ascites?
I&O measures the current fluid status (does not track daily progression)
What is an indication of end-stage liver disease? It is most important to assess for?
- hepatic encephalopathy (excess ammonia due to inability to convert ammonia to urea to be excreted in urine)
- assess LOC
What is necessary to restrict when the ammonia level of patient dx with cirrhosis continues to rise? (3)
- meat/organ meat
- alcohol intake
- decrease protein intake
A high ammonia level contributes to hepatic encephalopathy. Which nursing implementation needs to be added to the nursing care plan as this level continues to increase?
Increase frequency of neurologic checks
S/S of esophageal varices? (3)
- vomiting blood
- hypotension
- tachycardia
Indications of internal blood loss? (3)
- poor perfusion
- SOB
- decrease in BP
Possible causes of internal blood loss (3)
- trauma
- loss of blood in the ABD cavity
- GI bleed
What is a hiatal hernia?
part of the stomach has moved upwards through the diaphragm (very painful!)
What is GERD (gastroesophageal reflux disease)
loss of the ability to contain stomach acid
Surgeries place the patient at a greater risk for?
Adhesions (the connection between two tissues that should not occur) and could contribute to a hernia
