med surg final uttyler

Question 1

what are some health promotions for a soft tissue injuries (ie. sprains and strains)

Answer 1

warming up muscles before activity and exercise
strength balance and endurance exercises
work against resistance to build muscles
balance exercises and endurance training

Question 2

acute care for soft tissue injuries ( strains and sprains)

Answer 2

R-rest the affected limb (stop the activity and limit the movement)
I-ice the extremity immediately. DO NOT place ice directly on the skin (20 mins on 30 mins off) this is done for 24-24 hours
C-compression start distally and then work way up
E-elevated the extremity above the heart
Provide pain meds such as ibruprofen

Question 3

closed reduction

Answer 3

there is no incision that is required
under local or general anesthesia
usually done in the er
as the nurse you should manage the airway.
they will have a cast placed after this procedure

Question 4

open reduction

Answer 4

this includes a surgical incision normally pins, rods, or nails.
the main disadvantage of this is infection , complications associated with anesthesia, and effects on pre-existing conditions.

Question 5

open reduction with internal fixation

Answer 5

this heals faster
decreases the risk of immobility
nursing management includes ear;y ROM exercises, continuous passive motion machine that can be used to prevent DVT and adhesion within the joint and surgical site
education the patient on immobilization after the surgery and the use of any assistive devices

Question 6

what are some post op interventions to perform for a patient with ORIF

Answer 6

turning repostioning and extremity support
pain management: proper alignment
assess dressing/casts for bleeding/ drainage: measure drainage and report

Question 7

traction

Answer 7

the application of pulling force to to an injured or diseased part of the body or extremity

Question 8

neurovascular assessment of an injured extremity

Answer 8

pallor-color
pulselessness- cap refill
pressure-edema
paresthesia-changes in sensation such as numbness and tingling
paralysis-this may be a late sign of neurovascular damage
pain
ALWAYS ASSESS THE INJURED SITE ALONG WITH THE PART DISTAL TO IT BILATERALLY

Question 9

compartment syndrome

Answer 9

swelling and increased in pressure inside a limited space
onset is usually instantly or within several days
unrelieved pain is the FIRST indication

Question 10

what do you do if suspect the patient has compartment syndrome?

Answer 10

inform the HCP
do not elevate the extremity
notify the health care provider of the patient changing condition
avoid cold compresses
remove/loosen bandage/reduce traction and weight
a fasciotomy may be performed

Question 11

what are the two most common causes of compartment syndrome

Answer 11

decrease in compartment size such as restrictive clothing, excessive traction, or casts
increased in compartment contents such as with bleeding, edema, or inflammation

Question 12

what is something that can occur because of compartment syndrome and why

Answer 12

AKI

this can occur because of bone death and breakdown which will lead to rhabdomyosis

Question 13

venous thromboembolism

Answer 13

this occurs especially in the lower extremities

Question 14

drug therapy for VTE

Answer 14

warfarin
fondaparinux (arixtra)
rivariorxaban (xerlelto)
eliquis

Question 15

management of VTE

Answer 15

compression hose
scds
enoxaparin
ROM

Question 16

management of fat embolism syndrome

Answer 16

supportive therapy-respiratory and fluids to maintain MAP
include intubation along with peep
try not to manipulate the patient as much as possible to prevent dislodging the embolism
correction of acidosis by deep breathing and coughing

Question 17

Pelvic fracture management

Answer 17

determine the extent of the injury
if stable and non displace there will be LIMITED intervention and early mobilization
if unstable and displaced you will treat with pelvic sling traction, skeletal traction, and external fixation, ORIF
if patient is having extreme blood loss treat this to prevent hypovolemic shock
use extreme caution when moving these patient and neurovascular check must be done after every movement
assess bowel and urinary elimination regularly

Question 18

serious complications that can occur from a pelvic fracture

Answer 18

paralytic ileus
hemorrhage
urethra, bladder, and colon laceration

Question 19

what are s/s of pelvic fracture complications

Answer 19

abdominal swelling
tenderness
abnormal movement
deformity
ecchymosis

Question 20

nursing management of hip fractures

Answer 20

temporary immobilization:bucks traction for 24 hours
surgical treatment (GOAL)
teach patients that post op restricts weight bearing for 6-12 weeks

Question 21

clinical manifestations of hip fracure

Answer 21

external rotation
muscle spasm
shortening
severe pain and tenderness at the fracture site
needs reduction quickly to prevent avascular necrosis

Question 22

mandible fracture post op

Answer 22

educate the patient regarding procedure, postop airway, communication and nutrition
oral or nasopharyngeal suctioning
oral hygiene
communication
pain management
nutrition

Question 23

nursing management of mandibular fracture

Answer 23

lay patient on side with HOB elevated
have wire cutter/scissors with on all appointments away from the bed side with this
prevent choking and vomiting
have trach always available at the bedside.

Question 24

what do you do if a patient is choking/ vomiting with mandibular fracture

Answer 24

attempt to suction the airway
NG tube to decompress the stomach and prevent vomiting
prophylactic anti-emetics
cute wire/rubber bands if needed.

Question 25

what are some indications for an amputation

Answer 25

PVD
atheroslerosis
atherosclerosis
vascular impairment from DM
trauma
thermal in injuries
tumors
osteomyelitis
congenital limb disorders

Question 26

indications for amputation

Answer 26

PVD
atherosclerosis
vascular impairment from DM
trauma
thermal injuries
tumors
osteomyelitis
congenital limb disorders.

Question 27

management of elective amputation

Answer 27

make sure you consider co morbidities and infection
help the client understand the need for amputation
assure that rehabilitation can result in a healthy and active life.

Question 28

emergency amputation management

Answer 28

this is more physically and emotionally complicated

therapeutic complication

Question 29

health promotions for amputation

Answer 29

education to prevent amputation (pts with PVD, DM)
teach to carefully examine lower extremities everyday
wear shoes as much as possible
enlist the caregivers help with assessment and teaching
assess for changes in skin color temp, decrease/absent sensation, burning pain, lesions

Question 30

what are some potential complications from amputations

Answer 30

post operative complications

phantom limb pain

Question 31

osteomyelitis

Answer 31

severe infection of the bone, bone marrow and surrounding soft tissue
staph aureus is usually the main cause
mainly effect boys younger than 12

Question 32

clinical manifestations of acute osteomyelitis

Answer 32

less than 1 month duration
pain worsens with activity with unrelief from pain resting
swelling tenderness
warmth at the infection site
fever, chills, night sweats, restlessness, malaise, and drainage

Question 33

early indication of osteomyelitis

Answer 33

bone marrow edema

Question 34

pain control for osteomyelitis

Answer 34

immobilize limb with careful handling
NSAIDs
opioids
muscle relaxants
nonpharmacolgical pain management
proper body alignment
frequent position changes

Question 35

infection control for osteomylelitis

Answer 35

proper handling of soiled dressings
prevent cross contamination
proper hand hygiene
home IV care

Question 36

health management for osteomyelitis

Answer 36

control existing infections
orthopedic prosthetic device
vascular insufficiency
educate patient and family on s/s and prevention