OSCE Flashcards
1
Q
Clinical Manifestations of fracture
A
- swelling/edema
- deformity
- pain/tenderness/muscle spasm
- crepitus
- inability to bear weight
- loss of function
- bruising/discoloration
2
Q
risk factors of a fracture
A
- smoking/alcohol use
- OP
- diabetes
- age
- previous fracture
- inactivity
- medications
3
Q
complications of a fracture
A
- infection
- compartment syndrome
- VTE
- Fat embolism
- malunion/nonunion
- osteomylelitis
4
Q
compartment syndrome
A
caused by increased pressure in compartments, affects circulation and function of tissue
5
Q
6 Ps of compartment syndrome
A
pain, paresthesia, pallor, pressure, pulselessness, and paralysis
6
Q
nursing management of compartment syndrome
A
- leave limb flat
- do not ice or cool
- remove or loosen cast, bandage, etc
- reduce traction
- analgesia
- surgical decompression, fasciotomy
- amputation
7
Q
subjective assessment for fracture
A
- mechanism of injury (how)
- locations and characterization of symptoms
- past hx
- medications
- last meal
8
Q
Teaching cast care
A
- apply ice for 24 hours
- dry cast for water exposure
- elevate for 48 hours
- encourage ROM above and below
- do not scratch/alter cast
- report increased pain, diminished circulation, bleeding, damage, sores
9
Q
Common cardiac symptoms
A
- chest pain
- fatigue/malaise/weakness
- dizziness
- SOB, dyspnea, diaphpresis
- palpitations
- edema, cough, nocturia
10
Q
Clinical manifestations of MI (heart attack)
A
- pain (jaw to abdomen)
- ashen, clammy, cool skin
- s3 and s4, murmor, BP, HR and crackles
- N&V
- fever
- mood changes, dysrhythmia
- elevated CKa nd troponin
- increased WBC
11
Q
MI complications
A
- dysrhythmias
- heart failure
- cardiogenic shock
- papillary muscle dysfunction
- ventricular aneurysm
- pericarditis
12
Q
diagnostics of ACS (acute coronary syndrome- MI and unstable angina)
A
serum cardiac malers
-increased troponins ( I&T/CK/Myoglobin)
- ECG
- Cardiac catheterization
- stress test, echo, stress undcues ECG
13
Q
Nursing Management for ACS
A
- rapid diagnosis
- ABCs and VS
- 12 lead ECG
- ongoing pain assessment
- apply O2 as necessary
- IV access x2
- chewable ASA, nitro SL, morhpine
- best rest, NPO,
14
Q
Patient teaching for cardio
A
- medical alert bracelet
- smoking cessation/decrease alcohol consumption
- diet and wt control
- decrease stress
15
Q
Hypothyroidism
A
results from insufficient thyroid hormone
-decreased T3 and T4/ increased TSH
16
Q
Clinical manifestation of hypothyroidism
A
- anemia (deficiencies in cobalamin, iron, folate)
- increased lipids
- decreased GI motility
- cold intolerance, dry/coarse skin, brittle nails
- WEIGHT GAIN
- myxedema
- lethargic
17
Q
Complications of Hypothyroidism
A
- myxedema coma- MEDICAL EMERGENCY
- notable impairment of consciousness- lethargy or coma, hypotension, hypoventilation, low temp
18
Q
Diagnostic tools for hypothyroidism
A
- hx and physical exam
- TSH levels, free T4 levels
- T3 and T4
- presence of thyroid peroxidase
- TRH stimulation tes
19
Q
Treatment for Hypothyroidism
A
- levothyroxine (Synthroid)
- lifelong therapy
- requires follow up (4-6 weeks post drug adjustment)
- low calories, high fibre diet
20
Q
Nursing Management for Hypothyroidism
A
- monitor mental changes, VS, wt, I&O, temp, edema, cardiac status bradycardia, skin and nails
- hypertonic saline for pts with hyponatremia till reached 130 ml
- warm environment
21
Q
Subjective GI data
A
- History of present illnesses
- PMHx
- GI- appetite, dysphagia, abdominal pain, N&V, bowel habits
- family hx
- medications
- alcohol/smoking
22
Q
Diagnostic Test for Cirrhosis
A
- blood test (liver enzymes, bilirubin, protein/albumin, ammonia levels, coagulation study)
- abdominal ultrasound/MRI
- liver biopsy
- transient elastography
- serum fibrosis markers
23
Q
clinical manifestations of CIrrhosis
A
uncompensated
- liver is unable to function normally- most tests will be abnormal
- symptoms can be abrupt with anorexia, dyspepsia, N&V, weakness, muscle loss, diarrhea, constipation
24
Q
clinical manifestation of Cirrhosis pt 2
A
metabolic- Hypokalemia, Hyponatremia, hypoalbuminemia
cardio- fluid retention, peripheral edema, ascites
Gastro- dull abdominal pain,
25
complications of cirrhosis
- portal HTN
- esophageal varies
- ascites and peripheral edema
- hepatic encephalopathy
- hepato-renal syndrome
26
Health teaching for esophageal varices
-avoid ASA, alcohol and NSAID
-avoid irritating foods
-avoid coughing
-avoid vomiting/constipation
-control BP
monitor S&S of bleeding
-PPI
-follow up blood work regularly
27
collaborative care for Cirrhosis
- provide rest periods
- monitor for dyspnea, N&V, hematemesis, LOC, U/O, BM, lab results, I&O, daily wt
- observe body fluids
- meticulous skin/oral care/ position q2hr
- high calories (3000), high carb and moderate to low fate
28
patient teaching; cirrhosis
- avoid alcohol
- BP control
- avoid precipitating factors of complications (constipation, heavy lifting)
- sodium restriction
- S&S of bleeding
- vaccination
29
Risk factors of CKD
- Age > 50
- diabetes, HTN, CVD
- hx of kidney disease during childhood
- current or hx of malignancy
- nephrotoxic medication/illegal drugs/toxins/pesticides
- obesity
- smoking
- race-indigenous, south asain, african and Hispanic
30
clinical manifestations of CKD, metabolic disturbances
- decreased eGFR
- increased BUN
- increased serum creatinine
- hyperkalemia
31
Diagnostic studies for CKD
- history
- physical exam
- albumin-creatine ratio
- GFR or eGFR
- CBC; renal, electrolyte, albumin
- 24 hour urine
- renal ultrasound
- CT scan
- renal biopsy
32
Nutritional therapy for CKD
- protein restriction
- fluid restriction (600ml)
- sodium restriction
- potassium restriction- 2-4 g
- phosphate restriction (1000mg)
33
Nursing Management nursing diagnoses for CKD
- electrolyte imbalance
- excess fluid volume
- fatigue
- imbalanced nutrition- less than
- grieving
- risk for infection
34
clinical manifestations of vWFD
- easy bruising
- skin bleeding
- prolonged bleeding from mucosal surface
- heavy menstrual bleeding
35
nursing management for VWD
- stop bleeding-direct pressure/ice
- administer specific coagulation factors
- monitor hyponatremia
- dental care
- wear gloves with chores
- plan for invasive procedures
36
subjective data for VWD
- medications
- surgery or other treatments
- social and occupational hx
- self care hx
- ADL
- elimination process
- nutritional-metabolic hx
37
prevention for nose bleeds
- maintain humidity
- gently blow nose
- stop picking nose
- avoid allergens
- minimal use/avoid cold or allergy drugs
- no snorting drugs
- keep nasal moist
38
triggering factors of seizures
- intense exercise
- nonadherence to medications
- infection; fever
- menstrual cycle
- stress, excitement, emotional upset
- lack of sleep
- alcohol
- very warm weather, hot baths or shower
- poor diet
- flashing lights, loud music
39
clinical manifestations of seizure
phases
- prodromal- signs or activities that precede a seizure
- aural-sensory warning
- ictal- full seizure
- postictal-period of recovery
40
atonic seizure
opposite effect of tonic seizures: a sudden loss of control of the muscles, particularly of the legs, that results in collapsing to the ground-consciousness returns when hitting the ground.
41
clonic seizure
begins with loss of consciousness, and sudden loss of muscle tone, followed by limb jerking that may or may not be symmetrical
42
tonic seizure
cause sudden muscle stiffening (increased tone) in the extensor muscles, often associated with impaired consciousness and falling to the ground.
-has NO MEMORY of seizure
43
myoclonic seizure
consist of a sudden, brief muscle jerk of the body or the extremities; the jerk can be forceful enough to hurl the person to the ground. May occur in clusters.
44
complications of a seizure
- status epilepticus and death
| - psychosocial - unemployment, driving restriction, depression, anxiety, suicide
45
status epilepticus
- state where seizures recur in rapid succession; 30 minutes or longer
- causing ventilator insufficiency, hypoxemia, dysrhythmias, hyperthermia
-treatment- lorazepam
46
diagnostic of seizure
- hx and physical exam
- MRI and CT
- EEG
- lumbar puncture
- lab- CBC, urinalysis, electrolytes, creatinine, fasting blood glucose
47
manifestations of hypovolemic shock
vital signs- tachycardia, hypotension, tachypnea, hypoxia
Neuro- agitation, confusion
integ- cool, clammy skin; diaphoretic, dry mucous membrane
CVS- rapid HR, diminished PP, prolonged cap refill
resp- rapid, shallow resp
GI- absent bowel sounds
GU- diminished urine output
48
Lab results for hypovolemic shock
- increased sodium levels
- decreased potassium
- increased lactate
- increased urea and creatine
- decreased HBG, HCT, and platelets
