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CNUR 204 > OSCE > Flashcards

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
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2
Q

risk factors of a fracture

A
  • smoking/alcohol use
  • OP
  • diabetes
  • age
  • previous fracture
  • inactivity
  • medications
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3
Q

complications of a fracture

A
  • infection
  • compartment syndrome
  • VTE
  • Fat embolism
  • malunion/nonunion
  • osteomylelitis
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4
Q

compartment syndrome

A

caused by increased pressure in compartments, affects circulation and function of tissue

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5
Q

6 Ps of compartment syndrome

A

pain, paresthesia, pallor, pressure, pulselessness, and paralysis

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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
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7
Q

subjective assessment for fracture

A
  • mechanism of injury (how)
  • locations and characterization of symptoms
  • past hx
  • medications
  • last meal
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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
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9
Q

Common cardiac symptoms

A
  • chest pain
  • fatigue/malaise/weakness
  • dizziness
  • SOB, dyspnea, diaphpresis
  • palpitations
  • edema, cough, nocturia
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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
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11
Q

MI complications

A
  • dysrhythmias
  • heart failure
  • cardiogenic shock
  • papillary muscle dysfunction
  • ventricular aneurysm
  • pericarditis
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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
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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,
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14
Q

Patient teaching for cardio

A
  • medical alert bracelet
  • smoking cessation/decrease alcohol consumption
  • diet and wt control
  • decrease stress
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15
Q

Hypothyroidism

A

results from insufficient thyroid hormone

-decreased T3 and T4/ increased TSH

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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
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17
Q

Complications of Hypothyroidism

A
  • myxedema coma- MEDICAL EMERGENCY

- notable impairment of consciousness- lethargy or coma, hypotension, hypoventilation, low temp

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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
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19
Q

Treatment for Hypothyroidism

A
  • levothyroxine (Synthroid)
  • lifelong therapy
  • requires follow up (4-6 weeks post drug adjustment)
  • low calories, high fibre diet
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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
Q

complications of cirrhosis

A
  • portal HTN
  • esophageal varies
  • ascites and peripheral edema
  • hepatic encephalopathy
  • hepato-renal syndrome
26
Q

Health teaching for esophageal varices

A

-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
Q

collaborative care for Cirrhosis

A
  • 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
Q

patient teaching; cirrhosis

A
  • avoid alcohol
  • BP control
  • avoid precipitating factors of complications (constipation, heavy lifting)
  • sodium restriction
  • S&S of bleeding
  • vaccination
29
Q

Risk factors of CKD

A
  • 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
Q

clinical manifestations of CKD, metabolic disturbances

A
  • decreased eGFR
  • increased BUN
  • increased serum creatinine
  • hyperkalemia
31
Q

Diagnostic studies for CKD

A
  • history
  • physical exam
  • albumin-creatine ratio
  • GFR or eGFR
  • CBC; renal, electrolyte, albumin
  • 24 hour urine
  • renal ultrasound
  • CT scan
  • renal biopsy
32
Q

Nutritional therapy for CKD

A
  • protein restriction
  • fluid restriction (600ml)
  • sodium restriction
  • potassium restriction- 2-4 g
  • phosphate restriction (1000mg)
33
Q

Nursing Management nursing diagnoses for CKD

A
  • electrolyte imbalance
  • excess fluid volume
  • fatigue
  • imbalanced nutrition- less than
  • grieving
  • risk for infection
34
Q

clinical manifestations of vWFD

A
  • easy bruising
  • skin bleeding
  • prolonged bleeding from mucosal surface
  • heavy menstrual bleeding
35
Q

nursing management for VWD

A
  • stop bleeding-direct pressure/ice
  • administer specific coagulation factors
  • monitor hyponatremia
  • dental care
  • wear gloves with chores
  • plan for invasive procedures
36
Q

subjective data for VWD

A
  • medications
  • surgery or other treatments
  • social and occupational hx
  • self care hx
  • ADL
  • elimination process
  • nutritional-metabolic hx
37
Q

prevention for nose bleeds

A
  • maintain humidity
  • gently blow nose
  • stop picking nose
  • avoid allergens
  • minimal use/avoid cold or allergy drugs
  • no snorting drugs
  • keep nasal moist
38
Q

triggering factors of seizures

A
  • 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
Q

clinical manifestations of seizure

A

phases

  • prodromal- signs or activities that precede a seizure
  • aural-sensory warning
  • ictal- full seizure
  • postictal-period of recovery
40
Q

atonic seizure

A

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
Q

clonic seizure

A

begins with loss of consciousness, and sudden loss of muscle tone, followed by limb jerking that may or may not be symmetrical

42
Q

tonic seizure

A

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
Q

myoclonic seizure

A

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
Q

complications of a seizure

A
  • status epilepticus and death

- psychosocial - unemployment, driving restriction, depression, anxiety, suicide

45
Q

status epilepticus

A
  • state where seizures recur in rapid succession; 30 minutes or longer
  • causing ventilator insufficiency, hypoxemia, dysrhythmias, hyperthermia

-treatment- lorazepam

46
Q

diagnostic of seizure

A
  • hx and physical exam
  • MRI and CT
  • EEG
  • lumbar puncture
  • lab- CBC, urinalysis, electrolytes, creatinine, fasting blood glucose
47
Q

manifestations of hypovolemic shock

A

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
Q

Lab results for hypovolemic shock

A
  • increased sodium levels
  • decreased potassium
  • increased lactate
  • increased urea and creatine
  • decreased HBG, HCT, and platelets

CNUR 204 (3 decks)

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