?s From self Reading Flashcards
Define a Second Degree Strain
Involves a tearing of more muscle fibers and is manifested by edema, tenderness, muscle spasm, ecchymosis, and a notable loss of load bearing strength of the involved extremity.
Define a First Degree Strain
Reflects tearing of few muscle fibers and is accompanied by minor edema, tenderness, and mild spasm, without a noticeable loss of function.
Define a Third Degree Strain
Involves a complete disruption of at least one musculotenous unit that involves separation of muscle from muscle, muscle from tendon, or tendon from bone.
What is an Avulsion?
A fracture in which a bone fragment is pulled away from bone by a tendon
Explain the significance of the acronym RICE as it is associated with treating musculoskeletal injuries?
1) R - Rest prevents additional injury and promotes healing.
2) I - Ice during the first 24-48 hours after injury produces vasoconstriction, which ⬇ bleeding edema and discomfort.
3) C - Compression bandages helps control bleeding, reduces edema, and provides support.
4) E - Elevation controls swelling.
Define a Colles’ Fracture
A fracture of the distal radius (wrist)
Define the following fractures:
1) Comminuted
2) Depressed
3) Impacted
4) Stress
1) Comminuted - A fracture in which bone has splintered into several fragments.
2) Depressed - A fracture in which fragments are driven inward (i.e., fractures of the skull and face)
3) Impacted - A fracture in which a bone fragment is driven into another bone fragment.
4) Stress - A fracture that results from repeated loading of bone and muscle.
Define Poikilothermia
Poikilothermia mean “cold limb”, and it is a sign of peripheral neurovascular impairment
How would you assess the functioning of the following in a patient:
1) Radial nerve
2) Median nerve
3) Ulnar nerve
1) Radial nerve - Ask the patient to extend the forefinger against resistance or check the sensation of the web spacing between the thumb and index finger.
2) Median nerve - Ask the patient to make the ok sign.
3) Ulnar nerve - Ask the patient to spread their fingers as widely as possible.
The nurse recognizes that which of the following is an early sign of fat embolism?
a) Chest pain and dyspnea
b) Increased respirations, pulse, and temperature
c) Altered mental status
d) Petechiae
a) Chest pain and dyspnea - Occurs within 48 hrs
b) Increased respirations, pulse, and temperature - Later sign
c) Altered mental status - CORRECT (earliest sign)
d) Petechiae - later sign
What is the medication Probnecid (Benemid) indicated for?
Probenecid (Benemid) is an anti gout medication that ⬆ the excretion of Uric acid; increased fluids will ⬆ its excretion; side effects include nausea, rash, and constipation.
(T/F) The only safe method of enhancing muscle strength and venous return in a casted extremity is by isometrics, such as quadriceps setting or straight leg raises.
True
During an acute bout of gouty arthritis, the nurse should expect the patient’s affected foot to appear what color?
Red
The nurse assesses a patient with a diagnosis of OA. The nurse expects to find which of the following SxS?
a) Pain on abduction of the hips, waddling gait
b) Fever, rash, and nodules over bony prominences
c) Swollen, reddened, painful joint with limitation of motion
d) Stiffness of the hips, knees, vertebrae, and fingers
a) Pain on abduction of the hips, waddling gait - SxS of OA
b) Fever, rash, and nodules over bony prominences - SxS of SLE
c) Swollen, reddened, painful joint with limitation of motion - SxS of RA, OA does is not inflammatory.
d) Stiffness of the hips, knees, vertebrae, and fingers - CORRECT
As the nurse approaches a pedestrian in the parking lot who just got hit by a car, the pedestrian cries out “I think my leg is broken”. Which action should the nurse takes first?
Cut away the clients pant leg on the affected side and inspect for bleeding, swelling, or deformity.
(T/F) You should avoid use of any COX-2 inhibitor, sulfa or NSAIDs if they are allergic to Aspirin.
True
(T/F) The dosage of prednisone must be increased and decreased gradually?
True
What are the 2 important characteristics of Paget’s Disease?
1) Kyphosis and bowing of the legs are characteristics; both of which cause a ⬇ in height.
2) It is the 2nd most common bone disease after OSteoperosis
Which nursing intervention is MOST appropriate for a patient diagnosed with RA?
Assist the patient with heat application and ROM exercises
What is the significance of a positive Antinuclear Antibody (ANA)?
Positive ANA tests are associated with systemic rheumatic diseases such as SLE, RA, and Scelroderma, and CREST Syndrome.
What is Viscosupplementation?
Viscosupplementation is a therapeutic approach used to in tearing OA. Hyaluronic acid is injected into joint space to provide a short-term lubricant and analgesic effect by buffering synovial nerve endings directly.
What are the 5 clinical manifestations of Glucocorticoid toxicity?
1) Hyperglycemia
2) Psychosis
3) Cataracts
4) Hypertension
5) Hirsutism
(T/F) Leukotrienes are chemical mediators that initiate and mediate the inflammatory response.
True
What is Arthrodesis
Arthrodesis is a surgical fusion of a joint
(T/F) A ⬇ C4 level is associated with RA
True
The side effect of bone marrow depression may occur with which medication used to treat Gout?
Allopurinol
What type of ROM exercises are indicated for the following stages of Rheumatic Diseases:
1) Acute
2) Remission
3) Inactive
4) Subacute
1) Acute - Passive ROM
2) Remission - Active ROM or isometrics
3) Inactive - Active ROM or isometrics
4) Subacute - Active assist or active ROM
What is the plasma protein discussed in class that is involved/associated with immunologic reactions?
Compliment
Which symptom may be the first and only sign of symptomatic OA?
Limited passive movement
Define Ankylosis
Ankylosis is fixation or immobility of a joint
Which connective tissue disorder is characterized by insoluble collagen being formed and accumulating excessively in the tissues?
Scleroderma
What is Paget’s Disease?
Paget’s Disease (osteitis deformans) is a disorder of localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones and vertebrae.
(T/F) A classic mosaic (disorganized) pattern of bone develops in patient with Paget’s Disease.
True
Why is temperatures of the skin overlying the affected bone increased in patients with Paget’s Disease?
Because Paget’s disease causes increased bone vascularity
(T/F) Patients with Paget’s Disease have usually have normal blood calcium levels.
True
What are the 3 stages of Deep Sepsis after Arthroplasty?
1) Stage 1 (Acute Fulminating) - Occurring during the first 3 months after surgery. Frequently associated with hematoma, drainage, or superficial infection.
2) Stage 2 (Delayed Onset) - Occurring between 4-24 months after surgery.
3) Stage 3 (Late Onset) - Occurring 2 or more years after surgery, usually as a result of hematogenous spread.
Sequestrum Vs. Involucrum
1) Sequestrum - Abscess cavity containing dead bone
2) Involucrum - New bone growth around a Sequestrum
Which 3 main clinical manifestations are associated with chronic ischemia of a limb?
1) Atropy of the limb
2) Thickened nails
3) Loss of toe or finger hair
What is Tinel’s Sign?
Tinel’s sign is a way to detect irritated nerves by lightly percussing over the nerve to illicit a sensation of tingling. (Can be used to detect carpel tunnel syndrome).
What is a Hallux Valgus?
Hallux Valgus aka a bunion is when the big toe deviates laterally.
Which position should be avoided in severe back pain?
Prone, because it accentuates lordosis
Define Avascular Necrosis
Tissue death due to anoxia (extremely low oxygen)
What are the 6 SxS of a Pulmonary Emboli?
1) Sudden onset of SOB
2) Restlessness
3) Tachypnea
4) Tachycardia
5) Chest pain
6) Low-grade temp
What is Achalasia?
Achalasia is the absent or ineffective peristalsis of the distal esophagus, accompanied by failure of the esophageal sphincter to relax in response to swallowing.
What are the 3 clinical manifestations of Achalasia?
1) Regurgitation
2) Heartburn (Pyrosis)
3) Secondary pulmonary complications resulting from aspiration of gastric contents
Which 5 methods are used to Dx Achalasia? Which is the best method?
1) X-ray
2) Barium swallow
3) CT
4) Endoscopy
5) Mamometry (best method)
What are the 6 contraindications to inserting an NG tube?
1) Facial and head trauma
2) Severe Coagulopathy
3) Deviated septum
4) Esophageal strictures
5) Diverticula
6) Hx of alkali ingestion
What is Xerostomia
Xerostomia refers to a dry oral cavity resulting from a decreased function of salivary glands.
Which 3 signs may indicate that an NG tube has migrated?
1) Decreased pulse oximetry
2) Coughing
3) Gagging
Medium length Nasoenteric tubes are used for what purpose?
Feeding
(T/F) Salem Sump and Levine tubes are used to decompress the stomach and keep it empty?
True
What is Sialadenitis?
Sialadenitis refers to the bacterial or viral infection of the salivary glands.
If TPN feedings are stopped too abruptly, what condition can happen to the patient?
The patient can get rebound hypoglycemia
What is the of the following skin graft conditions:
1) Pale
2) Cyanotic and cool
3) Purple
1) Pale - Arterial thrombosis
2) Cyanotic and cool - Possible necrosis
3) Purple - Venous congestion
(T/F) Metoclopramide is used to treat GERD, but also has the advantage of accelerating gastric emptying.
True
(T/F) People with type O bloodtype are more susceptible to peptic ulcers than those with blood type A, B, or AB.
True - it is genetically linked
Which antibiotic should be questioned if being given to a patient with peptic ulcer disease and why?
E-mycin because it is irritating to the GI tract
What are the 3 factors that can classify a person as obese?
1) 2 times or more than ideal body weight
2) BMI of 30 or more
3) 100 pounds or more than ideal body weight
Which med used for obesity improves cardiovascular risk factors in obese patients with metabolic syndrome?
Rimonabant (Acomplia)
Which meld used for the treatment of obesity prevents the absorption of triglycerides?
Orlistat (Xenical)
What are the 4 dietary guidelines for a patient who just had Bariatric Surgery?
1) Include 2 protein snacks per day
2) Eat 3 meals per days
3) Eat slowly
4) Meal size should be less than 1 cup
What is one EARLY symptom of gastric cancer?
Pain relieved by antacids
Cholelithiasis Vs. Colecystitis
1) Cholelithiasis - Presence of stones in the gallbladder
2) Cholecystitis - An inflammation of the gallbladder
What is the diagnostic method of choice for diverticulitis?
CT scan
Celiac sprue is an example of which category of malabsorption?
Mucosal disorder causing generalized malabsorption
Classify the following types of laxatives:
1) Bisacodyl (Dulcolax)
2) MOM
3) Metamucil
4) Mineral Oil
1) Bisacodyl (Dulcolax) - Stimulant laxative
2) MOM - Saline laxative
3) Metamucil - Bulk-forming laxative
4) Mineral Oil - Lubricant laxative
Why is a patient with Ascites on a restricted sodium diet?
To achieve a negative sodium balance and reduce fluid retention. Recommended sodium intake of patients with ascites should be 2,000 mg or less.
Lactulaose (Cephulac) is administered to reduce serum levels of what and can be used to treat what?
Lactulaose reduces serum ammonia levels and can be used to treat Hepatic Encephalopathy.
(T/F) A vitamin C defficiency may result in hemorrhagic lesions of scurvy.
True
Which type of deficiency results in Macrocytic Anemia?
Folic Acid deficiency
Which med is likely to be the initial therapy for Esophageal Varices and why?
Vasopressin (Pitressin) because it produces constriction of the splanchnic arterial bed and decreases portal hypertension.
What is Asterixis?
An involuntary flapping movement of the hand associated with metabolic liver dysfunction
Clay-colored stools is associated with with patient condition?
Cholelithiasis
What med can be used to dissolve small, radiolucent gallstones and how long is the therapy?
Ursodeoxycholic Acid (UDCA) has been used to dissolve them and therapy takes 6-12 months.
Which position should you place a patient who has just undergone a liver biopsy and why?
On his right side because the capsule at the site of penetration is compressed against the chest wall and the escape of blood or bile through the perforation made by the biopsy is impeded.
What are the 4 risk factors for pancreatic cancer?
1) Tobacco use
2) Obesity
3) Non-hereditary chronic pancreatitis
4) Diabetes mellitis
What are the 3 dietary guidelines for a patient diagnosed with acute pancreatitis?
1) High-carb
2) Low-fat
3) Low-protein
What’s is the implication of a lactulose overdose?
Watery diarrhea
Gynecomastia is a side effect of which diuretic?
Spiromolactone (Adalactone)
Which type of positioning should be utilized for patient undergoing a paracentesis?
Upright at the edge of the bed
What is it called when the patient experiences Ecchymosis around the umbilicus?
Cullen’s Sign - may indicate severe pancreatitis with retro peritoneal hemorrhage
Describe the following factors associated with a Superficial Partial-thickness Burn (1st degree):
1) Cause
2) Skin Involvement
3) Symptoms
4) Appearance
5) Healing
1) Cause - Sunburn & low-intensity flash
2) Skin Involvement - Epidermis; possibly a portion of the dermis
3) Symptoms - Tingling, hyperesthesia, pain that is soothed by cooling.
4) Appearance - Reddened, blanches w/pressure, dry, minimal or no edema
5) Healing - complete recovery within a week, some peeling, no scarring.
Describe the following factors associated with a Deep Partial-thickness Burn (2nd degree):
1) Cause
2) Skin Involvement
3) Symptoms
4) Appearance
5) Healing
1) Cause - scalds and flash flame contact
2) Skin Involvement - Epidermis, upper dermis and a portion of the deep dermis
3) Symptoms - Pain, hyperesthesia, sensitive to cold air
4) Appearance - Blistered, mottled, red base, broken epidermis, weeping surface.
5) Healing - Recover in 2-4 weeks, some scarring and due pigmentation, contractures, infection may convert it to full-thickness
Describe the following factors associated with a Full-thickness Burn (3rd degree):
1) Cause
2) Skin Involvement
3) Symptoms
4) Appearance
5) Healing
1) Cause - Flame, prolonged exposure to hot liquids, electric current and chemical contact.
2) Skin Involvement - Epidermis, entire dermis, and sometimes SQ tissue. May involve connective tissue, muscle & bone.
3) Symptoms - Pain free, shock, hematuria, hemolysis, entrance and exit wounds if electrical
4) Appearance - Dry, pale white, leathery, or charred. Broken skin with fat exposed, edema.
5) Healing - Eschar sloughs, grafting needed, scarring and loss of contour an Fx, contractures, loss of digits or extremity possible.
What are the 3 characteristics of a Minor Burn injury?
1) 2nd degree burn of <2% TBSA not involving special areas such as eyes, ears, face, hands, feet, perineum or joints.
3) Excludes electrical and inhalation burns
What are the 3 characteristics of a Moderate (Uncomplicated) Burn injury?
1) 2nd degree burns of 15-25% TBSA
2) 3rd degree burns of <10% TBSA not involving special care areas.
3) Excludes electrical and inhalation burns
What are the 4 characteristics of a Major Burn injury?
1) 2nd degree burns >25% TBSA
2) All 3rd degree burns > or equal to 10% TBSA
3) All burns involving special care areas such as eyes, ears, face, hands, feet, perineum and joints.
4) All electrical and inhalation burns
What is the implication of administering Cimetidine (Tagamet) too fast?
It causes bradycardia
What are two other names for vitamin k?
1) Phytoniadione
2) Mephyton
