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Test Three Flashcards

1
Q

What is a closed or simple (nondisplaced) fracture

A

skin over the fractured area remains intact

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2
Q

What is a comminuted fracture?

A

the bone is splintered or crushed, creating numerous fragments (shattered)

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3
Q

What is a complete fracture?

A

the bone is separated completely by a break into two parts

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4
Q

What is a compression fracture?

A

a fractured bone is compressed by another bone

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5
Q

What is a depressed fraction?

A

bone fragments are driven inward

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6
Q

What is an incomplete fracture?

A

fracture line does not extend through the full transverse width of the bone

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7
Q

What is an oblique fracture

A

The fracture line does not extend through the full transverse width of the bone, usually a diagonal angle as well.

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8
Q

What is an open or compound fracture?

A

the bone is exposed to air through a break in the skin, and soft tissue injury and infection are common

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9
Q

What is a pathological fracture?

A

the fracture results from weakening of the bone structure by pathological processes such as neoplasia or osteoporosis; aka spontaneous fracture

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10
Q

What is a spiral fracture?

A

the break partially encircles bone, usually in children of abuse (twisting of the arm)

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11
Q

What is a transverse fracture?

A

the bone is fractured straight across

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12
Q

What is a Greenstick fracture?

A

One side of the bone is broken and the other is bent; these fractures occur most in children.

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13
Q

What is an impacted fracture?

A

A part of the fractured bone is driven into another bone (usually from a high fall (high pressure), also in the spine if they fall on their head)

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14
Q

What are the 5 complications of fractures?

A

Fat embolism, compartment syndrome, infection and osteomyelitis, avascular necrosis, and pulmonary embolism

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15
Q

What type of fractures are at the greatest risk for fat embolism to occur?

A

pts with long bone fractures

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16
Q

What are some assessment findings that often suggest pulmonary embolism?

A

restlessness, hypoxemia, mental status changes, tachycardia, hypotension, and petchial rash over the upper chest and neck

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17
Q

What are some (6) priority nursing actions if the pt has a fat embolism?

A

notify dr, administer oxygen, administer IV fluids, monitor vitals and respiratory statues, prepare for intubation, document

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18
Q

What is Crush syndrome?

A

lots of bleeding, usually from a car accident, blood has no where to go and becomes acute compartment syndrome, kidney failure due to lark CK from muscle injury, more severe than ACs, pt will die if not treated

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19
Q

What is an intracapsular hip fracture?

A

(upper third of femur) fractures of the head or neck of the femur; greater risk for nonunion and avascular necrosis (usually have a hip replacement in this type of fracture)

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20
Q

What is an extracapsular fracture?

A

fractures of the trochanter region

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21
Q

With hip fracture pts, what is done while the pt is waiting for surgery?

A

Buck’s traction (initially used to immobilize affected extremity)it reduces the fracture and decreases muscle spasms

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22
Q

What are the 2 treatment options for an intracapsular hip fracture?

A

total hip replacement or ORIF (open reduction internal fixation) with femoral head replacement

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23
Q

What are the nursing priorities for hip fracture pts?

A

hydration, respiratory support, circulation checks, pain control, prevention of immobility complications, Hx of chronic conditions and medications

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24
Q

Can you adduct the hip after surgery?

A

NO! no foced into adduction

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25
Can you cross your legs after hip surgery?
NO! no crossing legs
26
Can you sit in chairs without arms after hip surgery?
No!
27
Can you internal rotate your hip after hip surgery?
No!
28
Can you force your hip into greater than 90 degrees of flexion after hip surgery?
No!
29
How should you use the toilet after hip surgery?
use toilet with elevator on toilet seat
30
How should you shower after hip surgery?
place a chair inside shower and remain seated while bathing
31
How should you sleep after hip surgery?
put a pillow between for the first 8 weeks post op when lying on good side or supine
32
After hip surgery, what should you tell your dentist?
that you have a prosthesis before dental work is preformed so that prophylactic antibiotics can be given
33
How long do total knee arthroplasty last for?
10-15 years depending on pt age and activity level, doesn't last long if they don't change their lifestyle (losing weight, etc)
34
What does a CPM do?
continuous passive rand of motion (machine), used 1-2 days post-op, prevents scar tissue from forming, keeps knee in motion, helps pt regain strength and mobilize early
35
What are the 3 pt teaching after total knee replacement surgery?
- Knee should be in neutral position - Teach pt s/s of infection, bleeding, neurovascular complications (DVT) - Use of walker and cane
36
What does losing a pulse indicate? (after surgery)
that something is wrong, possibly ACS
37
What is osteoporosis?
a metabolic disease characterized by bone demineralization, with loss of calcium and phosphorous salts leading to fragile bones and the subsequent risk for fractures
38
Where does osteoporosis mainly occur in the body?
wrist, hip, and vertebral colum
39
What are the risk factors for osteoporosis?
smoking, early menopause, excessive use of alcohol, family history, female, increasing age, insufficient intake of Ca, sedentary lifestyle, thin small frame, white or asian
40
What is primary osteoporosis?
most often occurs in postmenopausal women or men with low testosterone
41
What is secondary osteoporosis?
causes include prolonged therapy with corticosteroids, thyroid reducing medication, aluminum-containing antacids, or anticonvulsants
42
What are some of the s/s of osteoporosis?
possibly asymptomatic, back pain after lifting, bending or stopping, back pain that increases with palpation; pelvic or hip pain; problems with balance; decline in height; kyphosis (hump); degeneration of lower thorax and lumbar vertebrae on radiographic studies
43
What are the 5 causes of GERD?
``` Incompetent LES Pyloric stenosis Hiatal hernia Delayed emptying Motility problems ```
44
Which disease is this? | chronic systemic inflammatory disease
RA
45
Which disease is this? | destruction of connective tissue and synovial membrane within joints
RA
46
Which disease is this? | spongy soft feeling in the joints, low grade fever, anorexia, anemia
RA
47
Which disease is this? | stiffness worse in the am, exercise will help stiffness, symmetric joint pain, cells attack cartilage and then bone
RA
48
Which disease is this? | progressive deterioration of articular cartilage
OA
49
Which disease is this? | causes bone buildup and loss of cartilage, affects weight bearing joints
OA
50
Which disease is this? | worse at night, exercise will worsen symptoms,
OA
51
Which disease is this? | limited inflammation, ostephytes (bone spur) usually present, asymmetrical joints effected
OA
52
What is the treatment for osteomylitis? How long?
IV antibiotics 3-6 months, irrigate wound with antibiotic solution, pack with antibiotic dressing, pain control, hyperbaric oxygen therapy, surgical debridement, bone graft, muscle flap
53
How does hyperbaric oxygen therapy work for osteomylitis?
Hyperbaric oxygen therapy to help cells get oxygen so they can heal, delivers 100% oxygen at high pressure to ensure oxygenation of infection site, usually 90 minute treatments, at least 30 treatments
54
What are you going to worry about in a Pt w regurgitation? What would you listen for?
Aspiration | –Crackles
55
What are the main two differences in gastric and duodenal ulcers?
in gastric ulcers: pain 1-2 hours after meals, more common in females -in duodenal ulcers: pain is relieved by food, more common in males
56
How do you assess for a hiatal hernia?
heartburn, regurgitation or vomiting, dysphagia, and feeling of fullness (barium swallow study or EGD to diagnose)
57
What is a hiatal hernia?
esophageal or diaphragmatic hernia, a portion of the stomach herniates through the diaphragm and into the thorax
58
What are some complications of hiatal hernias?
ulceration, hemorrhage, regurgitation and aspiration of stomach contents, strangulation, and incarceration of the stomach in the chest with possible necrosis, peritonitis, and mediastinitis.
59
How is Hep A transmitted?
fecal-oral route by oral ingestion of fecal contaminants (water, shellfish, food), oral-anal sexual activity
60
How is Hep B transmitted?
Body fluids (blood, semen, saliva)
61
How is Hep C transmitted?
Circulation (blood, semen) | -sharing needles, tattoos, blood transfusion/organ transplants before 1992
62
How is Hep D transmitted?
blood
63
How is Hep E transmitted?
fecal-oral (waterborne)
64
Which hepatitis's have vaccines?
A and B
65
What is the first and second leading reasons for a liver transplant?
1st: hep C 2nd: acetaminophen
66
What are the causes of cirrhosis? (4)
- alcoholism (Laennec's cirrhosis) - billiary cirrhosis (chronic biliary obstruction, stasis, inflammation) - Post necrotic cirrhosis (occurs after massive liver necrosis from hepatitis or inherited metabolic disease) - Cardiac Cirrhosis (severe right sided heart failure -->big, edema congested liver)
67
What are the complications of cirrhosis? (7)
portal hypertension, ascites, bleeding esophageal varices, coagulation defects, jaundice, portal systemic encephalopathy, hepatorenal syndrome
68
What are the s/s of cirrhosis? early and late symptoms
-early: Fatigue, Significant change in weight, Gastrointestinal symptoms, Abdominal pain and liver tenderness, Pruritus -late: Jaundice and icterus, Dry skin, rashes Petechiae, or ecchymosis, Spider angiomas, Warm, bright red palms of the hands, Peripheral and sacral dependent edema
69
What are the fluid and electrolyte imbalances associated with cirrhosis?
ascites, decreased effective blood volume, hypo or hypernatremia, hypocalcemia, hypokalemia, peripheral edema, water retention (ascites)
70
In cirrhosis, what lab results are increased? (8)
ALT, AST, LDH, ALP, total serum bilirubin, NH4 (ammonia), serum Cr and PTT
71
In cirrhosis, what lab results are decreased? (7)
total serum protein and albumin, WBC, H&H, PLt, hyponatremia, hypokalemia, and hypomagnesmia
72
What are the diagnostic tests of cirrhosis?
Liver biopsy (gold standard), abd Xray/CT scan, MRI, ultrasound, EGD, ERCP
73
Why do we do a abd X-ray/CT scan for cirrhosis?
hepatomegaly, splenomegaly, ascites
74
Why do we do MRI for cirrhosis?
to detect mass of liver
75
Why do we do ultrasounds for cirrhosis?
hepatomegaly, splenomegaly, ascites, stone, biliary duct obstruction
76
WHy do we to EGD (esophageal gastral duodenal ) for cirrhosis?
esophageal varices
77
Why do we do ERCP for cirrhosis?
exam liver, gallbladder, bile ducts, and pancreas. Remove stones, sphincterostomies, bx, stent
78
What are the signs and symptoms of peritonitis? (10)
rigid boardlike abdomen! high fever and chills, pallor, abdominal distention and pain, tachycardia and tachypnea, rebound tenderness, decreased urine output (dehydration), hiccups, inability to pass flatus or feces
79
Ascites is an accumulation of fluid in the peritoneal cavity that results from...
venous congestion of the hepatic capillaries - capillary congestion leads to plasma leaking directly from the liver surface and the portal vein - caused by an increased hydrostatic pressure rom portal hypertension
80
What is the pt teaching for carpal tunnel?
drug therapy (NSAIDs, corticosteroids), immobilization (splints, braces), ergonomically appropriate workstations (required by law now)
81
How does plantar fasciitis present?
inflammation of the arch of the foot, severe pain (especially when getting out of bed), worsened with weight bearing
82
What 4 nutrients are necessary for the production of new bone?
calcium, phosphorus, vitamin D, and protein
83
What 2 conditions affect the rate in which bone heals?
chronic diseases (like PVD) and menopause (loss of estrogen)
84
S/S that something’s going very wrong w a fracture?
pulselessness, edema, severe pain, reduced blood flow, sensory deficits, paresthesia, pallor, cyanosis, tingling, numbness, paresis, necrosis, hypovolemia, hyperkalemia, dark brown urine, rhabdomyolysis, crackles, decreased SaO2, petechiae, retinal hemorrhage, altered LOC,
85
How can a hip fracture result in avascular necrosis?
happens if the area of the femoral neck is broken and disrupts the blood supply to the head of femur -->AVN (causes death and necrosis of bone tissue
86
What is AVN?
avascular necrosis (aka ischemic necrosis or osteonecrosis) blood supply to the bone is disrupted, leading to the death of bone tissue, most common a complication of hip fractures or other displaced bones
87
Whats the worst thing that can happen w a fractured hip?
Fat embolism, b/c break in the long bone, obstructs the pulmonary vascular bed by fat globules
88
In a fracture, if an artery is severed what happens?
bleeding and shock
89
What is an indication that an artery is severed? (in a fracture)
pedal pulses (or radial pulses) would not be palpable
90
If an artery is severed in a fracture, what long term complication results? How would you know?
infection, check perfusion then s/s of infection
91
What causes oral candidiasis? (4)
long term antibiotic therapy (it destroys the normal flora and allows candida to overgrow) -also in pts on immunosuppressive therapy (chemo, radiation and steroids)
92
In Barrett's esophagus, what are you going to worry about?
- swallowing, strictures (hemorrhage and aspiration pneumonia) - cancer, response to Barrett's esophagus is dysplasia which becomes cancerous
93
What is Barrett's esophagus?
ulceration of the lower esophagus leading to the replacement of normal tissue with columnar epithelium (which often leads to cancer)
94
What do you do to prevent night-time reflux? (3)
wait 3 hours after a meal before lying down and elevate head of bed 6-9 inches, sleep on the right side-lying positions
95
What kinds of meds make Barrett's esophagus worse? (10)
Calcium channel blockers, beta blockers, nitrates, anticholinergics, high levels of estrogen and progesterone, iron, nicotine, Diazepam, and Theophylline
96
What kinds of foods make Barrett's esophagus worse? (7)
fatty foods, caffeinated/carbonated beverages, chocolate, citrus fruits, peppermint/spearmint, alcohol, onion
97
Peptic Ulcer – what would you see, smell that would indicate peptic ulcer?
tarry stool (melena), hematemesis, sharp pain, dyspepsia,n/v
98
How do you assess for abdominal hernias? (5)
pt comes in with lump, if reducible it may disappear when pt is lying flat, auscultate for bowel sounds (if absent could mean obstruction or strangulation), Valsalva maneuver (observe for bulging), palpate inguinal ring and notice any changes when pt coughs,palpate the spermatic cord to the external inguinal cord (pt has lump, check if reducible, auscultate BS, Valsalva maneuver, Palpate inguinal ring and external inguinal cord)
99
How does prolonged fever contribute to acid base imbalances?
increases the rate of metabolism causing a metabolic acidosis by increasing the rate of carbon dioxide production
100
______ ulcer pain is aggravated by food
gastric
101
________ ulcer pain is relieved by food
duodenal
102
In hepatic failure, don't feed the pt _____
starches/carbs
103
In renal failure, don't feed the pt _______
protein
104
What is a common ABG with cholecystitis?
CO2 retention b/c you’re not breathing deeply b/c it hurts so bad, RESPIRATORY ACIDOSIS

Med Surg 1 (5 decks)

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