Advanced Medsurge Test 2

Front 1

what are the mechanisms of injury for spinal cord injuries

Back 1

acceleration and deceleration

Front 2

what are the classifications of spinal cord injuries

Back 2

hyperflexion, hyperextension, compression, rotational, penetrating

Front 3

hyperflexion to the cervical spine by cause tearing of what

Back 3

posterior ligamentous comlex, resulting in anterior dislocation

Front 4

hyperextension SCI injuries are related to what

Back 4

falls in which the chin is struck

Front 5

hyperextension SCI may cause rupture of what

Back 5

anterior ligaments

Front 6

hyperflexion injury in the lumbar area can be caused by what

Back 6

falling on the buttocks

Front 7

what is torn in a rotational SCI injury

Back 7

posterior ligamentous complex

Front 8

what are the types of spinal cord dynddromes

Back 8

central core, brown sequard, anterior cord, posterior cord

Front 9

what is central cord syndrome associated with

Back 9

loss of motor power and sensation in upper extremities, imcomlete loss in thoracic area

Front 10

what is brown sequard syndrome

Back 10

loss of pain and temperature sensation on opposite side, loss of voluntary motor control on the same side as the cord damage

Front 11

what is anterior cord syndrome

Back 11

loss of motor power, pain and temperature sensation, with preservation of position, vibration, and touch sense in lower extremities

Front 12

what are the types of shock associated with spinal core injury

Back 12

spinal shock and nuerogenic shock

Front 13

what is the management for
SCI

Back 13

hemodynamic stability, cord decompression/immobilization, pharmacological, nutrition, elimination

Front 14

what are major complications of SCI

Back 14

respiratory and temperature control complications, DVT, mobilizatoin/skin care, autonomic dysreflexia

Front 15

rehabilitation of SCI depends on what

Back 15

level of injury

Front 16

what are the 2 layers of the skin

Back 16

epidermis and dermis

Front 17

what is the epidermis composed of

Back 17

dead cells

Front 18

what does the dpidermis provide

Back 18

a protective barrier

Front 19

how ofter does the epidermis regenerate

Back 19

every 2-3 weeks

Front 20

how thick is the dermis

Back 20

1-2 mmthick

Front 21

what is the dermis composed of

Back 21

connective tissue and collagenous fiber bundles

Front 22

what does the dermis contain

Back 22

blood vessels, sweat and sebaceous glands, nerves, sensory fibers

Front 23

what are the skin functions

Back 23

maintain body temperature, barrier to insensible water loss, metabolism, protective barrier agianst microbes, protection through touch, pain, pressure

Front 24

skin tissue exposure to burn substances (heat chemicals ect) leads to what

Back 24

enzyme malfunctionand protein breakdown

Front 25

what does prolonged exposure and extreme temperatures lead to

Back 25

cell death and protein coagulation

Front 26

what is the zone of coagulaton

Back 26

central zone

Front 27

what is the zone of stasis

Back 27

middle zone

Front 28

what is the zone of hyperemia

Back 28

outer zone

Front 29

what is the area of greatest exposure

Back 29

zone of exposure

Front 30

what happens in the zone of coagulation

Back 30

irreversible skin death

Front 31

what happens in teh zone of stasis

Back 31

impaired circulation with potential loss of blood flow, potentially salvageable but can convert to full thickness wound

Front 32

What are factors that lead to conversion to a full-thickness wound

Back 32

inflammation, infection, inappropriate fluid resuscitation or wound care, chronic illness, malnutrition

Front 33

what happens in teh zone of hyperemia

Back 33

vasodilation, minimal cell involvement, often early spontaneous recovery

Front 34

how is the size of burn injuries classified

Back 34

the rule of nines

Front 35

how is the depth of a burn injury classified

Back 35

superficial, partial thickness, full-thickness

Front 36

superficial burns effect which part of the skin

Back 36

epidermis

Front 37

what are the symptoms of superficial burns

Back 37

erythema, mild discomfort, pain

Front 38

when does the pain from superficial burns resolve

Back 38

48-72 hours

Front 39

what can cause superficial burns

Back 39

sunburns, mild steam burns

Front 40

what is the heal time of 1st degree burns

Back 40

2-7 days

Front 41

what part of the skin is damaged in partial-thickness burns

Back 41

epidermis and upper 1/3 of dermis

Front 42

what is the appearance of a partial thickness burn

Back 42

light to bright red of mottled appearance, weeping, blisters

Front 43

healing time of partial thickness burns is dependent on what

Back 43

depht of burn

Front 44

what is the range of healing time for partial thickness burns

Back 44

7-21 days
4-6 weeks
+6 weeks

Front 45

what is the long term effects for partial thickness burns

Back 45

minimal scarring to skin grafting

Front 46

what part of the skin is damaged in a full thickness burn

Back 46

epidermis, dermis and subcutaneous tissue

Front 47

what do full thickness burns look like

Back 47

pale white, charred, red or brown, leathery

Front 48

what is the pain level of full thickness burns

Back 48

painless

Front 49

what is the treatment for full thickness burns

Back 49

skin grafting

Front 50

what are complications of full thickness burns

Back 50

infection, fluid and electrolyte imbalance

Front 51

what are the types of burns

Back 51

thermal, chemical, electrical, radiation

Front 52

what is the most common type of burn

Back 52

thermal

Front 53

what are the causes of thermal burns

Back 53

steam, scalds, direct contact with heat, fire injuries

Front 54

what are the most severe types of chemical burns

Back 54

alkalis often more severe than acids

Front 55

what do chemical burns extent depend on

Back 55

chemical concentration and length of exposure

Front 56

what are the causes of chemical burns

Back 56

household/industrial chemical (cement), tar, asphalt

Front 57

low-voltage electrial cords lead to what

Back 57

mouth burns

Front 58

high voltage and lightening lead to what

Back 58

entrance wuond and exit wound, possible arcing

Front 59

electrical burns are produced by what

Back 59

heat

Front 60

what do electrical burns do

Back 60

depolarizes muscles and nerves, initiates abnormal electrical rhythms in heart and brain

Front 61

radiation burns are usually what

Back 61

localized, may look like thermal burn

Front 62

Exposure to what causes radiation burns

Back 62

industrial or medical therapy

Front 63

what gets priority admission to burn trauma unit

Back 63

burns of the hands, face, and genitalia, inhalation injury, chemical or electrical injury, comorbidities, TBSA > 10% partial thickness and all full thickness burns

Front 64

what is done in the inital ER management for burns

Back 64

ABCs, accurate history, wet gauze dressings, tetanus injection

Front 65

what is done on arrival to the BTU

Back 65

ABCs, wound care, pain management

Front 66

what is the parkland formula for

Back 66

fluid resuscitation

Front 67

what is the parkland formula

Back 67

4 ml x kg x % TBSA

Front 68

what is given over the first 24 hours

Back 68

lactated ringers

Front 69

how is the fluid distributed over the 24 hour period

Back 69

1/2 over 1st 8 hours
1/4 over 2nd 8 hours
1/4 over 3rd 8 hours

Front 70

what are escharotomies performed

Back 70

performed on all cicumferential burns, often lateral chest

Front 71

what is a circumferential burn

Back 71

involves the entire extremity circumference

Front 72

why is an escharotomy perfored on a lateral chest burn

Back 72

to improve chest compliance and ventilation

Front 73

when does burn shock occur

Back 73

can occurin 35% TBSA

Front 74

what does capillary dilation lead to

Back 74

increased capillary permeability which leads to leaking plasma which causes blisters and edema

Front 75

what does negative interstital hydrostatic pressure lead to

Back 75

generates edema

Front 76

what causes arteriolar vasodilation after a burn

Back 76

histamine, prostaglandins, kinins, oxygen radicals

Front 77

what are the cardiovascular results of burns

Back 77

decreased myocardial contractility and cardiac output, increased systemic vascular resistance and increases pulmonary vascular resistance

Front 78

what can PVR lead to

Back 78

pulmonary edema

Front 79

what do you do more fluids after the 1st 24 hours

Back 79

titrate IV to maintain urine output of 30-50 ml/hr for adults
1 ml/kg/hour for children

Front 80

how often are urine outputs measured

Back 80

hourly

Front 81

what are the GI effects of burns

Back 81

paralytic illeus, stress ulcers

Front 82

how do you treat paralytic illeus

Back 82

rest GI

Front 83

how do you treat stress ulcers

Back 83

prophylacticaly

Front 84

what is given for pain management

Back 84

opiates, sedatives, anxiolytics

Front 85

how are pain meds given

Back 85

no IM or SQ injections

Front 86

why can carbon monoxide cause hypoxia

Back 86

it is a by product of carbon combustion and has affinity with hemoglobin 200 X that of oxygen causing hypoxia

Front 87

what are the early signs of CO poisoning

Back 87

decreased LOC, increased heart rate, increased respiratory rate

Front 88

what are the later sings of CO poisoning

Back 88

N/V, unresponsive, respiratory failure

Front 89

how do you treat CO poisoning

Back 89

100% oxygen

Front 90

what are severe signs of CO poisoning

Back 90

cherry red mucous membranes, skin and nail beds

Front 91

when is inhalation injury seen

Back 91

burns to face, head, and neck

Front 92

what are the symptoms of inhalation injury

Back 92

singed facial hair, swollen lips and mouth, burns to the airway can cause swelling that blocking flow of air into the lungs

Front 93

how is an inhalation injury diagnosed

Back 93

ABG's, fiberoptic bronchoscopy

Front 94

how is inhalation injury treated

Back 94

mechanical ventilation, suctioning, bronchdilators, pulmonary hygiene, tracheostomy

Front 95

what do you do for chemical burns

Back 95

remove all clothing, rinse generously with water or saline, alkali burns to eyes require hours of irrigation

Front 96

how do you treat electrical burns

Back 96

EKG and baseline cardiac enzymes
titrate IV fluids to urine output of 100-150 ml/hr (2ml/kg/hr in kids) to prevent myoglobulinuria and concurrent renal failure

Front 97

what is done for wound cleansing in burns

Back 97

hydrotherapy, topical antibiotics, and dressings

Front 98

what do you need to watch in topical antibiotics

Back 98

watch WBC with silvadene, ointments to face

Front 99

how are dressings applied to burns

Back 99

lightly as possible, fine mesh gauze to face or open, tube gauze

Front 100

what are the types of debridement

Back 100

mechanical, enzymatic, surgical

Front 101

what is the typical surgical procedure seen with burns

Back 101

excision of full-thickness burns with split thickness skin graft

Front 102

what kind of graft is a split-thickness skin graft

Back 102

autograft

Front 103

how are grafts left intact

Back 103

staples

Front 104

what are donor sites covered with

Back 104

opsite or xeroform gauze

Front 105

what is done for graft care

Back 105

remove staples, dress with fine mesh gauze impregnated with antibiotic ointment

Front 106

what is a homograft

Back 106

from live or decreased donor

Front 107

what is a heterograft

Back 107

porcine

Front 108

what are the risks for homo and heterografts

Back 108

infection and antigenicity

Front 109

what are the disadvantages of cultured epithelial cells

Back 109

fragility and contracture development

Front 110

what is done in rehab for burn patients

Back 110

physical therapy-contracture prevention
occupational therapy-splinting
nutrition- supplements, tubefeedings, TPN

Front 111

what do jobst stockings do

Back 111

reduces scarring

Front 112

what often form to STSG

Back 112

blisters

Front 113

what are the categories of donors

Back 113

deceased cadaver donor, deceased after cardiac death donor
living, related donor
living, unrelated donor

Front 114

what is an autograft transplant

Back 114

self

Front 115

what is an allograft transplant

Back 115

same species-homograft

Front 116

what is an isograft transplant

Back 116

identical twins

Front 117

what is a xenograft

Back 117

another species-heterograft

Front 118

what is an orthotopic transplant

Back 118

graft at a natural place or on the proper part of the body

Front 119

what are the heart indications for transplant

Back 119

cardiac tumor, congenital heart disease, cardiomyopathy, myocarditis, primary pulmonary hypertension may require heart and lung

Front 120

what are the kidney indications for transplant

Back 120

genetic disease-polycystic
primary glomerulonephritis
systemic diseases- diabetic nephropathy, hypertension, SLE
irreversible damage from drug therapy

Front 121

what are the indications for kidney/pancreas transplants

Back 121

end-stage diabetic nephropathy, type 1 diabetes with life-threatening hypo/hyperglycemia refractory to medical management, isolated pancreas for brittle type 1 diabetes without advanced nephropathy, no significant secondary complications of diabetes

Front 122

what are the indications for liver transplant

Back 122

alcoholic liver disease, cholestatic liver disease-primary bilary cirrhosis, sclerosing cholangitis
chronic hepatitis- viral, autoimmune
genetic disorder
hepatocellular carcinoma

Front 123

what are the single lung indications for transplant

Back 123

COPD-emphysema
Interstitial lung disease- idiopathic pulmonary fibrosis, carcoidosis
primary pulmonary hypertension- may require double lung transplant

Front 124

what can't a patient have before transplant

Back 124

an infection-active infection can lead to sepsis and clinical instability

Front 125

what are the common key aspects for candidacy for all organs

Back 125

estimation of patient's risk or developing disease recurrence in allograft, estimation of patient's risk for undergoing transplant surgery, evaluation of patient's ability to tolerate immunosuppression therapy, evaluation of any psychological pathology, assessment of social support, evaluation of resources

Front 126

what are the lab studies for all candidates

Back 126

histocompatability- blood types, tissue type (HLA)
Panel reactive antibody screen
Serologies/infectious disease- CMV, EBV, hepatitis, HIV, HSV, VZV
Blood chemistries
liver function tests
prothrombin and partial thromboplastin time
urinalysis
24-hour urine for creatinine clearance and protein

Front 127

what are additional tests needed for liver transplant

Back 127

abdominal ultrasound and CT scan
Alpha fetoprotein levels

Front 128

what are additional tests needed for lung transplant

Back 128

CT of chest, echocardiogram, exercise capacity tests

Front 129

what are additional tests needed for heart transplant

Back 129

echocardiogram, metabolic exercise training, hemodynamic measurements

Front 130

what are additional tests needed for kidney transplant

Back 130

noninvasive cardiac testing, coronary angiography

Front 131

long term success of transplants depends on what

Back 131

immune system

Front 132

what are the three phases of the primary immune response

Back 132

recognition of non-self
proliferation of immunocompetent cells
action against the foreign substance

Front 133

what is the secondary immune response

Back 133

immunologic memory

Front 134

what are the class 1 HLA antigens

Back 134

present on almost all body cells "self"

Front 135

what are class II HLA antigens

Back 135

on B lymphocytes-induce immune response

Front 136

what are class III HLA antigens

Back 136

on some RBCs and complement

Front 137

where are immune cells produced

Back 137

bone marrow as stem cells

Front 138

what do stem cells become

Back 138

lymphocytes or phagocytes

Front 139

what do B cell lymphocytes mature

Back 139

in the bone marrow

Front 140

where do T cell lymphocytes mature

Back 140

in thymus- develop ability to recognize self from non-self

Front 141

what is humoral immunity mediated by

Back 141

b cells

Front 142

what does humoral immunity do

Back 142

produces antibodies/immunoglobulins and mark the antigens for destruction by antibodies

Front 143

what is cell-mediated immunity determined by

Back 143

T cells

Front 144

what do cytotoxic T cells do

Back 144

kill invading cells

Front 145

what do helper T cells do

Back 145

stimulate B cells for antibody production, identified by T4 or CD4 markers

Front 146

what do suppressor T cells do

Back 146

suppress the immune response

Front 147

what are natural killer cells

Back 147

another types of lymphocyte; attack and destroy non-self cells

Front 148

what are phagocytes

Back 148

macrophages present antigen to help T cells and cytotoxic T cells; produce interleukins that stimulate maturation of helper and cytotoxic T cells

Front 149

what are complements

Back 149

series of 25 proteins; activation coverts to enzymes that promote lysis of cells

Front 150

what happens in graft rejection

Back 150

transplanted tissue recognized as non-self by immune system
cell-mediated- HLA class II antigens on donor cells activate helper T cells
Natural kiler cells attack any HLA class I antigens
transplanted organ infiltrated with cells that destroy the grafted tissue
humoral-mediated rejection also occurs at the same time with antigen-antibody
complement promotes tissue destroying cells at the transplant site

Front 151

what is a hyperacute rejection

Back 151

within hours; humoral mediated

Front 152

what is an acute rejection

Back 152

weeks to months; cellular mediated

Front 153

what is chronic rejection

Back 153

varying times; progesses for years until destruction of transplanted organ; humoral and cell mediated

Front 154

what is graft vs. host disease

Back 154

donor cells perceive recipient tissue as "non-self"- cell mediated

Front 155

how is graft vs host disease treated

Back 155

with immunosuppression and supportive therapy

Front 156

what are the skin symptoms of GVHD

Back 156

micropapular rash on soles, palms, earlobes

Front 157

what are the liver symptoms of GVHD

Back 157

elevation of all liver labs; degeneration small bile ducts

Front 158

what are the small bowel symptoms of GVHD

Back 158

liters of diarrhea watery or bloody

Front 159

what tests do you run for surveillance for rejection in the pancreas

Back 159

C peptide or glucose

Front 160

what tests do you run for surveillance for rejection in the liver

Back 160

LFT

Front 161

what tests do you run for surveillance for rejection in the kidney

Back 161

BUN/creatinine

Front 162

what tests do you run for surveillance for rejection in the heart

Back 162

echocardiogram

Front 163

what tests do you run for surveillance for rejection in the lungs

Back 163

pulmonary function test

Front 164

what is the only organ in which biopsy is only definitive diagnosis of rejection

Back 164

heart

Front 165

what can be done for prevention of rejection

Back 165

pre-transplant studies for histocompatability and immunosuppressant regimes

Front 166

what are the pre-transplant studies for histocompatability

Back 166

degree of shared antigens between two or more individuals, panel reactive antibody, human leukocyte antigens- antigens determined by major genes within the major histocompatibility complex

Front 167

what medication therapies are done in immunosupressant regimes

Back 167

combination medication therapies

Front 168

what is the initial immunosuppression

Back 168

higher dose immediately after transplant, maintenance dose defined over time

Front 169

what is the induction therapy of immunosuppressant therapy

Back 169

usually administered prior to transplant, used for patients with higher risk of rejection, used for protocols to induce chimerism

Front 170

what are the drugs used in immunosuppressive therapy

Back 170

corticosteroids, cyclosporine, tacrolimus, azathioprine, mycophenolate mofetil

Front 171

what do corticosteroids do in immunosuppression

Back 171

used in maintenance and acute rejection, multiple adverse effects

Front 172

what does cyclosporine do

Back 172

inhibits cytotoxic T cells
impairs secretion of interleukins

Front 173

what does tacrolimus do

Back 173

approved for liver transplants, inhibition of interleukin 2, fewer adverse effects

Front 174

what does azathioprine do

Back 174

interferes with antibody production, suppresses WBC production

Front 175

what does mycophenolate mofetil do

Back 175

inhibits response of T and B cells without global bone marrow suppression

Front 176

what are the sources of infections in transplant patients

Back 176

exogenous sources- allograft, blood transfusion, environment
endogenous sources- latent virus, normal flora
opportunistic-most common, hospital acquired infections, organisms that produce significant morbidity under condition of depressed host resistance

Front 177

what are microbial factors for infection

Back 177

endogenous sources- skin and GI tract with gram negative bacteria
transmission via donated blood
transfusion of blood and blood products
transmission from environment- human, water system, air

Front 178

what are some ways to prevent infection

Back 178

minimize risk factors in environment, prophylactic medications, vaccinations, educate patients and family regarding sources, hand washing

Front 179

what are some prophylactic medications for infections

Back 179

bactrim, acyclovir

Front 180

what is done in the care of transplant recipients

Back 180

stabilizze immunosuppressant regime, wound care, assessment of organ function, observe for complications, infection surveillance and prophylaxis, strength/mobility/stamina, education

Front 181

what education needs to be done on medications for organ recipients

Back 181

immunosuppression, prophylactic meds, wound and tube care

Front 182

what education needs to be done on infection surveillance for organ recipients

Back 182

fever, change in mental status/mentation, skin changes/change in wound, new cough or congestion, GI symptoms, change in urine

Front 183

what education needs to be done on infection prevention for organ recipients

Back 183

environmental exposures-soil, pets
exposure to others-influenza, vaccinated kids

Front 184

what are late/long term complications of transplant

Back 184

acute rejection, chronic rejection, infection, medication side effects

Front 185

what are some common medication side effects

Back 185

osteoporosis, renal impairment, malignancy, hyperlipidemia, hypertension

Front 186

what is blunt trauma

Back 186

injuries are produced by a rapid decrease in velocity over a short distance; deceleration

Front 187

what does the severity of injury of blunt trauma depend on

Back 187

energy that is transferred during deceleration that occurs in a crash or fall

Front 188

what is acceleration

Back 188

applied to a body when a stationary/slow moving object is stuck by a faster moving object- energy from faster moving object is transferred to the slower object

Front 189

what is penetrating trauma

Back 189

object penetrates the body lacerate, disrupt destroy or contuse tissue

Front 190

what are the contributing factors of a gun shot wound

Back 190

bullet's trajectory, extent of cavitation, degree of combustion involved

Front 191

what is the bullet's trajectory

Back 191

pathway projectile takes as it travels thru body

Front 192

what is the extent of cavitation

Back 192

kinetic energy from impact-blast effect

Front 193

what is important when evaluating the extent of stab wounds

Back 193

position of patient

Front 194

what is impalement

Back 194

usually occurs secondary to fall onto object or sustained by machinery

Front 195

what is important to remember for impalement

Back 195

object could be providing tamonade of major vessels; never remove an impaled object

Front 196

what is done from trauma resuscitation

Back 196

primary secondary and tertiary surveys

Front 197

what is a primary survey

Back 197

lasts 15 seconds:
A- airway with c-spine stabilization
B-breathing
C-circulation
D-disability
E-exposure

Front 198

what is done in a secondary survey

Back 198

head to toe exam-foley, NGT
AMPLE-allergies, meds, past illness, last meal, events
imaging
definitive care-includes surgery, splinting, meds, consults or transfers
F-full set of vitals
G-give comfort measures
H-history; head to toe assessment
I-inspect posterior surfaces

Front 199

what is a tertiary survey

Back 199

involves repeating the primary and secondary survey within 24 hours for missed injuries

Front 200

what is done on the chest assessment

Back 200

inspect, palpate, auscultate, percuss

Front 201

what does the chest inspection look at

Back 201

determine the respiratory rate/depth, look for chest wall asymmetry, look for paradoxical chest wall motion, look for ecchymosis, seat belt of steering wheel marks, penetrating wounds

Front 202

what does chest palpation examine

Back 202

feel the trachea for deviation, assess for adequate and equal chest wall movement, feel for chest wall tenderness or rib crunching indicating rib fracture, feel for sub-q emphysema

Front 203

what does chest auscultation examine

Back 203

listen for normal, equal breath sounds bilaterally
listen especially in teh apices and axillae and at the back of the chest

Front 204

what does chest percussion examine

Back 204

percuss both sides of the chest looking for dullness or resonance

Front 205

what are the lethal six life threatening injuries of chest trauma

Back 205

airway obstruction, tension pneumothorax, cardiac tamponade, open pneumothorax, massive hemothorax, flail chest

Front 206

what are the hidden six immediate life threatening injuries of chest trauma

Back 206

traumatic rupture of the aorta, major tracheobronchial disruption, blunt cardiac injury, diaphragmatic tear, esophageal perforation, pulmonary contusion

Front 207

what are the causes of an airway obstruction

Back 207

tounge-most common cause in unconscious pt.
dentures, teeth, secretions, blood
bilateral mandibular fracture, laryngeal trauma

Front 208

what are the physical findings of an airway obstruction

Back 208

stridor, hoarseness,, sub-q emphysema, ALOC, use of accessory muscles, apnea

Front 209

what is the management of an airway obstruction

Back 209

when in doubt, just intubate, maintain c-spine immobilization

Front 210

what is a pneumothorax

Back 210

collection of air in the pleural cavity causing loss of the normal negative intrapleural pressure resultingin compression of the injured lung forcing it to collapse

Front 211

what are the signs and symptoms of a pneumothorax

Back 211

respiratory distress-SOB, decreased O2 sats, cyanosis
decreased breath sounds on affected side-muffled
hyperresonance when percussed on affected side
unequal chest movement-tracheal deviation

Front 212

how can a pneumothorax cause the lung to collapse

Back 212

air leaks from inside of the lung to the space between the lung and the chest wall which leads to collapse

Front 213

on an x-ray, what does the dark portion represent

Back 213

dark side of the cest is filled with air that is outside of the lung tissue

Front 214

when does an open pneumothorax occur

Back 214

usually results from a penetrating injury; impalement or GSW

Front 215

what do you do first for an open pneumothorax

Back 215

emergently cover wound with a sterile dressing-taped on three sides to allow the intra pleural air to escape

Front 216

what treatments are done for an open pneumothorax

Back 216

place chest tube (not near wound), intubate if breathing remains compromised

Front 217

when does a tension pneumothorax occur

Back 217

occurs with a disruption involving viceral or parietal pleura, or tracheobraonchial tree

Front 218

what forms in a tension pneumothorax

Back 218

a one way valve forms allowing air inflow into pleural space and prohibiting air outflow

Front 219

why is their increased pressure in a tension pneumothorax

Back 219

volume of air aincreases with each inspiration

Front 220

what happens when the pressure increases in a tension pneumothorax

Back 220

the ipsilateral lung collapses which leads to hypoxia

Front 221

what does pressure build up cause in a pneumothorax

Back 221

causes mediastinum to shift toward the contralateral side and impinge on both contralaterlung lung and vasculature entering rt atrium which leads to worsening hypoxia dn cmpromised venous return

Front 222

what are the types of injuries that may result in a tension pneumothorax

Back 222

penetrating chest injury, blunt trauma with parenchymal lung injury, mechanical ventilation with high airway pressures

Front 223

what are the signs and symptoms of a tension pneumothorax

Back 223

severe respiratory distress, hypotension, JVD, diminished or absent breath sounds on affected side, hyperresonance, tracheal shift to unaffected side

Front 224

what is the treatment for tension pneumothorax

Back 224

life threatening emergency-must immediately decompress the collapse lung by inserting a 14 gauge angiocath through 2nd intercostal space in the mid clavicular line. This will turn the tension into a simple pneumothorax

Front 225

what is a hemothorax

Back 225

collection of blood within the pleura

Front 226

what is a hemothorax often result of

Back 226

a penetrating injury

Front 227

where is damage often seen when a hemothorax appears

Back 227

intercostal vessels, pulmonary parenchyma, pulmonary and great vessels

Front 228

what is an exsanguinating hemmorage

Back 228

massive blood loss from severe lung laceration or injury to the hear (2-4L of blood)

Front 229

what are the causes of a hemothorax

Back 229

pulmonary parenchymal laceration, intercostal artery laceration, or disruption of a major pulmonary or bronchial vessel

Front 230

what is a moderate hemothorax and what can is result in

Back 230

500-1500ml and can result in symptoms

Front 231

what is a massive hemothorax and what does it require

Back 231

1500-2000ml and requires immediate chest tube insertion, autotransfusion and possible thoracotomy

Front 232

what are the signs and syptoms of a hemothorax

Back 232

signs of both respiratory and cardiovascular distress, severey compromised lung vital capacity, dyspnea and hypoxemia related to massive collections of blood in thel ung tissue.

Front 233

what is heard when percussion is done over a hemothorax

Back 233

dullness over injured lung fields

Front 234

what should you beware of in a hemothorax

Back 234

potential of hypovolemic shock

Front 235

what is the treatment for a hemothorax

Back 235

chest tube-drainage is imperative
IV-be prepared for volume replacement-immediate resuscitation occurs while blood is being evacuated
open thoracotomy

Front 236

when is further surgical exploration required in a patient with a hemothorax

Back 236

if blood loss is greater than 500ml/hr for 2 hours
if hemodynamic instability continues despite adequte fluid resuscitation
serial HCT values decline to severely low levels

Front 237

what is cardiac tamponade

Back 237

compression of the heart due to fluid accumulation within the pericardium

Front 238

what causes cardiac tamponade

Back 238

bleeding or air in the pericardial sac increasing pericardial pressure

Front 239

what does cardiac tamponade prevent

Back 239

prevents ventricles from adequately filling or pumping blood

Front 240

what are the signs and symtoms of cardaic tamponade

Back 240

hypotension, JVD, muffled heart sounds, tachycardia, peripheral vasoconstriction, elevated CVP, PCWP

Front 241

when is beck's triad seen

Back 241

in cardiac tamponade

Front 242

what is becks triad

Back 242

fall in the systolic blood pressure, rising jugular venous pressure, and muffled heart sounds

Front 243

what is the treatment of cardiac tamponade

Back 243

pericardiocentesis, pericardial window

Front 244

what is flail chest

Back 244

multiple rib or sternal fracture, which isolates part of the chest wall allowing the chest to move independently of the thorax

Front 245

what is flail chest a marker of

Back 245

severe trauma

Front 246

what is seen if flail chest is not corrected

Back 246

respiratory distress, sub-q emphysema

Front 247

what is flail chest mangement

Back 247

if the patient is in severe distress or shock-intubate
stabilize the flail segment
pain control-opioids, PCA, intercostal nerve block
aggressive pulmonary toilet
early mobilization
surgical stabilization

Front 248

what does an aortic rupture usually result from

Back 248

blunt chest trauma-vertical or horizontal deceleration injury or crushing chest injury

Front 249

aortic rupture in teh leading cause of immediate death from what

Back 249

blunt trauma in pts involved in MVC and falls

Front 250

what is the most common area for aortic ruptue

Back 250

descending aorta, can be a partial or complete tear

Front 251

what do you need to assess for in an aortic rupture

Back 251

other injury-1st or 2nd rib, high sternal fracture, or left clavicular fracture

Front 252

what are the signs and symptoms of aortic rupture

Back 252

severe CP radiates from midscapular region to back, shock, harsh precordial systolic murmur, left hemothorax, widened mediastinum on CXR-aorta gram
loss of pulses in lower extremities

Front 253

what is the treatment for ruptured aorta

Back 253

fluid resuscitation-may need vasoactive drugs
emergency surgery to repair the tear-be prepared for an emergency thoractomy in the ED

Front 254

what is essential in a ruptured aorta

Back 254

if the aorta is cross clamped, know how long the aorta was cross clamped,
comtniured hemodynamic monitoring is essential

Front 255

what is the assessment focused on in an aortic rupture

Back 255

CV system

Front 256

what difference may you seen in an aortic rupture

Back 256

may see differences in teh presence or quality of pulses between upper and lower extremities or between arms

Front 257

what may you see in the upper extremities in an aortic rupture

Back 257

hypertension, precordial or intrascapular systolic murmurs

Front 258

when and where does a diaphragmatic rupture occur

Back 258

usually occurs on teh lt side after severe blunt thoracoabdominal trauma
Can occur from penetrating injury to diaphragm

Front 259

when is there a high index of suspicion in a diaphragmatic ruptuer

Back 259

with a rapid deceleration injury, direct crush to upper abdomen, severe chest trauma with lower rib fracture, penetrating injury to chest or upper abdomen

Front 260

what are the major symtoms of diaphragmatic rupture

Back 260

pain and dyspnea

Front 261

what is the treatment of diaphragmatic rupture

Back 261

surgical repair; laparotomy

Front 262

what causes a myocardial cntusion

Back 262

caused by high speed deceleration injuries or kicking injuries from animals

Front 263

when is a myocardial contusion suspected

Back 263

when trauma is severe enough to produce rib/sternal fracutre, pulmonary contusion or patient reccives severe anterior blunt trauma

Front 264

what are the signs and symptoms of a myocardial contusion

Back 264

anginal type CP refractory to nitrate therapy
non-specific ST segment or T wave change, possible dysrhythmias
elevated CPK_MB isoenzymes
observe the patient and treat dysrhythmias

Front 265

what do you do if enzymes are elevated and there are ischemic changes

Back 265

treat as AMI

Front 266

what is teh treatment for myocardial contusion

Back 266

bedrest to decrease myocardial oxygen demands

Front 267

when is a pulmonary contusion seen

Back 267

serious injury to lung parenchyma

Front 268

what does a pulmonary contusion result in

Back 268

interstitial hemorrhage with resulting alveolar collapse
atelectasis
consolidation of the uninjured areas of lung
ventilation perfusion mismatch from shunting of blood

Front 269

what are the signs and symptoms of a pulmonary contusion

Back 269

hemoptysis, fever, wheezing and rales, decreased breath sounds, signs of hypoxemia

Front 270

what si the treatment for pulmonary contusion

Back 270

oxygen therapy, pain mangement, careful fluid mangement, meticulous pulmonary care, if severe-intubate/mechanically ventilate
antibiotics are only used if a documented infection exists

Front 271

what do you use on the patient if they need to be intubated

Back 271

neuromuscular blocking agent

Front 272

what do intraabdominal injuries result from

Back 272

compression causing crush injury
abrupt shearing force causing tears of organs or vascular pedicles
sudden rise in intraabdominal pressure causing rupture of an intraabdominal viscus

Front 273

what are teh 3 collisions involved in a MV crash

Back 273

MV impacts another object
victim stikes internal parts of the car
soft tissues vs. supporting structures of body- shearing injury-transection of thoracic or abdominal aorta

Front 274

what is penetrating trauma

Back 274

injury as a result of a penetrating object which lacerates, disrupts, destroys or contuses tissue

Front 275

what is penetrating trauma the result of

Back 275

GSW, stab wound, or impalement

Front 276

what is penetrating trauma management dependent on

Back 276

wound and location, trajectory, degree of tissue injury and complete understanding of anatomy

Front 277

what are the 3 abdominal cavities

Back 277

peritonem, retroperitoneum, pelvis

Front 278

what is in the upper peritoneum

Back 278

liver, spleen, diaphragm, stomach and transverse colon

Front 279

what is in the lower peritoneum

Back 279

small bowel and sigmoid colon

Front 280

what is in the retroperitoneum

Back 280

abdominal aorta, IVC, duodenum, pancreas, kidneys, ureter, ascend/decend colon

Front 281

what is in the pelvis

Back 281

rectum, bladder, iliac vessels and genitalia

Front 282

what are the 4 components of an abdominal assessment

Back 282

inspection, auscultation, percussion, palpation

Front 283

how is an abdominal inspection done

Back 283

remove all clothing, do not remove any protruding or impaled objects

Front 284

what is done in an abdominal inspection

Back 284

inspect for asymmetry, ecchymosis (seat belt sign), abrasions, lacerations, or penetrating injury. Do not forget to inspect the flank and back

Front 285

what is cullen's sign

Back 285

blue discoloration in the periumbilical area

Front 286

what does cullen's sign suggest

Back 286

hemoperitoneum

Front 287

what is grey-turner's sign

Back 287

ecchymosis in the flank region

Front 288

what is grey-turner's sign associated with

Back 288

retroperitoneal hemorrhage

Front 289

what is kehr's sign

Back 289

injury to the spleen can cause irritation ot the diaphragm (phrenic nerve) resulting in referred pain to the left shoulder

Front 290

when is an abominal auscultation done

Back 290

always done before percussion and palpation

Front 291

what does auscultation begin with

Back 291

assessment of bowel sounds

Front 292

what are normal bowel sounds

Back 292

high pitched; every 5-10 seconds

Front 293

what is a bruits

Back 293

vascular sounds due to turbulent blood flow

Front 294

what does a bruits signal

Back 294

arterial injury or aneurysm

Front 295

what is peritoneal friction rub an indication of

Back 295

inflammation

Front 296

when is a peritoneal friction rub heard

Back 296

during respiratory cycle in upper quad in presence of hepatic or splenic disorder

Front 297

what is a percussion done

Back 297

determine areas of pain, if pina is severe skip percussion and palpation

Front 298

what does percussion determine

Back 298

organ location and size

Front 299

what does tympany show

Back 299

air/gas filled

Front 300

when is dullness heard

Back 300

with solid organs or fluid filled structures

Front 301

what is light palpation

Back 301

fingers pressed about 1cm in depth

Front 302

what does a light palpation detect

Back 302

detects areas of tenderness or rigidity

Front 303

what is a deep palpation

Back 303

finger pressed about 1cm in depth

Front 304

what does a deep palpatioin determine

Back 304

determine organ size and presence of masses
guarding or rebound tenderness

Front 305

what are the diagnostics for abdominal trauma

Back 305

x-rays, labs, focused abdominal sonography for trauma, diagnositc peritoneal lavage, compute tomography, cystogram, laparotomy

Front 306

what may plain radiographs show

Back 306

peritoneal gas

Front 307

findings of plain radiographs are associated with what

Back 307

abdominal injuries

Front 308

what do plain radiographs assist in determining

Back 308

trajectory with penetrating injury

Front 309

what are the laboratory evaluations for abdominal trauma

Back 309

CBC, electrolytes, PT/PTT, ABG, types and screen, UA, ETOH or drug screen, amylase/lipase

Front 310

what do labs not provide

Back 310

inital evidence of injury

Front 311

what does a FAST asses for

Back 311

free fluid in teh peritoneal cavity

Front 312

how is a FAST done on

Back 312

hemodynamically unstable

Front 313

what is a FAST floowed up with

Back 313

a CT

Front 314

what are the disadvantages of FAST

Back 314

unable to identify or grade retroperitoneal injuries, unable to identify injuries to the bowel or solid organs, cannot distinguish between blood and ascites, findings may be difficult to inerpret in the obsese or patient with pervious abdominal surgeries

Front 315

when is a dianostic peritoneal lavage done

Back 315

blunt abdominal trauma with an equivocal or unreliable abdominal examination, unexplained BP drop or blood loss, hemodynamically unstable; unable to transport to CT

Front 316

what are the contraindications of a DPL

Back 316

pregnancy and if laparotomy is alrady indicated

Front 317

what must a patient have before getting a DPL

Back 317

foley and NGT

Front 318

how is a DPL done

Back 318

catheter is blindly inserted through the peritoneal fat and peritoneum into the peritoneal space

Front 319

when are teh DPL results positive

Back 319

gross blood is present on aspiration
greater than 100,000 RBC
greater than 500 WBC
if bile, bacteria, or food particles returned

Front 320

what does a CT scan evaluate

Back 320

solid organ injury, intraabdominal blood, fluid or air

Front 321

what is a systogram used for

Back 321

to rule out bladder injury/rupture

Front 322

what are the indications of a cystogram

Back 322

gross hematuria with a seat belt sign or pelvic fracture

Front 323

when should a cystogram be don

Back 323

before DPL

Front 324

what are the normal results of a cystogram

Back 324

complete bladder emptying without bladder emptying without reflux or obstruction to flow of urine

Front 325

what are the indications for a laparotomy

Back 325

obvious peritoneal signs, decreased BP with distended abdomen, GSW with peritoneal penetration, stab wound with evisceration, peritonitis or decreased BP, postive DPL, any diagnostic suggestive of intraabdominal injury

Front 326

what is the laparotomy procedure

Back 326

incision, control bleeding, contamination control, systemic exploration, closure

Front 327

what is damage control surgery

Back 327

abbreviated laparotomy with containment of bleeding a contamination; intra abdominal packing for inital injury control

Front 328

what is phase 1 of damage control

Back 328

immediate exploratory lap to control hemorrhage and contamination; definitive reconstruction is delayed

Front 329

what is phase II of damge control

Back 329

secondary and continuous resuscitation in ICU, optimizing O2 comsumption and delivery, lactate clearance, core rewarming, correction of coagulapathy, ventilatory support

Front 330

what is phase III of damage control

Back 330

return to OR for packing removal, definitive injury repair and possible closure

Front 331

where is the liver located

Back 331

RUQ

Front 332

what are the hepatic functions

Back 332

assists in intestinal digestion with bile secretion, destroys aged RBC, stores a large volume of blood, synthesis of clotting factors, metabolism of fats, proteins, and carbs, metabolic detoxification

Front 333

what is the most commonly injury intra-abdominal organ

Back 333

liver

Front 334

when does hepatic injury most often occur

Back 334

with penetrating trauma

Front 335

what is grade one of the hepatic injury

Back 335

subcapsular hematoma less than 1 cm in maximal thickness, capsular avulsion, superficial parenchymal laceration less than 1cm deep, and isolated periportal blood tracking

Front 336

what is grade 2 of the hepatic injury scale

Back 336

parenchymal laceration 1-3 cm deep and parenchymal/subcapsular hematomas 1-3cm thick

Front 337

what is grade 3 of the hepatic injury scale

Back 337

parenchymal laceration more than 3cm deep and parenchymal or subcapusular hematoma more than 3cm in diameter

Front 338

what is grade 4 of the hepatic injury scale

Back 338

parenchymal/subscapular hematoma more than 10 cm in diameter, lobar destruction, or devascularization

Front 339

what is grade 5 of the hepatic injury scale

Back 339

global destruction or devascularization of the liver

Front 340

what is the operative management of hepatic injury

Back 340

resuscitation, damage control, laparotomy/celiotomy for repair

Front 341

what is the nonoperative management of hepatic injury

Back 341

blunt injury; without other intraabdominal injury requiring laparotomy, hemodynamically stable, lack of continued need for transfusion, without peritoneal signs, can be done regardless of grade of injury

Front 342

where int he spleen located

Back 342

LUQ

Front 343

what are the splenic functions

Back 343

blood filtering, removal/destruction of aged and defored RBCs, platelet and RBC storage, phagocytosis of bacteria, production of antibodies

Front 344

splenic injury most often is the result of what

Back 344

blunt trauma; compression or deceleration force

Front 345

what is grade 1 of teh splenic injury scale

Back 345

laceration: less than 1 cm in depth
hematoma: subcapsular less than 10% of surface

Front 346

what is grade 2 of the splenic injury scale

Back 346

laceration: 1-3 cm in depth not involving a trabecular vessel
hematoma: subcapsular 10-50% of surface area or 5cm in diameter

Front 347

what is stage 3 of teh splenic injury scale

Back 347

greater than 3 cm depth or any depth involving a trabecular vessel
Hematoma: subcapsular greater than 50% of surface are or intraparenchymal

Front 348

what is stage 4 of the splenic injury scale

Back 348

segmental or hilar vessel involvement

Front 349

what is stage 5 of the splenic injury scale

Back 349

shattered splled or hilar bessel disruption

Front 350

what is the operative management of splenic injury indicated for

Back 350

an emergent splenectomy is indicated with significant accumulation of intraperitoneal blood (greater than 1000ccs)
blood transfusion greater than 2 units
progressive decrease in H/H
hemodynamic instability

Front 351

what happens after a splenectomy

Back 351

lifelong risk for a variety of serious infections; Strep. pneumoniae, H. influenzae, and Neisseria meningitis.

Front 352

what is the most severe infection post-splenectomy

Back 352

overwheliming post-splenectomy infection

Front 353

what must be done for the patient post splenectomy

Back 353

must be vaccinated

Front 354

what is OPSI symptoms

Back 354

fever, malaise, myalgias, headache, N/V/D

Front 355

what does OPSI rapidy progress to

Back 355

bacteremic septic shock accompanied by a decrease in BP, decrease in blood sugar, anuria, and DIC

Front 356

what is the mangement post splenectomy

Back 356

immunoprophylaxis, antibiotic prophylaxis, antibiotic prophylaxis, and patient education

Front 357

what does immunoprophlaxis consist of

Back 357

a series of vaccinations; pneumococcal, meningococcal, and haemophilus influenzae B and annual influenza

Front 358

what does antibiotic prophlaxis consist of

Back 358

2 year prophylaxis, or standby antibiotic therpay; the patient retains a personal supply of antibiotics and takes them upon the first sign of even mild respiratory infections

Front 359

what is teh key in post splenectomy management

Back 359

preventing serious infection and pt education

Front 360

what pt education should be done post splenectomy

Back 360

even a common cold can be serious, should contact their physician immediately when not feeling well, wearing a medic alert tag and carrying a wallet card is important

Front 361

when is there nonoperative management of splenic injury

Back 361

hemodynamically stable, grade 1 or II

Front 362

what is the nonoperative management of splenic injury

Back 362

serial abdominal exams, serial vital signs, serial H/H, monitored unit with immediate access to CT, surgeon and OR

Front 363

Risk of failure of non-operative managment correlates with what

Back 363

grade of injury

Front 364

small bowel injury is primarily from what

Back 364

penetrating injury

Front 365

CT of a small bowel injury has a significant what

Back 365

false negative test

Front 366

what is teh management of a small bowel injury

Back 366

surgical-repair small perforations, bowel resection for large wounds, ileostomy

Front 367

what are large bowel injuries often result of

Back 367

penetrating injury

Front 368

what is the mangement of large bowel injury

Back 368

surgical- primary repair, resection and anastamosis, colostomy

Front 369

renal injury occurs most often with what

Back 369

blunt trauma

Front 370

what is teh mangement for renal injury

Back 370

bedrest with serial H/H
angiography/embolization
nephrectomy

Front 371

when to most bladder injuries occur

Back 371

pelvic fracture

Front 372

what is an intraperitoneal rupture associated with

Back 372

seat belt injury with rupture to dome of the bladder

Front 373

what is the appearance seen iwth an intraperitoneal rupture

Back 373

appearance of free dye outlining the loops of the bowel

Front 374

what is the mangement of an intraperitoneal rupture

Back 374

surgical

Front 375

what is an extraperitoneal rupture associated with

Back 375

fracture to superior and inferior pubic rami

Front 376

what is the appearance of an extraperitoneal rupture

Back 376

sunburst appearance

Front 377

what is the management of an extraperitoneal rupture

Back 377

foley or suprapubic catheter and follow up cystogram

Front 378

what is abdominal compartment syndrome the result of

Back 378

result of increased intraabdominal pressure

Front 379

what does abdominal compartment syndrome involve

Back 379

all organ system of the body and if untreated it can be fatal

Front 380

what are the contributing factors to abdominal compartment syndrome

Back 380

bowel edema from injury and resuscitation
perihepatic packing
blood accumulation in the mesentery
persistent hemorrhage

Front 381

what are the cardiovascular changes seen with abdominal compartment syndrome

Back 381

IAP increases resulting in decreased venous return
decrease CO
decreased BP
increased SVR

Front 382

what are the pulmonary changes seen with abdominal compartment syndrome

Back 382

upward pressure on diaphragm,
decrease in chest wall expansion
decreased tidal volume
decreased compliance
increased peak pressures

Front 383

what are the renal changes seen with abdominal compartment syndrome

Back 383

decreased renal blood flow
decreased urine output
renal failure

Front 384

what are the contributing factors to abdominal compartment syndrome

Back 384

bowel edema from injury and resuscitation
perihepatic packing
blood accumulation in the mesentery
persistent hemorrhage

Front 385

what is teh monitoring done for abdominal compartment syndrome

Back 385

bladder pressure moniotring-insert foley; instill 60-100ml NSS and measure the pressures by water manometer or transducer/monitor q

Front 386

what are the cardiovascular changes seen with abdominal compartment syndrome

Back 386

IAP increases resulting in decreased venous return
decrease CO
decreased BP
increased SVR

Front 387

what is normal bladder pressure

Back 387

0

Front 388

what are the pulmonary changes seen with abdominal compartment syndrome

Back 388

upward pressure on diaphragm,
decrease in chest wall expansion
decreased tidal volume
decreased compliance
increased peak pressures

Front 389

what happens if bladder pressure is greater than 25

Back 389

requires urgent intervention

Front 390

what are the renal changes seen with abdominal compartment syndrome

Back 390

decreased renal blood flow
decreased urine output
renal failure

Front 391

what is the management of abdoinal compartment syndrome

Back 391

decompression- surgical

Front 392

what is teh monitoring done for abdominal compartment syndrome

Back 392

bladder pressure moniotring-insert foley; instill 60-100ml NSS and measure the pressures by water manometer or transducer/monitor q

Front 393

what is orthopedic trauma

Back 393

fractures

Front 394

what is normal bladder pressure

Back 394

0

Front 395

what are the complications of orthopedic trauma

Back 395

PE
Fat emboli

Front 396

what happens if bladder pressure is greater than 25

Back 396

requires urgent intervention

Front 397

what is the management of abdoinal compartment syndrome

Back 397

decompression- surgical

Front 398

what is orthopedic trauma

Back 398

fractures

Front 399

what are the complications of orthopedic trauma

Back 399

PE
Fat emboli

Front 400

what are the contributing factors to abdominal compartment syndrome

Back 400

bowel edema from injury and resuscitation
perihepatic packing
blood accumulation in the mesentery
persistent hemorrhage

Front 401

what are the cardiovascular changes seen with abdominal compartment syndrome

Back 401

IAP increases resulting in decreased venous return
decrease CO
decreased BP
increased SVR

Front 402

what are the pulmonary changes seen with abdominal compartment syndrome

Back 402

upward pressure on diaphragm,
decrease in chest wall expansion
decreased tidal volume
decreased compliance
increased peak pressures

Front 403

what are the renal changes seen with abdominal compartment syndrome

Back 403

decreased renal blood flow
decreased urine output
renal failure

Front 404

what is teh monitoring done for abdominal compartment syndrome

Back 404

bladder pressure moniotring-insert foley; instill 60-100ml NSS and measure the pressures by water manometer or transducer/monitor q

Front 405

what is normal bladder pressure

Back 405

0

Front 406

what happens if bladder pressure is greater than 25

Back 406

requires urgent intervention

Front 407

what is the management of abdoinal compartment syndrome

Back 407

decompression- surgical

Front 408

what is orthopedic trauma

Back 408

fractures

Front 409

what are the complications of orthopedic trauma

Back 409

PE
Fat emboli

Front 410

what is seen on the insepction of orthopedic trauma

Back 410

comparison- both sides of body for symmetry, contour, size and alignment
skin and soft tissue-edema, ecchymosis, gross deformity
joints-deformity, edema, erythema, ROM, rotation

Front 411

what is examined on the palpation of orthopedic trauma

Back 411

temperature, quality of pulses, capillary refill, muscle strength, DTR

Front 412

long bone or pelvic fractures can lead to what

Back 412

fat emboli

Front 413

what is the best way to prevent emboli

Back 413

immoblize the fractured extremity

Front 414

how can the fractured extermity be immobilized

Back 414

MAST trousers in the field

Front 415

pelvic fractures may cause what

Back 415

serious intraabdominal injury

Front 416

what are the signs of a PE

Back 416

local swelling, tenderness, deformity, unusual pelic movement and eccymosis

Front 417

what do you assess in a pelic fracture

Back 417

neurovascular status of the lower extremities

Front 418

how are pelvic fractures usually diagnosed

Back 418

x ray

Front 419

what is the treatment for a stable pelvic fractures

Back 419

bedrest for a stable fracture- up to 6 weeks

Front 420

upper extremity fractures may affect what

Back 420

ability to do ADLs

Front 421

fractures of the upper extremities may require what

Back 421

casting, percutaneous pins

Front 422

upper extremity fractures may affect what

Back 422

ability to do ADLs

Front 423

what do you monitor in an upper extremity fracture

Back 423

neurovascular status
pain

Front 424

fractures of the upper extremities may require what

Back 424

casting, percutaneous pins

Front 425

what helps mortality and morbidity of lower extremity fractures

Back 425

early internal fixation

Front 426

what do you monitor in an upper extremity fracture

Back 426

neurovascular status
pain

Front 427

lower extremity fractures may require what

Back 427

plates and pinning

Front 428

what helps mortality and morbidity of lower extremity fractures

Back 428

early internal fixation

Front 429

what do you monitor in lower extremity fractures

Back 429

NVS
Pain

Front 430

lower extremity fractures may require what

Back 430

plates and pinning

Front 431

what is important in extremity trauma

Back 431

important to splint until bone can be reset

Front 432

what do you monitor in lower extremity fractures

Back 432

NVS
Pain

Front 433

what does splinting do

Back 433

immobilizes the bone, aids in control of hemorrhage, reduce pain and prevent furthur injury

Front 434

what is important in extremity trauma

Back 434

important to splint until bone can be reset

Front 435

what are the complications of extemity trauma

Back 435

compartment syndrome, pulmonary embolism, fat embolism

Front 436

what does splinting do

Back 436

immobilizes the bone, aids in control of hemorrhage, reduce pain and prevent furthur injury

Front 437

what is compartment syndrome

Back 437

extremities havemultiple compartments that encase muscle, nerves, and blood vessels and enveloped by fascia that is tough and non-elastic: when pressure rised the vascular and neuro structures become compressed and compromised

Front 438

what are the complications of extemity trauma

Back 438

compartment syndrome, pulmonary embolism, fat embolism

Front 439

what is compartment syndrome

Back 439

extremities havemultiple compartments that encase muscle, nerves, and blood vessels and enveloped by fascia that is tough and non-elastic: when pressure rised the vascular and neuro structures become compressed and compromised

Front 440

upper extremity fractures may affect what

Back 440

ability to do ADLs

Front 441

fractures of the upper extremities may require what

Back 441

casting, percutaneous pins

Front 442

what do you monitor in an upper extremity fracture

Back 442

neurovascular status
pain

Front 443

what helps mortality and morbidity of lower extremity fractures

Back 443

early internal fixation

Front 444

lower extremity fractures may require what

Back 444

plates and pinning

Front 445

what do you monitor in lower extremity fractures

Back 445

NVS
Pain

Front 446

what is important in extremity trauma

Back 446

important to splint until bone can be reset

Front 447

what does splinting do

Back 447

immobilizes the bone, aids in control of hemorrhage, reduce pain and prevent furthur injury

Front 448

what are the complications of extemity trauma

Back 448

compartment syndrome, pulmonary embolism, fat embolism

Front 449

what is compartment syndrome

Back 449

extremities havemultiple compartments that encase muscle, nerves, and blood vessels and enveloped by fascia that is tough and non-elastic: when pressure rised the vascular and neuro structures become compressed and compromised

Front 450

upper extremity fractures may affect what

Back 450

ability to do ADLs

Front 451

fractures of the upper extremities may require what

Back 451

casting, percutaneous pins

Front 452

what do you monitor in an upper extremity fracture

Back 452

neurovascular status
pain

Front 453

what helps mortality and morbidity of lower extremity fractures

Back 453

early internal fixation

Front 454

lower extremity fractures may require what

Back 454

plates and pinning

Front 455

what do you monitor in lower extremity fractures

Back 455

NVS
Pain

Front 456

what is important in extremity trauma

Back 456

important to splint until bone can be reset

Front 457

what does splinting do

Back 457

immobilizes the bone, aids in control of hemorrhage, reduce pain and prevent furthur injury

Front 458

what are the complications of extemity trauma

Back 458

compartment syndrome, pulmonary embolism, fat embolism

Front 459

what is compartment syndrome

Back 459

extremities havemultiple compartments that encase muscle, nerves, and blood vessels and enveloped by fascia that is tough and non-elastic: when pressure rised the vascular and neuro structures become compressed and compromised

Front 460

where does compartment syndrome most commonly occur

Back 460

in hand, lower arm, lower leg and foot

Front 461

what are the signs and symptoms of compartment syndrome

Back 461

6 p's
pain
pallor
pulse
polar
paresthesia
paralysis

Front 462

compartment syndrome may require what

Back 462

fasciotomy

Front 463

how does a pulmonary embolism form

Back 463

blood clots form in peripheral veins of lower extremities and pelvis. sudden blood flow changes and an increase in pressure dislodge the clost intro the peripheral circulation. the clot travels through circulation and lodges in the pulmonary artery or one of the smaller branches- obstructing distal blood flow

Front 464

what causes vasoactive substances to be released in a pulmonary embolism

Back 464

tissue typoxia

Front 465

what happens when vasoactive substances are released

Back 465

increase pulmonary resistance, right ventricular strain/failure, shock

Front 466

what are the signs and symptoms of a pulmonary embolism

Back 466

new onset of dyspnea, sudden onset of chest pain, pale, dusky, cyanotic skin, hemoptysis, fever, increased anxiety, decreased level of consciousness, pleuritic pain, bronchial breath sounds, hypoxemia

Front 467

what are the diagnositcs for PE

Back 467

EKG-may see changes
CXR-WNL initally but later will show s/s of atelectasis of infarction
d-dimer-specific test for fibrin split products; positive if greater than 500
V/Q scan-WNL or show a perfusion deficit
spiral chest CT
pulmonary angiogram

Front 468

what does a normal VQ scan show

Back 468

equal distribution of gas (darker spots)

Front 469

what does a PE V/Q scan show

Back 469

gas is not taken into the perfused area (no picture or very light/cold spots

Front 470

how do you ensure an adequate interpretaton of a V/Q scan

Back 470

read in conjunction with CXR

Front 471

what is the most definitve diagnostic tool for diagnosing a PE

Back 471

pulmonary angiogram

Front 472

what is the goal of PE treatment

Back 472

improve gas exchange and pulmonary tissue perfusion

Front 473

what is the treatment of PE

Back 473

high fowlers postion, supplemental oxygen, mechanical ventilation, pain management, heparin therapy, low molecular weight heparin, fibrinolytics, hemodynamically unstable, filter

Front 474

what does high fowlers postion do

Back 474

faciitates breathing; increases diaphragmatic excursion

Front 475

what do you have to monitor when giving heparin therapy

Back 475

PTT-keep at 2-2.5xnormal

Front 476

what does a fat embolism usually occur from

Back 476

traumatic injury to long bones, pelvis, and multiple skeletal fractures

Front 477

when are fat embolisms usually seen

Back 477

24-48 hours post injury

Front 478

wht are the signs and symptoms of a fat embolism

Back 478

tachycardia, tachypnea, alkolosis, low grade fever, new onset dyspnea, hypocarbia, increased respiratory rate and effort, CXR with new pulmonary inflitrates

Front 479

what is the treatment for a fat emboli aimed at

Back 479

preserving pulmonary function and maintaining hemodynamic stability

Front 480

what is the treatment for fat emboli

Back 480

immobilize injuries to prevent emboli from occurring, supplemental oxygen, possible intubation/mechanical ventilation, monitor hemodynamic status, monitor for cardiac dysrhythmias

Front 481

what do arterial, central venous, and pulmonary artery catheters measure

Back 481

pressure

Front 482

what are the serious risks of inserting a catheter

Back 482

infection and bleeding

Front 483

where are central venous pressure lines seen

Back 483

on the floor

Front 484

where are arterial lines and pulmonary artery catheters seen

Back 484

in critical care units

Front 485

when are catherters inserted

Back 485

with MI's, trauma, septic, burns, there is a real potential for ineffective tissue/cellular perfusion

Front 486

what are the components to all pressure monitoring systems

Back 486

invasive catheter, high pressure tubing, transducer, flush system
bedside monitor

Front 487

what does high pressure tubing do

Back 487

firm do reflect high pressure transducer, not to surrounding air

Front 488

what does the tranducer do

Back 488

converts mechanical energy to electrical energy

Front 489

what is the vent/stopcock for

Back 489

opening to atmosphere for zeroing

Front 490

what is zeroing for

Back 490

to accouint for descrepancy in atomospheric pressures

Front 491

what is dynamic pressure

Back 491

the kinetic energy of the moving fluid (BP)

Front 492

what is the residual or static pressure

Back 492

the static pressure within the vessel (BP)

Front 493

what is the hydrostatic pressure

Back 493

weight of teh fluid in a fluid filled column

Front 494

where is the transducer supposed to be

Back 494

level with the heart- 4th intercostal space and midaxillary line

Front 495

what happens if the transducer is lower than the heart

Back 495

pressure increases

Front 496

what do A-lines do

Back 496

direct and continuous monitoring of systolic and diastolic BP
assessf fluid volume status
monitor effects of vasoactive drugs
obtain ABGs and other blood samples
intra aortic balloon pump
mean arterial pressure

Front 497

what is a mean aterial pressure

Back 497

average driving force of teh movement of blood in arterial system throughout systole and diastole

Front 498

what is the equation for a mean BP

Back 498

(sbp+2(DBP))/3

Front 499

what is a normal MAP

Back 499

70-90

Front 500

what happens when a map is less than 60

Back 500

jeopardizes coronary artery perfusion in brain and kidneys and other vital organ perfusion

Front 501

what happens if the MAP is greater than 105

Back 501

indicates hypertension or vasocontrictive disease

Front 502

what are the a line sites

Back 502

radial and femoral arteries

Front 503

what are the complications of a lines

Back 503

infection, accidental blood loss, imparied circulation, embolus, hematoma, electrical hazards

Front 504

what factors can cause inaccurate readings on an A line

Back 504

transducer is to high or low, transducer is not zeroed, waveform is underdamped, mean arterial pressure reads falsely high, you start nitroprusside, calibration is off, system underreads by 10, MAP flasely low, you give fluid or start dopamine

Front 505

what can new A lines give

Back 505

MAP, CO, continous systolic and diastolic BP

Front 506

what is cardiac output

Back 506

heart rate per minute times stroke volume

Front 507

what is the normal cardiac output

Back 507

4-6L/m

Front 508

what is preload

Back 508

amount of pressure or stretch exerted on the walls of the ventricle by the volume of blood filling the ventricle at the end of diastole
volume of blood within the ventricle at the end of diastole

Front 509

what does too much prelaod do

Back 509

overstretches ventricles

Front 510

what does too little preload do

Back 510

doesn't stretch enough

Front 511

how is preload on teh right side measured

Back 511

CVP catheter

Front 512

prelaod on the right side is what

Back 512

RT atrial pressure

Front 513

how is preload on the left side measured

Back 513

pulmonary artery catheter

Front 514

what is the afterload

Back 514

resistance against which the Right and Left ventricles ahve to contract; sum of all teh forces of all the loads against which the ventricle must shorten to eject blood out into the circulation

Front 515

what happens in the afterload is too high

Back 515

the heart works harder to get the valve open, uses more oxygen, the ventricle does't empty well, cardiac output decreases

Front 516

what is seen if the afterload is too low

Back 516

the ventricle generates very little pressure to open
weak contraction
cardiac output decreases

Front 517

what is contractility

Back 517

force and velocity of myocardial fiber shortening-it is independent of preload and afterload

Front 518

how is contractility measured

Back 518

LVSWI

Front 519

what is the LVSWI

Back 519

work involved in moving blood against the resistance

Front 520

how is lvswi measured

Back 520

Pap catheters

Front 521

what are the normal levels of cardiac index

Back 521

2.4-4.0

Front 522

what is cvp

Back 522

central venous pressure

Front 523

what does the CVP measure

Back 523

pressure on right side of heart

Front 524

what is the levels of CVP

Back 524

2.8 cm water or 2-6 mmhg

Front 525

what does low CVP indicate

Back 525

inadequate venous return because of fluid deficit or hypovolemia, too much vasodilating drug

Front 526

what does a high CVP indicate

Back 526

inadequate right ventricular emptying because of fluid overload, rt ventriculat failure or pulmonary disorders

Front 527

where is a CVP inserted

Back 527

IJ or subclavian

Front 528

where is the tip of theCVP

Back 528

superior vena cava

Front 529

what is the difference in pulse between overload and rt. sided failure

Back 529

weak in rt failure, bounding in overload
tachy in failurem, normal in overload

Front 530

what is teh difference in urine output between overload and rt sided failure

Back 530

urine output high in overload

Front 531

what is the difference in JVD between overload and Rt. sided failure

Back 531

seen in both

Front 532

what is the difference in edema between overload and Rt. sided failure

Back 532

seen in rt failure

Front 533

what measures the pressure on the left side of the heart

Back 533

pulmonary artery catheters

Front 534

where are pulmonary artery catheters inserted

Back 534

internal jugular or subclavian

Front 535

what shows pressurese on the left side of the heart

Back 535

PA diastolic pressure

Front 536

what are the normal levels of PA diastolic pressure

Back 536

8-15

Front 537

what does PA diastolic estimate

Back 537

the left ventricular prelaod status; amount of stretch in myocardium at end of diastole;volume of blood within left ventricle at end of diastole

Front 538

what does pulmonary artery wedge pressure measure

Back 538

left ventricular end diastolic pressure or left ventricular preload

Front 539

what is the normal PA wedge pressure

Back 539

4-12

Front 540

what do you do if you see al ow PAWP or PAD

Back 540

fluid or blood replacement, vasoconstrictors

Front 541

what do you do if there is a high PAP and PAWP

Back 541

diuretics, fluid restriction, NTG, enhancing contractility decreasing afterlaod with arteriole vasodilators

Front 542

how is afterlaod calculated

Back 542

SVR

Front 543

how is contractility calculated

Back 543

LVSWI

Front 544

what is a pacemaker

Back 544

a device that generates an electrical impulse.

Front 545

what is the purpose of a pacemaker

Back 545

to deliver an electrical impulse to the heart at needed.

Front 546

what are the types of pacemakers

Back 546

transcutaneous, temporary, permanent

Front 547

when to you use a transcutaneous pacemaker

Back 547

when evern the patients rhythm strip/ekg shows that the hearts normal pacemaker and the hearts back up pacemakers aren't kicking to save the heart

Front 548

what are the implications for a transcutaneous pacemaker

Back 548

very painful, adjust output and rate, valium-mophine, stop gap until other pacemaker can be implanted

Front 549

what does an impulse to the heart from a pacemaker do

Back 549

depolarizes the heart resulting in a contraction

Front 550

what do you need to set when putting in a pacemaker

Back 550

rate, output and sensitivity

Front 551

what do you set the rate at with a pacemaker

Back 551

60-80 unless overdrive pacing

Front 552

what do you set the output at

Back 552

find of how much current/output you need to capture to make the heart depolarize then multiply by 2

Front 553

what should you set the sensitivity at

Back 553

1mV

Front 554

how are bipolar leads set up

Back 554

negative end touches the heart, positive end is on same catheter little more proximal

Front 555

what are unilateral leads set up

Back 555

negative end touches heart, positive is the generator. much greater sensing area

Front 556

how are bipolar leads set up

Back 556

negative end touches the heart, positive end is on same catheter little more proximal

Front 557

what is the risk of a transveous pacemaker

Back 557

threading anything into the heart, possibility for deadly arrhythmia, bleeding, infection, puncture heart or lung, microshock. failure to pace, capute or sense

Front 558

what are unilateral leads set up

Back 558

negative end touches heart, positive is the generator. much greater sensing area

Front 559

what are the types of external pacemakers

Back 559

transvenous, epicardial, transthoracic

Front 560

what is the risk of a transveous pacemaker

Back 560

threading anything into the heart, possibility for deadly arrhythmia, bleeding, infection, puncture heart or lung, microshock. failure to pace, capute or sense

Front 561

where are pacemaker leads placed

Back 561

tip of lead in RA or RV depending on where pacing needed or for biventricular, left ventricular lead through coronary sinus into cardiac vein on surface of LV

Front 562

what are the types of external pacemakers

Back 562

transvenous, epicardial, transthoracic

Front 563

what does the first letter in the mode represent

Back 563

what the pacemaker is pacing

Front 564

where are pacemaker leads placed

Back 564

tip of lead in RA or RV depending on where pacing needed or for biventricular, left ventricular lead through coronary sinus into cardiac vein on surface of LV

Front 565

what does the second letter in the mode represent

Back 565

sensing, what the pacemaker is looking at to determine if the pacer should fire

Front 566

what does the first letter in the mode represent

Back 566

what the pacemaker is pacing

Front 567

what does the third column represent

Back 567

the responsek, what the pacemaker does now, knowing what was sensed
I=inhibit
T=trigger

Front 568

what does the second letter in the mode represent

Back 568

sensing, what the pacemaker is looking at to determine if the pacer should fire

Front 569

what is failure to capture

Back 569

see pacer spikes but no contraction/depolarization follows. call

Front 570

how are bipolar leads set up

Back 570

negative end touches the heart, positive end is on same catheter little more proximal

Front 571

what does the third column represent

Back 571

the responsek, what the pacemaker does now, knowing what was sensed
I=inhibit
T=trigger

Front 572

what are unilateral leads set up

Back 572

negative end touches heart, positive is the generator. much greater sensing area

Front 573

what is failure to sense

Back 573

under sensing: see pacer spikes too soon after an intrinsic beat or see with no relation

Front 574

what is failure to capture

Back 574

see pacer spikes but no contraction/depolarization follows. call

Front 575

what is the risk of a transveous pacemaker

Back 575

threading anything into the heart, possibility for deadly arrhythmia, bleeding, infection, puncture heart or lung, microshock. failure to pace, capute or sense

Front 576

what is failure to sense

Back 576

under sensing: see pacer spikes too soon after an intrinsic beat or see with no relation

Front 577

what are the types of external pacemakers

Back 577

transvenous, epicardial, transthoracic

Front 578

where are pacemaker leads placed

Back 578

tip of lead in RA or RV depending on where pacing needed or for biventricular, left ventricular lead through coronary sinus into cardiac vein on surface of LV

Front 579

what does the first letter in the mode represent

Back 579

what the pacemaker is pacing

Front 580

what does the second letter in the mode represent

Back 580

sensing, what the pacemaker is looking at to determine if the pacer should fire

Front 581

what does the third column represent

Back 581

the responsek, what the pacemaker does now, knowing what was sensed
I=inhibit
T=trigger

Front 582

what is failure to capture

Back 582

see pacer spikes but no contraction/depolarization follows. call

Front 583

what is failure to sense

Back 583

under sensing: see pacer spikes too soon after an intrinsic beat or see with no relation

Front 584

what is failure to pace

Back 584

pacer isnt working, no spikes

Front 585

when should people with a pacemaker call

Back 585

with fever and chills
lightheaded, fainting, lack of energy, rapid pounding heart beat or skipped beat, usually they don't check their pulse, may need telephone monitoring device

Front 586

what are the requirements for a successful CABG

Back 586

significant lesion, space above and below the lesion, viable dissue distal to the graft

Front 587

what are the indications for CABG surgery

Back 587

angina-intractable or unstable
acute myocardia infarction
CHF

Front 588

what are the types of grafts used

Back 588

saphenous veins, internal mammary artery graft, radial artery graft

Front 589

what is the preoperative nursing care for a CABG

Back 589

Physical exam-HP, chest x-ray, EKG, possible echo, pulmonary function tests, carotid doppler studies, IV access, Lab work
clip hair instead of shaving
placing bactriband into nares to decrease nosicomial infection rates that day before

Front 590

what meds are held before a CABG

Back 590

those that contribute to bleeding

Front 591

what med is often ordered before a CABG

Back 591

antibiotic

Front 592

what do you do with an ICD before a CABG surgery

Back 592

call physician, usually turned off

Front 593

where are the cannulas inserted in a cardiopulmonary bypass

Back 593

into the rt atrium and inferior VC

Front 594

what is the purpose of a cariopulmonary bypass

Back 594

oxygenate and circulate blood during the procedure

Front 595

how does a cardiopulnonary bypass work

Back 595

drains blood from the heart and perfuses tissues during cardiac arrest

Front 596

how does the cardiopulmonary bypass have myocardial preservation

Back 596

aortic cross clamping, systemic hypothermia, cardioplegia

Front 597

how do you wean the patient off a cardiopulmonary bypass

Back 597

rewarm core temperature to 37.0, wean cardiopulmonary blood flow, prophylactic antibiotics, reverse with protamine

Front 598

what are the effects of cariopulmonary bypass

Back 598

third spacing, hypertension, coagulopathy, immune system, hyperthermia, electrolyte imbalance, cardiac effects, pulmonary effects, renal effects

Front 599

when are renal effects seen in a cardiopulmonary bypass

Back 599

if aorta clamped too long

Front 600

how is an off pump cardiovascular surgery done

Back 600

thoracotomy approach or small midsternal incision

Front 601

what is a thorascope used for

Back 601

to visualize the vessels

Front 602

what is harvested and where are tehy attached in off poump cardio surgery

Back 602

arterial conduits are harvested and attached to the myocardium

Front 603

what do you do in initial trasfer to icu post op

Back 603

extubate as soon as possible, aggressive ambulation, continue with prophylactic antibiotics, continuous gtt tight control on glucose, chest tube management

Front 604

what is chest tube management

Back 604

assess drainage hourly, do not strip the chest tubes, avoid dependent loops of tubing, assess the patient for cardiac tamponade

Front 605

what do you do more managing heart rate

Back 605

epicardial pacing, digoxin, amiodarone

Front 606

what do you do to manage prelaod

Back 606

volume, diuretics

Front 607

what do you do to manage afterload

Back 607

pressors (norepinephrine, neosynephrine, nirtoprusside, IABP, rewarming

Front 608

what do you do the manage contractility

Back 608

inotropes (dopamine, dobtuamine, milrinone

Front 609

what are teh causes of low cardiac output

Back 609

decreased contractility- stunned myocardium, intra-op infarct, cononary artery spasm, air emboli, graft dysfunction, cardiac tamonade
inadequate fluid status (preload)
increased systemic vascular resistance (afterload)

Front 610

what are teh sympotoms of low cardiac output syndrome

Back 610

decreased BP
decrease in urine output
decreased peripheral perfusion
decreased SVO2/mixed venous

Front 611

how do you treat low prelaod

Back 611

administer volume

Front 612

how do you treat high preload

Back 612

venodilators and diuretics

Front 613

how do you treat high afterload

Back 613

nipride, Ace-inhibitors, morphine

Front 614

how do you treat low afterload

Back 614

phenylephrine, norephinephrine

Front 615

how do you treat decreased contractility

Back 615

vasopressors, dogoxin, michanical assist devices:IABP

Front 616

what are the causes of bleeding post-op

Back 616

coagulopathy, surgical bleeding

Front 617

what are the interventions for post-op bleeding

Back 617

assess chest tube drainage, correct coagulation defects

Front 618

how do you correct coagulatioin defects post-op

Back 618

protamine sulfate (25mg increments IV very slowly)
FFP, platelets
rewarm the patient
replace volume: PRBCs, autotransfusion

Front 619

how do you prevent cardiac dysrhythmias post-op

Back 619

prevent hypoxia, hypercarbia, monitor and replace electrolytes, administer drugs

Front 620

what is the treatment for cardiac dysrhythmias post-op

Back 620

pharmacologic
pacing

Front 621

how does kidney dysfunction occur post-op

Back 621

hymolysis of RBCs in CPB results in hemoglobinuria, which damages renal tubules-resulting in kidney dysfunction

Front 622

what is the drug of choice to prevent renal involement post-op

Back 622

lasix

Front 623

why is lasix given most op

Back 623

to maintain minimum urine output of at least 25-35 ml/hr

Front 624

why doyou have to worry about hypothermia post-op

Back 624

physiologic effects of rewarming-shivering, afterdrop, rewarming shock, acidosis

Front 625

what is the nursing management for hypothermia

Back 625

assess for shivering, restore heat loss, modify the rate of heat loss, prevent shivering through drug administration

Front 626

what are you concerned with about the neurologic status post-op

Back 626

hypoxia

Front 627

what are the signs of hypoxia

Back 627

restlessness, confusion, headache

Front 628

what is given for pain management post-op

Back 628

opioids

Front 629

what are the goals for post-op care

Back 629

maintain adequate tissue perfuison, maintain adequte gas exchange, maintain fluid and electrolyte balance, pain relief, maintain normal termperature, promote adequate rest, encourage self care activites

Front 630

what is important after a cabg

Back 630

lifestyle changes-smoking cessation, cardiac rehabilitation, psychosocial management

Front 631

how do you diagnosis valvular disease

Back 631

physical assessment, EKG for dysrhythimias (AFIB), Echo, doppler ultrasound, transesophageal echo

Front 632

what is the patho of mitral stenosis

Back 632

incomplete opening of the valve during diastole, LA enlargement and impaired filling of LV, see elevation of LA pressure, as disease progresses see symptoms of of decreased CO during exertion and with tachycardia

Front 633

what are the manifestations of mitral stenosis

Back 633

dyspnea on exertion, fatigue and weakness, palpitations, chest pain, orthopnea, paroxysmal nocturnal dyspnea, mild hemoptysis, increased risk of getting pulmonary infections

Front 634

what are the physical findings of mitral stenosis

Back 634

pulmonary congestion on Chest x-ray, AFIB, diastolic murmur heard after S2, increase in pulmonary artery pressure and pulmonary capillary wedge pressure and low cardiac output

Front 635

what are the indications to relieve the stenosis

Back 635

uncontrolled pulmonary edema, limiting dyspnea and intermittent pulmonary edema, pulonary hypertension with RVH, limited activity despite medical management and rate control of A fib, recurrent systemic emboli despite anticoagulation

Front 636

what is the patho of mitral valve regurgitation

Back 636

incomplete closure of mitral valve, retrograde flow with each contraction, increase volume load of LV, left atrial dilation and hypertrophy, left ventricular dilation and hypertrophy

Front 637

what are the manifestations of mitral valve regurgitation

Back 637

weakness and fatigue, exertional dyspnea, palpitations, signs of left ventricular failure

Front 638

what are the physical signs of mitral valve regurgitaion

Back 638

enlarged left atrium and ventricle with pulmonary congestion on Chest x-ray
on EKG-left ventricular hypertrophy and AFIB
murmur throughout systole
elevated pulmonary artery pressure and pulmonary capillary wedge pressure
S3

Front 639

what is the patho of aortic stenosis

Back 639

increased resistance of ejectio nof blood from the LV, LV hypertrophy due to inability of ventricle to empty, decrease in CO, pulmonary congestion, Rt. sided failure, sudden cardiac death

Front 640

what are the manifestations of aortic stenosis

Back 640

exertional dyspnea, exercise intolerance, marked fatigue, syncope, angina, lt, sided heart failure, slower hr

Front 641

how do you diagnosis valvular disease

Back 641

physical assessment, EKG for dysrhythimias (AFIB), Echo, doppler ultrasound, transesophageal echo

Front 642

what is the patho of mitral stenosis

Back 642

incomplete opening of the valve during diastole, LA enlargement and impaired filling of LV, see elevation of LA pressure, as disease progresses see symptoms of of decreased CO during exertion and with tachycardia

Front 643

what are the manifestations of mitral stenosis

Back 643

dyspnea on exertion, fatigue and weakness, palpitations, chest pain, orthopnea, paroxysmal nocturnal dyspnea, mild hemoptysis, increased risk of getting pulmonary infections

Front 644

what are the physical findings of mitral stenosis

Back 644

pulmonary congestion on Chest x-ray, AFIB, diastolic murmur heard after S2, increase in pulmonary artery pressure and pulmonary capillary wedge pressure and low cardiac output

Front 645

what are the indications to relieve the stenosis

Back 645

uncontrolled pulmonary edema, limiting dyspnea and intermittent pulmonary edema, pulonary hypertension with RVH, limited activity despite medical management and rate control of A fib, recurrent systemic emboli despite anticoagulation

Front 646

what is the patho of mitral valve regurgitation

Back 646

incomplete closure of mitral valve, retrograde flow with each contraction, increase volume load of LV, left atrial dilation and hypertrophy, left ventricular dilation and hypertrophy

Front 647

what are the manifestations of mitral valve regurgitation

Back 647

weakness and fatigue, exertional dyspnea, palpitations, signs of left ventricular failure

Front 648

what are the physical signs of mitral valve regurgitaion

Back 648

enlarged left atrium and ventricle with pulmonary congestion on Chest x-ray
on EKG-left ventricular hypertrophy and AFIB
murmur throughout systole
elevated pulmonary artery pressure and pulmonary capillary wedge pressure
S3

Front 649

what is the patho of aortic stenosis

Back 649

increased resistance of ejectio nof blood from the LV, LV hypertrophy due to inability of ventricle to empty, decrease in CO, pulmonary congestion, Rt. sided failure, sudden cardiac death

Front 650

what are the manifestations of aortic stenosis

Back 650

exertional dyspnea, exercise intolerance, marked fatigue, syncope, angina, lt, sided heart failure, slower hr

Front 651

what are the physical signs of aortic stenosis

Back 651

chest xray shows calcification of aortic valve,
left ventricular hypertrophy of EKG
systolic ejection murmur, palpable LV heave or thrill, increase pulmonary capillary wedge pressures, increase in LVEDP

Front 652

what is the patho of aortic valve regurgitation

Back 652

incompetent valve allows blood flow back into LV during diastole, increase volume in LV, LV dilation and hypertrophy, LV failure

Front 653

what are the manifestations of aortic valve regurgitaion

Back 653

fatigue, dyspnea on exertion, tachycardia, palpitations, aroxysmal nocturnal dyspnea, pulmonary edema, angina

Front 654

what are the physical signs of aortic valve regurgitation

Back 654

cardiomegaly, left ventricular hypertrophy on EKG, diastolic murmur, hyperdynamic heart, bounding pulses, wide arterial pulse pressure

Front 655

what is mitral valve prolapse

Back 655

failure of one or both leaflets to fit together resulting in displacement of leaflet edge toward the atrium during systole

Front 656

what is the patho of mitral valve prolapse

Back 656

mitral valve leaflets become enlarged and floppy so prolapse back into the LA during systole

Front 657

what are the manifestations of mitral valve prolapse

Back 657

non specific chest pain, dyspnea, fatigue, palpitations, lightheadedness

Front 658

what are teh physical signs of mitral valve prolapse

Back 658

characteristic mid systolic click
may have late or pansystolic murmur

Front 659

what is the treatment of mitral valve prolapse

Back 659

focused on relief of symptoms and prevention of complications: beta blockers for palpitations of chest pain, avoid caffeine, alcohol, and cigs
antibiotic prophylaxis

Front 660

what are the three types of mechanical valves

Back 660

caged-ball, tilting-disk, bi-leaflet

Front 661

what is the selection of replacement valve dependent on

Back 661

patients age, patients size, medical history, ability to comply with a medical regime

Front 662

what are the complications associated with prosthetic valves

Back 662

thrombus formation, leaking around valve, endocarditis, degenerative changes in tissue valves, complications associated with prolonged anticoagulation therapy

Front 663

what is the medical management for valve disease

Back 663

low sodium diet, pharmacology to treat heart failure-increase contractility, reduce preload and afterload, antiarrhythmics, anticoagulation and antiplatelet, prophylaxis for dental procedures with antibiotics

Front 664

what is the nursing management for vale disease

Back 664

maintain adequate cardiac output-assess cardiac output, monitor for signs of low cardiac output
optimize fluid balance-auscultate breath sounds, monitor I&O; daily weights, assess for JVD, hepatomegaly

Front 665

when is an ICD indicated

Back 665

for patients experiencing cardiac arrest caused by VF or VT
spontaneus sustained VT not responsive to drug therapy
syncope with hemodynamically compromising VT or VF during EP study

Front 666

what is the first line of treatment on an ICD

Back 666

tachycardia pacing

Front 667

what are some potential complications post-procedure

Back 667

bleeding or severe bruising, pneumothorax, myocardial puncture, infection

Front 668

what should a patient do if shock occurs

Back 668

call MD within 24 hours
Call MD for second chock

Front 669

when should the patient call the doctor

Back 669

fever greater than 100, three or more shocks, tenderness over site, SOB

Front 670

what are thrombolytics

Back 670

stimulate lysis of a clot by converting inactive plasminogen to plasmin, an enzyme responsible for the degradation of fibrin

Front 671

what is the selection criteria for therapy

Back 671

less than 75, no more than 12 hours from onset of chest pain
St segment elevation on AKG
ischemic chest pain of 30 minutes or longer
chest pain unresponsive SL nitroglycerin

Front 672

what is the exlusion criteria for throbolytic therapy

Back 672

condition that may predispose the patient to bleeding

Front 673

what do thrombolytics do

Back 673

stimulate the lysis of a clot by converting inactive plasminogen to plasmin, an enzyme responsible for the degradation of fibrin.

Front 674

what is the selection criteria for therapy

Back 674

age less than 75, no more than 12 hours from onset of chest pain, ST segment elevation of EKG, ischemic chest pian of 30 minutes or longer, chest pain unresponsive to SL nitroglycerin

Front 675

what is the exclusion criteria for thrombolytic therapy

Back 675

- recent surgery/trauma, stroke or cerebrovascular event, uncontrolled hypertension, pregnancy, active internal bleeding

Front 676

when do you want to administer a thrombolytic

Back 676

within 30 minutes of presentation or during transport

Front 677

what is the dosage of t-PA (alteplase)

Back 677

100mg over 90 minutes with the first 15 mg given as a bolus followed by 50mg over the next 30 minutes and 35mg over the next hour

Front 678

what is the action of t-PA (alteplase)

Back 678

binds to fibrin at the clot and promotes activation of plasminogen to plasma

Front 679

what is the special considerations of t-PA (alteplase)

Back 679

short half life, bloused with heparin and infusion started at 1000u/hr to maintain PTT at 1.5-2X control for at least 24 hours

Front 680

what is the dosage of r-PA (reteplase)

Back 680

10 units given as a bolus over 2 minutes then repeated in 30 minutes

Front 681

what is the action of r-PA (reteplase)

Back 681

binds to fibrin at the clot and promotes activation of plasminogen to plasma

Front 682

what is the special considerations of r-PA (reteplase)

Back 682

15 minutes half life, bloused with heparin, asa administered

Front 683

what is the dosage of TNKase (tenecteplase

Back 683

30-50 mg based on body weight, given as single bolus

Front 684

what is the action of TNKase

Back 684

binds to fibrin at the clot and promotes activation of plasminogen to plasma

Front 685

what are the special considerations for TNKase

Back 685

half life-20 minutes, heparin and infusion stated with administration of drug, asa administered

Front 686

what is the dosage of SK

Back 686

1.5 million units, 750,000u over 20 minutes followed by 750000 over 40 minutes

Front 687

what is the action of SK

Back 687

wcatalyzed the conversion of plasminogen to plasmin which results in lysis of fibrin

Front 688

what are the special considerations for SK

Back 688

may cause allergic reaction and hypotension, asa administered

Front 689

what are the possible allergic manifestations related to SK therapy

Back 689

anaphylaxis, uticaria, itching, nausea, flushing, fever, chills

Front 690

what is the dosage of APSAC (anistreplase)

Back 690

30 units via slow bolus over 2-5 minutes

Front 691

what is the action of APSAC (anistreplase)

Back 691

a molecular combination of streptokinase and plasminogen with action similar to streptokinase

Front 692

what is the special considerations of APSAC (anistreplase)

Back 692

may cause allergic reaction and hypotension, long half life, so heparin is usually started 6 hours after APSAC and only used for 24-72 hours, asa administered

Front 693

what is TIMI 3

Back 693

normal or brisk flow through the coronary artery

Front 694

what is TIMI 2

Back 694

partial flow, slower than in normal vessels

Front 695

what is TIMI 1

Back 695

sluggish flow with incomplete distal filling

Front 696

what is TIMI 0

Back 696

no flow

Front 697

what is the evidence of reperfusion

Back 697

reperfusion dysrhythmias, abrupt cessation of chest pain, rapid return of ST segment to baseline, early and marked peaking of creatine kinase

Front 698

how is reocclusion noted

Back 698

reoccurrence of chest pain, ST segment elevation

Front 699

what is administered prophlyaxtically in thrombolytic therapy

Back 699

antacids and H2 blocker

Front 700

what are the indications for ICD

Back 700

patients experiencing cardiac arrest caused by VF or VT, spontaneous sustained VT not responsive to drug therapy, syncope with hemodynamically compromising VT or VF during EP study

Front 701

what is the first line of treatment in an ICD

Back 701

tachycardia pacing

Front 702

when will the ICD generator cardiovert VT or defibrillate VF

Back 702

if programmed bursts of pacing are unsuccessful

Front 703

what are the potential complications post ICD procedure

Back 703

bleeding of severe bruising, pneumothorax, myocardial puncture, infection.

Front 704

what does the patient do if shock occurs

Back 704

call MD within 24 hours of shock, call MD for second shock

Front 705

what does a patient with an ICD avoid

Back 705

stay 6 inches away from magnetic fields

Front 706

when should the patient call the MD

Back 706

fever greater than 100, three of more shocks, tenderness over site, SOB

Front 707

what is an IABP

Back 707

volume displacement device which provides assistance to the LV by the inflation and deflation of a balloon which is synchronized with the cardiac cycle

Front 708

how does an IABP work

Back 708

by rapidly shuttling helium gas or CO2 in and out of the double lumen balloon chamber

Front 709

what are the indications for an IABP

Back 709

acute MI, ischemic heart disease, cardiogenic shock, ventricular aneurysm, aortic stenosis, mitral insufficiency, ventricular septal defect, adjunct to thrombolytics, prophylaxis during angioplasty/surgery, post cardiopulmonary bypass failure, bridge to transplant

Front 710

what are the contraindications for an IABP

Back 710

aortic valve insufficiency, aortic aneurysm, end stage disease, peripheral vascular disease

Front 711

when does inflation occur

Back 711

during the diastolic phase of the cardiac cycle

Front 712

what does the inflated balloon do

Back 712

augments diastolic pressure by pushing blood in the aorta back toward the coronary arteries thus increasing myocardial oxygen supply

Front 713

when does deflation occur

Back 713

prior to thenext systole during the isovolmetric contraction phase during the isovolmetric contraction where 90% of myocardial O2 consumption takes place

Front 714

what do you see when deflation occurs

Back 714

increase in stroke volume related to decreased afterload

Front 715

what is the most reliable trigger

Back 715

R wave

Front 716

how is the IABP timed

Back 716

use arterial pressure waveform
can be placed in 1:1, 1:2, 1:3 or 1:4 augmentation

Front 717

where does inflation occur and what do you want to see

Back 717

inflation occurs at the dicrotic notch, want to see a sharp V

Front 718

what are the 3 general rules from timing

Back 718

peak diastolic augmented pressure should be greater than patient systolic pressure, balloon-assisted aortic end diastolic pressure should be lower than patient aortic end diastolic pressure

Front 719

what are the side effects and complications of an IABP

Back 719

limb ischemia, excessive bleeding at insertion site, thrombocytopenia, immobility of balloon catheter, balloon leak, infection, aortic dissection, compartment syndrome

Front 720

what are the nursing implications of an IABP

Back 720

monitor vital signs, assess timing Q1H, document quality of peripheral pulses and neurological status prior to balloon insertion, assess radial and pedal pulse Q1h, monitor urine output, avoid hip flexion, auscultate lung and heart sounds, assess tissue perfusion, monitor for signs of low CO, monitor sign integrity, maintain adequate nutrition, organize care to allow for rest periods, sedate patient as necessary, medicate for pain

Front 721

what is the time required to wean patient from therapy

Back 721

hours to days

Front 722

what may you see when weaning the patient from therapy

Back 722

dependence signs: chest pain, dysrhythmias, and other symptoms of deteriorating condition

Front 723

what is done post removal of IABP

Back 723

hold pressure for 45 minutes or an hour or clamp, check pulses, lay flat for 6 hours