Med Surge - Test 3 Back Pain / Primary & Secondary Lesions / Conscious Sedation /

Front 1

-Lordosis is a exaggerated curve in what region of the lower spine?

Back 1

lumbar

Front 2

Lordosis or Scoliosis

common finding in adults who have abdominal obesity…

Back 2

lordosis

Front 3

Lordosis or Scoliosis


a loss of lumbar curvature

Back 3

lordosis

Front 4

Lordosis or Scoliosis


is described as “flat back” syndrome..

Back 4

lordosis

Front 5

Lordosis or Scoliosis

– curves from side view.

Back 5

scoliosid

Front 6

Lordosis or Scoliosis

- is established when crawling as an infant and the baby begins to lift the head/trunk into extension.

Back 6

cervical lordosis

Front 7

Lordosis or Scoliosis

-when the baby begins to stand and walk about..due to gravitational exertion

Back 7

lumbar lordosis

Front 8

Lordosis or Scoliosis

a lateral curvature of the spine (S shaped)

Back 8

Scoliosis

Front 9

Lordosis or Scoliosis

it’s what you see when looking at the back of someone from behind

Back 9

Scoliosis

Front 10

Lordosis or Scoliosis

occurs when the vertebrae rotate and begin to compress

Back 10

Scoliosis

Front 11

Lordosis or Scoliosis


the spinal column begins to move into a lateral curve, most commonly in the right lateral thoracic area. as the degree of curvature increases, damage to the vertebral bodies results. the degree of the curvature increases during periods of growth, such as adolescence.

Back 11

Scoliosis

Front 12

Lordosis or Scoliosis

-3 types:

Back 12

Scoliosis

Front 13

Lordosis or Scoliosis


A) congenital - which occurs during embryonic development (ex: wedge vertebrae, fused ribs or vertebrae)

Back 13

Scoliosis

Front 14

Lordosis or Scoliosis


B) Neuromuscular which results from a neuromuscular condition in childhood or adult hood, such as cerebral palsy or spinal cord tumors (develops several months after asymmetrical paralysis of the drunk muscles from polio, cerebral palsy, or muscular dystrophy)

Back 14

Scoliosis

Front 15

Lordosis or Scoliosis

C)idiopathic is the most common form and the cause is unknown

Back 15

Scoliosis

Front 16

Lordosis or Scoliosis


-2 types of classifications: structural, which follows some deviation of the spinal column…nonstructural results from a cause outside the spine itself, such as a leg discrepancy.

Back 16

Scoliosis

Front 17

How to assess these areas (Lordosis and Scoliosis)

-observe the patient how?

Back 17

from the front and back while standing and during forward flexion from the hips

Front 18

How to assess these areas (Lordosis and Scoliosis)

Physical examination reveals

Back 18

asymmetry (uneven) hip and shoulder height,

prominence of the thoracic ribs (rib hump) and scapula on one side,



and the visible curve in the spinal column.

Front 19

How to assess these areas (Lordosis and Scoliosis)

Inspect and palpate each vertebrae of the spine in the neck down. Mark each vertebrae with a pen to assess for curve

true or false

Back 19

true

Front 20

How to assess Scoliosis
Scoliosis-


ask the patient to flex forward from the hips and inspect for

Back 20

a lateral curve in the spine (you should expect a straight vertical spine while standing and also while bending forward.


posterior ribs should be symmetric with equal elevation of shoulders, scapulae, and iliac crests.

Front 21

Lordosis or Scoliosis

is just about lumbar region

Back 21

Lordosis

Front 22

Lordosis or Scoliosis

entire spinal column being affected

Back 22

Scoliosis

Front 23

herniated disc

sign and symptoms

Back 23

pain and stiffness in the neck and top of the shoulders scapula upper extremities and head.

Paresthesias (numbness and tingling) may be felt because spinal nerves have both motor and sensory fibers.

Front 24

herniated disc

-Diagnosis:

Back 24

MRI

Front 25

herniated disc
-in a lumbar herniation a person will complain of what s/s?

Back 25

muscle weakness,

sensory loss and alteration of tendon reflexes.

causes low back pain and muscle spasms with radiation of pain down 1 leg or hip.

Front 26

herniated disc
-in a lumbar herniation


pain is aggravated by?

Back 26

bending, lifting, sneezing, or coughing.

Front 27

herniated disc
-in a lumbar herniation

occurs at what interspaces?

Back 27

normally occurs at L4 – L5 or L1 – S1 interspaces

Front 28

-Herniated disc is AKA:




they most often occur between which vertebrae

Back 28

herniated nucleus pulposus (HNP)













that most often occur between the 4th and 5th lumbar vertebrae (L4-L5)

Front 29

-herniated disc: nucleus of the disk protrudes into the annulus (ring-shaped structure) causing nerve compression

Back 29

true

Front 30

-cervical disk herniation occurs where?




what s/s do they feel

Back 30

in the neck at C5-C6 or C6-C7 interspaces


pain and stiffness in neck and top of shoulders, scapula, upper extremities, and head. paraesthesis and numbness of upper extremity.

Front 31

-herniated disk: is a bulging in the lumbosacral area that can press on the adjacent spinal nerve (usually sciatic nerve), causing what

Back 31

severe burning or stabbing pain down into the leg or foot.

Front 32

herniated disk:

-the HNP may press on the spinal cord itself, leg weakness and what other 2 organ dysfunctions?

Back 32

bowel and bladder dysfunction











(sacral spinal nerves are part of the reflex system for the bowel and bladder, they also contain parasympathetic nerve fibers, which help control bowel and bladder function)

Front 33

herniated disk occurs when what happens?

Back 33

when all or part of the nucleus pulposus (the soft, gelatinous, central portion of an intervertebral disk) forces through the weakened or torn annulus fibrosus (outer ring) which compresses the nerve root











(p. 710 med surge nursing made incredibly easy book)

Front 34

S/S of nerve impingement

Back 34

Pain,

sensory loss, or impairment,

motor loss or impairment,


sphincter disturbance (bladder before bowel)

Front 35

S/S of nerve impingement

-The extruded disk may impinge on spinal nerve roots as they exit from the spinal canal or on the spinal cord itself, resulting in back pain and other signs of nerve root irritation.

Back 35

..

Front 36

S/S of nerve impingement

Back 36

-tingling, numbness, burning, shooting down the buttocks and legs or in the neck, shoulders, arms, and fingers
-some pain is referred. pinched nerve in lower back may be felt in calf

Front 37

What do dermatomes represent?

Back 37

sensory input from spinal nerves to specific areas of the skin

Front 38

Dermatomes
-area controlled by what?

Back 38

Area controlled by each spinal nerve

Front 39

how do dermatomes help a nurse?

Back 39

. Allows nurse to determine which nerve is being compressed. A dermatome is the area of skin supplied by nerves originating from a single spinal nerve root. assist in finding the location of disk herniation and nerve impingement

Front 40

Surgery for back

-Laminectomy involves removal of what?

Back 40

part of the laminae and facet joints too obtain access to the disk space and decompress the nerve roots.

Front 41

Surgery for back

-when the surgeon removes one or more of the bony laminae that cover the vertebrae is called what?

Back 41

-Laminectomy

Front 42

Back surgery

-Laminectomy (2 main uses)

Back 42

torelieve pressure on the spinal cord or spinal nerve roots resulting from a herniated disk ,


and





to treat compression fracture or dislocation of vertebrae or a spinal cord tumor

Front 43

Surgery for neck

fusion of the vertebrae with a bone graft if the spine is unstable.

Back 43

cervical fusion

Front 44

Surgery for neck

-when repeated laminectomies are performed or if the spine is unstable, the surgeon may perform what to stabilize the affected area.

Back 44

a spinal fusion (arthrodesis)

Front 45

Surgery for neck
spinal fusion (arthrodesis)

what happens in this procedure?

Back 45

. chips of bone are removed, typically from the iliac crest or obtained from a donor bone and are grafted between the vertebrae for support and to strengthen the back. metal implants (usually pins, screws, plates, or rods) may be required to ensure the fusion of the spine.

Front 46

Potential complications of neck and back surgery

- minor ones:

Back 46

hoarseness, temporary dysphagia (usually not serious), initiate bowel program, braces

Front 47

Potential complications of neck and back surgery

- major ones:

Back 47

CSF leakage,
fluid volume deficit,
paralytic ileus,
acute urinary retention,
fat embolism syndrome,

persistent or progressive lumbar radiculopathy (nerve root pain) ,

infection (wound, diskitis, hematoma)

Front 48

Diabetes Insipidus

-specific gravitiy


-osmolarity

Back 48

-low specific gravitiy 1.005











-low osmolarity between 50-200 (tissue are dehydrating, taking water intracellular volume) based on blood volume.

Front 49

Diabetes Insipidus

encourage pt to drink fluids equal to that of urine output


true or false

Back 49

true

Front 50

Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)


What is the complication associated with this disease?

Back 50

delusion

hyponatremia,

hyperkalemia (cardiac issues)


increase in plasma fluid increases the glomular filtration rate, which inhibits the release of rennin and aldosterone leading to grater hyponatremia

Front 51

Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)


heat or cold intolerance

Back 51

heat --always hot

Front 52

Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)

sodium level is less than

Back 52

-sodium less than 115

Front 53

Wet to dry dressings why are they done

a dressing technique used to treat a dirty wound or to prevent build-up of exudate on a wound.


how do you perform this dressing?

Back 53

Apply a saline moistened (damp not soaking wet) gauze pad to the wound and then cover this with a dry gauze pad. The reason it is called a “wet to dry dressing” is that the moist gauze directly on the wound is allowed to dry out. When this bottom layer of gauze is removed, it pulls off the exudate, debris, and non-viable tissue which have become stuck to the gauze.

Front 54

continuous wet gauze:

Back 54

the wound surface is continually bathed with a wetting agent of choice, promoting dilution of viscous exudates and softening of dry eschar

Front 55

Conscious sedation

what reflexes remain intact?

Back 55

defensive reflexes remain intact (gag and swallow reflexes)

Front 56

Conscious sedation

what route??


what drugs are used??

Back 56

IV delivery of sedative, hypnotic, and opioid drugs

• Diazepam (Valium) , midazolam (huge amnesia component), meperidine, fentanyl, alfentanil, and morphine sulfate are the most commonly used drugs.

Front 57

Conscious sedation


-these drugs do what???

Back 57

reduces the level of consciousness but allows the client to maintain a patent airway and to respond to verbal commands.

Front 58

Conscious sedation


what 2 monitors is the patient connected too?

Back 58

-on cardiac monitor, and oxygen, monitor, nurse never leaves them

Front 59

Conscious sedation

Nursing assessment of what??



how often????

Back 59

of airway,

level of consciousness,

oxygen saturation,

electrocardiographic status,

vital signs are monitored






















every 15 to 30 minutes.

Front 60

furosemide

Back 60

Lasix

Hint 60

loop diuretic

Front 61

Diabetes


greatest risk for hypoglycemia is when?

Back 61

peak

Front 62

Myxedema
-results from what?

Back 62

hypothyroidism

Front 63

Myxedema

Low metabolic rate causes what to happen?

Back 63

the cellular energy to be decreased and metabolites build up inside the cells,


which increases the mucous and water, forms CELLULAR edema, and changes organ texture.


The edema is mucinous (called myxedema). This edema changes the pts appearance, nonpitting edema forms everywhere.

Front 64

Myxedema

The edema is mucinous (called myxedema). This edema changes the pts appearance, what forms everywhere.

Back 64

nonpitting edema

Front 65

-Myxedema coma is a rate, but serious complication of untreated or poorly treated _____________

Back 65

hypothyroidism

Front 66

Myxedema coma

The decreased metabolism causes the heart to become what?

Back 66

flabby and the result is decreased CO, perfusion to the brain and other vital organs.

Front 67

omeprazole

Back 67

Prilosec

Hint 67

proton pump inhibitor

Front 68

Primary lesions

flat lesions of less than 1 cm in diameter. their color is different from that of the surrounding skin --most often red, brown, or white

Back 68

maculues

Front 69

Primary lesions

examples are freckles, moles, or rubella

Back 69

macule

Front 70

Primary lesions

macules that are larger than 1 cm in diameter. they may or may not have some surface changes - either slight scale or fine wrinkles

Back 70

patches

Front 71

Primary lesions

examples are vitiligo of cafe au tait spots

Back 71

patch

Front 72

Primary lesions

are small, firm, elevated lesions less than 1 cm in diameter

Back 72

papules

Front 73

Primary lesions

examples are warts or elevated moles

Back 73

papules

Front 74

Primary lesions

elevated, plateau like patches more than 1 cm in diameter that do not extend into the lower skin layers

Back 74

plaques

Front 75

Primary lesions

examples are psoriasis or seborrheic keratosis

Back 75

plaques

Front 76

Primary lesions

elevated, marble like lesions more than 1 cm wide and deep

Back 76

nodules

Front 77

Primary lesions

examples are lipomas

Back 77

nodules

Front 78

Primary lesions

nodules filled with either liquid or semisolid material that can be expressed

Back 78

cysts

Front 79

Primary lesions

examples are sebaceous cyst

Back 79

cysts

Front 80

Primary lesions

-blisters filled with clear liquid. less than 1 cm in diamter

Back 80

vesicles

Front 81

Primary lesions

exampels are acute dermatitis

Back 81

vesciles

Front 82

Primary lesions

-blisters filled with clear liquid.
more than 1 cm in diameter

Back 82

bullae

Front 83

Primary lesions

vesicles filled with cloudy or purulent fluid

Back 83

pustules

Front 84

Primary lesions

examples are acne and acute impetigo

Back 84

pustules

Front 85

Primary lesions

elevated irregularly shaped, transicent areas of dermal edema

Back 85

wheals

Front 86

Primary lesions

examples are uticaria and insect bites

Back 86

wheals

Front 87

Primary lesions

wider than fissures but involve only the epidermis

Back 87

erosions

Front 88

Primary lesions

they are often associated with vesicles, bullae, or pustules

Back 88

erosions

Front 89

Primary lesions

example is varicella

Back 89

erosions

Front 90

Secondary lesions

are visibily thickened stratum corneum. they appear dry and are usually whitish. they are seen moost often with papules and plaques

Back 90

scales

Front 91

Secondary lesions

example is psoriasis

Back 91

scales

Front 92

Secondary lesions

deep erosions that extend beneath the epidermis and involve the dermis and sometimes the SQ fat

Back 92

ulcers

Front 93

Secondary lesions

example is pressure sores

Back 93

ulcers

Front 94

Secondary lesions

are palpably thickened areas of epidermis with accentuated skin markings.

Back 94

lichenifications

Front 95

Secondary lesions

caused by chronic rubbing and scratching

Back 95

linchenifications

Front 96

Secondary lesions

caused by chronic rubbing and scratching

Back 96

linchenifications

Front 97

Secondary lesions

example is chronic dermatitis

Back 97

linchenifications

Front 98

Secondary lesions

are composed of dried serum or pus on the surface of the skin beneath which liquid debris may accumulate.

Back 98

crusts and oozing

Front 99

Secondary lesions

result from broken vesicles, bullae, or pustules

Back 99

crusts and oozing

Front 100

Secondary lesions

linear cracks in the epidermis, which often extend into the dermis

Back 100

fissures

Front 101

Secondary lesions

examples are eczema and late stage impetigo

Back 101

crusts and oozing

Front 102

Secondary lesions

athletes foot

Back 102

fissures

Front 103

Secondary lesions

characterized by thinning of the skin surface with loss of skin markings

Back 103

atrophy

Front 104

Secondary lesions

the skin is translucent and paper like.

Back 104

atrophy

Front 105

Secondary lesions

if involvign the dermal layer results in skin depression

Back 105

atrophy

Front 106

Secondary lesions

examples are striae and aged skin

Back 106

atrophy

Front 107

cysts
-what are they?

Back 107

flesh colored nodules that contain liquid or semisolid fluid

Front 108

cysts
-tell me about palpation?

Back 108

they can be moved and manipulated on palpation

Front 109

what is the difference between cysts and nodules

Back 109

nodules are firm

cysts are soft and can be moved