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60 Cards in this Set
- Front
- Back
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Protrusion of the stomach into the mediastinal cavity through esophageal hiatus (opening) of the diaphragm into the chest.
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Hiatal Hernia
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Prevalence of Hiatal Hernias most often occurs in...
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Women
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Hiatal Hernias may become_____ (stuck or fitted in herniated position) or ______ (cut off blood supply).
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Incarcerated, strangulated
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The herniated stomach portion in hiatal hernia in large hernias can affect...
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Heart and lung functions maybe compromised R/T increased pressure.
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What are the two types of Hiatal Hernias?
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Sliding (aka axial) or paraesophageal
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Type of Hiatal Hernia when increased stomach and GER junction are displaced upward and slide in and out of thorax...
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Sliding Hiatal Hernia (AKA axial)
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Type of Hernia when there is a protrusion of hernial sac containing the intestines and the inguinal opening.
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Inguinal Hernia
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Type of Hiatal Hernia which is less frequent and is when all or part of the stomach is pushed through the diaphragm next to the GER herniation.
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Paresophagel Hernia
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Casued be weakened abdominal muscles by a congenital defect, malformation, traumatic injury, intraabdominal pressure, exertion, obesity and straining.
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Inguinal Hernia
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When is a congenital inguinal hernia usually noted??
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In the 7th month gestation when the peritoneal sac descends before the the testicle.
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What are the two types of inguinal hernias?
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Direct and indirect
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sac protrudes through the internal inguinal ring into the inguinal canal often descending into the scrotum.
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Indirect Inguinal Hernia
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Hernial sac protrudes through muscles in the region of the rectus abdominus muscle and inguinal ligament. Accounts for 80% of all hernias.
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Direct Inguinal Hernia
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An irreducible hernia in which the intestinal flow is completely obstructed
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Incarcerated
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An irreducible hernia where blood flow and intestinal flow are completely obstructed
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Strangulated
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A hernia where the protruding mass can be placed back into the abdominal cavity , has blood and intestinal flow.
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reducible
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Developes when the loop of the intestine in the sac becomes twisted or swollen and a constricion is produced at the neck of the sac in a hernia.
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Strangulated
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The protruding hernia cannot be placed back into the abdomen, but has intestinal and blood flow.
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Irreducible
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Dx eval of a hernia would include:
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Abdominal Xray that would show increased gas in the intestine, increased hematocrit
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What would the WBCs show of an incarcerated hernia?
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an increase
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Tx for hernia...
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Mechanical or surgical
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What are the two types of surgeries done to repair a hernia?
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Herniorrhapy or Hernioplasty
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Removal of hernia sac and abdominal contents put back in and sutured..
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Herniorrapy
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In hernias, reinforcement of sutures with mesh for more extensive repairs
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Hernioplasty
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What type of surgery would be done for an ischemic bowel?
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Resection of the ishcemic bowel and hernia repair.
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Amputation is a surgical intervention commonly used in the tx of advanced
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PVD
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What is the underlying pathology that results in Peripheral Vascular Disease and amputation in more than 50% of patients?
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Diabetes
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What are other pathologies than diabetes that result in PVD and amputation in more than 50% of patients?
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Chronic arterial occlusive disease, birth defects and malignancies
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What is the sequence of events which leads to amputation??
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An injury or occurance that blocks blood flow leading to chronic tissue ischemia that results in necrosis and then gangrene.
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What type of gangrene is associated with diabetics?
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Dry
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Moist gangrene is more common when...
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After limb trauma when the limb is filled with blood and infectious materials
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When the bone is cut approximately 2 inches less than the skin flap, to create a stump for weight bearing, the incision and sutures are placed posteriorly to prevent irritation with prosthesis and drains are placed in the incision for the removal of waste and blood.
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Closed amputation
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The bone and muscle are cut at the same level, the wound is left opeded to drain after which a second procedure would be done to close the wound would be done.
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Open amputation
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Pre op dx testing for amputation would include:
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Doppler ultrsound, Thermography, radioisotope clearance and arterogrram to assess circulation.
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Pre op teaching of an amputation would include what?
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Physical therapy consult, teaching about transfer techniques, safe use of crutches, over the bed trapeze, assessment of support systems and coping skills related to loss of limb, pain management, discharge planning with eval. of home, prosthesis fitting schedule.
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Monitoring for post-op amputee complications would include:
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V.S until stable, assess wound and drainage systems every two hours, surgical tourniquet at bedside for hemmorrhage, stump dressing is usually not disturbed for 2-3 days. I&O, deep breathing cough and turning exercises.
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Type of drainage expected after amputation would be...
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Serosanguinous, call MD if bright red.
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What are the classic sx. of hemorrhage and shock?
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Tachycardia and hypotension
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Position of the stump 24 hours after amputation?
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Elevated
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After the first 24 hours the stump is supported and not elevated, why?
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To prevent contractures
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Position changes for an amputee are made how often?
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every 2 hours
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If delayed prosthesis fitting is the plan what is the care of the stump??
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Wrap stump snuggly in dressing and ace wraps to provide compression and minimize pain. A compression bandage is worn at all times except for care and a shrinker bandage is applied at least once daily.
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What should not be applied to the stump after amputation?
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Lotions, oils or powders
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The goal of stump care is to...
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Achieve a well healed and appropriate shaped stump whose surface skin is tough enough to absorb the pressure of weight bearing with a prosthesis.
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Therapeutic interventions for skin ulcers are...
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Air-fluidized beds, low air loss beds, kinetic beds, administration of protein supplements or TPN to prevent a negative nitrogen balance. Administration of vitamin and mineral supplements to promote wound healing, particularly vitamin C and Zinc. Debridement of necrotic tissue which interferes with healing and promotes bacterial growth, mechanical irrigation, chemical debridement with enzyme preparations, surgical debridement wet to damp.
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Dressing that maintains wound humidity that promotes epithelial cell growth
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Moist gauze
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Dressing that absorbs drainage
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Absorption dressing
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Dressing that provides a barrier to bacteria and external fluid: promotes a moist environment and permits viewing of the wound.
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Polyurethane dressing
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Maintains wound humidity, liquifys necrotic debris, provides a protective cushion...
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Hydrocolloid dressing
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Dressings that promote wound healing...
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Moist gauze, Absortion dressing, Polyurethane dressing, and Hydrocolloid drsg.
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Assessment for the source of poisoning would include:
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Intense monitoring of V.S and L.O.C, maintain open airway, blood, gastric contents and urine tests for toxicology, fluid and lyte balance.
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Medical management for poisoning includes:
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large bore IV, O2 for respiratory depression, shock prevention, prevention of aspiration of gastric contents, F/C to monitor renal functions.
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preventing further injury after poisoning by absorption would include:
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Administration of inactivated charcoal with a catharctic, induce emesis with ipecac, gastric lavage, hemoperfusion, forced diuresis, hemodialysis.
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How is ipecac given?
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Given with warm water until vomiting occurs
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Do not use Ipecac if what is suspected?
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Corrosive poisoning
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If a corrosive poisoning is suspected, what anecdote is used?
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Milk, M.O.M, activated charcoal or chelating agents
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Nursing measurements for poisoning includes:
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Monitoring V.S, fluid I&O, LOC
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What position should you put a pt in with a recent poisoning?
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On side with head down. Have suction and oropharyngeal airway ready.
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What is the toxic dose of Aceteminophen?
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150 mg/kg of body weight per day
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Clinical findings of Aceteminophen poisoning include:
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N&V, profuse diaphoresis, decreased urine output
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