Nur 145 Final Exam

Front 1

Preoperatice phase includes?

Back 1

begins, when decision for surgery is made and ends when patient is in the OR
Pre-admission testing (PAT)
Admission to surgical cente
rIn holding area
Pre-op assessment – done before surgery, usually the pt will see the anesthesiologist and a nurse. The surgeon will mark the patient prior to the surgery.

Front 2

Preoperatice phase includes?

Back 2

begins, when decision for surgery is made and ends when patient is in the OR

Pre-admission testing (PAT)

Admission to surgical cente

rIn holding area

Pre-op assessment – done before surgery, usually the pt will see the anesthesiologist and a nurse. The surgeon will mark the patient prior to the surgery.

Front 3

Intraoperative Phase includes?

Back 3

begins when the patient is transferred to the OR and ends when patient is in PACU

Nurses act as scrub nurse, circulating nurse or RN first assist

Maintain safety

physiologic monitoring

psychological support while patient is conscious

Front 4

Postoperative phase includes?

Back 4

Begins in PACU ends with follow up evaluation

Transfer patient to PACU

Post op assessment in recovery area

surgical nursing unit

home or clinic

Front 5

What is emergent surgery?

Back 5

needs to be done immediately to prevent serious injury or death

Front 6

What is Urgent Surgery?

Back 6

Surgery needs to be done within 24 hours

Front 7

What is required surgery?

Back 7

Needs to be done within a few weeks or months

Front 8

What is elective surgery?

Back 8

Patient should have surgery, however not doing it would not be catastrophic

Front 9

What is optional surgery?

Back 9

Decision rests with the patient

Front 10

What is diagnostic Surgery

Back 10

exploratory to determine cause of the problem

Front 11

What is curative surgery?

Back 11

removal of problem surgically

Front 12

Reparative surgery?

Back 12

Fixing a wound

Front 13

Palliative Surgery?

Back 13

relieves pain

Front 14

Reconstructive/ Cosmetic Surgery?

Back 14

Repair External Appearance

Front 15

What is inpatient surgery?

Back 15

Patient needs to remain overnight or longer for surgery

Front 16

Ambulatory Surgery?

Back 16

outpatient same-day surgery

Front 17

Nutritional Risk factors for surgery?

Back 17

obesity, weight loss, malnutrition, metabolic abnormalities, supplements taken,

Electrolytes.

Protein to heal

Allergies***shelfish - including shrimp may be allergic to iodine or contrast

Front 18

Dentition- Surgical Risk Factors

Back 18

Dental Caries, loose teeth, partial plates are significant because they may become dislodged during intubation and occlude airway.

Any infection..even in the mouth... can be a source of a post operative infection

Front 19

ETOH surgery risk factors?

Back 19

even moderate amounts of alcohol can weaken the immune system and increase the likelihood of developing post op infections

can impede effectiveness of medications and anesthesia

withdrawal syndrome 2-4 days

Front 20

Respiratory surgery risk factors?

Back 20

educate patient in breathing exercises and use of incentive spirometer

educate about no smoking

ALL resp related issues are significant

Front 21

CV surgery risk factors?

Back 21

Ensure that cardio system can support O2 fluid and nutritional needs

Hx of arrhythmias HTN, heart surgeries, cardio drugs taken

EKG

if taken beta blockers may be allowed to take with a sip of water before surgery if Dr permits

Front 22

hepatic and renal risk factors

Back 22

liver metabolizes, kidneys excrete

optimal function of the liver and urinary system

ALT/AST

Impairment increases mortality rate

Front 23

Endocine surgical risk factors

Back 23

pt with diabetes is at risk for hypo and hyperglycemia

stress from surgery can cause an increase in blood glucose

surgical risk factors for a person with controlled diabetes is no greater than a patient without diabetes

hyperglycemia increaes the risk for infection

Front 24

what is the nurses responsibility for a consent form?

Back 24

The nurses responsibility is to be a WITNESS

Front 25

Purpose of Opiods for Surgery?

Back 25

Pain relief, relaxation

Nursing considerations: Respiratory depression, decreased LOC and BP, at risk for falls and constipation

Morphine - prototype

Front 26

Purpose of benzodiazepines for Surgery?

Back 26

Relieve Anxiety, cause Amnesia effect, east the anesthesia that is necessary

Nursing Considerations: Decreased LOC and BP, at risk for falls and respiratory depression along with blurred vision

midazolam (Versed)

**Versed - forget what they said**

Front 27

Purpose for antiemetics with surgery?

Back 27

prevent N/V r/t anesthesia to prevent aspiration

Nursing Considerations: light sensitivity, constipation, and drowsiness

prochloprazine and metoclopramide

Front 28

Purpose for H2 Receptor Antagonists with Surgery?

Back 28

Decreases stomach acid, lacrimation, urination and defectation

No special considerations

climetidine

Front 29

Purpose of Anticholinergics and Antihistamines

Back 29

decreases secretions

Nursing Considerations: Dry Mouth and dilated pupils

glycopyrolate hydralazine

Front 30

Elements of a safe time out

Back 30

Correct patient- 2 identifiers

Correct site - marked prior to coming to the OR by patient and surgeon

Allergies

Antibiotics administeres

Equipment and supplies available

Xrays available and labeled and labs checked

everyone is in agreement

Front 31

Potential Intraoperative complications?

Back 31

Anesthesia Awareness, N/V, Anaphylaxis, Latex Allergy, Hypoxia, Hypothermia, Malignant Hyperthermia

Front 32

Effects of General Anesthesia

Back 32

not arousable, even to painful stimuli

lose the ability to maintain a patent airway

CV function may be impaired as well

Drugs are inhaled or given IV

Larger amount are given at first to saturate tisues then less is given to maintain

inhaled drugs are miced with 02 nitrous

Front 33

Stage 1 of General Anesthesia

Back 33

beginning - breath in drugs, warmth, detachment felt, may hear ringing in ears, loss of motor control, sounds are amplified.

Front 34

Stage 2 of General Anesthesia

Back 34

Excitement - patient struggles, sings, shouts, talks, cries, can be avoided if drugs are given quickly and smoothly.

Front 35

Stage 3 of General Anesthesia

Back 35

surgical anesthesia: reached by continued use of vapor/gas. Pupils are small and contract in light, respirations are normal, pulse volume/rate are normal, skin is slightly flushed. With proper drug use this state can be maintained for hours at four ranges light (1) to deep (4)

Front 36

Stage 4 -of General Anesthesia

Back 36

medullary depression: happens if too much drug given, respirations shallow, pulse weak/thready, pupils dilated with no response to light, cyanosis occurs and death can rapidly occur. Drugs must be stopped and respiratory and circulatory support is begun.

Front 37

Regional Anesthesia

Back 37

patient awake and aware unless given a sedative. Drug injected around nerves so the area is anesthetized blocking sensory nerves more readily than motor nerves (they have thicker myelin). It is not worn off until all three systems are back to normal

Front 38

Epidural anesthesia

Back 38

drug given in epidural space around the dura mater (L4-L5) a higher dose required than with spinal anesthesia because the it has to cross the dura mater, but has the advantage of not causing a headache (common to spinal)

Front 39

Spinal anesthesia

Back 39

nerve block given in subarachnoid space between L4-L5 used for lower limb procedures. Patient lies on side with knees to chest. Continuous sedation can be achieved by inserting a catheter. Body elevation is changed to get the drug to flow to desired location (depending on specific gravity of drug). If patient gets too much, respiratory paralysis can occur. Headache, nausea, vomiting may occur; try to control with proper hydration/IV fluid; flat bed, quiet room.

Front 40

Local conduction block/nerve block

Back 40

injection into a nerve plexus to achieve localized anesthesia.

Front 41

Moderate sedation

Back 41

conscious sedation. Patient is never left alone and monitored for dysrhythmias, LOC, and vitals

Front 42

Local anesthesia/infiltration

Back 42

injection into tissue of procedure site. Often combined with regional block. Often given with epinephrine (vasoconstriction) prolonging action. Preferred method but not used with anxiety, or if many injections would be needed

Front 43

Primary Intention

Back 43

clean wound, edges well approximated, minimal tissue trauma, clean sutured or stapled surgical incision, granulation tissue is not visible, and a hairline scar forms, usually covered with a dry dressing or liquiband

Front 44

Secondary Intention

Back 44

typically dirtier, edges not well approximated; larger with more tissue damage, takes longer to heal, larger scar forms, usually packed with a moist dressing, then covered with dry dressing, wounds from major trauma or burns, may leave open to heal; increased risk for infection

Front 45

Tertiary Intention

Back 45

healing that occurs when there is a delay in wound closure; may happen when a deep wound is not sutured immediately or is purposely left open until there is no sign of infection and then closed with sutures; has increased risk for infection

Front 46

Serous Drainage

Back 46

Clear

Front 47

Sanguineous

Back 47

Bloody Drainage

Front 48

Sero-Sanguineous

Back 48

Blood-tinged

Front 49

Purulent Drainage

Back 49

White, Gray, baige, green, infected

Front 50

S&S of infection

Back 50

New/increased slough; maceration

Drainage excess or change in character

Poor granulation tissue

Warmth, redness, swelling, pain (inflammation)

Elevated glucose

Odor

Increased sizeCheck COCA

(color, odor, consistency, amount)

Front 51

Desirable amount of fluid intake and ouput in adults

Back 51

1500-3500 mL's in 24 hours

Front 52

Average Amount of fluid intake and output in adults

Back 52

2500-2600 every 25 hours

Front 53

Fluid Volume Deficit

Back 53

An abnormal decrease in the volume of blood plasma

Excessive water and solutes are lost in the same porportion from the ECF

Thirst; weight loss over short period; weakness; fatigue; anorexia; dry mucous membranes; poor skin and tongue turgor; sunken eyes; flat neck veins; urine output <30 mL/hr; postural hypotension; weak/rapid pulse;­↑SG,­↑ ­Hct,­↑ ­BUN, ­↑­serum Na+

Front 54

Fluid Volume Excess

Back 54

An abnormal increase in the volume of blood plasma

Weight gain over short period; peripheral edema (may be pitting); ­BP, shortness of breath, crackles/ wheezes in lungs; full/bounding pulse; NVD; polyuria; ascites; pleural effusion; pulmonary edema; ↓BUN, ↓Hct, ↓serum Na+, ↓SG

Front 55

Hyponatremia

Back 55

Anorexia; nausea/vomiting; lethargy, confusion/altered mental status; muscle cramps; muscular twitching seizures, coma, SG < 1.010

Front 56

Hypernatremia

Back 56

Thirst; ­↑ temp; tongue dry, swollen; sticky mucous membranes; severe: disorientation, hallucinations, lethargy, irritable, hyperactive, seizures, coma; SG > 1.015

Front 57

Hypokalemia

Back 57

Fatigue; anorexia; nausea; vomiting; muscle weakness; weakened RR (auscultate lungs) ; decreased bowel motility; cardiac arrhythmias (prolonged PR interval & wide QRS complex, peaked T waves, absent P waves); ­ ↑sensitivity to digitalis; polyuria; nocturia; dilute urine; postural/orthostatic hypotension; ECG changes; paresthesias; tender muscles; leg cramp

Front 58

Hyperkalemia

Back 58

Vague muscle weakness/ reduced muscle strength; cardiac arrhythmias; paresthesias of face, tongue, feet, and hands; flaccid muscle paralysis; GI distress

Front 59

Hypocalcemia

Back 59

Trousseau’s and Chvostek’s signs; numbness & tingling of fingers & toes; mental changes; seizures; spasm of laryngeal muscles; ECG/cardiac rhythm changes: brady/tachy; cramps in muscle extremities

Front 60

Hypercalcemia

Back 60

Muscular weakness; tiredness; lethargy; constipation; anorexia, nausea/vomiting; ↓ memory & attention span; polyuria & polydipsia; renal stones; neurotic behavior; cardiac arrest

Front 61

Hypomagnesemia

Back 61

Neuromuscular irritability ­ (↑reflexes, coarse tremors, seizures); tachyarrhythmias; ­ ↑susceptibility to digoxin toxicity; disorientation, mood changes; ↑DTR; muscle cramps; numbness; tingling; resp paralysis

Front 62

Hypermagnesemia

Back 62

Flushing; warm skin; ↓ BP; depressed respirations; drowsiness; hypoactive reflexes; muscular weakness; cardiac abnormalities;↓ DTRs

Front 63

Hypophosphatemia

Back 63

Flushing; warm skin; ↓ BP; depressed respirations; drowsiness; hypoactive reflexes; muscular weakness; cardiac abnormalities;↓ DTRs

Front 64

Hypophosphatemia

Back 64

Cardiomyopathy;↓ acute resp failure; seizures; tissue oxygenation; joint stiffness; slow peripheral pulses-->cardiac muscle damage

Front 65

Hyperphosphatemia

Back 65

Short-term: tetany, tingling of fingertips, mouth, numbness, muscle spasmsLong-term: precipitation of calcium phosphate in nonosseous sites

Front 66

Hypochloremia

Back 66

Hyperexcitability of muscles; tetany; hyperactive DTRs; weakness; muscle cramps

Front 67

Hyperchloremia

Back 67

Tachypnea; weakness; lethargy; diminished cognitive ability; hypertension;↓ cardiac output; dysrhythmias; coma

Front 68

Erythropoiesis

Back 68

Production of RBC in the myeloid tissue of the bone marrow Stimulated by erythropoietin (hormone produced by the kidneys)The liver detects when O2 levels are low and releases more hormones (anemia, or if you are in high elevation) Iron, Vitamin B12, and Folate deficiencies are called anemiasAverage life for a RBC is 120 days, then they are lysed in the liver, spleen, or bone marrow

Front 69

Iron deficiency

Back 69

A decrease in RBCs due to a lack of iron available because of high demand( menstruation, GI bleeding), poor diet, or poor absorption

Front 70

Folic acid deficiency

Back 70

A decrease in RBCs due to a lack of folic acid (folate/B vitamin). Occurs in malabsorption states, alcoholism, pregnancy, some medications

Front 71

B12 deficiency

Back 71

A decrease in RBCs due to a lack of vitamin B12, commonly caused by the inability of the GI tract to absorb needed amounts of B12 or strict vegetarian diet

Front 72

Pernicious anemia

Back 72

A decrease in RBCs due to a lack of intrinsic factor produced by the gastric mucosa, therefore vitamin B12 cannot be absorbed

Front 73

Misc. anemias

Back 73

A decrease in RBCs due to low erythropoietin levels (renal failure, hemodialysis), or medications (post op pt, chemotherapy); note: sickle cell anemia was not discusse

Front 74

Multiple Myeloma

Back 74

*MM is the second most common hematologic cancer in the US*Median 5-year survival rate for newly-diagnosed patients is 39%

C- calcium (hypercalcemia)R- renal insufficiencyA- anemiaB- bone lesions

Front 75

Non-Hodgkin Lymphoma

Back 75

*NHL is the 7th most common type of cancer diagnosed in the US*Incidence rates have almost doubled in the past 35 yrs*The incidence increases with each decade of life*The average age at diagnosis is 65 yrs*Many lymphomas can be cured

Front 76

Acute Myeloid Leukemia

Back 76

*AML is the most common nonlymphocytic leukemia*Any age group can be affected, usually occurs after 55 yrs; average age is 67 yrs*The prognosis is highly variable; patients who are younger may survive for 5 years or more after the diagnosis—less for older people

Front 77

Chronic Lymphoid Leukemia

Back 77

*CLL is the most common malignancy in older adults; average age 72 yrs*Most common form of leukemia in the US & Europe*Vietnam vets who have been exposed to Agent Orange may be at risk*Most patients survive more than 20 yrs

Front 78

Acute Coronary Syndrome

Back 78

An umbrella classification encompassing clinical presentations ranging from unstable angina through myocardial infarctions.

Front 79

Hypertensive Emergency

Back 79

CrisisBP is severely elevatedand there is evidence of actual or probable target organ damagepotential target organ damageleft ventricular hypertrophymyocardial infarctionheart failuretransient ischemic attack (TIA)cerebrovascular accident (CVA, stroke, brain attack)renal insufficiency and failureretinal hemorrhage

Front 80

Hypertensive Urgency

Back 80

CrisisBP is severely elevatedbut there is no evidence of immediate or progressive target organ damageTreatmentpatient requires close monitoring of blood pressure and CV statusassess for potential evidence of target organ damageMedications:Fast acting oral agents:BB - labetalolACEI - captoprilAlpha₂-agonist - clonidine

Front 81

Coronary Atherosclerosis

Back 81

Atherosclerosis is the abnormal accumulation of lipid deposits and fibrous tissues within arterial walls and lumenBlockages and narrowing of the coronary vessels reduce blood flow to the myocardium.leading cause of death in the US

Front 82

CK-MB

Back 82

the concentration of the enzyme creatine phosphokinase in the myocardium, increases during MI

Front 83

Myoglobin

Back 83

an oxygen-binding protein found in skeletal and cardiac muscle cells, released into circulation after an injury

Front 84

Troponin T and I

Back 84

biochemical markers for cardiac diseases, increases during MI

Front 85

Brain Natriuretic Peptide

Back 85

a neurohormone secretion primarily in the cardiac ventricles and increases in response to volume expansion and pressure overload

Front 86

CRP

Back 86

C-reactive protein is produced in the liver in response to tissue injury and inflammation

Front 87

Homocysteine

Back 87

naturally occurring amino acids found in blood plasma in response to inflammation

Front 88

lipid profile

Back 88

cholesterol <200HDL female >60 male>50LDL <100 HD <70Triglycerides <150

Front 89

ECG

Back 89

12 leadContinuous monitoring, hardwire, telemetryCardiac stress testing - exercise (treadmill)Pharmacologic stress testing (nuclear stress test, isotope given to take a picture that makes the heart stand out)

Front 90

CAD Prevention

Back 90

Control cholesterolDietary measuresPhysical activityMedicationCessation of tobacco useManage HTNControl diabetes

Front 91

CAD Treatment:

Back 91

seeks to decrease myocardial oxygen demand and increase oxygen supplymedicationsoxygenreduced control risk factorsrefusion therapy may also be done

Front 92

Right Sided Heart Failure

Back 92

Viscera and peripheral congestion

JVD

Dependent Edema

Hepatomegaly

Ascites

Weight Gain

Front 93

Left Sided HF (Lungs)

Back 93

Pulmonary Congestion, crackles

S3 or Ventricular

Gallop

Dyspnea on exertion

Orthopnea

Dry, nonproductive cough initially

Oliguria

PND/paroxysmal nocturnal dysrhythmia

Front 94

ACEI

Back 94

*vasodilation*diuresis*decreases afterload*monitor for: hypotension, hyperkalemia, altered renal function*cough

Front 95

ARBS

Back 95

prescribed as an alternative to ACEI, but works similarly

Front 96

Hydralazine and Isorbide Dinitrate

Back 96

prescribed as an alternative to ACEI

Front 97

Beta-Blockers

Back 97

prescribed in addition to ACE inhibitors*may be several weeks before effects seen*use with caution in patients with asthma

Front 98

Diuretics

Back 98

Decrease fluid volume

monitor serum electrolytes

Front 99

Digitalis

Back 99

*improves heart contractility*monitor for digitalis toxicity especially if patient is hypokalemic*check digitalis and potassium levels

Front 100

Prevention and Management of VTE

Back 100

Elastic hose

Pneumatic compression devices

Subcutaneous heparin or LMWH,

warfarin for extended therapy

Positioning: periodic elevation of lower extremities

Exercises: active and passive limb exercises; deep breathing exercises

Early ambulation

Avoid sitting or standing for prolonged periods; walk 10 minutes every 1 to 2 hours.

Front 101

Tolazamide, Chlorpropamide, and Tolbutamide are what class of Drugs?

Back 101

First Generation Sulfonylureas

Front 102

glipizide, glyburide, and glimepiride are what class of drug?

Back 102

Second Generation Sulfonylureas

Front 103

Action of Sulfonylureas

Back 103

Stimulate the beta cells to secrete more insulin and improve insulin at the cellular level - Not Oral Insulin

Front 104

When is it recommended to take Sulfonylureas?

Back 104

with the first meal of the day

Front 105

repaglinide and nateglinide are what class of OHA?

Back 105

Meglitinides

Front 106

What is the action of Meglitinides?

Back 106

similiar to Sulfonylureas - increase insulin production

Front 107

acarbose and miglitol are what class of OHA?

Back 107

Alpha Glucosidase Inhibitors

Front 108

MOA for Alpha Glucosidase Inhibitors?

Back 108

"starch blockers" - taken with meals to decrease carbohydrate absorption in small intestine

Front 109

pioglitazone hydrochloride and rosiglitazone maleate are what form of OHA's?

Back 109

Thiazolidinediones

Front 110

MOA of Thiazolidinediones?

Back 110

Increase insulin sensitivity at target tissues*May improve lipid profiles and BP*

Front 111

metformin hydrochloride is what form of OHA?

Back 111

Biguanides

Front 112

MOA of Biguanides?

Back 112

Decrease glucose production by liver, augments glucose uptake particularly in muscles.

Front 113

sitagliptin phosphate, saxagliptin, linagliptin are what form of OHA's?

Back 113

Dpp-4 Inhibitors

Front 114

Dpp-4 Inhibitors MOA?

Back 114

Shows inactivation of incretine hormones

Front 115

MOA of Incretin hormone or GLP-1 Hormones?

Back 115

-Increase response to food-tell brain stomach is full-slow emptying of stomach-stimulate the pancreas to release insulin-decrease liver production of glucose.

Front 116

What is Osteoarthritis?

Back 116

NON SYSTEMIC - Degenerative disorder of joint cartilage and the underlying bone, results in pain and stiffness - LOCAL

Front 117

What is Rheumatoid Arthritis?

Back 117

an autoimmune, chronic, progressive, inflammatory disease that causes inflammation in the joints, resulting in painful deformity and immobility - SYSTEMIC DISEASE

Front 118

Joints involved in RA?

Back 118

Begins in the most distal joints:Finger, wrists, feet, progresses into the proximal and larger joints; knees, shoulders, hips, elbows, ankles, and spine.

Front 119

common symptoms & clinical manifestations of RA?

Back 119

Bilateral & Symmetric joint pain,Morning joint stiffness lasting longer than 1 hour,Pain, tenderness,Swelling, warmth, erythema,Lack of function,Spongy or boggy joint tissu,Deformity,Low-grade fever,Lymph node enlargement,Sensory changes,Fatigue,Anemia,Weight loss,Nodules form behind elbows,Raynaud’s Phenomenon

Front 120

Diagnostic Tests for RA?

Back 120

Antibodies to anti-CCP in 95% of patients*Rheumatoid factor in 80% of patients*ESR (erythrocyte sedimentation rate) increased ­ in acute phase*CRP (C-reactive protein) increased ­ in acute phase*RBCs and C4/CR4 compliment decreased*ANA (anti-nuclear antibody) results are positive*Arthrocentesis (aspiration of synovial joint fluid) reveals fluid that is cloudy, milky, yellow, ­ WBC*X-rays show body erosion and narrowed joint spaces (should be performed at baseline and every 3 years)

Front 121

Complications of RA?

Back 121

*Pain*Sleep disturbance*Fatigue/weakness*Altered mood*Limited mobility*Deformity/contractures*Depression*Autoimmune meds often mask infection (see Dr. ASAP if have fever and cold symptoms)

Front 122

Symptoms and Clinical Manifestations of OA?

Back 122

Unilateral & Asymmetric joint pain*Morning joint stiffness lasting less than 30 mins*Aggravated by movement or exercise and relieved by rest*Pain*Stiffness*Enlarged joint with decreased ROM*Functional impairmen

Front 123

Diagnostics of OA?

Back 123

*X-rays show a narrowing of the joint space, osteophytes formation, and dense thickened subchondral bone

Front 124

Complications of OA?

Back 124

*Quality and quantity of life are reduced, especially when obesity and OA are combined*Pain*Limited ROM*Sleep disturbance*Depression*Comorbidities

Front 125

Define Primary Osteoporosis?

Back 125

Occurs in women after menopausea decrease in calcitonindecrease in estrogen and increase in PTH

Front 126

Define Secondary Osteoporosis?

Back 126

result of medications or diseases that affect bone metabolismmore prominent in menexcessive corticosteroid useexcessive alcohol intake

Front 127

What is Osteoporosis?

Back 127

The word osteoporosis literally means "porous bones." It occurs when bones lose an excessive amount of their protein and mineral content, particularly calcium.Reduced bone massDeterioration of bone matrix and diminished architectural strength

Front 128

Nursing Interventions for Total Knee Replacement?

Back 128

Ice or cold packs may be applied to control edema and bleeding· Assess NV status (movement, sensation, color, pulse) of affected leg every 2 hours· Monitor for complicationso Avascular necrosiso Loosening of prosthesis (osteolysis)o Excessive wound drainage* monitor COCA* first 24 hours: 200-500mL* 48 hours: total drainage in 8 hours 30mL or lesso DVT/VTE/PE (mobilize early, SCDs, anticoagulants, TED hopes, isometric exercises, PT)o Infection (wash hands, sterile technique, monitor fever, monitor dressing, monitor drainage, remove catheter ASAP)* High risk: old age, obese, poorly nourished, smoke, corticosteroid use, diabetes, RA, concurrent infections, hematomaso Pressure ulcers (float heels, long posey boots, nutrition, pressure-relieving mattress)o Immobility (early ambulation, repositioning every 2 hours, PT)o Respiratory (incentive spirometer, deep-breathing, coughing, semi-fowler’s position)o GI (prevent constipation, diet, mobility, stool softeners)

Front 129

Nursing Interventions for Total Hip Replacement

Back 129

Monitor for complicationso Dislocation of hip prostheses (greatest risk first 8-12 weeks)* Prevention: cradle boot, abduction pillow, don’t turn on surgical side, never flex more than 90 degrees, do not adduct, do not cross* Symptoms: Pain at surgical site, swelling, acute groin pain, shortening of extremity, abnormal rotation, hip poppingo Heterotopic ossification (formation of bone in the periprosthetic space)o Avascular necrosiso Loosening of prosthesiso Excessive wound drainage* monitor COCA* first 24 hours: 200-500mL* 48 hours: total drainage in 8 hours 30mL or lesso DVT/VTE/PE (mobilize early, SCDs, anticoagulants, TED hopes, isometric exercises, PT)o Infection (wash hands, sterile technique, monitor fever, monitor dressing, monitor drainage, remove catheter ASAP)* High risk: old age, obese, poorly nourished, smoke, corticosteroid use, diabetes, RA, concurrent infections, hematomaso Pressure ulcers (float heels, long posey boots, nutrition, pressure-relieving mattress)o Immobility (early ambulation, repositioning every 2 hours, PT)o Respiratory (incentive spirometer, deep-breathing, coughing, semi-fowler’s position)o GI (prevent constipation, diet, mobility, stool softeners)

Front 130

Two types of hip fractures?

Back 130

Intracapsular--neck of femurExtracapsular--trochanter region

Front 131

What is Osteomyelitis?

Back 131

an infection of the bone that results in inflammation, necrosis, and formation of new bone

Front 132

What is a Strain?

Back 132

a pulled muscle or tendon. An injury caused by overuse, overstretching, or excessive stress. They are graded based on post-injury symptoms and loss of function and reflect the degree of injury

Front 133

Define First Degree Strain?

Back 133

mild stretching of the muscle or tendon.S&S – minor edema, tenderness, and mild muscle spasms.

Front 134

Define Second Degree Strain

Back 134

partial tearing of the muscle or tendon.S&S – loss of load-bearing strength with edema, tenderness, muscle spasm, and ecchymosis.

Front 135

Define Third Degree Strains?

Back 135

severe muscle or tendon stretching with rupturing and tearing of the involved tissue.S&S – significant pain, muscle spasm, ecchymosis, edema, loss of function. X-ray – should rule out bone injury and MRI – reveals third degree.

Front 136

Define Sprain?

Back 136

an injury to the ligaments and tendons that surround a joint caused by a twisting motion or hyperextension of a joint. Function of a ligament is to stabilize a joint while permitting mobility. A torn ligament causes joint to be unstable, blood vessels rupture causing edema, and joint tenderness so the movement becomes painful.

Front 137

First degree Sprain?

Back 137

stretching ligamentous fibers – minimal damage.S&S – edema, local tenderness, and pain when joint is moved.

Front 138

Second Degree Sprain?

Back 138

partial tearing of the ligament.S&S – edema, tenderness, pain with motion, joint instability, and partial loss of normal joint function.

Front 139

Third Degree Sprain?

Back 139

ligament is completely torn or ruptured. May also cause an avulsion of the bone.S&S – severe pain, tenderness, edema, and abnormal joint motion.

Front 140

What does RICE-P stand for?>

Back 140

RestIceCompressionElevationProtection

Front 141

What is a dislocation?

Back 141

a condition in which the articular surfaces of the distal and proximal bones that form the joint are no longer in anatomic alignment. The bones are “out of joint”.

Front 142

What is a Subluxation?

Back 142

a partial dislocation and does not cause as much deformity as a complete dislocation.· Traumatic dislocations are orthopedic emergencies bc the associated joint structures, blood supply, and nerves are displaced and may be entrapped with extensive pressure on them

Front 143

What is a complete fracture?

Back 143

break across the entire bone, frequently displaced

Front 144

What is an Incomplete Fracture?

Back 144

Break through only part of the bone

Front 145

What is a comminuted Fracture?

Back 145

Break that produces several fragments

Front 146

what is a closed/simple fracture?

Back 146

does not break skin surface

Front 147

What is an Open/Compound/complex fracture?

Back 147

Breaks skin and are gradedGrade 1 - clean wound less than 1 cmGrade II Larger wound without extensive tissue damageGrade III- highly contaminated, extensive soft tissue damage

Front 148

What is an intraarticular fracture? (epiphyseal)

Back 148

extends to the joint surface, not always visible on X-ray due to cartilage at ends of bone, often lead to post-traumatic arthritis

Front 149

What is an Avulsion?

Back 149

Fx where a fragment is pulled away by a tendon and its attachment

Front 150

What is a compression Fx?

Back 150

common in vertebrae

Front 151

what is a depressed fx

Back 151

fragments driven inward, common in skull fractures and facial fractures

Front 152

what is a greenstick fracture?

Back 152

fracture on one side of the bone and the other side bends, common in kids

Front 153

impacted Fx?

Back 153

- bone fragment driven into another bone fragment, common in hip breaks

Front 154

Oblique Fx?

Back 154

breaks diagonally across bone, less stable than transverse

Front 155

Pathologic Fx?

Back 155

occurs in areas of bone disease (osteoporosis, cancer, Paget’s disease, etc.) can occur without trauma

Front 156

Spiral Fx?

Back 156

twists around shaft of bone

Front 157

Stress Fx?

Back 157

results from repeated loading of the bone

Front 158

Transvers Fx?

Back 158

fractures straight across the bone

Front 159

Straight/Buck’s (skin traction)/running traction?

Back 159

pulls in a straight line with body part resting on the bed

Front 160

Balanced suspension traction?

Back 160

supports extremity off the bed allowing for some movement

Front 161

Manual traction

Back 161

force supplied by the hands

Front 162

Skin traction

Back 162

controls spasm and immobilizes area before surgery. Weights (4.5-8lbs for extremity, 10-20 for the pelvis) pull on traction tape or a boot attached to the skin. Includes Buck’s traction which is used for femur fracture prior to surgery.

Front 163

Skeletal traction

Back 163

is applied directly to bone (using Steinmann pins and Kirschner wire), used for tibia, femur, and cervical spinal fractures. Uses 15-25lbs of weights as spasm relaxes weight is adjusted. Inspect/clean pins frequently at least every 8 hours. Check lung frequently for atelectasis

Front 164

What are the five P's of Compartment Syndrome/

Back 164

Pain, Paresthesia, Paralysis, Pallor, Pulselessness.

Front 165

Effects of mobility on Perfusion?

Back 165

Blood pressure decreases, decrease resistance offered by the bloodvessels contributes to the pooling of blood. Deep vein thrombosis can developand as a result of the DVT the patient can experience a pulmonary embolus. Heartrate increases as a result of immobility. It is important when the patient isgetting up to encourage patient to dangle feet while setting on the side of thebed prior to standing,

Front 166

Effects of Immobility on Oxygenation?

Back 166

Secretions pool;atelectasis and pneumonia may occur. What can we do to prevent this?"

Front 167

Effects of Immobility on Mobility?

Back 167

Decreased energy, contributes quickly to debility. There is musclewasting and a reduction of muscle strength of 5-10% per week. In 2 months thepatient has lost approximately 50% of their muscle mass. Contractures canoccur, loss of flexibility and bone demineralization. Lose calcium also.

Front 168

Effects of Immobility on MetabolicProcesses?

Back 168

Body requires lessenergy so the patient may gain weight. Patient also may experience anorexia.

Front 169

Effects of Immobility on GISystem (elimination):

Back 169

Decreased appetite; or the opposite weightgain; decreased peristalsis. Constipation

Front 170

Effects of Immobility on Skin Integrity?

Back 170

Pressure sores may develop. Breakdown mayform from shearing and friction from sliding in the bed.

Front 171

Effects of Immobility on Psychological Wellbeing?

Back 171

The patient may become socially isolatedand develop depression, apathy, decreased coping ability, sleep/wake cycledisturbances.

Front 172

What is Type 1 Diabetes?

Back 172

Type 1 diabetes is a metabolic disorder characterized by an absence of insulin production and secretion from autoimmune destruction of the beta cells of the islets of langerhans in the pancreas known as juvenile diabetes, insulin dependent diabetes or type 1 diabetes

Front 173

What is Type 2 Diabetes?

Back 173

Type 2 diabetes is a metabolic disorder characterized by a relative deficiency of insulin production and a decreased insulin action and increased insulin resistance, formerly called non-insulin dependent diabetes, adult onset diabetes, or type II diabetesq

Front 174

What is the function on Insulin?

Back 174

Transports and metabolizes glucose for energyStimulates storage of glucose in the liver and muscle (as glycogen)signals the liver to stop the release of glucoseEnhances storage of dietary fat in adipose tissueAccelerates transport of amino acids (delivered from dietary protein) into cellsInsulin also inhibits the breakdown of stored glucose, protein and fat.

Front 175

What is Hypoglycemia?

Back 175

means low sugar in the blood and occurs when the blood glucose falls to less than 70 mg/dl. Severe hypoglycemia - glucose levels are less than 40mg/dl

Front 176

what are S&S of Hypoglycemia?

Back 176

Mild - Sweating, tremor, tachycardia, palpitation, nervousness, and hunger Moderate - inability to concentrate, headache, lightheadedness, confusion, memory lapses, numbness of the lips and tongue, slurred speech, impaired coordination, emotional changes, irrational or combative behavior, double vision or drowsiness Severe Hypoglycemia - Disoriented behavior, seizures, difficulty arousing from sleep, or loss of consciousness.

Front 177

What is DKA?

Back 177

Diabetic Ketoacidosis - caused by an absence or markedly inadequate amount of insulin ^^S&S Polyuria, Polydipsia, and marked fatigue. may experience blurred vision, weakness, and headache *patient may have acetone breath** ( a fruity odor) *

Front 178

How do you manage diabetic sick days?

Back 178

Hyperglycemia impairs the ability of leukocytes to destroy bacteria and increases chance of infectionStress, infection, and surgery can lead to elevated BGLthe need for insulin may increaseAlways take meds even if you can’t eatDrink lots of fluids (not diet fluids) to prevent dehydration (sweet tea and gatorade)Check BS q 2-3 hoursCheck urine for acetone

Front 179

What points need to be taught for insulin self management?

Back 179

How to prepare and inject (and mix)To rotate sites to prevent dystrophyPeaking timesHow to individualize scheduleRe-use of needles/ refrig. of insulin\Do not massage site after injectionWhen working out do not take insulin in an area that will be exercised i.e if you are going to work out your arms take insulin in your stomach