Tissue Trauma Test 8

Front 1

How will vitals be altered in tissue trauma?
1. pulse
2. temp
3. resp.
4. wheezing
5.smoke inhalation

Back 1

1. elevated
2. altered
3. decreased
4. wheezing
5. hoarseness

Front 2

How will neurological status be altered in tissue trauma?

Back 2

confusion, lethargy, restlessness

Front 3

How will neurovascular status be diminished in tissue trauma?

Back 3

diminished peripheral pulses

Front 4

digestive and elimination patterns in tissue trauma

1. urinary system?
2. bowel sounds and why?
3. GI?

Back 4

1.frequency
2. absence (bowel obstruction, paralytic ileus)
3.constipation

Front 5

alterations in mobility in tissue trauma

Back 5

gait disturbance, weakness

Front 6

1.alterations in comfort in tissue trauma?
2. possible causes?
3. treatments

Back 6

1. pruritis
2. eczema, lice, CRF, liver/thyroid diseases, iron deficate, opiate drugs
3. antihistamines(block substance P), emollients, humidity, topical steroids, antihistamines

Front 7

alterations in integument and mucous membranes in tissue trauma?

Back 7

1. sloughing (of dead tissue) edema, erythema, (red warm) ulceration, loss of tissue, crater), hematoma, (blood under tissue, due to trauma)

Front 8

1.altered fluid and electrolyte balance
2. Tx

Back 8

1.metabolic alkalosis (hyperventilation GI losses via emisis)metabolic acidosis, (GI loss ulcerative cholitis) fluid volume deficit (GI, GU, wound drainage losses, low intake, fluid shift), fluid shift in burn patients (increased cellular permeability causes fluid to shift from vascular to interstitial
2. lactated ringers, crystaloids, fluids to pull fluid to vascular and fluid replacement)

Front 9

Factors influencing the occurence and cause of tissue trauma

Back 9

1.age (depressed immune response and delayed healing in the older adult , rapid healing in children, developmental stage)
2. physical activity patterns, developmental stage
3. psychological factors:stress, body image, confusion, altered thought process
4. lifestyle, health practices, occupation, avocation, spiritual and religous beliefs, substance abuse, housing
5. obesity=low circulation in adipose tissue slows healing post op, malnutrition(vitamin C, protein needed for wound healing, calcium for bone strength, protein and calories for hypermetabolic state in pts with burns
6.history or presence of other illness= diabetes mellitus, (low circ. low healing NIDD need insulin during and after surgery high metabolic needs)cardiac disease, long term steroid therapy (risk for infection) substance abuse

Front 10

Site of tissue trauma

Back 10

body areas prone to pressure, (bony prominences) friction, (high risk for pressure ulcer shearing force) and/or moisture (masceration, high risk for skin break down pressure ulcers, excoriation) Extent (measured by total body surface involved rules of nine and lund and browder chart for children)or severity (age, medical history, extent and depth of burn, body area involved, type of tissue)

Front 11

1.closed wounds include what?
2.what are they caused from?

Back 11

1.contusions and hematomas
2. blunt trauma, such as a fall, baseball bat strike, heavy weight or motor vehicle crash, open wounds include abrasions, lacerations, punctures, avulsions, and amputations
3. mechanism of injury-how, what,when, where, who, ABC's, determine tetanus and immuniztion status, wound location, size, presence, and amount of bleeding, elevate, cleanse wound thoroughly with sterile normal saline solution. prepare wound for closure, maintain layered sterile dressing, admin. abx, and tetanus prophylaxis

Front 12

Falls
1.are the most common what?
2.Second highest death rate due to what?
3.high incidence in who?
4.more likely in men or women?
5. preventing falls teaching

Back 12

1. non fatal injuries in the U.S.
2.injury-1st is MVA
3.elderly
4. 2x more in women
5. ambulation devices, improved lighting, corrective eyeglasses, non-sliding rugs, etc.

Front 13

Traumatic Amputations
1.usually what parts?
2. result from what type of trauma?
3. post op instructions

Back 13

1. finger, toe, arm, or leg
2. cutting, tearing, or crushing trauma
3. teach care of stump and to call Dr. if incision appears open or is red, swollen, warm, painful,or seeping drainage

Front 14

Hiatal Hernia
1.What is it?
2. why does it occur
3. dx
4. treatment
5.NSG teaching

Back 14

1. pyrosis (heart burn)
2. pain, reflux inflammation due to stomach protruding through hiatus into diaphragm
3. by endoscopy
4.small bland meals, antacids, antiemetics, sometimes surgical repair
5. teach to raise HOB, increase number of pillows, or put HOB on Blocks, stay upright after meals, avoid heavy lifting increased and reflux (increase intraabdominal pressure and reflux)

Front 15

bee stings and animal bites
1.what is concern
2. animal can produce what type of response
3. bee life threatning reaction
4. what do ticks cause?
5. sx of local reactions
6. sx of systemic reactions
7. assesment

Back 15

1. rabies & infection, may need tetanus shot or booster
2.local/systemic or hypersensitivity
3. anaphylactic
4. lyme disease and rocky mountain spotted fever
5. pain, erythema, edema, bleeding, tissue necrosis
6. fever, chills, malaise, weakness, n/v, joint and muscle pain, neurotoxicity (restlessness, vertigo, paralysis) SOB, laryngospasms, wheezing, tachycardia, and thready pulse, hypotension, and circulatory collapse, coagulation disorders(snakes), seizures, coma, resp and cardiovascular failure, death
7. history of injury:when and what, Medical tx-epinephrine is the drug of choice, when less severe admin. oral antihistamines, analgesics, tetanus, prophylaxis, and abx

Front 16

Burns
1.thermal
2.nonthermal
3. 4 categories of depth
4. superficial partial thickness
5. partial thickness
6. deep partial thickness
7. full thickness

Back 16

1. direct flames, hot liquids, radiation)
2.(chemical, electrical, radioactive) measured in depth, extent and severity and effect
3.listed below
4. 1st degree ie.sunburn, no b listers, painful tx.iv fluids if n&v nsaids h20 solution heals 3-5 days
5. 2nd degree, vessicles/blisters pain heal in 3-4 weeks if well nourished and without comp.
6.2nd degree (entire dermis) no skin appendeges involved ie. hair follicles, sweat glands tx. excision and graft (autograft-skin graft self own skin) homograft(same species-human) allograft(other species pig)hypertrophic scarring may occur
7. 3rd degree, epidermis, dermis, and SC muscle and bone may be destroyed *dry leathery appearance *eschar); white cherry red or black marked edema "painless" *distal circulation compromised in circumferential burns *(compartment syndrome), *escharatomy; skin graft required

Front 17

How are extent of burns measured?

Back 17

by total body surface involved, rules of nines and lundar and browder chart

Front 18

head and neck and arms = how many of a %

Back 18

9 %

Front 19

anterior and posterior of trunk =

Back 19

18%

Front 20

genitalia and perineum =

Back 20

1 %

Front 21

leg

Back 21

18%

Front 22

chart on page 3

Back 22

for burns

Front 23

WHat are the factors regarding severity of a burn

Back 23

age, medical hx, extent and depth of burn, body area involved

Front 24

The effect of a burn depends on what

Back 24

extent of body surface affected, depth of cutaneous injury

Front 25

what is the % of burns in peds and adults considered

Back 25

peds= 10%
adults=>20%

Front 26

What physical problems happen in serious burns?

Back 26

*Massive evaporative loss, large amounts of fluids and electrolytes , general adema, and hypovalemia

Front 27

burns to what area of the body are the most serious?

Back 27

face, hands, genitals

Front 28

what is "Burn Shock"?

Back 28

HYPOvolemia shock and cellular disruption fluid shift due to high cellular permeability, (burn edema)

Front 29

Hypovolemia in burn shock

Back 29

massive fluid loss from circulation . blood volume *high cappilary permeability)-lasts 24 hrs tx. *fluid resuscitation (*IV lactated ringers (*IV lactated ringers-(pulls fluid from tissue to vascular dept)

Front 30

what else happens in burn shock?

Back 30

1. cardiac contractility decreases and blood shunts away from the liver, kidney, gut and other viscera
2.Cellular Metabolism-disrupted and increases cell membrane permeability loss of electrolytes, mediators of inflammation (prostoglandins, thromboxanes, histamine, serotonin) & myocardial depressent factor (decreases contractility)
3.Cellular Response-to burn transmembrane potential change in cells-Na/pump, low Mg and Ph, high LDH and lactic acid metabolic Response (sympathetic response)-high catecholamines, cortisol, glocagon, insulin levels, gluconeogenesis, lipolysis, and proteolysis. Tissue hypoxia/lactic acidosis, HYPERMETABOLIC state. (causes incread water loss) general systemic -inflammatory response
4. CV Response to burns *fluid and protein leave the vascular compartment incease hematocrit, leukocytosis, hypoproteinemia (low protein and albumin) if not Rx'd irriversible shock/death in hours
After 24 hrs "capillary seal" restorationof capillary integrity,lymph system decreases in edema.
5. Immun

Front 31

Frostbite
1.cause
2.mechanism
3.mild
4.severe
5.most severe

Back 31

1. exposure to extreme cold-fingers, toes, ears, nose, cheeks more prone
2. direct injury from ice crystal formation and impaired circ./anoxia. Classified by severity
3.skin white or yellow, waxy, during rewarming, redness and discomfort-normal in a few hours
4.cyanosis and mottling=redness, burning pain on rewarming greater than 24-48 hours-vesicles and bullae =to crusts
5.gangrene and loss of affected part

Front 32

classified by depth of injury
1.superficial
2.deep skin.
3.deep tissue
4.treatment
5. teaching

Back 32

1. skin freezing-partial skin (1st degree)-full thickness (2nd degree)
2. freezing-full thickness and SC tissue 3rd degree
3. freezing (4th degree)
4. immediate treatment (cover affected areas)-do not rub or massage, immersion in warm water until frozen tissue thawed;gentle cleansing, no pressure. Remove constrictive clothing/jewelry. Give warm oral fluids (not alcohol and caffenie) Assess circulation. tx.pain severe (analgesics/opiates) high in affected extremity, provide bed cradle to prevent pressure on area. prophylatic antibiotics/tetanus immunoization if skin broken and pt not current (no tetanus shot in last 10 years)
-amputation of necrotic tissue delayed unitl line of demarcation is established
5. pts at high risk wear mittens not gloves, 2 pairs of socks, scarf and hat, avoid alcohol and smoking, increase physical activity to maintain body warmth

Front 33

chemical cause by injury
1. causes damage to what?
2.what does it block?
3.What does it disrupt?
4.when are cells destroyed?

Back 33

1. damage to plasma membrane
2.block enzyme pathways
3. disrupt osmotic and ionic balance
4. destroys cells as soon as contact with body (corossive substances)-injures cells during metabolism or elimination (carbon tetrachloride damages liver during metabolism)

Front 34

common poisons and their antadotes
1.aspirin
2.acetaminophen
3.digitalis
4.iron
5.methanol & ethylene glycol
6. CO
7. Narcotics
8.Cu, As, Pb
9. Cyanide

Back 34

1. dialysis
2. N-acetylcystine
3. lidocaine
4. deferoxamine
5. ethanol
6. 02
7. narcan, naloxone
8. penicillamine
9. sodium nitrite or sodium thiosulfate

Front 35

tylenol
1.tx?
2. p.c.?
3.do what?

Back 35

1. tx: acytlcysteine
2. P.C. liver failure
3.induce vomiting

Front 36

aspirin
1.tx?
2.p.c.?
3.do what?

Back 36

1.sodium bicarb, vit K, dialysis
2. kidney failure, hyperthermia, increased coagulation
3. induce vomiting

Front 37

Chemical Poisons:acid ingestion
petroleum based
1. dont do what because of what risk?
2. tx?

Back 37

1. induce vomiting-aspiration, lipid pneumonia
2. gastric lavage followed by water milk or mineral oil

Front 38

chemical poisons:acid ingestion
Corrosive
1.dont do what
2.keep what available
3. order what to decrease what?

Back 38

1.induce vomiting
2. emergency trach kit
3. dilution with water or weak vinegar solution steroids to decrease inflammation

Front 39

1.What are chemical toxins?
2. smoke inhalation injuries cause damage to what?
3. What are the 3 classifications?

Back 39

1. smoke and carbon monoxide
2. respiratory mucosa
3. carbon monoxide, inhalation injury above the glottis, inhalation injury below the glottis

Front 40

1. carbon monoxide
2. inhalation injuries above the glottis
3. inhalation injuries below the glottis

Back 40

1. hypoxic injury attracts hgb, none available for RBC's
2. injury above gottis caused by hot air, steam, or smoke, can cause mechanical obstruction **look for singed nasalhairs, hoarsness, painful swallowing**
3. usually chemically produced, can manifest as ards

Front 41

chemical burns
1.caused by what kind of chemical substances?
2. what are the most difficult types of substances to manage?
3. tissue damage can occur up to how long after initial injury occured?
4. tx

Back 41

1.necrotizing substances(burn)
2. acids
3. 72 hours
4. lavage, remove contaminated clothes

Front 42

lead posioning
1.high levels of what?
2. What are the normal levels?
3.sources
4.effects
5. sx
6. Medical tx

Back 42

1. plumbism
2. <10/100 ml
3.lead paint, drinking water, occupation, hobby exposure
4. RBC's, GI, kidneys, CNS
5.weighty loss, anorexia, constipation, anemia, pallor, fatigue, lead line on teeth along bones, Beh:irritability, hyperactive, insomnia, H/A, convulsions, death(pica)
6.screening for at risk pts educateparents sources of lead, the common behavior involved (ex.pica) and associated hazards, nutritional assessment (lead absorption is increased by increased nutrition ex. high fat and or low calcium and iron
6. decontamination, gastric lavage, activated charcoal, chelation (the AAP does not reccomend the use of chelating agents for venous lead levels of less than 45 mcg/dl

Front 43

Mercury
1.more dangerous in what form?
2. Is also toxic when ___?

Back 43

1. inhaled
2. mercury is ingested ie. fish treating with chelating agents to remove it from the system

Front 44

Inflammatory
GI protective Mechanisms
1. mucosal
2. epithelial cells
3. mucosal blood flow removes excess acid

Back 44

1. production of mucous and HCO3 creates a PH gradient from the gastric lumen (low ph) to the mucosa (neutral PH). The mucous serves as a barrier to diffusion of acid and pepsin
2. remove excess hydrogen ions via membrane transport systems and have tight junctions which prevent back diffusion of H+ ions
3. Mucosal blood flow removes excess acid that has diffused across the epithelial layer . Several growth factors (ie. epidermal growth factor, insulin like growth factor I) and prostoglandins have been linked to mucosal repair and maintenance of mucosal integrity

Front 45

Appendicitis
1.most common in who and what age?
2. sx
3. pc
4. NSG care-dont do what for prevejntion of rupture

Back 45

1. men in puberty -25
2. pain localized right in the lower abdomen (McBurney's point), a sudden cessation of ab pain, diffuse tenderness in midepigastrium and around the umbilicus that worsens when asked to cough or upon gentle percusiion . Moderately elevated WBC's
3. peritonitis
4. no analgesia-masks pain, no heating pad-risk rupture, no cathartics or enemas-risk rupture

Front 46

Crohns Disease (IBD)
1. affects what age?
2. what can it affect and where is it found
3. cause is unknown but may include?
4. signs/sx?
5. Dx?
6. Complications?
7.DIet?

Back 46

1. 20-40
2. can affect any GI tissue mouth to anus primarily found in small intestine and colon
3. lymphatic obstruction, infection, allergies or immune disorders
4. (remission and exacerbations) fatigue, fever, abdominal pain, diarrhea, and occasional weight loss. Diarrhea after emotional upset or eating poorly tolerated foods (milk, fatty foods, and spices), anorexia, n/v, steady, colicky or cramping ab pain, does not improve after stoole. Diarrhea is soft or semi liquid stool without gross blood. affected bowel tissue in patches with normal tissue in between fetal occult, c dif, stool CX, o and p, cbc, c reactive protein, ESR
5. inflammation may penetrate deep into the tissue of the intestines/colon and form ulcers or fistulas (tunnels through the intestines that allow waste material to move into other areas, bowel obstructions, anemia from bleeding tissues, and infections.
7. nutritous, avoid any foods that seem to worsen sx. (many report milk spicy foods exasperbate sx

Front 47

Ulcerative Cholitis (IBD)
1.What does it affect
2. sx
3.dx
4. comp.
5.tx
6.diet

Back 47

1. the surface lining of the colon, lesions continously spread distal to proximal (start @ anus)
2. bloody stooles is the hallmark, others include high frequency of stooles, abd cramping, weight loss
3. same as for chrons, rule out infections, allergies, visualize colon, assess level of inflammation and infection
4. hemorrhage , perforation, peritonitis, anemia, toxic megacolon (most serious complication) a section of the colon becomes paralyzed waste accumulates and dilates the colon abdominal pain, fever, and weakness and become life threatning if untreated
5. -cortisone 5-aminosalicyclic acid (5-ASA), help control inflammation
-sulfasazine is a combo of sulfapyridine and 5 ASA and is used to induce and maintain remission
-corticosteroids such as prednisone and hydrocortisone also reduce inflammation
-immunomodulators such as azathioprine and 6 mercapto purine (6-MP) reduce inflammation
-blood replacement, surgery (permanent or temporary illeostomy or colostomy) if med measures fail
6. individuali

Front 48

Diverticulitis
1.What is it?
2. more common where?
3. occurs in what age?
4. possible comp.?
5. what is considered a major cause?
6. When it is present under age 40 what is likely the cause?
7. Interventions

Back 48

1. oupouching or herniation of the mucous membrane lining of the bowel through a defect in the muscle layer
2. the sigmoid colon
3. people over 60
4. perforation
5. a low intake oof fiber
6. congenital predisposition
7broad spectrum abx, relive and prevent constipation with bland diet, stool softeners, occasional dose of mineral oil. increase oral fluid intake 2 liters/day. encourage exercise to promote peristalsis

Front 49

cholecystitis
1. what is it?
2. which sex has greater chance of developing gall bladder disease?
3. what is the saying?
4. sx of cholecystitis?
5.sx of cholelithiasis?
6.when does cholelithiasis occur?
7.MED TX?

Back 49

1. acute inflammation/infection of the gall bladder
2. women by 4 times
3. female, fertile, forty, fat
4. pain, tenderness, and rigidity of the upper right abdomen, n/v
5. may be silent with no pain, or mild GI sx's
6. acute or chronic epigastric distress after a high fat meal, URQ pain radiating to back or R shoulder, n/v, several hours after a meal. jaundice, dark urine, clay colored stools, fat soluble vitamin deficiencies (ADEK).
7. WHAT TYPE OF DRUGS???

Front 50

gastritis
1. causes?
2. sx?
3. assesment?
4. tx?

Back 50

1. diet (hot drinks, spices) stress meds (nsaids) radiation tx, hpylori, staph, salmonella, smoking
2. anorexia, N&V, ab pain, hemorrhage, pt usually recovers in a day, although the appetite may be diminished for 2-3 days. May be chronic or acute
3. sx, onset, sx relief measures
4. rehydration or maintenance fluids by IV, antacids neutralize stomach acids, NPO no ETOH until resolved, use of IV therapy to prevent dehydration, Monitor for GI bleed, medicate for pain but avoid aspirin or ibuprofen (may cause GI upset)

Front 51

Peptic Ulcer DIsease
1. what is it?
2. where?
3. dx?
4.comp?
5.what are 2 types
6. gastric ulcer
7. duodenal ulcer

Back 51

1. excoriated segment of the GI mucosa
2.typically in the stomach(gastric ulcer)or first few centimenters of the duodenum (duodenal ulcer is most common), which penetrates through the muscularis mucosae
3. based on hx and sx + FIBEROPTIC ENDOSCOPY dx. of choice more-detects esophagitis and esophageal ulcers ulcers located on the posterior wall of the stomach and at sites of surgical anastomosis or DOUBLE CONTRAST BARIUM XRAY
4. HEMORRHAGE, hematemesis, hematochezia and melena and weakness, orthostatis, sncope, thirst, and sweating caused by blood loss tx:endoscopy woith electrocautery, heater probe coagulation, or laser, or by injection of alcohol, sclerosant, or epinephrine. Angiographic embolization of branch vessels supplying the bleed site may stop the bleeding. antisecretory therapy (h2 blockers or proton pump inhibitors)given orally and anti H pylori therapy initiated if needed PERFORATION sudden intense, steady epigastric pain that spreads rapidly throughout the abdomen, GASTRIC OUTLET OBSTRUCTION:

Front 52

Prostatis-Acute Bacterial
1.What is it?
2. sx
3.prostate gland will present how
4. dx
5. tx
6.p.c.

Back 52

1. acute bacterial inflammation of the prostate gland
2. chills, high fever, urinary frequency and urgency, perineal and low back pain, sx of urinary obstruction, dysuria or burning, nocturia sometimes gross hematuria, and often arthralgia and myalgia.
3. tender, swollen, indurated, usually warm on palpation
4. urinalysis (pyuria acute cystitis often accompanies) culture (pos most commonly enteric, gram negative) blood cultures (occ+) DO NOT MASSAGE PROSTATE until ABX level established
5. general support, bed rest, analgesics, stool softeners, and hydration ABX. about 30 days to prevent chronic bacterial prostatis (inital therapy with a fluoroquinolone BID while waiting for Chest x ray results) if sepsis is suspected, broad spectrum abx covering gram neg and gram pos organisms (ex.a combination of ampicillin and gentamicin) should be given IV until the bacteria sensitivity is known
6. abcess

Front 53

Prostatis-Chronic Bacterial
1. hallmark sx
2.most common cause, and what else?
3. tx

Back 53

1. relapsing UTI
2. gram neg-bacilli also enterococci and chlamydiae
3. oral fluoroquinolone therapy is more effective than trimethoprim-sulfamethoxazole and is usually given twice daily for 4-12 weeks

Front 54

prostatis-chronic non bacterial
1.more common than what?
2. cause
3. sx
4. Treatment

Back 54

1.bacterial
2. unknown
3. WBC's and oval fat bodies increase in prostatic secretions. history of UTI is rare. Lower-tract localization cultures of of urethral,bladder, and prostatic secretions are required for diagnosis to rule out a bacterial pathogen.
4. hot sitz bath, anticholinergic drugs, and periodic prostatic massage (especially for congestive prostatis) NSAIDS

Front 55

epididymitis
1.WHat is it?
2.Can result from what?
3. sx
4. acute bacterial
5.tx

Back 55

1.inflammation of the epididymis and testis
2. UTI with prostatitis or urethritis, a sequlae to gonorrhea, a complication of prostatic surgery, or a result of infection secondary to an indwelling catheter
3. painful, tender swelling with scrotal edema and erythema. Gram negative bacteria and chlamydia trachomatis are usually involved.
4. comp. of bacteriuria, bacterial urethritis or prostatitis-unilateral or bilateral. sx fever and pain and swelling in the scrotum. induration, erythema, and marked tenderness of a portion of or all of the affected epididymis and sometimes the adjacent testis
5.bed rest, scrotal elevation, scrotal ice packs, analgesics, and oral antimicrobial therapy for 7-10 days. If sepsis is suspected, a parenteral aminoglycoside or 3rd generation cephalosporin POS vasoligation (vasectomy)

Front 56

What are some of the surgical interventions r/t tissue trauma

Back 56

hernia repair, reconstructive surgery, exploratory, laparotomy, laparoscopic surgery, surgical debridement, burns, ulcers

Front 57

General Abdominal surgery
1.preop do what
2. npo for how long before
3. post op

Back 57

1. cbc, UA, enema may be given, skin is shaved and cleansed from nipple line to the pubis
2. 8 hours prior
3. ABC's, check tubes and catheters, connects drainage tubes to collection containers, checks dressing for excessive bleeding or drainage. VS I&O TCDB q hour Inspirometer routine pain meds

Front 58

Appendectomy
1.what is it
2. PC
3. NSG care
4. Preop
5.Post op

Back 58

1. removal of veriform appendix
2. perforation, peritonitis
3. general abdominal surgery care
4.no enema
5.care if appendix has perforated , a drain may be left in the incision , dressing changesre more frequent, and appropriate antibiotics are prescribed, ileus may be present and pain may be acute. IV fluids, electrolytes, and analgesics are usually given

Front 59

Tosillectomy
1.Which ones are removed to prevent what
2. preop
3.postop
4. PC

Back 59

1. palatine tonsils to prevent recurrent tonsillitis
2. labs, coagulation studies, CBC, UA
3. an airway remains in place until swallowing returns-ABC's
4. HEMORRHAGE (high pulse, low BP, restlessness, or frequent swallowing) ice chips or clear liquids without a drinking straw

Front 60

Gastrectomy
1.What is it?
2. what is it for?
3. preop
4. postop
5. PC

Back 60

1. surgical excision of all or part of the stomach with anastmosis
2. to remove a chronic peptic ulcer, stop hemorrhage in a perforating ulcer, or to remove a malignancy
3. a GI series is done and a NG tube. Under general anesthesia, 1/2 to 2/3 of the stomach is removed, including the ulcer and a large area of acid-secreting mucosa. Gastroenterostomy joining the remainder of the stomach to the jejunum or duodenum
4. observes NG drainage, TCDB, VS, NPO until peristalsis returns, clear liquid gradually progresses to six small bland meals a day with 120 ml of fluid hourly between meals
5. hemorrhage, dumping syndrome, infection

Front 61

dumping syndrome
1.what are the sx?
2. when are sx felt?
3. what is it?
4. what to do to tx?

Back 61

1. combo of prefuse sweating, nausea, dizziness, and weakness
2. soon after eating
3. when contents of stomach empty too rapidly into the duodenum
4.high protein, high calorie diet, w/out concentrated sweets, small frequent meals, no liquid with meals or with in 1 hour, lye down for 30-60 minutes after mean to decrease sx

Front 62

Ileostomy
1.What is it?
2.When do people have them?
3. preop
4.postop

Back 62

1. permanent or temporary (anastmosis when bowel heals)
2. tx in advance or for reoccurent ulcerative cholitis, crohns disease, or cancer of the large bowel
3. low residue diet, reduced to fluids 24 hours before surgery to decrease intestinal residue. Intestinal antibiotics to decrease the bacterial count. A NG or intestinal tube
4. NSG typical Post op care ABC's TCDB ankle pumps VS protect skin from digestive enzymes, stoma and NG drainage in place, teach and support pt

Front 63

Cholecystectomy
1.for what?
2.What is treated first?
3. preop

Back 63

1.to treat cholelithiasis and cholecystitis.
2.Acute inflammation
3.ECG and left PC's a disruption of the hepatic or biliary system ducts (surgical correction req.) infection, hemorrhage, bile leakage, jaundice, jackson pratt

Front 64

analgesics
1. for what?
2. S.E. of narcotic analgesics?

Back 64

1. pain relief
2. resp depression, urinary retention, constipation

Front 65

What type of infection are antimicrobials used for?

Back 65

prophylaxis infection

Front 66

chelating agents are used for what?

Back 66

plumbism

Front 67

NSAIDS
1. WHat are they used for?
2.avoid which type in pts with ulcers?
3.WHat if an NSAID is ineffective
4.1st med given when?
5.what form?

Back 67

1.pain control, antiinflammatory and fever reduction effects
2.ASA, and motrin
3.try a different one
4.post op
5.parenteral

Front 68

Corticosteroids
1.What does it do?
2. PC
3. used for what?
4.what form?

Back 68

1. antiinflammatory effect
2. risk for infection, masks infection signs
3.pruritus
4.topical

Front 69

WHat is the antidote for tylenol over dose?

Back 69

acytelcysteine

Front 70

Morphine
1.What type of drug?
2. drug of choice for what?
3. S.E.?

Back 70

1. narcotic, antagonist
2. burn pain
3. resp depression, constipation, urinary retention

Front 71

antihistamines
1.do what?
2.tx for what?

Back 71

1. block substance P
2. puritus and allergies

Front 72

Beta inhibitor?

Back 72

ff

Front 73

Anticholinergics
1.does what?
2.given when?

Back 73

1.drys secretions
2. preop

Front 74

What are the 3 types of anesthesia?

Back 74

local, general, spinal

Front 75

preop teaching?

Back 75

post op activities included and demonstrated in preop teaching
also usually given premedication

Front 76

Intraoperative care

Back 76

1.anesthesia
2. replacement of blood and blood products
3.fluid replacement
4. position flat until consciousness regained, side lying, prevent aspiration post op

Front 77

Post op care
1.assesment
2. routine care
3. comfort management
4. wound care
5.physical activity
6.diet

Back 77

1. immediate for postop patient, ABC's
2. ABC's, VS, bed flat until pt awake, position on side to prevent aspiration
3. pain meds admin. around the clock, spinting, environmental control, CAT methods
4. aseptic technique MD 1st dressing, nursing reinforce until then
5. up ASAP if not contraindicated, decrease PO complications, (dvt, pneumonia)
6. npo until gag reflex returns, Blood sugar returns 48 hours post general anesthesia

Front 78

tepid soak?

Back 78

?

Front 79

antidotes
1. syrup of ipecac
2. narcotics

Back 79

1.induce vomiting
2.narcan

Front 80

Why do fractures get splinted?

Back 80

to prevent soft tissue nerve trauma

Front 81

When is epinephrine (adrenaline) used?

Back 81

for bee stings (anaphylactic shock

Front 82

Burn treatments
1.what type of technique
2. necrotic tissue-do what?
3. how does dressing stay in place
4. what type of garment and for what
5. exercise does what?

Back 82

1.aseptic
2. debride to prevent bacteria growth
3. anchor dressing with gauze wrap or netting (NO TAPE!),-Silvaden-sulfamylan, skin grafts
4. jobst garmets-help prevent scarring and positioning, splinting
5. helps prevent contractures

Front 83

Pressure dressings do what?

Back 83

slow/stop bleeding, inhibit edema, prevent scarring in burn patients

Front 84

skin grafts
1.for what?
2. what 3 types
3. what type of dressings and why?
4.When can it be done

Back 84

1. burns
2. auto-self, homo-someone else, hetro-pig
3. bulky dressing covers extremities to keep graft from shearing off
4. with in 48 hours of admission

Front 85

objective data
1. activity tolerance
2. behavioral responses

Back 85

subjective data
1.nutrition status
2. meds
3.health habits
4.avocation

Front 86

normal central venous pressure

Back 86

100 mm H20

Front 87

a high temp indicates what?

Back 87

infection

Front 88

Shock
1.bp
2.pulse
3.resp.

Back 88

1. low
2. high
3.high

Front 89

1.chrons will have what type of lesions
2. ulcerative cholitis has what type of lesions

Back 89

1. patchy
2. continous lesions distal to proximal

Front 90

bones, fractures, dislocations, and lung consolidation are diagnosed how?

Back 90

X RAY

Front 91

NORMAL serum ELECTROLYTE values
1. K+
2. Ca+
3. Na+
4. Cl

Back 91

1. 3.5-5
2. 3.5-5.5
3. 35-146
4. 95-112

Front 92

burn pts
1.will have what type of labs?
2. why

Back 92

high Na+ and low K+
fluid shift

Front 93

Malabsorption syndromes would include what?

Back 93

chrons, ulcerative cholitis, dumping syndrome

Front 94

what type of fluid shifts will pts with malabsorption have?

Back 94

low Mg, low K+

Front 95

1.What is a normal serum albumin level?
2. will be high in what?
3. will be low in what?

Back 95

1. 3.5-5
2. burns, cirrhosis, dehydration
3.malabsorption, liver disease

Front 96

What can be detected by a CBC level?

Back 96

anemia, infection, allergy, TCP, inflammatory response

Front 97

When will liver enzymes be high?

Back 97

in hepatic disease, & acetaminophen toxicity

Front 98

Lead levels
1.normal level is?
2. not normal & will have s.e. at what level?

Back 98

1. under 10
2. over 45

Front 99

What factors should be assessed in pts that can minimize tissue trauma?

Back 99

1. mobility
2. strength
3. ability to use assised devices

Front 100

1. Why do nurses synthesize data?
2.what part of the nursing process is it in?

Back 100

1. to identify pts actual or potential health problems (to come up with a diagnosis)
2. analysis

Front 101

altered peripheral tissue perfusion is related to what health problem?

Back 101

thrombus formation

Front 102

What is the objective in PLANNING?

Back 102

to determine expected outcomes (patient centered goals) and formulate specific strategies to achieve

Front 103

what should be considered as part of the planning in a pt with chrones?

Back 103

cultural dietary restrictions

Front 104

what should be considered in planning in a pt with a hx of substance abuse?

Back 104

pain management

Front 105

WHat is very important to monitor in a patient with burns?

Back 105

monitor fluid and electrolyte balance, and I & O's

Front 106

What is the objective of IMPLEMENTATION?

Back 106

carry out nursing plans designed to move the patient toward the expected outcomes, establish a collaborative relationship with the pt

Front 107

1. it is important to do what in a pt with an ileostomy?
2. use what type of precaution when changing a burn dressing?

Back 107

1. provide skin care
2. surgical asepsis

Front 108

it is important to provide what type of care to a pt with a t-tube drainage site?

Back 108

skin care

Front 109

after a pt has a gastrectomy what type of fedding schedule should they be on?

Back 109

small frequent feedings

Front 110

What should be monitored in a pt receiveing K+ supplements?

Back 110

electrolytes

Front 111

in analgesic admin. what should be done prior to?

Back 111

assess vitals

Front 112

monito what in a pt receiving lactulose?

Back 112

elimination patterns

Front 113

consider modification of meds in what type of pt?

Back 113

elderly or babies

Front 114

what should be monitored in a pt receiving corticosteroids?

Back 114

blood sugar

Front 115

what should be monitored in a pt receiving chelating agents?

Back 115

lead levels

Front 116

A pt with an ileostomy should be referred to what type of group?

Back 116

self help

Front 117

reinforce what for a pt with an amputation?

Back 117

crutch walking

Front 118

patient should have a pain rating of what or less after admin. of narcotic analgesics?

Back 118

4 or less

Front 119

what should be recorded in a pt with burns?

Back 119

urinary output and body weight

Front 120

Ask the nurse assistant to report what in a pt with chrones?

Back 120

number and characteristics of stooles

Front 121

ask LPN to describe what in a pt with an ileostomy?

Back 121

drainage

Front 122

Burns are assessed by what 3 things?

Back 122

first, second and third degree burns

Front 123

The severity of a burn depends on what 5 things?

Back 123

1.the body surface area affected
2. depth of the burn
3. part of the body effected
4. age
5.past medical hx of the person

Front 124

Severe burns are treated where?

Back 124

specialized burn centers

Front 125

The labels of 1st, 2nd, and 3rd degree are associated with what?

Back 125

the depth of the burn

Front 126

The depth/degree of the burn depends on what?

Back 126

the layers of skin which are damaged or destroyed

Front 127

First degree burn
1. what is effected
2. what type of burn
3. appearance of burn mimics what?
4. many sunburns are what type of burn?
5. the partial thickness superficial degree burn is what?
6. What type of severity are they considered?
7. how long until they heal?

Back 127

1. epidermis
2.superficial
3. sunburn
4.1st degree
5.painful and erythematous
6.minor
7.few days

Front 128

Second degree burn
1. what is effected
2. WHat else can it affect
3. What will they look like?
4. What does the fluid/blister do?
5. are they painful burns
6. How long does it take for skin too regenerate in superficial 2nd degree burns if wounds are kept clean and dry and pt receives adequate hydration and nutrition?
7. how should second degree burns be treated?
8.When could a second degree burn turn into a full thickness (3rd degree) burn?

Back 128

1.epidermis and part of the dermis
2. they cn be superficial partial thickness effecting the epidermis and outer half of the dermis but sparing hairs or deep partial thickness, destruction of epidermis and reticular dermis
3.redness, blisters, and considerable pain are present
4. lifts the skin off the underlying tissue
5. yes because nerve endings are left intact
6.3-4 weeks
7. as an open wound and be protected from infection
8. if infection, progressive thromus, or mechanical trauma occur

Front 129

Deep partial thickness burns
1.they are treated like what type of burn?
2.appearance
3. pain-yes or no
do they take longer to heal than a second degree burn
4.do they require grafting
5. Why are they not allowed to heal on their own
6. when is a 2nd degree burn minor?

Back 129

1.3rd degree
2. white and waxy
3.less pain than the superficial partila thickness burn
4. yes
5.because of potential for scarring
6. when affecting less than 10% of BSA in adult and less than 6% of BSA in child or moderate affecting 15-25% of the BSA in adults and 10-20% in children

Front 130

Third degree burns
1.WHat type?
2. involve what layers?
3. appearance
4. pain-yes or no
5. what is lost in this burn
6. What are real risks?
7. what is used to replace fluids?
8. What are other tx?
9. why will a 3rd degree burn not heal on its own?
10. when is a 3rd degree burn minor?
11.When are they major
12. All burns related to what are considered major severity regardless of BSA
13. Why
14. all burns in who are considered major
15. why

Back 130

1.full thickness
2.epidermis and dermis and also maybe destruction of adipose tissue, fascia, muscle and bone
3.dry & leathery with black, white, red, or brown coloring
4. no but feelings of tightness and decreased sensation
5. all protections and functions of destroyed tissue
6.fluid loss, electrolyte imbalance, dehydration, shock, kidney failure and infection
7.IV fluids high in protein, lactated ringers are often used
8.debridement, gastric tube feedings and skin grafting
9. the elements needed for regeneration have been destroyed
10.if less than 2% of BSA is affected in adults , 10%=moderated
11.when they cover more than 10%
12. inhalation, complicated by medical status/injuries, effecting the hands, face, eyes, ears, feet or perineum
13. can cause comp. such as respiratory arrest, due to swelling, infection, or thrombosis
14. infants or elderly
15.they are at high risk for comp. such as fluid loss and dehydration even with first degree burns
5.

Front 131

What are the 4 types of burns?

Back 131

1.thermal
2.chemical
3.electric al
4.smoke/inhalation

Front 132

Classification of burns by what 3 things?

Back 132

1.depth (1st 2nd 3rd degree)
2. extent (rule of 9's, Lund-Browder)
3. location (face and neck, circumferential burns of chest)

Front 133

burns to what jeopardize function later on?

Back 133

hands and feet, joints, and eyes

Front 134

What 3 things have poor blood supply

Back 134

ears nose and cartilage

Front 135

Superficial partial thickness burn
1. appearance
2. example

Back 135

1.erythema, blanching on pressure, pain, and mild swelling
2. sunburn without blisters or quick heat flash

Front 136

Deep partial thickness burn
1.description
2.example

Back 136

1. fluid filled vessicles that are red, severe pain, mild to moderate edema
2. flame, flash, scald, contactg burns

Front 137

Full thickness
1.description
2. some classification systems list bone involvement as what
3. examples

Back 137

1. dry, waxy, white, lesthery or hard skin, visible thrombosed vessels, insensitivity to pain and pressure because of nerve destruction, possible involvement of muscles, tendons and bones
2. 4th degree
3.flame, scald, chemical, tar, electric current

Front 138

Phases of burn management
1. how to stop the burning process
2.if chemical what do you do?
3. what to do for smaller thermal burns
4. large thermal burns

Back 138

1.remove person from source of burn
2. brush solid particles off the skin and wash with large amounts of water (wear protective clothing)
3. cover with clean cool tap water
4. wrap in clean sheet or blanket

Front 139

what to do with clothing on 3rd degree burns?

Back 139

cut it away, but dont try to pull it off 3rd degree burns, cut around it

Front 140

emergent phase
1.usually lasts how long
2. begins with what
3. ends when what

Back 140

1. 24-48 hours
2. fluid loss and edema formation
3. fluid mobilization and diuresis begins

Front 141

acute phase
1.begins with
2.ends when

Back 141

1. mobilization of extracellular fluid and subsequent diuresis
2. burned area is completely covered or when the wounds are healed

Front 142

Fluid shifts
1.increased capillary permeability causes fluid to shift from where to where
2. decreased intravascular fluid causes what?
3. where is fluid also lost
4. adequate replacement of fluid during initial 1-2 hours is necessary why?

Back 142

1. intravascular to interstitial space
2. decreased blood pressure and increased pulse (vessels constrict to support BP for about 2 hours then dilate-so watch for drop in BP after 1-2 hours)
3. through areas where skin has burned off
4. to prevent hypovolemic shock

Front 143

What 3 systemns are most effected by burns

Back 143

1.cardiovascular
2. respiratory
3. renal

Front 144

renal system problems
1. in hypovolemia what happens in relation to the kidneys
2.also myoglobin from muscle breakdown and hemoglobin from RBC breakdown may do what?

Back 144

1. blood flow to the kidneys is decreased causing renal ischemia resulting in renal failure
2.may occlude renal tubules

Front 145

Respiratory system problems
1.Edema causes what?
2. carbon monoxide poisoning from smoke inhalation causes what?

Back 145

1.mechanical airway obstruction
2. increased carboxyhemoglobin levels

Front 146

Formulas for estimating fluid replacement
1. Brooke Army Medical
2.parkland

Back 146

1. lactated ringers solution: 2 ml/kg/% burn given duringfirst 8 hour, 1/2 given duringnext 16 hours
2. lactated ringers solution 4 ml/kg/% burn, 1/2 given first 8 hours, 1/4 given each next 8 hours

Front 147

What is the most serious threat to further tissue injury and possible sepsis?

Back 147

infection

Front 148

What is used for wound care

Back 148

silvadene, sulfamylan

Front 149

what is a cultured epithelial graft?

Back 149

patients own skin and cell culture

Front 150

Why could a pt with large burns need an NG tube?

Back 150

they may have a paralytic ileus for 2-3 days

Front 151

metabolic needs may be how much above normal?

Back 151

50-100%

Front 152

pt needs what for nutrition to heal?

Back 152

high protein, high carbs, high fat diet to supply calories and nutrients necessary to heal

Front 153

Complications for burns
1.scar formation
2. emotional damage
3. social problems

Back 153

1. jobst garments and positioning, splinting, exercise help prevent contractures
2. body image disturbance
3. long term care expense