1
Q
MRIs
A
- radio waves of magnetic field are used to view soft tissu
- especially useful in the diagnosis of avascular necrosis, dise disease, tumors, osteomyelitis, ligament tears, cartilage tears
- contraindicated in pts with aneurysm clips, metallic implants, pacemakers, electronic devices, hearing aids and shrapnal
procedure is painless, loud tapping noises - no metal on clothing
- check for allergies to contrast if ordered
2
Q
sprains vs strains
A
- sprains: injury to ligaments. can be extremely painful
- strains: excessive stretching oa muscle, fascial sheath or tendon.
1) stop activity and limit movement
2) apply ice compresses to injured area
3) compress the extremity
4) elevate extremity
5) provide analgesia as necessary
RICE = rest, ice, compression , elevation - rest: movement restricted and extremity rested as soon as pain is felt
- ice: causes vasoconstrition and reduction of transmission and perception of pain. reduce inflamm and edema. apply immediately and keep on for 20-30 minutes
- compression: start wrapping distally and progress proximatly. keep on 30 minutes then remove for 15 minutes
- elevate: above heart level. elevate during sleep. NSAIDs for pain
3
Q
compartment syndrome
A
- condition in which swelling and increased pressure within a limited space presses on and compromises the function of blood vessels, nerves and/or tendons that run through that compartment
- causes capollary perfusion to be reduced below a level necessary for tissue viability
1) decreased compartment size resulting from restictive dressings, splints, casts, excessive traction, premature closure of fascia
2) increased compartment contents related to bleeding, inflamm, edema, IV infiltration - s/s: ischemia to extremity, contracture, disability, loss of function can occur
- 6 Ps: (1) pain distal to the injury that is not relieved by opiods and pain on passive stretch of extremity (2) pressure in compartment (3) paresthesia, numbness and tingling (4) pallor, coolness and loss of normal color of the extremity (5) paralysis or loss of function (6) pulselessness or diminshed or absent pulses
- causes: trauam, crushing injuries, humerous and tibia fractures are most common cause, extremity trapped under something with pressure
- care: assess urine for myoglobin = kidney and muscle damage, do NOT elevate above heart, do NOT apply cold, fasciotomy, monitor for infection after procedure
4
Q
purpose of traction
A
- the application of pulling force to an injured or diseased part of the body or an extremity
1) prevent or reduce pain and muscle spasms assocaited with low back pain or cerbvical sprain/whiplash
2) immobilize a joint or part of the body
3) recude a fracture or dislocation
4) treat a pathologic joint condition (tumor, infection) - provides immobolization to prevent soft tissue damage, promote active and passive exercise, expand a joint
- reallignment, decease pain and muscle spasms
- weights off floor
- pin care, watch for infection
5
Q
nursing care for fractured hip pt
A
- pain meds before activity
- how weight bearing status
- know assist status
- make sure to assess circulation if in a cast
6
Q
complications of an open fracture
A
- infection
- skin is open, exposing bone and soft tissue
7
Q
in-hospital and home care/treatment for osteomyelitis
A
- long term IV abx
- teach about how to care for their PICC line and how to administer their meds
- teach family members how to care
- scheduling Abx admin
- when to have follow up appts and lab testing
8
Q
how do we treat osteoporosis
A
- porous bone, chronic progressive metabolic bone disease characterized by low bone mass and structural deterioration of bone tissue, leading to increased bone fragility
- weight bearing exercise
- calcium and vitamin d supplements
- biphosphonates (foasamax, bonefos, didronel, boniva, aredia)
- salmon calcitonin (calcimar)
- selevtive estrogen receptor modulator
9
Q
risk factors, treatment and nursing care for gout
A
- risk factors: alcohol, red meats exacerbate flare ups, increase in uric acid production, underexcretion of uric acid in the kidneys, or inreased intake of foods containing purines which turn into uric acid in the body, prolonged fasting
- s/s: usually occurs in less than 4 joints, joints may appear dusky or cyanotic and extremely tender, inflamm of the great toe is the first problem that appears, tophi
- treatment/nursing care: low purine diet, protect foot and toes, blankets off feet, allopurinol, colchicine, NSAIDs, cortcosteroids, weight reduction, avoid alcohol, avoid red meat
10
Q
side effects and concerns of using NSAIDs
A
- GI bleeding
- renal impairment
11
Q
symtoms of osteoarthritis
A
- not normal part of aging
- cartilage destruction or joint instability
- not systemic
- joint pain, joint pain with rest, early morning stiffness but resolves
- heberden’s nodes, bouchard’s nodes
12
Q
care and treatment for ankylosing spondylitis
A
- males with hump backs
- respiratory issues due to bent back
- teach them to cough and deep breath
- maintain maximal skeletal mobility while decreasing pain and inflammation
- NSAIDs and salicylates
- once pain is managed, exercise is essential, postural control
13
Q
what meds should be given to a patient dependenton alcohol and in what order should they be given?
A
1) thiamine/banana bag
2) dextrose
14
Q
symptoms of withdrawl from nicotine
A
- cravings, irritabikity, headache
- give them a nicotine replacement while in the hospital to help with these effects
- always try to get pts to quit
15
Q
symptoms and complications of simulant overdose
A
- restlessness, paranoia, agitated delirium, confusion, and repetitive sterotyped behaviors
- death can result from dysrhythmias, MI, stoke, increased BP
- no antidote
16
Q
breakthrough pain
A
- when a pt is treated with sustained-release pain meds, but they develo a high pain level during the treatment
- treat with same immediate release medication
- drip of morphine, give morphine IVpush
17
Q
best pain med for the elderly
A
- tylenol
- don’t give NSAIDs - renal issues
18
Q
common concerns regarding tylenol use and how much can be given in 24 hours
A
- don’t give more than 3-4grams/day
- can result in acute or chornic liver failure, hepatotoxicity
19
Q
common causes of respiratory problems in the PACU? what action do you take for each?
A
- obstruction: tongue – jaw thrust, lay on side, sit up bed
- hypoxemia: pulse ox
20
Q
signs of resp problems in patients after surgery?
A
- decreased pulse ox reading
- decreaesd respiration rate
- crackles
- note sputum and color
- note gag reflex
21
Q
risks associated with poor wound healing
A
- infection
- poor nutrition
- diabetes with poor wound healing
22
Q
side effects of external radiation to the pelvis? how do you manage them?
A
- stomatitis, mucositis, esophagitis: encourage nutritional supplements, be aware of sawllowing difficulties, clean oral cavity, discourage smoking
- diarrhea: give antidiarrheals as needed, encourage low fiber, low residue diet, fluids 3L/day
- skin issues: clean with mild soap and water, nonmedicated lotion, rinse with saline, avoid harsh fabrics, avoid direct exposure to sun,
- increased infection risk
- reproductive dysfunction: harvest eggs prior
23
Q
nursing are for vomiting, mucositis, anorexia?
A
- vomiting: encourage pt to eat and drink when not nauseated; administer antiemetics, use diversional activities
- mucositis: assess oral health, encourage nutritional suppliments, artificial saliva
- anorexia: monitor weight, encourage pt to eat small frequent meals with lots of protein, food diary, serve food in pleasant environment
24
Q
what lab values are of most concern wwhen a patient is receicing cancer treatment?
A
- CBC: wbc, H&H, platelets
- neutrophils
RBC: 4-5.5 Hemoglobin: 12-17 hematocrit: 35-50% WBC: 4-11 Platelet: 150-450
25
what do you know about "lols"
- Best blockers
- atenolol, bisoprolol, metoprolol
- action: decreaed BP, decrease CO, decrease renin secretion
- nursing considerations: monitor BP and pulse
26
how do you know the treatment of ADHF is working?
- ADHF: acute decompensated heart failure
- decreased SOB, decreased crackles, decreased weight
- give diuretics and morphine
- my
27
what is BNP and how does it relate to heart failure?
- checks for heart failure
| - substance secreted in response to heart changes
28
Rheumatic Fever
- risk factors: delayed result of untreated Step A
- symptoms: affects heart, skin, joints, CNS,; criteria = carditis, monoarthritis, polyarthritis, syndehams chorea, erythema marginatum, SQ nodules
- treatment: echocardiogram (shows valvular insufficiency and pericardial fluid or thickening), bed rest, antibiotics, NSAIDs, salicylates, corticosteroids
- long term implications: chronic RH, prophylactic abx every month for 10 years
29
symptoms of deceased cardiac output
- decreased BP
- weak thready pulses
- increased HR
- fatigue
30
pericarditis
- risk factors: inflammation of the pericardial sac of the heart; infection, uremia, acute MI, neoplasms, trauma, radiation, myxedema, rheumatic fever
- diagnostic studies: echocardiogram
- symptoms: chest pain, worse with deep inspiration
- treatment: NSAIDs
- complications: cardica tamponade, paricardial effusion
31
aortic stenosis
- manage symptoms with rest
- most common problem with aging
- hear murmors
- replace with a mechanical valve and on anticoagulants for the rest of their life
- manifestations: angina, syncope, dyspnea on exertion, heart failure, normal or soft s1, diminished or absent s2, systolic murmor, prominant s4
32
infective endocarditis
- risk factors: dental work, UTI, rhematic fever or heart disease, IV drug use, mechanical valve, step A
- treatment:
- symptoms: fatigue, fever, murmor, janway lesions, oslar nodes
- complications: embolis
- diagnosis: positive blood culture, new or worsening murmor, vegetation
33
raynaud's phenomemenon
- avoid the cold, don't smoke
34
difference between arterial and venous disease
- arterial: pale, no edema, no hair, 6 ps ( ), do not elevate, small, deep, dry, don't compress, intermittent pain
- venous: brown/bronze skin, edema, elevate, large, shallow, wet, dull achy pain
35
complications of VTE (venous thromboembolism)
- pulmonary embolism, post thrombotic syndrome, phlegmasia
- SOB, chest pain, decreased pulse ox, increased pain with inspiration, leg edema, tenderness with palpation, warm skin, redness
36
pre/post care for bronchoscopy
- NPO pre and post
- check for return of gag reflex
- give sedative
- blood tinged mucous is not abnormal
- of biopsy was done monitor for hemmorhage and pneumothorax
37
what is the focus of a respiratory assessment and what findings are most concerning
- fine crackles: interstitial edema, alveolar filling, loss of lung volume
- coarse crackles: heart failure, pulmonary edema, pneumonia with severe congestion, COPD
- rhonci: COPD, cystic fibrosis, pneumonia, bronchiectasis
- wheezes: bronchospasms, COPD
- stridor: croup, epiglottitis
- absent breath sounds: pleaural effusion, mainstem bronchi obstruction, large atelectasis, pnsumonectomy, lobectomy
38
concerns for a patient undergoing rhinoplasty
- airway
| - put head of bed up
39
how do you prevent aspiration pneumonia?
- neuro deficit: increased risk for aspiration, lay on side if low LOC
- assess gag reflex and diet restrictions
40
what nursing intervention will relieve SOB in lung cancer pt?
- tripod position
- sit pt up
- have a fan on
41
what diagnostic tests confirm the presence of TB?
- 3 positive sputum cultures for acid fast bacilli
42
what pts cannot receive a TB test?
- those who have had the BCG vaccine
| - those who have been positive for TB in the pastd
43
how do you ensure pts being treated for TB are taking their medications?
- sputum specimens, compliance, direct observation theraoy, monitor liver functions
- INH, Rifampin, pyrizinomide, athambutol
44
what is the purpose of asthma medications?
- decrease inflammation and open airways
- SABAs, albuterol = ER
- LABAs, corticosteroids = maintenance
45
peak flows
- 3 puffs, take best one
- green: good
- yellow: saba use acutely, if not better then go to dr
- red: SABA and go to doctor
46
priority drug for an asthma attack
- albuterol, SABA, nebulizer
47
rules for giving oxygen to a copd patient
- maintain o2 at 90%
- titrate slowly
- humidify
48
cerebellum
- balance and equilibrium
49
frontal lobe
- higher function
- reasoning and judgement
- personality
- speech
50
post procedure care for a pt with cerebral angiography
- monitor bleeding, pressure dressing, iodine allergy, check circulation and pulses
51
what diagnostic test is most important for suspected strokes and why?
- CT
| - shows bleeding or clots
52
what should be the priority assessments for the patient with suspected stroke?
- vitals signs and respiratory
53
cardinal symptoms, history of ischemic stokes?
- TIA attacks are usually a percursor
- thrombotic, embolic
- s/s develop slowly, usually some improvement
- FAST: facial drooping, weakness, speech issues, unilateral weakness
- tx: TPA
- hemorrhagic: headache
- stoke scale NIH
54
treatment for migraines
- triptans, quiet dark room, sleep,
55
what should the nurse do for a pt who is seizing
- watch, document, ativan, calium IV then dose of dilantin
56
tonic-clonic seizures
- stiff and jerky
- most deadly
- acute onset
- reversible
57
delirum vs dementia
- delirum: resolves, quick onset, CAM
| - dimentia: doesnt resolve, mini cog, mini mental state
58
unexpected findings of a GI assessment
- bleeding
| - weight loss
59
meds for peptic ulcer disease
- h2 blockers, PPI
- decrease acid production
- keraphate coats stomach
60
s/s of scute liver failure
- jaundice
- bilirubin
- increased LFTs
- itchy skin
61
urinary terms
Dysuria – painful urination
Nocturia – frequency of urination at night
Hematuria – blood in the urine
Enuresis – involuntary nighttime urination
Anuria – no urination
Oliguria – ↓ in amount of urine (100-400 mL)
Polyuria – large volume of urine
62
nephrotic syndrome
- glomerulus is exessively permeable to plasma protein, causing proteinuria that leads to low plasma albmin and tissue edema
- s/s: anasarca, massive edema, hypertension
- decreased emema = good
63
incontinence
- stress: sudden increase in intraabdominal pressure causes involuntary passage of urine; coughing, sneezing, laughing, heavy lifting; pelvic floor muscle strenghthening
- urge: randomly involuntary urination; treat underlying cuase, anticholinergic drugs
- overflow: pressure of urine in overfull bladder overcomes pshinter control; urinary catheter
- reflex: no warning or stress preceedes periodic involuntary urination; treat underlying cuase
- toilet training q 2 hours
64
glomerulonephritis
- inflammation of glomeruli affects kidneys
- causes: strep A
- s/s: edema, facial edema, proteinuria, hematuria, flank pain
- compliance to abx, have urine rechecked if it doesnt help
65
UTI instructions
- finish abx, compliance
66
what causes HHS
- untreated diabbetes type 2
- bs > 600
- no ketones
- tx; fluids
67
lab values indicadive of DKA
- ketones, acidosis, decreased PH, decreased bicarb, decreased potassium
68
insulin
- rapid acting: lispro (humalog), aspart (novolog), glulisine (apidra) -- onset: 10-30, peak 30-3hr, duration 305hr
- short acting: regular, humulin R, novolin R -- onset 30-1hr, peak 2-5hr, duration -8hr
- intermediate acting: NPH Humulin N, novolin N -- onset 1.5-4hr, peak 4-12 hr, duration 12-18hr
- long acting: glargine (lantus), detemir (levemir) -- onset .8-4hrs, peak no pronounced peak, duration 24+ hours
Med Surge 1
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