MEdical Surgical Lpn Exam #2
this is for the LPN course @ CONA. Second mid-term exam. Objesctives 4,5,6
what are wet dressings used for?
used to apply solution to skin lesions, left in place until debridement used
what tempuature should a therapeutic bath be ?
what is the purpose of using a therapeutic bath?
relives inflammation, itching, also aids in removal of crusts and scales
what is surgical excision?
excision of tissue by, laser therapy, cryosurgery, electrodesication
ifammation due to affected hair follicles and sebaccous glands
what is a furuncle?
furuncle with purulent drainage
signs and symtoms of psoriasis?
patches of erythema covered with silvery scales
treatment for psoriasis?
corticosteroids, coal tar extracts and in extreme cases Photochemotherapy
it is important to pt teaching for photochemothereapy____________
to avoid sunlight for 8hr after receiving treatment
common and infectious
Signs and symptoms of scabies?
sever itching, especially at night. Mostly affects webs of fingers, elbows, armpits......etc.
treatment for scabies?
topical scabicide. Apply in think layer, leave on for 8-12 hrs and then wash off. wash all clothing/linens in HOT water
Shingles (herpes Zoster)
virus lays dormant in nerve root, migrates to cranial or spinal nerve root)
signs and symptoms of shingles
vesticles follow along nerve pathway
what is pediculosis
treatment of pediculosis?
what are the major complications of a burn?
Edema, fluid loss, low blood pressure, SHOCK, electrolyte deficits
characteristics of a 1st degree burn?
superficial, epidermis injured, painful
characteristics of a 2nd degree burn?
+3 wks to heal, may need debridement, may require skin graphs
characteristics of a 3rd degree burn?
destroys all layers of the skin, needs debridement and grafting, may involve muscle and bone
the main thing to look for in a burn pt?
inhalation injury, hypovolemic shock
initial Tx of a burn?
Lay pt flat, assess respiratory status
what do you NOT do for burns?
do not apply anything to the burn, do not remove clothing, nothing by mouth, so not immerse burn in cold water
Acute care for burns would include the following:
ventilation, fluid resuscitation, analgesics for pain, inserting catheter, monitor input and output, prevention of shock
wound management for burns would include:
remove foreign material, shave hair around burn, open or closed method of Tx
nsg care for burns:
Assess for respiratory distress, maintain airway, monitor breathing: maintain fluid balance
When assessing for pain for a burn injury the Pt may need ____________
freq. sedation, esp for a dressing change
when assesing a burn Pt for infection you should :
be aware of sepsis, reverse isolation, monitor temp, keep Pt warm
in preventing dangers of immobilization be aware of:
proper alignment,keep the skin surfaces from touching, use turning frames and cradles
inhance tissue repair in burn Pt's by :
increase calorie intake to 6000cal/day, diet high in protein
Common diagnostic tests include:
arthroscopy, arthrocentesis, bone densitometry, and bone scan
a surgical procedure to view inside a joint
surgical puncture of the joint space to remove synovial fluid
x-ray to measure bone density & compare to known standards for age & gender
uptake of a radioactive substance is measured in bone
traumatic injuries include:
strain, contusion, sprain
a painful injury to a joint caused by a sudden wrenching of its ligaments
muscle stretched beyond capacity
soft tissue injury from blow or blunt trauma
a displacement of a part (especially a bone) from its normal position (as in the shoulder or the vertebral column)*may disrupt blood supply, hear a Popping sound!
Nsg for dislocation
elevate and immobilize, perform neurovascular checks every 30min
a break in a bone
signs and symptoms of a fracture
severe pain, pain increases with movement , deformity, crepitus
Crackling sound produced when ends of bone rub against each other or against roughened cartilage.
Closed reduction (dealing with fracture)
bone is restored to normal position by external manipulation, used bandage or traction
Open reduction (dealing with fractures)
Surgery to realign bones, internal fixation may be used
rigid mold, hip spica, cylindar and body cast
pins inserted into bones from outside skin
bones secured with metal screws, rods, nails, pins
(orthopedics) the act of pulling on a bone or limb (as in a fracture) to relieve pressure or align parts in a special way during healing
Signs and symptoms of a fractured femur
severe pain, ecchymosis (bruising), connot move hip/knee,
Tx for fractured femur?
skeletal traction, SPICA CAST
Nsg for fractured femur?
pin site care, prevention of pressure ulcers, constapation, pneumonia, blood clots etc.
Asses for shock by?
assessing Loss Of Consciousness, and mental status, monitor pulse and BP
assessing for anxiety by?
involve Pt's , encourage contact w/ family
What are some signs and symptoms of a broken hip?
pain radiating to the knee, affected leg shorter and externally rotated
Nsg care for a broken hip would be?
place trochanter roll beside affected when in recumbent position, this prevents the hip from rolling outward. Also elevate; flexion no more then 90 degrees
open method exposure involves this:
reverse isolation, Escher removal by debridement
Closed method involves more then ____ ___ ___ ______ .
one type of dressing
what is envolved in surgical management of a burn?
What are some of the benifit of skin grafting?
decreased the chance of infection, as well as decrease fluid loss
tissue that is taken from one site and grafted to another site on the same person
tissue or organ transplanted from a donor of the same species but different genetic makeup
tissue from an animal of one species used as a temporary graft (as in cases of severe burns) on an individual of another species
skin substitute or synthetic skin is applied when?
after cleansing and debridement
how is synthetic skin grown?
from the clients own cells
some complications of fractures include?
shock, pulmonary embolism, compartment syndrome avascular necrosis
what is compartment syndrome?
tissue profusion into muscle compartment compromised by tissue swelling, hemmorage, or a cast that is to tight
how could compartment syndrome be prevented?
elevation of extremity, application of ice, neurovascular checks
bone tissue death due to interruption of blood supply
a chronic autoimmune disease with inflammation of the joints and marked deformities
what are some signs and symptoms of rheumatoid arthritis?
Acute onset with blateral and symmetrical joints affected, decrease in mobility, the joint become spongey, nodules over joints
what are some systemic signs of rheumatoid arthritis?
Anorexia and weight loss, muscle weakness, extremities appear smooth and glossy as well as they may be cold and clammy
Tx for rheumatoid arthritis may include?
although there is no real treatment, gold therapy may be used
Nsg care for rheumatoid arthritis could include?
Transcutaneous electrical nerve stimulation (TENS), teaching about the disease, medications and heat and cold therapy
chronic breakdown of cartilage in the joints
Characteristics of osteoarthritis
limited to one or two joints, degenerative, common in the elderly and obese
early signs of osteoarthritis include:
joint stiffness, pain after inactivity
later signs of osteoarthritis may include:
pain unrelieved by rest, develop herberden/ bouchard nodes
herberden / bouchard nodes
Hard and tender bumps and lumps, crepitus
Tx of osteoarthritis includes
NSAIDS, TENS, heat, rest
Nsg care for osteoarthritis
medication teaching, encourage good posture, keep head of bed 45 degrees or less
a painful inflammation of the big toe/foot or hand/fingers caused by defects in uric acid metabolism resulting in deposits of the acid and its salts in the blood and joints
characteristics of gout include:
attacks last 1-2 weeks, swelling and tenderness may last longer
Tx for gout includes
try to control attacks in two ways 1) anti-gout meds, decrease amount of ingested purines
malocclusion of teeth, bruxism (grind teeth)meniscus displaced from fossa of temporal bone, jaw pain form muscle spasm
Systemic Lupis Erythematosus
Connectice tissue disease, Affects multiple body systems, most prominent sig being red butterfly rash on face
a chronic disorder characterized by widespread aching and stiffness of muscles and soft tissues and fatigue
inflammation of a bursa
S&S of bursitis include
painful movement of joint, distinct lump at joint
Tx fro bursitis
rest, mild ROM exercises, salicytates, NSAIDS
chronic, progressive arthritis with stiffening of joints, primarily of the spine
S&S of ankylosing spondylitis
flattened lumbar curve, aortic regulation, permanently flexed neck, reduced lung sounds
Tx for ankylosing spondylitis
medications, back brace
bone pain, waddling gait caused form insufficient calcium deficiency
abnormal bone remodeling, skeletal deformity
bone infection, treated by antibiotics and immobilization
an infection caused by the bite of an infected tick; symptoms vary but may include a rash at the site of the bite and flulike symptoms such as fever, headache, joint pain, and fatigue
An abnormal growth of tissue confined to a particular area; not considered to be cancer.
mass of cells that invade the surrounding tissue. Caused by radation exposure, toxic chemicals
Originating from bone,
metastatic, originating from somewhere else in the body
a surgical removal of all or part of a limb
some compilactain of an amputation may include:
hematoma, hemorrhage, infection, "phantom Limb"
1-2 days after amputation surgery Nsg should:
encourage self care, assist with walk/crutches, assist with active isometric exercise, no put a pillow btwn the legs
It is important aftet amputation to
keep the stump elevated only for the first 24-48 hours, after this DO NOT ELEVATE THE STUMP.
consists of water molecules of undissolved substances
1U whole blood contains
475ml bld cells and plasma, 60-70ml added preservatives and anticoagulants
a simple water-soluble protein found in many animal tissues and liquids
deficient in clotting factors, hemophilia A&B
What complications can occur when giving a blood transfusion?
Allergic, hemolytic, febrile, anaphalatic, circulatory
what is the NSg for an allergic reaction when transfusing blood?
decrease infusion rate, report, give antihistamine
what are the main characteristics of a hemolytic reaction when transfusing blood?
back pain, chest pain, shock . this is the most deadly and most rare of all reactions
Transfusion reaction caused by incompatibility
Nsg for a hemolytic reaction include
Call for help, Stop transfusion, infuse normal saline and a increased rate in a lower port
febrile reaction is
allergy to proteins in donor blood, it is also the most common
Tx for a febrile reaction is
stop transfusion and start normal saline
caused by sensitivities to immune globulins passed from donors blood
Signs and symptoms of anaphylactic reaction during a blood transfusion
respiratory distress, dyspnea, cyanosis
Tx for anaphylactic reaction during transfusion
STOP transfusion, do not restart, administer meds,
Circulatory over load during a transfusions is ?
a rapid transfusion in a short period, a sign of this is hypertension, dyspnea, and bounding pulse
Nsg for circulatory over load would be
Stop transfusion, notify Dr, give Oxygen and elevate head of bed
before obtaining blood products/ component from the blood bank you must verify:
client availability, client ID band affixed properly, written or verbal order documented, clients vital signs are acceptable, IV access established
what should the infusion start at
50-120ml /hr for the first 15 min, if there are no adverse reactions then increase the rate to 150ml/hr
how long is the time frame for each unit of blood given
2hrs, you should also stay with the Pt for the first 15min of the infusion
what is the MAX time acceptable blood can be hung for a transfusion
what percentage of people are RH positive>