Complex Exam 2 Flashcards
What type of fracture causes the bone to be fragmented?
comminuted
What type of fracture is common with physical abuse?
spiral
What type of fracture is common in children?
greenstick
Does a greenstick fracture go all the way through the bone?
NO
What type of fracture might require a tetanus shot?
an open fracture
What is the grating sound created by the rubbing of bone fragments?
crepitus
What is the internal rotation of the extremity, a shortened extremity, or visible bone with an open fracture?
deformity
What causes ecchymosis with fractures?
bleeding from trauma into underlying soft tissues
What is a late finding with fractures?
subcutaneous emphysema
What causes compartment syndrome?
excessive swelling from a fracture
What does a neurovascular assessment consist of?
The 5 P’s
- pain
- paralysis
- paresthesias
- pallor
- pulses
How often should you do neuro checks with compartment syndrome?
q 15 mins
What is the hallmark sign of fat embolism?
petechiae on the chest and abdomen
What can a fat embolism result in? When are they most common?
- acute respiratory insufficiency or impaired organ perfusion
- long bone fractures
What can anticoagulants and ambulating prevent after a fracture?
DVT and PE
What type of fractures are most likely to cause infection?
open
What is important to determine with fractures?
mechanism of injury
What should you NOT do with fractures?
manipulate
What is malunion?
when a fracture heals incorrectly
What is nounion?
a fracture that never heals
What should you watch for with casts?
- skin breakdown
- ability to move fingers
- good perfusion
How do weights hang with skin traction?
over the edge of the bed but not touching the ground
How much weight can be used for skin traction?
no more than 10 pounds
What is Buck’s traction used for?
hip fractures and dislocation
How much weight can be used for skeletal traction?
15-30 pounds
What should you assess pin sites for?
drainage and redness
What is ORIF?
plates are added to straighten the bone during surgery
When would you use external fixation?
if surgery cannot be done yet or the fracture is not the priority problem
What is essential in improving circulation after a fracture?
fluids
How should you get out of bed after a fracture?
unaffected side first
Shoudl you elevate the extremity after an amputation or fracture?
YES
Shoudl you elevate the extremity affected with compartment syndrome?
NO
How can you monitor circulation after an amputation?
- angiography
- ankle-brachial index
When would an amputation be left open?
if there is an active infection
What does RICE stand for?
- rest
- ice
- compress
- elevate
How should you assess for perfusion after an amputation?
take pulses most proximal to amputation at the same time
What medication should you give for phantom limb pain within the first week?
calcitonin
What other medications can you give for phantom limb pain?
- BB
- gabapentin
- baclofen (muscle relaxer)
How can you help flexion contractures?
- ROM
- d/c elevation after 24-48 hours
- lie prone for 20-30 mins several times per day
What causes compartment syndrome?
a tight cast or splint or an internal source (accumulation of blood or fluid)
What is a fasciotomy?
a surgery to open the faschia to decrease pressure and increase perfusion
When might you see abrasions, hematomas, contusions, or deglovong?
with crush injuries
Why should you put a heart monitor on a patient with a crush injury?
crush injuries release potassium
What type of fluids should you give for crush injuries?
- warmed NS or LR
- blood products (PRBC’s or whole blood)
What should you check the urine for with crush injuries?
myoglobin (makes it concentrated and dark)
What type of pain arises from inflammation of tissue?
nociceptive
What can have somatice pain?
- joints
- bones
- muscles
- skin
- tissues
What can have visceral pain?
organs
What is referred pain?
pain comes from a different place than it is felt
What are the types of breakthrough pain?
- incident
- idiopathic
- end of dose medication failure
What can cause psychogenic pain?
depression, dewer endorphins
When should you use skin stimulation, distraction, relaxation, imagery, and elevation?
pain
What medications are most used for pain?
- analgesics (acetaminophen)
- PCA (morphine, delaudid)
What can happen to the urine with urinary calculi?
- frequency/urgency
- hematuria
- oliguria/anuria
How can you catch stones with urinary calculi?
strain the urine
What does shock wave lithotripsy do?
breaks up the kidney stone to help it pass
What does stenting do?
dilates the ureter
What surgeries can be done for urinary calculi?
- uterolithotomy
- pyelolithotomy
- nephrolithotomy
What should be limited with urinary calculi?
- sodium
- calcium
- animal protein
- purine sources
What should be avoided with urinary calculi?
- oxalate sources
- high phosphate foods
What electrolyte imbalances should seizure precautions be implemented for?
- sodium
- hypocalcemia
What electrolyte imbalance should you restrict fluids for?
FVO (hypervolemia)
What electrolyte imbalance should you encourage fluids for?
hyponatremia
How much sodium replacement can be done in 24 hours?
12 mEq
How should calcium gluconate/carbonate be given to someone with hypocalcemia?
as a bolus diluted in dextrose and water
What type of medications are important to avoid with hypocalcemia?
nephrotoxic (vancomycin, NSAIDS)
What electrolyte imbalance causes a positive Chvostek’s and Trousseau’s sign?
hypocalcemia
How can hyperkalemia be treated?
- glucose/insulin
- kayexelate/calcium gluconate
What marks the end of the onset phase of AKI?
the development of oliguria
How long does the onset phase of AKI last?
hours to days
How long does the oliguria phase of AKI last?
1-3 weeks
How long does the diuresis phase of AKI last?
2-6 weeks
How long can the recovery phase of AKI last?
up to 12 months
What are the main manifestations of AKI?
- anemia
- FVO
- hyperkalemia
What electrolyte imbalance shows peaked T waves and a wide QRS on the EKG?
hyperkalemia
What type of AKI has lack of perfusion to the kidney?
prerenal
How is the prerenal type of AKI reversed?
restoration of blood flow
What type of AKI has direct damage to the kidney from lack of oxygen?
intrarenal
What type of AKI is the hardest to reverse?
intrarenal
What type of AKI is the bilateral obstruction of structures leaving the kidney?
postrenal
What type of AKI is the easiest to reverse?
postrenal
What might you feel with postrenal AKI?
- full bladder
- flank pain
Does urine output usually increase or decrease with AKI?
decrease
What are the biggest risk factors for AKI?
- CKD
- HF
What should you watch for with hemodialysis?
- proteinuria
- metabolic acidosis
- oliguria
- dark urine
What is the antidote for anticoagulants?
protamine
What should be put in place to prevent infection from hemodialysis?
- aseptic technique
- standard precautions
What should you avoid doing to the arm with AV access?
compressing (BP, laying on it)
What is important to assess for with AV access?
palpable thrill and audible bruit
What causes disequilibrium syndrome from hemodialysis?
rapid increase in BUN and circulating blood volume
When should you slow the flow rate of hemodialysis?
- hypotension
- disequilibrium syndrome
What should you give for anemia caused by hemodialysis?
erythropoietin and blood products
What are manifestations of end stage renal disease?
- anuria
- proteinuria
- azotemia
- electrolyte imbalances
- FVE (HF, pulmonary edema)
What must match between the donor and recipient during a renal transplant?
tissue
What ages should be considered before having a kidney transplant?
> 70 or < 2
What type of meds will you take for the rest of your life after a kidney transplant and why?
immunosuppressants to prevent rejection
Why should you weight a kidney transplant patient everyday?
to assess for fluid retention
Why are hemodynamics so important after a kidney transplant?
internal bleeding
What might the urine look like after a kidney transplant?
pink tinged, bloody
When does a hyperacute rejection reaction occur after a kidney transplant?
in the first 48 hours
When does an acute rejection reaction occur after a kidney transplant?
1 week to 2 years after
What type of pain is caused by a UTI?
- lower back or abdominal
- urination
What symptoms do older adults have from UTI?
- confusion
- incontinence
- loss of appetite
- hypotension
- tachycardia, tachypnea
When would you experience frequent urination, foul smelling urine, dysuria, feeling of incomplete bladder, hematuria, nocturia, and voiding in small amounts?
with a UTI
