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Flashcards in BIG exam 1 topics Deck (57)
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1
Q

Stage 1

A

skin intact

2
Q

Stage 2

A

skin not intact, no bruising, possible fluid filled blister

3
Q

Stage 3

A

positive brusing, no m/b/t exposed

4
Q

Stage 4

A

m/b/t exposed, positive brusing

5
Q

REEDA

A

Redness
Edema
Echymosis
Drainage
Approximation

6
Q

COCA

A

Color
Odor
Consistancy
Amount

7
Q

Dehiscence

A

“incision split”
Risk - above 30, steriods, diabetes, obesity, immune deficency, malnutrition

8
Q

Evisceration

A

total seperation, organs coming out
cover w sterile 4x4 guaze, call md, stay w pt

9
Q

Purulent (PROBLEM)

A

creamy yellow pus - staph
greenish/blue “fruity odor” - pseudomonas
beige “fishy” proteus
brown - fecal aerobic

10
Q

Sanguineous

A

bloody (immediate after surgery)

11
Q

Serosanguineous

A

yellowish mixed with light red, pale pink

12
Q

serous

A

serum like or yellow

13
Q

Pruitus

A

itching
avoid itching r/t breaking skin and getting another infection
tx - cooling agents (ice packs)

14
Q

Urticaria

A

hives
white/red edamatous papules/wheals
tx - antihistamine (AVOID ALCOHOL r/t CNS stimulant)

15
Q

Psoriasis

A

autoimmune, genetic
flaky/scaly plaques
avoid tanning beds
D/C biologic agents in fever/sore throat/sickness, call MD STAT

16
Q

Cellulitis

A

warn, tender, painful, swollen, red, edema, LYMPH EDEMA
warm compress

17
Q

Clubbing is r/t

A

copd, hypoxia, HD pts, lung cancer
edema/spongy when palpated

18
Q

Spoon like is r/t

A

anemia, IRON DEFICENCY, diabetes
flat/curved nail plate

19
Q

Skin Cancer

A

Asymmetry one half unlike the other
Border irregular
Color aries
Diameter (LESS THAN 6CM)
Evolving looks differernt from rest
Body mole map - monthly, complete before getting in shower

20
Q

Parasitic Disorders

A

DISINFECT WITH HOT WATER AND DETERGENT

21
Q

Informed Consent

A

Nurse gets pt to sign
Nurse can witness
SURGEON HAS TO DO TEACHING
Blind - sign, x2 witness
Cant write - “x” x2 witness
Language/hearing impairment - qualified translator, x2 witness

22
Q

PRE SURGERY

A

Shower/bath with chlorhexadine

23
Q

Decrease DVT by

A

enoxaparin day 1 post op
sequential stockings RIGHT before surgery
early ambulation

24
Q

Inflammation

A

doesnt mean there is always a POSITIVE infection
Neutrophils increased? infection process

25
Q

Hand Hygiene

A

15-30sec

26
Q

Surgical asepsis

A

3-5minutes

27
Q

CDIFF

A

contact

28
Q

MRSA/VRE

A

contact

29
Q

Pediculosis (lice)

A

contact

30
Q

RSV

A

contact

31
Q

scabies

A

contact

32
Q

diptheria

A

droplet

33
Q

streptococcyl pharngitis

A

droplet

34
Q

influenza A/B

A

droplet

35
Q

PNA

A

droplet

36
Q

rubulla

A

droplet

37
Q

mumps

A

droplet

38
Q

pertusis

A

droplet

39
Q

meningitis

A

droplet

40
Q

measles

A

airborne

41
Q

varcilla

A

airborne

42
Q

shingles

A

airborne

43
Q

Nurse role in OR

A

temp 62-64
PT ROM
sterile field
padding extrem

44
Q

general sedation

A

give benzo (versaid) intubated - always check for GAG REFLEX before giving anything/ice chips

45
Q

Malignant hyperthermia

A

LIFE THREATENING muscle disorder r/t anesthesia drugs
s/s: increased c02 level, decreased 02, tachycardia, EXTREAM temp
TX: dantrolene sodium

46
Q

Spinal anesthesia

A

fetal position, L4/L5
CHECK DISTAL PULSES TO LOCATION AND SENSATION

47
Q

POST OP to HOME
3 goals

A
  1. maintain 02 saturation
  2. basline b/p 20mm up or down systolic
  3. pain management
48
Q

Post op bowel function?

A

minimum of 4 hrs bs should return

49
Q

High risk pts for dehiscence

A

diabetes, malnutrition, obesity, immune deficiencies, steriod use

50
Q

Possible post op hemmorrhage sign?

A

skin discoloration

51
Q

urinary retention

A

bladdder scan- does not require order
should NOT be able to palpate bladder

52
Q

hypothermia

A

beir hugger blanket, can warm IV fluids, heat packs 20 min on 20 min off

53
Q

anemia s/s

A

cold, pale, fatigue, LOW b/p, HIGH RR/HR, nails refill slowly

54
Q

sickle cell (IHOP)

A

genetic
RBC are affected, leading to LOW 02 level
IV
Hydrate NS/LR
OXYGEN
PAIN (high dose IV dilulaid (PCA pump)
keep hob 30 or higher
AVOID high altitudes, extreme temps, pregnancy
keep room at 72 (not hot/cold)
CBC to check HGB/HCT levels

55
Q

Iron deficiency

A

s/s: spoon shaped nails, persistant HA
TX: iron supplements, FOODS ( green leafy vegs, red beets, organ meats )
risk = alcoholism

56
Q

B12 Deficiency

A

s/s: parasthesia, infertility, GLOSSITIS, poor balance
TX: subQ B12 injections for life (90 angle)
FOOD ( protein, fish, eggs, nuts, dairy, citrus fruits, MODERATE green leafy vegs
RISK = gut issues (chrons, diverticulitis, baratric, diarrhea )

57
Q

Folic Acid
“FALL COLORED FOODS”

A

TX: squash, avacodo, tomatoes, apricots, zucchini
RISK = pregant woman, immunocompromised (cancer pts), malabsorption (wt loss)