surgical conditions

Question 1

non-modifiable risk factors for fractures?

Answer 1

increasing age, osteogenesis imperfecta, malabsorption of vit D and calcium

Question 2

modifiable risk factors for fractures?

Answer 2

low vit D, alc, smoking, glucocorticoid use (increases Ca renal excretion)

Question 3

types of fractures

Answer 3

1. open/ close
2. greenstick
3. impacted/ buckled
4. comminuted
5. spiral

Question 4

recovery phases for fractures

Answer 4

1. inflammatory phase
2. reparative phase
3. remodelling phase

Question 5

what happens in the reparative phase?

Answer 5

callus is formed by osteoblasts

Question 6

what happens in the remodelling phase?

Answer 6

callus is replaced with bone

Question 7

complications of fractures?

Answer 7

1. compartment syndrome (swelling & bleeding results in increased pressure under the skin, decreasing blood flow to tissues, resulting in tissue necrosis)
2. fat embolism for long bone fractures, which can result in pulmonary embolism
3. immobilised pts - pressure injury & DVT
4. hypovolemic shock (due to loss of blood)

Question 8

what are the 3 types of healing abnormalities?

Answer 8

1. malunion (inadequately aligned)
2. delayed union (more time needed)
3. nonunion (failure to align)

Question 9

treatment for fractures?

Answer 9

open/ close reduction (alignment)

Question 10

nursing mgmt for fractures?

Answer 10

circulatory motor sensory CMS check every 2h, limb elevation, analgesics and/ or ice packs for pain

Question 11

risk factors for cleft lip/ palate?

Answer 11

FACE
Folate deficiency
Advanced maternal age
antiConvulsants & steroids
Exposure to teratogens & maternal infections

Question 12

cause of cleft lip/ palate?

Answer 12

mutation of a gene

Question 13

complications of cleft lip/ palate?

Answer 13

feeding (weight loss/ failure to thrive), speech, otitis media (ear inflammation)

Question 14

treatment of cleft lip/ palate?

Answer 14

cheiloplasty (3-6 mths)
palatoplasty (6-12 mths)

Question 15

nursing mgmt for cleft lip/ palate pts?

Answer 15

NBM/ NGT, elbow restraints for 10 days, logan bow, keeping incision site clean and washed, upright position after eating

Question 16

what is hirschsprung disease?

Answer 16

neuron ganglia of a segment of the colon is missing, resulting in build-up of stool in the LI and hence, constipation.

Question 17

complications of HD?

Answer 17

excessive constipation results in massive colon dilation, and megacolon which can rupture

Question 18

clinical manifestations of HD?

Answer 18

1. infant fails to pass 1st stool meconium
2. bilious vomiting
3. failure to gain weight
4. constipation
5. refusal to eat

Question 19

diagnosis of HD?

Answer 19

1. digitial rectal exam results in explosive gas/ diarrhoea (squirt/ blast sign)
2. rectal biopsy show absence of ganglion cells to cfm diagnosis
3. abdominal x-ray (colon filled with stool seen)
4. anorectal manometry (assess muscles, fx and pressure in anus; lack of relaxation of internal sphincter muscle seen)

Question 20

non-surgical intervention of HD?

Answer 20

stool softeners, rectal irrigation to help with constipation

Question 21

what is the surgical intervention of HD called?

Answer 21

colostomy, resection of aganglionic segment of colon

Question 22

what to watch out for colostomy pts?

Answer 22

colostomy site care, rosy red/ pink stoma intact, clean and well above skin surface, will be on for a few months

Question 23

what to watch out for non-colostomy pts?

Answer 23

will have a lot of diarrhoea initially

Question 24

what to watch out for HD pts who resection of colon?

Answer 24

anus may need to be gently dilated/ stretched for several weeks

Question 25

what is pyloric stenosis?

Answer 25

pylorus doubles in size and narrows

Question 26

clinical manifestations of pyloric stenosis?

Answer 26

1. olive-shaped mass at epigastrium, above umbilicus 2. non-bilious projectile vomiting 3. excessive hunger 4. irritable, fussy mood 5. visible peristaltic waves

Question 27

complications for pyloric stenosis?

Answer 27

build-up of food causes gastric distention, resulting in vomiting. alkalosis due to loss of stomach acid and in the long run, weight loss and failure to thrive

Question 28

treatment for pyloric stenosis?

Answer 28

pyloromyotomy where pylorus is cut and separated

Question 29

nursing mgmt for pyloric stenosis?

Answer 29

it is normal to vomit after a few days post op 1-2 days

Question 30

what is the pain assessment scale for infants?

Answer 30

FLACC face, legs, activity, cry, consolability scale

Question 31

cause of PS?

Answer 31

unknown

Question 32

risk factors for PS?

Answer 32

1st born male