Med-Surg II Pretest *underlined means mentioned somewhere on the test Textbook page # 1010 1014 Pre-test keywords Systemic

lupus erythematosus Osteomyelitis Possible (Related) Answer(s) believed to be autoimmune Definition: inflammation within the bone secondary to penetration by infectious organisms (trauma, surgery) Complications: septicemia, thrombophlebitis, muscle contractures, pathologic fractures, nonunion fractures -complication related to bone fracture (isotonic solutions) ringers lactate & 0.9% sodium chloride

ATI (799) 206, 995(table 62-1)

226, 227(table 18-5) 734(table 48-1), 741(fig 48-5) 155

Treatment for hypovolemic shock (a complication of fractures)? Isotonic, hypotonic, hypertonic solution Interleukin-2 (IL-2): used in combination w/chemotherapy Solid stool: what type of colostomy? Surgical room +in relation to infection? (choices: lights, # of people, steel furniture, room temp)

-stimulate the production of lymphocytes Side effects: flu-like symptoms, GI disturbances, alopecia, low blood counts Sigmoid colostomy Furniture is made of stainless steel for easy cleaning & disinfecting. Temperature in the OR is kept below 70 degree Fahrenheit to provide a cooler environment that does not promote bacterial growth, to offer more comfort for OR personnel working in bright lights & wearing OR attire, & to maintain a temperature that enhances pt comfort & safety. Food & fluids are to be withheld, often at least 8-10 hrs before surgery. After midnight the night before surgery, pt usually is NPO. Clear fluids up to 3 or 4 hrs before surgery. The nurse is responsible for ensuring that all necessary parties have signed the consent form & that its in the pts chart before the pt goes to the OR. -Clinical manifestation of Fat embolism: cutaneous petechiae -Physical assessment finding for pulmonary embolism: petechiae

148

Food & fluid restrictions

147

Whose responsibility is it to get the surgical consent form signed?

995 (table62-1)

Complications related to a bone fracture or its treatment: compartment syndrome, fat embolism, pulmonary embolism

996

Fractured femur?

Usually treated w/ some form of traction to prevent deformities & soft-tissue injury. Skeletal traction or an external fixator is used to align the fracture in preparation for future reduction if the fracture occurred in the lower 2/3s of the femur. -Most common injury in older adults. -Assessment finding: a large blood loss may accompany subtrochanteric & intertrochanteric fractures, leading to hypovolemic shock. - signs of systemic infection (fever, increased WBC, chills, malaise). -Type of traction: skin traction e.g. Bucks traction (used for hip fractures preoperatively for immobilization in adult pts. -Hip arthroplasty nursing management: use an abductor pillow /abduction device between the pts legs while in bed (& w/ turning). Additional risk factors: female, older than 50 years of age, 1st degree relative w/ breast cancer, etc. -Nausea & vomiting, stomatitis, alopecia, fatigue, myelosuppression. Severe anemia, bleeding tendencies, leukopenia, neutropenia, & thrombocytopenia are possible if bone marrow depression is profound. - Immunosuppression due to bone marrow suppression by cytotoxic medications is the most significant adverse effect of chemotherapy. -pt must sign consent form before receiving any preoperative sedatives. -know procedural sedation a. b. c. d. Portal HTN Esophageal varices Ascites Hepatic encephalopathy-CNS manifestation of liver failure r/t an increase serum ammonia level that often leads to coma & death. Indications of CNS effects include disorientation, confusion, personality changes, memory loss, asterixis(flapping tremor, liver flap), positive babinski reflex, fetar hepaticus (sulfurous breath odor)

Fractured hip + complication w/ hip fracture (malaise, chills), indicates what?

971, 996

Traction + abductor/abduction

850

222

Risk factors of Breast cancer: early menarche, late menopause, having no children or having children after 30 years of age Adverse effects of chemotherapy

ATI

147 153 708-715

Sedatives/sedation

Complications of cirrhosis

640

Barium enema

141, 142

Transfusion reaction w/ bones + calcium (postmenopausal)

1016 159-162 (Nutrition notes 14-1) 163 165-166

Wound care: most important part in teaching

-a.k.a. lower GI series-used to identify polyps, tumors, inflammation, strictures, & other abnormalities of the colon. -To reduce the formation of stool & remove any residual stool, pt follows prescribed restrictions & procedures 24-48 hrs before barium enema: a. low-residue diet 1-2 days before test b. clear liquid diet the evening before test c. laxative the evening before test d. NPO after midnight e. may have up to 3 cleansing enemas the morning of the test (if not contraindicated by inflammation or active bleeding) -reduced levels of serum Ca+ can produce symptoms in pts who receive massive transfusion of blood over a very short time. Citrate, which is added to the donor blood, binds w/ calcium in the recipients blood causing hypocalcemia. S/S: tingling of fingers, hypotension, muscle cramps, convulsions Cause: multiple blood transfusions containing anticalcium agents Actions: stop blood infusion. Maintain an IV infusion w/ 0.9% NaCl. Report findings. Be prepared to give antidote, calcium chloride. Osteoporosis -protein, calories, Vitamins A & C, & zinc are important for wound healing & immune system functioning. -Client & family teaching 14-1: care of postoperative wounds/incisions -Standard V: wound healing is promoted & wound management is provided. Know Interventions since it relates! -One of the systemic complications of ulcerative colitis. -Surgical Procedure for Ulcerative Colitis: Colectomy with or without ileostomy -Therapeutic management: partial or complete colectomy, w/ ileostomy or anastomosis -Complications: Peritonitis may occur due to perforation of the bowel. Abscess formation; Bleeding occurs due to deterioration of the bowel. Fluid and electrolyte imbalance occurs due to loss of fluid through diarrhea and vomiting, and may occur with nasogastric

682

Malignant neoplasm

682, ATI

Crohns disease

736

Possible postoperative complications for an ileostomy S/S of advanced liver disease (a failing liver, as in advanced cirrhosis) answer is not jaundice Total hip replacement

715

suctioning. Intestinal obstruction; bleeding; impaired blood supply to, stenosis of, or prolapse or excessive protrusion of stoma Confusion or difficulty thinking (according to Ms. K) Pt needs to have legs abducted & extended because the opposite positions of adduction & flexion beyond 90 degrees can dislocate the prosthetic femoral head from the acetabulum. Pt need to sit in an elevated chair or on a seat raised by pillows, so that the flexion remains less than 90 degrees. -Box 61-5 Avoiding hip dislocation after conventional replacement surgery - nutrition notes 54-1: client @ risk for breast cancer Hormone therapy: Gonadotropin-releasing hormone (GnRH)-leuprolide (Lupron) -inhibits estrogen synthesis -may be used in premenopausal women to stop or prevent the growth of breast tumors

980

861 ATI (699)

Breast cancer + premenopausal