MedSurg Test 4 2nd Semester

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MedSurg Test 4 2nd Semester
2013-10-25 18:33:54
MedSurg Test 2nd Semester

MedSurg Test 4 2nd Semester
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  1. what is a contusion?
    bleeding into soft tissue as a result of of blunt force
  2. what is a muscle strain?
    stretching injury to a muscle or a muscle-tendon unit caused by mechanical overload
  3. what are the s/s of a muscle strain?
    pain, limited motion, muscle spasm, swelling and possible muscle weakness
  4. what is a sprain?
    • stretch or tear of a ligament surrounding a joint
    • *ankle and knee are most common
  5. what are s/s of a sprain?
    cant move joint, discoloration, pain, rapid swelling
  6. what does RICE stand for?
    • Rest
    • Ice
    • Compression
    • Elevation
  7. what is a dislocation?
    ends of two connected bones separate as a result from extreme force put on a ligament
  8. what are symptoms of dislocation?
    pain, swelling, immobility, deformity, warmth, bruising, or redness in injured area
  9. what is bursitis?
    • inflammation of the bursa
    • bursa is a tiny fluid-filled sac located adjacent to the tendona near large joints
  10. what causes bursitis?
    injury, infection, underlying rheumatic condition, inflammation of bursa from gout crystals
  11. how is bursitis treated?
    ice, rest, anti-inflammatory and pain meds, aspiration of bursa fluid, cortisone injection
  12. how is septic bursitis identified?
    aspiration and culture of fluid to identify organism
  13. how is septic bursitis treated?
    • aggressive vancomycin treatment
    • may need repeated aspiration of fluid
    • surgical drainage and removal of infected bursa sac
  14. what is carpal tunnel syndrome?
    the median nerve in the wrist becomes compressed causing pain and numbness
  15. what are clinical manifestations of carpal tunnel syndrome?
    • phalen's maneuver, tinel's sign, numbness, painful tingling, weak pinch, clumsiness and difficulty with fine movements. 
    • progresses to muscle weakness
  16. how is carpal tunnel syndrome diagnosed?
    xray, emg, mri, ultrasound
  17. how is carpal tunnel treated?
    • nsaids, corticosteroid injections
    • immobilization of wrist
    • surgical nerve decompression
  18. what causes a torn meniscus?
    usually a result of twisting the leg when the knee is flexed and foot is on the ground
  19. what are the s/s of a torn meniscus?
    • pain, swelling and tenderness in the knee
    • clicking or snapping sound when the knee is moved
  20. what is a muscle spasm?
    involuntary movement or contraction of muscles without full control
  21. what causes muscle spasms?
    muscle fatigue, dehydration, low Mg or Ca, alcoholism, kidney failure
  22. how are muscle spasms treated?
    • antispasmodic muscle relaxants
    • nsaids
    • opioid analgesics
    • steroids
    • relaxation techniques
  23. what is a complete fracture?
    break is across the entire width of the bone, the bone is divided into two distinct sections
  24. what is an incomplete fracture?
    the fracture does not divide the bone into two distinct sections, break is through only part of the bone
  25. how do you perform a neurovascular assessment on a fracture?
    • compare the injured area with its systemic counterpart
    • assess color, temp, movement, sensation, pulse, cap refill, pain
  26. emergency treatment of a fracture:
    • cover with sterile dressing if open
    • immobilize
    • do not attempt to clean
    • do not reduce
  27. what are the s/s of a fracture?
    pain, diminished mobility, change in bone alignment, shortening of extremity, swelling, discoloration, crepitation - a grating aound created by bone fragments rubbing together
  28. what are the complications of a fracture?
    • acute compartment syndrome secondary to swelling
    • dvt secondary to immobility
    • infection (osteomyelitis)
    • fat embolism syndrome
    • delayed union, nonunion and malunion
  29. what is acute compartment syndrome?
    pressure from edema and hemorrhage
  30. what are internal and external causes of acute compartment syndrome?
    • internal=hemorrhage
    • external=casts and constricting dressings
  31. what are s/s of acute compartment syndrome?
    • numbness and tingling (paresthesia)
    • pallor of tissue, weak pulse
    • weakness of extremity
    • pain with passive movement of extremity
    • pain that is unrelieved by pain medication
  32. what are risk factors for infection?
    • open fracture
    • diminished bloodflow
  33. infection leads to...
    • delayed wound healing
    • osteomyelitis
    • tissue death and necrosis
  34. what is a fat embolus?
    • fat globules lodge in lungs or peripheral circulation
    • occur in long bone fractures
  35. what are s/s of a fat embolus?
    • petechiae
    • dependent on where that fat has lodged
  36. how is a fat embolus prevented?
    early stabilization of fracture
  37. what types of casts are available?
    • plaster of paris
    • fiberglass
    • polyester-cotton knit
  38. what complications can occur from a cast?
    • infection
    • circulatory impairment
    • peripheral nerve damage
    • complication of immobility
  39. what is an external fixation?
    pins are implanted into the bone and held in place ny an external metal frame to prevent bone movement
  40. what are s/s of a hip fracture?
    • affected leg will be shorter
    • affected leg will be externally rotated
    • edema, stiffness and bruising
    • pain in hip or groin
    • inability to bear weight on affected extremity
    • muscle spasm
  41. what is the chief concern in a pelvic fracture?
    hemorrhage and shock
  42. what are most compression fractures of the spine associated with?
  43. how are compression fractures ofthe spine treated?
    • nonsurgical management = bedrest, analgesics, and physical therapy
    • surgical = vertebroplasty and kyphoplasty in which bone cement is injected
  44. paget's disease is characterized by...
    an excess of bone destruction and unorganized bone formation
  45. what is the cause of pagets disease?
    • unknown
    • genetic predisposition in 10% of patients
    • slow viral infection may trigger the disease
    • autoimmune dysfunction
  46. what bones does paget's disease affect?
    vertebrae, skull, pelvis, femur, and tibia
  47. paget's disease : pathophysiology
    • increase in osteoclasts cause bone reabsorption
    • increase in osteoblasts cause bone formation
    • result is new bone that is structurally weak and enlarged
    • deformities and bony enlargement occur
  48. what are s/s of paget's disease?
    • none in early stages
    • severe and persistent pain that intensifies with weight bearing
    • cranial enlargement (headaches, hearing and vision impaired)
    • kyphosis, barrel shaped chest, asymmetrical bowing of tibia and femur
    • site warm and tender
    • slow and incomplete healing of fractures
  49. what is osteomalacia?
    • adult bone disease
    • vitamin d deficiency resulting in decalcification and softening of the bone
  50. what are s/s of osteomalacia?
    • pain
    • difficulty walking
    • fractures and delayed healing
    • height loss
    • kyphosis
  51. which foods contain vitamin d?
    eggs, low fat milk, fish, vegetables
  52. what is osteoporosis?
    • porus bone with low bone mass
    • structural deterioration of bone tissue
    • known as the silent thief
  53. what are the risk factors for osteoporosis?
    female, increasing age, family hx, white or asian, small stature, early menopause, hx of anorexia or oophorectomy, sedentary lifestyle, insufficient dietary calcium, cigarette smoking, alcoholism
  54. which medications may cause osteoporosis?
    • corticosteroids
    • anti-seizure meds
    • aluminum-containing antacids
    • heparin
    • certain cancer treatments
  55. what are clinical manifestations of osteoporosis?
    • back pain or spontaneous fracture
    • fracture from minimal trauma
    • hip, vertebral or wrist fracture
    • spinal deformities
  56. which foods are high in calcium?
    sardines, milk, ice cream, cottage cheese, yogurt
  57. which dietary factors should be decreased in patients with osteoporosis?
    alcohol and caffine
  58. what is osteomyelitis?
    bacterial infection of the bone caused by fungus, parasites, and virus
  59. what is hematogenous osteomyelitis?
    pathogens are carried in the blood to the bone from sites of infection elsewhere in the body
  60. how can a patient get osteomyelitis?
    • from a contiguous infection
    • vascular insufficiency
  61. what are risk factors for osteomyelitis?
    • intravenous drug abusers
    • hemodialysis patients
    • recent trauma
    • diabetes mellitus
    • spleenectomy
  62. how is osteomyelitis diagnosed?
    • bone scan
    • blood test/culture
    • wound culture
  63. what is localized scleroderma?
    • a chronic autoimmune disease that causes hardening of the skin and scarring
    • can be limited around  the fingers or in large areas such as limbs
  64. what does CREST stand for?
    • Calcinosis - calcium deposits in the skin
    • Raynauds syndrome 
    • Esophageal dysfunction - acid reflux and decrease in motility of the esophagus
    • Sclerodactyly - thickening and tightening of the skin on the fingers and hands
    • Telangieactasias - dilation of capillaries causing red marks on the surface of the skin
  65. what are clinical manifestations of osteoarthritis?
    • joint pain (grating pain that diminishes after rest and intensifies after activity)
    • joint stiffness after a period of inactivity
    • crepitus (grating sound)
    • joint enlargement due to bony hypertrophy
    • joint is rarely hot or inflamed
  66. what are systemic signs of rheumatoid arthritis?
    • loss of appetite
    • low grade fever
    • anemia
    • fatigue
  67. what are localized signs of rheumatoid arthritis?
    • muscle and joint aches
    • stiffness
    • muscle joints are inflamed in a symmetrical pattern
    • joints become red, swollen, painful, and tender
  68. what is primary gout?
    • most common type
    • results from inborn errors of purine metabolism or a decrease in renal uric acid excretion
  69. what is secondary gout?
    involves hyperuricemia caused by another disease process such as renal insufficiency, multiple myeloma, certain carcinomas
  70. what are clinical manifestations of gout?
    • pain, swelling, redness, warmness and stiffness in the affected joint
    • inflammation of the tissue around the joint also causes the skin to be swollen, tender and sore
  71. post-op care for a total hip replacement:
    • wound care: stitches or staples will be removed 2 weeks after surgery, avoid getting wet, bandage over incision, observe for bleeding
    • may have drain in place: monitor output
    • assess for neurovascular compromise: color, temp, pulses, cap refill, movement/sensation, compare to non-operative side
    • pain: epidural analgesia, pca
  72. progression of activity for a total hip replacement:
    • pt gets out of bed the day after surgery and physical therapy is started
    • raised toilet seats and chairs to prevent hyperflexion
    • a patient with a cemented implant is allowed immediate partial weight bearing (PWB) or full weight bearing (FWB)
    • a patient with a noncemented implant cannot tolerate FWB until bony ingrowth occurs
  73. post-op care for a total knee replacement:
    • similar to THR
    • maintain the knee in a neutral position - not internally/externally rotated
    • knee brace
    • continuous passive motion device