NURS 6560 LATEST UPDATE NEW!!!!! FINAL Q&A LATEST VERSION

NURS 6560 LATEST UPDATE NEW!!!!! FINAL Q&A LATEST VERSION Alcoholic liver disease: etiology, findings, management – ANSWER Most common cause of cirrhosis Women twice as sensitive to alcohol toxicity then men Binge drinking High mortality rate Diagnosis on report of alcohol intake, evidence of liver disease, lab abnormalities AST and ALT often high than 2 Score for mortality: Maddreys' score - Abstinence - MDF score greater than 32: prednisone for 4 wks - May require liver transplant Wilson's: what, etiology, findings, management - ANSWERFamilial autosomal recessive disease with neurological symptoms, by chronic liver disease, leading to cirrhosis. can be lethal. Caused by a lack of a certain gene that causes diminished excretion of copper into bile. Thus copper injury. Any pt between 3 and 55 with liver disease without clear cause. Abnormal aminotransferase Ceruloplasmin low (less than 50) 24-hr uriary copper: copper greater than 40. Liver biopsy to measure copper high bilirubin to alkaline phosphatase ratio greater than 2 D-penicillamine, initial ansd maintenance Zinc, blocks absorption of copper Avoid food and water with copper May need liver transplant when cirrhosis is present Family screening Fulminant liver failure/ acute liver failure: what, etiology - ANSWER- sudden impairment of liver cell function - Hep A, B, C, D, E - CMV, Epstein-Barr - drug-induced (Tylenol) - Toxins (mushrooms) - Vascular (heat stroke) - other liver disorders Acute liver failure: findings, management - ANSWERWeakness, fatigue weightloss, n/v, abd pain Change in bowel pattern - Check BMP, ABG, lactate, toxicology screen, acetaminophen screen, Hep panel, PT/ INR - Treat specific etiology: charcoal for acetaminophen and N-acetylcysteine) Supportive for Hep A and E Antiviral for Hep B Test for Wilson - ICU management: watch for cerebral edema, hyperventilate if present, mannitol. CT head for encephalopathy McMurray test, Lachman Test, straight leg test - ANSWERMcMurray: turn foot and bend knee. Positive with Meniscus injury Lachman test: Hold upper and lower leg, around knee, stretch. Hyperstretch: ACL injury Straight leg test: Pain when raising leg, while supine. Positive for herniated disk. Dislocation management - ANSWEREarly reduction is essential: closed/ manual if no fracture. If fracture then may need surgery. Postreduction immobilization (splint, cast, sling) surgical repair of ligaments PT/ OT NSAIDS Muscle relaxant for muscle spasms Narcotics for short term use Soft tissue injury: definition, classifications, incidence - ANSWERInjury to non-bony tissue, such as muscle, ligament, tendon, bursa, cartilage, skin Classification: - Closed injury: contusion, hematoma, crush, strain (muscle), sprain (ligament, first to third degree), rupture (muscle and ligaments: instability, inability to move) - Open injury: laceration, abrasion, penetrating/ puncture, amputations trauma exercise/ overuse autoimmune (RA, SLE) obesity age (skin tear elderly) Findings and diagnostics soft tissue injury - ANSWER pain swelling feeling of instability of joint Ruptures/ muscle tear: decreased ROM, immediate swelling and hematoma, abnormal contour muscle, instability of joint, pain/ guarding, watch neurovascular integrity Ligaments/ sprain: pain on palpation and ROM, decreased ROM with moderate swelling, Lachman's test (hypermobile joint is positive sign) Strain/ muscle or tendon: swelling, decreased/ absent ROM, pain/ guarding Cartilage: swelling, click during McMurray's test (would indicate meniscus tear), pain/ guarding Bursa: swelling with boggy feeling, erythema over bursa, decreased ROM Skin: abrasion, laceration, puncture Soft tissue injury findings and diagnostics - ANSWERWBC increased, especially with bursitis Hgb decreased with massive hematoma Synovial fluid aspiration: WBC with inflammation, RBC with bleeding into joint, crystals with gout Xr will reveal swelling MRI (knee/ shoulder) location and degree of injury Soft tissue injury management - ANSWERPRICE (protection, rest, ice, compression, elevation) possible immobilization surgery, if rupture, grade III ligaments sprain, septic bursa, wound closure PT NSAIDS Muscle relaxant Opioids - short term Broad spectrum ab's (cephalexin, cefazolin) Fracture Classification - Gustillo - ANSWER- Closed - Open: Type 1: wound smaller than 1cm Type 2: wound larger than 1cm, moderate contamination Type 3: high degree of contamination, severe fracture instability, soft tissue damage. T3A: soft tissue coverage adequate, T3B: extensive injury soft tissue, exposed bone, T3C: open fracture with arterial injury - Incomplete or complete - stress - traumatic/ pathologic - displaced/ non-displaced Type of fracture lines - ANSWERTransverse Spiral Oblique Comminuted Logtitudinal butterfly segmental impacted Salter-Harris Fracture Classification - ANSWERConcerns growth plate S: straight across growth plate A: Above growth plate L: BeLow growth plate T: Through growth plate R: ERaser of growth plate (Rammed) Cause of fractures - ANSWERTrauma, tumor, osteoporosis, drugs (prednisone), nutritional deficiency (Vit D), neuromuscular disorders Findings and diagnostics of fractures - ANSWERPain History of traumatic event Neuromuscular dystrophy: headache (autonomic dysreflexia) Deformity of limp Diminished/ absent pulses ecchymosis and swelling xr, always order anteroposterior and lateral CT scan for pelvic and spinal fractures MRI for suspected spinal cord injury Mortise view (leg inward) for ankle to check talus bone oblique films for humerus, femur, ankle DEXA scan to determine degree of osteoporosis Acute Fractures Management - ANSWER- ABC care (Airway, breathing, circulation), musculoskeletal second survey - fluid resuscitation - early reduction of fracture - cover open wounds - surgical irrigation and debridement for open fracture - Ab's: Cefazolin for gram pos. Clindamycin for tetani infection - pain: opioids - tetanus shot of unknown - calcium upon discharge for osteoporosis - cement injection in bone with vertrebroplasty Fractures: Reduction - ANSWER- Orthopedic surgeon referral - buddy-tape toe fracture for immobilization - radius/ ulna: splint with ace-wrap, unless open - post reduction xr - check neurovascular function pre and post reduction - intramedullary rodding for closed femoral and tibial fracture - external fixation for open fracture Compartment syndrome: what, who - ANSWERIncreased pressure in tissue limits the circulation and function of the contents within that space (compartment: bone, blood vessel, nerves, muscle, soft tissue). Most often in arms and legs (most compartments), also abdomen Men under age 35 stemming from fracture of tibia stemming from splint, cast, scar increased swelling due to hemorrhage, coagulation disorder, infiltrated iv site, trauma/ surgery, burn, bite Compartment syndrome finding and diagnostics - ANSWERpain out of proportion to injury hx of trauma paresthesia heaviness in affected extremity Six P's: Pain on passive stretch Paresthesia Paralysis of affected limb (late finding) Pulses, bounding first then pulseless later Pallor of affected limb Polar/ poikilothermia (ice cold limb) Elevated WBC Hyperkalemia (tissue necrosis) CPK and LDH elevated Myoglobin in urine Elevated compartment pressure (normal 0-8) Clinical diagnosis, MRI may confirm Acute renal failure (due to myoglobinuria) Compartment syndrome management - ANSWERNon surgical: - limb at heart level (do not elevate) - remove bandages/ immobilizers - diuretic - neurovascular checks - CRRT/ dialysis to treat ARF - intracompartmental pressure monitoring Surgical: - fasciotomy, with delayed closure of wounds (negative pressure wound vac) - skin grafting - amputation if septic from necrotic tissue Restorative: - functional splinting - ROM - early prostethic fitting post amputation Low back pain - four major syndromes - ANSWER1. Back strain 2. Disk herniation 3. Osteoarthritis/ disk degenration; osteophyte (bone spur) 4. Spinal stenosis: narrowing spinal foramen leading to spinal nerve entrapment Specific findings for back pain - ANSWER- numbness - saddle anesthesia (CA, mass) - bowel, bladder dysfunction (emergency surgery) - pain worse at rest (CA, tumor, infection) - Discitis, epidural abcess (IV drug use) - Decreased rom - Radiculopathy (pain down leg), not with OA - Crossover straight leg test: herniated disk - back, buttock, leg pain when ambulating (neurogenic claudication with spinal stenosis). Also positive straight leg raise test with spinal stenosis xr anteroposterior, to rule out scoliosis, bone spur MRI for soft tissue structure, bulging disk CT for bony imaging Cauda Equina Syndrome - ANSWERSpinal cord compression from metastatic lesion to spine. Causes: gradual to sudden weakness and inability to move/ lift legs, bowel/ bladder incontinence, diminished sensation in legs: saddle. Surgical emergency!