NRNP 6560 MIDTERM EXAM WITH BEST
SOLUTION FROM EXPERT GRADED A+
General rules for surgery: testing - ANSWERS-ECG before
surgery only if coronary disease, except when low risk surgery
Stress test not indicated before surgery
Do not do prophylactic coronary revascularization
Meds before surgery - ANSWERS-- Diabetic agents: Use insulin
therapy to maintain glycemic goals(iii) Discontinue biguanides,
alpha glucosidase inhibitors, thiazolidinediones, sulfonylureas,
and GLP-1 agonists
- Do not start aspirin before surgery
- Stop Warfarin 5 days before surgery. May be bridged with
Lovenox.
- Do not stop statin before surgery
- Do not start beta-blocker on day of surgery, but may continue
Assessment of surgical risk - ANSWERS-- Unstable cardiac
condition (recent MI, active angina, active HF, uncontrolled HTN,
severe valvular disease), concern with CAD, CHF. arrhythmia,
CVD
- patient stable or unstable?
- urgency of the procedure (oncology will be time sensitive)
- risk of procedure
- nutritional status
- immune competence
- determine functional capacity (need to be more than 4 METS,
more than 10 METs makes low risk)
Low risk surgeries - ANSWERS-catarcts
breast biopsy
cystoscopy, vasectomy
laporascopic procedures
Plastic surgery
Surgery risk classes - ANSWERS-Class 1: benefits outweigh risk,
should be done
Class 2a: reasonable to perform
Class 2b: should be considered
Class 3: rarely appropriate
intermediate risk surgeries - ANSWERS-Head/ neck surgery
thyroidectomy
Intraperitoneal
Prostate
Laminectomy
Hip/ knee
Hysterectomy
cholecystectomy
nephrectomy
non majot intrathoracic
High risk surgeries - ANSWERS-aortic/ cabg
transplants
spinal reconstruction
peripheral vascular surgery
Lee's revised cardiac risk index - ANSWERS-6 points:
High risk surgery = 1
CAD = 1
CHF = 1
Cerebrovascular disease = 1
DM 1 on insulin = 1
Creat greater than 2 = 1
1 = low risk
2 = moderate risk
3 = high risk
SCIP pre-operative infection measures - ANSWERS--
Prophylactic antibiotics should be received within 1 h prior to
surgical incision
- be selected for activity against the most probable antimicrobial
contaminants
- be discontinued within 24 h after the surgery end-time
Postoperative infection reduction methods - ANSWERS-- pre-op
hair removal (clippers)
- wash hands
- normothermia
- maintain euglycemia
- urinary catheters are to be removed within the first two
postoperative days
Osteoarthritis: what, incidence - ANSWERS-Slow destruction of
bones/ joint followed by production of replacement collagen
which causes inflammatory changes
- older than 60
- more female after 55
- more black than white women
- men and women equal risk between 45 - 55
- abnormal height or weight (obesity)
- repetitive movement
- prior trauma (sprains/ dislocations)
- diabetic neuropathy
- genetic
Osteoarthritis findings and diagnostics - ANSWERS-- Pain in
weight bearing joints
- stiffness after sitting, gets better when arising
- feeling of instability on stairs
- fine motor skills deficit
- larger affected joints
- Heberden nodules (bony bumps on the finger joint closest to
the fingernail)
- Bouchard's nodules (bony bumps on the middle joint of the
finger)
- limited ROM with crepitus
- xr shows narrowing of joint space (need anteroposterior and
lateral knee films bilaterally)
- synovial fluid is clear and without WBC
Osteoarthritis treatment - ANSWERS-Goal is to relieve
symptoms, maintain/ improve function, and avoid drug toxicity
Hand OA:
- rest/ joint protection, with splinting
- heat/ cold therapy
- topical capsaicin
- topical NSAID (trolamine salicylate) (especially for older than
75)
- Oral NSAIDS, incl COX2 inhibitors such as celecoxib (Celebrex)
(may cause cardiac problems)
- tramadol
- no opioids
Hip/ knee OA:
- weight reduction, cardiovascular exercises
- transcutanous external nerve stimulator
- acetaminophen
- Topical NSAIDS (knee)
- intraarticular corticosteroid injections
- surgery (joint replacement)
Rheumatoid arthritis: what, who - ANSWERS-chronic, systemic
autoimmune disease that causes inflammation of connective
tissue, first that of jionts them other soft tissues (renal,
cardiovascular, pulm). TNF-alpha plays a big role
- more women than men
- unknown cause
- Epstein Barr virus
Rheumatoid arthritis: Findings and diagnostics - ANSWERS--
symmetric joint/ muscle pain, worse in the morning then gets
better
- weakness, fatigue
- anorexia, weight loss
- generalized malaise
- swollen joints/ boggy feeling of joints with deformity of joints
- warm, red skin on affected joints
later:
- pleural effusions and pulmonary nodules
- inflammation of sclerea (scleritis)
- pericarditis, myocarditis
- splenomegaly (Felty's syndrome)
- anemia (hypochromic, microcytic) with low ferritin
- possibly: positive rheumatoid factor
- XR: joint swelling, later cortical and space thinning
- synovial fluid: yellow, thick with elevated WBC up to 100.000
Felty's syndrome - ANSWERS-rheumatoid arthritis,
splenomegaly, neutropenia
Rheumatoid arthritis treatment - ANSWERS-- early treatment
better than stepwise
- early referral rheumatologist
- disease-modifying anti-rheumatic drugs (DMARDs):
- methotrexate ( no alcohol, monitor renal and liver, give with
folic acid)
- cyclosporine
- Gold preparations (can cause thrombocytopenia)
- Hydroxychloroquine: antimalarial drug (may cause visual
changes, monitor)
- sulfasalazine, moderate RA
- Leflunomide, moderate to severe RA
- Etanercept
- monitor liver function with DMARDs
- screen for TB (skin test) and Hep B
- surgery: joint debridement, joint replacement
Gout: what, who - ANSWERS-Inflammatory disorder in response
to high uric acid production/ levels in blood and synovial fluid
causing crystallization which causes inflammation (Type A and
Mediterranean)
- impaired renal function which causes excess uric acid
- foods high in purine, such as dairy, red meat, shellfish, beer
advanced pathophysiology advanced pharmacology ati comprehensive predictor ati exit ati exit exam 2024 version comprehensive retake test ati fundamentals proctored ati rn fundamentals biology computer science computer studies education fundamentals of nursing health care health care/ nursing health care/ nursing/pediatrics health care/ nursing/pharmacology hesi a2 hesi rn exit exam mathematics medical-surgical nursing nclex nursing nutrition pharmacology psychotherapy with multiple modalities
Snel, betrouwbaar, veel aanbod van samenvattingen. Goed en duidelijk weergegeven.
Tijdens mijn studie aan de Arteveldehogeschool en KU Leuven heb ik opdrachten gemaakt die ik nu via Knoowy deel met andere studenten.
Ik ben altijd erg blij met de samenvattingen van Knoowy.
Bij Knoowy vind ik notities van vakken die mij helpen bij het leren.
Als student voor de examencommissie besparen samenvattingen mij een heleboel opzoekwerk!
Knoowy is handig voor tijdens de examens en biedt hulp bij tijdsnood. Heel gemakkelijk!
Knoowy heeft mij geholpen om aan samenvattingen te komen, zodat ik tijd bespaar door het zelf niet te hoeven maken.
Knoowy is heel handig om te gebruiken en je vind snel het materiaal dat je nodig hebt.