Revalida 3rd Year 2nd Sem

IV Therapy

• Installation of fluid, electrolytes, medication, nutrition in the vein

• Can be intermittent or continuous;

IV Drip

This refers to the continuous administration of IVT

42 days

RBC Storing

Isotonic solution

• These are solutions that have the same osmotic pressure as that found within the cell (similar concentration of solutes as plasma)

• Used to expand IV COMPARTMENT - increase circulating volume

Hypotensive and hypovolemic

In what condition is Isotonic Fluids used for?

Hypotonic Solutions

• These have less osmotic pressure than cell  (less concentration of solutes than plasma) 

• Less osmolarity than serum (less sodium ion concentration than serum) 

• Cell = Bloat

Sudden fluid Shifts

What must we look out for in patients with hypotonic solutions?

D5W, Half NS

Give examples of hypotonic solutions

Hypertonic solutions

• Greater osmotic pressure (greater concentration of solutes than plasma) 

• Cell = shrink

• Administered to post-operative patients to maintain circulating volume and prevent edema

Cell dehydration

What is the contraindication for hypertonic solutions?

Vein selection

• Use distal veins first

• Use non-dominant had if possible

Avoid

What do we do when a patient’s vein feels like a cat’s tail?

72 - 96 hrs

We must choose a vein that can support the IVT for how many hours?

Infiltration

This occurs when the needle becomes dislodged from the vein

Thrombophlebitis

This is a condition due to the overuse of a vein, irritating solution, medication, clot formation or large-bore catheter

Circulatory Overload

This complication results from administration of excessive amounts of IV fluids

• S/Sx: headache, flushed skin, rapid pr, increased bp, wt gain, syncope and faintness, pulmo edema, SOB, tachypnea, shock

Temporary colostomy

• This is a type of colostomy generally performed for traumatic injuries or inflammatory conditions of the bowel.

• They allow the distal diseased portion of the bowel to heal

• May be needed for a period of time to allow a portion of the colon to heal and later be reanostomosed (rejoined).

Permanent colostomy

• This is a type of colostomy that is  performed to provide a means of elimination when rectum or anus is nonfunctional as a result of a birth defect or a disease such as cancer of the bowel.

• Usually performed at the sigmoid colon

liquid fecal drainage

What is the stool characteristic presented in ileostomy?

Ascending colostomy

• similar to ileostomy drainage is liquid and cannot be regulated and digestive enzymes are present.

  • However odor is a problem requiring control.

Transverse Colostomy

• produces a malodorous, mushy drainage because some of the liquid has been reabsorbed.

• There is usually no control

Descending Colostomy

• produces increasingly solid fecal drainage. Stools from a sigmoidostomy are of normal or formed consistency.

• People with sigmoidostomy may not have to wear appliance at all times, and odors can usually be controlled.

Peristomal skin excoriation

• is the most common skin complication. It can lead to redness, weepy bleeding areas, pain, itching, stinging or burning sensations.

• Other factors which lead to excoriation include chemotherapy, radiation, side effects of certain drugs like steroids, antibiotics or immunosuppressives

• Poor hygiene, an inappropriate pouching system as well as allergies or sensitivity can cause skin reactions

Mechanical Irritation

• Is another common source of irritation. This tends to be related to the removal technique of ostomy appliances or due to fragile skin.

• If an appliance is removed too quickly, then the first layer of the skin may become damaged leaving a patchy, red, painful area that may “weep” fluid.

• Routine removal of the appliance should be done slowly and gently by rolling or pushing the skin away from the back of the appliance.

Allergies or sensitivities

•  These reactions are not always predictable and may take months or years to develop. Sometimes, the reaction can occur quite quickly, particularly if there is known previous sensitivities to tapes.

• The reaction can range from persistent itchiness without actual rash or skin breakdown, to blistering and redness.

• If there is actual blistering of the skin, then at an absolute minimum, the choice of appliance must be change

Folliculitis

• Infected hair follicles can cause redness and sometimes pustules at the base of the hair follicles.

• There is often itching, burning and pain. This can be due to damage to the hair follicles usually after the traumatic removal of an appliance or when tape is removed too quickly.

• To prevent damage to the hair follicles, excess hair around the stoma should be gently removed with an electric razor. Always shaving in the direction of hair growth

Monilia/ Candida Albicans

• occur under the appliance as a result of excessive moisture and heat (eg.perspiration on hot humid days; long soaks in hot tubs)

• After antibiotic use, or when someone is immunocompromised (eg.chemotherapy).

• Patches of yeast are solid red in color with an irregular border and will have tiny little red or white points scattered out from the main rash called “satellite lesions”. It can be itchy and in severe cases may weep slightly

Pectin-based powder, mycostatin powder

What is the treatment choice of monilia/ candida albicans?

Retracted stoma

• This can be described as a stoma that has sunk below skin level. A retraction may be partially or completely below the skin level.

• Causes: Technical difficulty at the time of surgery, Weight gain post-operatively, Pregnancy when the stoma may become stretched

• The goal is to increase the degree to which the stoma protrudes.

• This can de done by adding convexity to the pouching system which will help to “bud” the stoma.

• Another if convexity does not resolve the problem then add flexibility to the pouching system which may help to conform and adhere to uneven skin surfaces

Peristomal Hernia

• is characterized by bulging of the area around the stoma.

• It can result in a blockage or obstruction.

• A hernia can occur due to weak abdominal muscles, inadequate healing or difficulties at the time of surgery

• Hernias can be supported by hernia belt, a wide tensor bandage or light-weight panty girdle.

• A flexible pouching system might adhere better to the bulging skin surface.

• Surgical repair may be necessary if pain or obstructive symptoms become an issue of concern.

Prolapsed Stoma

• Is an increase in size of the stoma, usually in the length of the stoma.

• Causes: obesity, too large an abdominal opening for the bowel which may prevent the mesentery from remaining secured to abdominal wall, increased intra-abdominal pressure that may occur with coughing, sneezing or vigorous peristalsis.

• In the event of prolapse, it is recommended that the patient lie down and the stoma covered with a warm damp cloth.

• The bowel can then be gently manipulated back in place.

Cut Stoma

• The signs of a cut stoma would include a noticeable break in the integument of the stoma which may be accompanied by bleeding.

• Causes: movement of a flange which is not properly fixed to the peristomal skin, a sharp blow, or an inadvertent cut by scissors or nails.

• Bleeding may be stopped through use of silver nitrate stick, a stitch or use of a haemostatic dressing. Surgical intervention may be necessary if bleeding persists.

80

How many bones are in the axial skeleton?

126

How many bones are in the appendicular skeleton?

• Inflammatory

• Soft Callus

• Hard Callus

• Remodeling

What are the four processes of bone healing?

• Reduction

• Immobilization

• Restoration

What are the three principles of fracture management?

Closed Reduction

• This is a type of reduction fraction management done under GA

• Accomplished by bringing the bone fragments by closed manipulation and manual traction

Open reduction

• This is a type of reduction fraction management done in OR

• Through the use of internal and external fixation

• Internal fixators

• External fixator

Traction

Is the act of pulling and drawing which is associated with counter traction

• Pain

• Pallor

• Paresthesia/ numbness

• Paralysis

• Polar Temperature

• Puffiness

• Pulselessness

What are the seven P’s of orthopedic assessment?

Chest tube thoracostomy

This is the insertion and placement of a chest tube into the pleural cavity for the purpose of removing air, blood, purulent drainage, or other bodily fluid foreign to this space and to restore the mechanical function of the lung.

5th intercostal space at the midaxillary line

Where is the usual chest tube placement performed?

Chylothorax

This is an indication of CTT that is a rare but serious condition in which lymph formed in the digestive system (chyle) accumulates in your chest cavity fluid containing WBC and proteins that moves through your lymphatic system and drains into your bloodstream

Empyema

This refers to the collection of pus in the cavity between the lung and the membrane that surrounds it (pleural space)

Hemopneumothorax

Accumulation of air and blood in the pleural cavity

Hemothorax

Accumulation of blood in the space between the chest wall and the lung (pleural cavity)