Evidence-Based Practice, Hierarchy of Evidence, and Medical-Surgical Nursing Topics (Flashcards in Vocabulary Style)

Vocabulary-style flashcards covering Evidence-Based Practice concepts, hierarchy of evidence, hip fracture basics, DVT and fat embolism, acute abdominal conditions (appendicitis), gallstone disease, PUD, and inflammatory bowel disease (UC/CD) based on the provided notes.

Evidence-Based Practice (EBP)

An approach that combines the best external evidence, the clinician’s expertise, and the patient’s values and preferences to guide nursing decisions.

EBP five steps

1) Ask a clear clinical question and set an ultimate goal; 2) Acquire evidence from legitimate sources; 3) Appraise the evidence for validity, quality, and relevance; 4) Apply the evidence to practice using nursing expertise; 5) Assess outcomes.

Ask a clear clinical question

Formulate a focused question about the patient’s issue and define the desired outcome or goal.

Acquire evidence

Search relevant clinical articles from legitimate sources to answer the clinical question.

Appraise resources

Evaluate validity, quality (level of evidence), and relevance to the patient’s context.

Apply evidence

Incorporate the evidence with nursing expertise and patient values to guide decisions.

Assess outcomes

Determine if the treatment was effective and whether it should be considered for other patients.

Level I evidence

Systematic reviews and meta-analyses of randomized controlled trials; the highest level of evidence.

Systematic Review

A comprehensive synthesis of all relevant randomized trials on a topic, with quality assessment.

Meta-Analysis

A statistical technique that combines data from multiple studies to derive a pooled estimate.

Level II evidence

Well-designed randomized controlled trials (RCTs).

Level III evidence

Controlled trials without randomization.

Level IV evidence

Cohort and case-control studies.

Level V evidence

Systematic reviews of descriptive and qualitative studies.

Level VI evidence

Single descriptive or qualitative studies.

Level VII evidence

Opinions of authorities and expert committees.

How the hierarchy is used

guides literature searches, directs critical appraisal, informs clinical decision-making, and helps in research design.

Literature search priority

Prioritize higher levels of evidence first when searching for information.

Critical appraisal

Systematic evaluation of the quality and applicability of a study.

Clinical decision-making

Prioritize stronger, more trustworthy evidence to inform patient care.

Mobility in hospitalized patients

Movement can improve recovery but may have risks if not managed properly.

Positive effects of mobility

Improved circulation, reduced deconditioning, fewer complications.

Negative effects of mobility

Increased risk of falls, pain, fatigue if not properly planned.

CSM assessment

Circulation, Sensation, and Movement assessment of a limb after injury.

Intracapsular fracture

Fracture of the femoral head/neck within the hip joint capsule; often impacts blood supply to the femoral head.

Extracapsular fracture

Fracture around the trochanteric region outside the hip capsule; includes intertrochanteric and subtrochanteric fractures; associated with acute blood loss and AVN noted in the notes.

Intertrochanteric fracture

Fracture between the neck of the femur and the lesser/greater trochanter.

Subtrochanteric fracture

Fracture immediately below the lesser trochanter.

DVT (Deep Vein Thrombosis)

Clot in a deep vein with risk of pulmonary embolism; signs include calf pain, swelling, redness, warmth; prevention includes early ambulation, compression stockings/SCDs, anticoagulants.

Fasciotomy

Emergency surgery to release pressure by cutting the fascia to prevent/relieve compartment syndrome.

Fat embolism syndrome

Fat emboli after long-bone/pelvic fractures; triad: respiratory distress, neuro changes (AMS), petechial rash; treat with oxygen, fluids, immobilization.

Appendicitis

Inflammation of the appendix; periumbilical pain migrating to the RLQ at McBurney’s point; rupture may briefly relieve pain; requires antibiotics and often surgical removal.

Peritonitis signs

Severe abdominal pain, rebound tenderness, rigid abdomen, possible fever; may indicate perforation.

Non-surgical management of appendicitis

Antibiotics, IV fluids, possible drainage; surgery (laparoscopic appendectomy) is common.

Laparoscopic cholecystectomy (lap choley)

Surgical removal of the gallbladder; preferred treatment for gallstones (cholelithiasis).

Ursodiol

Oral dissolution therapy for gallstones; used in high-risk patients or when surgery is not suitable.

Lithotripsy

Use of shock waves to break gallstones into smaller pieces.

Percutaneous drainage

Drainage procedure for gallbladder stones or abscess; used in high-risk patients.

Peptic ulcer disease (PUD)

Ulcers caused by mucosal breakdown in areas exposed to gastric acids (esophagus, stomach, duodenum); most common in the duodenum.

H. pylori

Helicobacter pylori infection associated with PUD; eradication reduces ulcer risk.

NSAIDs

Nonsteroidal anti-inflammatory drugs; inhibit prostaglandin synthesis, reducing mucosal protection and increasing ulcer risk.

Corticosteroids in PUD

Steroids can increase ulcer risk, especially when used with NSAIDs.

Anticoagulants/antiplatelets in PUD

Worsen bleeding risk if an ulcer bleeds.

SSRIs

Selective serotonin reuptake inhibitors; may increase bleeding risk with NSAIDs or anticoagulants.

Bisphosphonates

Oral medications for bone disease that can irritate gastric mucosa.

Safe analgesic in PUD

Acetaminophen (paracetamol) is preferred for pain/fever.

Acid-suppressing therapy

PPIs or H2 blockers promote healing and prevent recurrence of ulcers.

Cholelithiasis risk factors (nonmodifiable)

Female sex, age, ethnicity (e.g., Hispanic); genetic predisposition.

Cholelithiasis risk factors (modifiable)

Obesity/abdominal fat, sedentary lifestyle, poor diet with low fiber and high fat, rapid weight loss, pregnancy, certain medications.

Cholelithiasis treatment options

Surgical lap chole; non-surgical ursodiol; lithotripsy; percutaneous drainage (high-risk patients).

Ulcerative colitis (UC)

Chronic inflammatory bowel disease limited to the mucosa of the colon/rectum; hallmark is bloody diarrhea and abdominal pain.

Crohn’s disease (CD)

Chronic inflammatory bowel disease that is transmural and can affect anywhere from mouth to anus; common in terminal ileum and proximal colon; skip lesions, fistulas, and strictures are common.

IBD umbrella term

Ulcerative colitis and Crohn’s disease are encompassed under inflammatory bowel disease.

UC complications related to hepatobiliary system

Pancreatitis and sclerosing cholangitis may occur with UC.

CD complications

Fistulas, abscesses, strictures, malabsorption, weight loss.

Nutritional deficits in IBD

Anemia, hypoalbuminemia, weight loss, and malnutrition may occur.

Colorectal cancer risk in IBD

Long-term complication with increased risk of colorectal cancer, particularly in UC.