100 q amp a nrnp6560 midterm exam nrnp 6560 week 6 midterm exam nrnp6560 week 6 midterm exam walden university | 100 correct q amp a |
École, étude et sujet
Walden University
NRNP 6560 - Advanced Care of Adults
Tous les documents sur ce sujet (7)
1
vérifier
Par: archieonegal3 • 5 mois de cela
Vendeur
S'abonner
WALDENUNIVERSITYQUIZ
Avis reçus
Aperçu du contenu
NRNP 6560 Midterm exam
Surgery risk classes
Correct answer- Class 1: benefits outweigh risk, should be done
Class 2a: reasonable to perform
Class 2b: should be considered
Class 3: rarely appropriate
General rules for surgery: testing
Correct answer- 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
Correct answer- - 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
Correct answer- - 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
Correct answer- catarcts
breast biopsy
cystoscopy, vasectomy
laporascopic procedures
Plastic surgery
intermediate risk surgeries
Correct answer- Head/ neck surgery
High risk surgeries
Correct answer- aortic/ cabg
transplants
spinal reconstruction
peripheral vascular surgery
Lee's revised cardiac risk index
Correct answer- 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
Correct answer- - 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
Correct answer- - 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
Correct answer- 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
Correct answer- - 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
Correct answer- 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
, Rheumatoid arthritis: what, who
Correct answer- 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
Correct answer- - 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
Rheumatoid arthritis treatment
Correct answer- - 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
Les avantages d'acheter des résumés chez Stuvia:
Qualité garantie par les avis des clients
Les clients de Stuvia ont évalués plus de 700 000 résumés. C'est comme ça que vous savez que vous achetez les meilleurs documents.
L’achat facile et rapide
Vous pouvez payer rapidement avec iDeal, carte de crédit ou Stuvia-crédit pour les résumés. Il n'y a pas d'adhésion nécessaire.
Focus sur l’essentiel
Vos camarades écrivent eux-mêmes les notes d’étude, c’est pourquoi les documents sont toujours fiables et à jour. Cela garantit que vous arrivez rapidement au coeur du matériel.
Foire aux questions
Qu'est-ce que j'obtiens en achetant ce document ?
Vous obtenez un PDF, disponible immédiatement après votre achat. Le document acheté est accessible à tout moment, n'importe où et indéfiniment via votre profil.
Garantie de remboursement : comment ça marche ?
Notre garantie de satisfaction garantit que vous trouverez toujours un document d'étude qui vous convient. Vous remplissez un formulaire et notre équipe du service client s'occupe du reste.
Auprès de qui est-ce que j'achète ce résumé ?
Stuvia est une place de marché. Alors, vous n'achetez donc pas ce document chez nous, mais auprès du vendeur WALDENUNIVERSITYQUIZ. Stuvia facilite les paiements au vendeur.
Est-ce que j'aurai un abonnement?
Non, vous n'achetez ce résumé que pour $20.49. Vous n'êtes lié à rien après votre achat.