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Med Surg Exam 4

Crouch MC 2012

Severe Right Upper Quadrant colicky pain comes in waves Cholecystitis
What is Murphy's Sign? unable to take deep breath when pressure is placed over lower liver border
Pain in the abdomen with guarding. Often lessen by drawing the knees up & worsen with extension Pancreatitis
Protease initiates what? a chain reaction of inflammation that results in the conversion of prothrombin to thrombin causing DIC.
What is Turner's sign? purple discoloration in the flanks
What is Cullen sign? purple discoloration around the umbilicus
When is demerol given rather than morphine? with Pancreatitis
chronic alcoholic pancreatitis
Pancreatic cancer in the head metastasis by direct extension
Pancreatic cancer in the body metastasis by blood & lymph
What is the Whipple procedure? removal of the head of the pancreas, duodenum, & parts of the stomach
excessive pain is 1st clue Compartment Syndrome
What is Volkman's contracture? contraction of the hand & fingers & related tissue degeneration caused by decreased blood flow
Purpose of treatment for compartment syndrome restoring blood flow by performing a fasciotomy. once pressure is relieved & swelling goes down fascia & skin are closed.
Compartment syndrome important to remember time means muscle
By recognizing compartment syndrome early it prevents what? complications & deformities
Renal failure is caused by what in compartment syndrome? injured fibers gaining access to bloodstream & filter in to the nephrons
For a total hip replacement how should patients sit? legs abducted & no flexion greater than 90 degree angle
#1 Complication of Total Joint Replacement Hemorrhage
Complications of Total Joint Replacement Hemorrhage, sepsis, thrombophlebitis & embolism, infection, dislocation, skin breakdown
treatment includes early ambulation that is what for total joint replacement? non-weight bearing
Type I DM affects what? metabolism of fat, protein, & carbohydrates
Dx DM for HBA1c >6.5%
Dx DM for FPG >126 mg/dL
Dx DM for 2 hr plasma glucose >200 mg/dL
Dx DM for an individual with classic symptoms of hyperglycemia or hyperglycemic crisis with a random plasma glucose of >200 mg/dL
Type I DM Treatment combination of insulin therapy, meal planning, & exercise regimen
What is the symogogy effect? hypoglycermia in the middle of the night
What is the Dawn phenomenon? increase in morning levels
Dx Criteria for Metabolic Syndrome increased waist circumference >40 males & >35 females plascma triglycerides >150 mg/dL plasma HDL cholesterol < 40 mg/dL males & <50 females BP >130/85 FPG >100 mg/dL
How many criterias does one have to have in order to be diagnosed with metabolic syndrome? 3 out of 5
3 P's Polyphagia Polydipsia Polyuria
4 Categories of DM Type 1, Type 2, Other specific types, gestational
What percentage of the beta cells must be destroyed to cause a decline in insulin leading to hyperglycemia? 80-90%
Glucagon's role acts in the liver to decrease blood glucose by stimulating glycogenolysis & gluconeogenesis
in addition to insulin decrease what other hormon is decreased? amylin
What is amylin's function? suppress glucagon release
What causes the weight loss in DM pt? protein & fat breakdown because of lack of insulin
Risk factors for Type II DM age, obesity, HTN, physical inactivity, & famiily hx
metabolic syndrome is a constellation of disorders that increase the risk of developing Type II
Constellation of disorders in metabolic syndrome central obesity, dyslipidemia, prehypertension, increased fasting glucose level
insulin resistance suboptimal response of insulin-sensitive tissues to insulin & often associated with obesity
Nonspecific symptoms & signs for DM fatigue, pruritis, recurrent infections, visual changes, & sx of neropathy
Without treatment what can result? coronary & peripheral artery & cerebrovascular disease
1st approach for Type II DM diet & exercise
kussmaul respirations & fruity acetone breath Diabetic ketoacidosis
Chronic Complications of DM reinopathy, nephropathy, neuropathy, macrovascular, infection
What is Compartment syndrome? fascia compresses the swelling tissue causing decrease in vascularity of tissue & nerves
Complications of Compartment syndrome? necrosis, paralysis, volkman's contracture, rhabdomyolysis, renal failure, & infection
Treatments for cholecystitis t-tube after cholecystectomy low-fat diet lithotripsy demoral antispasmodics antiemetics gallstone dissolution meds
Pancreatitis is outlet becomes blocked becuase of inflmmation, gallstones, or digestive enzymes
Complications of Pancreatitis shock respiratory distress renal failure hemorrhage
Treatment of pancreatitis NPO, O2, IV analgesic Demerol,antiemetics, IV fluids, expanders, & PRBC
Complications of Pancreatic Cancer DVT, VCA, DM, postop infection, fistula, peritonitis, paralytic ileus, malabsorption disorder, death
Created by: midnight1854