HESI MED SURG STUDY GUIDE

Fat embolism - A syndrome in which fat migrates into the blood stream and combines with pletlets to
form emboli; the greatest risk is 36 hours after a fracture; more common in clients with multiple fractures,
fractures of the long bones, fractures of the pelvis. Initial symptom is confusion due to hypoxemia; assess
for respiratory distress, restlessness, irritability, fever and petechiae; notify physician stat, draw ABGs,
administer oxygen, assist with intubation

Thromboembolism - In patient's with hip fractures, this is the most common complication; prevention
includes ROM, elastic stocking, elevation of the foot, low dose heparin

Assessment of client with fracture/in a cast - Skin color, temperature, sensation, capillary refill, mobility,
pain and pulses

Pain, paresthesia, pulse, pallor and paralysis - The 5 Ps of neurovascular functioning

Joint replacement - A surgical procedure in which a mechanical device, designed to act as a joint, is used
to replace a diseased joint; most common joints: hip, knee, shoulder, finger; accurate fitting is essential;
excellent pain relief; infection is a post-op concern

Nursing assessment for joint replacement - Joint pathology: arthritis, fracture, pain not relieved by
medication, poor ROM

Nursing plans and interventions for joint replacement - Monitor incision site, assess for bleeding ad
drainage, assess suture line for erythema and edema, assess suction drainage apparatus, assess for signs of
infection; monitor functioning of extremity - check circulation, sensation and movement of extremity
distal to placement; I&O; 3Lfluid/day; work closely with health care team to increase client's mobility
gradually

Infection - Big problem after joint replacement

Fracture - Predispose the client to anemia, especially if long bones are involved; check HCTq3-4 days to
monitor erythropoiesis

Amputation - Surgical removal of a diseased part or organ; causes are perpherial vascular disease, trauma,
congenital deformities, malignant tumors, infection

Nursing assessment for amputation - Assess for symptoms of peripheral vascular disease: cool extremity,
absent peripheral pulses, hair loss on affected extremity, necrotic tissue or wounds, leathery skin on
affected side, decrease of pain sensation; assess for inadequate circulation: arteriogram, Doppler flow
studies

Nursing plans and interventions for amputation - Provide wound care, change dressing as needed,
maintain proper body alignment in and out of bed; position the client to relieve edema and spasms at
residual limb site: passive ROM

Dressing change for amputation - Maintain aseptic technique, assess wound color and warmth, assess for
wound healing, monitor for signs of infection

Care of amputated stump - Elevate for the first 24 hours but do not elevate 48 hours post op; keep stump
extended position and turn client to prone position three times a day to prevent hip flexion contracture

Residual limb - Should be elevated on one pillow; if elevated too high, can cause a contracture