NSG 233 MED SURG 2 EXAM 2 MASTER
REVIEW SET 2026
◉ Ileal conduit- postop complications. Answer: Complications that
may follow placement of an ileal conduit include wound infection or
wound dehiscence, urinary leakage, ureteral obstruction,
hyperchloremic acidosis, small bowel obstruction, ileus, and
gangrene of the stoma. Delayed complications include ureteral
obstruction, contraction or narrowing of the stoma (stenosis),
kidney deterioration due to chronic reflux, pyelonephritis, renal
calculi, and cancer recurrence
◉ Burns Electrical. Answer: Electrical injuries are devastating and
complex burns. Heat generated by electricity is directly responsible
for tissue damage, but unlike most thermal burns, visual
examination is not predictive of burn size and severity. It is helpful
to know the circumstances of the injury to anticipate potential tissue
damage and complications. Superficial injuries present themselves
as contact points on physical examination. Deep tissue injuries may
not be visible on initial clinical presentation but in most
circumstances should be assumed on presentation so that timely
intervention may be initiated. Mechanisms of injury include flash,
conductive, and lightning injury.Resuscitation fluid calculations
based on total body surface area are inaccurate in conductive
electrical injuries, including some lightning injuries. It is difficult to
quantify the extent of tissue injury without surgical exploration
because the damage may not be visible on physical examination.
,Serum creatinine kinase levels are useful in determining the degree
of muscle injury in the early phases of care. Myoglobinuria, common
with muscle damage, may cause kidney failure if not treated. IV fluid
administration titrated to a higher target of urine output per hour
than usual may be indicated until the urine is no longer red. It is
common practice to add 50 mEq of sodium bicarbonate per liter of
IV fluid in an effort to assist in alkalinizing the urine. Serum
myoglobin and urine myoglobin levels may be monitored as
indicators of the need for continued resuscitation.
Finally, the surgical treatment of an electrical injury is as complex as
the injury itself. Vasculature is commonly affected; thus, progressive
tissue necrosis occurs over time. Sequential surgical debridement
may be necessary, using caution to preserve viable tissue.
◉ Burns Full Thickness. Answer: Third-degree (full-thickness) burns
involve total destruction of the epidermis, dermis, and, in some
cases, damage of underlying tissue. Wound color ranges widely from
pale white to red, brown, or charred. The burned area lacks
sensation because nerve fibers are damaged. The wound appears
leathery and dry due to the destruction of the microcirculation; hair
follicles and sweat glands are destroyed. The severity of this burn is
often deceiving to patients because they have no pain in the injury
area
◉ Burns Partial Thickness. Answer: Second-degree burns involve
the entire epidermis and varying portions of the dermis. They are
painful and are typically associated with blister formation. Healing
, time depends on the depth of dermal injury and typically ranges
from 2 to 3 weeks. Hair follicles and skin appendages remain intact.
◉ HIV Candidiasis. Answer: Oropharyngeal and esophageal
candidiasis (fungal infections) are common in patients with HIV
infection. Oropharyngeal candidiasis is characterized by painless,
creamy white, plaque-like lesions that can occur on the buccal
surface, hard or soft palate, oropharyngeal mucosa, or tongue
surface. Lesions can be easily scraped off with a tongue depressor or
other instrument which is in contrast to lesions associated with oral
hairy leukoplakia. In women with early-stage HIV infection, Candida
vulvovaginitis usually presents the same as in women without HIV
infection, with white adherent vaginal discharge associated with
mucosal burning and itching of mild-to-moderate severity and
sporadic recurrences
◉ AIDS Dementia. Answer: HIV encephalopathy was formerly
referred to as AIDS dementia complex (see Chart 36-10). It is a
clinical syndrome that is characterized by a progressive decline in
cognitive, behavioral, and motor functions as a direct result of HIV
infection. HIV has been found in the brain and cerebrospinal fluid
(CSF) of patients with HIV encephalopathy. The brain cells infected
by HIV are predominantly the CD4+ cells of monocyte-macrophage
lineage. HIV infection is thought to trigger the release of toxins or
lymphokines that result in cellular dysfunction, inflammation, or
interference with neurotransmitter function rather than cellular
damage. Chronic confusion
REVIEW SET 2026
◉ Ileal conduit- postop complications. Answer: Complications that
may follow placement of an ileal conduit include wound infection or
wound dehiscence, urinary leakage, ureteral obstruction,
hyperchloremic acidosis, small bowel obstruction, ileus, and
gangrene of the stoma. Delayed complications include ureteral
obstruction, contraction or narrowing of the stoma (stenosis),
kidney deterioration due to chronic reflux, pyelonephritis, renal
calculi, and cancer recurrence
◉ Burns Electrical. Answer: Electrical injuries are devastating and
complex burns. Heat generated by electricity is directly responsible
for tissue damage, but unlike most thermal burns, visual
examination is not predictive of burn size and severity. It is helpful
to know the circumstances of the injury to anticipate potential tissue
damage and complications. Superficial injuries present themselves
as contact points on physical examination. Deep tissue injuries may
not be visible on initial clinical presentation but in most
circumstances should be assumed on presentation so that timely
intervention may be initiated. Mechanisms of injury include flash,
conductive, and lightning injury.Resuscitation fluid calculations
based on total body surface area are inaccurate in conductive
electrical injuries, including some lightning injuries. It is difficult to
quantify the extent of tissue injury without surgical exploration
because the damage may not be visible on physical examination.
,Serum creatinine kinase levels are useful in determining the degree
of muscle injury in the early phases of care. Myoglobinuria, common
with muscle damage, may cause kidney failure if not treated. IV fluid
administration titrated to a higher target of urine output per hour
than usual may be indicated until the urine is no longer red. It is
common practice to add 50 mEq of sodium bicarbonate per liter of
IV fluid in an effort to assist in alkalinizing the urine. Serum
myoglobin and urine myoglobin levels may be monitored as
indicators of the need for continued resuscitation.
Finally, the surgical treatment of an electrical injury is as complex as
the injury itself. Vasculature is commonly affected; thus, progressive
tissue necrosis occurs over time. Sequential surgical debridement
may be necessary, using caution to preserve viable tissue.
◉ Burns Full Thickness. Answer: Third-degree (full-thickness) burns
involve total destruction of the epidermis, dermis, and, in some
cases, damage of underlying tissue. Wound color ranges widely from
pale white to red, brown, or charred. The burned area lacks
sensation because nerve fibers are damaged. The wound appears
leathery and dry due to the destruction of the microcirculation; hair
follicles and sweat glands are destroyed. The severity of this burn is
often deceiving to patients because they have no pain in the injury
area
◉ Burns Partial Thickness. Answer: Second-degree burns involve
the entire epidermis and varying portions of the dermis. They are
painful and are typically associated with blister formation. Healing
, time depends on the depth of dermal injury and typically ranges
from 2 to 3 weeks. Hair follicles and skin appendages remain intact.
◉ HIV Candidiasis. Answer: Oropharyngeal and esophageal
candidiasis (fungal infections) are common in patients with HIV
infection. Oropharyngeal candidiasis is characterized by painless,
creamy white, plaque-like lesions that can occur on the buccal
surface, hard or soft palate, oropharyngeal mucosa, or tongue
surface. Lesions can be easily scraped off with a tongue depressor or
other instrument which is in contrast to lesions associated with oral
hairy leukoplakia. In women with early-stage HIV infection, Candida
vulvovaginitis usually presents the same as in women without HIV
infection, with white adherent vaginal discharge associated with
mucosal burning and itching of mild-to-moderate severity and
sporadic recurrences
◉ AIDS Dementia. Answer: HIV encephalopathy was formerly
referred to as AIDS dementia complex (see Chart 36-10). It is a
clinical syndrome that is characterized by a progressive decline in
cognitive, behavioral, and motor functions as a direct result of HIV
infection. HIV has been found in the brain and cerebrospinal fluid
(CSF) of patients with HIV encephalopathy. The brain cells infected
by HIV are predominantly the CD4+ cells of monocyte-macrophage
lineage. HIV infection is thought to trigger the release of toxins or
lymphokines that result in cellular dysfunction, inflammation, or
interference with neurotransmitter function rather than cellular
damage. Chronic confusion
