NURS 640 ACTUAL FINALS QUESTIONS AND
ANSWERS SURE A+
✔✔assessment after fall - ✔✔injury assessment
- head & neck assess
- area of injury- fx, soft tissue, hematoma
risk factor assessment
- precipitating events
- recent chanegs
- normal baseline
- past falls
- foot wear
✔✔assessment after fall - ROS - ✔✔CV: orthostatic hypotension, dizzy, syncope,
arrhythmia
MS: strength, activity level, deconditioning, assistive devices
neuro: LOC, weakness, sensation, vision, neuro baseline
infection sx
urinary/bowel complaints.
✔✔assessment after fall - hx - ✔✔PMH
- CV, pulm, neuro, MS
Social
- substance abuse
- env where injury occurred
✔✔assessment after fall - PE - ✔✔ABC
injury assessment
- head/spine inj
,- 6 P's of ortho inj (pain, pallor, paresthesia, poikilothermic, paralysis, pulselessness)
- cardiac: VS, postural BP, heart sounds
- neuro: deficits (inj vs stroke), general neuro exam (mental status, balance gait,
sensation, strength, vision), focal neuro exam (area of inj)
- MS: area of inj ( inspect, palp, ROM)
- infection: focal findings
✔✔testing after a fall - ✔✔in
- consider x-ray for fx assess
- head/spine assessment
cardiac exam and testing
- EKG
- consider 24 hr monitor and echo
neuro
- consider head CT
- consider spine assessment
blood testing
- anemia, inf, metabolic disease (DM, hypoglycemia, thyroid)
- chem and coag panels
med review
- therapeutic levels
- hypnotics, muscle relax, anti-hypertens, diuretics, antidepressants, anti-
hyperglycemics
- beers criteria for inappropriate drugs
fall in facility
- diagnosis, therapeutics, env
fall in home
- assess env risk factors
✔✔assessment after fall - eval & mgmt - ✔✔inj mgmt
- pain manage
- anticoag manage
- improve over time (if not improving, need further eval)
- fracture manage and adverse outcome prevention (mobility, thrombosis prophylaxis)
fall prevention strategies
- facility: protocols and interventions
- home: home assessment and intervention (PT/OT, social work)
,- medical interventions: manage bowel/bladder, manage CV, neuro, MS, wision,
hydration, nutrition
risk reduction medication changes
- initiate and evaluate changes
✔✔MS injuries - types - ✔✔dislocation: subluxation
- articulating surfaces out of anatomic position
- shoulder most common site
- hip common after MVC
- Subluxation is partial/incomplete dislocation
sprain/strain
- sprain: tear in a ligament that surrounds joint
- strain: overstretching injury to muscle/tendon
- commonly in wrist
fracture
- damage to the bone continuity
- commonly result of impact/stress
- medical risk factor: osteo, bone ca, osteogenesis imperfecta
types of fx
- closed (skin intact) vs open (skin not intact): open classified further by degree of
damage
- comminuted: >2 fx
- impacted: fracture ends compressed together, more stable
- transverse: fracture perpendicular to bone
- oblique: fracture angle approx 45 to 60 degrees
amputation
- limb removal due to trauma, illness, surgery
- medical causes: DM, inf, malig, ischemia, relief of chronic pain
✔✔MS HPI - ✔✔- age, patient risk factors
- what is CC
- duration of sx
- where is pain or other sx located
- trauma vs non trauma
- hx injury/trauma in past
✔✔SMART assessment- MS - ✔✔•S: Scan/survey
•M: Motion/active motion (patient)
•A: Assisted motion evaluation (clinician)
•R: Resistance testing - muscles/tendons
-1: strong, pain free
-2: strong, painful
, -3: weak, painful
-4: weak, painless
•T: Tests that are special
-Ex: pull test
✔✔Triage - MS - ✔✔- obvious tissue disruption
- significant loss of func >2 weeks after tissue disrupting event
- >6 weeks pain/functional deficits
- recurrent dislocation/instability
imaging
- if non- MS etiology suspected
- trauma + func loss
- failed conservative measures
✔✔fracture - subjective - ✔✔HPI
- mech of inj
- pain assess
- baseline func assess
PMH
- comorbidities (DM, bone dx, bleeding)
- past trauma, injury
- medications and allergies
PSH
- any surgery in affected area
Social
- substance use, recent use
✔✔fracture - PE - ✔✔gen trauma assessment
- ABCs
- head/neck: inspect, pain, neuro
focal assessment of inj site
- 6 Ps
- inspection, palpitation, ROM, sensation
general medical assessment
- pulm, CV, neuro, MS, inf, bruising
✔✔fracture- testing - ✔✔Xray
-Initial assessment of suspected fractures
-1 view generally not helpful, minimum A&P
-When in doubt, ask radiology for standard views
ANSWERS SURE A+
✔✔assessment after fall - ✔✔injury assessment
- head & neck assess
- area of injury- fx, soft tissue, hematoma
risk factor assessment
- precipitating events
- recent chanegs
- normal baseline
- past falls
- foot wear
✔✔assessment after fall - ROS - ✔✔CV: orthostatic hypotension, dizzy, syncope,
arrhythmia
MS: strength, activity level, deconditioning, assistive devices
neuro: LOC, weakness, sensation, vision, neuro baseline
infection sx
urinary/bowel complaints.
✔✔assessment after fall - hx - ✔✔PMH
- CV, pulm, neuro, MS
Social
- substance abuse
- env where injury occurred
✔✔assessment after fall - PE - ✔✔ABC
injury assessment
- head/spine inj
,- 6 P's of ortho inj (pain, pallor, paresthesia, poikilothermic, paralysis, pulselessness)
- cardiac: VS, postural BP, heart sounds
- neuro: deficits (inj vs stroke), general neuro exam (mental status, balance gait,
sensation, strength, vision), focal neuro exam (area of inj)
- MS: area of inj ( inspect, palp, ROM)
- infection: focal findings
✔✔testing after a fall - ✔✔in
- consider x-ray for fx assess
- head/spine assessment
cardiac exam and testing
- EKG
- consider 24 hr monitor and echo
neuro
- consider head CT
- consider spine assessment
blood testing
- anemia, inf, metabolic disease (DM, hypoglycemia, thyroid)
- chem and coag panels
med review
- therapeutic levels
- hypnotics, muscle relax, anti-hypertens, diuretics, antidepressants, anti-
hyperglycemics
- beers criteria for inappropriate drugs
fall in facility
- diagnosis, therapeutics, env
fall in home
- assess env risk factors
✔✔assessment after fall - eval & mgmt - ✔✔inj mgmt
- pain manage
- anticoag manage
- improve over time (if not improving, need further eval)
- fracture manage and adverse outcome prevention (mobility, thrombosis prophylaxis)
fall prevention strategies
- facility: protocols and interventions
- home: home assessment and intervention (PT/OT, social work)
,- medical interventions: manage bowel/bladder, manage CV, neuro, MS, wision,
hydration, nutrition
risk reduction medication changes
- initiate and evaluate changes
✔✔MS injuries - types - ✔✔dislocation: subluxation
- articulating surfaces out of anatomic position
- shoulder most common site
- hip common after MVC
- Subluxation is partial/incomplete dislocation
sprain/strain
- sprain: tear in a ligament that surrounds joint
- strain: overstretching injury to muscle/tendon
- commonly in wrist
fracture
- damage to the bone continuity
- commonly result of impact/stress
- medical risk factor: osteo, bone ca, osteogenesis imperfecta
types of fx
- closed (skin intact) vs open (skin not intact): open classified further by degree of
damage
- comminuted: >2 fx
- impacted: fracture ends compressed together, more stable
- transverse: fracture perpendicular to bone
- oblique: fracture angle approx 45 to 60 degrees
amputation
- limb removal due to trauma, illness, surgery
- medical causes: DM, inf, malig, ischemia, relief of chronic pain
✔✔MS HPI - ✔✔- age, patient risk factors
- what is CC
- duration of sx
- where is pain or other sx located
- trauma vs non trauma
- hx injury/trauma in past
✔✔SMART assessment- MS - ✔✔•S: Scan/survey
•M: Motion/active motion (patient)
•A: Assisted motion evaluation (clinician)
•R: Resistance testing - muscles/tendons
-1: strong, pain free
-2: strong, painful
, -3: weak, painful
-4: weak, painless
•T: Tests that are special
-Ex: pull test
✔✔Triage - MS - ✔✔- obvious tissue disruption
- significant loss of func >2 weeks after tissue disrupting event
- >6 weeks pain/functional deficits
- recurrent dislocation/instability
imaging
- if non- MS etiology suspected
- trauma + func loss
- failed conservative measures
✔✔fracture - subjective - ✔✔HPI
- mech of inj
- pain assess
- baseline func assess
PMH
- comorbidities (DM, bone dx, bleeding)
- past trauma, injury
- medications and allergies
PSH
- any surgery in affected area
Social
- substance use, recent use
✔✔fracture - PE - ✔✔gen trauma assessment
- ABCs
- head/neck: inspect, pain, neuro
focal assessment of inj site
- 6 Ps
- inspection, palpitation, ROM, sensation
general medical assessment
- pulm, CV, neuro, MS, inf, bruising
✔✔fracture- testing - ✔✔Xray
-Initial assessment of suspected fractures
-1 view generally not helpful, minimum A&P
-When in doubt, ask radiology for standard views
