01/26 Flashcards
What is the paramount worry of a ruptured appendix?
A. bowel obstruction
B. peritonitis
C. elevated CBC
D. elevated temp
Answer: B
Rationale: most concerned about/priority = paramount; peritonits most/main concerned about with ruptured appendix - part GI tract - if any part GI tract ruptures leaks poo/GI contents - full bacteria - lot bacteria supposed be there because aids digestion - only supposed be inside gut not outside but once outside get peritonitis but can quickly lead to sepsis: outcomes with sepsis not great - extended hospital stays and death
Bowel obstruction - can also lead to peritonitis - backs up and colon/gut gets stretched too far and tears leaking into abdominal cavity resulting in peritonitis
Elevated CBC - part of CBC most worried about WBC elevated - shows have active infection - sign but not biggest worry for pt - help make decisions - point in right direction; CUE
Elevated temp - CUE - something going on with pt; sign have an issue; not biggest concern
Biggest concern: what kill pt first
Which of the following is NOT a cause of peritonitis?
A. ruptured appendix
B. abdominal stab wound
C. peritoneal dialysis
D. paralytic ileus
Answer: D
Rationale: NOT; peritonitis can cause a paralytic ileus - GI tract loses ability to push food bolus forward get paralytic ileus - gut is not moving food bolus/waste product (depending on part) forward and holding still - can cause bowel obstruction and goes further downhill; other things besides peritonits result in paralytic ileus; acid-base metabolic issues out of balance - can get more acidic than norm gut - excess H ions affect ability of muscle contraction gradients and gut to push forward causing paralytic ileus; besides peritonitis may have delayed GI motility through tract: post-op surgery (time for GI tract wake up)
Ruptured appendix - cause peritonitis
Abdominal stab wound - lot squishy areas; odds piercing organs is high; if part GI tract punctured have gut flora that should be inside now outside GI tract leading to peritonitis; potential cause peritonitis
Peritoneal dialysis - diff than hemodialysis; for pts with renal failure; involves GI cavity; have sys installed and have inflow and outflow out abdomen; pt do own dialysis at home; benefits: not go to dialysis clinic and have sit there for longer periods of time, feel lot better compared to hemodialysis - nightly basis so not as big buildup waste products in blood and still fluid shift but not as drastic fluid shift; good option for many pts with renal failure before hemodialysis; two ports into peritoneal cavity - anytime break into skin have risk for infection; is a sterile procedure; train pts to be sterile technique when doing instilling dialsate and doing outflow; some pts more compliant and cleaner than others; screening - see if can handle this on own and if can candidate; if develop peritonitis from lack sterile technique or sites infected, let by once (learning experience), second time - go to hemodialysis; each time get peritonitis (inflammation - lead to long-term scarring/scar tissue build up: not work well) - once scar tissue builds up not work same as normal tissue: not perform same functions
What enzymes cause anutodigestion in pancreatitis?
A. amylase and lipase
B. aspartate aminotransferase and alanine aminotransferase
C. blood urea nitrogen and creatinine
D. entecavir and tenofovir
Answer: A
Rationale: what enzymes made in the pancreas; digestion of cells; blockage leading to pancreatitis - cannot get out - digest tissue around them - autodigestion; pancreatitis - pancreas eating self: number one complaint: pain - pain control - NEVER/not priority - pay attention to pain control for pt - go straight to dilaudid - lot pain; not tolerate much PO
Amylase digests carbs - also made in salivary glands
Lipase digests fats
Fats and carbs have issues
AST and ALT - liver enzymes; liver failure - look at these; elevated when damage to cells of liver with cells that normally contain enzymes when cells lyse/contain inflammation - enzymes leak out and detected in blood stream - so elevated; go with liver issues
BUN and creatinine - kidneys; BUN - affected with liver issues: urea nitrogen produced by liver and filtered by kidneys; Cr - part muscle tissue break down: filtered by muscles - and broken down and filtered by kidneys
Entacavir and Tenofovir - meds and anti-virals because ends in -vir; both used for Hep B; Tenofovir - also used for HIV
What manifestation of cirrhosis of the liver would be equated with decreased level of consciousness?
A. portal hypertension
B. jaundice
C. hepatic encephalopathy
D. vitamin deficiencies
Answer: C
Rationale: elevated ammonia (NH4) in bloodstream; brain not func if issues with high ammonia; med: lactulose - better to get off sooner; induces diarrhea - ammonia excreted via stool - if have diarrhea - acid base imbalance: bicarb (metabolic acidosis), K, Na
Portal HTN: elevated pressure in portal veins - portal vein connects blood flow from GI tract into liver; body not like fighting against high pressure all time - leads to comps; get back up blood into lower esophagus (esophageal varices - extended periods portal HTN can lead to varices) and GI tract; what happening in liver: liver is getting harder because fibrosis/scar tissue: lead to it: alcohol (#1), any Hep viruses (esp Hep B/C), genetics; scar tissue cause excess pressure; varices - rupture and bleed - very high mortality rate - big vessels - lose lot blood quickly in abdominal cavity quickly
Vitamin deficiencies: cirrhosis:
A, C, E, K
Vitamin deficiencies: Cholecystitis:
A, D, E, K; fat-soluble vitamins: need bile from gallbladder to digest fat
Over dosage of Acetaminophen is classified as what type of liver disorder?
A. non-viral hepatitis
B. hepatitis C
C. cirrhosis
D. hepatitis B
Answer: A
Rationale: non-viral hepatitis - inflammation of liver - frequently caused by viral issues but not always; max 24 hr dose: 3-4g/day
Hepatitis C and B - viral hepatitis
Cirrhosis - hepatitis can lead to cirrhosis but not due to tylenol
Vaccines
Travel vaccine
Transmitted via fecal oral route - issues with water-sanitation and not have health inspectors - high risk for contracting for Hep A
Transmitted via fecal oral route - poor hand hygience, contaminiated water; waste products in water supply
Hepatitis A
Vaccines
Transmitted via Blood (more likely) and body fluid
IV drug use major transmission factor - want get Hep panel
Not everybody who has Hep B gets Hep D
Hepatitis B
Transmitted via Blood (more likely) and body fluid
IV drug use major transmission factor - want get Hep panel
Hepatitis C
Transmitted via Blood (more likely) and body fluid
Not get unless already have Hep B - go together; not everybody who has Hep B - everyone has Hep D has Hep B
Hepatitis D
Transmitted via fecal oral route - poor hand hygience, contaminiated water; waste products in water supply
Hepatitis E
Take out ¾ of abdominal contents and put all back together
Whipple procedure
4.2-6.1 million cells/microL
RBC
5,000-10,000 mm3
Tells us about infection
High - indicate might have infection
Low - indicate immunocompromised
White Blood Cell:
12-18 g/dL
Carries oxygen around in body
Low: blood loss, anemic
High: excess of RBC
Hemoglobin:
37-52%
Low: indication of hydration, fluid overload
High: more concentrated, more indicated that dehydrated
Hematocrit:
150,000-400,000 mm3
Big in clotting
Low: patient could have much higher risk for bleeding because do not have enough could bleed easier
High: could be at risk of blood clot
Platelets:
3.5-5 mEq/L
Biggest electrolytes
Has sig impacts on heart if high or low; can have sig cardiac dysrhythmia; affects electrical activity of heart - muscle and K+ has huge impact on muscle
Potassium:
136-145 mEq/L
Sig impacts on fluid volume; abnormalities with fluid volume
high/low indicated fluid volume imbalance; also huge impact on neurological func; high/low dehydrated or overloaded fluid wise
Sodium:
8.4-10.5 mg/dL
Sig impacts on cardiac but also gen musculature; muscle hypertonia where it is really high tone muscle or muscle weakness
Calcium:
0.5-1.2 mg/d:
Very common lab look at
Very rare see low: indicate nutritional deficiencies because related to protein
High: key factors someone having renal/kidney probs
Creatinine:
10-20 mg/dL
Nitrogenous wastes
Low: sometimes fluid overload
High: indication of dehydration
BUN and creatinine high tell us renal issue but sometimes dehydrated concentration nitrogenous waste higher and so have higher BUN and try giving fluids
BUN:
70-110 mg/dL (fasting)
Big lab look at for diabetic patients
Too low: hypoglycemic: could also be our diabetic patients
High: hyperglycemic: could be diabetic
Glucose:
11-12.5 sec
Telling you how long takes for blood to clot
Higher number takes longer for blood to clot and increased risk for bleed
Prothrombin Time (PT):
0.76-1.27
Very sim to PTT just normalized
Diff labs run norm ranges diff
INR norm range is always same regardless of location in world is because certain meds given to clients that are given based INR and clotting factor so if they were traveling and had to have lab drawn want to have normalized so know same and not adjusting meds
International Normalized Ratio (INR):
60-70 sec
Another coag factor
Looked at commonly
Base certain meds on it
How long blood takes to clot
Higher number is increased risk of bleed because longer takes body to clot
Flip side if any low means increased risk of clotting because does not take long for blood to clot so that they could clot easily because bleeding a lot is bad but acculding a blood vessel and clotting is bad as well
Partial Thromboplastin Time (PTT):
