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ANCC Boards Review > (1) Common problems in acute care > Flashcards

(1) Common problems in acute care Flashcards

1
Q

Acute Pain - what is the duration

A

< 6 months caused by tissue damage

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2
Q

Chronic Pain - What is the duration

A

Continual or episodic pain of >6 months

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3
Q

Acute versus chronic pain

A

acute < 6 months

chronic > 6 months

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4
Q

Dislocated knee playing tennis. What type of pain

A

Somatic

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5
Q

Cutaneous - describe

A

Skin

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6
Q

What type of pains is Cholelithiasis - gall bladder pain?

A

Visceral

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7
Q

Visceral - describe

A

Around internal organs

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8
Q

What type of pain is Sciatica?

A

Neuropathic

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9
Q

Neuropathic pain - describe

A

Along nerve pathway injury or compression

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10
Q

What type of pain is Herpes zoster?

A

Neuropathic

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11
Q

Somatic - describe

A

Soft tissue

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12
Q

WHO ladder of pain management

A

3 step initiative - cancer, anesthesia

  1. Non-opioid +/- adjuvants
  2. Non-opioid +/- adjuvants + mild narcotic
  3. Non-opioid +/- adjuvants + moderate narcotic
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13
Q

WHO ladder of pain management

Breakthrough cancer pain

A

Sustained release patch

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14
Q

When discussing pain management, what is an adjuvant

A 
Not typically used for pain management:
Antidepressants 
Muscle relaxers
Sedatives 
Anti-anxiety 
Anti-seizure
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15
Q

Q!
58 year old korean male, complains of chest pain 4/10, pallor, reluctant to answer questions. What would cause NP to admit the patient to Chest pain unit?

A

Ethnicity -

stoic asian cultural - taught not to express pain

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16
Q

Q!

Cancer patient with break-through pain on MSO4. What is the best next step?

A

Add a fentanyl patch

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17
Q

What is normal body temp in C?

A

37 degrees = 98.6F

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18
Q

What is a fever in C?

A

38.3 = 101.5 F

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19
Q

Causes of fever - that require antibiotics

A

Bacterial, viral, rickettsial, fungal, or parasitic infections

All other causes - do not require antibiotics

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20
Q 
Patient shows up to ER with high fever, history of taking anti-psychotics.  Which is priority? and what is likely diagnosis?
A. Analgesics
B. Antibiotics
C. IVF
D. PRBC
A

Likely diagnosis Malignant hyperthermia

C. IVF - flush it out

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21
Q

Non-infectious post-op fever. What are the first questions?

A

What do lungs sound like?

What is I&O?

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22
Q

What is the 3 leading causes of non-infectious post-op fever?

A
  1. Atelectasis
  2. Dehydration
  3. Drug reactions
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23
Q

What drugs cause Non-infectious post-op fever?

A 
Amphotericin B
Trimethorpim-sulfamethoxazole
Beta-lactam
Procainamide
Isoniazid (INH)
Alpha-methyldopa
Quinidine
ect...
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24
Q

Can someone have a drug reaction with a 2nd dose of the drug?

A

Yes

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25
Causes of INFECTIOUS post-op fever
1. Left shift - bandemia 2. Surgical sites 3. Catheters
26
is WBC > 30,000 due to infection?
Not likely look more towards leukemia
27
``` Q! - Post-op patient fever for 3 days WBC 15,000 Eosinopils 9% Blood cultures negative What is diagnosis? ```
Drug Fever Rationale - Viral infection - Eosinophilia - allergic reaction Bacterial infection - cultures negative Malignant hyperthermia - Happens immediately after succinylcholine
28
Malignant Hyperthermia
Succinylcholine given with anesthesia Increase temp Remove stimulus Give IVF and Dantrolene
29
``` All of the findings are expected with cluster headaches except? A. Nasal congestion, rhinorrhea B. daily peri-orbital pain C. Precipitated by alcohol D. Vice like pain ```
D. Vice-like pain Pain with cluster headache -- pain around eye
30
Headache evaluation (5)
``` Chronology Location and duration Associated activity Associated symptoms Triggers ```
31
3 major types of headaches
Tension Migraine Cluster
32
Tension Headache | S/S, Labs, Management
``` Most common - 90% of headaches S/S - vice like generalized no focal neurological symptoms Management - Relaxation OTC analgesics ```
33
Tension Headache - | S/S, Labs, Management
``` Most common - 90% of headaches S/S - vice like generalized no focal neurological symptoms Management - Relaxation OTC analgesics ```
34
Migraine types (2)
Classic migraine (migraine with aura) Common migraine (migraine without aura)
35
Migraine
Female Late adolescence/early adulthood Family history +
36
Migraine incidences
Female Late adolescence/early adulthood Family history +
37
Migraine Triggers
``` Emotional/physical stress Lack/excess sleep Missed meals Specific foods Alcohol Menstruation Use of birth control Nitrates Changes in weather ```
38
Migraine Symptoms
``` Unilateral, lateral throbbing episodically May be dull/throbbing Build up gradually Focal neurologic disturbances -- numbness, visual, clumsy Photophobia and phonophobia ```
39
Migraine diagnosis
IF new migraine - rule out organic causes - - BMP, CBC - - VDRL - neuro syphilis - - ESR - - CT scan of head with neuro findings
40
Migraine management
Avoid triggers Relax/stress management Prophylactic daily therapy if >2-3xmo -- topiramate, gabapentin, amitryptyline, propanolol
41
Migraine management of acute attack
Rest in dark/quiet room ASA sumatriptan (imitrex) 6mg SQ at onset x 3 Imitrex 25mg PO at onset
42
Cluster headache - causes
``` causes Middle-aged man Alcohol s/s Severe - unilateral periorbital pain daily Occurs at night < 2 hours Ipsilateral nasal congestion Rhinorrhea Eye redness ```
43
What is the black box warning for tricyclic antidepressants?
Prolongation of the QT
44
Cluster headache treatment
100% O2 Sumatriptan 6mg SQ Ergotamine tartrate aerosol inhalation
45
Sumatriptan is given to treat?
Cluster headaches and migraines
46
Nutritional support | What is the normal Albumin level & what does low albumin look like?
3.5-5 < 3.5 Protein malnutrition < 2.7 -- edematous
47
What gives you the earliest indication of malnutrition?
Pre-albumin
48
What is the normal hemoglobin? When do we transfuse?
Women 12-15.5 Men 13.5-17.5 Transfuse < 8/24 -- in certain patients 7 might be acceptable
49
Why do men have higher H&H than women?
Testosterone stimulates erythropoietin production.
50
What is the hemoglobin/hematocrit ratio?
1/3 | Hemoglobin 10 - hematorcit 30
51
1 Unit PRBC should affect your H&H by how much?
Hemoglobin up by 1 | Hematocrit up by 3
52
Clinical observation of Good nutrition
``` Clear nail beds free of ridges Pink moist mucous membranes Skin is shiny Musculature Hair not easily plucked ```
53
Determining the type of Nutritional Support
Use the gut if you can - - > 6 weeks - Enterostomal Tube (PEG) - - < 6 weeks - NGT - ----At risk for aspiration? uses Duodenal tube (nasoduodenal tube) NO gut - -> 2 weeks - Central vein (also needed if 10% dextrose or more) - - < 2 weeks - PIV
54
Complications of Enteral support (7)
``` Aspiration Diarrhea Emesis GI bleeding Mechanical obstruction of the tube Hypernatremia Dehydration ```
55
Complications of Parenteral Nutritional Support (8)
``` Pneumothorax Hemothorax Arterial laceration Air emboli Catheter thrombosis Catheter sepsis Hyperglycemia HHNK ```
56
Re-feeding syndrome
low phosphorus
57
What are some changes you can make if diarrhea r/t enteral feeding occurs? (3)
Dilute solution If on bolus feeding - change to continuous Decrease rate
58
``` Q! - Suspected CLABSI. What is best intervention? A. Start antibiotics B. Cultures C. Change wire D. D/C line ```
If suspected - GET IT OUT D. D/C line - pull line to get the tip
59
Q! - What does protein-rich supplementation do?
Aids in post op healing
60
``` Q! - What value is most critical in a cachexia patient? A. Mag B. Na C. K D. Ca ```
K - most critical
61
``` Q! - If a patient on TPN is in sepsis, What labs are appropriate A. Blood cultures B. CBC C. LFT D. BMP ```
D. BMP - glucose and electrolytes

ANCC Boards Review (9 decks)

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