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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
Q

Causes of INFECTIOUS post-op fever

A
  1. Left shift - bandemia
  2. Surgical sites
  3. Catheters
26
Q

is WBC > 30,000 due to infection?

A

Not likely

look more towards leukemia

27
Q 
Q! - Post-op patient fever for 3 days
WBC 15,000
Eosinopils 9%
Blood cultures negative
What is diagnosis?
A

Drug Fever

Rationale -
Viral infection - Eosinophilia - allergic reaction
Bacterial infection - cultures negative
Malignant hyperthermia - Happens immediately after succinylcholine

28
Q

Malignant Hyperthermia

A

Succinylcholine given with anesthesia
Increase temp

Remove stimulus
Give IVF and Dantrolene

29
Q 
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
A

D. Vice-like pain

Pain with cluster headache
– pain around eye

30
Q

Headache evaluation (5)

A 
Chronology
Location and duration
Associated activity
Associated symptoms
Triggers
31
Q

3 major types of headaches

A

Tension
Migraine
Cluster

32
Q

Tension Headache

S/S, Labs, Management

A 
Most common - 90% of headaches 
S/S - vice like
generalized
no focal neurological symptoms
Management - Relaxation 
OTC analgesics
33
Q

Tension Headache -

S/S, Labs, Management

A 
Most common - 90% of headaches 
S/S - vice like
generalized
no focal neurological symptoms
Management - Relaxation 
OTC analgesics
34
Q

Migraine types (2)

A

Classic migraine (migraine with aura)

Common migraine (migraine without aura)

35
Q

Migraine

A

Female
Late adolescence/early adulthood
Family history +

36
Q

Migraine incidences

A

Female
Late adolescence/early adulthood
Family history +

37
Q

Migraine Triggers

A 
Emotional/physical stress
Lack/excess sleep
Missed meals
Specific foods
Alcohol
Menstruation 
Use of birth control 
Nitrates
Changes in weather
38
Q

Migraine Symptoms

A 
Unilateral, lateral throbbing episodically
May be dull/throbbing
Build up gradually 
Focal neurologic disturbances
-- numbness, visual, clumsy 
Photophobia and phonophobia
39
Q

Migraine diagnosis

A

IF new migraine - rule out organic causes

    • BMP, CBC
    • VDRL - neuro syphilis
    • ESR
    • CT scan of head with neuro findings
40
Q

Migraine management

A

Avoid triggers
Relax/stress management
Prophylactic daily therapy if >2-3xmo
– topiramate, gabapentin, amitryptyline, propanolol

41
Q

Migraine management of acute attack

A

Rest in dark/quiet room
ASA
sumatriptan (imitrex) 6mg SQ at onset x 3
Imitrex 25mg PO at onset

42
Q

Cluster headache - causes

A 
causes
Middle-aged man
Alcohol 
s/s
Severe - unilateral periorbital pain daily
Occurs at night
< 2 hours
Ipsilateral nasal congestion 
Rhinorrhea
Eye redness
43
Q

What is the black box warning for tricyclic antidepressants?

A

Prolongation of the QT

44
Q

Cluster headache treatment

A

100% O2
Sumatriptan 6mg SQ
Ergotamine tartrate aerosol inhalation

45
Q

Sumatriptan is given to treat?

A

Cluster headaches and migraines

46
Q

Nutritional support

What is the normal Albumin level & what does low albumin look like?

A

3.5-5
< 3.5 Protein malnutrition
< 2.7 – edematous

47
Q

What gives you the earliest indication of malnutrition?

A

Pre-albumin

48
Q

What is the normal hemoglobin?

When do we transfuse?

A

Women 12-15.5
Men 13.5-17.5

Transfuse < 8/24
– in certain patients 7 might be acceptable

49
Q

Why do men have higher H&H than women?

A

Testosterone stimulates erythropoietin production.

50
Q

What is the hemoglobin/hematocrit ratio?

A

1/3

Hemoglobin 10 - hematorcit 30

51
Q

1 Unit PRBC should affect your H&H by how much?

A

Hemoglobin up by 1

Hematocrit up by 3

52
Q

Clinical observation of Good nutrition

A 
Clear nail beds free of ridges
Pink moist mucous membranes
Skin is shiny 
Musculature
Hair not easily plucked
53
Q

Determining the type of Nutritional Support

A

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
Q

Complications of Enteral support (7)

A 
Aspiration
Diarrhea
Emesis
GI bleeding
Mechanical obstruction of the tube
Hypernatremia
Dehydration
55
Q

Complications of Parenteral Nutritional Support (8)

A 
Pneumothorax
Hemothorax
Arterial laceration
Air emboli
Catheter thrombosis
Catheter sepsis
Hyperglycemia
HHNK
56
Q

Re-feeding syndrome

A

low phosphorus

57
Q

What are some changes you can make if diarrhea r/t enteral feeding occurs? (3)

A

Dilute solution
If on bolus feeding - change to continuous
Decrease rate

58
Q 
Q! - Suspected CLABSI. What is best intervention?
A. Start antibiotics
B. Cultures
C. Change wire
D. D/C line
A

If suspected - GET IT OUT

D. D/C line - pull line to get the tip

59
Q

Q! - What does protein-rich supplementation do?

A

Aids in post op healing

60
Q 
Q! - What value is most critical in a cachexia patient?
A. Mag
B. Na
C. K
D. Ca
A

K - most critical

61
Q 
Q! - If a patient on TPN is in sepsis,  What labs are appropriate
A. Blood cultures
B. CBC
C. LFT
D. BMP
A

D. BMP - glucose and electrolytes

ANCC Boards Review (9 decks)

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