1st Flashcards
Normal pH
Co2
Hco2
pH 7.35-7.45
Co2 35-45
Hco2 - 22-26
Metabolic acidosis
Causes?
**Bicarb low ** - GI loss (diarrhea)
Acid high - increase in lactic acid (poor perfusion, carbon monoxide poisioning), DKA, toxin
Impaired renal exretion (not excreting acid)
alcoholism, starvation
S/S of Metabolic acidosis
Hyperkalemia = ECG monitoring, Tall Tented T waves
Kussmaul respiration (deep labored breathing)
Diarrhea, nausea
Fatique, confusion
What is compensation for metabolic acidosis
Nursing interventions - Monitor what labs
Lungs compensate by increasing resp/min to blow off co2
Monitor labs, serum lactic acid, replace fluids and electrolytes
Metabolic Alkalosis
Reasons
Gi loss (vomit, suction)
Ingesting too much bicarb (antiacids)
Diuretics, thiazides (excreting too much hydrogen in urine), hyperaldosteronism
Hypokalemia
S/S Metabolic alkalosis
Hypokalemia - Muscle cramps, weakness, twitching
Confusion, lethargy, dizzy
Compensatory - Hypoventilation
What is compensation for metabolic alkalosis
Nursing interventions
lung breath slower to hold on to Co2
ABGs, replace fluids/electrolytes, avoid suction
Respiratory acidosis
Causes
Acute vs Chronic
S/S
Compensation
Nursing intervention
Cause: hypoventilation/breathing slow
Acute - airway obstruction (choking, aspiration),chemical depression - overdose. Weak lungs - guillain barre, spinal cord injury
Chronic - obesity, COPD, emphysema
S/S hypoxia, confusion, lethargy, drowisness, headache
Compensation - secrete more H+, reabsorb bicarb, kidneys slow
Nursing interventions - Improve air way, HOB up, suction, O2, medications, poss IV push bi carb
Respiratory Alkalosis
Causes
S/S - late
Compensation
Nursing interventions
Causes: hyperventilation/breathing fast, releasing too much acid, panic attack, pneumonia, asthma exacerbation, pE, fever, high altitude, improper vent setting
**S/S ** lightheaded, dizzy, confusion, tachycardia, calcium imbalances (numbness & tingling), arrhythmias Late = seizure/coma
Compensation - reabsorb H+ , kidneys compensate slow
**Nursing interventions **- improve airway, 02 meds, encourage slow deep breathing. NOT paper bag.
Hyperphosphatemia
Causes & always assoc w/?
S/S
Interventions
Normal 2.7-4.5 mg/dl (4.5 mg/dl+)
Causes: From tumor lysis syndrome, decreased renal excretion, increased renal reabsorption (hyperparathyroidism), acidosis, hypoparathyroidism. always assoc with hypocalcemia
S/S - numbness, tingling, muscle spasms, tetany, larynogspasm, stridor, chvosteks and trousseau signs
**Nursing interventions **- Monitor serum levels, correct low calcium (calcium gluconate IV), monitor IV site, give phosphate binders (calcium carbonte) ALWAY DISSOLVE NEVER CHEW, 8 ounce water with meals. can cause constipation
Hyponatremia
Causes
S/S
Interventions
What precautions?
Replacing too quickly?
<135
Causes - too little sodium or too much water
* Sodium loss: Gi loss - vomit, NG suction, renal losses, diuretics, adrenal insufficiency, burns, fasting diets
* Excess water -Hypotonic IV fluids, polydipsia, cirrhosis, HF, SIADH
S/S - neurologic, cerebral edema, headache, nausea, vomiting, lethargy, confusion, seizures, coma.
Nursing interventions - monitor serum sodium, seizure precautions, replace sodium, fluid restriction, loop diuretics, don’t increase sodium too fast can lead to OSMOTIC DEMYELINATION SYNDROME = brain damage, monitor I &O
Metered Dose Inhaler
Deliver meds straight to lungs / avoid systemic side effects
Short acting beta agonists
Long acting
Inhaled corticosteroids
Primarily used for COPD
**SHake well for 3-5 sec, tilt head back slightly and exhale slowly for 3-5 sec. inhale and hold breath for 10 sec. Wait 1-2 mins before 2nd puff
Standard precautions
When do we use
How?
- All patients, all situations
- Hand hygiene (before/after contact
- Contact w/ blood, fluids, non-intact skin, mucous membranes, after removing gloves
Airborne precautions
When do we use it?
How?
Spread by small aerosolized particles
* Measles (Rubeola),
* Tuberculosis,
* Varicella
* Smallpox
* Covid
**MTV in ****S****mall **C**ountries
- Negative pressure room closed door
- N95
- Wear surgical mask when transported out of room
Droplet Precautions
When?
How?
spread by respiratory droplets
(Pertussis, flu, mumps, pneumoic plague, haemophilus influenza type B, neisseria meningitis) PIMPIN
- Private room
- Surgical mask
- Wear mask when transported out of room
Patients with what type of infection should be in isolated room first?
Airborne
Droplet
Contact
Airborne
What is abdominal Aortic aneurysm?
AAA
How diagnosed?
Risk factors?
S/S?
Trtmt?
Weakening in vessel wall creating a blood filled buldge
Diagnosed: Ultrasound, CT scan
Risk factor: Smoking, HTN, plaque, age, male
Pulsatile abdominal mass!!! Intense ab/back/flank pain, hypotension, tachycardia
TRTMT RBC, IV fluids, surgery, monitor I&O, peripheral pulses
Angina
Chronic?
Unstable?
Vasospastic?
Chest pain in response to MI or vasospasm
Chronic - fixed partial obstruction - occurs during exertion. STABLE and PREDICTABLE 02, beta blockers, Calcium blockers, nitro
Unstable/preinfarction - unpredictable. At rest or exertion. Sit upright, 02, 12 ECG, biomarkers, nitrate, morphine, coronary angiography
Variant/vasospastic - occurs at rest/sleep, triggered by smoking. May or may not be related to blockage, long acting nitrates, or Ca channel blockers
Alkalosis symptoms
*As the pH goes, so does my patient
What equiptment?
Except for potassium / hypokalemia & metabolic compensation breathing
Irritability, HTN, Tachypnea, tachycardia, Diarrhea, hyperreflexia, borborygmi (^bowel sounds), seizure
*Suction
Acidosis symptoms
*As the pH goes, so does my patient
expect what equiptment?
Except for potassium / hyperkalemia & metabolic compensation breathing
Hypotension, bradypnea (resp) / Kussmaul (metabolic), bradycardia, paralytic ilieus, constipation, hyporeflexia, flaccid, coma
*Resp arrest / ambu bag
What acid/base imbalance is Kussmaul resp
Metabolic acidosis
Aortic dissection
Type A
Type B
Risk
Diag
Trtment
Tear in aorta
Type A - affect heart & above. Sudden onset anterior chest pain. Tachycardic, diaphoretic. Fatal
Type B - heart & below. Ab/back pain. Reduced blood flow = Stroke, AKI, paralysis, cold legs/arms, MI
Risk: HTN, drug use, marfan syndrome
Diag: TEE, chest x ray, CT scan
*Trt: *reduce HR and BP. Labetalol or esmolol, upright position. Systolic between 100-120
Chronic venous insufficiency
Risk
S/S
Incompetent venous valvues = blood flows backwards and pools in leg
Risk: prolonged standing, DVT, obesity
S/S edema, red brown skin, Thick skin, ULCERS irregular shape above MEDIAL MALLEOLUS & painful in dependant position
if patietn has prolonged GI suction or vomit, what acid/base balance is it?
Metabolic alkalosis
For everything else that isnt lung or prolonged GI suction or vomit, what acid base imbalance?
Metabolic acidosis
Coronary Artery Disease (CAD)
Risk
S/S
Diag
Trtmt
Hardening of Coronary arteries due to plaque = impaired blood supply to heart
Risk: smoking, obesity, diet, stress. Family, sex, age, ethnicity. HTN, Hyperlipidemia
S/S asymptomatic until 50-70% is occulated then angina.
* Women - heartburn, epigastric pain
Diag - 12 lead, stress test, elevate lipid levels
Trtment - aspirin, clopideral, nitrates, statins, beta blockers, ACE, ca blocker, PCI, CABG
DVT
Causes (3)
S/S
Diag
Blood clot logged in deep veins (leg) blocked blood flow = inflammation
Causes: stasis (pooling), endothelial damage (surgery/trauma = more clotting factors), hypercoagulable state (preg)
S/S unilateral edema, pain, warmth, decreased sensation
Diag D-dimer, ultrasound
Trtmt anticoagulants, monitor for bleeding
MI
S/S
Atypical s/s
Diag
Trtmt
Unstable plaque ruptures and occuldes coronary artery = cell death
**S/S ** chest pain/ heavy pressure - radiating pain unreleaved by rest & nitro
Atypical S/S dizzy, tired, headache, GI syptpoms
Diag Changes in ST, cardiac enzymes (troponin, myoglobin, CK-MB) 4-6hours after MI
Trtmt Aspirin, Nitrates, Moprhine, 02, beta blockers, heparin
NSTEMI
Non ST elevated MI
Thrombus only partial occluding coronary artery / blood flow reduced
STEMI
ST seg elevation
Fully occlude / no blood flow
PCI
Percutaneous Coronary intervention
Perform within what time frame?
1st line treatment in MI
Perform within 90 mins
Thrombus retrieval, angioplasty, stent
CABG
Too large of blockage for a stent/balloon
Open heart / very invasive
Go around blockage from vein in leg
Peripheral Artery Disease (PAD)
S/S
Diag
Narrowing of arteroes due to atherosclerosis = decreased tissue perfusion
S/S* Intermittent claudication - ischemic pain during exertion relieved with rest*
Cool, dry, shiny skin, loss of hair, brittal nails, delayed pulse and cap refill. Tissue necrosis
Diag ankle brachial index. Pressures higher in Arm than leg in PAD
Septic Shock
Causes
S/S
Labs
Exaggerated immune response to microorganism causing vasodilation, leaky capillary, altered blood flow. Wide spread infection
Causes: gram - & + bacteria
S/S fever or hypothermia, tachycardia, persistent hypotension (leaky capillary), bounding pulses, resp distress, mental status changes, cold mottled skin
Labs Leukocytosis, positive blood cultures, increased blood glucose, lactic acid increase, coag alterations (DIC)
Signs of arterial insufficiency
Muscle pain
Decreased pulses
Hair loss
Cool, dry shiny skin
Gangrene
Thick brittle nails
Small circular deep ulcers
Signs of venous insufficiency
Varicose vein
Warm thick skin
Bronze brown color
Large irregular shaped superficial ulcer with drainage
edema
Diabetes insipidus
Central
Nephrogenic
S/S
Trtmt
Insufficient production of ADH by pit gland or lack of response to ADH
Central - Trauma or
Nephrogenic - resistance from kidneys from lithium, hypercalcemia, heredity
S/S polyuria, diluate and pale urine, freq urine, tachycardia, hypotension, dry mucous membranes, diminished peripheral pulses. Increased serum sodium, decreased urine specific gravity
Trtmt - central - desmopressin. Both hypotonic IV (.45% sodium chloride)
Diabetes Mellitus - TYPE 1
S/S
Need more insulin when?
Hypoglycemia?
Autoimmune destruction of panceatic beta cells
S/S - Thin. 3 P’s Polyuria, polydipsia, polyphagia, fruity breath, blurred vision, noturia, yeast infection.
*More insulin during illness, infection or stress
Hypoglycemia - under 70. Im glucagon if unconscious
DKA - process
S/S
Diagnosis
Trt
Lack of insulin = intracellular starvation = body uses fat for energy = high lvls of acidic keytones = kidneys increase excretion of excess glucose
* Diuresis - dehydration - hypovolemic shock
* 3P’s, nausea, fruity, kussmaul, lethargy, dry skin, hypotension, tachycardia, dizzy
Diag - blood glucose lvl, lvl serum/urine keytones, low serum pH, hyperkalemia
Trt - Fluid volume resus FIRST , then IV insulin. Then D5W to prevent glucose from getting too low
*pseudo hyperkalemia / monitor for rebound hypokalemia
Signs of hyperglycemia
Polyuria
Polydipsia
Nausea/Vomit
Fruity breath
Kussmaul respirations
Lethargy
Hypoparathyroidism
S/S
Monitor for
Trtmt
Parathyroids secrete PTH which affect calcium level
S/S decreased calcium, increased phos & decrease in PTH
Tingling, numbness, trousseau & chvostek sign, muscle cramp, pronlonged QT, Tetany, SEIZURES & precautions!
Monitor for dysrhythmias, high vit D (dark green & tofu), low phos diet
IV calcium gluconate
What does hormone PTH do
Cause bones to release calcium and increase renal absorption of calcium
PTH increases so does calcium. PTH decreases so does calcium
How to check Trousseau sign?
Check BP above Sys bp for 3 mins. Thumb and Wrist flex = positive
How to check Chvostek sign
Taping on facial nerve and patient spasm facial muscles
Acute Pancreatitis
Direct injury
Obstruction
S/S
Trtmt
Inflammation of pancreas
* Direct injury - alcohol, virus, meds (thiazide diuretics)
* obstruction - tumor, gallstones
S/S - severe ab pain after eating (epigastric/upper left ab/back), nausea/vomit, elevated lipase & amylase levels, CT shows inflammation
Trtmt - pain mgmt, IV fluids, antiemetics, NPO, monitor blood glucose and calcium lvls
Chronic pancreantitis
S/S
TRTMT
Repeated inflammation Can lead to fibrosis on pancreas
S/S ab pain, Malabsorption, fatty stools, weight loss, DM
TRTMT - small bland freq meals, give pancreatic enzymes w/ meals, supplement vit and minerals
SIADH
Causes
S/S
TRTMT
Excessive production of ADH = leads to excessive water retention
Causes:
* CNS disturbance (stroke, hemorrhage, trauma)
* Meds (pneumoia)
* Cancers
S/S Low urine output, Weight gain, HTN, Hyponatremia (confusion, seizures, coma), increased urine specific gravity
TRTMT - daily weight, I&O, neuro checks, Seziure precaution. Diuretics, vasopressin antagonists, monitor electrolytes
What are the isotonic solutions?
Used for
0.9Sodium chloride, LR
To replace extracellular fluid: dehydration, hypovolemia, vomiting
Maintenance fluids: surgery or illness
Electrolye imbalances
Blood transfusion
Wound irrigation
What are the hypotonic solutions?
Used for?
2.5% dextrose, 0.45 NaCl
Cause water to move from extracellular space into cells
* DKA & HHS
* Hypernatremia
* Conditions of excessive water loss
What are the hypertonic solutions?
Used for?
Dextrose 5% & 0.9& NacL, Dextrose & LR, Dextran, albumin
Causes water to move out of cells into extracellular space
* * Hyponatremia
* Reducing ICP
* Volume expansion
* Parenteral nutrition
* Electrolyte imbalances
S/S of Addison Disease
AKA Primary adrenal insufficiency
Depression, hypotension, hyperpigmentation, decreased public/axillary hair, decreased appetite, fatique, hypoglycemia, muscle weakness
Signs of hypoglycemia
Anxiety
Shakiness
Clammy skin
Diaphoresis
Tachycardia
Hunger
Weakness/fatique
S/S Cushing Syndrome
Moon face
Muscle wasting
Fat pads
Bruising
Central obesity
Striae
Appendicitis
Cause
S/S
Absence of pain?
Avoid?
Inflammation of appendix
Cause: Obstruction - hardened fecal matter or infection
S/S GRADE. Garding, Rebound tenderness (RLQ) MCBURNEYS POINT, Anorexia/absent bowel sounds, Diffuse ab pain, Elevated WBC/temp
***Absence of pain = rupture
Avoid heat and enema & cathartics
Bowel obstruction
Mechanical
Non-mechanical
S/S
Trtmt
Mostly in sm intestine
Mechanical - Surgery adhesions, hernia, tumor
Non-mechanial/paralyitc ileus - ab surgery, neuromuscular & vascular problems
S/S - ab pain, distention, inability to pass stool/fart, Nausea/vomit,
* * Mechanical = increased bowel sounds, nonmechanical = decreased bowel sounds *
* Vomiting = hypokalemia & metabolic alkalosis
TRTMT - Avoid opioids, NPO, NG tube, antiemetics (ondansetron)
Celiac Disease
S/S
What grains to eliminate?
Autoimmune - inability to process gluten
S/S Ab discomfort, diarrhea, bloating, steatorrhea, iron def anemia, vit def
BROW - Barley, Rye, Oats, Wheat - elimate
Cholecystitis
Risk
S/S
How to test murphys sign
Inflammation of gallbladder - Cystic duct is obstructed by gallstone
Risk Female over 40, multiparous, obesity, birthcontrol, elevated cholesterol
S/S pain in upper right quad, radiate to R shoulder/back, pain worse after eating. Nausea, vomit, positive murphys sign, fever, tachycardia, leukocytosis
Testing Murphy - press under right rib / medial to mid clavicular before asking to take a deep breath. Pt will halt inhalation due to pain.
Cirrhosis / End stage liver disease
4 things liver does and how its affected
Risk factors
Scarring of liver tissue after repeated inflammation
* Decreased bilirubin metabolism - jaundice, itching/dry skin, dark urine, pale stool
* Decreased protein synthesis - bruising, edema ab & lower
* Altered metabolism of hormones - gynecomastia, loss of pubic hair, palmar erythema
* Altered blood flow to liver - portal HTN, esophageal varices, splenomegaly, acscites
Risk Chronic hep B or C, Alcoholism, fatty liver disease (obese)
TRTMT - sit up, diuretics, paracentesis, daily weight, avoid sedatives, acetaminophen
Cirrhosis
Increased and decreased lab values
Increased serum bilirubin & serum ammonia
increased PT, PTT, ALT, AST
Decreased albumin, platelets and WBC
C difficle
How long can spores surivive
S/S
Complications
Precautions?
TRTMT
Spore forming, gram positive
Spores from diarrhea can survive on skin, clothes and environmental surfaces for months
S/S profuse watery diarrhea, Ab pain, nausea, fever, dehydration
TOXIC MEGACOLON - pertonitis
Contact precautions - wash hands
TRTMT Vancomycin, fidaxominicin
Diverticulitis
S/S
What to avoid
Complication of current diverticulosis that leads to Inflammation/infection
S/S Fever, constipation now loose stools or just constipation, occult stools, ab pain LLQ worse with cough, strain or lift.
No colonoscopy! could cause tears
High fiber/avoid fried
Diverticulousis
Risk
Sac like pouches form in colon wall
Risk: constipation, obesity, straining, heavy lifting
High fiber diet
Enteral feeding
Types
Nursing interventions
Means of providing nutrition to pt who cannot eat or drink
Short or long term (Gastrostomy tube or jejunostomy tube)
* Bypass damaged portion of GI tract
Types: bolus (30-60min q 3-6hrs), Continuous /24hrs, Cyclical continuosly /8-16hours
Nursing verify tube to prevent aspiration, warm feeding to room temp, elevate HOB, check bowel sounds before, during, after.
If resudial is >500ml, stop and call HCP**
Esophageal Varices
S/S with rupture
Trtmt
Distended torturous blood vessel /Seen with Cirhossis
S/S Can rupture - excessive bleeding, could be coffee ground emesis, melena, hypotension, tachycardia
TRT with rupture NPO, protect airway, inbutation, IV fluids, PRBCS, Octreotide, PPI, emergency EGD procedure (Sclerotherapy, band ligitation, sengstaken-blakemore tube)
Gasteroenteritis
Transmitted
Viral
Bacteria
S/S
Acute GI infection
Transmitted fecal0oral, containimated food/water, person to person
Viral - Norovirus, rotavirus, enteric adenovirus
Bacteria - food poisioning
S/S Diarrhea, vomit, fever, hyperactive bowel sounds, dehyrdation, hypovolemia
GERD
Risks
S/S
Barret esophageous
Avoid
Back flow of stomach acid into esophagous / chronic condition
Risk Obesity, preg, hiatal hernia, foods/meds
S/S heartburn, indegstion, dysphagia, regurgitation, cough, wheezing - increased bending, lying down
Barrett esophagous - early indication of cancer
Avoid caffeine, chocolate, alcohol, carbonated drinks, spicy foods, citrus, lying down 2-3 hours after eating
Hepatitis
Causes
A
B/C
S/S
Meds
Widespread inflammation of liver
Causes virus, alcohol, meds
A - virus spread fecal-oral
B/C - blood, sex, mother/child - only B & C can lead to chronic infection
S/S anorexia, pain RUQ, jaundice, dark urine, pale stool,
Meds - antivirals
Ostomies
Stoma
Stool changes
Signs of returning motility post op
Teaching
Creation of stoma in ab wall for passage of stool to bypass diseased partion of colon
Stoma - pink to red, moist/vascular
Stool changes - more liquid proximally, more solid distally
Signs of returning motility post op - Less nausea, active bowel sounds, flatus in ostomy bag, edema red stoma
Teaching -Empty 1/3 of way full, increase fiber, avoid foods that cause odor
Peptic ulcer disease
Risk
S/S
TRTMT
breakdown of protective lining in stomach
Risk - h. pylori, NSAIDS, smoking, alcohol, caffeine, stress, trauma
S/S ab pain (1-2 hours after meal), gi bleeding
TRTMT - non bleeding = antibiotics, PPI, Sucrulafate - forms protective lining (take before PPi)
Bleeding - NPO, check hemoglobin, hematocrit
Sickle Cell
S/S sickle cell crisus
Vaso-occulsive?
Sequestions?
Hyperhemolytic?
S/S
TRTMT
Autosomal recessive - both partents have to have it
Alter in hemoglobin - occuld small blood vessels
S/S sickle cell crisis -
* vaso-occulsive - Painful distal ischemia (Hand/feet)
* Sequestration - pooling of blood in liver and spleen
* Hyperhemolytic - anemia
S/S Tachyardia, pain/pain in joints, infection, WBC over 10,000, anemia, increased reticulyte count
Trtmt - diet, vitmain w/o iron, folic acid, hydration, vaccinations, 02, pain meds
Anaphylaxis
What happens in body?
Common offenders?
S/S
TRTMT
life threathing immediate hypersensitivity reaction
* Vasodilation & increase cap permeability
* Laryngospasm & bronchospasm
-Peanuts, shellfish, beestings, red dyes, vaccines, rubber blood transfusion
**S/S **- Warm, wet rash. Swollen, SOB, HTN, arrythmias, GI upset
TRTMT stop transfusion, emergency response team. IM epi q 5-10 mins, recumbent position and elevate lower extrem, IV fluids, 02, intubate if needed. Albuterol, corticosteroids, antihistamines.
Influenza
Transmitted via
Most infectious when?
S/S
Interventions
Highly contagious respiratory viral infection
* Transmitted via droplet
* Most infectious 24 hours BEFORE symptoms
S/S Sudden onsest of fever/chills, fatique, body aches, resp symptoms
>65 yr - altered mental, anorexia, dizzy
Interventions - Droplet, flu shot, antipyretics, analgesics, OSELTAMIVIR
Tuberculosis
Latent
Active & S/S
Miliary
Diag
interventions + Meds
Resp disease / spread through aerosols
Latent - no signs of infection
Active - spread to other organs// slow onset// Cough, fever, chills, night sweats, weightloss
Miliary - any organ (brain, liver, kidney, bones)
Diag - 15mm is standard, active is seen on chest xray
Interventions - neg pressure room, N95 mask, ISONIAZID, RIFAMPIN, PYRAZINAMINDE, ETHAMBUTOL - Monitor for hepatotxicity
Eczema
S/S
Complications
Chronic recurring skin disorder
S/S dry scaly lesions, erythema, papules
Complication - lichenification (thickening skin), 2ndary infection, impetigo (gold crust)
Impetigo
Spread?
S/S
TRTMT
Highly contagious skin infection caused by staph or strepp
Spread directly or indirectly
S/S - Nonbullous - papulses golden thick crust
Bullous - fluid filled vesicle
**TRTMT **- Topical antibiotic, oral antibiotic
Gout
Risk
S/S
Diag
Trtmt
what food to avoid
Excess uric acid accumlated in synovial joints
Risk obesity, hyperlipidemia, Dm, high protein high fat diet, excessive alcohol
S/S severe pain, joint warmth, red, swelling
Diag serum uric acid
TRTMT NSAID, Colchicine, elevate, ice, hydration
AVOID food high in purine (organ meat, wines, aged cheese)
Guillain-Barre Syndrome
Preceeded by
S/S moving in what direction
Auto immune disorder that affects peripheral nerves
* Preceeded by infection
S/S symmetric ascending muscle weakness, diminished deep tendon reflexes, paresthesia, back pain, urinary retention, cardiovascular instability
TRTMT - NO CURE, just supportive, resuscitative equipt ready
P wave refers to?
QRS wave refers to?
P wave - atrial
QRS wave - Ventricular
Normal Sinus rhythm
Ventricualr fibrillation
Ventricular tachycardia
Asystole
Myasthenia Gravis
S/S
Triggered by
Meds
Myasthenic crisis
Auto immune muscle disease / tumor in thymus gland
S/S Fluctuating skeletal weakness, ocular, lower face/neck, resp impairment, neck and limb weakness
Triggered by stress, infection, meds, temp changes
Meds Pyridostigmine / take before meal
Myasthenic crisis - Severe oropharyngeal and respi muscle weakness / intubate & semi fowler. Corticosteroids & plasmapheresis or IV immunoglobin
Osteoporosis
Risk
S/S
Interventions
Holes in bone / fragile
Risk advanced age <60, low estrogen, low testosterone, Thin/low weight, smoking, alcohol
S/S kyphosis, typically no symptoms until fracture
Interventions Vit D supplements, Calcium carbonate, biphosphonates, sun exposure
Parkinson Disease
S/S
Interventions
Degeneration of dopamine & uncontrolled acetylchoine = lewie bodies in brain
S/S “TRAP” Tremor, Rigidty of muslces, akinesia, postural instability. Shuffling gait & stooped posture
Interventions - Carbidopa/Levodopa (replace dopamine)
Rheumatoid Arthritis
S/S - elevated lab? 2 main deformities?
TRTMT
Chronic autoimmune inflammation and damage to synovial joints
S/S periods of remission & exacerabation, joint pain, Prolonged morning stiffness lasting longer than 1 hour. Symmetric joint involvment, Joints tender, swollen and warm to touch
Tired, weightloss, elevate ESR* Swan neck deformity, ulnar deviation *
**TRTMT **NSaids, glucocorticords, DMARDS - methotrexate / avoid repeatitive movemnet
Spinal cord injury
Complete VS Incomplete
Diag
Autonomic dysreflexia
S/S & Trtmt
CNS
Complete - interruption of all motor/sensory below level of injury
Incomplete - motor/sensory not fully interrupted
Diag - CT or MRI
Autonomic Dysreflexia - Noxious stimuli below level of injury (distended bladder, impacted rectum, constrictive clothing)
* Severe HTN, Severe headache, nasal stuffiness, flushing, bradycardia
* Raise HOB, Loosen clothing, Antihypertensive meds
Bacteria Meningitis
S/S Adults/peds & neonates
Diagnosis
Interventions
What precautions
Life threathening inflammation or infection of meningies / caused by nisseria or strep pneumonia
S/S - ADULTS/peds - Fever, headache vomit, neck stiff
Neonates - Poor feeding, bulging fontanels
Diagnosis - CSF exam, lumbar puncture (cloudy, WBC, high protein, low glucose)
Interventions - prevent ICP
* Droplet precautions/seizure precautions
Cerebral Edema
Caused by
S/S
CUSHING TRIAD
Interventions
Excessive fluid in brain
Caused by trauma, surgery, tumor
S/S Headache, vomit, change in LOC, Decorticate & Decerebrate, hyperthermia,
CUSHUNG TRIAD - HTN w/ widening pulse pressure, Bradycardia, irregular respirations
Interventions - Hypertonic saline, HOB 30 degrees, Neutral position, Osmotic diuretic stool sofetener
Diabetic neurophathy
Peripheral neuropathy S/S
Autonomic neuropathy S/S
Treatment
Irreversible nerve damage
Peripheral neuropathy - Stocking glove paresthesia / tingling & burning, decreased or absent reflexes, ulcers, sensory ataxia (Romberg test)
Autonomic neuropathy - hypoglycemia unawareness, orthostatic hypotension, Gastroparesis, bowel dysfunction, neurogenic bladder, erectile dysfunction
Trtmt - Antidepressants, anticonvulsants, topical capsaicin
Ischemic Stroke
Risk
S/S BE FAST
TRTMT
Thrombus (formed in Cerebral artery) or embolus (clot that moved)
Risk HTN, DM, Hyperlipidemia, smoking, CAD, Afib,
TIA - Warning sign of stroke. Neurologic deficit last only mins or hours
S/S BE FAST. Balance, Eyes, Face (weakness, drooping), Arms/Legs (weakness), Speech, Time
Diag - CT w/o contrast. Rules out hemorrhage so they can use TPA
Trtmt - TPA must administer with in 4.5hrs, look for active bleeding, recent brain surgery
*Permissive HTN for nonTPA patients *
If a patient has a stroke in LEFT hemisphere what will it affect?
Language, reading, reasoning, math and sciences, touch and movmt on right side
If a patient has a stroke in RIGHT hemisphere what will it affect?
Spatial processing, emotion, art music. Touch and movment on left side
Lack of QRS ?
Saw tooth?
Chaotic always used to describe?
Bizarre?
Lack of QRS - Asystole
Saw tooth - Flutter
Chaotic - fibrillation
Bizarre - Tachycardia
When to be concerned about PVC?
- More than 6 /min
- 6 in a row
- PVC falls on T-wave of previous beat
Benign Prostatic Hyperplasia
S/S
Complications
Meds
Surgery?
Gradual and abnormal prostate enlargement - compressing urethra = voiding dysfunction
S/S Weak urinary stream, Hesitancy, straining to void, Freq, noctura
Complications (Back up of urine) AKI, Hydronephrosis, UTI
Meds - Alpha-adrenergic antagonists (Sm muscle relax)- Tamsulosin, doxazosin
5-Alpha reductaste Inhibitors (decreases prostate) Finasteride
TURP - surgery
What meds cause urinary retention?
Anticholinergics, antihistamines, decongestants
Acute Respiratory distress Syndrome (ARDS)
3 patho systems
S/S
Diag
Interventions
Progressive respiratory failure usually after lung injury or multie system organ disease
* Stiff lungs
* Increased permeability = increase of fluid in lungs & decrease of 02 exchange
* Cytokine storm
S/S SOB, Refractory hypoxemia, tachypnea, intercostal retractions, tachycardi, fever, pulmonary edema
Diag - low Po2 (under 80), repiratory acidosis, Chest Xray - diffuse infilatrates
interventions - fowlers positiong, ventilator w/ PEEP, Restrcit fluids, prone, increase 02 to 100% before suctioning
Pneumonia
4 types
S/S
Diag
Interventions
Inflammatory reaction in lungs - increased secretions & impaired gas exchange
* Community aquired
* Hospital
* Ventilator
* Aspiration
S/S Diff breathing, productive cough w/ purulent sputum, increased RR, Chest pain on deep breathing, fever chills, tachycardia, hear crackles
Older - may only be confused/hypoxia
Diag - chest Xray, high WBC, Sputum culture
Interventions - hydrate, deep cough q 2hour, incentive spirometer 10X every hour, lay on side with infected lung UP
Pneumothorax
3 types
S/S
interventions
Auir enters pleural space and cuases collapse of lung
* Open - air enters through hole (trauma, gunshot)
* Closed - air enters through hole in lung tissue (surgery injury)
* Tension pneumothorax - air enters but cannot escape -Trachea shifts, hypotension
S/S Dyspnea, restless, cyanosis, chest pain, hypotension, tachycardia, low 02 sat, dimished lung sounds
Interventions - 3 way occulsive dressing over sucking wound, fowler position, chest tube
Pulmonary Embolism
Virchow triad
S/S
Diag
Interventions
Occlusion of pulmonary arteries by blood clot, fat, air or amniotic fluid
**Virchow triad **- Stasis, Endothelial damage, Hypercoagulable state
S/S dyspnea, pleuritic chest pain, hypoxemia, tachypnea, cough, hemotysis, impending doom, hypotensive, respiratory acidosis
Diag - D dimer, CT pulmonary angiogram with contrast
Intervention - high fowler, anticoagulants, analgesic, Tpa or embolectomy
Acute Glomerulonephritis
Causes
S/S
Diag
Complications
inflammation and destruction of glomerulus = loss of kidney function
Causes - Strep infection, systemic lupus
**S/S **oliguria, Dark, rust colored urine, protienuria, edema (periorbital), HTN, weight gain, flu like symptoms
Diag - Urinalysis, BUN and Creatinine elevated, evidence of recent strep infection
Complications - Hypertension encephalopathy, AKI, Fluid overload
Chronic Kidney Disease (CKD)
Staging
Causes
S/S
TRTMT - HTN, Anemia, Edema, bones, hyperkalemia, hyperphosphatemia, metabolic acidosis
Diet -
Irreversible slow progressive disease
Staging is based on GFR. Stages 1-3 kidney still functioning. 4-5 severely impaired
Causes DM & HTN
S/S Volume overload, edema, pulmonary edema, pleural effusion, HTN, lethary, neurological changes / elevated Potassium & phosphorus. Low calcium. Metabolic acidosis
TRTMT - HTN - ACE inhibitor, angiotensin 11 receptor blockers
Anemia - Erythropoietin injection
Edema - Diuretics (stages 1-3)
Bones - Calcium & vit D
Hyperkalemia - PO intestinal K binder
Hyperphosphatemia - PO phosphate binders
Metabolic acidosis - Sodium bicarb
DIET - low potassium, phosphorus, sodium and water
Hemodialysis
Purpose
3 access ports
Closed system outside of body
* Removes waste, excess water, corrects electrolytes, restores acid base
3 access ports Central venous double lumen, arteriovenous fistula, arteriovenous graft
Interventions - admin heparin, monitor for bleeding, vitals
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Peritoneal Dialysis
Phases
Interventions
Peritonitis
Abnormal outlfow
Uses peritoneum as semi permeable membrane - surgical placement of cathether
Phase - Fill - instill dialysate, Dwell - Dialysate remains in cavity alloweing exhange of fluid, electrolytes and waste, Drain - dialysate, electrolytes, waste are drained via gravity
Interventions - aseptic technique, pt wear a mask,
Peritonitis - tachycardia, fever, ab pain, cloudy effluent
**Abnormal outflow ** Cloudy = infection, Blood = expect during first few, later indicates vascular issue, Fecal/brown = intestinal perforation
Tumor Lysis Syndrome
Causing what 3 disorders and assoc complications
S/S
Interventions
Chemo attacks tumor cells - tumor cells open and spill out intercellalur components - Potassium, phosphate, uric acids
Causing
* hyperphosphatemia (AKI & Hypocalcemia)
* hyperuricemia (AKI)
* hyperkalemia (Cardiac arrhythmias
S/S AKI, elevated BUN & creatinine, flank pain, cardiac arrhythmias, seizures
Interventions - aggressive IV fluids (Allopurinol, rasburicase)
UTI
Diagnosis
Bacterial infection of lower urinary tract (Cystitis) or lower tract (pyelonephritis)
Diag - clean catch mid stream urine sample, WBC and nitrates
S/S dysuria, urinary freq and urgency, hematuria, lower ab pain, nausea, fever, flank (pyelonephritis)
Macular degeneration
Risk
Type
S/S
TRTMT
Progressive aged related loss of vision
Risk - older age, HTN, tobacco vision
Types Dry - ischemia and atrophy of macula from drusen build up
Wet - bleeding and leaking fluid from formation of new vessels
S/S blurry vision, wavy vision, scotomas (blind spots), loss of central vision
TRTMT - increase Vit C&D, dark leafy veg, angiogenesis inhibiots, laser therapy
Meniere Disease
S/S
Diag
TRTMT
Often affects 1 year but can affect both. Excess fluid build up in inner ear - affecting balance and hearing
S/S vertigo, tinnitus, sensorineural hearing loss, feeling fullness in ear
Diag audiometry
TRTMT - Antiemetics, low dose diuretics,
Otitis Externa
S/S
TRTMT
Infection of outer ear cannal (swimmers ear)
S/S Rapid on set/w/in 48hours, swelling, itching
TRTMT - antibiotic drops & hydrocortisone
What are different types of loosening of association?
Flight of ideas
Word salad
Neologisms
Ideas of reference
You think everyone is talking about you
Anorexia Nervosa
Restrictive & binge eating types?
S/S
Indications for hospitalizations
Eating disorder - crave control
Restrictive type - extreme fasting, excessive excercise
Binge eating/purging - eat large portions and binge, laxatives, diuretics
S/S - low and slow. Confusion, dry skin, hair loss, decreased libido, low BMI <18.5) fatique, cold intolerance, hypotension, bradycardia, constipation, muscle wasting
Indications for hospitalization <70% of expect weight or under 15 BMI, refeeding syndrome, hemodynamic instability, refuse to eat
ADHD
S/S
Interventions
Deficiency in neurotransmitters - Norepinephrine and dopamine
S/S inattention, distractibility, hyperactice for at least 6 months, present before 12years
Interventions behavioral therapy, Methylphenidate, amphetamines, SNRI
Bulimia Nervosa
S/S
Eating disorder by cycle of overeating followed by compensatory behaviors (vomit, excessive excercise, fasting, laxatives) / emotional triggers
S/S normal to elevated BMI, enamel erosins, Russel sign (hand calluses), GERD, cardiac arrhythmias, dehydration, hypokalemia, metabolic alkalosis
over
Tetralogy of Fallot
4 defects?
S/S
Tet spell intervention
Congenital heart defect characterized by 4 defects
1. Pulomanry Stenosis - Narrowing of pulm valve = decreased blood to lungs
2. Overriding aorta - positioned between R&L vents which allows deoxygenated blood to enter circulation
3. Ventricular septal defect - opening between R and L vents which allows oxgenated and deoxenageted blood to mix
4. Right ventricular hypertrophy - Enlargement of R vent = ineffective pumping and blood to body
S/S fatique, dyspnea, cyanosis, Central cyansosi worse with exertion, Systolic ejection murmur
Tet spell intervetnion - Knee chest position
Hypertrophic Pyloric Stenosis
S/S
Complications
Thickening of pyloric sphincter in infants = blocks passage of gastric contents into intestines
S/S Postprandial projectile vomiting, 3-6 weeks of age, irritable & crying, persistent hunger
Complications Dehydration, sunken anterior fontanel, dry mucous membrane, metabolic alkalosis, decreased stool, olive shaped mass in epigastric
Refeeding syndrome
S/S
reintroducing caloric intake too quickly
S/S hypokalemia -cardiac dysrhythmias
Hypophosphatemia - muscle weakness - resp failure
Hypomagnesemia - Seizures or PVC
Hyperglycema
Tracheoesophageal fistula (TEF) and Esophageal Atresia
S/S
Complications
Congenital malformations/ diagnosed typically as newborn
Atresia - a part of body that is closed or absent. Blind pouch
Fistula - abnormal connection of two parts of body
S/S coughing, choking and vomiting when eatiig, drooling, frothy salivia, ab distension, apnea, coarse breath sounds
Complications can lead to aspiration pneumonia
Acute lymphoblastic Leukemia
S/S
Interventions
Cancer of bone Marrow - affects lymphoblasts - Rapid growth of immature WBC - decreases healthy cells
S/S Pancytopenia, Anemia, decreased RBC, Pallor, fatique, decreased platelets, bleeding ,brusing, petechiae, decreased WBC, neutropenia
–Weight loss, bone pain, lymphadenopathy, hepatosplenomegaly
Intervention - bone marrow biospy and aspiration, Neutropenic precautions (gown, gloves, mask) Private room. AVOID raw foods/veg, fresh flowers, rectal thermometer, live vaccines, large crowds
Acute Myelogenous Leukemia
S/S
Complications
Cancerous disorder of bone marrow - Myloid cells (WBC) overproduced immature WBC take up nutrients of mature WBC
S/S Pancytopenia (decreased RBC, platelets, WBC)
Interventions - Bone marrow biospy/aspiration, Chemo/radiation, Blood products.
Complications - Neutropenia
Mononuceolosis
Spread via
S/S
Complications
Acute disease caused by epstein barr virus
Spread via direct contact with oral secretions, blood or transplantation
S/S Severe and prolonged fatique, sore throat, Tomsillar hypertrophy, hepatosplenomegaly, rash
Complications - Rupture of spleen (avoid contact sports for 3-4 weeks)
Pertussis
Spread
S/S
Interventions
Whooping cough/bacterial respiratory infection
Spread resp droplets
S/S
* Catarrhal phase - cough, rhinitis, sneezing, fever for 1-2 weesl
* Paroxysmal phase - Violent spasmodic coughing attacks followed by an inspiratory whoop (emesis, syncope, rib fracture, apnea, bleeding)
* Convalescent phase - Mild cough for 6-10 weeks
Interventions standard + droplet precautions, antibiotics, humidified air
Cerebral Palsy
Caused by
Risks
Treatment
Nonprogressive, permanent motor and postural disorder
Caused by brain injury during or after birth.
Risk peirnatal infection, PROM, Premature, low birth weight, cord prolapse, preeclampsia
S/S abnormal muscle tone, posture and coordination. Spasticity, disturbance in gait, impairment in speech and swallowing, difficultly learning, seizures
Treatment ROM, muscle relaxants, assistive positioning devices
Bacterial Meningitis
Life threatning inflammation/infection of meningies
S/S
* Adults - fever, headache vomit / neck stiff
* Ped - fever, headache, vomit / rask, neck stiff
* Neonates - Poor feeding / buldging fontanels
Acute Pediatric Epiglottitis
S/S
Swelling of epiglottis - most commonly caused by HiB (Haemophilus flu typeB)
S/S sudden onset, fever, sore throat, agitated, resp distress, tripod position
* Drooling, Dysphonia (muffled voice), Dysphagia, Distress
Asthma
S/S
Diagnosis
Treatment
Peak flow meter
Chronic obstruction of airway
* Hyperactive airway, inflammation, hypersecretion of mucus
* Triggers - Allergens, medications, environmental, infection
S/S chest tightness, diff breathing, wheezing, cough
Diag spirometry
**Treatment ** Short acting beta 2 - Albuterol, anticholinergic - ipratropium, corticosteroids
Maintenance - long actinge beta agonist, bronchodilater before steroids
Peak flow meter - measures amount of air able to push out lungs.
Bronchiolotis and RSV
S/S
Interventions
Inflammation of bronchioles - produces thick mucus - obstruction of bronchioles
Spread by droplets and direct contact
S/S Rhinorrhea, cough, pharyngitis, sneezing, fever, adventitious lung sounds
Interventions - droplet precautions + standard, 02, hydration
Cystic Fibrosis
Diag -what test?
S/S
Autosomal recessive - both parents
Causes defective chloride channel secreting thick sticky secretion
* Obstruct small airways
* Blocks exocrine ducts - not able to produce enzymes
* Instestinal tract and reproductive tract
Diag - postive sweat chloride test.
S/S Freq infection of lungs, Chronic cough, Barrel chest, suspect in infants who cannot pass stool in 24-48 hours, steatorrhea, failure to grow, DM,
Meds used to treat enuresis
Desmospressin (anitdiuretic)
Oxybutynin (anticholinergic)
Imipraminie (TCA)
Hemolytic Uremic Syndrome HUS
Caused by E coli bacteria. after a diarrheal illness, results in triad of
* Hemolytic anemia - Tired, pallor
* Thrombocytopenia - Petechiae, bruising, purpura
* AKI - olgiuria, edema, HTN
Interventions - contact precautions, maintain fluid balance, monitor strict I&O
Ectopic Pregnancy
S/S
TREATMENT
Egg implants in fallopian tube
S/S pain in ab on one side, abnormal bleeding/spotting, hypotension, referred shoulder pain
TREATMENT - Methotrexate (urine toxic up to 72hours), avoid analgesics stronger than acetaminophen, surgery may be required
Preeclampsia
Pre E W/o
Pre E W/
Complications for maternal and fetal
HTN disorder of pregnancy - High bp after 20 weeks of gestation
**Pre E w/o severe features **- Bp greater than 140/90, preteinuria
**Pre E w/ severe features **- Bp greater than 160 or 110, Thrombocytopenia, increased creatinine, increased LFT, visual or cerebral changes
* Maternal - AKI, pulmonary edema, ischemic stroke, hepatic failure, DIC, eclampsia
* Fetal - Placental abruption, restricted growth, preterm birth, fetal demise
**Preterm labor **
Very preterm
Moderate
Late
S/S
Term after 37 wks, Preterm before 37 wks
* Very preterm - less than 32 wks
* Moderate - 33-34wks
* Late - 34-37 wks
S/S Painful freq contractions, low back pain
Stages of Labor
False vs true labor
1st stage
2nd stage
3rd stage
4th stage
Labor - regular contractions which cause progressive cervical dilation and effacement
False labor - irregular contractions, no cervical dialtion, effacement, or fetal descent
True - regular contractions, dilation, effacement, fetal descent
1st stage - Start of contractions to pushing
Latent - 05cm cervical dilation
Active - 6-10cm dilations / bloody show
Transition - 8-10 dilations
2nd Stage - 10cm dilated to birth
3rd stage - delivery of placenta (oxytocin give)
4th stage - 1-4hours post delivery
Umbilical Cord prolapse
S/S
Interventions
Obstetric emergency
S/S visualized cord protruding from vagina, palpation of cord during exam, sudden fetal heart rate changes, Fetal bradycardia, moderate to severe decelerations
Interventions - Wrap protruding umbilical cord with sterile towel and warm saline, IV fluid bolus + 02, push head upward off cervix, mom to knee chest position,
Cleft lip and Palate
Increased risk for?
Interventions
Cleft palate - small bones of roof of mouth do not fuse appropriately
* Increased risk for aspiration, issues feeding, poor sucking, aspiration pneumonia, recurrent ear infections, speach difficulties
Interventions - feed in upright position, burp after every oz, surgery at 6-12 months
-elbow restraints, observe for obessive swallowing, no straws or pacifiers
Hirschsprung Disease
S/S
Interventions
Congential - Bowel does not contain certain cells that allow it to contract to pass stool. Bowel is tightened
S/S Dilated bowel, ab distention, feeding intolerance, bilious vomiting, Ribbon like stools, poor weight gain, delayed meconium passage by 48 hour mark
Intervention - Surgery to remove nonfunctional part of bowel
Infant botulism
S/S
Interventions
Occurs through food poisioning. Toxins released which can inhibit acetylcholine causing muscle paralysis
S/S symmetric descending muscle paralysis, ptosis, absent gag reflex, poor feeding, constipation
Interventions IVIG, mechanical vent, tube feeding
Neonatal Abstinence Syndrome
S/S
Interventions
Withdrawl caused by exposure in utero to substances
S/S CNS, irritable, high pitched cry, hypertonia, tremors, short sleep cycle, sneezing, yawning, tachypnea, vomit, diarrhea
Interventions daily weight, freq small feeding, minimize environment, swaddle tightly, Opioid agonists
Newborn Hypoglycemia
Risks
S/S
Blood glucose of less than 40
Risks preterm, small or large for gestational age, mom has DM, respiratory distress
S/S Hypotermic, poor feeding, tremors, irritability, exaggerated moro reflex, tachypnea, lethargy
Spina Bifida
Closed S/S
Open S/S
Risks
Interventions
Defect within vertebrae of spine. Leaves an opening
**Closed (Occulta) **- Dimple above but or hair tuff, hemangioma, or subcutaneous mass
**Open (Cystica) **- See spinal cord, nerves, fluid, sac protruding. Everything below will be affected. Abnormal hip development, hydrocephalus, neurogenic bladder
**Risk **decreased in folic acid, tetragenic meds,
Interventions - use latex free gloves, cover site with saline soaked non adherent dressing, ONLY neurosurgeon can remove dressing, no diaper
Lactational Mastitis
S/S
Interventions
Occurs when there is inadqueate breast milk drainage or inadequate lactation
Bacteria enters
S/S usually just one breast, swelling, redness, flu like symptoms
Interventions antibiotics, warm compress, continue breastfeeding
Postpartum Hemorrhage
Blood loss
Common causes
Interventions
Blood loss greater than 1000ML
Common causes: Tone, Trauma, Tissue, Thrombin
Interventions Vitals, void, fundal massage, Uterotonics (oxytocin, misoprostol, methlergonovine, carboprost) Fluid resuscitation
