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AGACNP > acute care common problems > Flashcards

acute care common problems Flashcards

1
Q

What are the 3 steps of pain management: WHO Ladder of Pain Management

A

Step 1: acetaminophen, NSAIDS, adjuvants- non traditional ex. amitriptyline (non-narcotics)
Step 2: add oral narcotics
Step 3: add IV narcotics

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2
Q

what kind of dressing should be applied to pressure wound with high amounts of slough or drainage?

A

hydrocolloid dressing

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3
Q

what are causes of post-op fever?

A

atelectasis- reduce with incentive spirometer
increased basal metabolic rate
dehydration
drug reactions

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4
Q

what is a tension headache?

A

most common type of headache
s/s: tight, band sensation around head, generalized, no focal neurological symptoms, lasts several hours
Management: OTC pain meds, relaxation

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5
Q

describe migraine headaches: w/wo aura

A

class migraine- with aura, common migraine- without aura
lasts 2-72 hours
onset- adolescence, early adulthood, familial relation, females > males
triggers: emotional or physical stress, lack or excess sleep, missed meals, specific foods, alcohol, menstruation, OCP, nitrate containing foods, changes in weather
s/s: unilateral throbbing, building up gradually, possible neurological disturbances, visual disturbances; field defects, luminous visual hallucinations, aphasia, numbness, tingling, clumsiness or weakness, nausea, vomiting, photophobia, phonophobia.
if new migraine- rule out other causes of the symptoms; no new migraines in 50+ people
diagnostic w/u for other causes: CBC, BMP, venereal disease research laboratory test (syphilis), ESR, CT head
Pharm management: amitriptyline, divalproex, propranolol, imipramine, clonidine, verapamil, topiramate, gabapentin, methysergide, magnesium

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6
Q

describe cluster headaches

A

very painful, middle aged men common
cause/ incidence: alcohol, not familial. occurs at night, awaken from sleep, last less than 2 hours, severe unilateral periorbital pain daily for several weeks, ipsilateral nasal congestion, rhinorrhea and eye redness.
management: oral drugs don’t help. 100% supplemental oxygen can help, sumatriptan SQ, ergotamine tartrate aerosol inhalation

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7
Q

what electrolyte abnormalities are associated with refeeding syndrome?

A 
hypophosphatemia
hypokalemia
hypomagnesemia
hypocalcemia
thiamine deficiency

–> all low in these electrolytes: calcium, magnesium, potassium, phosphorus

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8
Q

should cat bite/dog bite wounds of hands/ lower extremities be open or closed?

A

leave the bite wounds open

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9
Q

what should antibiotic coverage look like for human and animal bites?

A

prophylaxis: staphylococci and anaerobes

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10
Q

on gram stain, what do gram positive and gram negative bacteria look like?

A

gram positive- pink/ purple: retain the stain

gram negative- (do not retain the stain)

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11
Q

which antibiotics have MRSA coverage?

A

ceftaroline (5th gen), clindamycin, daptomycin, linezolid, tedizolid, TMP/SMX (bactrim), vancomycin

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12
Q

what is anti-rejection triple therapy ?`

A
  1. corticosteroid: methylprednisolone, prednisone
  2. antimetabolite: Imuran, cellcept, myfortic, cytoxan- azathioprine, mycophenolate mofetil, mycophenolate sodium, cyclophosphamide
  3. calcineurin inhibitor (Tacrolimus, cyclosporine) or mammalian target of rapamycin inhibitor (mTOR): sirolimus, temsirolimus, everolimus
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13
Q

what is the treatment for herpes zoster (singles)?

A

acyclovir, famciclovir, valacyclovir

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14
Q

if shingles impacts the eye, what should you do?

A

urgent referral to ophthalmologist

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15
Q

who should get shingrix?

A

all adults > 50 years, regardless of previous shingles vaccine; two dose regimen, 2nd dose given 2-6 months after initial dose

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16
Q

describe squamous cell carcinoma

A

comes from actinic keratoses
firm irregular papule or nodule
develops over a few months- 3-7% metastasis
prolonged sun exposed in fair skin people
tx: biopsy, surgical excision

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17
Q

seborrheic keratoses

A

benign, not painful. beige brown or black plaques
“stuck on”, 3-20mm in diameter
tx. liquid nitrogen, or no tx

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18
Q

basal cell carcinoma

A 
most common skin cancer
slow growing 1-2cm after years
waxy pearly appearance, shiny or red
central depression or rolled edge, 
telangiectatic vessels
tx: shave biopsy, surgical excision
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19
Q

how to detect skin cancer: abcdee

A

asymmetry, border irregularity, color variation, diameter > 6cm, elevation, enlargement

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20
Q

malignant melanoma

A

highest mortality rate of all skin cancers
median age of diagnosis = 40
may metastasize to any organ

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21
Q

when are gastric lavage or activated charcoal indicated?

A

within 1st hour of ingestion

often used with Sorbitol as well

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22
Q

acetaminophen intoxication

A

delayed symptoms- 24-48 hours- hepatotoxicity: jaundice, LFTs elevated, PT prolonged, AMS, RUQ pain

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23
Q

Tx of tylenol overdose

A

N-acetylcysteine (mucomyst)

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24
Q

Salicylate Intoxication (ASA)

A

tinnitis, dizziness, n/v, respiratory distress, LFTs

tx activated charcoal, sodium bicarb for severe acidosis

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25
Q

Organophosphate (insecticide) poisoning

A

blurred vision, bradycardia, AMS

wash skin, if ingested- activated charcoal
atropine- drug of choice

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26
Q

antidepressant toxicity

A

s/s- AMS, urinary retension, hemodynamic instability, seizures– need ICU admission
activated charcoal
sodium bicarb- dysrhythmias and maintain pH

27
Q

serotonin syndrome management

A

Dantrolene sodium (dantrium), clonazepam - rigor, cooling blankets

28
Q

opioid toxicity

A

narcan
activated charcoal
emetics contraindicated

29
Q

pupillary effects: opioids vs cocaine

A

pinpoint: miosis: opioids
dilated: mydriasis: cocaine

30
Q

Benzodiazepine overdose

A

flumazenil IV
activated charcoal
respiratory/ BP support

31
Q

beta blocker overdose

A

hypotension, SB, bronchospasm

tx: charcoal, glucagon***, atropine for SB, airway stabilization

32
Q

Ethylene Glycol (antifreeze) overdose

A

Fomepizole (antizol)

Ethanol (if fomepizole not available)

33
Q

Stages of ethylene glycol overdose

A 
1st stage (30 min-12 hours): loss of coordination, headache, slurred speech
2nd stage (12-24 hrs):  irregular HR, shallow breathing, BP changes
3rd stage 24-72 hrs: kidney failure
34
Q

Burns: Rule of 9s- what are the body percentages?

A 
each arm- 9%
each leg- 18%
thorax- 18% front, 18% back
head-9%
perineum/ genitalia- 1%
35
Q

what is Parkland’s formula? for burns

A

4ml/kgx TBSA % burned = fluid resuscitation goal in 1st 24 hours. 1/2 of fluid goal in first 8 hours, 1/2 in the remaining 16 hours
crystalloids** no colloids
monitor for metabolic acidosis, - presents in early resucitaiton phase
hyperkalemia in first 24-48 hours, then hypokalemia after that- - fluid shifts

36
Q

Burn mangement pearls

A

maintain normal temperature
sterile saline for treatment, wrap in sterile towels
pain management IV narcotics, conscious sedation

37
Q

definition of AIDs

A

HIV + and

CD4< 200 cells/uL and/ or presence of opportunistic infection

38
Q

what is ELISA test?

A

enzyme-linked immunosorbent assay (ELISA) is an immunological assay commonly used to measure antibodies, antigens, proteins and glycoproteins in biological samples.

39
Q

HIV testing

A

HIV 1/2 antigen/ antibody combination immunoassay; if positive, then do HIV 1/2 antibody differentiation immunoassay

PCR: viral load- high numbers correlate to progression of HIV- should be zero or undetectable with AART

40
Q

pneumocystis jirovecii

A

pneumonia that is an opportunistic infection in HIV

patients need prophylaxis for this with Bactrim

41
Q

AART

A

active antiretroviral therapy:
take as soon as HIV+ diagnosis occurs.
danger of drug resistance- adherence is extremely important

42
Q

PrEP

A

indicated for HIV negative people that are at risk:

have sex with HIV + person, IV drug uses that share needles

43
Q

PEP

A

post-exposure prophylaxis:
Truvada (emtricitabine/tenofovir disoproxil fumarate)- prevent HIV for all people at risk
Descovy (emtricitabine/tenofovir alafenamide)- not studied in people with receptive vaginal sex

Descovy- improved renal and bone safety- 90% decrease in plasma levels, more intracellular concentrations- smaller doses needed.
Truvada- can cause significant renal and bone density effects due to high plasma concentration

44
Q

osteoarthritis vs rheumatoid arthritis

A

OA: asymmetrical, older, better in morning, worse at the end of the day, Xray- narrowing of joint space,
RA: symmetrical, younger onset, worse in morning, better as day progresses, warm joints, ESR elevaed, synovial aspirate- WBCs, joint swelling

45
Q

Heberden’s nodes

A

distal interphalangeal joints

finger tips

46
Q

Bouchard’s nodes

A

proximal interphalangeal joints
mid finger knuckles
osteoporosis

47
Q

osteoarthritis medication management

A

ASA, acetaminophen, NSAIDS, celebrex (but likely avoid in cardiac patients)

48
Q

Rheumatoid arthritis pharmacological management

A

high dose ASA, NSAIDs,
disease modifying antirheumatic drugs; corticosteroids, methotrexate, antimalarials (hydro chloroquine), gold salt injections

49
Q

define avulsion

A

bone fragment pulled off by attached ligaments and tendons

50
Q

define subluxation

A

incomplete dislocation- often for vertebrae

51
Q

how to objectively assess for compartment syndrome?

A

Stryker tonometer- intra-compartmental pressure > 30 mm Hg- needs fasciotomy

52
Q

What is delta pressure?

A

for compartment syndrome
delta pressure = diastolic blood pressure- intra-compartmental pressure
if < 30 mmHg, fasciotomy needed

53
Q

systemic lupus erythematous s/s

A

butterfly rash, fever, malaise, weight loss, splinter hemorrhages, alopecia, joint symptoms, vasculitis, nephritis, ocular manifestations, pericardial and pulmonary manifestations, abdominal pain

**so many impacted areas; multisystem inflammatory autoimmune disorder

54
Q

SLE diagnostics

A

ANA + in 95% of patients
antiphospholipid antibodies
anemia, leukopenia, thrombocytopenia; CBC

55
Q

SLE pharmacological management

A

NSAIDs, hydroxychloroquine, glucocorticoids

56
Q

Many medications can create lupus-like syndrome

A

cardiac meds, psych meds, antibiotics, cholesterol meds, seizure meds, OCPs,
amiodarone, atenolol, buproprion, diltiazem, gemfibrozil, hydralazine, lithium, macrobid, OCPs, phenytoin, rifampin, tetracycline

57
Q

Giant cell arteritis

A

temporal arteritis -inflammation of temporal artery,
age 50+, can lead to permanent blindness
s/s: fever of unknown origin, headache, scalp tender, visual complaints, temporal artery tender

58
Q

giant cell arteritis diagnostics and treatment

A

ESR very high, normal WBC,
temporal artery biopsy- gold standard
Prednisone, referral needed

59
Q

diabetic retinopathy eye exam findings

A

microaneurysms, ruptured is late finding- retinal hemorrhages- cotton-wool spots- deep layers of retina or superficial- flame- shaped hemorrhages

60
Q

AV nicking on eye exam

A

sign of chronic hypertension

61
Q

arcus senilis

A

cloudy appearance of cornea with gray/white arc or circle- due to deposition of lipid material - no visual impairment

62
Q

bacterial conjunctivitis antibiotics:

A

drops: levofloxacin, ciprofloxacin, tobramycin, gentamycin

63
Q

gonococcal conjunctivitis treatment

A

ophthalmic emergency- copious, purulent discharge
ceftriaxone 250 mg IM and azithromycin
same treatment for chlamydial conjunctivitis

64
Q

open vs closed angle glaucoma

A

open: chronic, asymptomatic, elevated IOP, cupping of disc, constriction of visual fields, prostaglandin analogs: latanoprost, travoprost, alpha 2 adrenergic agonists- brimonidine
beta-adrenergic blockers- timolol
miotic agents- pilocarpine
Closed: acute, extreme pain, blurred vision, halos, pupil dilated or fixed; carbonic anhydrase inhibitors- acetazolamide IV (diamox), osmotic diuretics- mannitol, surgery to relive humoral pressure

AGACNP (19 decks)

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