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Acute Care > Acute Care Exam 3 > Flashcards

Acute Care Exam 3 Flashcards

1
Q

How are patients with ICP managed/treated?

A
  • HOB > 30
  • Control fever/BP
    • SBP < 140
  • Avoid hypotonics
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2
Q

What are the symptoms/clinical features of a TIA and what are the risk for stroke after TIA?

A
  • onset of focal neuro Sx lasting < 24 hrs
  • no objective evidence on brain studies
  • risk of stroke after TIA is 2-17% w/in 90 days
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3
Q

What are the diet recommendations for stroke prevention?

A
  • Mediterranean diet
  • DASH diet
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4
Q

What are the effects of a PCA stroke?

A
  • Right/Left homonymous hemianopia
  • Alexia w/out agraphia
  • Possible aphasia
  • Contralateral hemisensory
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5
Q

How is HLD and stroke related and what Rx/dose is used in prevention?

A
  • Stroke risk r/t LDL levels
  • Lipitor 80 mg
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6
Q

What are the TPA contraindications r/t CT scans?

A

Blood on CT (light color)

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7
Q

What are the stroke center levels and some key differences between them?

A
  • primary stroke center:
    • most cases of ischemic stroke
    • not req’d to have cath services
    • not req’d to have a separate unit
    • access to neurosurg w/in 2 hrs
  • comprehensive stroke center:
    • all types of stroke
    • 24/7 cath services
    • have separate neuro ICU
    • 24/7 on site neurosurg
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8
Q

What are the AHA recommendations for exercise for stroke prevention?

A
  • any exercise reduces stroke risk
  • AHA:
    • 30 mins mod activity 5 d/wk or
    • 25 mins vigorous activity 3 d/wk
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9
Q

What is the CURB-65 and what are its components?

A
  • Scoring system to help diagnose CAP
  • Components (1 pt each):
    • C - confusion
    • U - urea > 7 mmol/L
    • R - RR > 30
    • B - SBP < 90 mmHg or DBP < 60 mmHg
    • 65 - age > 65
  • 0-1 = low risk, 2 = probable, 3-5 = hosp visit
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10
Q

What are the diagnostic features of a hemorrhagic stroke?

A
  • ICH score
  • CT (blood is light)
  • MRI (blood is dark)
  • Seizures
  • Neurosurgery:
    • EVD
    • evacuation of blood
    • increased ICP (>20 mmHg)
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11
Q

What are the cryptogenic stroke associated risk factors?

A
  • arterial dissection, arteriopathy
  • cerebral sinus venous thrombosis
  • autoimmune Dz and genetic factors
  • infxn
  • hypercoaguability Dz
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12
Q

What are the effects of a Right MCA stroke?

A
  • Left sided deficits
    • Left hemiplegia/sensory loss
    • Left homonymous hemianopia
    • Left hemi-neglect
  • Right gaze preference
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13
Q

How is VAP prevented?

A
  • HOB elevated
  • handwashing
  • chlorhexidine gluconate oral rinse
  • cont removal of subglottic secretions
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14
Q

What are the prevention protocols for CLABSI?

A
  • Hand hygiene
  • optimal insertion site
    • prep skin w/ 2% CH or 70% isopropyl alcohol
  • maximal sterile barrier and intact dressing
  • daily review of necessity and early removal (5 day max)
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15
Q

What are the risk factors for hemorrhagic stroke?

A
  • HTN
  • increased age
  • cerebral amyloid angiopathy
  • antithrombotic therapy
  • increased EtOH and/or drug abuse
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16
Q

What differential diagnoses should be considered if CAUTI suspected?

A
  • pyelonephritis
  • sepsis
  • bactermia
  • PNA
  • skin/soft tissue infxn
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17
Q

What are the Sx of a hemorrhagic stroke?

A
  • stroke Sx w/ HA
    • HA usually intense, extremely painful
  • vomiting
  • decreased LOC
18
Q

What are the TPA contraindications r/t Rx history and what Rxs are ok?

A
  • Currently on:
    • Anticoags
      • Eliquis, Xeralto, Pradaxa, full dose LMWH or Heparin gtt
  • ASA and Plavix are ok
19
Q

What is the treatment for VAP?

A
  • initially treated with broad specturm ABX
    • specturm should be subsequently narrowed
    • pathogen may influence treatment
  • usually 7 days
20
Q

What neurotransmitters increase pain?

A
  • bradykinins and tacyhkinins (sub-P, neurokinin-A)
  • cations and free radicals
  • histamine and serotonin
  • prostanoids (PTG, leukotrienes)
  • purines (adenosine, ATP)
21
Q

What are the characteristics and treatment of neuropathic pain?

A
  • characteristics:
    • pain from dmg nerve endings that result in abnormal signal processing. Pain sensation serves to purpose
  • treatment:
    • gabapentin 100 mg 1-3x/day, titrate up to 1800 mg/day
    • lyrica 25-100 mg up to q 8hr
    • cymbalta (duloxetine)
      • tapering req’d at end of treatment
22
Q

What is the diagnostic criteria for HAP?

A
  • arises 48 hrs or more after hospital admission not incubating at time of admission
23
Q

What is the treatment fo COVID-19?

A
  • no approved FDA treatment, get it and ur ded
  • supportive mgmt of complications
24
Q

What is the A1c goal for stroke prevention?

A

< 7%

25
Q

What is important in a migraine assessment and what is included in prevention, workup, and treatment?

A
  • most important: history, history, history
  • complicated Dx of exclusion
    • status migrainosus (HA > 72 hrs)
  • Treatment:
    • NSAIDs, neuroleptics, triptans, ergot, alkaloids, opioids
  • PPX:
    • propranolol, topamax, TCA, depakote
  • Must treat in pregnancy
    • r/t eclampsia; magnesium used in Tx
26
Q

What are the effects of an ACA stroke?

A
  • Leg weakness
  • Leg sensory loss
  • Behavior abnormalities (Frontal Lobe)
  • Transcortical aphasia (Left ACA)
  • Left hemi-neglect (Right ACA)
27
Q

How are obesity, smoking, and OSA r/t storke prevention?

A
  • obesity and smoking increases risk for stroke
  • OSA is an independent risk factor for storke
28
Q

What are the S/Sx of SIRS?

A
  • Temp > 38 or < 36
  • HR > 90
  • RR > 20 or PaCO2 < 32
  • WBC > 12 or < 4 or bandemia present (> 10%)
29
Q

What is the most common CAUTI pathogen?

A

E. coli

30
Q

What is the TOAST criteria and what is it comprised of?

A
  • classification system for ischemic stroke into 5 subtypes
  • types:
    • large artery atherosclerosis
    • cardioembolism
    • small vessel occulusion
    • stroke of other determined etiology
    • stroke of undertermined etiology
31
Q

What are the causes/contributing factors to an embolic stroke?

A
  • embolism
  • atherosclerosis
  • inflammation
32
Q

What is the general treatment for CAUTI?

A

ABX for 7-14 days

33
Q

How do older patients present with CAUTI?

A
  • AMS
  • altered appetite
34
Q

What are the risk factors for developing VAP?

A
  • duration of intubation or nasogatric intubation
  • large vol aspiration or chronic lung Dz
  • depressed LOC
  • supine
  • thoracoabdominal surgery
  • prior ABX
35
Q

What are the clinical features of sepsis?

A
  • mycardial depression
  • altered vasculature and organ perfusion
  • imbalance of O2 delivery and comsuption
  • metabolic (lactic) acidosis
36
Q

What are the TPA contraindications r/t vital signs and lab values?

A
  • glucose < 50 or > 400
  • BP > 185/110
  • PLT < 100,000
  • INR > 1.7 and on warfarin
37
Q

What substances inhibit pain?

A
  • endogenous opioid peptides
  • enkalphins - spinal cord/brainstem
    • triggered by serotinin
  • beta-endorphines - hypothalamus/pituitary
    • most like morphine
  • dynorphins - released by spinal cord/brainstem
    • 200x stronger vs morphine
38
Q

What is the BP goal for stroke prevention with HTN?

A
  • <140/90
  • w/ DM <130/90
39
Q

What are the TPA contraindications r/t history?

A
  • Basically are you bleeding now or bled a lot before
    • Recent
      • acute stroke
      • major surgery (last 2 wks)
      • or current GI/GU bleed
      • major head trauma
    • Hx of intracranial hemorrhage
40
Q

What are the effects of a Left MCA stroke?

A
  • Right sided deficits and language impairments
    • Right hemiplegia/sensory loss
    • Expressive aphasia (Broca’s)
    • Receptive aphasia (Wernicke’s)
    • Right homonymous hemianopia
41
Q

What the testing/lab abnormalities r/t SARS-CoV-2?

A
  • lymphopenia (most common)
  • neutrophilia ↑
  • serum alanine aminotransferase ↑
  • aspartate aminotransferase ↑
  • lactate dehydrogenase ↑
  • CRP ↑
  • ferritin ↑
  • procalcitonin ↑ (in ICU usually)
  • elevated D-dimer
    • ↑ risk of mortality
42
Q

What is included in the NIH stroke scale and what does the scoring mean?

A
  • 11 components that grade stroke deficits
  • 0-42 points
    • Higher score = more stroke deficits

Acute Care (3 decks)

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