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Adult Health II > Adult Health II -- Test 2 > Flashcards

Adult Health II -- Test 2 Flashcards

1
Q

Risk factors – fall

A 
occupation
contact sports
drugs (steroids AEDs thryroid tetracycline, chemos e.g. methotrexate, radiation)
Vit A in excess (> 1.5 mg/day)
overweight
elderly
male
lack weight-bearing exercise
systemic disease
diminished senses
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2
Q

S/S of fractures

A 
loss of function
crepitus (don't test ROM)
swelling
pain
deformity
discoloration
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3
Q

Nerve / Circ check

A 
8 Ps
pain
paresthesias
pallor
pulses
paralysis
polar (temp)
perception (sensation)
pressure (tension)
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4
Q

Crutches – basics

A

4-6” below axilla
good going up
bad going down

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5
Q

Cast Care Info

A 
dry rest on CLOTH pillo
turn q 2 r/t drying out the cast
use palms not f-tips when wet
dry = hard/white/odorless/resonant
don't paint or varnish
report broken cast
will loosen
hair dryer (NEVER insert) for itch
keep dry
report color change if wound beneath
report foul smell
report excessive pain
nerve / circ checks
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6
Q

Nx for traction – skin traction

A

usu short term
<10 lbs of weight
check skin underneath

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7
Q

Nx for traction – skeletal traction

A 
align pts body in center of bed
weights are correct and swing freely
pulleys aligned and ropes OK
ropes knotted properly
no feet touching end of bed
nerv / circ checks
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8
Q

Nx for traction – pin site care

A

per order
NS or 1/2 strength H202
sterile in hospital / clean at home
loose gauze around pin

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9
Q

Compartment syndrome – patho

A

progressive muscle necrosis d/t swelling and decreased blood flow
compartment pressure inc / arterial flow occld
impeded venous return

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10
Q

Compartment syndrome – contributing Fx

A 
burns
tight dressings
poor position
long bone fractures and soft tissue damage
hypotension
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11
Q

Compartment syndrome – S/S

A 
increased pain UNRELIEVED c analgesics
ALTERED nerv / circ checks
excessive swelling
diminished / absent pulses
decreased  sensation / movement
numbness / tingling
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12
Q

Compartment syndrome – Tx

A 
PROMPT REC = SAVE THE LIMB
bivalve cast
LMW Dextran or Mannitol
decompression fasciotomy
monitor CPK -- MM and uring for myoglobin (product of muscle necrosis - damages renal)
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13
Q

Osteomyelitis – S/S

A

LOW GRADE SMOLDERING FEVER 99-100
malaise
local tenderness / swelling / warmth
purulent discharge

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14
Q

Osteomyelitis – Tx

A

debridement
antibiotics
prophylactic antibios if internal hardware

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15
Q

Fat embolism – path

A

fat globules from exposed marrow
into blood and into lungs
high risk < long bone fractures and crushing

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16
Q

Fat embolism – S/S

A

PETECHIAE in palate, chest, conjunctive d/t transient thrombocytopenia
chest pain
pulse ox down
dyspnea / tachypnea / crackles

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17
Q

Fat embolism – Tx

A

aim at prevention by swift fracture immobilization and repair
02
fluids if hypov / diuretics if edemic
Heparin or LMW dextran = expand vessels

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18
Q

DVT – S/S

A

unilateral leg pain / edema / warmth / redness

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19
Q

DVT – Prevention

A

TED, SCD, Lovenox

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20
Q

DVT – Dx

A

venous doppler

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21
Q

DVT – Tx

A

Heparin, Coumadin

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22
Q

Hypovolemic shock – S/S

A

extreme blood loss =
pale / cool / clammy
Hgb and Hct <
confused

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23
Q

Hypovolemic shock – Tx

A

fluid resuscitation, blood transfusion

vasoconstrictors 02

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24
Q

THA – pre-op

TKA also

A

no smoking
no ASA 1-2 weeks, no ibu 1-2 days
lose weight
donate own blood

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25
Q

THA – post-op

A 
abductor pillow (NO ADDUCTION)
OOB ON OPERATED SIDE
elevated toilet seat
no squatting etc 3-6 mos
don't lean forward
reachers
PCA
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26
Q

THA – post-op monitor

A

nerv / circ

Hemovac of JP – 100/150 mL/4 hrs serosang then sanguinous

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27
Q

TKA – post-op

A

nerv / circ
PCA
immobilize when OOB
CPM machine – ALWAYS MOVE PT LEG IN AND OUT IN FULL EXTENSION

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28
Q

Coumadin

A 
INR 2-3
PT 18-24 secs
fall precautions
monitor: hematuria confusion (CB)
no OTCs with ASA  or ibu
no high Vit K foods (unless always)
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29
Q

Dexa scan

A

measures BMD in hip, spine, forearm

= or > T -1

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30
Q

Risk factors – osteoporosis

A 
smoking
> 65
inadequate Ca intake
not enough sun
too much Na / protein / ETOH / caffeine
late start or early menopause
small lean frame
Asian and Caucasian
personal and family Hx
> estrogen post-meno
renal / DM
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31
Q

Risk factors – osteoporosis – Rx

A

steroids
AEDs
chemo
excessive thyroid drugs

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32
Q

Rx Tx for osteoporosis

A

Ca up to 500 mg at a time (nsg c thyroid hormones, tetra, steroids, Fe, antacids)

Calcitronin – inhibits osteoclasts but SE

Aldendronate / Fosamax inhibit resorption TAKE ON EMPTY STOMACH 1ST IN AM, 30 PRE FOOD, C H20 ONLY, NO ANTACIDS

Evista/Raloxifene – mimic estrogen on bone S/E = leg cramps and hot flashes

Forteo/Teriparatide – PTH stimulates osteoblasts S/E = Dz

Prolia/Denosumab – post-meno
check Vit D and CrC within normal

33
Q

Amputation – post-op

A

bleeding – Tx c tourniquet
flexion traction – Tx pillow under residual limb
or lay prone 20-30 TID or QID

infection
phantom limb pain

34
Q

IICP – CT

A

20 or greater in AC fossa

consent for contrast and assess allergies and Tx c anti-hist and steroids

document evidence of renal Fx BUN Cr WNL – dye renal damage

NPO midnight c contrast

hold Metformin

force fluids wash out dye

35
Q

IICP – MRI

A

can use Gaudolinium contrast etc

remove all metal
check for prostheses or old tattoos

36
Q

IICP – PET scan

A

NPO
no caffeine / ETOH / tobacco 24 hrs
no sedatives no glucose preps/drugs

37
Q

IICP – angiogram

A

thru femoral artery to cerebral circ
assess for allergies / CrC WNL / meds vs contrast (AEDs antidep Metformin)

4-6 hrs post rest
pressure dressing, assess bleeding

38
Q

IICP – LP

A

subarachnoid below L2
obtain / measure / inject into CSF

Pre need consent / empty bladder / strict asepsis

Post lie flat, force fluids replace CSF H/A

39
Q

Normal ICP

A

5-15 mm Hg in lateral ventricles

40
Q

Ventriculostomy

A

aka ICP monitoring

also drain CSF and admin meds

41
Q

CPP – range

A

normal 70-100 mm Hg

very bad < 50 or > 150

42
Q

CPP – calculate

A

MAP - ICP = CPP

MAP = SP + 2 X DP / 3 (normal = 70-110)

43
Q

CPP auto-regulation – pressure

A

as SBP goes up, vessels constrict

as SBP goes down, vessels dilate

44
Q

CPP auto-regulation – metabolic

A

O2 CO2 and temp cause constriction or dilation in order to change CBF and bring O2

45
Q

IICP – Cushing’s Triad

A

Very ominous

1) bradypnea
2) widening pulse pressure SP > and DP <
3) bradycardia

= pressure in cranial vault and attempt to increase cranial blood flow

46
Q

GCS

A

Eye 1-4
Verbal 1-5
Motor 1-6

severe < 8
mod 9-12
mild 13+
< 7 very ominous

47
Q

Painful pressure – when no Rs to verbal

A

gentle shake > nail bed pressure > supraorbital pressure > trap squeeze

localizing >

48
Q

Decorticate

A

Pigeon in hands and feet

49
Q

Decerebrate – worse > decorticate

A

Extend out

50
Q

Cranial Nerve reflexes

A 
Gag -- 9 & 10
Corneal -- 5 & 7
Oculocephalic / doll's eyes -- 4 & 6
Oculovestibular / cold H2O -- 4 & 6
Babinski -- motor
51
Q

IICP Nx and Tx

A 
O2
ICP drain
control hyperthermia > 38
control Sz
limit suctioning < 10 secs
reduce cellular demands -- sedate / paralyze 
diuretics
stool softener
elevate HOB
watch opioids -- OK but assess RR
Mannitol -- pulls H2O < brain use filter needle
52
Q

Basilar skull fracture

A

Racoon eyes
Battle’s sign
tears dura – CSF from nose or ears

53
Q

Classification head injury Open / Closed

A 
Open = tears dura
Closed = dura intact
54
Q

Concussion

A

Least serious
brain jarring
at home observe for V / LOC / severe H/A / Sz / fever / salty drainage

55
Q

Contusion

A

> concussion
areas of hemorrhage, necrosis & cerebral damage
coup or contracoup
post amnesia for wks-mos

56
Q

Laceration

A

traumatic tearing of brain tissue d/t open fracture or penetration
perm brain damage
hemotomas

57
Q

Epidural hematoma

A 
b/w skull and dura
MIDDLE MENINGEAL ARTERY IN TEMPORAL AREA
arterial bleed
unconc > conc > unconc
immediate craniotomy
58
Q

Subdural hematoma

A 
b/w dura and arachnoid
VENOUS BLEED
acute w/i 48 hrs
subacute w/i 2-14 days
chronic wks-mos
elderly fall and hit their head
59
Q

Intracerbral hematoma

A

bleeding into brain tissue
GSW or aneurysm
size and location – often fatal

60
Q

Post-op craniotomy

A 
LOC
VS -- temp and IICB
ABG -- hypoxemia
Sx dressing for blood or CSF
Meds for cerebral edema
electrolytes -- esp Na
Sz / DVT prevent with Hep / TED / SCD
61
Q

S/S of IICP

A

widening pulse pressure
bradycardia
RR <
Temp >

62
Q

Dx CSF leak

A 
drain ENT that is salty
glucose positive 
halo sign on pillow etc
H/A improves when lying down
Nucal rigidity
63
Q

Urine specific gravity

A

normal – 1.001 - 1.040

usu – 1.015 - 1.025

64
Q

Sz –simple partial

A 
no LossOC
< 1 min
motor -- unilateral movement eg arm
sensory -- ringing, metallic
autonomic -- racing HR
65
Q

Sz – complex partial

A

altered csnss
automatisms but not aware of them
altered memory deja vu

66
Q

Sz – generalized

A

whole brain – LossOC

Absence (petit mal) – brief loss, often children
Myoclonic – sudden jerk / stiff / fall
Atonic – loss of muscle tone / may fall
Tonic Clonic (grand mal) – tonic stiff / the clonic jerk, cyanosis, salivation, hrs-days to recover

67
Q

DILANTIN

A

PO or IV

THERAP LEVEL = 10-20 mcg/mL
ONLY WITH NS
GIVE SLOWLY
reduces voltage, frequency, and spread of electrical discharges
grand mal / status epilepticus

teratogenic / hypersensitivity = Steven Johnsn Syndrome
gingival hyperplasia

68
Q

Sz precautions

A

1) added side rails up
2) O2 and suction at bedside
3) saline lock in place
4) go glass
5) bed L&L

69
Q

AEDs S/E

A 
bone marrow suppression
osteoporosis
gingival hyperplasia
nystagmus
teratogenic
ataxia
DON'T STOP ABRUPTLY = SZ CAUSING
70
Q

BMT or HSCT

A

bone marrow or hemapoietic stem cell trans
leukemia / lymphoma / SC / MM
marrow is eradicated and then “rescued”

71
Q

Types of BM donor

A

Auto

Allo – matches HLA human leukocyte antigen = sygnenic / related / MUD

72
Q

CSF used

A

make more stem cells in BMT process

73
Q

Allo BMT

A

may change blood type

will need re-immnunization

74
Q

BMT complications

A

infection
GVHD – graft (marrow) rejects the host (usu host rejects graft = HVGD)
w/i 100 days

75
Q

Rx vs GVHD

A

methotrexate
cyclosporine
corticosteroids

76
Q

S/S Leukemia

A

swollen lymph nodes

- fever
- easy bruising
- bone or joint pain
- fatigue/malaise
- anorexia
- weight loss
77
Q

MMyeloma

A

hypercalcemia
Pamidronate = inhibits osteoclasts

8.5-10.0 SERUM CALCIUM

78
Q

Skin Cancer ABCD

A 
A: asymmetry
B: border (irregular)
C: color (uneven)
D: diameter (>6mm)
E: Evolving
79
Q

Cancer stages of grief

A

ABDA

Adult Health II (3 decks)

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