CEN FLASHCARDS
Treatment for cocaine OD for A.C.S.?
Nitroglycerin
Positive for ethylene glycol toxicity in urine?
Calcium oxalate crystals
Patient loses 30% of blood volume. What happens?
Shunting to increase end organ perfusion. VASOCONSTRICTION
INCREASE PERIPHERAL VASCULAR RESISTANCE INCREASE PRELOAD
INCREASE CARDIAC OUTPUT
Classic triad for CARDIOGENIC SHOCK?
Tachypnea / Distended Neck Veins / Hypotension
Recommended bolus with blood products in pediatrics?
10ml / kg
Life threatening emergency caused by edema above the vocal cords. Rapid onset of high fever. Sore throat. Mouth breathing, drooling, and tripod positioning.
Acute Epiglottitis
Psychotic situation that’s a symptom of schizophrenia?
Paranoia
Implied consent
Unable to give consent but needs life saving measures.
Expressed consent
Written or oral agreement.
Involuntary consent
Patient refuses but police or MD deem it necessary.
Informed consent
Full understanding.
Excess A.D.H. causes what kind of electrolyte imbalance?
Puts the patient at high risk for developing _______ which leads to ________.
Hyponatremia
Cerebral edema which leads to seizure activity
What’s the opposite of Excess A.D.H.?
Diabetes Insipidus (suppression of A.D.H.)
Can be a life threatening condition if infection spreads to deeper tissues like skull base, cranial nerves, and even coratid artery. Usually starts at the ear. Whose at risk?
Malignant otitis externa
Elderly and immunocompromised patients
What type of stool with peptic ulcers?
Tarry stools
Foul smelling fatty stools
Pancreatitis
What type of stools with Ulcerative Colitis?
Bloody diarrhea stools
What type of stools with I.B.S.?
Large frequent stools
Right Atrial Hypertrophy EKG changes
Leads 2 and 3 has peaked P waves, more than 2.5mm in height.
Left Atrial Hypertrophy EKG changes
Broad notched P waves in V1.
Recommended treatment to lower b/p with chronic HTN?
Decrease by ____to____% over what time frame?
20-30% over 2-3 hours
Define Q-wave? Type of deflection? Appears after _____. Height?
Negative deflection
Comes after P wave
Deeper than 1/3 QRS height or longer than 0.04 seconds.
What to watch for with unknown amount of Tricyclic Antidepressant (Elavil) ingested?
Cardiovascular status because it causes prolonged PR, QT, widened QRS, and eventually leads to v-tach.
Most common dysrhythmia of a patient that has suffered electric shock?
v-fib
What’s the palpation systolic pressure for
Coratid, Femoral, and Radial pulse?
CORATID 60mmhg
FEMORAL 70mmhg
RADIAL 80mmhg
GSW arrives to ED. During the assessment and documentation the nurse would do what with
forceps, clothes, wounds, and gun powder.
Place plastic over the teeth to not damage the bullet.
Place clothes in clean paper bag, seal, and label.
Document as wound; not entrance and exit.
Scrape gun powder onto clean paper and place into envelope, seal, and label.
2 days after patient is in car crash they c/o flashes of light, floaters in peripherals, or looking through cob webs, what do you do?
Shield the eyes and obtain ophthalmology consult.
DETACHED RETINA
You decrease the K in a patient in renal failure. What are the EKG changes to show the treatment worked?
Shortened PR interval
Decreased T save height
Increased HR
Shortened QRS
COPD characteristics of fingers, type of breathing, expiratory phase does what?
Clubbing
Prolonged Expiratory Phase
Purse lipped breathing to aid in exhalation r/t permanent over-distention of alveoli
Patient has been to the ER 4 times in the past 2 months w/ asthma flare ups at night. Bronchiodilators given with the ABG reading Bicarb of 30mEq & PaCo2 50mmhg. What’s the problem?
Gastroesophageal Reflux
Pt with tension pneumo needs what before what?
Needle thoracentesis (treatment) before CXRAY (diagnostics).
The purpose of a water seal chamber in a chest tube drainage system is to ……
allow air out of the chest but not let air into it. Once the air is expelled from the chest the chamber shouldn’t bubble. If it does then there is an air leak. Start at the chamber and work your way towards the patient in order to trouble shoot.
Critical Incident Stress Debriefing (CISD) sessions should commence with in what time frame of the event?
1-4 hours
Partial seizure
Facial grimace or lip smacking (specific body part).
Absence (Petite Mal)
children 4-12, abrupt LOC, last about 15 seconds
Tonic Clonic (Grand Mal)
Sudden LOC, major muscle group movements
Status Epilepticus
Series of consecutive seizures or a single one that doesn’t respond to treatment.
Damage to which area of the central cord will result in loss of voluntary movement?
Anterior Corticospinal Tract
Complication with Diphtheria and why? How to diagnose?
Difficulty breathing and swallowing r/t the GRAY WHITE membrane covering the pharynx and larynx. Diagnostic by throat culture.
List 3 s/s with thyrotoxic crisis. One being more serious than the others. What’s another name for this disorder?
Tachydysrhythmias, hyperthermia, and agitation
Thyroid storm
Cardiac arrest r/t 9.3 K. What’s the treatment and why? Most 2 important drugs to give.
Calcium to antagonize the toxic effects of K at the myocardial cell membrane.
Albuterol for intracellular shift.
Other drugs like sodium bicarbonate, insulin, D50, and Kayexalate (onset 1-2 hours).
Most common fluid electrolyte imbalance seen in renal failure?
Elevated K (LIFE THREATENING)
Decreased NA
Decreased Calcium
Elevated Phosphorus
Most reliable diagnostics for suspected pancreatitis.
CT scan
Blunt force trauma, diffuse abdomen tenderness, and pain shoots to the testicles. What organ is injured?
Duodenum
Indication that the patient is being paced?
Wide complex after the spacer spike, palpable central pulse at 70 beats per minute.
Implantable defib/pacer who develops v-fib, what to do?
Difibrillate and avoid placing pads over the pacemaker.
The time frame for the start of iron overdose symptoms? When does it peak?
60 minutes
3-4 hours
What does the water chamber do when patient is breathing?
Moves up and down. On exhale it may bubble a little r/t lung trying to expand.
8 hour history of priapism, what’s the priority?
Pain meds and then drain.
Side effect of Tensilon (given for myasthenia gravis). You need to have ______ at the bedside.
BRADYCARDIA
Atropine
Antidote for thyroid storm? Mortality rate?
Propylthiduracil (PTU). High.
Hep A incubation period and can’t work for how many days?
15-50 days and can’t work for 1 month
What happens to oxygen level, metabolic state, b/p, blood vessels, and hematocrit level in patient with sickle cell crisis?
Hypoxia Acidosis Hypotension Vasoconstriction Increase in hematocrit
Primary complication associated with Addison’s? Why? What 3 meds used to treat?
Shock
Cortisol deficiency is life threatening because corticoids are needed for maintenance of blood volume, blood pressure, hemostasis (process which causes bleeding to stop), and glucose.
Steroids, Glucose, and vasopressors.
Reye’s syndrome in children is characterized by what lab test? Ranges for Reye’s? 2 Tests in particular.
Ammonia, will be greater the 300mg/dl (normal 10-60)
Lactic Acid, will be around 21mmol/L (normal is 0.5-1)
Clinical feature of hypercalcemia? EKG? Urination? General feeling, muscle strength, and reflexes?
QT shortening with wide T wave.
Polyuria.
Fatigued, decrease strength and reflexes.
Ectopic pregnancy given methotrexate, patient teaching?
Vaginal bleeding doesn’t occur until patient has normal period.
Pt with ectopic pregnancy is likely to have another one.
Beta-HCG should drop; if not she needs another dose.
Incomplete Abortion
Inevitable Abortion
Threatened Abortion
Missed Abortion
Incomplete - Heavy vaginal bleeding, abd cramping, retention of SOME POC.
Inevitable - Heavy vaginal bleeding, abd cramping, open cervix but no passage of POC.
Threatened - Vaginal bleeding, mild cramping, closed cervix.
Missed - Death of fetus w/o expulsion, no maternal symptoms, no FHT, no movement.
Early s/s of hypovolemic shock? Respiratory, Diastolic, LOC?
Increase rate and depth
Diastolic increases r/t sympathetic response on peripheral vascular resistance (Vasoconstrict to save vital organs).
Anxiety, restlessness, and confusion
Residual volume in children vs. elderly.
What is residual volume?
DECREASED in children
INCREASED in elderly
Amount of air left in the lungs after exhalation.
Corticoid steriods may cause _______ in elderly.
Confusion
Serious side effect in dilantin?
Hypotension and Bradycardia
Elderly with head injury and gets progressively altered over 3 weeks?
Subdural Hematoma
What area of the rhythm is the synch button synching with?
R-Waves
Patient presents to ED with lacrimation, salivation, n/v, bradycardia after eating blackberries? What is it from? Medication to treat?
Organophosphates (Nerve Agent).
Administer atropine sulfate.
Treatment of hydrofluoric acid (found in home rust removers)? Antidote? DO NOT apply_____?
Calcium Gluconate
Water
______ ______ are not calculated in the total body surface area.
Superficial burns.
3 S/S of epididymitis?
Urethral Discharge
Pain develops gradually
Pain decreases w/ scrotal elevation
Sounds with obstruction of trachea vs. larynx?
Trachea - wheezes
Larynx - hoarseness, aphonia
Joint effusion presents with…..
Localized pain, warm skin, limited ROM, erythema, joint tenderness, and edema.
Early sign vs. late sign of ICP.
Early- decreased LOC
Late- widened pulse pressure / low HR / Dilated nonreactive pupils.
Body position for ICP? List 2.
Supine with neutral body position.
Reverse Trendelenberg
CVP monitoring ranges? Where does it measure from? What’s it for?
8-12mmhg
Measures pressure in the Rt. Atrium.
Gives estimation of the fluid volume in the vascular system.
Pt. vomiting every 30-40 minutes would put them in ______ ______ and ______ as an electrolyte imbalance.
Metabolic Alkalosis (loss of potassium, chloride, and hydrogen ions)
Hypokalemia.
Pt’s discharge instructions for mononucleosis. List 3. What organ do you need to be concerned about? Symptoms last? Return to ER if?
No heavy lifting related to splenomegaly; may cause splenic bleeding.
Pt may have fever for 10-14 days, as well as sore throat, diarrhea, and earache.
Return to ER if increased abd pain, SOB, cough, chest pain, and increase fever.
Lap belt injury from MVC will be at risk for (ADULT)?
Rupture of the colon.
Discharge instructions with acute prostatitis?
Increase fluids to assist in bacteria elimination.
Drug treatment for preclampsia? Watch for what side effect?
Respiratory rate needs to be closely monitored. Muscle weakness.
Greatest concern in a patient with a chemical burn to the eye?
Altered visual sensory perception.
STD discharge
Trichomoniasis
Gonorrhea
Candidiasis
Trichomoniasis = Gray or Greenish
Gonorrhea = Yellow
Candidiasis = Thick and White (Cheese Like)
Kehr’s sign? Injury to what organ?
Left shoulder pain r/t irritation by the diaphragm; found in splenic injury.
NSR and the pt’s ICD goes off, what is the treatment?
Place magnet over it to turn it off.
Organism associated with respiratory infections?
Streptococcus Pyogenes
Organism associated with puncture wound of the foot while wearing a rubber soled shoe?
Pseudomonas Aeruginosa
Injured the central cord that’s responsible for proprioception, fine touch. Which part?
Posterior Tract
Spinal Cord injury assessment C 2,3,4 C 5,6,7 L 2,3,4 L 4,5 S 3,4,5
C 2,3,4 Diaphragm (Needs to be placed on vent)
C 5,6,7 Extension / Flexion of arms
L 2,3,4 Extension / Flexion of legs
L 4,5 Flexion of foot / Extension of toes
S 3,4,5 Anal sphincter tone
Diagnostic for posterior wall MI?
EKG to the back of the patient.
ST elevation in
Inferior Wall MI
Anterior Wall MI
Lateral Wall MI
Inferior - II, III, AVF
Anterior Septal - v1 -v4
Lateral - v4, v5, Lead 1, AVL
Why administer beta blockers to STEMI pt?
Reduce mortality and morbidity.
Characterized by alternating euphoric moods with depressive moods?
Bipolar disorder
Characterized by bizarre behaviors, hallucinations, and an inability to care for self or function well in a social environment.
Schizophrenia
Colorimetric exhale CO2 detector colors and what do they mean?
Purple or Beige = Placement is questionable. If it yields a purple color on inspiration and stays purple on expiration it is most likely in the esophagus (when adequate perfusion is present).
Yellow = It’s in place.
