CEN Psych and Medical Emergencies Flashcards
Patient going through withdrawal should be approached in a
non-judgmental manner Keep sentences short and simple Room quiet with little stimulation
A patient who is hypoglycemic and conscious should be given________ and if the patient is unconscious give _____________
10 to 15g of carbohydrates IV glucose
Examples of 15 g of carb food: MOCHS
1 cup of milk 8 small sugar cubes 3 tsp of honey 1/2 cup of orange 8 hard candies.
All types of Hemophillia are equally
severe
What happens in hemophilia? there is ______ of factor _____ and _______
ABSENCE not a lack; VIII and IX
Hemophillia is inherited and most often occurs in
Male
Hemophillia prevent the formation of a firm _______ _______ and results in ______ _______
fibrin clots:; continuous bleeding.
Severity of hemophilia depends on
extent of fibrin function.
Children develop anxiety when they are _________ from parents. Adolescents often develop anxiety disorders when they feel pressure to ________ and Adults often develop anxiety disorders when they experience ____pressures. Older adults often develop when their _______is taken away
separated; achieve; career; independence.
If the patients platelet count are greater than 50,000, they patient can tolerate surgery, T or F
True
A patient with low platelet between ______ and _________ may experience spontaneous intracranial bleeding
20, 000 and 30000
A patient with platelet less than 10,000 then the patient may experience
Spontaneous intracranial hemorrhage.
Which clotting profiles assesses the COMMON PATHWAY and the INTRISIC COAGULATION PATHWAY
activated Partial Thromboplastin Time (aPTT)
Which clotting profiles assesses the COMMON PATHWA and the EXTRINSIC COAGULATION PATHWAY
Prothrombin Time
What does the thrombin time assess? The amount of time it takes for _______to converts to ______into a _____
the amount of time it take for thrombin to convert to fibrinogen into a clot
What does the bleeding time assesses?
Platelet function.
Cushing syndromes the result of
Excessive STEROIDS
Excessive systemic Corticosteroids can lead to
Cushing syndrome
Cushing syndrome is associated with 4 symptoms
hypernatremia, hyperglycemia, hypokalemia, hypocalcemia
In cushing syndrome if steroids aren’t weaned what happens__________
Addisonian crisis.
If the patient had an infection is at risk for ______shock, if they had external blood loss they are at risk for ______Shock; if they had an allergic reaction they are at risk for ________ shock and if they had a head injury they are at risk for ______shock
Septic; hypovolemic; anaphylactic; neurologic.
Normal ionized calcium level is _____to ______.
4-5
Symptoms of hypocalcemia
Numbness and tingling N/V muscle tremor Twitching Chvostek’s sign Trousseau’s sign hyperactive reflexes seizures Prolonged QT interval and ST segment
Sudden onset of anxiety that is caused by fear and panic
A panic disorder
Behavior that are repetitive and driven by persistent thoughts and feelings
Obsessive-compulsive disorder.
Results of one having persistent thoughts and memories after a traumatic events
PTSD
Feelings of anxiety that occur within a month after the cessation of substances
Substance-induced anxiety disorder.
Persistent eating disorder of non-nutritive susbtances.
PICA
Eating disorder related to repeatedly overeating and induced vomiting or laxative consumption
BULIMIA NERVOSA
Disorder of INFANCY related to repeatedly regurgitating food or rechewing food is known as
RUMINATION
In a patient with CRF, an interference with RBC synthesis and maturation process could cause ______; an interference with prostaglandin synthesis could cause _______; An interference with renal bone mineralization could cause _________
Anemia; hypertension; osteodystrophy
Aggressive correction of hyponatremia with fluid can cause what?
Pituitary damage
Hyponatremia is either to ______extracellular sodium or _____Extracellular volume
low; high;
For severe hyponatremia, ________Saline solution is administered followed by _________
hypertonic; Diuretics
What is the most common cause of hyperthyroidism
Grave’s disease
Precipitating factors of hyperthyroidism:
Thyroiditis, nodular goiter, iodine excess, thyroid CA, pituitary tumors
A patient going through withdrawal, how often should the vital signs be taken?
___________has four features: (1) The patient’s symptoms are typically disproportionate to physical examination findings of organic disease. (2) A preoccupation with one’s own body. (3) A compulsive insistence on being labeled as “sick” and subsequently crippled. (4) Continuous and unsatisfactory pursuit of medical care and opinion with a history of intervention yet eventual return of symptoms.
every 15-30 mns until stable
Hypochondriasis
What kind of hallucination in which the patient feels things occurring in her own body?
Somatic
Hallucinations involve the perception of bodily movements?
Kinethics
Hallucinations involving odors
Olfactory
Hallucinations involving tastes
Gustatory
What are examples of MATURATIONAL crisis
Pregnancy Death Marriage
A crisis that occurs over time and IS part of the life cycle’s normal development
MATURATIONAL
A crisis that occurs over time and is NOT part of the life cycle’s normal development
Situational( unemployment, vehicle accidents, sexual assault, divorce, diagnosis of terminal illness)
Abrupt discontinuation of steroid may result in _________
Acute Adrenal Crisis
Acute adrenal crisis is treated with __________ administered IV along with _____ and electrolytes
Hydrocortisone Fluids
Which is more common primary or secondary adrenal insufficiency? an example of secondary is______
Secondary: steroids induced adrenal crisis.
Symptoms of adrenal crisis
hypotension, hyperpigmentation, weakness, fatigue
Patient’s thoughts have some connectivity but little association between the, what though process is that
TANGENTIAL
When patient loses the ability to have a normal thought process?
Looseness of association
When to patient is distracted by his/her environment and leaps from one thought to another unrelated thought
Flight of ideas.-
Thought process that occurs when a patient uses a roundabout way to connect his/her thoughts to the original topic
Circumstantial
The initial vasopressors of choice for HYPOTENSION in SEPTIC SHOCK are
Norepinephrine (levophed) and DOPAMINE
What should be done prior to initiation of any vasoactive medications?
Fluid resuscitation.
Indications that a patient is having a febrile reaction to a blood transfusion are:
fever, muscle pain, vomiting, chills, flushing, increased HR.
When does febrile transfusion reaction occurs?
Immediately or up to 6 hours after the transfusion
Mild allergic transfusion reaction occurs during or up to _____hour and the symptoms are_____ ___ ____ _____
one; flushing, hives; urticaria, itching
occurs days to weeks after the transfusion and have the following symptoms____ ___ ___ ____
Delayed Hemolytic transfusion reactions; fever, anemia, mild jaundice, purpura
Noncardiac pulmonary edema transfusion reactions occur _____ or shortly after transfusion and includes
fever, chills, shock, dyspnea, hypoxemia, cough and crackles.
In a patient with mania, which type of medication would be prescribed to regulate the patient’s mood?
Anticonvulsants
A patient with mania would be prescribed ____ for psychosis
Antipsychotics
A psych patient may be prescribed ______to block the effects of catecholamines
Beta Blockers
A patient with depression needs _______to rule out hypothyroidism
Thyroid function tests
How many types of hypersensitivity reactions are there?
4
Immediate hypersensitivity reactions occurs within minutes of exposure is type ______and include reactions to ______,PCN, pollen and _______
Type I, food products; insect venom
Cytotoxic hypersensitivity reactions is type _____ generally occur within minutes to days and include a reaction to ______ ______ ______
Type II; Transfusion of mismatched blood
Immune complex mediated reaction is type _____ generally occurs within _____ and include reactions to ________ ______
III; hours: environmental antigens.
Delayed or cell-mediated hypersensitivity reactions generally within one or ____ days and include ________ ____ ____ ____
type IV; more; Tuberculosis skin testing reactions.
What is normal PT time
11.9-18.5 seconds
What is normal aPTT
24-36 seconds
the normal thrombin time
10-15 seconds
What is the normal bleeding time_________
less than 8 minutes.
Why is benzodiazepines administered to patient who are suffering from substance abuse?
To prevent seizures
Patient who are suffering from substance abuse should be monitored for _______ and _____
DT and Death
The thought process that occurs when patients suspects or doubts something?
Suspicious
When the patient believing somthing even though there is evidence to the contrary?
Delusion
The correct dosage for IM epinephrine administration in anaphylactic Shock is: ______ administration may be repeated after _____ to ___minutes
1:1000; 15-20
What is the purpose of epinephrine during anaphylactic reaction?
Promote vasoconstriction, dilate the bronchioles, inhibits further release of mediators.
What is the correct dosage concentration for IV epinephrine
1:10,000
The use of the blood product CRYOPRECIPITATE is for replacement of
Clotting factors.
The most common replacement for fibrinogen is _____ and is indicated for patients who are _______bleeding or at risk
CRYO; acutely
What blood products are used to restore oxygen-carrying capacity?
PRBCs and Whole blood
Which blood products are used to expand blood volume?
FFP, albumin and plasma protein fraction.
What act ensures that all patients receive the same level of care regardles sof their race, religion, origin, age, gender or disability?
Civil Rights Act
It is the responsibility of the _______ _____ _____ to ensure that all practitioners are qualified to perform thier duties
state’s governing board.
HIPAA stands for ______ ____ _____ _____ ____ and date year
Health Insurance Portability and Accountability Act; 1996
The main difference among HHS and DKA is that HHS consists of more severely elevated _______ and the lack of _________; HHS occurs most commonly in Type ____DM while DKA occurs most often in type _____ DM. And _____carry a higher mortality rate than ______
Glucose; ketoacidosis ; Type II; Type I; HHS ; DKA
Diagnosis of Dehydration: Hematocrit is ______ , serum OSMOLALITY is _______ and serum sodium is _______
Elevated, elevated, elevated
The diagnosis of SIADH : Hematocrit is _____; serum osmolality is _____ and BUN is ______ along with urine specific gravity greater than _______
low; low; low; 1.005
The diagnosis of water excess syndrome: serum osmolality less than ______ and a decreased _____ and ________
280; sodium; hematocrit
The diagnosis of HYPERVOLEMIA : Decreased __________; ________; and ________along with urine specific gravity of less than _____
hematocrit; serum osmolality and BUN; 1.010
When a patient shows signs of sepsis transfusion reaction you should ______
stop the tranfusion and obtain culture of the patient’s blood with the remaining tranfusion blood.
When a patient shows symtpoms of a noncardiac pumonary edema transfusion reaction, you should stop the transfusion and :
Administer oxygen
When a patient shows symptoms of a delayed hemolytic transfusion reaction, you should monitor the ______ and ______
urine output; hemoglobin
Signs of hypermagnesemia include:____ _____ ________
Muscular weakness, Loss of Deep tendon reflexes and even RESPIRATORY Muscle paralysis
What is given IV to reverse the neuromuscular effects of Hypermagnesemia
CALCIUM GLUCONATE
All patients in the ER who reports IV drug use should be tested for
HIV
In DKA, glucose is greater than _____ and his blood serum ketone will be greater than ____
250; 5
In hyperosolar nonketoci hyperglycemic crisis, blood glucose is greater than _____ and ketone is _______
600; normal
The psychiatric disorder that causes an individual’s intellectual functioning to deteriorate is
DEMENTIA
The psychiatric disorder that causes an individual’s moood to be disturbed due to sadness, negativity or loss of interest
Agoraphobia is
DEPRESSION
Agoraphobia is anxiety about or avoidance of situations or places from where escape might be difficult.
The psychiatric disorder that causes an individual to have an _______mood; _______ mood and _______ mood is _____
elevated; irritated; expansive; MANIA
Psychiatric disorder that is associated with the loss of contact with reality; a decrease in the ability to function socially and a deranged personality is
________
Pt with persistent fever, diaphoretic, on haldol, tachy cardic, suspect which condition_____________
Treatment of _____________ consists of fever reduction, intravenous rehydration, and supportive measures. ___________ a direct-acting muscle relaxant, should be used in severe cases.
Psychosis;
Neuroleptic Malignant Syndrome
Dantrolene
Malignant proliferation of BLAST CELLS or IMMATURE WBCs is
LEUKEMIA
Symptoms of Leukemia include :
fever, nightsweats, lymphadenopathy, spenomegaly, pallor, bone or joint pain
Genetic disorder that causes blood not to clot normally is______ and there is LACK of one of the two essential ciruclating plasma proteins either factor ____ or _____
Hemophillia; VIII; IX
Hematologic emergency involving decrease in clotting factors and platelets?
DIC
2 types of psychosis:
functional or organic
Predisposing factors of functional psychosis include
schizophrenic disorder, severe depression and a brief psychotic episode or mania
Predisposing factors of organic psychosis include
Bipolar disorder can be treated primarily with mood stabilizing medications such as _______,_______,_______
dementia, delirium, shock, and ingestion of a toxic susbtance.
valproic acid, lithium, or carbamazepine.
The co-administration of ______ and _____can result in serious complications and death
alcohol and benzodiazepines
Before prescribing benzodiazepines, you should assess the patient for recent ____use because benzodiazepines are _______with ________
__________ the most common adverse effect seen Haldol.
It involves the sudden onset of involuntary contraction of the muscles of the face, neck, or back. The patient may have protrusion of the tongue (buccolingual crisis), deviation of the head to one side (acute torticollis), sustained upward deviation of the eyes (oculogyric crisis), extreme arching of the back (opisthotonos), or rarely laryngospasm. Treat with _______
alcohol; synergistic; alcohol
Acute distonia
Cogentin
Normal mag for adult____ ; for a child ______ for an infant
1.3-2.1; 1.4-1.7; 1.4-2.0
Kubler Ross stages of grief in ________ include ____ ____ ____ ____ ___ DABDA
1969; Denial, anger, bargaining, depression; acceptance
Protease inhibitors for HIV are a specific class of drug within ____
HAART therapy
Side effects of Protease inhibitors are :
Hepatotoxicity, HLD, hyperglycemia. LACTIC ACIDOSIS,
To make a diagnosis of depression, depressive symptoms must be present for all or ____ of the day for at least _______
most; 2 weeks
Thought process that occurs when patient stops the flow of his thoughts or speech
Blocking
Refractory septick shock include
tachycardia, hypotension, cool skin, anuria and hypothermia
Compensated septic shock include
Tachycardia, NORMAL TO LOW BP, Bounding pulses; Warm skin Wide pulse pressure, hyperthermia and OLIGURIA
There are several factors that predispose one to sickle cell crisis
cold temperature, high altitudes, recent infection, metabolic or respiratory acidosis and STRESS.
For patients with hematologic emergencies undergoing high dose chemo, ________ is a serious complication
Neutropenic fever
For hypotension that is refractory to both fluid resuscitation and vasopressors what should be administered?
Hydrocortisone
Secretion of ADH leads to an increase in _______ _______. And ________ stimulated the antidiuretic hormone _ADH_
Water resorption; HYPERTHERMIA, pain, decreaed blood volume , hypotension and stress
What stimulated the RAAS?
Hyponatremia
_________Stimulates the atrial natriuretic peptide
Volume expansion
Mechanisms that regulate body fluid:
ADH, thirst, RAAS, atrial natriuretic peptide
what is given to a patient in anaphylactic shock to block histamine receptors?
antihistamine.
Steroids is given to anaphylactic shock patients to
prevent delayed reaction, decreased capillary permeability, stabilize mast cells.
Frequent episodes of binge eating due to emotional distress is a common factor for individuals with
BULIMIA NERVOSA
Which type of blood is considered universal donor
Type O
A blood type is compatible with
A and O
B blood type is compatible with
B and O
What is the goal of crisis intervention?
return individual back to his normal level of functioning.
SIADH results from abnormal amounts of ADH from the ______ results in _______ intoxication. Asymptomatic patients can be treated with ______ ______ from ___ to ____ ml but symptomatic patients can be treated with ______ and _______
pituitary; water; Fluid restriction; 500-1000ml; hypertonic; diuretics
Which type of of anemia bone marrow fail to produce blood cells?
Aplastic
Type of anemia that has a deficiency in absorbing Vitamin B12
PERNICIOUS
What is the role of the electrolytes PHOSPHORUS?
Regulating oxygen delivery to the tissues.
_______ facilitates muscle contraction
Sodium
______Maintain intracellular osmolality
Potassium
What is the BEST recommendation for the prevention of SEPTIC SHOCk
Avoid invasive procedures
Best recommendation to prevent NEUROGENIC SHOCK
IMMOBILIZE THE SPINE
Best recommendation to prevent anaphylactic shock
__________is a state of motor restlessness characterized by a physical need to move constantly.
remove the offending agent.
Akathisia
To prevent cardiogenic shock best to perform
Emergency decompression
In early septic shock, oxygen delivery to the tissues is ______. But _____ and ______are impaired.
increased; extraction ; utilization
Patient who are undiagnosed or undertreated from hypothyroidism _________; occurs in ____ older than ___ in ____Months
Myxedema coma; women; 60; winter
DTs associated with _______ and _______which can lead to ________and ______
AMS; sympathetic overdrive; cardiovascular collapse; death.
The MAJORITY of anaphylaxis cases involves symptoms related to the
SKIN
Suicidal thoughts are not always conscious thoughts they can be______thoughts as well.
A useful mnemonic for eliciting signs of depression is IN SAD CAGES _______
unconscious
Interest, Sleep, Appetite, Depressed, Concentration, Activity, Guilt, Energy, Suicide
Blood product that contains platelets, WBC and plasma is ________. Plasma protein fraction contains _____ and _______ is a saline solution.
PLATELETS; albumin and globulin.
