Chapter 19, 20, and 32 Flashcards
What is the reticular activating system?
series of neurologic circuits in the brain that control the functions of staying awake, paying attention and sleeping. oxygen, water, and glucose control normal consciousness
What is altered mental status?
usually the most common causes hypoxia. can lead to combativeness
What is the pancreas?
midline of upper abdomen producing insulin
What is glucose?
a form of sugar, the body’s basic source of energy
What is insulin?
a hormone produced by the pancreas or taken as a medication by many diabetics
What is diabetes mellitus?
also called “sugar diabetes” or just “diabeteres,” the condition brought about by decreased insulin production or the inability of the body cells to use insulin properly. the person with this condition is a diabetic
What is type 1 diabetes?
insulin- dependent diabetes when pancreatic cells fial to function properly and insulin is not secreted normally not having enough insulin in system to transfer circulating glucose into cells
What is type 2 diabetes?
non-insulin dependent diabetes when body cells fail to use insulin properly pancreas may be secreting enough but body is unable to use or move glucose out of blood and into cells.
What is hypoglycemia?
low blood sugar. rapid onset occurs when take too much insulin, reduces sugar intake by not eating, over exercising exerting and using up sugar faster than normal, vomits a meal, increases metabolic rate by sickness lead to sympathetic response: pale, sweaty skin, tachycardia, and rapid breathing can lead to unconsciousness, seizures, and permanent brain damage less than 60 mg/dL, 50 mg/dL unresponsive. regular to rapid/shallow respirations; skin pale, cool and clammy; AMS, combative, lethargic; weak, rapid pulse; normal to low BP; behavior may mimic stroke or intoxication; seizure, fainting or coma; blood glucose levels
What is hyperglycemia?
high blood sugar, decrease in insulin leaving sugar in bloodstream instead of cells occurs over months or weeks chronic thirst and hunger, warm red skin, breathe deep and rapid, abdominal pain, vomiting and increased urination with nausea causing dehydration and diabetic ketoacidosis. 140 mg/dL greater than 300 mg/dL dehydration and other medical symptoms. so give glucose. skin warm, pink and dry; AMS more progressive, drowsiness and lethargy; severe dehydration causing thirst and dark urine “polydipsia and urea; visual or sensory deficits; muscle weakness or pain, seizures; as blood glucose levels increase kussmaul respirations may develop; blood glucose levels > 300 mg/dL. need fluids before insulin, glucometer history must be able to speak and swallow can give oral glucose not going to be more detrimental to a hyperglycemia but will save life of hypoglycemia.
What is diabetic ketoacidosis?
a condition that occurs as the result of high blood sugar (hyperglycemia), characterized by dehydration, altered mental status, and shock fruity acetone odor on breath.
What are the diabetic medicines?
humulin, glucotrol, glucophage, and micronase
What are oral glucose?
patient has history of diabetes, altered mental status, away enough to swallow ingest whole tube or based on size. can give via intranasal via atomizer
What is altered mental status?
can be caused by hypoxia, sepsis, drug and alcohol use, brain injuries traumatic and medical, metabolic abnormalities, brain tumor, and infectious diseases meningitis.
What is sepsis?
infection usually UTI pneumonia and skin/wound infections, especially a severe, system wide response to infection causing systemic inflammation causing drop in pressure in cardiovascular system, hypovolemic shock leading to hypoperfusion of body tissues. microbes then release toxins harming cardiac output furthering shock state.
What is seizure?
sudden change in sensation, behavior, or movement. the most severe form of seizure produces violent muscle contractions called convulsions
What is partial seizure?
a seizure that affects only one part or one side of the brain may or may not lose consciousness. tingling, stiffening, or jerking in just one part of body; may be aura such as smell, bright lights, burst of colors, rising sensation in stomach may spread and develop into tonic-clonic seizure. complex partial seizure (psychomotor or temporal lobe- abnormal behavior varies from person to person involve confusion, glassy stare, aimless moving about, lip smacking or chewing, or fidgeting with clothing appearing drunk or on drugs not violent but may struggle or fight if restrained rarely screaming, running, disrobing, or showing great fear.
What is a generalized seizure?
a seizure that affects both sides of the brain and affects consciousness. absence seizure- brief usually less than 10 second no dramatic motor activity and person doesn’t slump or fall with temporary loss of concentration or awareness and may go unnoticed to everyone except person and knowledgeable members of family can have several hundred throughout the day
What is a tonic-clonic seizure?
a generalized seizure in which the patient loses consciousness and ahs jerking movements of paired muscle groups. tonic- body becomes rigid, stiffening for no more than 30 seconds breathing may stop and patient may bite his tongue (rare), and bowel and bladder control may be lost. clonic- body jerks about violently, no more than 1-2 minutes (can last 5) with patient possibly foaming at mouth and drool face and lips often becoming cyanotic
What is postical phase?
the period of time immediately following a tonic-clonic seizure in which the patient goes from full loss of consciousness to full mental status. when convulsions stop patient may regain consciousness immediately entering state of drowsiness and confusion may remain unconscious for several hours with headache. vary in length, and may become combative
What is an aura?
a sensation experienced by a seizure patient right before the seizure, which might be a smell, sound or general feeling
What is a seizure?
caused by pediatric (fever), hypoxia, stroke, traumatic brain injury, toxins, hypoglycemia, brain tumor, congenital brain defects, infection, metabolic, and idiopathic, and can be seen with epilepsy, measles, mumps and other childhood diseases, eclampsia, and heart stroke
What do you do when seizing?
place patient on floor and side if no spine injury, loosen restrictive clothing, remove objects that can harm, protect from injury but don’t hold them
What do you do after seizures are over?
protect airways, if blue ensure open airway providing artificial ventilations with supplemental oxygen, treat any injuries or rule out trauma may have to immobilize patient. if patient refuses make sure someone stays with them and doesn’t drive
What is epilepsy?
a medical condition that causes seizures. multiple seizures from unknown cause, what was the person doing what did person do during and after seizure
What is status epilepticus?
a prolonged seizure or situation when a person suffers two or more convulsive seizures without regaining full consciousness or single seizure lasting more than 10 minutes when have give oxygen and call ALS
What is a stroke?
a condition of altered function caused when an artery in the brain is blocked or ruptured, disrupting the supply of oxygenated blood or causing bleeding into the brain. formerly called cerebrovascular accident (CVA). death or injury of brain tissue deprived of oxygen.
don’t know that there is something wrong, transient ischemic same as stroke with all normal stroke type symptoms but usually resolve themselves within 24 hours and patients with pre-existing heart conditions. ischemic- thrombotic (originating at that point) ischemia block in cerebral arteries and enough pressure pushes it through, embolic (works its way from somewhere else) or hemorrhagic- bleed comes on suddenly and worst headache of their life
What is an ischemic stroke?
clot or embolism occludes an artery. hemorrhagic stroke- caused by bleeding into brain, from long-standing high blood pressure (hypertensions) occurring when weak area of artery (aneurysm) bulges out and eventually ruptures, forcing brain into smaller than usual space within skull. one-sided weakness (hemiparesis), patient may be unable to form words and be speaking incomprehensibly, patient trouble forming words using inappropriate phrasing or jumbled pattern of speech- expressive or receptive aphasia. less commonly headache- subarachnoid hemorrhage
What is a transient ischemic attack?
confused, weak on one side, and having difficulty speaking but appear fine or mini-stroke looks like stroke but unlike has complete resolution of symptoms without treatment within 24 hours. small clots temporarily blocking circulation to part of brain when breaks up patient resolves has a significant risk of having full-blown stroke
What is Cincinnati prehospital stroke scale?
assess for facial droop have patient to grimace or smile showing teeth, test control of facial muscles should be able to use both sides of face abnormal response is unequal movement or no movement at all, speech difficulties like slurred speech using wrong words or unable to speak, assess for arm drift asking them to close eyes and extend arms palms up for 10 seconds (usually are able to) stroke patient will have arm drift or palm rotation and affected side will drift downward or turn over. facial droop (patient shows teeth or smiles)- bystander said it’s not normal looking. normal- both sides of face move equally. abnormal- one side of face does not move as well as other. bells palsy- neuromuscular affecting certain muscular junctions from viruses trauma or tumor and is self resolving
arm drift )patient closes eyes and extend both arms straight out for 10 seconds) normal- there is no drift at all or both arms drift the same. abnormal- one arm drifts/moves down compared to the other arm or one arm noticeably weaker than the other.
speech (score first attempts: patient repeats “sky is blue in boston” speech at all, order of words different, not saying right words. normal: patient says correct words with no slurring of words o first attempt. abnormal: patient slurs words, says wrong words or is unable to speak on first attempt
one of more sudden acute stroke symptoms: sudden numbness, weakness or paralysis of face, arm or leg on one side of body; sudden confusion, trouble speaking or understanding speech; sudden trouble seeing in one or both eyes; sudden trouble walking, loss of balance or coordination; sudden severe headache with no known cause.
What are the signs of symptoms of stroke?
confusion, dizziness, numbness weakness or paralysis, loss of bowel and/or bladder control, impaired vision, high blood pressure, difficult respiration or snoring, nausea or vomiting, unequal pupils, headache, loss of vision in one eye, unconsciousness (uncommon) or can mimic signs of stroke or hypoglycemia analyzing blood glucose level
What are things that mimic strokes?
tumor or infection in brain, head injury, seizures, hypoglycemia, and bacterial or viral infections causing weakness or paralysis of facial nerves
What are the treatment of strokes?
transport to hospital that has CT scan, find out exact time of onset
What is syncope?
fainting with brief loss of consciousness with spontaneous recovery from a few second to a few minutes. will feel light-headed, dizzy, nausea, weakness, vision changes, sudden pallor (loss of normal skin color), or sweating, incontinence of bladder and/or bowel occurs during. can be caused by life threatening things ex. chest (palpitations, sensation of racing heart (tachycardia), slow heart rate (bradycardia, or headache)
What is dizziness?
means different things to different people, weakness such as sensation or loss of strength, vertigo, light-headedness. causes of dizziness such as hypoxia, hypoglycemia, and hypovolemia interfering with normal brain functions
What are cardiovascular causes causes of dizziness?
immediate consideration sign of acute myocardial infarction caused by alteration in heart’s ability to pump caused by electrical changes in heart resulting in abnormal heart rates; cardiac dysrhythmia where heart beats extremely fast with tachycardia leading to dizziness or syncope. when heart beats fast, ventricles don’t have time to fill before pump blood out. or bradycardia can also result in dizziness can be bad or from overactive carotid sinus fom
What are hypovolemic causes causes of dizziness?
low fluid volume, not enough blood for brain from dehydration, internal bleeding, and trauma such as bleeding. if women lower abdominal pain could be ectopic pregnancy and internal bleeding or aneurysm or gastrointestinal bleeding in older
What is metabolic causes of dizziness?
something wrong with brain structures around or near, middle ear inflammation from drugs, with stroke or seizure but if longer than a few minutes its not a syncope
What is the environmental/toxicological causes of dizziness?
alcohol or drugs central nervous depressants or panic attacks and anxiety changing breathing
What do you do to treat dizziness?
when did it start, how long did it last, what position were you in, similar episodes, on meds, signs or symptoms, nausea, vomiting (blood), black stools (digested blood), see or feel something. lay patient flat and untighten clothing around neck
What is poison?
any substance that can harm the body by altering cell structure or functions. can be corrosive or irritant, destroying skin or other tissues or entire system overstimulate nervous system causing vomiting and diarrhea preventing cells from carrying oxygen or interfere with biochemical processes
What are toxins?
a poisonous substance secreted by bacteria, plants, or animals. plants: mistletoe, holly berries, rubber plant
What is ingested poison?
poisons that are swallowed such as common household and industrial chemicals, medications, improperly prepared or stored foods, plant materials, petroleum products, and agricultural products made to control animals weeds, insects, and crops
What is an acetaminophen overdose?
loss of appetite, nausea, and vomiting causes irreparable liver damage with delayed and not very specific signs
What is inhaled poisons?
poisons that are breathed in. gases, vapors or sprays can be similar common household items acting as suffocating agent, such as carbon monoxide (car exhaust, wood-burning stoves, and furnaces), carbon dioxide (industrial sources) ammonia (household cleaners), chlorine (pool chemicals), insect sprays and gases from industrial solvents that are volatile. may have to use SCBA (self-contained breathing apparatus when chlorine gas, ammonia or moke), oxygen is very important
What is carbon monoxide poisoning?
most common inhaled poison, motor-vehicle exhaust and fire suppression from wood-burning stoves and charcoal for heating and indoor cooking in areas without adequate ventilation. malfunctioning oil, gas and coal-burning furnaces and stoves can be sources. symptoms: headache band around head, dizziness, breathing difficulty, nausea, cyanosis, and altered mental status with unconsciousness vague flu-like symptoms in enclosed area. give oxygen
What is smoke inhalation?
serious problem on fire scenes. indicate smoke inhalation: red watering eyes, injury to airway, difficulty breathing, coughing, breath with smoky smell, black residue in mouth or nose, black sputum when coughed, nose hairs singed. give oxygen no matter pulse oximetry reading.
smoke from burning materials can contain poisonous and toxic substances, including CO, amonia, chlorine, and cyanide. substances can irritate skina nd eyes, damage lungs, and progress to respiratory or cardiac arrest. signs and symptoms: difficulty breathing, coughing, “smoky” or checmical smell on breath, black (carbon) residue in mouth nose or sputum, signed nasal or facial hair
What are detergent suicides?
mixing easily obtained, release toxic hydrogen sulfide, pesticide and cleaner preventing oxygen from binding to iron by binding to them. mild exposure: coughing, eye irritation, sore throat, with more sever: dizziness, nausea, shortness of breath, headache, and vomiting. severe cases: fluid collect in lungs, resulting in death. beware of small, enclosed spaces with tape sealing windows and doors. method of suicide in japan and Us.two easily obtained chemcials release toxic hydorgen sulfide gas inside enclosed space. can be absorbed through skin damaging it, may need to decontaminate before treatment. remove powder, irrigate with clean water for at least 20 minutes during transport
What are absorbed poisons?
poisons that are taken into the body through unbroken skin can damage skin, corrosive or irritants injuring it and slowly absorbing into body tissues and bloodstream causing widespread damage or others don’t injure skin but are absorbed such as insecticide and agricultural chemicals. irritate or damage skin but same can be absorbed with little or no damage to skin. remove poison by: brushing powder off patient, with liquid poisons irrigate with clean water for 20 minutes, and when in eyes: irrigate with water for 20 minutes
What are injected poisons?
poisons that are inserted through the skin, for example, by needle, snake fangs, or insect stinger. Illicit drugs,
What is activated charcoal?
a substance that absorbs many poisons and prevents them from being absorbed by the body. give in covered cup and if vomit save all vomit
When is activated charcoal contraindicated?
cannot swallow, altered mental status whereby might choke or aspirate, ingested acids or alkalis (oven cleaners, drain cleaners, toilet bowl cleaners, and lye) because of possible damage to digestive tract, gasoline, and food poisoning. if refuse when overmedicating contact medical control
How do you treat absorbed poisons?
need to know what substance bringing container, when did it occur, how much using maximum, over how long ingestion occurred, interventions, effects from ingestion with nausea and vomiting most common. may find altered mental status, abdominal pain, diarrhea, chemical burns, and unusual breath odors. call poison centers 1-800-221-1222 when local protocol says so but may not have authority for decisions
What is the syrup of ipecac?
orally administered causes vomiting removal of ⅓ of stomach contents hardly used because slow
What is dilution?
thinning down or weakening by mixing with something else. ingested poisons are sometimes diluted by drinking water or milk
What is an antidote?
a substance that will neutralize the poison or its effects such as naloxone
What is naloxone?
antidote reversing narcotics’ depressant effects on level of consciousness and respiratory drive with no effect on someone without drugs, via intranasally
What is alcohol abuse?
person could have low blood sugar levels, poor nutrient, gastrointestinal bleeding, heart attack, hypoglycemic and taken with other meds- depressed vital signs . other conditions: diabetes, epilepsy, head injuries, high fevers, hypoxia, can appear to be alcohol related. signs and symptoms of alcohol abuse: alcohol odor on breath or clothing and not acetone breath (diabetic), swaying and unsteadiness of movement, slurred speech, rambling thought patterns, incoherent words or phrases, flushed appearance to face with patient sweating and complaining of being warm, nausea or vomiting, poor coordination, slowed reaction time, blurred vision, confusion, hallucinations visual or auditory, lack of memory (blackout), altered mental status. be alert for violent tendencies and make sure to keep them alert and always transport as under implied consent. potent drug affect CNS, can be addictive, emergencies resulting from recent consumption or years of abuse, treat patients as others, can lead to or worsen other medical conditions, often consumed with other drugs, impaaired can be uncooperative or combativ
What is withdrawal?
referring to alcohol or drug withdrawal in which the patient’s body reacts severely when deprived of the abused substance. symptoms of withdrawal: confusion and restlessness, unusual behavior, to point of “insane behavior”, hallucinations, gross tremor (obvious shaking) of hands, profuse sweating, seizures (common and not serious), hypertension, and tachycardia. drug withdrawal symptoms: shaking, anxiety, nausea, confusion and irritability, hallucinations visual or auditory, profuse sweating, increased pulse and breathing rate
What is delirium tremens?
a severe reaction that can be part of alcohol withdrawal, characterized by sweating, trembling, anxiety, and hallucinations. severe alcohol withdrawal with the DTs can lead to death if untreated
What is substance abuse?
chemical substance taken for other than therapeutic (medical) reasons. increased risk from things they abuse as well as effects from impaired judgements and have illness. designer drugs have worse effect than traditional. including upers, downers, narcotics, hallucinogens, and volatile chemicals.
What are uppers?
stimulants such as amphetamines that affect the central nervous system to excite the user relieving fatigue or create feelings of well-being ex. bath salts (hallucinogenic) caffeine, amphetamines- pill, and cocaine- snorted, smoked or injected. symptoms include: excitement, increased pulse and breathing rates, rapid speech, dry mouth, dilated pupils, sweating, and complaint of not sleeping. with repeated doses having “speed run,” resulting in restless, hyperactive, and apprehensive and uncooperative
What are downers?
depressants, such as barbiturates, that depress the central nervous system, which are often used to bring on a more relaxed state of mind, sleeping pill, or tranquilizer. ex. barbiturates- pill, rohypnol (roofies) date rape, GHB goop sense of euphoria and hallucinations- need assisted ventilations. signs and symptoms: sluggish, sleepy patient lacking typical coordination of body and speech with low pulse and breathing rate to emergency
What are narcotics?
a class of drugs that affect the nervous system and change many normal body activities. their legal use is for the relief of pain. illicit use is to produce an intensive state of relaxation such as stupor or sleep. ex. codeine, oxycodone (chronic pain), heroin (injected), overdoses have three signs: coma (depressed level of consciousness), pinpoint pupils, and respiratory depression (slow, shallow respiration) opiate triad. symptoms: reduced rate of pulse and rate and depth of breathing, seen with lowering of skin temperature, pupils constricted and pinpoint, muscles relaxed, sweating is profuse, sleepy and doesn’t want to do anything. overdoses: coma, respiratory arrest or cardiac arrest rapidly
What are hallucinogens?
mind-affecting or mind-altering drugs that act on the central nervous system to produce excitement and distortion of perceptions. ex. LSD, PCP, and mushroom eaten and dissolved in mouth and mucous membranes or ecstasy also an upper. symptoms: fast pulse rate, dilated pupils, flushed face seeing or hearing things no concept of real time and not aware of environment making no sense and may be aggressive or timid
What are volatile chemicals?
vaporizing compounds, such as cleaning fluid, model cement, and correction fluids that are breathed in (by “huffing” breathing fumes directly or from substance impregnated facbir and bagging from substance sprayed in bag” by the abuser to produce a “high.” give an initial rush then act as depressive. Symptoms: appear dazed or temporary loss of contact with reality, develop a coma, linings of nose and mouth with swollen membranes, funny numb feeling or tingling inside head with changes of heart rhythm leading to death
What is the labia?
soft tissues that protect the entrance of the vagina. urethral opening, and nerve-rich center of sexual stimulation clitoris found in anterior aspects of labia with high vascular tissues prone to significant bleeding with trauma
What is the perineum?
the surface area between the vagina and anus and is prone to tearing during childbirth
What is mons pubis?
soft tissue that covers the pubic symphysis area where hair grows when a woman reaches puberty
What is the vagina?
birth canal, smooth muscle connecting uterus to outside world and stretch to accommodate passage of fetus during delivery and passageway for menstrual waste products leaving uterus at conclusion of menstrual cycle
What is the ovary?
female reproductive organ that produces ova in lower abdominal quadrants producing hormones
What are the fallopian tubes?
narrow tube that connects ovary to uterus called oviduct where fertilization occurs
What is an ectopic pregnancy?
ovum implants in fallopian tubes and is dangerous because they cannot expand as fetus develops and can lead to rupture and severe bleeding
What is a uterus?
muscular abdominal organ found on the midline where the fetus develops and can stretch and grow as fetus gets larger; the womb. top, or fundus found as high as the xiphoid process in a late-term pregnant women with the lower aspect connected to the vagina. becomes less protected by abdominal cavity as it is thinner walled and gets larger during prengnancy
What is the cervix?
neck of uterus at the entrance to the birth canal but closed off in nonpregnant female but during labor cervix thins and dilates allowing muscular walls of uterus to contract and push fetus out through vagina and into outside world
What is ovulation?
phase of female reproductive cycle in which ovum is released from ovary and when walls of uterus thicken in preparation for implantation and egg is moved by peristalsis through the fallopian tubes and if fertilization does not occur, hormone levels change and slough off
What is an embryo?
baby from fertilization to 8 weeks of development implanting in lining of uterus and developing basic connections between itself and the mother
What is a fetus?
baby from 8 weeks of development to birth develop for 32 more weeks. 1st trimester fetus is being formed remaining quite small with little uterine growth, second trimester uterus grows rapidly reaching navel by fifth month and epigastrum (upper abdomen) by sevent month