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SEMESTER 6: Chronic, Clinical, Emerg > Chronic FINAL > Flashcards

Chronic FINAL Flashcards

1
Q

What medication reduces muscle spasticity in people with SCIs?

A

Oral baclofen

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2
Q

At what point can you discontinue your anti-epileptic meds?

A

After a minimum of 1-2 years seizure-free

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3
Q

What point can you develop epilepsy?

A

Early childhood or old age

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4
Q

What are the 2 types of nociceptive pain?

A
  • somatic

- visceral

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5
Q

What are the 2 types of neuropathic pain?

A
  • dysesthetic

- neuralgic

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6
Q

What is the best terms to use when doing a pain assessment on those with cognitive impairment?

A

discomfort/soreness

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7
Q

What are the 2 best pain assessment tools to use for those with cognitive impairment?

A
  • VRS (verbal rating scale)

- Numerical scale

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8
Q

What is the best type of therapy for epilepsy?

A

MONOTHERAPY with AED

- if does not work, referral to epileptic surgery

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9
Q

What is the part of the brain that is worked on during epileptic surgery?

A

corpus callosum

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10
Q

AEDs and pregnancy/oral contraceptives?

A
  • increased risk of brith defects

- increased failure rate in contraceptives if on AEDs

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11
Q

What is the most common psych problem in people with SCI?

A

depression

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12
Q

What are 2 things that must be screened for the nutrition management of those with SCIs?

A
  • vitamin D (for BONE HEALTH)

- dysphagia

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13
Q

What medication therapy helps with incontinence in those with SCI?

A

Anticholinergic therapy

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14
Q

How do anticholinergic medications help with incontinence?

A

decrease effect of AcH in the brain which decreases signals for bladder contractions.

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15
Q

How do you treat a UTI?

A

ciprofloxacin over 14 days

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16
Q

What are the 2 best options for bowel mgmt in those with SCI?

A
  • Transanal irrigation

- bisacodyl suppositories

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17
Q

What are the benefits of physical activity in SCI pts?

A
  • promotion of strength, endurance, overall improvement of ADLs
  • improve CV and Bone Health
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18
Q

What is the most common barrier to sexual health in SCI pts?

A

bladder/bowel problems

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19
Q

What operation can help improve women with tetraplegia’s sexual health and self-image?

A

continent urinary diversion

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20
Q

What is the most common chronic illness of childhood?

A

asthma

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21
Q

what is 1st line treatment of asthma?

A

albuterol

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22
Q

What is FEV1 and FVC?

A

FEV1: forced expiratory volume in 1sec
FVC: forced vital capacity, of complete exhale

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23
Q

What is a methacholine challenge?

A

When methacholine is administered because of suspected asthma, however spirometry is normal.

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24
Q

What is the target FEV1 level for those with asthma?

A

at least 80%

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25
Q

any FEV1 reading below ____ is consistent with asthma.

A

80%

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26
Q

What kind of cells are highly present in the large airway of a COPD pts lungs?

A

neutrophils

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27
Q

What kind of cells are highly present in the small bronchi and parenchyma of a COPD pts lungs? (3)

A

CD8, macrophage, lymphocytes

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28
Q

what is emphysema?

A

collapsed alveolis and increased mucus

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29
Q

A women with CHF and osteoarthritis has come into the clinic. Her drug regimen is as follows:

  • metoprolol
  • furosemide
  • enalapril
  • ibuprofen PRN
  • vitamex

What are you concerned about?

A

CHF pts cannot be on NSAIDs. Too much stress to the kidney, high risk kidney damage.

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30
Q

What are we cautious about when looking at CHF pts lab values when they are on an ARB?

A
  • calcium, risk of hypercalcemia with their drugs if on ARB
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31
Q

What must you know about ACEI + ARB meds?

A

they cannot be given together.

- high risk vascular events due to severe hypotension and high kidney damage

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32
Q

Whats the deal with CHF + CCB drugs?

A

You cannot give a pt with CHF a CCB. It increases exacerbation risk because it decreases the force of contraction in the heart!!!

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33
Q

What drug is NOT effective for CHF pts of the black population?

A

ACEI are not effective. Use an ARB

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34
Q

what is the difference between isotonic and isometric exercise?

A

ISOTONIC: movement of the joints
ISOMETRIC: holding the same position

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35
Q

Isotonic or isometric exercise is recommended for heart failure?

A

ISOTONIC. isometric exercise is not indicated, although can be increased very gradually.

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36
Q

What is V02?

A

Total oxygen consumption, represents oxygen use of the whole body and mainly skeletal muscles

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37
Q

What is V02 MAX and what is the formula?

A

Aerobic capacity: maximum amount of O2 that can be used by the body during intense exercise
- 02/kg/min

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38
Q

What is MV02, how is it measured and what is the formula for estimation if not directly measured?

A
  • The actual oxygen consumption of the heart
  • measured by cardiac cath
  • HRxSBP/100
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39
Q

what is rate pressure product and its formula?

A

work required by heart

- RPP = SBPxHR

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40
Q

what is metabolic equivalent and its formula (2)?

A

amount of energy used at rest

  • 1kcal/minute
  • 3.5mL O2/kg/min
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41
Q

What does a MET score mean?

A

how much energy is required for that activity.

- a higher MET score means more energy is used!!

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42
Q

What are the limitations on MET values for Class I, II, III, IV heart failure?

A

CLASS I: less than 7
CLASS II: less than 5
CLASS III: between 2-5
CLASS IV: no more than 2

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43
Q

What is a clearance heart rate?

A

maximum HR attained on stress test

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44
Q

What is the target heart rate during exercise for a pt with CHF?

A

70-85% of clearance heart rate

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45
Q

How do you calculate your average maximum heart rate?

A

220 - age = max HR

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46
Q

ACEI must be administered indefinitely in pts with: (4)

A
  • left ventricle ejection fracture of less than 40%
  • HTN
  • Diabetes
  • stable kidney disease
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47
Q

Beta blockers should be considered in all asymptomatic patients with _____

A

LVEF less than 40%

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48
Q

What are some factors other than cardiac that can increase BNP levels on a test?

A
  • old age
  • renal failure
  • bacterial sepsis
  • severe burns
  • chemotherapy
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49
Q

What is BNP and why does it elevate?

A

can quickly verify or rule out heart failure.

- heart releases BNP in response to pressure overload on the heart

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50
Q

Tight glycemic control can help reduce a diabetic pts risk of heart failure. T or F?

A

false, there is no evidence

- we therefore cannot recommend an intensive glycemic control strategy to pts

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51
Q

What medication can we consider for reducing the risk of diabetic patients getting CHF? What medication is NOT recommended?

A
  • prescribe SGLT-2 inhibitor

- NOT DPP-4 inhibitors.

52
Q

A black patient with Class III or IV HF enters the clinic, they are on a full regimen of cardiac drugs but are still symptomatic. What medications do we add?

A

hydralazine and/or nitrates

- both are antihypertensives and relax sm. muscle, dilating vessels

53
Q

What are the 3 approved betablockers for heart failure?

A

metoprolol, bisoprolol, carvedilol

54
Q

What is an MRA?

A

diuretic

55
Q

When an atrioventricular block is present, what drug is considered?

A

digoxin

56
Q

What are the 2 considerations for ICD or pacemaker therapy?

A
  • class 2-3 with EF of 35%

- class 1 with EF of 30%

57
Q

When do we not recommend ICD therapy?

A

in class 4 HF pts who are not expected to improve with any further therapy, also not candidates for cardiac transplant

58
Q

How much salt is recommended in HF for the low-sodium diet?

A

2-3g

59
Q

T or F: The older population with double in 10 years.

A

FALSE… it will double in 20 years.

60
Q

What populations are mostly likely to have unmet needs in regard to home care? (3)

A
  • low SES
  • immigrant
  • family caregivers
61
Q

What are some longterm consequences of home care in Canada? (3)

A
  • unnecessary costly trips to emergency room
  • increased hospital admissions
  • caregiver burnout
62
Q

Name some risks of caregiving

A
  • increased risk of substance abuse, premature death, depression
  • decreased selfcare
  • emotional and physical strain
63
Q

What are signs of caregiving stress:

A
  • headaches
  • digestive problems
  • OBESITY
  • DIABETES
  • HEART PROBLEMS
  • sleep disorders
  • worry, anxiety
  • anger, depression
  • confusion
    etc. …. could go on forever
64
Q

What are red flags that a child is being abused?

A
  • wary of contact with adults
  • extreme anxiety
  • lack of rxn to frightening events
  • repeated ER visits
  • fear of parent or going home
  • lying still while surveying environment
  • inappropriate reaction to injury
65
Q

What is the resource available for child abuse at the IWK?

A

SeaStar Child and Youth Advocacy centre

66
Q

domestic violence does not discriminate. T or F

A

true

67
Q

Characteristics of batterers:

A
  • controlling
  • sense entitlement
  • manipulative
  • frequently charming
  • uninvolved parents
  • contempt for others
68
Q

What makes batterers so powerful?

A
  • isolation of victim
  • societal denial
  • use of religious issues
  • threats of retaliation
69
Q

What do you do when a client admits to abuse or there is a strong suspicion of abuse?

A
  • acknowledge what you have heard

- use supportive statements “no one deserves to be treated like this”

70
Q

Why don’t they just leave???? (in regard to abuse)

A
  • low self esteem
  • fear/risk of death
  • isolation and loss of relationship
  • lack of resources
  • promises to change
71
Q

Leaving the abusive relationship will relieve all of the issues. T or F

A

False, this is a myth. Violence escalates if you try to get away

72
Q

Leaving is a process!! What are some of the things that may hold the victim/survivor back?

A
  • threats of retaliation
  • safety issues
  • fear of talking about abuse to others
  • breaking isolation
  • batterer accountability
73
Q

What is neprilysin? And what are the drugs that involve them?

A

Neutral endopeptidase.

  • inhibiting neprilysin will increase substances that promote the counteraction of vasoconstriction and Na retention THEREFORE LOWERING BLOOD PRESSURE
  • —- these drugs are called ARNIs ——-
74
Q

what are some cautions with ARNIs?

A
  • they SHOULD NOT be administered concurrently with ACEIs or within 36hrs of last dose
  • the SHOULD NOT be given to pt with angioedema
75
Q

A symptomatic heart failure patient is intolerant to ACE and ARBs, what do you give them?

A

hydralazine (diuretic) and isosorbide dinitrate (vasodilator)

76
Q

Statins are always given to patients with CHF. T OR F

A

False… they are ONLY given is indicated or in pts with CVD

77
Q

CCBs in heart failure?

A

NOPE

78
Q

According to the NIHSS, how many points are needed to say the person has good/moderate/severe stoke prognosis?

A 
good = less than 4
moderate = 4-20
severe = over 20
79
Q

What score on NIHSS considers the individual a candidate for tPA (activator that breaks down clots)?

A

a moderate score… 4-20

80
Q

Functional recovery lags behind neurological recovery by _____ wks.

A

2 weeks

81
Q

___% of indviduals will benefit from rehabilitation.

A

80%

82
Q

Majority of neuro recovery takes place in the first ____ months

A

3-6

83
Q

What is something important to keep in mind in regard to incontinent bladder in stroke and SCI pts?

A

must remove indwelling catheter ASAP because of infection risk
- med and maneuvers instead

84
Q

How can we relieve spasticity? (NO DRUG)

A
  • ROM exercises
  • IM botox
  • FES (functional electrical stimulation)
  • surgery
85
Q

How can we relieve spasticity? (DRUGS ONLY) (main = 3, + 3 extra)

A
  • Baclofen (muscle relaxant)
  • clonazepine (relieve anxiety)
  • dantrolene (reduce muscle contraction, HOWEVER WATCH DOSE CLOSELY B/C CAN CAUSE MUSCLE WEAKNESS)

As well as….

  • SSRIs (fluoxetine)
  • dopaminergic agents / levodopa
  • acetylcholinesterase inhibitors
86
Q

Stages of motor recovery (Brunstromm).. explain them.

A
  1. flaccid limb
  2. some spasticity.. weak flexion and extension
  3. prominent spasticity WHERE VOLUNTARY MOTION RETURNS
  4. selective activation of muscles.. spasticity reduced
  5. spasticity further reduced, still present with rapid movement
  6. near normal coordination with isolated movements
  7. restoration to normal
87
Q

What Brunstromm stage does spasticity peak?

A

stage 3

88
Q

For constraint induced movement therapy for strokes, the pt must commit to the constraint for ___% of waking hours.

A

90%

89
Q

What is a good predictor of prognosis for ischemic stroke?

A

sitting balance

90
Q

What kind of stroke is almost impossible to predict prognosis for?

A

hemorrhagic

91
Q

What are some poor prognostic factors for upper limb recovery in ischemic stroke?

A
  • severe spasticity
  • prolonged flaccid period
  • no voluntary hand movement at 4-6wks
92
Q

______ reduces cerebral edema.

A

hyperventilation

93
Q

What is SPIKES and what does it stand for?

A 
how to break bad news...
S- good setting
P- families perception
I- how much info do they wanna know?
K- share knowledge
E- respond to emotion
S- sumarize, strategize
94
Q

How does brain death occur?

A
  • brain hemorrhage or edema
  • increased ICP
  • brain herniation, impedes blood flow
95
Q

How many physicians must sign off on brain death? What is something important to note here….

A

2 physicians,

- they must also no longer be affiliated with the transplant process.

96
Q

What reflexes must be absent for brain death to be confirmed?

A

the brainstem reflexes:

  • cough/gag/spontaneous resp
  • corneal
  • oculocephalic/Dolls eyes
  • pupillary
  • deviation of eyes to irritation
97
Q

How is brain death confirmed? (three essential findings..)

A
  • coma
  • absent brainstem reflexes
  • apnea
98
Q

What is the apnea test? How do you know if the results are positive (the two criteria)?

A

CO2 challenge that tests the breathing drive of the brain…… it is positive if:

  • CO2 > 60mmHg and 20 above baseline
  • pH < 7.28
99
Q

How do you keep the organ viable for donation?

A
  • no endocrine disorder
  • no acid-base imbalance
  • no severe electrolyte imbalance
100
Q

What are the contraindications of organ donation?

A
  • uncontrolled sepsis

- HIV/Rabies/Creutzfeld-Jakob disease

101
Q

What acronym determines if your pt can be considered an organ donor? (what does each letter mean)

A

G- GCS <5, or grave prognosis
I- injured brain, non-recoverable injury
V- ventilator-dependent
E- end of life discussion already made with family

102
Q

If your pt meets all of the GIVE criteria, they can become an organ donor on the spot. T or F?

A

FALSE.. They must be screened before the option is given to the family

103
Q

What are some consideration (maybes) to organ donation?

A
  • pt with history of cancer

- pt with Hep B or C

104
Q

TISSUE DONOR identification criteria?

A
  • must be 70yrs or younger
  • 2.7kg to 136kg
  • time of death MUST BE KNOWN
  • no obvious infection
  • no communicable disease
105
Q

Contraindications to tissue donor?

A
  • lab diagnosed infection
  • blood cancer
  • neurological disease
  • severe sepsis
106
Q

Tissues can be retrieved up to ___hrs after death. (___hrs for corneas)

A

24hrs for tissue

8hrs for cornea

107
Q

Tissue retrieval is a surgical procedure performed by ________

A

regional tissue bank specialists in the OR

108
Q

Organ donation is Nova Scotia and assessment occurs only at what hospital and unit?

A

QEII MSN/ICU unit 5.2

109
Q

There is no age limit on organ donation. There is an age limit on TISSUE donation. T or F

A

TRUEE!!

110
Q

Donor management requires what:

A
  • routine blood work and ABO
  • tissue typing
  • aggressive hemodynamic mgmt
  • insulin infusion for stable glucose levels
  • combined hormonal therapy
111
Q

For TISSUE donation, how many hours after death is the donation viable for?

A

24 HOURS

112
Q

Optimal ischemic times for the following organs:

  • heart
  • lungs
  • pancreas
  • kidney
  • liver
A
  • heart: 4-6
  • lungs: 4-6
  • pancreas: 12-24
  • kidney: 12-24
  • liver: 8-16
113
Q

For a cardiocirculatory death, the pt is taken off life support. If they die within ___hrs, when is death legally declared?

A

if they die within 2 hours, death is declared after 5 minute wait.

114
Q

What organs can be donated in a cardiocirculatory death?

A
  • kidney and liver

- sometimes lungs and pancreas

115
Q

A pt dies from a heart attack. They meet the brain death criteria. T or F

A

False, a cardiocirculatory death does not meet brain death criteria

116
Q

What are 3 causes of chronic renal failure?

A
  • reduced blood flow to kidney
  • damage of renal tissue
  • obstruction of outflow/backflow
117
Q

No matter how renal failure occurs, the end result will always be ______!!! (this leads to…?)

A

retention of wastes!!

- this leads to metabolic acidosis, which means organ failure.

118
Q

How much urine output is consistent with chronic renal failure?

A

less than 30cc/hr or 400mL/day

119
Q

Signs and symptoms of CRF?

A
  • tachycardia
  • HTN
  • pulmonary and peripheral edema
  • worsening metabolic acidosis
120
Q

Nursing interventions for CRF?

A
  • heart/lung sounds
  • neuro checks
  • urine intake/output
  • SaO2 and ABGs
  • ECG check for rhythm changes
  • daily wts
  • ## electrolyte status
121
Q

FOR CRF: keep urine output above ___!!!

A

30cc/hr or 400cc/day

122
Q

What condition increases risk of developing CRF? (2)

A
  • diabetes mellitus

- uncontrolled HTN

123
Q

What is the most cause of death for most pts with CRF?

A

cardiovascular disease

124
Q

What is the aim of treatment for CRF?

A

preserve function and delay dialysis

125
Q

What is a renal diet?

A

low sodium, phosphorus and protein

126
Q

What are the risks of donating one of your kidneys?

A
  • very minimal, slightly increased risk of HTN and protein in urine

SEMESTER 6: Chronic, Clinical, Emerg (4 decks)

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