Common Problems in Acute Care Flashcards
How long does acute pain last for?
Less than 6 months
Where is cutaneous pain located?
On the skin/surface of the body
Visceral pain originates where?
Internal organs
What is somatic pain?
Non-localized, from muscles, bone or soft tissue
What is the WHO’s ladder of pain management?
Starts with aspirin, Tylenol or an NSAID and builds thru three steps with heavier narcotics added, while keeping the original nonopioid
What type of pain are Fentanyl patches recommended for?
Breakthru cancer pain
Bisphosphonates should be used for management of what type of pain?
Metastatic bone pain management
Intact skin with nonblanchable redness is what stage pressure ulcer?
Stage 1
Partial thickness loss of skin with exposed dermis is what stage pressure ulcer?
Stage 2
Full thickness skin loss is what stage pressure ulcer?
Stage 3
Visible adipose tissue indicates what stage pressure ulcer?
Stage 3
Pressure ulcer with exposed tendon, ligament, cartilage or fascia is what stage?
Stage 4
Pt must maintain a good level of what to prevent pressure ulcer development?
Albumin
What is a normal albumin level?
3.5-5
What is a major complication of pressure ulcers?
Osteomyelitis
Fever is a body temp above what?
37
What induction agent can cause malignant hyperthermia?
Succinylcholine
Which electrolyte imbalance is an absolute contraindication for the use of succinylcholine?
Hyperkalemia
What are the two most commonly cultured organisms in the hospital?
Staph epi and staph aureus
Should you give Tylenol before cultures are drawn?
No
What might cause a postop fever?
Increased basal metabolic rate
A fever caused by what tends to “linger”?
A drug fever
If there is no indication of infection, what should be first line to treat postop fever?
Hydration and lung expansion
What are the three most common types of HA?
Tension, migraine, cluster
What is the treatment for a tension HA?
Over the counter analgesics and relaxation
What is a classic migraine?
Migraine w/aura
What is a common migraine?
Migraine w/o aura
Do most people with migraines get an aura?
No
What does a VDRL test rule out?
Syphilis
If someone has a migraine more than how many times per month, they are put on migraine prophylaxis?
2-3 times
What is the most common drug used for migraine tx?
Sumatriptan
Cluster HA usually affects what demographic?
Middle aged men
What type of pain does cluster HA cause?
Unilateral, periorbital
What type of HA may cause rhinorrhea and eye redness?
Cluster HA
How is cluster HA tx?
With 100% O2 with or without sumatriptan
What is normal phos?
3.5-5
What is normal K+?
3.5-5
Edema may be seen if albumin level drops below what?
Below 2.7
What is normal mag?
1.7-2.2
When would you use an enterostomal tube (ie PEG tube) for nutritional support?
When you can use the GI tract and the pt needs nutritional support for longer than 6 weeks
When would you use a nasoenteric tube?
When you can use the GI tract but pt needs nutritional support for less than 6 weeks
When is a duodenal tube used instead of an NG tube?
If pt is at risk for aspiration
When would a central line be used for parenteral nutrition?
If pt needs support for greater than 2 weeks
What is refeeding syndrome?
Electrolyte imbalances that can occur once you start feeding a pt enterally who has not been fed in a while
What is a major electrolyte imbalance seen in refeeding syndrome?
Hypophosphatemia
Diarrhea is a major complication of what type of feeding?
Enteral
What are three strategies to manage diarrhea that occurs during enteral feeding?
Change from bolus feedings to continuous, slow feeding rate, reduce concentration of formula
What three things should be evaluated when looking at a pt with hyponatremia?
Urine sodium, serum os, clinical status
What is a normal urine sodium?
10-20 mEq/L
What is a normal serum os?
2 x the serum sodium
What is a normal serum sodium?
135-145
What is a normal serum os?
275-285
A urine sodium greater than 20 suggests what?
A problem with the kidneys
A urine sodium less than 20 suggests what?
A problem other than the kidneys
What is isotonic hyponatremia caused by?
Extreme hyperlipidemia
What is the tx for isotonic hyponatremia?
Cut down on fat
Dehydration will cause what type of hypotonic hyponatremia? What will urine Na+ be?
Hypovolemic hyponatremia. Na+ will be less than 10
What does hypovolemic hyponatremia with a urine Na+ >20 suggest?
That the kidneys cannot conserve sodium
What is the most common cause of hypovolemic hyponatremia with urine Na+ >20?
Diuretic therapy
What type of hyponatremia requires water restriction?
Hypervolemic, hypotonic
What is the most common cause of hypertonic hyponatremia?
Hyperglycemia (usually from HHNK)
What is serum os in hypertonic hyponatremia?
Above 290
When would you give 3% NS in hyponatremia?
If CNS sx are present
Hypernatremia is usually caused by what?
Excess water loss
What kind of acid base imbalance can cause hypokalemia?
Alkalosis
Hypokalemia can lead to what EKG changes?
Broad T waves and prominent U waves
How should you manage hypokalemia with a K+ > 2.5 with no EKG changes?
Oral replacement
Which other electrolyte abnormality can impair K+ correction?
Magnesium
What class of drug can cause hyperkalemia?
Hyperkalemia
How to emergently manage hyperkalemia?
10 units of insulin and 1 amp D50
What is a normal total calcium level?
8.5-10.5mg/dl
What is a normal ionized calcium level?
4.5-5.5 mg/dl
Which calcium measure does not vary with the albumin level?
Ionized CA
Hypocalcemia does what to deep tendon reflexes?
Increases them
Which electrolyte imbalance causes prolonged QT?
Hypocalcemia
What is the tx for acute hypocalcemia?
IV calcium gluconate
What is the most common tx for hypercalcemia in the acute setting?
Calcitonin
Respiratory acidosis will have a pH of what and CO2 of what?
pH < 7.35 and pCO2 > 45
Myoclonus with asterixis is a sign of which acid base imbalance?
Respiratory acidosis
What should you do for a vented pt with respiratory acidosis?
Increase the vent rate
Respiratory alkalosis is caused by what?
Hyperventilation
What will pH and CO2 be in respiratory alkalosis?
pH > 7.5 and pCO2 < 35
Is bicarb low or high in metabolic acidosis?
Low
What is the formula for anion gap?
[Na + K] - [HCO3 + Cl]
What is a normal anion gap?
7-17
What are three major causes of increased anion gap acidosis?
DKA, alcoholic ketoacidosis, lactic acidosis
Renal tubular acidosis causes what type of metabolic acidosis?
Non-anion gap acidosis
What is normal bicarb?
22-26
What drug may be used to treat metabolic alkalosis?
Acetazolamide
Bite wounds in what location should be left open to heal?
Hands and lower extremities
Any wound greater than how many hours old should be left open to heal?
Greater than 6 hours old
For human and animal bites, how long should pt be on a course of abx?
3 to 7 days
Abx should cover what two types of organisms for animal and human bites?
Staphylococci and anaerobes
Which organism is the most common cause of acute otitis media?
S. pneumoniae
S. pneumoniae is the most common pathogen causing which 5 infections?
Otitis media, sinusitis, bronchitis, meningitis, CAP
Endocarditis is most commonly caused by which organism?
S. aureus
What are signs of an immediate transplanted organ rejection?
Immediate failure of the organ + flu-like syndrome
What is the first thing to do if you think pt is rejecting an organ?
Immediate biopsy of the organ
What type of therapy is used in antirejection regimens?
Triple therapy
What are the components of triple therapy for antirejection regimen?
Corticosteroid + antimetabolite + calcineurin inhibitor or mTOR inhibitor
Shingrix is indicated for adults over what age?
Over age 50
Actinic keratoses are premalignant to what type of skin CA?
Squamous cell carcinoma
What is the most common skin CA?
Basal cell carcinoma
Body temp must be what to be declared brain dead?
37C or above
What is a normal PaO2?
75-100
What is a normal PaCO2?
35-45
