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Med-Surg II > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

5 Lead EKG placement

A

R arm: White - 2nd ICS
R leg: Green (Snow over Grass) - Base of ribs

L arm: Black - 2nd ICS
L leg: Red (Smoke over Fire) Base of ribs

V1: Brown (Chocolate in the middle) - R sternal edge, 4th ICS

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2
Q

3 Lead EKG placement

A

R arm: Red - 2nd ICS
L arm: Yellow - 2nd ICS
L leg: Green - Base of ribs

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3
Q

SA node

A

R atria
Near superior vena cava
Pacemaker of heart

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4
Q

AV node

A

R atrium near AV valve
Delays ventricular impulse

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5
Q

What is next in the cardiac conduction after AV node

A

Bundle of HIS

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6
Q

What comes after Bundle of HIS in cardiac conduction

A

Purkinje fibers

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7
Q

P wave

A

SA node in the atrium depolarizes

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8
Q

P-Q segment

A

Atrial systole/contraction
Time conduction takes from SA to AV node

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9
Q

QRS complex

A

Ventricular depolarization
AV node fires

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10
Q

Q

A

Intraventricular septum depolarizes

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11
Q

R

A

Main mass of ventricles depolarize

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12
Q

S

A

Depolarization at the base of ventricles

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13
Q

When does atrial repolarization occur

A

It is hidden in the QRS complex

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14
Q

ST segment

A

Plateau of myocardial action potential
Ventricles contract

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15
Q

T wave

A

Ventricular repolarization

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16
Q

Layers of lung

A

Parietal pleura: Outer layer
Pleural space: Serous fluid maintains negative pressure
Visceral pleura: Inner layer

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17
Q

Pneumothorax

A

Air in pleural space/cavity

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18
Q

Pleural effusion

A

Fluid in pleural space

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19
Q

Hemothorax

A

Blood in pleural space

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20
Q

Tension pneumothorax

A

Complication from obstruction in chest tube or trauma
Causes tracheal deviation and puts pressure on opposite side

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21
Q

Mediastinal chest tube

A

Inserted into mediastinum to relieve pressure on heart to prevent cardiac tamponade

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22
Q

Cardiac tamponade

A

Fluid in pericardial space

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23
Q

Empyema

A

Infection in pleural space

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24
Q

Wet suction (Chest tube)

A

Suction is regulated by the height of water
- Water evaporates
- Bubbling = normal

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25
Q

Dry suction (Chest tube)

A

Uses suction monitor bellow
- Adjust with dial knob

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26
Q

Normal amount of chest tube drainage

A

Less than 100 mL/hr

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27
Q

Normal suction type and amount for chest tube

A

regular continuous suction
-80 to -100 (usually -80)

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28
Q

What is normal for the water seal chamber

A

When pt breathes water will fluctuate
Light/intermittent bubbling is normal - caused by pneumothorax

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29
Q

What does excessive bubbling mean in chest tubes

A

Air leak

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30
Q

What do you do if chest tube becomes dislodged

A

Cover with sterile dressing
Tape on 3 sides (allow air to escape)
Notify MD

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31
Q

What to do if the chest tube system breaks

A

Insert tubing into 1 inch sterile water bottle and get a new system

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32
Q

When to contact physician for chest tubes

A

Bubbling increases over time
Bubbling returns after having stopped
Output more than 100-150mL/hr

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33
Q

What to do when physician removes chest tube

A

Tell pt to perform valsalva maneuver and bear down

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34
Q

How often to assess chest tube

A

Assess drainage amount Q1H for first 8 hr, then Q8H
Mark drainage amount with marker at end of shift

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35
Q

K normal range

A

3.5-5.5

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36
Q

Calcium normal range

A

8.5-10.5

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37
Q

Magnesium normal range

A

1.5-2.0

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38
Q

Atelectasis

A

Alveolar collapse due to obstruction

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39
Q

S/Sx of Atelectasis

A

Increased work of breathing - dyspnea
Decreased breath sounds
Crackles
Hypoxia

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40
Q

How to dx atelectasis

A

Chest X ray

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41
Q

Tx for atelectasis

A

Remove secretions
Frequent turning, early ambulation, lung volume expansion (incentive spirometer), deep breathing, coughing

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42
Q

Surgical/procedural tx for atelectasis

A

Endotracheal intubation, mechanical ventilations = last resort
Thoracentesis

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43
Q

Pneumonia patho

A

Movement of WBC’s into alveoli leads to perfusion issues
Development of thick sputum leads to ventilation issues

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44
Q

Community-Acquired Pneumonia

A

Pt that have not been hospitalized/lived in long-term care within 14 days

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45
Q

Hospital-Acquired Pneumonia

A

Begins 48 hours+ after hospital admission
Ex. Ventilator-associated pneumonia (VAP)

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46
Q

Tx for bacterial pneumonia

A

Abx

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47
Q

Aspiration pneumonia

A

Entry of material from mouth into trachea/lungs

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48
Q

Necrotizing pneumonia

A

Rare complication
Lung tissue turns into thick/ liquid mass

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49
Q

Opportunistic pneumonia

A

Occurs in immunocompromised pts
- Malnutrition, HIV, chemotherapy

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50
Q

Risk factors for pneumonia

A

Smoking, COPD, immobility, depressed cough, NGT/other drains, old age, aspiration risks

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51
Q

How is pneumonia dx

A

S/sx, CXR, blood cx, sputum cx, bronchoscopy

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52
Q

S/sx of pneumonia

A

Cough, fever, chills
Dyspnea, tachypnea, chest pain
Confusion - elderly
Coarse crackles, purulent sputum - vocal fremitus
Elevated RR
Decreased SpO2
Elevated WBC, + sputum culture
Respiratory acidosis

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53
Q

Infection goal of care

A

Remove bacteria and clear purulent drainage/sputum

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54
Q

Nursing interventions for infection (lung infection/pneumonia)

A

Sputum culture
Abx administration
- Should be working by 48-72h
- Not for viral infections, but could be used for secondary bacterial infection

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55
Q

Nursing interventions to promote airway clearance

A

Oxygen therapy - continuous SpO2 (humidified)
Hydration
Chest PT (physiotherapy)
- Inventive spirometer, cough and deep breath (IS/CDB)
NT (nasotracheal) suction

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56
Q

Pt goals to increase fluid status during tachypnea

A

Fluid intake 2-3L/day
Monitor I/O’s
- UOP >30mL/h
Monitor fluid and electrolytes
Continuous cardiac monitoring

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57
Q

Medications for pneumonia

A

Antipyretics
Cough suppressants
Mucolytics

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58
Q

Long-term interventions for pneumonia

A

Pneumococcal vaccine
Oral abx - once pt is stable
Assess for aspiration risk - NG/OG tube = increased risk
Prevent hospital acquired infection
Teach abx adherence
Follow up with PCP in 6-8 wks

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59
Q

Cause of pleural effusion

A

Typically secondary to pneumonia, HF or TB
Pulmonary edema or infectious process

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60
Q

Empyema

A

Accumulation of thick, purulent fluid in pleural space

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61
Q

Cause of empyema

A

Bacterial pneumonia, TB, or lung abscess

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62
Q

S/sx of empyema

A

Acute illness
Dyspnea, chest pain, decreased/absent breath sounds over affected area

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63
Q

Intervention for empyema

A

Abx
Percutaneous drainage
Chest tube insertion

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64
Q

Reason for thoracentesis

A

Lung abscesses
Effusion/empyema with severe SOB

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65
Q

Thoracentesis

A

One time insertion of needle to drain purulent fluid
Fluid sent for culture

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66
Q

Pleurisy

A

Inflammation of both layers of lung pleurae

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67
Q

Pleurisy s/sx

A

Severe inspiratory pain
Pleural friction rub heard

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68
Q

Post thoracentesis nursing interventions

A

Monitor HR and BP
Monitor for pneumothorax

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69
Q

Dx for pleurisy

A

CXR
Sputum analysis
Thoracentesis

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70
Q

Tension (spontaneous) pneumothorax

A

Accumulation of air in the pleural space under pressure, compressing the lungs and decreasing venous return to the heart

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71
Q

Iatrogenic pneumothorax

A

Traumatic pneumothorax secondary to an invasive procedure or surgery

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72
Q

Chylothorax

A

Rare but serious condition in which lymph formed in the digestive system (chyle) accumulates in your chest cavity

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73
Q

S/SX of closed pneumothorax

A

Sudden pain
Tachypnea, air hunger, accessory muscle use
Absent breath sounds
Tracheal shift
Hypotension
Jugulovenous distention (JVD) - thoracic pressure
Hypoxemia - can lead to cyanosis

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74
Q

Tx for closed pneumothorax

A

Cover with vent dressing
Chest tube

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75
Q

Lung abscess

A

Necrosis of lung tissue
Usually due to oral secretions

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76
Q

How to drain lung abscess

A

Postural drainage
Chest physiotherapy

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77
Q

Lung abscess nursing interventions

A

IV antibiotics
Educate deep breathing and coughing
Encourage high protein and calorie diet

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78
Q

Non-small cell vs small cell lung cancer

A

SCLC has higher morbidity and mortality

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79
Q

S/sx of lung cancer

A

Chronic cough, dyspnea, hemoptysis, chest pain
Fever, lobar pneumonias

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80
Q

Dx for lung cancer

A

CXR
CT scan
Pulmonary function tests
PET scan

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81
Q

Lung cancer tx

A

Surgery: Lung resection
Radiation
Chemo

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82
Q

Wedge resection

A

Removal of small lesion/tumor

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83
Q

Lobectomy

A

Removal of lung lobe

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84
Q

Segmentectomy

A

Removal of segment of the bronchial tree

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85
Q

Pneumectomy

A

Removal of an entire lung

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86
Q

Tx and interventions for ineffective airway clearance

A

IS/CDB
Suctioning
Bronchoscopy
Positioning - “good” lung down so “bad” lung can drain
Monitory for s/sx of PNA

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87
Q

Sleeve resection

A

Removal and resection of a part of the bronchial tree

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88
Q

Video assisted thorascopic

A

Allows surgeon to look at the thorax
Used for thoracotomy

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89
Q

Pre-op imaging for thoracic surgery

A

CT scan
MRI
Bronchoscopy

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90
Q

Nursing consideration post-op pneumectomy

A

AKA removal of entire lung
Do not fully turn pt to operative side
- Causes heart to fall into lung cavity

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91
Q

Pain management for thoracic surgery

A

Epidural or intervertebral blocks
Pt controlled analgesia (PCA)
Lidocaine patches
Splinting of chest

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92
Q

S/sx of hemorrhage post surgery

A

Increased HR
Decreased BP, CVP (central venous pressure), LOC
Cool, clammy extremities

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93
Q

How is TB contracted

A

Through air, person to person
Mostly effects immunocompromised

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94
Q

Primary TB

A

Inhalation of organism, walling off of the TB lesion

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95
Q

Latent TB

A

Positive TST (Tubercullin skin test) w/o s/sx of infection
- Unable to transmit

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96
Q

Active TB disease

A

Active infection that is able to be transmitted

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97
Q

S/x of tuberculosis

A

High fever, chills, flu-like symptoms
Extrapulmonary TB (outside of lungs)

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98
Q

INF-gamma assay

A

Blood test for TB antibodies

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99
Q

Tuberculosis dx

A

CXR + Mantoux
Sputum specimen and culture

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100
Q

BCG vaccine

A

Recommended for infants born in countries with high prevalence of TB - Africa, Asia, Eastern Europe

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101
Q

BCG vaccine side effects

A

Swollen lymph nodes
Fever (mild)
Headache
Injection site reactions

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102
Q

TB precautions

A

Airborne isolation with HEPA filter
Pt must wear surgical mask outside of room

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103
Q

Rifampin nursing considerations

A

Tx for TB
Orange urine/secretions
Liver failure - AE
Decreases hormonal birth control effectiveness

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104
Q

Pulmonary embolism patho

A

Blockage of one or more pulmonary arteries by thrombus, fat or air embolus, or tumor tissue
Obstructs alveolar perfusion
Most commonly in lower lobes

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105
Q

Risk factors for pulmonary embolism (PE)

A

DVT
Immobility
Surgery
Obesity
Smoking
HF
Pregnancy
Clotting disorders
A fib
Fx of long bones

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106
Q

S/Sx of PE

A

Dyspnea
Tachypnea, cough, chest pain, hemoptysis, crackles/wheezing, fever
Tachycardia, syncope, LOC changes

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107
Q

How to dx PE

A

D-Dimer
Spiral (helical) CT scan
Angiogram
Labs: ABG’s, Troponin, B-type natriuretic peptide

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108
Q

D-Dimer

A

Lab test that measure a protein fragment that is present when a blood clot dissolves

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109
Q

Acute interventions/tx for pulmonary embolism

A

Heparin drips, fluids, diuretics, analgesics
IVC filters - inferior vena cava
Embolectomy - removal of clot

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110
Q

Laryngeal obstruction s/sx

A

Use of accessory muscles
Retractions in neck/intercostals
Increased WOB - work of breathing

111
Q

Laryngeal obstruction tx

A

Remove airway edema - cricuthyroidotomy (trach replacement) or
remove obstruction - Heimlich, intubation, cricothyroidotomy - tracheostomy placement

112
Q

Risk factors for head and neck cancer

A

Tobacco, ETOH, environmental exposure, HPV, over 50 men

113
Q

S/sx of head and neck cancer

A

Hoarseness, cough, sore throat, dysphagia, dyspnea, foul breath - ulcerations in larynx

114
Q

Dx for head and neck cancer

A

Laryngoscopy with biopsy of tumor
CT/MRI
Barium swallow
Pharyngoscopy and laryngoscopy

115
Q

Head and neck cancer tx

A

Surgery - first line
- Stage 1&2: Partial laryngectomy
- Stage 3&4: Total laryngectomy
Radical neck dissection
Radiation therapy

116
Q

Radical neck dissection

A

Removal of:
All cervical lymph nodes
Sternocleidomastoid muscle
Internal jugular vein
Spinal accessory muscle
- Tx for severe head/neck cancers

117
Q

Normal amount of drainage from JP drain

A

80-120 mL in first 24 hours

118
Q

Central venous pressure

A

Measures the amount of blood returning to the right atrium
- Decreased if blood volume is decreased
- 2-8 mm Hg (or 8-12?)

119
Q

Nursing interventions for post op laryngectomy

A

Prevent/monitor for aspiration PNA
- Confirm feeding tube placement
- Assist with swallowing, thick liquids, tuck chin
Oral care

120
Q

Guillan Barre

A

Autoimmune disorder that destroys myelin on nerve cells

121
Q

Causes of Guillan Barre

A

Viral infection: Flu, mycoplasma, HIV/Epstein Barr, campylobacter (GI bug)

122
Q

Guillan Barre s/sx

A

Paresthesia of hands/feet
Weakness of respiratory muscles
Can progress to blindness and dysphagia
No change in cognitive status

123
Q

Guillan Barre dx

A

Lumbar puncture or electromyelogram

124
Q

Tx of Guillan Barre

A

No tx - supportive measures until myelin regenerates
IVIG and plasmapheresis - reduces s/sx length
Monitor respiratory status
PT/OT for mobility

125
Q

Primary concerns for Guillan Barre

A

Altered breathing pattern
- Decrease in ventilation
Impaired swallowing - nutrition
Physical mobility
Autonomic dysfunction - controls bradycardic responses, rapid changes in VS

126
Q

First symptoms of Guillan Barre

A

Can’t feel middle finger
Feet feel funny
Can no longer lift 20lb box
Falling

127
Q

Trigeminal Neuralgia

A

Pain of the 5th cranial nerve (trigeminal nerve)
Pain with any stimulation (washing face, brushing teeth, eating)

128
Q

Tx for trigeminal neuralgia

A

Antiseizure medications
Surgical: Microvascular decompression of the trigeminal nerve
Radiofrequency thermal coagulation
Percutaneous balloon micocompression

129
Q

Bells Palsy

A

Facial paralysis caused by inflammation of 7th cranial nerve

130
Q

Bells Palsy manifestations

A

Unilateral facial muscle weakness/paralysis
Most pts recover in 3-5 wks and doesn’t recur

131
Q

Bells palsy tx

A

Corticosteroid therapy to reduce inflammation
Protect eye from injury
Facial exercises and massage to maintain muscle tone

132
Q

Antigen

A

Substance that creates an immune response

133
Q

Antibodies

A

AKA B cells
Produced by immune system to fight disease
Created in response to antigens

134
Q

Immunoglobulins

A

Binding sites on antibodies

135
Q

Bone marrow

A

Responsible for creating B cells

136
Q

Lymph nodes

A

Multiply immune cells and remove foreign material before it enters the blood stream

137
Q

Thymus

A

Creates T cells

138
Q

Hypersensitivity Reaction Type 1

A

Allergic response
Histamine release, itchy eyes, runny nose, rashes, edema, anaphylaxis

139
Q

Hypersensitivity Reaction Type 2

A

Antibody response
Cytotoxic cells kill the bodies normal cells
Ex. Autoimmunity and Transfusion reactions

140
Q

Hypersensitivity Reaction Type 3

A

Immune complexes
Too many antibody/antigen complexes clump together and deposit in joints, vessels, etc

141
Q

Hypersensitivity Reaction Type 4

A

Delayed immune response
Takes a couple of days to kick in
Ex. TB skin test, poison ivy

142
Q

Types of immunoglobulins on B cells

A

IgA
IgD
IgG
IgE
IgM

143
Q

IgE

A

Involved in hypersensitivity reactions

144
Q

IgG and IgM

A

Involved in blood transfusion reaction

145
Q

What is secreted in response to antigen exposure

A

Histamines
Platelets
Eosinophils
Neutrophils
- On second exposure

146
Q

Role of prostaglandins in anaphylaxis

A

Smooth muscle spasm - leads to larygneal obstruction
Vasodilation - hypotension
Increased capillary permeability - hypotension

147
Q

Passive immunity

A

Receiving antibodies rather than making them
- Ex. Globulin injection, mother’s breast milk

148
Q

Anaphylaxis s/sx

A

Tingling hands, flushing, oral swelling
Warm sensation, nasal congestion, periorbital swelling, difficulty swallowing, wheals

149
Q

Anaphylactic shock s/sx

A

Bronchospasm
Laryngeal edema
Dyspnea
Hypotension
Cyanosis

150
Q

Anaphylaxis tx

A

Epinephrine
Supplemental O2 with cooled water
Advanced airway
IV antihistamines
Corticosteroids

151
Q

Atopic reactions

A

Most common type 1 hypersensitivity
AKA seasonal/environmental allergies
Ex. Hay fever

152
Q

Atopic reaction s/sx

A

Allergic rhinitis
Atopic dermatitis
Urticaria - hives
Angioedema

153
Q

Atopic dermatitis

A

Type 1 hypersensitivity

154
Q

Atopic dermatitis tx

A

Avoid cause
Topical corticosteroid creams
NSAID’s
Skin moisturizer

155
Q

Dermatitis medicamentosa

A

AKA Drug reactions
Note rash, hives, itching, swelling when administering new medications, esp antibiotics

156
Q

Contact dermatitis

A

Type 4 delayed skin reaction
D/t metals or rubber compounds

157
Q

First line medications for allergic disorders

A

Antihistamines
- H1 antagonists (dipenhydramine - Benadryl) can cross BBB and cause CNS effects
- H2 antagonists (ceterizine, loratidine) fewer CNS effects

158
Q

Second line medications for allergic disorders

A

Afrin
Cromolyn - decreases mast cell activity in nasal passages
Corticosteroids
Immunotherapy - severe cases, allergens injected to build tolerance

159
Q

Apheresis

A

Machine removes blood stem cells or other parts of the blood from a person’s bloodstream then returns the rest to the body
Can be used to collect cells for transplantation

160
Q

Plasmapheresis

A

Removes IgG antibodies in autoimmune disorders
Removes inflammatory mediators
- Can lead to hypotension or hypocalcemia

161
Q

How to determine anion gap

A

Sodium (Na+) - (Chloride (Cl-) + Bicarbonate (HCO3-)

162
Q

Parkinson’s disease

A

Slow, progressive neurologic movement disorder due to decreased dopamine levels
- Unknown cause

163
Q

Parkinson’s risk factors

A

Increased incidence with age
More common in men 3:2
Well water, pesticides, rural residence

164
Q

Parkinson’s characteristics

A

Tremor
Rigidity
Bradykinesia, akinesia
Postural instability
Hypokinetic dysarthria (speech abnormalities)

165
Q

Dx of Parkinson’s

A

4 symptoms + responds to pharm therapy
Presence of Lewy bodies: protein deposits in the brain

166
Q

Parkinson’s tx

A

Levadopa/carbidopa
Deep brain stimulator
Ablation: destruction of affected part of brain

167
Q

Multiple sclerosis

A

Demyelinating disease of the CNS
T cells enter brain and cause inflammation, destroying myelin
Caused by virus

168
Q

Risk factors for multiple sclerosis

A

Smoking
Vit D deficiency
Epstein Barr exposure
Women 30-35 yrs

169
Q

Multiple sclerosis cause

A

Unknown
May be triggered by virus or northern climate

170
Q

What can multiple sclerosis lead to

A

Chronic inflammation
Demyelination of nerves
Scarring of CNS

171
Q

Multiple sclerosis s/sx

A

Initial: Poor coordination, loss of balance, double vision
Motor changes, sensory changes, cerebellar changes (nystagmus), changes in bowel/bladder/sexual function, cognitive changes, emotional changes

172
Q

Multiple sclerosis dx

A

CSF analysis
MRI of brain and spinal cord
- Evidence of 2 lesions

173
Q

Multiple sclerosis drugs

A

Muscle relaxants: Benzos, Baclofen, Dantrolene
CNS stimulants - for fatigue
Antiseizure drugs
Tricyclic antidepressants

174
Q

Multiple sclerosis complications

A

Urine retention - bladder training, avoid fluids at night, catheterization
Constipation - stool softeners, activity, high fiber/fluid diet

175
Q

Myasthenia Gravis patho

A

Antibodies attack acetylcholine receptors in nerve junctions
When nerves receive a signal they release ACH to stimulate muscle response
If there are no receptors, no signals get sent
Leads to weakness of voluntary muscles

176
Q

Myasthenia Gravis s/sx

A

Facial/eyelid droop
Flat affect
Dysphonia
Peek sign - after closing eyes the eyes open slightly to show sclera
May progress to respiratory failure

177
Q

Myasthenia Gravis dx

A

Tensilon test
Electromyelogram

178
Q

Tensilon test

A

IV Tensilon should stop ACH breakdown and increase ACH binding
Facial weakness should resolve in 5 mins = dx of MG

179
Q

Pharmacological tx for Myasthenia Gravis

A

Pyridostigmine bromide
IVIG - immune therapy
Plasmapheresis
Prednisone

180
Q

Surgical tx for myasthenia gravis

A

Thymectomy: Reduces T cell production

181
Q

How does Pyridostigmine bromide work

A

Inhibits ACH breakdown
Reduces symptoms of MG

182
Q

Pyridostigmine bromide AE

A

Abdominal pain, diarrhea

183
Q

Purpose of plasmaphersesis in myasthenia gravis tx

A

To remove antibodies to ACH

184
Q

Prednisone use for myasthenia gravis and AE

A

Decreases overall immune response
AE: Leukopenia and hepatotoxicity

185
Q

Myasthenic crisis

A

Exacerbation of MG symptoms
D/t extremely low ACH at neuromuscular junction from stressful event (URI, change in meds)

186
Q

S/sx of Myasthenic crisis

A

Extreme weakness
Double vision
Drooping eyelids

187
Q

Huntington’s disease

A

Chronic progressive hereditary disease
Results in choreiform (jerking or writhing) movements and dementia
- Death after 10-20 yrs of dx

188
Q

Huntington’s disease patho

A

Premature death of cells in the striatum of the:
Basal ganglia – leads to poor movement control
Cerebral cortex – defects in thinking, memory and judgement
Cerebellum – defects in coordination

189
Q

Huntington’s disease s/sx

A

Motor dysfunction: jerky movements
Cognitive impairments: attention deficits
Behavioral changes: apathy, blunt affect
Facial ticks
Slurred speech
Impaired swallowing
Disorganized gait

190
Q

Huntington’s disease dx

A

Family hx
S/sx
CAG repeats: polymorphic nucleotide repeats present in the androgen receptor gene

191
Q

Huntington’s disease meds

A

Benzos - control jerky movement
SSRI’s - psych symptoms
Antipsychotics - for late disease

192
Q

Amyotrophic Lateral Sclerosis

A

“Lou Gehrig disease”
Loss of motor neurons in the anterior horn of the spinal cord and loss of motor nuclei of the lower brainstem

193
Q

Amyotrophic Lateral Sclerosis risk factors

A

Smoking
Viral infections
Autoimmune diseases
Toxin exposure
- 40-60 yr olds

194
Q

ALS s/sx

A

Progressive weakness/atrophy
Spasticity - brisk/overactive DTR
Difficulty with speech, swallowing, breathing - ASPIRATION
No loss of cognitive function

195
Q

ALS dx

A

S/sx
Muscle biopsy
Electromyelogram

196
Q

ALS tx

A

No cure
Riluzole: prolongs life 3-6 months
Baclogen, Dantrium, Valium - for spasms
Provigil - for fatigue

197
Q

Pts at risk for aspiration

A

Seizure pts
Brain injury
Decreased LOC
Stroke
Swallowing disorders

198
Q

Aspiration prevention

A

HOB > 30 degrees while eating
Avoid sedatives
Assess feeding tube placement - bowel sounds and residuals
Swallow evaluation
Bedside suction available

199
Q

Primary immune deficiency dx

A

Multiple/unusual infections in early childhood
Low T cell and WBC count

200
Q

Primary immune deficiency tx

A

Stem cell transplants

201
Q

Emerging Infections

A

An infectious disease with an increase in the recent number of cases
Ex: Coronavirus

202
Q

Re-emerging infection (w/ examples)

A

Infections that were once eliminated, but now recurring
Vaccine-preventable diseases - Polio
Disease associated with travel - Malaria

203
Q

Resistant organisms (def. with examples)

A

Overprescription of antibiotics is a factor
MRSA, VRE (Vancomycin Resistant Enterococci), Enterobacter
- Skipping doses, not taking full course, self-prescribing abx

204
Q

Airborne diseases

A

Measles
Chicken pox
Pertussis (Whooping cough)
- N95 respirator

205
Q

Droplet diseases

A

Covid
Influenza
Strep Throat
- Surgical mask

206
Q

Contact precaution diseases

A

C. diff
Scabies
Norovirus/Rotovirus
MRSA
VRE

207
Q

HIV Patho

A

It is a retrovirus: attacks T cells and reproduces
Decrease in immune function (opportunistic infections)

208
Q

How is HIV transmitted

A

Body fluids: Blood, semen, vaginal secretions, amniotic fluid, breast milk

209
Q

What populations are at risk for HIV

A

Injection drug users
Sex with HIV+
HIV infected blood or organ transplant
Needlesticks - healthcare workers

210
Q

How to prevent HIV

A

Condoms, dental dams, female condoms
Treat addictive disorders/mental health diagnoses
1 sexual partner
Early testing
No sharing blood contaminated items - razors, toothbrush
Pre-exposure prophylaxis - antiretroviral therapies

211
Q

Tx for healthcare worker exposed to HIV

A

Post-exposure prophylaxis (PEP)
2-3 antiretroviral regimen taken within 72 hours of exposure
Taken for 28 days

212
Q

Acute infection phase of HIV

A

2-4 weeks after exposure
Virus can be transmitted
Flulike symptoms

213
Q

Asymptomatic infection

A

Vague/absent symptoms
Virus can be transmitted
T cells below 500

214
Q

Symptomatic infection

A

Initial signs: AMS, fever, mouth infection
Night sweats, diarrhea, headaches, severe fatigue
T cell 200-499

215
Q

AIDS

A

10+ years after untreated infection
Presence of systemic infection or complications of HIV: Infections, malignancies, wasting, cognitive changes
T cell count below 200

216
Q

What happens if HIV is untreated

A

Destruction of T cells
CD4 + T cell count drop below 500 cells/mcL (normal = 800-1200)
Below 200 cells/mcL = opportunistic infections

217
Q

Goal for CD4 count in HIV treatment

A

800-1200 CD4 count
Viral load “undetectable”

218
Q

How is HIV progression monitored

A

CD4 + T cell count: marker of immune function
Viral load: lower = less active disease

219
Q

Viral set point

A

When host’s immune becomes outnumbered by the virus

220
Q

Pre-exposure prophylaxis

A

PrEP
Used in conjunction with proven prevention interventions
Tenofovir/emtricitabine *do not need to know
- Ensure adherence (take the meds!)

221
Q

Classes of medications used for antiretroviral therapy

A

Reverse transcriptase inhibitors
Protease inhibitors
Integrase inhibitors

222
Q

Reverse transcriptase inhibitors

A

Prevent HIV DNA from forming in human cells

223
Q

Protease inhibitors

A

Prevent HIV from exiting the cell into the bloodstream

224
Q

Integrase inhibitors

A

Prevent HIV integration into human DNA

225
Q

Goals of antiretroviral therapies

A

CD4 and T cells maintained
Viral load below mutation level
Viral load below level of detection
Adherence is key

226
Q

HAART

A

Highly active anti-retroviral therapy
Medication regimen used to manage and treat human immunodeficiency virus type 1 (HIV-1)

227
Q

Nucleoside reverse transcriptase (NRTI) used for HIV

A

zidovidine (Retrovir)
Prevents transmission of HIV to fetus

228
Q

What is Retrovir often given with

A

Given in combo with Abacavir

229
Q

Non-nucleoside reverse transcriptase (NNRTI) for HIV considerations

A

Give with water on empty stomach
Do not use in pregnancy or liver disease

230
Q

Entry inhibitor drug for HIV

A

Miraviroc

231
Q

Miraviroc AE

A

Cardiopulmonary side effects

232
Q

Protease inhibitors AE

A

Increased BG

233
Q

Side effects of antiretroviral therapy

A

Hepatotoxicity - LFTs
Nephrotoxicity - Creatinine
Osteoporosis
Increased risk for MI/CVD
Fat redistribution, increased truncal fat
Caution in pregnancy

234
Q

Kaposi Sarcoma

A

Manifestation of herpesvirus
S/sx: Skin, GI, lung, and lymph node lesions - skin breakdown

235
Q

Kaposi Sarcoma tx

A

Radiation therapy

236
Q

AIDs-Complex Dementia

A

HIV virus interferes with neuron junctions and myelin
Progressive cognitive, behavioral, and motor decline

237
Q

AIDs-Complex Dementia s/sx

A

Peripheral neuropathy, memory changes, headache, decrease attention span, psychosis, hallucinations, tremors, seizures

238
Q

How to manage AIDs-complex dementia

A

Aid for communication and vision
Prevent aspiration and falls
Schedule activity and rest periods
Gabapentin or Lyrica for peripheral neuropathy pain

239
Q

HIV wasting syndrome dx

A

10% total weight loss
+ chronic diarrhea, chronic weakness, fever
Occurs late in disease process

240
Q

Pulmonary dysfunction

A

Starts as nonspecific cough, sputum may or may not be present

241
Q

Pneumocystis pneumonia

A

PCP
Serious lung infection that affects people with weakened immune systems

242
Q

Cytomegalovirus

A

Common virus, retained for life (no cure)
Spread through body fluids
S/sx: Fatigue, fever, sore throat, muscle aches

243
Q

What can activate latent TB

A

Antiretroviral therapy (AVT)

244
Q

Active TB tx

A

Four drug regimen:
Isoniazid, rifampin, pyrazinamide, and ethambutol
- Airborne precautions

245
Q

Thrush

A

Oral Candida Albicans
Painful swallowing, decreased oral intake
May progress to esophagus and stomach

246
Q

Thrush/candidiasis tx

A

Topical antifungals
Myclex troches or nystatin rinses
Ketoconazole

247
Q

Diarrhea tx (r/t HIV infection or enteric pathogens)

A

Octreotide acetate - severe chronic diarrhea

248
Q

Pneumocystis juirveci s/sx

A

Opportunistic infection
Cough, fever
Dyspnea with exertioin

249
Q

Cryptococcus neoformans s/sx

A

Opportunistic infection
Viral infection of the eye
Cough, SOB
Double/blurred vision
Headache

250
Q

Possible gynecologic manifestations of AIDs/HIV

A

Vaginal candidiasis
Genital ulcers/warts
Risk of cervical cancer, pelvic inflammatory disease

251
Q

How to tx vaginal candidiasis

A

Topical agents - just like oral candidiasis

252
Q

Bacterial meningitis

A

Inflammation of the membranes and fluid space surrounding the brain/spinal cord
Organism crosses the BBB, settles in CSF (increased ICP)

253
Q

Types of meningitis

A

Septic meningitis - bacterial (Streptococcus pneumoniae, Neisseria meningitidis)
Aseptic - viral, lymphoma, leukemia, or brain abscess

254
Q

How is meningitis transmitted

A

Secretions or aerosol contamination

255
Q

Fulminant meningitis

A

Can lead to adrenal issues, circulatory collapse, and hemorrhage

256
Q

Meningitis s/sx

A

Headache, fever
Changes in LOC, behavioral changes
Nuchal rigidity - positive Kernig’s sign, positive Brudzinski’s sign
Photophobia
Seizures and coma

257
Q

Kernig’s sign

A

Pain in opposite leg when one leg is extended at knee by 90 degrees
Positive indicates meningitis

258
Q

Brudzinski’s sign

A

Positive indicates meningitis
Raise neck, look for hips and knees the flex

259
Q

Bacterial meningitis

A

Medical emergency

260
Q

Bacterial meningitis dx

A

Swab of nares/lumbar puncture
CT scan

261
Q

Bacterial meningitis tx

A

Abx - started BEFORE dx is confirmed

262
Q

Bacterial meningitis prevention

A

Vaccines against Haemophilus influenzae and S. pneumoniae for all children and at risk adults
Meningococcal vaccine for adolescents and high risk groups

263
Q

Complications of meningitis

A

Brain abscess - one sided weakness
Seizures
CN 3 palsy - oculomotor nerve
Bradycardia
Hypertensive coma

264
Q

Viral meningitis

A

HIV or herpes-associated

265
Q

Viral meningitis dx

A

CSF sample tested for enterovirus

266
Q

Viral meningitis tx

A

Prophylactic Abx until viral or bacterial meningitis is confirmed

267
Q

How is pt positioned after lumbar puncture

A

Lay flat for 6-12 hours post procedure

268
Q

Encephalitis

A

Acute inflammatory process of brain tissue

269
Q

Encephalitis causes

A

Viral infections - herpes simplex virus, vector-borne viral infections, fungal infections

270
Q

Encephalitis s/sx

A

Headache, fever
Confusion, changes in LOC
Vector-borne: Rash, flaccid paralysis, Parkinson-like movement

271
Q

Encephalitis tx

A

Acyclovir - for HSV infection
Amphotericin or other antifungals - for fungal infection

272
Q

Central venous pressure

A

Blood pressure in the vena cava, which is near the right atrium of the heart
- Blood backs into R atrium
2-8 mm Hg

273
Q

Empyema Question

A

Answer: Pneumonia

Med-Surg II (4 decks)

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