Exam 2 Flashcards
PE vs. Pneumonia
- PE
- History of long term travel, DVT, or cancer
- Acute dyspnea, no other explainable finding
- My be hypotensive (obstructive shock) with pleuritic chest pain that goes away.
- Capno slightly lowered, gradually drops (normal waveform shape)
- Pulse ox normal to slightly low.
- ANXIOUS and LOCALIZED CP.
- May have JVD, blood backing up.
- Clear lung sounds
- Pneumonia
- Signs of infection.
- Fever, chills, pus/productive cough
- Green, yellow, rust sputum
- Tachypnea and tachycardia
- Crackles diffuse, scattered.
- May have crackles and wheezes
- May be altered, treat for sepsis
PE FAST, pneumonia SLOW
BOTH drop in capno
Pulse ox normal/low for PE, low in pneumonia
Causes of wheezes
- Narrowing or tightening of airways
- Asthma/bronchospasm, bronchitis, emphysema, allergic reaction
Visceral pain
- Visceral peritoneum
- Lining of abdominal organs
- Not a lot of nerves, hard for spinal cord to determine
- Nerves around an organ
- Cramping or gas type pain
- Diffuse, hard to localize
Somatic pain
- Parietal peritoneum
- Covers wall of abdominal cavity. TONS of nerves
- Bacterial or chemical inflammation in the peritoneum (peritinitis)
- SHARP, localized
- Ex: pancreatitis, since pancreas is so close to the skin
Referred pain
Pain away from the tissues that are causing the pain
What is disequilibrium syndrome?
- During or after hemodialysis, acute electrolyte changes occur.
- Normal s/s are headache, restless, fatigue, nausea
- Extreme s/s are confusion, seizures, AMS, coma.
- Osmolarity of the dialysis fluid causes movement of water into the brain, increasing ICP and cerebral edema.
Grey Turners Sign
- Bruising over the flanks.
- Retroperitoneal bleeding
- Pancreatic hemorrhage
- AAA rupture
Rovsing sign
- Pain in right lower quadrant of the abdomen when the LEFT lower quadrant is palpated
- Possible sign of appendicitis
McBurney sign
- Tenderness midway b/wthe anterior-superior iliac spine and the umbilicus
- May be acute appendicitis
Dysmenorrhea
Painful menstration, may be from cramps
When an embryo is fertilized, where does fertilization take place?
Distal portion of the fallopian tube
Ascites, what is it and what is it a sign of which chronic disease?
- Is an abnormal accumulation of fluid in peritoneal cavity.
- Caused by high pressure in the blood vessels of the liver (portal hypertension)
- Usually severe liver disease, or CHF or pancreatitis.
- SUPPOSEDLY it can also be caused by chronic renal failure.
- Cannot eliminate sodium, thus water is retained. Thus, a chronic buildup of fluids and edema
If a patient presents with emphysema and pedal edema, what other pulmonary condition may you find?
- Cor Pulmonale (Right ventricular hypertrophy/failure)
Zofran drug profile
Class:
Antiemetic
Action: Removes sensation to vomit in the brain
Indications/Dose:
- Nausea/Vomiting
- 4mg IVP, IO, PO
Contraindications:
- None
Side effects:
- Headache, dizziness
Reglan drug profile
- Metoclopramide
- Class
- Antiemetic, sodium channel blocker
- Action:
- Elevation of CTZ threshold
- Sensitizes GI smooth muscle to effects of acetylcholine by direct action
- Indications/Dose
- Nausea
- 10mg IV, IM
- Nausea
- Contraindications
- Hypotension
- Pt taking any other Na+ channel blockers
- Long QT syndrome
- Side effects
- Long QT
- Heart Blocks
- Hypotension
- Sedation
What is passive immunity?
- Type of acquired immunity
- Get antibodies from mother during fetal development
Pyelonephritis. What is it? What does it do when you pee?
- Inflammation of the kidney parenchyma (upper urinary tract)
- Usually result of lower UTI
- Abrupt S/S
- Lower back/flank pain
- Fever, chills
- Cloudy or bloody urine
- N/V
- NO burning in your urine since it is UPPER
What will cause burning sensation when you pee?
- Lower urinary tract problems
- Bladder infection (cystitis)
- Ureter problems
- Urethra problems
When would there be glucose in the urine?
- When BGL is too high (300+)
- Body wants to convert glucose to glycogen first, store it in the liver and tissues as fat.
- Body urinates glucose when it is too high, NOT NORMAL
What is glucosuria?
Glucose in the urine
What is the most common form of gynecological injury?
Straddle injury
What is crohns disease?
Colitis?
- Chronic inflammatory bowel disease of unknown origin that usually affects the ileum, proximal colon, or both.
- Can affect any part of the GI tract.
- Colitis affects only the large intestine
Hematochezia?
Bright red or frank blood in the stool.
Hemorrhoids or lower GI bleed
Zollinger Ellison syndrome is associated with which condition?
- Increased circulatory gastrin (creates stomach acids) from gastrin secreting tumors in the duodenum or pancreas
- Duodenal/peptic ulcers
Microscopic structure in the kidney that produces urine?
Nephron
Primary pathogen that causes gastroenteritis?
- Inflammation of the stomach and intestines accompanied by nausea,vomiting, diarrhea
- Norovirus most common, then Salmonella
Chronic Renal Failure: what is it?
- Abnormality of the kidneys lasting more than 3 months. (usually years)
Other, less common causes for chronic renal failure
Congenital, pyelonephritis (infection of the kidneys from lower UTI usually), OD on ibuprofen, renal calculus, lupus
What causes chronic renal failure?
Irreversible loss and damage of a large amount of nephrons.
- When the body is losing nephrons, it kicks the remaining ones into overtime, causing hyperfiltration, leading to further loss and kidney damage.
Strongest risk factors for chronic renal failure? What are the other causes?
Diabetes and hypertension
- Diabetes, hypertension, atherosclerosis, chronic toxins, renal calculi
Pathophysiology of chronic renal failure in diabetes
- Excess sugar in blood clogs up nephrons, too much blood gets unfiltered.
- Straings nephrons, chronically gets worse.
- Kidneys cant filter Na+, K+, water, blood volume. All gets messed up
Pathophysiology for chronic renal failure in hypertension
- Causes decreased blood flow to kidneys, altering renin angiotensin system, causing more hypertension.
- Too much BP in kidneys, over filtration leading to things getting pushed to urine that the blood needs. Alters blood content and pH.
- Become anemic due to no erythropoietin and no RBC creation.
- Wastes like urea and nitrogen build up in the blood. (azotemia)
Azotemia
Nitrogen in the blood
Uremia
Urea build up in the blood
5 stages of renal failure
- Stage 1 : No symptoms felt. Hypertension and abnormal urine tests
- Stage 2: No symptoms felt. Edema, hypertension, abnormal urine
- Stage 3: Fatigue, edema, nocturia, edema
- Stage 4: Fatigue, edema, anorexia, dyspnea pruritus, MODS, electrolyte anormalities
- Stage 5: Weight loss, dyspnea, AMS, HTN severe, pulmonary edema, acidosis, hyperkalemia
Treatment for renal failure
- Cardiac arrests: 1 g IV calcium
- Sodium Bicarb later
- 12 lead finds hyperkalemia?
- Once QRS widens/sine wave, give bicarb, calcium, or albuterol
Gastritis symptoms
- Severe abdominal pain, nausea, bloody emesis
- Erosion from alcohol, blood oozing from the mucosal lining
Does albuterol lessen force of contractions?
yes
If unexplained abdominal pain, what should you check?
BGL. Hypoglycemia can present with this.
Delivery complications that we cannot deliver in the field
- Placenta previa
- Transverse lie
- Arm presentation
- Prolapsed cord
- Cephalopelvic disproportion
Post delivery bleeding critical, what do you do?
Fundal massage, then oxytocin, 10 units 1 liter 30 drops/min until it stops (don’t give till everything expelled)
Changes in the newborn anatomically
- Ligament of Treitz (anchors the small intestine) is formed from the umbilical cord
- Foramen ovale (hole between atrias) becomes fossa ovale (sealed up foramen, a depression)
- Ductus venosum (oxygenated umbilical cord blood bypasses liver) turns into ligamentum venosum
- Ductus arterious (bypasses the lungs by connecting aorta and pulmonary artery) should close.
What varies the length of stages of labor?
- Nullipara (no births) vs multipara (multiple births)
What are the stages of baby delivery?
- First stage
- contractions to 10cm cervix dilation
- Can last hours
- Second stage
- Full dilation to newborn delivery
- 1 to 2 hours in nullipara
- 30 minutes or less in multipara
- Third stage
- Delivery of baby to placenta expulstion
- 5 to 60 minutes, regardless of parity
Abortion
Deliberate termination of a human pregnancy, usually during first 28 weeks
Menarche
First menstration
Dysmenorrhea
Menstrual cramps (due to uterus contracting)
Chlamydia
STD of parasitic bacterium causing infection
Intussusception
Telescoping of the bowel into another part of the bowel
Epididymitis
Inflammation of the tube at the back of the testicles that stores and carries the sperm
How does asthma cause increased risk of spontaneous pneumothorax?
- Asthma predisposes people to pleural bleb rupture (air in between lung and the visceral pleura)
- When bronchospasm and hyperinflation increase the pleural pressures (necessary to maintain ventilation) it can cause the bled to rupture, causing pneumothorax
- Can also be caused by COPD, cystic fibrosis, pneumonia
Signs of uremia
- Pasty, yellow skin discoloration
- Uremic frost caused by urea crystals on the skin
What positive findings would indicate appendicitis?
- Heel tap test
- Rovsings sign
- Palpate LLQ and pain in RLQ
- Psoas sign
- Hand above R knee, have patient raise leg and pain will present in abdomen
- Obturator sign
- Flex R knee and hip, put lateral pressure to knee, rotate lower leg laterally and causing rotation of femur, causes abdominal pain
- Cutaneous Hyperesthesia
- Lift folds of skin on abdomen without pinching, get painful response
3 causes of non traumatic acute pancreatitis
Gallstones, infection, alcohol use
3 causes of non traumatic acute pancreatitis
Gallstones, infection, alcohol use
Pancreatitis s/s
- Dramatic, sudden pain in LUQ, epigastric, umbilical pain, or flanks or L shoulder
- Vomiting, fever, shock, positive grey turner and cullen signs
- SOMATIC pain
Cullen sign
Umbilical bruising. Retroperitoneal hemorrhage, pancreatic hemorrhage, AAA rupture
Cullen sign
Umbilical bruising. Retroperitoneal hemorrhage, pancreatic hemorrhage, AAA rupture
Urine output in adults
about 800 to 2000mL per day
1-2ml/kg/hr
oliguria
small amounts of urine (less than 500mL per day)
Anuria
No urine output
Fothergills sign
Mass in abdomen
Will pyelonephritis by itself cause pain?
NO
Lower back pain intermittently radiating to groin?
Renal calculus
Does pancreatitis cause upper GI hemorrhage?
NO
Do peptic ulcers cause a lower or upper GI bleed?
Upper
Lower abdominal and back pain could be what?
UTI
What is pelvic inflammatory disease?
- Infection of the cervix, uterus, fallopian tubes, ovaries, and supporting structures.
- Usually STD Gonorrhea and Chlamydia
- Pain on ambulation
- PID Shuffle
- Shory, slow, guarding
- Need antibiotics
What presents most likely with colic pain (starts and stops abruptly) across the lower abdomen?
Crohns disease
melena
dark sticky stool with digested blood in it
