Exam 2

Question 1

epidural hematoma

Answer 1

An epidural hematoma results from bleeding between the dura and inner surface of the skull. An epidural hematoma is a neurologic emergency. It is usually associated with a linear fracture crossing a major artery in the dura, causing a tear.

Question 2

Venous epidural hematomas

Answer 2

Venous epidural hematomas are associated with a tear of the dural venous sinus and develop slowly

Question 3

Arterial Hematoma

Answer 3

With arterial hematomas, the middle meningeal artery lying under the temporal bone is often torn. Hemorrhage occurs into the epidural space, which lies between the dura and inner surface of the skull. Because this is an arterial hemorrhage, the hematoma develops rapidly.

Question 4

Classic signs of an epidural hematoma

Answer 4

Classic signs of an epidural hematoma include an initial period of unconsciousness at the scene, with a brief lucid interval followed by a decrease in LOC. Other manifestations may be a headache, nausea and vomiting, or focal findings

Question 5

Primary purpose of the respiratory system

Answer 5

Gas exchange: Transfer of oxygen (O2) and carbon dioxide (CO2) between atmosphere and blood
* BALANCE NEEDED! Adequate Oxygen from a healthy respiratory system AND adequate perfusion for distribution to body tissues

Question 6

What structures are included in the Upper respiratory tract?

Answer 6

Nose
—Warm, filter, humidify
Mouth
Pharynx
Epiglottis
Larynx
Trachea
—Carina—bifurcation

Question 7

What structures are included in the lower respiratory track?

Answer 7

Bronchi
Bronchioles
Alveolar ducts
Alveoli

Question 8

Surfactant

Answer 8

a lipoprotein lowers the surface tension in the alveoli-> stops collapsing

Question 9

SaO2

Answer 9

(SaO2); normal greater than 95% amount of O2 bound to hemoglobin in comparison to the amount of O2 the Hgb can carry
95 % of hgb attachments for O2 have O2 bound to them

Question 10

PaO2

Answer 10

(PaO2); normal 80 to 100 mm Hg amt of O2 dissolved in plasma

Question 11

Ventilation

Answer 11

Inspiration and expiration occur due to intrathoracic pressure changes and muscle action REMEMBER !
Expiration—passive
Elastic recoil—lungs return to original size after expansion

Question 12

carotid endarterectomy

Answer 12

carotid endarterectomy (CEA), the atheromatous lesion is removed from the carotid artery to improve blood flow.

Question 13

Transluminal angioplasty

Answer 13

Transluminal angioplasty is the insertion of a balloon to open a stenosed artery in the brain and improve blood flow. The balloon is threaded up to the carotid artery through a catheter inserted in the femoral artery.

Question 14

Stenting

Answer 14

Stenting involves intravascular placement of a stent to try to maintain patency of the artery. The stent can be inserted during an angioplasty. Once in place, the system can be used with a tiny filter that opens like an umbrella. The filter catches and removes the debris that is stirred up during the stenting procedure before it floats to the brain, where it can trigger a stroke.

Question 15

fibrinolytic action of tPA

Answer 15

The fibrinolytic action of tPA occurs as the plasminogen is converted to plasmin, whose enzymatic action then digests fibrin and fibrinogen, thus breaking down the clot. Control of BP (SBP less than 185 mm Hg) is critical during treatment and for 24 hours following.

Question 16

Respiratory Drugs: Anticholinergic drugs

Answer 16

Promote bronchodilation by preventing muscles around bronchi from tightening
Less effective than SABAs for asthma
Used more with COPD
Not used in routine management; except for severe acute asthma attacks
Ex: Atrovent HFA

Question 17

Three classes of anti-inflammatory drugs

Answer 17

Corticosteroids
Leukotriene modifiers
Monoclonal antibodies
—Anti-IgE
—Anti-Interleukin 5

Question 18

Corticosteroids

Answer 18

Corticosteroids—reduce bronchial hyperresponsiveness, block late-phase response, and inhibit migrations of inflammatory cells
Most effective long-term control drug
Examples: beclomethasone, prednisone, methylprednisolone

Oral corticosteroids—use 1 to 2 weeks for maximum effect for severe chronic asthma
Inhaled corticosteroids (ICS)—effects in 24 hours; used in long-term control on a fixed schedule
Little systemic absorption except for high dose (easy bruising, reduced bone density)

Question 19

Leukotriene modifying agents (LTMAs)

Answer 19

Examples: zafirlukast, montelukast, zileuton; administered orally
Interfere with synthesis or block the action of leukotrienes; produce both bronchodilator and antiiflammatory effects
Taken for prophylaxis and maintenance; not for acute attacks

Question 20

Anti-IgE (monoclonal antibody)

Answer 20

Example: omalizumab
Reduced circulating IgE levels
Prevents IgE from attaching to mast cells, preventing release of chemical mediators
Subcutaneous administration every 2 to 4 weeks for moderate-severe asthma
Risk of anaphylaxis-observe pt. for minimum of 2 hours post administration

Question 21

Anti-Interleukin 5 (monoclonal antibody)

Answer 21

Examples: mepolizumab and reslizumab
Inhibits interleukin 5 (IL-5) to inhibit the production and survival of eosinophils
Used with severe asthma attacks despite current asthma medications

Question 22

Sodium

Answer 22

135-145

maintain cxn and volume of extracellular fluid and influencing water distribution between ECF and ICF
-generates and transmits nerve impulses, muscle contractility, and regulation acid-base balance.

Question 23

Potassium

Answer 23

-neuromuscular and cardiac function
-Kidneys are primary route for potassium loss.
-Pt’s on diuretics- Large urine output can cause excessive potassium loss CKD pt’s
-Impaired kidney function can cause potassium retention.

Question 24

Calcium balance

Answer 24

Metabolic processes, blood clotting, transmission of nerve impulses,myocardial contractions, and muscle contractions. Major cation in bones and teeth.

Question 25

Magnesium balance

Answer 25

cofactor in many enzyme systems.carbohydrate metabolism, DNA and protein synthesis, blood glucose control, and BP regulation. It is needed for the production and use of ATP, which is also the energy source for the sodium-potassium pump. Muscle contraction and relaxation, normal neurological function, and neurotransmitter release depend on magnesium.

Question 26

Phosphate balance

Answer 26

essential in the function of muscle, red blood cells, and the nervous system. It is involved in acid-base buffering system; the mitochondrial formation of ATP; cellular uptake and use of cellular glucose and carbohydrate , protein, and fat metabolism. Adequate renal function is needed to maintain phosphate balance because the kidneys are a major route of phosphate excretion.

Question 27

hyponatremia manifestations

Answer 27

headache, irritability, and difficulty concentrating. Severe= confusing, vomiting, seizures, and even coma. If severe and develops rapidly, irreversible neurological damage or death from brain herniation can occur.

Question 28

Hyperkalemia

Answer 28

Most common cause=renal failure

Manifestations include fatigue, confusion, tetany, muscle cramps, paresthesias, and weakness. As potassium increases, loss of muscle tone and weakness or paralysis of other skeletal muscles, including respiratory muscles can occur. Abdominal cramping, vomiting, and diarrhea occur from hyperactivity of GI smooth muscle.

Question 29

Hypokalemia

Answer 29

Manifestations include skeletal muscle weakness, paresthesias, paralysis, and cardiac changes. Changes in smooth muscles function may lead to decreased GI motility (ex: constipation). Hypokalemia impairs insulin secretion, leading to glucose intolerance and hyperglycemia.

Question 30

Hypercalcemia

Answer 30

hyperparathyroidism and cancer. Manifestations=reduced excitability of muscles and nerves. Neuro= fatigue, lethargy, weakness, and confusion. Progress to hallucinations, seizures, and coma.

Question 31

Hypocalcemia

Answer 31

Manifestations= tetany, egg changes, chvostek’s sign, and trousseau’s sign. Chvostek’s sign is contraction of facial muscles in response to tap over facial nerve in from top ear. Trousseau’s sign refers to carpal spasms induced by inflating BP cuff on the arm. They occur within 3 minutes if hypocalcemia is present.

Question 32

Hypermagnesium

Answer 32

-increased magnesium intake accompanied by renal insufficiency or failure. (Watch your kidney patients…CKD). Initial manifestations= hypotension, facial flushing, lethargy, urinary retention, nausea, and vomiting. Progressing manifestations= deep tendon reflexes are lost, muscle paralysis, coma, respiratory and cardiac arrest can occur.

Question 33

Hypomagnesium

Answer 33

-Hypomagnesium= limited magnesium intake or increased GI or renal losses. Chronic alcohol use. Manifestations=mimc hypocalcemia ( neuromuscular=muscle cramps, tremors, hyperactive deep tendon reflexes, chvostek’s sign, Trousseau’s sign. Neurological=confusion, vertigo, and seizures.) Dysrhythmias (torsades de pointes and vfib). Monitor VS and infusion because rapid administration can lead to hypotension and cardiac or respiratory arrest.

Question 34

Hyperphosphatemia

Answer 34

-Hyperphosphatemia= common in patients with AKI or CKD, which alter the kidney’s ability to excrete phosphorous. Manifestations= can be asymptomatic unless calcium binds with phosphorous, then signs of hypocalcemia occur. Long-term increased phosphorus levels result in the development of calcified deposits on the outside of bones, and can be found in soft tissues, such as joints, arteries, skin, cornea, and kidneys. Can cause organ dysfunction, notably renal failure. Severe hyperphosphatemia= needs dialysis.

Question 35

Hypophosphatemia

Answer 35

-Hypophosphatemia=results from decreased intestinal absorption, increased urinary excretion, or ECF to ICF shifts. My occur in malnourished patients, respiratory alkalosis, and refeeding syndrome (reinstitution of nutrition to severely malnourished patients). Manifestations= mild to moderate is often asymptomatic. Acute manifestations= CNS depression, muscle weakness and pain, respiratory failure, and heart failure. Chronic= alters bone metabolism, causing rickets and osteomalacia.