Exam 2 Flashcards
common causes of upper GI bleeds
gastric and duodenal ulcers esophageal varices erosive gastritis esophagitis Mallory-Weiss tears angiomas of stomach or small bowel aortoenteric fistulas
common causes of lower GI bleeds
colonic angioma
diverticular
internal hemorrhoids
difference between upper and lower GI bleed
upper: above duodenal junction; vomit bright, dark, or coffee ground blood, black tarry stool
lower: colon, rectum, anus - rectal passage of red/maroon/bloody stool
most appropriate intervention for patient with large amounts of vomiting
NGT and upper endoscopy
how to stabilize pt with acute, critical GI bleed
replace volume loss with crystalloids and blood to stabilize hemodynamics
calculate blood replacement
each gram lost = 1 unit given
considerations when deciding how many units of blood to give during acute GI bleed resuscitation
hemodilution from fluid replacement
when to see results from PRBC
48-72 hours for intra- and extravascular equilibrium
Hep A route of infection
oral-fecal, contaminated food
Hep A Sx
fever malaise anorexia nausea abd discomfort jaundice
Hep B route of infection
blood + body fluid
Hep B Sx
jaundice fatigue loss of appetite nausea GI upset dark urine clay-colored stool joint pain
Hep C route of infection
blood and body fluid
Hep C Sx
80% w/o Sx
etiology of acute pancreatitis
iatrogenic, idiopathic infectious (HIV, mumps) gallstones genetics ETOH trauma steroids autoimmune, anesthesia scorpion, snake bites hyperlipid, hypoCa, hypothermia ERCP drugs
Trousseau’s sign and Chvostek’s sign present with what electrolyte disturbance
hypocalcemia
abnormal labs with acute pancreatitis
high: amylase, lipase, BG, triglycerides, LFTs, BUN/Creat, Hct, WBC, bili
low: albumin, calcium (binds to free fatty acid complexes, intracellular translocation)
ACLS adaptations for pregnancy
A - jaw thrust d/t larynx displacement
B - 18-22 breaths/min to maintain resp alkalosis
C - higher on chest
D - displace uterus left to improve circulation
deliver fetus after 4-5 min
remove fetal monitor before defib
increase pressure to paddles
benefits of enteral over parenteral feeding
prevent:
intestinal lumen atrophy
bacterial translocation
development of sepsis from bowel flora
care of thrombocytopenic pt
limit invasive procedures
no rectal meds, temps
electric razors only
bowel regimen to decrease straining
define prerenal AKI
decreased perfusion to kidneys w/o damage to renal tubules
cause of prerenal AKI
hypovolemia
altered PVR (sepsis)
decreased CO
meds
treat prerenal AKI
restore renal perfusion via: fluids pressors eliminate problem beds hemodynamic stability goal
define intrarenal AKI
decreased perfusion to kidneys d/t damage to kidney
cause of intrarenal AKI
prolonged hypotension or drugs toxic to tubular cells
treat intrarenal AKI
immunosuppressive or cytotoxic meds
confirm with renal biopsy d/t risk/benefit
define post renal AKI
obstruction of urinary flow (hydronephrosis)
cause of postrenal AKI
prostatic hypertrophy, other tumors
treat postrenal AKI
relieve obstruction
labs to send during stroke
CBC
electrolytes
glucose
PT/PTT
ischemic stroke supportive care
ABCs IV normal saline supine normoglycemia normothermia aspirin DVT prophylaxis dysphagia screen don't treat BP unless MAP>140 stroke unit
define delirium
disturbance of consciousness characterized by acute onset and fluctuating course of impaired cognitive functioning
define cerebral auto-regulation
- body’s ability to maintain adequate BP to brain
- cerebral circulation has capacity to maintain blood flow at constant level during changes in BP
- adequate cerebral blood flow is maintained by constriction/dilation of cerebral vessels in response to changes
ICP and CPP goals in patient with head trauma/injury
ICP > 20
CPP > 60
what happens when CPP drops?
cerebral ischemia
early signs of elevated ICP
confusion, agitation
headache
N/V
late signs of elevated ICP
puipillary changes
papilloedema
loss of motor fxn
cardiovascular vital sign changes (Cushings traid - HTN, bradycardia, irreg resps)
interventions of unstable pregnant patient
left lateral position or manually displace uterus
100% O2 via non-rebreather
fluid bolus
