Exam 3 Flashcards
With a SPRAIN in skeletal trauma the __[1]__ structure is affected, and the body parts __[2]__ & __[3]__ are most affected. Usually this is done through __[4]__ & __[5]__, After which you should do what intervention??
1: Ligment
2: Ankles
3: Knees
4: Twisting
5: Hyperextension
6: R.I.C.E.
With a STRAIN in skeletal trauma the __[1]__ & __[2]__ structures are affected, and the body parts __[3]__ & __[4]__ are most affected. Usually this is done through __[5]__, After which you should do what intervention??
1: Muscles
2: Tendons
3: Lower Back
4: Calves
5: Lifting
6: R.I.C.E.
What is the difference btwn a Subluxation and a Dislocation?
A Subluxation is a partial Dislocation
What are the 8 Clinical Manifestations of Skeletal Trauma?
- *Think ABC’s 1st!! ALWAYS assess Neuro!!!
- edema
- Pain
- Contusion/ecchymosis
- Decreased movement
- Crepitus
Severe:
- Shortening or rotation of extremity
- Inability to bear weight
- Muscle spasms
What is R.I.C.E.???
Rest
Ice
Compression
Elevation
(Immobilize but DO NOT reset joint)
(Remove Restrictive Items)
Fractures described by their “extent” would be described in what 4 ways?
Complete
Incomplete
Non-displaced
Displaced
Fractures are also described by their effect on surrounding tissues in what 2 ways?
-Closed (simple)
-Open (Compound)
o Skin Penetration
o Antibiotics will need to be used
o immunizations are up to date esp TDAP?
•__[1]__ reduction
o Non surgical
o Traction can be a closed reduction method
•__[2]__ reduction
o Surgical intervention
o ORIF
o immobilization May be used
1: Closed
2: Open
What is the Application of a pulling force to the body to provide reduction, alignment, and rest called?
Traction
What are the 6 main complications from fractures??
- Infection (to be discussed later)
- Compartment syndrome
- Venous thromboembolis (VTE)
- Fat Embolism Syndrome (FES)
- Shock
- Chronic complications: ischemic necrosis (avascular necrosis [AVN]), delayed bone healing or non union of bone
What is Normal Compartment Pressure?
0-10mm HG
>30= Bad JUJU
What are the 6 P’s to assess for Acute Compartment Syndrome (ACS)???
o Paraesthesia – may be first sign o Pain o Pressure o Pallor o Paralysis (Late Sign) o Pulselessness (Late Sign/Bad Juju)
When do you NOT use R.I.C.E. when dealing witha skeletal trauma?
• ACS: Do NOT elevate extremity in compartment syndrome & Do NOT apply ice
What must you be concerned about when muscle breakdown is occurring?
THE KIDNEYS!!
-It causes release of potassium and myoglobins
Which are large particles; They can clog the kidneys and cause renal failure.
-Released K+ can cause arrhythmia’s
What are the 4 main cinical manifestations of a Fat Embolism?
- Acute respiratory distress syndrome
- Changes in LOC
- Petechiae; on neck/upper arms/chest/abdomen
- Sense of impending doom
What are you most concerned about with chest fractures?
- Penetration of lungs, Heart, Or arteries.
- High risk for atelectasis/pneumonia (Shallow Breathing)
What are the 5 main Clinical Manifestations of a Hip fracture?
- External rotation of leg
- Shortening of leg
- Severe pain
- Tenderness/pain in leg or groin area
- disruption of blood flow -> avascular necrosis of femoral head
What is a Syme amputation?
Foot; Just below the ankle
With amputations… How do you treat residual limb pain different from Phantom Limb pain?
Residual: Opioids
Phantom: Beta blockers, Antiepileptics, antispasmotics, Nerontin, Lyrica
interventions post amputation?
ROM
Trapeze
Firm Mattress
Prone Postion Q3-4hrs/15min
Stump care Post Op?
Wash w/soap & Water
Stump Shrinker can be used to help with edema
_________ is a Bone infection caused by bacteria or other germs.
Osteomyelitis
What are the 3 steps in the patho of osteomyelitis?
- Initial Infection
- Site expands; Blocking Blood supply
- Bone Dies/separates/becomes sequestrum
Clinical Manifestations of Osteomeylitis?
Systemic S&S
-Fever, Chills, Restlessness, nausea, malaise
Local S&S
-Pain, swelling, tenderness, and warmth
** Treatment is Longterm Antibiotics(centeral line needed)/surgical debrisment/antibiotic beads/
This autoimmune disease leads to cephalic demyelination Of the nerve fibers of the brain and spinal cord. Occurs in exacerbations and remissions. And ultimately results in permanent loss of function.
Multiple sclerosis
-Usually affects women 20-50yo
Why is MS associated with Exacerbations and remissions?
Because in early stages the Myelin she is regenerated.
What replaces the Myelin sheath after it can no longer regenerate?
a Glial Scar
What drugs are used in acute Exacerbations of MS?
- Adrenocorticotropic hormone (ACTH)
- Methylprednisone/prednisone
PD affects which brain area & structure?
Which neurotransmitter is involved?
basal ganglia
substantia nigra
Dopamine (controls movement)
Pro-banthine/Ditropan are what kind of drugs? And used to treat what in MS?
- Anticholinergics
- Helps Prevent Bladder Spasm
- For MS Pt’s having issues with frequency
Valium/Lioresal/Dantrium/Zanaflex are what kind of drugs used in the Treatment of MS?
-Muscle Relaxants
PD affects which brain area & structure?
basal ganglia
substantia nigra
Valium/Lioresal/Dantrium/Zanaflex are what kind of drugs? And used to treat what in MS?
- Muscle Relaxants
- Used to help treat the Rigid/Shakiness of MS
Acetylcholinesterase Inhibitor (Aricept) are what kind of drugs? And used to treat what in MS?
- Muscle Stimulator
- Helps with initiating Movements
(Ampyra) is a Nerve Conduction enhancer are used to treat what in MS?
Help improve walking speed.
Phosphate Receptor Modulators like Fingolimod are used to treat what in MS?
-Help Prevent Disease progression by preventing T-cells (What attacks the Myelin) from getting to the CNS
Trauma, immunizations, birth, stress, and climate change are all Involved with MS in what way?
They are Triggers for Exacerbations
What is Fasiculation?
Muscle Twitching
This is an autoimmune disease characterized by symmetrical Ascending polyneuropathic paralysis caused by peripheral demyelination of the cranial Peripheral nerves. It IS Recoverable.
(1.5X more likely in M’s)
- Guillian Barre syndrome
- Often Triggered by a Virus, Truama, HIV, or
- IN 30%of cases Campylobacter Jejuni
How is PD Dx ?
What is the ultimate confirmation of PD?
2 out of 3 s/s of the Triad
Clinical presentation & Hx
+ve response to antiparkinsonian drugs
This disease results in less motor neurons in the brain stem and spinal cord which cuts communication between the brain and muscles And results in death in 2 to 6 years after diagnosis.
Usually affects people 40-70 y/o and occurs in more M than F.
ALS or Lou Gehrig’s disease
Weakness in the upper extremities, dysarthria, dysphagia, muscle twitching/fasiculation, & nasal sounding speech are S&S of what disease.
(Death is usually the result of respiratory infection)
ALS or Lou Gehrig’s disease
- Pt Does remain cognitively intact
- the Drug Rilotek, is used to Decrease Gluconate in brain
A patient has trouble starting to walk and trouble stopping. Is he most likely to have a Dx of MS, PD, or MG?
PD - trouble initiating actions and executing them due to lack of dopamine
List risk factors for Parkinsons
exposure to chemicals - especially in rural areas.
Well H2O, pesticides, herbicides, industrial chemicals
Dental fillings: amalgam - lead
Females >40 years old with decreased estrogen
genetic factors
What is the primary expected outcome for a pt. with PD? progressive difficulty w/mobility severe dementia malnutrition difficulty w/effective communication
ALL ARE CORRECT ****progressive difficulty w/mobility***** best answer severe dementia - late stage malnutrition - late stage difficulty w/effective communication
What is the primary goal for a pt. w/ PD
stay independent with ADLs for as long as possible
PD has 5 stages. Pt. do not necessarily progress through the stages in order. The stages exist to organise Tx.
The goal is to keep pt. in stages A____ - B______
The goal is to keep pt. in stages __1_- _3___ bc pt. can complete ADLs
Stages 4 & 5 SNIFs or ATC care
levodopa levodopa/carbidopa (Sinimet, Parcopa) Tx which disease? Class? Action? Tx which Sx's? Side effects
Tx PD
Class: dopamine precursors
Action: cross BBB converted to dopamine in basal ganglia
Tx bradykinesia, tremor, rigidity
SE: ortho hypotension, drowsiness, hallucinations,
Problem with levodopa & protein?
How avoid?
lots of dietary protein interferes with action of levodopa.
Give bulk of protein in evening so can digest overnight
What would Prednisone a Corticosteroid be used for in dealing with Myethenia Gravis?
Helps Suppress the immune response that’s responsible for the disease.
Entacapone (Comtan) tolcapone (Tasmar) Tx which disease? Class? Action?
PD
Class: Catechol O-Methyl Transferase Inhibitors (COMTs)
Action: Block COMT - slow peripheral breakdown of levodopa, protects dopamine so it can reach the CNS
—These are all S&S of What Disease???—
Symmetrical weakness of the lower extremities
Paresthesia followed by paralysis
Hypotonia/areflexia (↓Muscle Tone/↓Reflexes)
Orthostatic hypotension
HTN/SIADH
Bradycardia/heart block/asystole
Facial flushing/diaphoresis
Guillian Barre Syndrome
Selegiline (Deprenyl, Eldepryl) Rasagiline (Azilect) Tx which disease? Class? Action? AVOID WHAT?
PD
Class:Monoamine Oxidase Inhibitors
Actions: Block breakdown of dopamine
AVOID: tyramine - chocolate, wine, cheese (Basically just go ahead and DIE!!!)
benztropine (Cogentin) procyclidine (Kemadrin) Trihexyphenidyl (Artane) Tx which disease? Class? Action? Tx Sx's? SE?
PD
Class: anticholinergics
Action: block cholinergic receptors - balance cholinergic and dopaminergic activity
Tx: Tremor
SE: acute confusion, urinary retension, constipation, dry mouth, blurred vision
(dry things up & slow things down)
What is the Patho of Parkinson’s?
Environmental Factors like Pesticides/herbicides/chemicals/metals(Fillings) can ↑possible causes
Degeneration of the Dopamine producing neurons, which disrupts the dopamine/Acetylcholine balance. Dopamine is an essential neurotransmitter that assist with motor functions like postural, support, involuntary motion
Amantadine (symmetrel) Tx which disease? Class? Action? Tx Sx's? SE?
PD
Class: Dopamine agonist (anti viral also)
Action: Blocks reuptake of dopamine into presynaptic neurons
Tx: akinesia, tremors
SE: mood changes, confusion, depression, hallucinations, LE edema, nausea, epigastric distress, urinary retention, headache, visual impairment.
What do you assess as a nurse on a PT with Guillian Barre Syndrome?
Respiratory function ABG's Swallow reflexes BP Heart rate/rhythm (During Acute phase) **Goal is to support till Pt can Recover**
Selegiline (Deprenyl, Eldepryl) Rasagiline (Azilect) Tx which disease? Class? Action? AVOID WHAT?
PD
Class:Monoamine Oxidase Inhibitors
Actions: Block breakdown of dopamine
AVOID: tyramine - chocolate, wine, cheese (Basically just go ahead and DIE!!!)
Describe the Tremor feature of Parkinson’s?
- Primarily during rest
- Aggravated with emotional stress
- Can involve the diaphragm, tongue, lips, and Jaw
---These are S&S of what disease--- Witness in skeletal muscles particularly: -Eyelids -Chewing -Swallowing -Speaking -Breathing (Strength is usually restored after a period of rest)
Mysthenia Gravis
benztropine (Cogentin) procyclidine (Kemadrin) Trihexyphenidyl (Artane) Tx which disease? Class? Action? Tx Sx's?
PD
Class: anticholinergics
Action: block cholinergic receptors - balance cholinergic and dopaminergic activity
Tx: Tremor
How is Myethenia Gravis Dx’d?
Hx
Physical
Tensilon Test
What is the Tensilon Test?
Used to Dx Myesthenia Gravis.
- If after admin; Pt has ↑Muscle Contractility
- Dx: MG
- If after admin; Pt/No improvement
- Dx: Cholenergic Crisis aka Tensilon O/D
What counteracts Tensilon?
Atropine
The drugs Mestinon/Prostigmin are what type of drug? and used in what disease?
- Anticholinasterase
- Myesthenia Gravis
- *O/D can lead to Cholenergic Crisis
diphenhydramine (Benadryl) Tx which disease? Class? Action? Tx Sx's?
PD
Class: Antihistamine
Action: anticholinergic effects
Tx: tremor, rigidity
Amantadine (symmetrel) Tx which disease? Class? Action? Tx Sx's? SE?
PD
Class: Dopamine agonist (anti viral also)
Action: Blocks reuptake of dopamine into presynaptic neurons
Tx: akinesia, tremors
SE: mood changes, confusion, depression, hallucinations, LE edema, nausea, epigastric distress, urinary retention, headache, visual impairment.
What would Prednisone a Corticosteroid be used for in dealing with Myethenia Gravis?
Suppresses the immune response that’s responsible for the disease.
Why would Immunosuppressive agents like Imuran, Cellcept, and Sandimmune be used for Myesthenia Gravis?
Helps Suppress the immune response that’s responsible for the disease.
What are the 2 main Sx’s for those w/Parkinson’s?
-Deep Brain Stimulation
-Electrode placed in brain;↓’s neuronal activity
;Improves motor function/Dyskinesia
- Transplantation
- Of Fetal Neuronal Tissue; Produces Dopamine
Which drug Tx for PD might cause the pt. to need to take a drug holiday?
Why?
levodopa
Pt. builds up tolerance over time so drug no longer works
What Sx’s can be done for Myesthenia Gravis?
What Other Tx’s can be done?
- Thymectomy (for puberty-65y/o)
- Plasmapheresis (Short-term), & IV IgG
This disease is a chronic, progressive neurologic disease characterized by slow initiating and stopping of movements ↑muscle rigidity, tremor at rest, and unsteady gait.
(> in M/peaks in 70’s %chance ↑w/age)
Parkinsons Disease
Acetylcholine helps ___[1]___.
Dopamine helps ___[2]___.
1: Initiate Movement
2: Inhibit Movement
What are the Clinical Manifestations of the early Chronic phase of HIV?
(T4 Count >500)
- None; Pt is generally Asymptomatic
- Pt at this point the body is able to keep T4 Production ↑ which keeps the person seemingly healthy.
What are the Clinical Manifestations of the Intermediate Chronic phase of HIV?
(T4 Count 200-500)
- Persistent fever, night sweats, chronic diarrhea, recurrent headaches, severe fatigue.
- Opportunistic infections Like Thrush, Shingles, Herpes, Vaginal Yeast infections, Oral Hairy Leukoplakia (Caused by Epstein Barr), Pneumonitis Jiroveci (PCP), Kaposis Sarcoma (Lesions on face), Toxiplasmosis (in CATS)
What are the 3 early S&S of Parkinson’s?
Mild tremor
Slight limp
↓ Arm Swing
What are the 3 Late S&S of Parkinson’s?
Shuffling
Propulsive gait w/arms flexed
Loss of postural reflexes
Describe the Tremor of Parkinson’s?
- Primarily during rest
- Aggravated with emotional stress
- Can involve the diaphragm, tongue, lips, and Jaw
Describe the Rigidity feature of Parkinson’s
- ↑Resistance to passive ROM
- Pt may C/o Muscle soreness/achiness/tiredness
Depression, anxiety, apathy, fatigue, constipation, impotence, short-term memory impairment, akinesia, dementia, & dysphagia are all Non-motor related S&S of what disease?
Parkinson’s
How is Parkinson’s Dx’d?
- Hx
- 2 o/o 3 of the Triad MUST be present
Levodopa/Carbidopa are what type of drugs?
What do they do for Parkinson’s Pt’s?
- Dopamine Precursors
- Tx the triad
Symmetrel/Apokyn are what type of drugs?
What do they do for Parkinson’s Pt’s?
- Dopamine Agonists
- Tx the triad
Benadryl is what type of drug?
What do they do for Parkinson’s Pt’s?
- Antihistamine
- Tx Tremor/Rigidity
Eldepryl/Carbex/Azilect are what type of drugs?
What do they do for Parkinson’s Pt’s?
- Monoamine Oxidase Inhibitors
- Tx the Triad
Artaine/Cogentin/Akineton are what type of drugs?
What do they do for Parkinson’s Pt’s?
- Anticholinergics
- Tx Tremor
Parlodell/Mirapex/Requip/Neupro are what type of drugs?
What do they do for Parkinson’s Pt’s?
- Dopamine Receptor Agonists
- Tx the Triad
Comtan/Tasmar are what type of drugs?
What do they do for Parkinson’s Pt’s?
- COMT (Catechol O-Methol Transferase Inhibitors)
- Tx: Given With Levodopa; Prolongs action/Prevents Breakdown
What are the 2 main Sx’s for those w/Parkinson’s?
-Deep Brain Stimulation
-Electrode placed in brain;↓’s neuronal activity
;Improves motor function/Dyskinesia
Describe the Patho of HIV in 6 “Steps”.
- Fusion: Uses gp120 to attach to cell; endocytosis
- Reversetranscriptase: Converts RNA to DNA
- Integrase: Integrates Viral DNA into Cell DNA
- Viral Transcription: New Viral DNA is made
- Protease: Viral DNA Snipped into RNA
- Exocytosis: Packaged New RNA leaves cell
HIV attacks ___[1]___/___[2]___.
After initial infection the host enters a state of __[3]__. This State is known as the __[4]__.
After a few weeks viral load __[5]__ and HIV.
For the next __[6]__ to __[6]__ years the Virus continues to multiply.
1: CD4
2: T4
3: Viremia
4: Window Period
5: Drops
6: 10-12 years
People who have HIV may never have AIDS if their T4 count Remains above _________.
> 200
-Intermediate: 200-500 T4 Count
What does ETOH withdrawal involve?
(1st 24-48hrs) Hyperalert jerky movements irritability startled easily C/O "shaking inside" Might need to Frequently Orient to P/P/T My suffer from illusions: Misinterpretation of objects in environment
What are the Clinical Manifestation of the early Chronic phase of HIV?
None; Pt is generally Asymptomatic
- Pt at this point the body is able to keep T4 Production ↑ which keeps the person seemingly healthy.
- Considered to be a T4 count >500
What are the Clinical Manifestations of the Intermediate Chronic phase of HIV?
(T4 Count 200-500)
- Persistent fever, night sweats, chronic diarrhea, recurrent headaches, severe fatigue.
- Opportunistic infections Like Thrush, Shingles, Herpes, Vaginal Yeast infections, Oral Hairy Leukoplakia (Caused by Epstein Barr)
How is HIV Dx’d?
S&S
↓WBC count (Neutropenia common)
Elisa antibody test
Western Blot (Confirms/Definitive)
What is ART in reference to HIV?
Anti-Retroviral Therapy
- Multi-drug approach
- ↓HIV Replication
---What types of Drugs are these? (used for HIV)--- Retrovir Videx Zerit Epivir Ziagen Emtriva Combivir Trizivir Epizicom
Nucleoside Reverse Transcriptase Inhibitors
---What types of Drugs are these? (used for HIV)--- Viramune Rescriptor Sustiva Intelence
Nonnucleoside Reverse Transcriptase Inhibitors
—What types of Drugs are these? (used for HIV)—
Viread
Truvada
NucleoTide reverse Transcriptase Inhibitors
—What types of Drugs are these? (used for HIV)—
Raltegravir
Integrase Inhibitors
---What types of Drugs are these? (used for HIV)--- Invirase Crixivan Norvir Viracept Reyataz Lexiva Tipranavir Darunavir Kaletra
Protease Inhibitors
—What types of Drugs are these? (used for HIV)—
Fuzeon
Selzentry
Entry Inhibitors
_______ Is the habitual use of a substance that falls outside medical necessity/social acceptance in order to alter one’s mood/emotion/LOC.
Abuse
_______ Is the habitual Psychological/physiological dependence beyond one’s voluntary control.
Addiction
What are the 3 C’s to addiction?
Compulsion (to use)
continued (Use)
Control (The LOSS of it)
-Cognitive impairment (The 4th “C”)
There is a __[1]__ link to Predisposition to Addiction.
Those who abuse drugs are @↑Risk of ___[2]___.
The ___[3]___ Neurotransmitter is usually affected by most drugs.
1: Genetic
2: Suicide
3: Dopamine
Issues with the drug __[1]__ are the most common seen in the Hospital.
The Disorder ____[2]____ ___[2]___ is a result of Thiamine Deficiency and is associated with__[3]__.
The other Disorder associated with alcohol use is __[4]___ ___[4]___, which is characterized by irreversible Amnesia.
1: EOTH
2: Wernicke’s encephalopathy
3: EOTH
4: Korsakoff’s psychosis
What are the 3 areas of the brain that are affected by and contribute to Substance abuse?
- Brainstem: HR/Breathing/Sleeping
- Limbic System: “Reward Circuit”/Pleasure
- Cerebral Cortex: Process Sensory data/Think/Plan/Problem solve/Decisions
___[1]___ account for 40-60% of a persons vulnerability to addiction.
__[2]__ acts as a chemical “Present” to areas of brain that regulate motivation, emotion, cognition,learning, & pleasure.
1: Genetics
2: Dopamine
Opioids work on __[1]__ receptors.
EOTH works on __[2]__ receptors
1: Opioid receptors
2: GABA receptors
How do they Dx addiction?
Cage-aid Questionare
Toxicology Screen
Blood Alcohol Level
What does ETOH withdrawal involve?
(1st 24-48hrs) Hyperalert jerky movements irritability startled easily C/O "shaking inside"
This is an ETOH emergency and can lead to death that peaks 2-3 days after cessation.
ETOH Delirium
-Cause of death is usually Result of sepsis, MI, fat embolism, peripheral vascular collapse, electrolyte imbalance, aspiration, or suicide
The drug __[1]__ creates an imbalance w/Dopamine/epinephrine. It stimulates both sexual arousal and violent behavior. It blocks sensory tranmission; Mainly __[2]___ transmission.
1: Cocaine
2: Pain
Withdrawal from Cocaine S&S include:
Depression, paranoia, lethargic, anxiety, constricted/wide eyes, insomnia, nausea, vomiting, sweating, and chills
The term Opiate refers to what drugs?
Opium, morphine, heroin, codeine, fentanyl, methadone, and meperidine
The Term Hallucinogens refer to what drugs?
Mescaline (peyote), shrooms, LSD (acid)
_______ lessens touch and sensitivity to pain. S&S of it are Acute anxiety, psychosis, violence, ↓coordination
PCP
Users of this drug tend to be younger (13-17yo) because of their ease of access. S&S are similar to drunkenness.
Inhalants
This drug is most commonly used in Clubs (13-28yo); S&S include: ↑HR, euphoria, ↑Energy/self-confidence/sociability, and the feeling of “closeness” to people.
Ecstacy
- use can lead to HF, Hyperthermia, and kidney failure
