Final Flashcards
1
Q
Emergent triage
A
Respiratory distress
Chest pain
Active hemorrhage
Unstable vital signs
2
Q
Urgent triage
A
Severe abdominal pain
Displaced/multiple fractures
Complex/multiple soft tissue injuries
Respiratory infection
3
Q
Non-urgent triage
A
Skin rash
Strains & sprains
Cold
Simple fracture
4
Q
Exertional heat stroke
A
Sudden onset Strenuous physical activity in hot conditions Change in LOC Hypotension Tachycardia Tachypnea
5
Q
Classic heat stroke
A
Over period of time Chronic exposure to hot environment Change in LOC Hypotension Tachycardia Tachypnea
6
Q
Pit viper envenomation
A
Local necrosis & swelling
Minty, rubbery, metallic taste
Paresthesias of scalp, face, & lips
7
Q
Antivenom for pit vipers
A
C/I pineapple allergies
4-6 vials 1st 60 min
2 vials every 6 hrs for 18hrs
8
Q
Antivenom for coral snakes
A
3-6 vials over 2 hrs
9
Q
Early S/S frostbite
A
White, waxy appearance of skin
10
Q
Prerenal AKI
A
Caused by direct damage to kidneys (arrythmias, burns, dehydration, diuretic overuse) Hypotension Tachycardia Decreased urine output Lethargy
11
Q
Intrarenal AKI
A
Caused by nephrotoxins, transfusion reaction Edema Oliguria/anuria Lethargy NV Flank pain Hypertension Tachycardia
12
Q
Postrenal AKI
A
Caused by pelvic cancers & stones
S/S same as intrarenal
13
Q
Onset phase AKI
A
Begins with event & ends with oliguria
Hours to days
14
Q
Oliguric phase AKI
A
Urine output 100-400mL/24 hrs–does not respond to diuretics
Lasts 1-3 wks
Dyspnea
15
Q
Diuretic phase AKI
A
Sudden onset 2-6 wks after oliguric
Urine flow increases
Up to 10L/day
Normal kidney tubular function is reestablished
16
Q
Recovery phase AKI
A
May take up to 12 mos
Kidney function may not return to normal
17
Q
AKI drug therapy
A
Fluid challenge Diuretics CC blockers Kayexelate--hyperkalemia Glucose & insulin
18
Q
Chronic kidney disease
A
Progressive
Irreversible; kidney function doesn’t recover
19
Q
Reduced renal reserve
A
No buildup of wastes in blood
Nephrons compensate
No manifestations of kidney dysfunction
20
Q
Reduced GFR
A
Nephron damage has occurred
Increased dilute UO
Reduced GFR
21
Q
ESKD
A
Urea & creatinine build up in blood
Kidneys can’t maintain homeostasis
22
Q
Continuous ambulatory peritoneal dialysis
A
Dialysate infused & remains for specified time
Removed by gravity
23
Q
Automated peritoneal dialysis
A
Cycling machine
Continuously, intermittently, or at night
24
Q
Post-dialysis assessment
A
Hypotension Headache Nausea, vomiting Malaise Muscle cramps
25
Dialysis disequilibrium syndrome
Rapid decrease in fluid volume & BUN
26
PE manifestations
```
Dyspnea/tachypnea
Tachycardia
Chest pain
Dry cough
Distended neck veins
Hypotension
```
27
Ventilatory failure extrapulmonary causes
Neuro disorders
Spinal cord injuries
CNS dysfunction
Chemical depression
28
Ventilatory failure intrapulmonary causes
COPD, asthma
PE
Pneumothorax
ARDS
29
Oxygenation failure causes
High altitudes
Pneumonia
PE
ARDS
30
ARDS manifestations
Hypoxia even when O2 at 100%
Dyspnea
Pulmonary edema
Whited-out chest xray
31
Assist-control ventilation
Ventilator takes over the work of breathing for the pt
| Tidal volume & ventilatory rate preset
32
SIM ventilation
Allows spontaneous breathing at pt's own rate
| Tidal volume & ventilatory rate preset
33
BiPAP
Preset inspiratory pressure & expiratory pressure similary to PEEP
34
Tidal volume
Amount of air received with each breath
| 7-10
35
Peak inspiratory pressure (PIP)
Highest pressure reached during inspiration
36
CPAP
Positive airway pressure throughout entire respiratory cycle for spontaneously breathing pts
Keep alveoli open during inspiration & prevents collapse during expiration
37
PEEP
Positive pressure exerted during expiratory phase
| Prevents atelactasis
38
Barotrauma
Damage to lungs by positive pressure
| Pneumothorax
39
Volutrauma
Excess volume delivered to one lung over the other
40
Thrombotic stroke
Atherosclerosis in blood vessel wall
41
Embolic stroke
Emboli break off & travel to cerebral arteries
Common source is heart
Pts with atrial fibrillation
42
Left hemispheric stroke
Aphasia/dysphagia
Alexia
Agraphia
Acalculia
43
Right hemispheric stroke
Visual & spacial awareness
Disoriented to time & place
Personality changes
Poor judgement
44
Broca's aphasia
Pt understands, but can't communicate verbally
45
Wernicke's aphasia
Pt can't understand spoken & often written word
| May be able to speak, but speech is meaningless
46
Cushing's triad
Severe hypertension
Widened pulse pressure
Bradycardia
47
Normal ICP
10-15 mmHg
48
Epidural hemorrhage
Neurologic emergency
| Temporal bone fractures
49
Subdural hemorrhage
Highest mortality rate
| Laceration of brain tissue
50
Intracerebral hemorrhage
Brain edema & ICP elevation
| Brain stem hemorrhage
51
Brain herniation
Brain tissue may shift & herniate downward in presence of increased ICP
52
Brain abscess
Pus forms in extradural, subdural, or intracerebral areas
| Treat with penicillin
53
Bradycardia tx
Atropine 0.5 mg IV up to 3 mg
| Monitor for tachycardia
54
Tachycardia tx
Treat cause of tachycardia
55
PAC
Premature P wave
No symptoms
No caffeine
56
SVT
Usually caused by PAC
150-280 BPM
Adenosine 6 mg IV, then 12 mg IV push
Asystole after
57
A-fib
Alcohol excess (holiday heart)
No discernable p waves
Antidysrhythmics--cardizem, amiodarone, beta-blockers, digoxin
Anticoagulants
58
PVC
Wide QRS
Unifocal (all alike) or multifocal (different)
Multifocal more dangerous
Can trigger V-tach or V-fib
59
V-tach
Pt may seem fine
| Wide QRS
60
Torsade de pointes
Twisting--too fast to cardiovert
| Mg sulfate IV
61
V-fib
Epi--1mg (1:10,000) every 3-5 min
Vaso--50 mg for 1st 2 doses of epi
Ami--300 mg, then 150 IV push
62
1st degree AV block
PR >.20 sec
| No S/S; no treatment
63
2nd degree AV block type 1
PR gets wider & wider & then drops
| Atropine
64
2nd degree AV block type 2
PR normal & then drops
| Cardiac pacing
65
3rd degree AV block
P wave & QRS regular, but at different intervals
Cardiac pacing
Atropine
66
Bradycardia tx
Atropine 0.5 mg IV up to 3 mg
| Monitor for tachycardia
67
Tachycardia tx
Treat cause of tachycardia
68
PAC
Premature P wave
No symptoms
No caffeine
69
SVT
Usually caused by PAC
150-280 BPM
Adenosine 6 mg IV, then 12 mg IV push
Asystole after
70
A-fib
Alcohol excess (holiday heart)
No discernable p waves
Antidysrhythmics--cardizem, amiodarone, beta-blockers, digoxin
Anticoagulants
71
PVC
Wide QRS
Unifocal (all alike) or multifocal (different)
Multifocal more dangerous
Can trigger V-tach or V-fib
72
V-tach
Pt may seem fine
| Wide QRS
73
Torsade de pointes
Twisting--too fast to cardiovert
| Mg sulfate IV
74
V-fib
Epi--1mg (1:10,000) every 3-5 min
Vaso--50 mg for 1st 2 doses of epi
Ami--300 mg, then 150 IV push
75
1st degree AV block
PR >.20 sec
| No S/S; no treatment
76
2nd degree AV block type 1
PR gets wider & wider & then drops
| Atropine
77
2nd degree AV block type 2
PR normal & then drops
| Cardiac pacing
78
3rd degree AV block
P wave & QRS regular, but at different intervals
Cardiac pacing
Atropine
79
Chronic stable angina
Predictable following exertion
| Relieved by nitrates & rest
80
Unstable angina EKG
Depressed ST
Inverted T-wave
Resolves when pain goes away
At rest or with exertion
81
Variant angina
Coronary spasm
Elevated ST
Responds to nitrates
82
New onset angina
1st angina symptoms
| Increased exertion
83
Pre-infarction angina
Occurs in days or weeks before MI
84
Subendocardial
Only through subendocardial muscle
NSTEMI
More likely to have STEMI later on
85
Transmural
All the way through heart muscle
STEMI
ST elevation in 2 contiguous leads
86
Heart changes in MI
Blue & swollen initially
48 hrs gray with yellow streaks
8-10 days granulation tissue
2-3 mos scar tissue
87
Anterior MI
L anterior descending artery
ST elevation V1-V4
Tachycardia; 2nd & 3rd degree heart blocks
88
Posterior (lateral) MI
Circumflex artery
ST elevation V5 & V6
Sinus arrhythmias
89
Inferior MI
Right coronary artery
ST elevation in 2, 3, & aVF
Sinus bradycardia; heart blocks
90
LDL
<70 known CAD risk
91
HDL
>40
92
Triglycerides
<150 men
93
Metabolic syndrome risk factors
```
Hypertension
Decreased HDL
High LDL
High triglycerides
Large waist
```
94
Creatinine Kinase
Women 30-135
| Men 55-170
95
Cardiac catheterization
Determine extent & exact location of MI
| Watch for cold extremities
96
Unstable angina/NSTEMI treatement
```
Glycoprotein inhibitors
Beta-blockers
ACE inhibitors
ARBs
CC blockers
```
97
Thrombolytics C/I
```
Abdominal surgery/stroke
Intracranial hemorrhage
Malignant neoplasm
Ischemic stroke w/in 3 mos unless w/in 3 hrs
Closed head injury w/in 3 mos
```
98
Class 1 heart failure
Absent crackles & S3
| IV nitrates & diuretics
99
Class 2-3 heart failure
More aggressive interventions needed
100
Class 4 heart failure
```
Cardiogenic shock
Tachycardia
Hypotension
UO <30 ml/hr
Tachypnea
```
101
Cardiogenic shock tx
IV morphine--pain
O2--decrease O2 requirements
Vasopressors--maintain tissue perfusion
102
Intra-aortic balloon pump
Inflates during diastole to keep vessel open
103
PTCA
Balloon compresses plaque against wall of vessel
| Stent is usually inserted
104
CABG
Artery bypass
Angina w/ >50% occlusion
Acute MI w/ cardiogenic shock
PTCA not an option
105
Post-CABG hypertension
Nitroprusside
| Cover tubing with aluminum foil; absorbed in light
106
Cardiac tamponade
Sudden cessation of drainage
JVD
Pulsus paradoxus
107
Progression of CABG pt
3-6 hrs--ventilator
2 hrs after extubation--pt dangled side of bed
4-8 hrs--pt up to chair
1st day postop--ambulating 25-100 ft 3x/day
108
Mediastinitis
```
Infection develops 5 days to several wks postop
Fever beyond 4 days postop
Boggy sternum
Redness & swelling of sutures
Increased WBC
```
109
Initial stage shock
MAP decreased <10
Compensatory mechanisms effective
HR & RR increased or slight increase in diastolic BP may be only signs
110
Non-progressive (compensatory) shock
```
MAP decreased 10-15
Kidney & hormonal compensatory mechanisms kick in
Acidosis & hyperkalemia
Decreased UO
Stop conditions that cause shock
```
111
Progressive (intermediate) shock
MAP decreased >20
Compensatory mechanisms no longer deliver O2 to vital organs
Feeling of impending doom
Multi-organ failure
112
Irreversible (refractory) shock
Therapy can't save pt's life even if cause corrected & MAP returns to normal
113
Hypovolemic shock
Loss of blood volume
Loss of O2-carrying capacity--loss of RBCs
Hemorrhage/dehydration
Changes in mental status early signs
114
Cardiogenic shock
Actual heart muscle is unhealthy
115
Distributive shock
Fluid delivered to interstitial tissues & can't be circulated properly
116
Neurogenic shock
Spinal cord injury
Head trauma
Widespread vasodilation
117
Chemical induced distributive shock
Anaphylaxis
Sepsis
Capillary leak syndrome
118
Septic inflammatory response (SIRS)
Organisms escape local control
| Inflammatory response takes over
119
Septic shock tx
Vancomycin
Aminoglycosides
Penicillin
Cephalosporins
120
Primary prevention
Prevention of initial occurrence of disease or injury
Nutrition counseling
Sex education
Immunizations
121
Secondary prevention
```
Early detection of disease & treatments with goal of limiting severity & A/E
Screenings
Treatment of STDs
Treatment of TB
Control of communicable diseases
```
122
Tertiary prevention
Maximization of recovery after injury or illness
Rehabilitation
Support groups
Case management
123
School nurse primary prevention
Immunization status
| Knowledge regarding health issues
124
School nurse secondary prevention
Assess illness or injury
Early detection of disease--scoliosis, lice
Detect child abuse or neglect
125
School nurse tertiary prevention
Assess children with disabilities
| Long-term health needs--diabetes, asthma
126
HIV clinical A
Flu-like symptoms
| Enlarged lymph nodes
127
HIV clinical B
HIV with 1 or more infections
128
HIV clinical C
HIV with AIDS
129
HIV 1
CD4 at least 500
| 29%
130
HIV 2
CD4 200-499
| 14-28%
131
HIV 3
CD4 <14%
132
Superficial thickness burns
Epidermis injured
| Heals 3-5 days
133
Superficial partial-thickness burns
```
Involves entire epidermis
Blister formation
Blanchable
Increased pain (nerve endings exposed)
Heals 10-21 days
```
134
Deep partial-thickness burns
```
Deeper into dermis
No blister
May or may not blanch
Decreased pain (nerve endings are damaged)
Heals 3-6 wks
May require skin grafts
```
135
Full-thickness burns
```
Destruction of entire epidermis & dermis
Grafting necessary
Hard leathery eschar
No blood supply
Decreased sensation
Healing weeks to months
```
136
Deep full-thickness burns
Extends into fascia & tissues
Damage to bone, muscles, tendons
Excision & grafting
137
Fluid shift after burns
Capillary leak syndrom
Hyperkalemia
Hyponatremia
Hemoconcentration
138
Resuscitation/emergent phase
```
24-48 hrs
ABCs
Head to toe
Cool, cover, carry
Fluid resuscitation--crystalloids
```
139
Fluid resuscitation
4mL/kg/% burned
1st 1/2 over 1st 8 hrs
2nd 1/2 over next 16 hrs
140
Acute phase
36-48 hrs--fluid resuscitation finished to wound covered by tissue
Prevent infection--tetanus, antibiotics
Debridement
Silvadene
141
Autograft
Skin from burn victim
142
Homograft
Cadaver skin
| Usually rejected 2-3 wks
143
Heterograft
Pig skin
| High infection rate--treat with silver nitrate
144
Rehabilitative phase
Years-end of life--burn healing to reconstruction complete
