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final exam Flashcards

1
Q

Oncology: Tumor, Grade I

A

well differentiated; low grade

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2
Q

Oncology: Tumor, Grade II

A

moderately differentiated; intermittent grade

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3
Q

Oncology: Tumor, Grade III

A

poorly differentiated; high grade

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4
Q

Oncology: Tumor, Grade IV

A

undifferentiated; high grade

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5
Q

Oncology: Benign Tumors

A

well differentiated

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6
Q

Oncology: Tumor, Anaplasia

A

lack of differentiation; malignant

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7
Q

Oncology: Tumor Markers

A

Breast cancer- CEA
Liver- AFP
Pancreatic- CA 125, CEA
Lung - CA 125, CEA
Stomach- CEA
Colon- CEA
Prostate- PSA
Testicular- AFP, HCG

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8
Q

Oncology: These can be impacted by radiation

A

Electronic devices-pacemakers, pain/insulin pumps, pods (On Body Injector, Omnipods, Dexcom)

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9
Q

Oncology: Radiation side effects

A

Fatigue, skin reactions

N/D
urinary incontinence, impotency
decreased salvia, difficulty swallowing, mouth dryness

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10
Q

Oncology: Treatment, IV

A

vesicant (irritant)
avoid small veins and AC
prefer central line
blood return- do not admin w/o

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11
Q

Oncology: Bone Marrow Toxicity

A

Thrombocytopenia- low platelets
neutropenia- (decrease in # of circulating neutrophils) levels of severity

1 unit @ a time
1 gr per unit of blood

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12
Q

Oncology: Chemotherapy N/V cause

A

Chemotherapy is toxic to the enterochromaffin cells that are found throughout the GI tract and causes them to release increased amounts of the neurotransmitter serotonin. (5HT3)

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13
Q

Oncology: Chemotherapy N/V complications

A

Mallory–Weiss tear: esophageal tear caused by vomiting

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14
Q

Oncology: Chemotherapy N/V prevention

A

prevention over treatment
oral is as effective as IV in prevention

-5-HT3 receptor antagonists (ondansetron- effective in acute)
-NK-1 receptor antagonist
-corticosteroids
-benzos
-antipsychotics (olanzapine)
-dopamine
-cannabinoid

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15
Q

Oncology: mucositis, factors

A

Exposure to irritants: citrus, spicy, mouthwashes, tobacco, ETOH, temp. extremes, poor fitting dentures
Dehydration, malnutrition, quality of life
Comorbid conditions: Renal & hepatic dysfunction

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16
Q

Oncology: Management of Constipation

A

-Increase dietary fiber
-increase fluid consumption
-active/passive
exercise
-limit caffeine intake
-avoid cheese, chocolate
-probiotics
-switching to transdermal fentanyl

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17
Q

Oncology: Oncologic emergency

A

-neutropenic sepsis
-spinal cord compression
-SVC
-Cardiac Tamponade
-Hypercalcemia
-Tumor Lysis

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18
Q

Oncology: S/S of infection

A

Fever & change in mental status

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19
Q

Oncology: Sepsis, Nursing intervention

A

Initiate antibiotic therapy within 1st hour of sepsis/septic shock

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20
Q

Oncology: Spinal Cord Compression, symptoms

A

-earlylocalized pain (dull, achy)
-latemotor weakness/dysfunction
Pain increases with cough, sneeze, or Valsalva maneuver

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21
Q

Oncology: Superior Vena Cava Syndrome definition

A

Obstruction of the blood flow returning to the heart from the:

Head, neck, upper thorax & upper extremities

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22
Q

Oncology: SVC Superior Vena Cava Syndrome s/s

A

Swelling of arms, neck or face
Prominent venous pattern on chest wall
Headache
Nasal stuffiness
Blurry vision
Dyspnea
Venous distention
Collateral circulation

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23
Q

Oncology: SVC Superior Vena Cava Syndrome Dx & Tx

A

CHEST X RAY
Mass, pleural effusion, mediastinal widening
CT CHEST (preferred)
Mediastinal mass
DYE STUDY OF LINES
Presence of thrombus

Radiation therapy
Removal of CV lines
Chemotherapy
Thrombolytic therapy
Stent placement
Steroids

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24
Q

Oncology: Hypercalcemia levels

A

Mild Hypercalcemia:
Calcium levels between 10.5 – 11.9 mg/dl*

Moderate Hypercalcemia :
Calcium levels between 12.0 – 13.9 mg/dl*

Severe Hypercalcemia: Calcium levels elevated above 14.0 mg/dl*

  • Corrected for Albumin
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25
Q

Oncology: Hypercalcemia, 4 types

A

-humoral
-osteolytic
-vitamin d secreting lymphomas
-ectopic hyperparathyroidism

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26
Q

Oncology: Hypercalcemia, Clinical management

A

-aggressive hydration
-biphosphonate therapy
-calcitonin
-corticosteroids

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27
Q

Oncology: Tumor Lysis Syndrome, definition

A

Metabolic imbalance occurs with the rapid release of intracellular potassium, phosphorous, and nucleic acid into the blood as a result of tumor cell kill

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28
Q

Oncology: Tumor Lysis Syndrome, Pathophysiology

A

hyperkalemia
hyperphosphatemia
hyperuricemia

hypocalcemia

LEADS TO RENAL FAILURE & ARRHYTHMIAS

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29
Q

Oncology: Tumor Lysis Syndrome, facts

A

Most likely to occur 24-72 hours after the initiation of treatment
May last up to 7 days after therapy
The goal is to prevent renal failure, & severe electrolyte imbalance

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30
Q

Oncology: Tumor Lysis Syndrome, medical management

A

Allopurinol (decreases uric acid production)
Rasburicase
Loop diuretics
kayexalate
aluminum hydroxide

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31
Q

Oncology: Tumor Lysis Syndrome, nursing interventions

A

Monitor for sequelae:
Decrease in BP
Irregular pulse
Chest pain, SOB

Assess for renal failure:
Decreased urine output
Altered mental status
Increased weight

Institute seizure precautions, as ordered
Assess for cardiac arrhythmias
Monitor lab data:
BUN & Creatinine
Potassium
Phosphorous
Uric Acid
Calcium

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32
Q

Spinal Cord Injury (SCI): AMPS

A

anterior- Ventral horn
Motor, essential for voluntary and reflex activity of muscles they innervate

Posterior- dorsal horn
sensory- serve as relay station for sensory/reflex pathway
proprioception

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33
Q

Spinal Cord Injury (SCI): vertebral column

A

Cervical 7
thoracic 12
lumbar 5
sacrum- fused mass of 5 vertebrae

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34
Q

Spinal Cord Injury (SCI): Upper motor neuron

A

Motor pathway from brain to spinal cord.
Damage here- (cervical or high thoracic)
Loss of voluntary skillful control, dexterity
Involuntary(reflex) uninhibited
Spastic paralysis (increased muscle tone)
No significant muscle atrophy
Hyperreflexia, clonus
Babinski

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35
Q

Spinal Cord Injury (SCI): lower motor neuron

A

All Voluntary movement depends upon excitation of LMN by UMN. Motor nerve damage between spinal cord and muscle.
Damage to LMN (lower thoracic or lumbosacral)-
Flaccid paralysis
Decreased Muscle Tone
Atrophy
Hyporeflexia
Babinski-neg

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36
Q

SCI: Central Cord Syndrome

A

Caused by injury or edema to central area of cord (usually cervical)
Motor deficits (in upper extremities)
Sensory loss varies (more pronounced in the upper extremities)
Bladder/bowel dysfunction
variable

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37
Q

SCI: Brown-Sequard Syndrome

A

AKA “Lateral Cord Syndrome”
Caused by transverse hemisection of cord
(Missile) knife, bullet, fracture, ruptured disc
Ipsilateral -paralysis or paresis /w loss of touch, pressure, vibration
Contralateral -loss of pain and temperature

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38
Q

SCI: Motor strength scale

A

Motor Strength
0 = no movement
1 = slight shrug
2 = same plane
3 = against gravity
4 = some resistance
5 = normal strength

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39
Q

SCI: Key muscles

A
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40
Q

SCI: Landmarks

A

C4 Diaphragm
T4 Nipple
T10 Umbilicus
S1 Perianal
S4-5
Anal contraction-if any sphincter control-motor incomplete

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41
Q

SCI: Spinal Shock

A
  • Depression of reflex activity below injury
  • Muscles without sensation, flaccid
  • Reflexes absent
  • Hypotension and bradycardia (leading to further SCI)
  • Bowel and bladder function affected
  • Paralytic ileus
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42
Q

SCI: Neurogenic Shock

A
  • Loss of autonomic nervous system function below level of injury
  • Decrease in HR, BP, CO
    Refractory to fluids
    Atropine or pacer may be needed
  • Venous pooling, peripheral vasodilation
  • Anhidrosis below injury
  • If cervical or upper thoracic injury, potential respiratory issues due to accessory muscles affected
  • May last 1-6 weeks after injury
  • Indicator of recovery: Bulbocavernosus & perianal reflex
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43
Q

SCI: Venous Thromboembolism s/s

A

PE: Pleuritic chest pain, anxiety, SOB, hypoxia

monitor leg circumference

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44
Q

SCI: Maintain bladder

A

Initially bladder is atonic and can not contract – Foley considered
Unable to detect pain
Assess distension
Intermittent or indwelling catheter
I & O
Hydration
Prevent and monitor for UTI
Autonomic dysreflexia

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45
Q

SCI: Maintain bowel

A
  • NGT early on if paralytic ileus
  • Prevent gastric ulcer
  • Assess sphincter tone
  • Bowel program /w onset of bowel sounds
  • Hydration
  • High Fiber diet
  • Stool softeners/laxatives
  • Digital stimulation
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46
Q

SCI: Management of Neurogenic bladder, upper motor neuron [spastic]

A

Loss of conscious sensation and motor control
Empties on reflex, no control to regulate
Dysfunction -Urinary frequency
Incontinence but may not empty completely
Re-establishing voiding patterns-
Triggering or facilitating techniques
Drug therapy as appropriate
Intermittent Catheterization
Consistent habitual toileting schedule
Increased fluids
Indwelling catheter (last resort)

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47
Q

SCI: Management of Neurogenic bladder, lower motor neuron [flaccid]

A

Bladder continues to fill and over-distends
Dysfunction
Urinary retention
Overflow
Re-establishing voiding patterns
Valsalva and Crede’ manuevers
Increased fluids
Intermittent or indwelling catheter

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48
Q

SCI: Autonomic Dysreflexia causes

A

Bladder distention-MOST COMMON!
Fecal Impaction
DVT
UTI
Pressure Ulcer
Ingrown Toenail
Menstruation
Tight clothing/shoes
Heat

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48
Q

SCI: Autonomic Dysreflexia s/s

A

Rapid, severe, hypertension
Bradycardia
Pounding Headache
Profuse sweating/flushing above injury
Gooseflesh
Blurred vision

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49
Q

SCI: Autonomic Dysreflexia tx

A

Elevate HOB (pools bld in LE)
Eliminate the noxious stimuli
90% URINE retention
Fecal impaction
Inspect skin
Manage the hypertension
Nitrates
Hydralazine
Close monitoring of BP until resolved
Teach patient s/s and prevention

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50
Q

SCI: Heterotopic Ossification

A

Overgrowth of bone
Hips, knees, shoulders, elbows
20-40% of all SCI patients
Very painful
Huge loss of ROM
Radiation therapy
May require surgical release to improve ROM

51
Q

HIV/AIDS: pre-exposure prophylaxis meds

A

combo drug: truvada-emtricitabine (nrti) & tenovir (nrti)

52
Q

HIV/AIDS: HIV molecule

A

retrovirus (RNA)
RNA inserted into helper T4 lymphocytes

53
Q

HIV/AIDS: Three viral enzymes

A
  1. Reverse transcriptase –copies viral DNA
    2.Integrase- integrates viral RNA into nucleus
    3.Protease- facilitates production of new virus
54
Q

HIV/AIDS: CD4+

A

T-cells lymphocyte (WBC); 2 types:
T-4 cells (CD4+) “helper cells”; lead attack vs infection
T-8 cells (CD8+) “suppressor cells”; end the immune response; also “killer cells” - fight cancer and viruses

55
Q

HIV/AIDS: CD4+ range

A

500-1600mm3

56
Q

HIV/AIDS: Viral Load Test

A

Quantitative -Measures presence of HIV viral genetic material in blood not body’s response
3 different ways to measure
RT-PCR (reverse transcriptase-polymerase chain reaction)
Nucleic acid sequence-based amplification, Nucleic Acid Test (RNA)
bDNA (branched DNA)
PCR usu 2x bDNA - be consistent with test type

57
Q

HIV/AIDS: other testing

A

Enzyme-linked immunosorbent assay (ELISA) False neg during “window period”, cancer and long term immunosuppression
*if positive must confirm with Western Blot
Western Blot-Confirms + ELISA, more sophisticated and $
OraQuick- In-home HIV test. Oral transmucosal exudate, results in 30-40 min. Confirm with further testing
*2 combined tests <0.1% chance of inaccurate result

58
Q

HIV/AIDS: test summary

A

NATs(RNA)look for the actual virus in the blood. Expensive test, not routinely used for HIV screening unless the person recently had a high-risk exposure or a possible exposure with early symptoms of HIV infection.
Antigen/antibody testslook for both HIV antibodies and antigens(HIV p24).
Antibody testsdetect the presence of antibodies, proteins that a person’s body makes against HIV, not HIV itself. Most rapid tests and home tests are antibody tests.

59
Q

HIV/AIDS: Classification system, Stage 0/1

A

Stage 0 Period between infection and antibody production
Stage 1:
Any patient with confirmed HIV infection
CD4 count >500 cells/mm3
CD4 Greater than or equal to 26%
No AIDS defining illnesses

60
Q

HIV/AIDS: Classification system, Stage 2

A

Stage 2:
Any patient with confirmed HIV infection
CD4 cell count between 200 and 499 cells
CD4 percentage between 14%-25%
No AIDS defining illnesses

61
Q

HIV/AIDS: Classification system, Stage 3

A

Stage 3:
Any patient with confirmed HIV infection
Less than 200 CD4+ cells, CD4 <14%
If higher CD4 counts or percentages AND documented AIDS defining illness
AIDS defining illness
Once stage 3 AIDS diagnosis is made, even if patient’s CD4 count returns to ≥200cells/mm3, AIDS diagnosis remains.
Patient does not return to only HIV positive
Implications for services- disability, housing, gov’t assistance.

62
Q

HIV/AIDS: Progresses to AIDS

A

1.Opportunistic infections (OI)
Bacterial, Fungal, Protozoal, Viral infections
2.Neoplasms
Kaposi’s sarcoma, non-Hodgkin’s lymphoma, invasive cervical cancer
3.Conditions specific to HIV disease
HIV encephalopathy, HIV wasting syndrome

63
Q

HIV/AIDS: Pneumocystis –Protozoal/Fungal

A

Pneumocystis jiroveci(carinii): Most common opportunistic, airborne; found in lungs of humans/animals; primary infection by age 4. Risk  as CD4 count 
Most are reactivation of primary infection, but new strains indicate re-infection also; 7% asymptomatic.
P. carinii pneumonia (PCP): Cough most common first S/S: non-productive progressing to productive; fever, DOE, dyspnea at rest.
Dx: organisms in tissue, bronchial lavage, sputum
Tx: Prophylaxis trimethoprim sulfamethoxazole (TMP sulfa) if CD4+ <200, corticosteroids; prevent reoccurrence.
High incidence of adverse rx with TMP, rash, fever, leukopenia, hepatitis,
Oral thrush common co-infection

64
Q

HIV/AIDS: Mycobacterium Avium Complex

A

(MAC)- Most common bacterial infection, occurs when CD4 counts <50
3 types of mycobacterium: avium, intracellulare & kensai
Usually environmentally acquired-Soil, H2O, animals, eggs, unpasteurized dairy products
S/S: Fever, night sweats, fatigue, anorexia, wt loss, abd pain, diarrhea
Difficult to tx, side effects of meds BAD - decision to tx depends on S/S & renal or liver dx.
Dx: S/S, +cultures of blood, lymph node, bone marrow or other
TX: Clarithromycin, Ethambutol

65
Q

HIV/AIDS: Mycobacterium Tuberculosis (TB)

A

Common bacterial infection due to airborne spread
Recommend yearly testing; Reportable to CDC
Can occur at any CD4+ count, should be tested for at time of HIV dx.
Pulmonary: cough, dyspnea, chest pain, hemoptysis.
Extrapulmonary: CNS, bone, pericardium, stomach, peritoneum, scrotum.
In severe immunodeficiency, can be rapidly fatal
TB and <200 CD4 count may not have +PPD (can’t mount immune response).
Need Quantiferon-TB Gold- most sensitive and rapid

66
Q

HIV/AIDS: TB treatment

A

4 Drugs: isoniazid, rifampin, pyrazinamide, ethamabol or streptomycin for 9 months
Multiple Drug resistant TB ( MDR - TB): result of insufficient abx tx - move to second line abx
Respiratory isolation until sputum negative
Follow up care focuses on symptom management and compliance /w drug regime to prevent reoccurance and spread of TB
Directly Observed Therapy (DOT)

67
Q

HIV/AIDS: GI, Cryptosporidiosis - PROTOZOAL

A

Cryptosporidium: Intestinal infection. Found in mammals, birds, reptiles, fish; ingestion of contaminated food/H2O; municipal H2O supplies w/o chlorine, contaminated swimming pools, handling infected animals, anal-oral contact /w infected pt.
Normal immune sys- dx self-limiting
HIV pt: CHRONIC

68
Q

HIV/AIDS: GI, Cryptosporidiosis - PROTOZOAL s/s

A

S/S: Intestinal-malabsorption, dehydration, malnutrition, profuse diarrhea, (15-25 L/day), flatulence, abd cramping/pain, anorexia, N/V, myalgia, electrolyte imbal.

69
Q

HIV/AIDS: GI, Salmonellosis- bacterial

A

Ingestion of contaminated foods (beef, pork, poultry, eggs), H2O, medications, diagnostic agents, handling of contaminated feces, sexual activity with oral/anal contact.
Food handlers, pets, esp. turtles carriers
NS, fever, fatigue, anorexia, wt loss, abd pain, diarhhea
Tx /w abx, symptom mgt, prevent breakdown of skin in perianal region.

70
Q

HIV/AIDS: neuro, Cryptococcosis- Fungal

A

Debilitating meningitis
Cryptococcus neoformans : pigeon droppings, nesting places, soil, fruit, unpasteurized juices

71
Q

HIV/AIDS: GI, Cytomegalovirus- VIRAL

A

CMV: ubiquitous throughout the world in humans; direct contact /w infected secretions, saliva, cervical secretions, urine, semen, breast milk, feces, blood.
Infects eyes, respiratory & GI tract, CNS
CMV retinitis- Main cause of blindness in AIDS pt

72
Q

HIV/AIDS: GI, CMV s/s

A

Asymptomatic or: chorioretinitis, pneumonitis, encephalitis. Non specific- fever, malaise, wt loss, fatigue

73
Q

HIV/AIDS: GI, CMV tx

A

ganciclovir, foscarnet, valganciclovir; lifetime suppressive therapy, compliance, resistance, reoccurrence. Med toxicities: bone marrow suppression renal and hepatotoxic, seizures

74
Q

HIV/AIDS: GI, Candidiasis

A

Candida albicans: Natural flora of GI tract, immune system can’t control growth
Stomatitis, esophagitis common

75
Q

HIV/AIDS: GI, Candidiasis s/s

A

related to site of infection:
dysphagia /w esophagitis
oral lesions /w thrush
cutaneous lesions /w intertrigo
vulvovaginal irritation & discharge with vaginitis
disseminated dx

76
Q

HIV/AIDS: GI, Candidiasis tx

A

Treatment is also site dependent:
oral: clotrimazole troches, nystatin susp, other abx susp
intertrigo / vaginitis: clotrimazole, miconazole, ketoconazole, fluconazole
disseminated dx: amphotericin B
Teach routine skin/mouth care
Eat 8 oz yogurt /w live cultures (lactobacillus acidophilus) to help control recurrent infection

77
Q

HIV/AIDS: neuro, Cryptococcosis- Fungal s/s

A

Aerosolized and inhaled; Smokers at higher risk
S/S: Fever, HA, blurred vision, nuchal rigidity, confusion, seizures

78
Q

HIV/AIDS: neuro, Cryptococcosis- Fungal, dx

A

CSF analysis, lumbar puncture

79
Q

HIV/AIDS: neuro, Cryptococcosis- Fungal, tx

A

Ampho B and fluconazole; Adverse reactions of amph B (anaphylaxis, renal and hepatic impairment).

80
Q

HIV/AIDS: Progressive Multifocal Leukoencephalopathy Disease-VIRAL

A

caused by J.C.virus; demylinating CNS disorder

81
Q

HIV/AIDS: Progressive Multifocal Leukoencephalopathy Disease-VIRAL, s/s

A

extremity weakness, ataxia, cognitive impairment, vision loss, speech impairment, HA - progresses to dementia, blindness, paralysis and death.

82
Q

HIV/AIDS: Progressive Multifocal Leukoencephalopathy Disease-VIRAL, tx

A

no effective tx

83
Q

ED: mandatory reporting

A

Abuses- elder & child
MVAs
communicable diseases: flu, HIV, SARS, COVID

84
Q

ED: triage, 3 categories

A

emergent-immediate
urgent- delayed
nonurgent- minor

85
Q

ED: C-circulation, isotonic replacement solutions

A

NS or LR

86
Q

ED: C-circulation, blood type to infuse in emergency

A

O-

87
Q

ED: ABCDE

A

airway
breathing
circulation
disability- alert, verbal, pain, unresponsive
exposure

88
Q

ED: heat stroke, meds to prevent shivering

A

diazepam, thorazine

89
Q

ED: Frostbite, T/F always associated with hypothermia

A

false

90
Q

ED: Frostbite, how to treat

A

Controlled, rapid rewarming in water bath
Very painful- analgesia
No massage! Elevate
Loose non adherent sterile dressings
Monitor for compartment syndrome
Risk for infection/tetanus
Examine for concomitant injuries
AROM after rewarming
Avoid vasoconstrictors

91
Q

ED: Hypothermia, assessment

A

<95 degrees
ataxia, drowsiness, clotting dysfunction, easier to go into VFIB

92
Q

ED: Decompression sickness (the bends)

A

Diving, high altitude flying, diving + flying in 24 hrs
Nitrogen bubbles trapped in muscle, joints, bloodstream ~ stroke, paralysis, MI
Hyperbaric Chamber

93
Q

ED: Snakebite care, most common antivenin

A

CroFa- immunoglobulin binds and neutralizes toxins (derived from sheep)

94
Q

ED: Alcohol detox, tx for respiratory depression

A

flumazenil

95
Q

Trauma: Secondary survey

A

Focused assessment
Head to Toe evaluation
Look , listen, feel- quick review
of primary
Communication to hospital
AMPLE

96
Q

Trauma: AMPLE

A

allergies
meds
pre exisiting conditions
last meal
events

97
Q

Trauma: Trauma center indications

A

Penetrating injury (not superficial wounds)
Gun shot wounds
2 or more proximal long bone fractures
Combo of burns > 15% or face/airway
Flail Chest
Major proximal amputation or degloving injury
Mechanism r/t Evidence of high impact

98
Q

Trauma: Primary survey

A

evaluate patent airway
administer IV fluids
monitor O2
remove clothing
assess pt responsiveness
assess position of artificial airway

99
Q

Trauma: Secondary survey

A

evaluate patent airway
admin IV fluid
splint fx humerus
monitor O2
review pt hx
xray
assess pt responsiveness
assess position of artificial airway

100
Q

Trauma: Cardiac tamponade

A

fluid accumulation in pericardial sac

101
Q

Trauma: Cardiac tamponade, s/s

A

chest pain
tachypnea
dyspnea
JVD- backing up
hypotension
muted heart sounds
pulsus paradoxus- pressure drops with inspiration

confirm w/echo

102
Q

Trauma: cardiac tamponade management

A

pericardiocentesis- relief comes quickly
complications- CA puncture, myocardial trauma, dysrhthmias

pericardiotomy (pericardial window)

103
Q

Trauma: Rib fx

A

most common 4-10
1st 3- lac of SC artery/vein
lower- spleen or liver

3 or more ribs fx- higher mortality and pneumonia rates for elder

104
Q

Trauma: tension pneumo s/s

A

absent BS
distended neck veins
LATE SIGN- tracheal deviation

105
Q

Trauma: tension pneumo, tx

A

darting- 2nd intercostal space
chest tube placement

106
Q

Trauma: chest tubes, water seal chamber function

A

To allow air to leave pleural space
To prevent air from entering pleural space

107
Q

Trauma: Liver facts

A

Pain R shoulder
NPO
Serial H & H- 1/3 of CO goes to liver
Gelpacs
Arteriogram

lac- grade I through IV

108
Q

Trauma: compartment syndrome s/s

A

Pain!!-not relieved by meds, weak pulse(pulseless-late!), pallor, paresthesia, palpably tense, pain on passive movement

109
Q

Trauma: peticchae across chest can suggest

A

respiratory distress

110
Q

HIV/AIDS: herpes simplex virus disease

A

S/S: painful vesicular lesions that rupture in mouth, genital or perianal region; can cause encephalitis, esophagitis, bronchitis, keratitis, pericarditis, hand infections.
Tx: Acyclovir, valacyclovir; topical anesthetic to lesions; reoccurrence, if chronic - lifetime suppression required.

111
Q

HIV/AIDS: Kaposi’s Sarcoma, facts

A

most common AIDS malignancy

malignancy of endothelial cells that line small vessels Kaposi’s lesions

112
Q

HIV/AIDS: Kaposi’s Sarcoma, s/s

A

start /w initial “patch” (flat, pink, looks like bruise, symmetrical on both sides), turns to dark, violet or black plaques. Lesions can be anywhere in the body (inside or out) & are painful.

113
Q

HIV/AIDS: Kaposi’s Sarcoma, tx

A

Depends on clinical picture: radiation, chemo, cryotherapy, antiretroviral agent.

114
Q

HIV/AIDS: HIV encephalopathy, triad of s/s

A

Cognitive Dysfunction- inability to concentrate, decreased memory, impaired judgment, slower thinking
Motor Problems -leg weakness, ataxia, clumsiness
Behavior Changes- apathy, decreased spontaneity, social withdraw, irritability, hyperactivity, anxiety, mania, delirium

115
Q

Burn: Burn center triage criteria

A

Partial Thickness >10%,
Children burned and in a facility not specializing in peds
Potential or presence of airway or inhalation injury
Any % burn to hands, face, feet, perineum, major joints
Significant pre-existing disease
Circumferential burns
Burns with Associated injury
Suspected abuse
Third degree burns
Electrical burns, inc lightning
Chemical burns

116
Q

Burn: deep full thickness

A

extends beyond skin- damages muscle, bone, tendons.
Wound is blackened, sensation absent
Early excision and grafting
Amputations possible

117
Q

Burn: lab used to monitor muscle damage

A

serum CK

118
Q

Burn: Burn injury zones

A

Zone of Coagulation: Central area of burn wound. Coagulation necrosis of cells
Zone of Stasis: surrounding center, injured cells may remain viable.
Zone of Hyperemia: minimal injury, may fully recover

119
Q

Burn: Fluid resuscitation formula

A

Thermal or chemical:
2mL IVF x wt in kg x % body burned(TBSA)
Electrical
4 ml IVF x wt in kg x % body burn.

120
Q

Burn: output monitoring

A

0.5ml/kg/hr minimum
electrical- 75mL/hr

121
Q

ARDS: PaO2/FiO2 Ratio

A

Example PaO2 92/ FiO2 21%(.21) = 438 Great!

122
Q

ARDS: ABCDE

A
  • Awakening and spontaneous
  • Breathing trial
  • Coordination
  • delirium
  • early mobility
123
Q

TBI: ICP

A

Cerebral perfusion pressure (CPP)
MAP – ICP = CPP
Goal in TBI = CPP 50 – 70 mmHg (best 70-80)

124
Q

TBI: GCS

A

Eyes- 4
verbal- 5
motor strength- 6

125
Q

TBI: assessing reflexes

A

Occulocephalic Reflex (Doll’s Eyes) + reflex: eyes move opposite of head position

Vestibulo-Ocular Reflex (Cold Calorics)
Eyes deviate towards cold, then nystagmus

341 (2 decks)

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