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Adult Care 1 > Final Exam > Flashcards

Final Exam Flashcards

1
Q

Sepsis Order

A

SIRS, Sepsis, Spetic Shock, MODS

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2
Q

SIRS Criteria

A

Must have two of the four
-body temp >100.5 or <96.8
-heart rate >90
-RR >20 or PaC02 <32mmHg
-leukocyte count >12,000 or <4,000

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3
Q

Sepsis

A

SIRS + Confirmed infection
-causes blood vessels to leak

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4
Q

What does Sepsis cause

A

hypotension
-because fluid is leaking
(decreased urine, increased HR+RR)

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5
Q

DIC (Disseminated Intravascular Coagulation)

A

clots using all bleeding factors and leads to the formation of small clots
-increased lactic acid and blood glucose
-confusion
-all tissue becomes hypoxic

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6
Q

Septic Shock

A

Sepsis + Hypotension
-oxygen exchange is not meeting cellular function
- serum lactate >2mm
-require vasopressor

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7
Q

Warm Shock (Comp)

A

(phase 1) EARLY
they can look better, but arent
warm extremities
increased HR, RR
decreased urine

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8
Q

Cold Shock (uncomp)

A

(Phase 2) LATE
pulling blood from vital organs
cold extremities
low cardiac output
organ dysfunction and failure (irreversible)

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9
Q

MODS

A

Organ Failure
two or more organs w/ dysfunction
hypotensive despite treatment
uncontrolled bleeding
cold and pale skin, cyanosis

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10
Q

Sepsis Risk Factors

A

immunocompromised, central lines, open wounds, malnutrition, DM, transplants, alcoholism, > 80 yo

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11
Q

qSOFA (quick sequential organ failure assessment)

A

alerts you pt needs more surveillance
1- Hypotension systolic <100mmHg
2- Altered Mental Status
3- Tachypnea RR>22
Score >/= 2 - risk of poor outcome

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12
Q

Sepsis Labs

A

WBC increased
Platelets decrease
serum lactate increased
procalcitonin increased

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13
Q

Sepsis 1 Hour Treatment Bundle

A

1- measure lactate
2- obtain blood cultures
3- Admin broad spectrum antibiotic
4- begin rapid 30mL crystalloid
5- apply vasopressors (hypotensive)

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14
Q

P Wave

A

Atrial Depolarization (contraction)

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15
Q

QRS Complex

A

Ventricular Depolarization (Contraction)

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16
Q

T Wave

A

Ventricular Repolarization (relaxation of ventricles)

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17
Q

PR interval

A

0.12- 0.20

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18
Q

QRS Interval

A

<0.10

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19
Q

QT Interval

A

<0.44

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20
Q

ECG box measurements

A

single block .04
5 blocks 0.2

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21
Q

QRS Measure

A

must be 6 boxes for measuremnts
multiply by 10

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22
Q

Heart Conduction

A

SA Node>AV Node>bundle>fibers

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23
Q

Heparin monitor

A

aPTT
daily and 6hr after admin

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24
Q

Warfarin monitor

A

aPTT w/ INR

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25
Q

Heparin Antidote

A

protamine sulfate

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26
Q

Warfarin Antidote

A

Vitamin K

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27
Q

DVT

A

sudden onset pain

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28
Q

Sepsis Glucose Level

A

140-180

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29
Q

Normal Sinus

A

60-100

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30
Q

Sinus Bradycardia

A

> 60
assess 4 hemodynamic compromise
treat underlying cause
medications
pacing

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31
Q

Sinus Tachycardia

A

> 100
assess s/s low cardiac output
treat underlying cause
medications

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32
Q

Beta Blockers on Heart

A

blocks the release of adrenaline and noradrenaline
reduces the force of blood pumping
lowers blood pressure

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33
Q

DVT/PE Risk Factors

A

-Age
-immobility
-injury/surgery
-smoking
-cancer

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34
Q

DVT/PE Diagnostics

A

Venous Duplex Ultrasound
doppler
venogram
MRI

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35
Q

Non-surgical interventions for DVT/PE

A

-early ambulation
-exercise
-compression stocking
-well hydration

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36
Q

DVT Therapeutic INR

A

1.5-2

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37
Q

Warfarin pt education

A

no vitamin k (leafy greens)
cholesterol within range

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38
Q

ABG Interpretion

A

Vomiting (Alkalosis)
Diarrhea (Acidosis)

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39
Q

Chest Xray

A

No metal
No pregnancy
tell them to hold breath

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40
Q

thoracentesis

A

-obtain consent
-will be sitting upright
-nurse at bedside w/ ultrasound
-don’t remove too much (1000ml)

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41
Q

Bronchoscopy

A

consent, anticoagulant use
NPO 4-8 hrs prior
montior gag reflex post

42
Q

methemoglobinemia

A

become unresponsive to oxygen therapy which leads to hypoxia
most likely from benzocaine

43
Q

rigid bronchoscopy

A

General anesthesia
can use benzocaine or lidocaine

44
Q

Pulmonary Function Test

A

determine lung function + breathing
dont smoke 6-8 hrs prior
no bronchodilators 4-6 hrs prior
performed during exercise
nose clip to prevent air escape

45
Q

Pneumothorax

A

air in pleural space
chest pain, SOB, deviation of midline, subcutaneous emphysema

46
Q

tension pneumothorax

A

medical emergency
air trapped and completely collapses lungs
respiratory distress, cyanosis, distended neck veins

47
Q

hemothorax

A

blood in the pleural space
simple <1000mL Massive >1000mL
can have both pleural and hemothorax

48
Q

pleural effusion

A

fluid in pleural space
chest xray, CT
thoracentesis is treatment

49
Q

Flail Chest

A

3+ rib fractures in 2 or more places
paradoxical chest movement
impaired gas exchange
monitor I+O, high fowlers

50
Q

Pulmonary Contusion (bruising)

A

asymptomatic at first
bruise to the lung tissue caused by trauma
impaired gas exchange

51
Q

Chest Trauma Prioritization

A

ABC’s
ensure oxygen
monitor for shock
chest tube malfunction

52
Q

Atelectasis

A

Collapsed Lung
-IS, Breathing exercises, ventilators, lung expansion therapy, bronchodilators

53
Q

NIPPV (noninvasive positive pressure ventilation)

A

noninvasive support w/o intubation
positive pressure keeps alveoli open
ONLY for alert pt
watch for skin breakdown

54
Q

CPAP (continuous positive airway pressure)

A

increases intrathoracic pressure
1 continuous pressure
pressure in alveoli can help push fluid out

55
Q

BiPAP (bilevel positive airway pressure)

A

different level on inspiration and expiration
prevent intubation

56
Q

PEEP (positive end exploratory pressure)

A

keeps alveoli open, doesnt allow them to close

57
Q

Chest Tube

A

consent
removes air, fluid, blood
restores intrapleural pressure ( lung expansion)
sterile water for troubleshooting

58
Q

chest tube for pneumothorax

A

2nd intercostal space

59
Q

chest tube for hemothorax

A

5th intercostal space

60
Q

Drainage Collection Chamber

A

water seal, drainage collection, suction control
notify if >70 mL

61
Q

wet suction

A

controlled suction based on amount of fluid

62
Q

dry suction

A

controlled by dial

63
Q

Water Seal Chamber

A

stops air from returning to lungs
gentle bubbling expected
(excessive=air leak)
(none=troubleshooting)

64
Q

tidal movement

A

expected movement of water in water seal chamber

65
Q

Suction Chamber

A

monitor level 24cm
refill every shift
check hourly
sterile water at bedside

66
Q

Chest Tube Complications

A

Air leak (continous bubbling)
disconnected
pulled out (cover w dry gauze and notify provider)
monitor for tension pneumothorax

67
Q

chest tube nursing management

A

premed 30 mins prior
suture removal kit
deep breaths and bear down
chest x ray post
monitor drainage and wound for infection

68
Q

hypothalamus

A

control center
makes ADH+Oxytocin

69
Q

pituitary gland

A

master gland

70
Q

thyroid gland

A

wraps around trachea
regulates bodys metabolism (t3+t4)

71
Q

parathyroid

A

regulates body calcium level

72
Q

adrenal glands

A

located above kidneys
cortex(outside) steriods
medulla (inside) catecholamines (fight/flight)

73
Q

Gonads

A

ovaries/testies

74
Q

DM Risk Factors

A

Family history
African Americans
High birth weight babies
PCOS
BMI >25

75
Q

Type 1 DM

A

Beta Cell destruction
autoimmune
insulin dependent
onset <30 yo
thirst,hunger, increased urine, weight loss

76
Q

Type 2 DM

A

Beta Cell dysfunction
insulin required for 20-30%
onset any age
frequently no s/s: thirst, fatigue, blurred vision
metabolic syndrome 60-80%

77
Q

Metabolic Syndrome

A

increases risk of type 2 DM
Must Have 3 for Diagnosis
1- abdominal obesity >40 male >35 female
2- hyperglycemia
3- hypertension
4- hyperlipidemia

78
Q

Normal Blood Labs

A

A1C 4-5.7%
fasting glucose 74-100
glucose tolerance <140

79
Q

Prediabetes Blood Labs

A

A1C 5.7-6.4%
fasting glucose 100-125 mg
glucose tolerance 140-199

80
Q

Diabetes Blood Labs

A

A1C >/= 6.5%
fasting glucose >/= 126
glucose tolerance >/= 200

81
Q

Metformin

A

reduces production of glucose in liver
slows carb absorption
increases sensitivity to insulin
contraindicated in gastroparesis
take vitamin b12 and folic acid
no alcohol (lactic acidosis)

82
Q

Rapid Acting Insulin

A

Humalog, premeal
onset: 10-30 min
peak: 1-3 hrs

83
Q

Short Acting Insulin

A

Regular Insulin, premeal
onset: 30 min
peak: 1-5hr

84
Q

U100

A

only admin IV
U500 never admin IV

85
Q

Intermediate Acting

A

NPH
onset: 60-120 mins
peak: 6-14hr

86
Q

Long Acting

A

insulin glargine
usually 1-2 every 24hr
no peak/trough
onset: 60-120 min

87
Q

insulin preferred injection site

A

abdomen
45-90 degrees (90 for obese)

88
Q

Hospitalized/Sick Pt DM

A

keep glucose between 140-180
monitor BG every 2-4 hours
test urine for ketones
increase fluid intake

89
Q

15g CHO

A

glucose tablets
120 mL fruit juice/ soda
5 hard candies
4 cubes/tsp of sugar
1tbs honey/syrup

90
Q

hypoglycemia treatment

A

15-15 Rule
BG <70=15g CHO
BG <50=30g CHO

91
Q

HHS (Hyperosmolar Hyperglycemic State)

A

most common in type 2 DM (undiagnosed)
slow onset
hyperglycemia, altered mental status
produce just enough to avoid DKA
Glucose >600
urine ketones negative
pH >7.4, HCO3 >20

92
Q

DKA

A

sudden onset
causes by stress,infection, or no insulin
s/s: kussmaul resp, fruity breath, nausea, abd pain, dehyrdation
glucose >300
postive urine ketones
pH <7.35, HCO3 <15

93
Q

Hypoglycemia

A

cool,clammy,sweaty skin
no dehydration
nervous,irritable, confusion, decrease LOC
weak,blurred vision, tachycardia, palpitations
glucose <70
negative ketones

94
Q

hyperglycemia

A

warm, dry skin
dehydration
kussmaul- fruity breath
stuporous, obtunded, coma
varies with DKA and HHS
> 180mg/dL
Positive ketones with DKA

95
Q

Diabetic Retinopathy

A

Changes of vessels in eye
vision loss

96
Q

diabetic neuropathy

A

loss of feeling in feet

97
Q

diabetic nephropathy

A

kidney dysfunction
-control blood glucose+BP
ACE/ARB’s ( decrease BP)
Albuminuria

97
Q

footcare education

A

wear shoes, lotion not between toes
do not cut toenails
wash in warm water

98
Q

Negative feedback loops

A

when a body receives signal, it either tells body to secrete more or less hormone

99
Q
A
99
Q

Hypopituitarism

A

selective: one hormone is deficient
panhypopituitarism: two or more
deficiencies of ACTH and TSH are most life threatening
treatment: lifelong hormone replacement therapy
risk factors: TUMORS
Primary: direct problem w pituitary gland
Secondary: orginaties in hypothalamus

Adult Care 1 (3 decks)

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