Final Exam Flashcards
medicare hospice-benefit criteria
Terminal illness
hospice interdisciplinary team
physician nurse case manager dietary counselor medical social worker bereavement counselor
double effect
primum non nocere
explains permissibility of action that causes harm as side effect of promoting good end
administration of opiods
PO preferred
avoid IM
merperidine
bad drug
toxic metabolites
avoid
constipation
bulk laxatives NOT recommended methynaltrexone stimulant laxatives enemas prevention
methynaltrexone
opiate antagonists that cannot x BBB
very $
dyspnea
Tx underlying cause
systemic opioids (nebulized may or may not be effective)
basics (position, O2, CPAP, CiPAP)
Nausea types
cerebral Cx
vestibular
chemo-trigger zone
GI
cerebral Cx nausea
causes: emotional stress, CA, or pain
Tx: Dexamethasone
counseling
anti-anxiety, anti-depressants, and opioids
vestibular nausea
cause: infection, motion sickness, CNVIII tumor
Tx: abx, anticholinergics, antihistamines
chemo-trigger nausea
causes: drugs, uremia, electrolyte imbalance
Tx: find underlying cause, 5-HT3 antagonists
GI nausea
causes: obstructional, gag reflex, irritation/distention
Tx: removing inciting agents, anti-inflammatory agents, anticholinergics, octreotide
Benzos and delerium
can have paradoxical exacerbation of terminal delirium
evaluating foreign bodies in wounds
x-ray: stones, metal, glass
CT, US, or MRI: organic material
cleansing wounds
tap or saline
avoid iodine and hydrogen peroxide
anesthetizing
25g or smaller
when should you seek surgical consult
deep wounds of hands/feet
full thickness laceration of eyelids, lip, or ear
lacerations involving nn, aa, bones, or joints
penetrating wounds of unknown depth
severe crush injuries
severely contaminated wounds requiring placement of drain
wounds leading to a strong concern about cosmetic outcome
non-absorbable sutures
silk nylon polypropylene cotton stainless steal
silk sutures
lowest tensile strength
rarely used
nylon
cheap
high tensile strength
hard to tie
polypropylene
high tensile strength
slippery- need extra knots
good for accommodating wound swelling
blue
absorbable sutures
catgut fast absorbing catgut polyglactin 910 poliglecaprone polyglycoic acid
catgut
only retains tensile strength for 5-7 days
chormic- delayed absorption time 10-14 dyas
lacerations in oral mucosa
fast absorbing catgut
good for epidermal suturing, especially facial lacerations
dissolves in 4-6days
polyglactin 910
lubricated braided synthetic
significant tensile strength for 3-4wks
complete absorption in 60-90 days
ideal for subQ
poliglecaprone
monofilament w/easy handling and less chance of infection
facial lacerations closed w/subcuticular running stiches
tensile strength lost my 21 dyas
polyclycoic acid
braided polymer
less reactive then gut sutures
50% of tensile strength left at 25days
high friction coefficient- binding and snagging when wet
polyclycoic acid
braided polymer
less reactive then gut sutures
50% of tensile strength left at 25days
high friction coefficient- binding and snagging when wet
interrupted stiches
easy
best for wounds that are jagged/irregular
continuous stiched
aka baseball stich
better for cosmetic results
subcuticular technique
ideal for low-tension, cosmetically important areas
vertical mattress
best for everting wound edges in anatomical locations which tend to invert
horizontal mattress
best for high yield tension wounds or wounds w/fragile skin
tissue adhesive
octylcyanoacrylate/dermabond
low tensile strength, cannot be used in high tension areas (joints)
cannot be used in moist areas
CI for tissue adhesive
higher risk for poor healing
contaminated wound
complex/jagged wounds
excisional Bx
L 3-4x W
face suture removal
3-5days
scalp suture removal
7-10 days
arms suture removal
7-10days
trunk suture removal
10-14days
legs suture removal
10-14days
hands/feet suture removal
10-14 days
palms/soles
14-21days
MSE
LOL AMEN level of consciousness orientation language attention memory executive fnx dominant hemisphere
attention
digit span, speeling, months/days forward/backwards
lack of attention may indicate delirium
executive fnx
verbal fluency similarities proverbs estimates list items in category (normal >20, dementia
gerstmann syndrome
apraxia acalculia agraphia cannot determine L/R cannot distinguish individual fingers damage to angular gyrus
anosognoisa
inability to recognize disability
CNIII
if lesion in CNS will spare pupil
CNIV
superior oblique
test by having pt look down andin
rhomberg
better for testing DCML rather then cerebellum
functionally illiterate
21%
moderately illiterate
25%
5th-8th grade reading level
cannot use bus schedule
literate
8th grade reading level
erythema toxicum
common
small blotchy erythematous areas w/raised yellow/white center
usually first 10days of life (up to 4wks)
harmless, no Tx
atopic dermatitis
diaper area spared
acute erythema, scaly, itchy
Tx w/topical steroids, antihistmaine, moisturize immediately after shower
HSP
systemic vasculitis of small cessels palpable purpura may present w/abdominal pain, rash, and arthritis acute glomerulonephritis HTN uncommon
benign murmurs in kids
low-pitched, non-tubulant, low velocity
stills
venous hum
stills murmur
heard at tricuspid post
best w/bell
decrease or disappear w/valsalva
venous hum
low pitched continuous murmur made by blood returning from great vv to heart
bell
PDA
G>B
more common in premies, NRDS, genetic d/o
small usually asymptomatic
large PDA
bounding pulse, murmur tachypnea poor feeding habits SOB sweating when feeding tiring easily poor growth
Tx of PDA
indomethacin or surgery
croup
steeple sign- subglottic narrowing of trachea
viral
Tx w/oral steroids or nothing if mild
if stridor present at rest add epi inhaler
foreign body
common cause of chronic cough or u/l nasal discharge
fowl smell
labial adhesion
Tx- mechanical seperation w/ointment estrogen cream (premarin) if needed if severe surgery
simple febrile seizures
last seconds-10min
followed by post-ictal period up to 30min
complex febrile seizures
longer then 15min
just one part of body
occurs again w/in same illness
hand-foot-mouth disease
coxackie A16
preschoolers
highly contangious
prodrome 1-2 days before rash
painful, shallow, yellow ulcers surrounded by red halos
oral lesions only- called herpangina
exanthema-rash on palmar, plantal, interdigital hand and foot +/- buttocks
erythema infectiosum
aka 5th disease
parvovirus B19
slapped cheeks
dangerous for 1st trimester-> hydrops fetalis
rocky mountain spotted fever
rash begins distally and moves centripetally
normal CSF pressure
7-30
LP
below L2
use short bevel
xanthochromic
slight yellow color of CSF d/t old blood
cloudy CSF
> 200 WBC/cc
or
400 RBC/cc
monocytes in CSF
indicates chronic issue
glucose in CSF
lags behind blood glucose by 1 hr
should never ben
protein
should be
T1
white matter brighter then gray
fluid dark
fat bright
T2
gray matter brighter then white
fluid bright
fat and calcification dark
T2
gray matter brighter then white
fluid bright
fat and calcification dark
MRI
not as good as CT for acute stroke
CT best for
acute cerebral bleeding
abscesses
and ALL fractures
