Final Exam Flashcards
What are the pain receptors?
Nociceptors
What are the four types of pain?
Acute, chronic, nociceptive, neuropathic
What are symptoms of acute pain?
Tachycardia, hypertension, anxiety, diaphoresis, muscle tension
Which nervous system response is activated in acute pain?
Sympathetic nervous system
How is chronic pain defined?
Pain lasting longer than 3 months
Symptoms of chronic pain?
depression and fatigue
Define nociceptive pain?
damage or inflammation of the skin
What are the two types of nociceptive pain?
Somatic and visceral
What are pain features of somatic pain?
Sharp, swelling, cramping, aching, gnawing, visible bleeding, localized
What are pain features of visceral pain?
Dull, deep, squeezing, pressure, aching, gnawing, visible bleeding, localized
Which type of pain can cause referred pain?
Visceral
What is neuropathic pain?
damaged pain nerves
How does neuropathic pain feel?
shooting pain or numbness and tingling
What is breakthrough pain?
exacerbation of already present pain
Three causes of breakthrough pain?
incident, idiopathic, end of dose medication failure
How does the gate control theory work?
When large nerves are stimulated there is enough room only for them to reach the brain, which closes the pain stimulus.
What are risk factors for pain?
age, gender, obesity, sedentary lifestyle, stress/anxiety, high risk activities, cultural beliefs
Which pain scale is used for children 6 months-5 years of age?
FLACC
Which pain scale is used for children?
FACES
Which pain scale is used for newborns?
CRIES
Risk factors of injury and poor healing?
osteoporosis, bone cancer, lack of vitamin D, calcium and phosphorous, aging, lifestyle choices
Ways to prevent injury and poor healing in fractures?
education, safe equipment, exercise, osteoporosis screening, safe living environment, fall prevention
What is the BROKEN acronym for symptoms of a fracture?
Bruising w/ pain and swelling, Reduced movement, Odd appearance, Krackling sound (crepitus), Edema and erythema, Neurovascular impairment
What is a complication of fractures?
Compartment syndrome
What is the treatment for compartment syndrome?
remove tight cast or fasciotomy
What are the 6 p’s of compartment syndrome?
pain, pallor, paresthesia, paralysis, pulselessness, poikilothermia
What are the 3 precursors for DVT?
- venous stasis
- injury to blood vessel walls
- altered blood coagulation
What are measures of prevention for dvt’s?
early immobilization
early ambulation
TEDs and sequential compression devices
anticoagulants
What are symptoms of a FES?
neurological dysfunction
Pulmonary insufficiency
petechial rash
what are risk factors for FES?
long bone fractures
major trauma
manifestations of FES?
dyspnea, hypoxemia, seizure, restlessness
What is the emergency severity index?
A process of assessing patients to determine management priorities
What is the nonurgent triage system?
Episodic or minor injury or illness in which treatment may be delayed for several hours without increased morbidity
What is the urgent triage system?
Serious illness or injury that is not immediately life threatening
What is the emergent triage system?
Potentially life threatening injuries or illnesses requiring immediate treatment
What is important to do in the primary survey while triaging patients?
ABCDE
What does ABCDE stand for?
Airway, breathing, circulation, disability, exposure
how do you assess disability during the ABCDE phase of the primary survey assessment?
AVPU, GCS;
How do you complete the exposure portion of the primary survey?
undress the patient
What is included in the secondary survey assessment?
Health history, HTT, reassessing the patient, arterial lines, catheters, splinting, wound care
What are priority emergency measures?
clear, establish and maintaining an airway
What are the different possible types of trauma?
Multiple, abdominal, crush injury, heat stroke, thoracic and burns
What is multiple trauma and an important consideration?
life threatening injury to 2 or more organ systems; c-spine precautions
What is important to know about abdominal trauma? how is it defined?
how the injury occurred and whether it was penetrating or nonpenetrating; blood loss in abdominal cavity
What are the two types of heat strokes?
exertional and non-exertional
manifestations of a non-exertional heat stroke?
102.5-105 degrees F; hot, dry, tachy, hypotensive
Who is at risk for a heat stroke?
those not used to heat, the old or young
How can you cool a patient that is having a heat stroke?
with cool sheets or towels, ice to the groin, cold water bath
Ice placement for a heat stroke?
Neck, armpits, groin
What are the four types of pneumothorax?
Spontaneous, Traumatic, Tension, Hemothorax
Features of a traumatic pneumothorax?
penetrating or nonpenetrating
Features of a tension pneumothorax?
fully collapsed lung; tracheal deviation, airway compromise
what is a hemothorax?
blood in the chest cavity
Which pneumothorax has hyperresonance on percussion?
pneumothorax
Which pneumothorax has dull percussion?
hemothorax
Diagnostic measures for pneumothorax?
ABG’s, chest xray
Additional diagnostic/treatment tool used for a hemothorax?
thoracentesis
considerations for nurses to follow regarding procedures/treatment for pneumothorax?
Chest tube placement O2 therapy Max ventilation=high fowlers=90 degrees sedatives analgesics emotional support monitor chest tube drainage
What are complications of pneumothorax?
decreased cardiac output
respiratory failure
flail chest
How often should you reassess chemical burns
24, 72 hours and 7 days after
How is severity of chemical burns determined?
by the strength of the concentration and amount of skin exposed
Which chemicals should be brushed off the skin and not washed?
lye and white phosphorous
What can electrical burns lead to?
cardiac, respiratory arrest, limb amputation
What are things a nurse must do for thermal cold injuries?
Monitor ABC’s, remove wet clothing and provide support
What are active rewarming techniques?
cardiopulmonary bypass, warm fluid admin, warm humidified oxygen, warm peritoneal lavage
What are passive rewarming techniques?
warm blankets
over the bed heaters
What are potential complications when cold blood returns to the extremities?
Because there will be a high lactic acid, it can cause cardiac dysrhythmias and electrolyte disturbances
What are risk factors for thermal cold injuries?
old people, babies, homeless, trauma, alcohol
Manifestations of thermal cold injuries?
white or mottled skin
How should the rewarming process be controlled?
Rapid at 37-40 degrees C and in a circulating bath for 30-40 minutes
what should you NOT do for thermal injuries?
massage the area or let the patient walk if the injuries are on the feet
What are features of minor heat thermal injuries?
treated at scene, less than 2% full thickness, less than 10% partial thickness
What are features of moderate heat thermal injuries?
Treated at the scene and transported to a burn center; 2-10% total body surface of full thickness burns, 15-25% partial thickness burns
What are features of major heat thermal injuries?
Emergency treatment at closest facility and then transfer to a burn center; greater than 10% of body surface for full thickness, greater than 25% partial thickness burns OR are over age 60, have cardiac/pulmonary/endocrine comorbidities, electrical burns, inhalation injury, burns to eyes, nose, face, hands, feet or perineum
What do superficial burns look like?
pink, red, no blisters, mild edema, painful, sensitive to heat (ex. sunburn)
Damage to epidermis
What do superficial partial thickness burns look like?
pink, red, blisters, mild-moderate edema (Ex. scalds)
Heal within 2-3 wks
Damage to epidermis and part of dermis
What do full thickness burns look like?
red-white, blisters are RARE, moderate edema, eschar soft and dry, scarring likely, grafting may be needed (ex. flames)
Heals 2-6 wks
Epidermis and Dermis
What do deep full thickness burns look like?
no pain, no blisters, severe edema, hard eschar, scarring, grafting (ex. high voltage)
Extends down to nerve tissue/muscles/bones
Heals in wks to months
Rule of 9’s formula:
Head/neck: 9% Upper limbs: 9% each Trunk: 36% Genitalia: 1% Lower limbs: 18% each
What are secondary complications of burn injuries?
pneumonia, PE or pneumothorax, hypotension, tachycardia, decreased cardiac output
What are the systemic complications of burns?
hemodynamic instability because of volume loss and fluid shifts Impaired respiratory function Hypermetabolic response Major organ dysfunction Sepsis related to infection
What are signs of smoke and CO2 inhalation?
singed nasal
How long should a patient with airway compromise after smoke and CO2 inhalation be monitored?
24-48 hours because the body can still have a reaction
What are s/s of smoke and CO2 inhalation?
hoarseness, wheezing, brassy cough, drooling
What is the hypermetabolic response related to burn injuries?
increase of nutritional demands, increased heat production, increased glucose use, increased fat wasting
What is the peak time for a hypermetabolic response in burns?
7-17 days post injury
What may patients need that are having a hypermetabolic burn response?
enteral or parenteral nutrition
What can major organ dysfunction lead to?
renal failure
what is an autograft?
using own skin as a skin graft
What is a homograft?
skin from a cadaver
What is a heterograft?
skin from a different species
When can an escharotomy only be completed?
when there is fluid stabilization to limit fluid loss
Calculation for thermal or chemical burn resuscitation?
2mL LR x kg X percent total body surface area partial thickness or greater burn
Calculation for electrical burns?
4mL LR x kg x percent total body surface area partial thickness or greater burn
how much fluid volume should be administered in the first 8 hours of post burn injury (from the time of burn)
1/2 of the total volume
how much fluid volume is administered in the remaining 16 hours post burn injury?
the other 1/2 of total volume
What should an adult’s urine output be for fluid resuscitation?
0.5-1mL/kg/hr
What should a child’s urine output be for fluid resuscitation?
1ml/kg/hr
Important consideration for fluid resuscitation?
getting hourly I/O’s
What labs are important to grab for burn patients?
CBC, serum electrolytes, BUN, ABG’s, glucose levels, liver enzymes, urinalysis
What are physiologic responses to shock?
hypoperfusion of tissues, hypermetabolism, activation of the inflammatory response
What does the activation of the homeostatic response activate?
An increased sympathetic response: increased HR, BP, cardiac contractility and output; decreased respiratory rate to increase O2 saturation; increase in catecholamines and cortisol to provide glucose; RAAS activation to reabsorb sodium and water, increased preload and decreased urine output
why are catecholamines and cortisol increased during shock?
to increase glucose metabolism
What is the goal of the physiologic responses of shock?
restore tissue perfusion and oxygenation
Why is the RAAS system activated in physiologic response to shock?
to provide reabsorption of sodium and water, increase the preload and decrease afterload
What are the cellular effects of shock?
cell swells, membrane becomes permeable; fluid and electrolytes seep from and into cell
MAP required to maintain adequate tissue perfusion?
65 minimum
What is the MEWS (Modified Early Warning System)?
A scoring system used to determine severity of illness a person has. The higher the score the worse condition the patient is in. This determines length of ICU state and likelihood of death. Scores are given on a 0-3 scale for each tested area.
What is tested on a MEWS?
RR, HR, BP, AVPU, Temp, Hourly urine
What type of fluids should be used for fluid replacement of shock patients?
Crystalloid and colloid solutions
What are important management considerations for shock patients?
Fluid replacement, nutrition support, intravascular support
What is the crystalloid you use for fluid replacement of shock patients?
0.9% Sodium chloride and Lactated Ringers
What is the expensive colloid requiring human donors that is used for fluid replacement of shock patients? What can it cause?
Albumin; heart failure
How should vasoactive medications be given to patients and how often should you check vital signs and why?
central line if possible; every 15 minutes because vasoactive medications cause an increased HR
What effects do vasoactive medications have? When are they given?
support hemodynamic status, stimulate SNS; when fluid replacement is not working
What drug classes are vasoactive agents?
Inotropic & vasopressor agents, vasodilators
Why is nutrition therapy important for shock patients?
It prevents further catabolism
What does glutamine do for shock patients?
help increase protein stores
What do vasodilators do?
reduce preload and afterload, reduce O2 demand of heart
What do vasopressors do?
Increase BP by vasoconstriction
What do vasopressors do?
Increase BP by vasoconstriction
Why do you give H2 receptors to shock patients?
to reduce ulcer formation
What are the stages of shock?
compensatory, progressive and irreversible
How soon should treatment be initiated for shock patients?
within 3 hours
What happens during the compensatory stage of shock?
SNS activates and catecholamines release, normal BP and increased HR, increase in contractility and vasoconstriction to maintain output, blood is shunted to important organs, anaerobic metabolism occurs which increases RR resulting in respiratory alkalosis
vital signs during compensatory stage?
normal BP, HR >100 bpm, RR >20 breaths/min, CO2 <32, clammy skin, decreased urine output, confusion, respiratory alkalosis
what is the acid base balance for compensatory shock?
respiratory alkalosis because of elevated respiration rate
What is the acid base balance for progressive shock?
metabolic acidosis because RR are decreased and body cannot get rid of excess CO2
Acid base balance of irreversible shock?
Profound acidosis
vital signs during progressive shock?
systolic <90, MAP <65, requires fluid resuscitation to support BP, HR >150 bpm, Rapid shallow respirations, paO2 <80, PaCO2 >45, mottled skin, urine output <0.5 ml/kg/h, lethargic, respiratory acidosis
vital signs during irreversible shock?
mechanical or pharmacologic support; erratic HR, requires intubation, jaundice, anuria–requires dialysis, unconscious, profound acidosis
What are the classifications of shock?
Cardiogenic, hypovolemic, obstructive, distributive
What are the three types of distributive shock?
septic, neurogenic, anaphylactic
What are things that can cause cardiogenic shock?
Acute Coronary Syndrome/ischemia, Myocarditis, Congenital Heart Disease, Toxins, Sepsis
What are things that can cause hypovolemic shock?
hemorrhage, dehydration
What are things that can cause obstructive shock?
pulmonary embolism, tension pneumo, cardiac tamponade
Which type of shock causes the heart rate to decrease?
neurogenic shock
What are causes of external fluid losses in hypovolemic shock?
trauma, surgery, vomiting, diarrhea, diuresis, diabetes insipidus
What are causes of internal fluid shifts with hypovolemic shock?
hemorrhage, burns, ascites, peritonitis, dehydration, necrotizing pancreatitis
goal of treating hypovolemic shock?
treating fluid loss and underlying causes
Nursing management of hypovolemic shock?
administering blood, fluids safely; implementing other measures
Medical management of cardiogenic shock? what is the primary goal?
correcting underlying causes, initiation of first line treatment; primary goal is to treat the oxygenation needs of the heart muscle to help improve a shock state
What are first line treatments for cardiogenic shock?
oxygenation, pain control, hemodynamic monitoring, lab marker monitoring, fluid therapy, mechanical assist devices
Pharmacologic therapy for cardiogenic shock?
dobutamine, nitroglycerine, dopamine, vasoactive and antiarrhythmic medications
How does circulatory/distributive shock take place?
the blood vessels dilate and blood cannot return to the heart properly. the three types are septic, neurogenic and anaphylactic shock
What type of fluid replacements are required for circulatory/distributive shock?
0.9% NS, lactated ringers, hypertonic solutions (3% hypertonic)
What should the nurse monitor for when patients are receiving large volumes of isotonic fluids?
pulmonary edema because of circulatory overload
Treatment for multiple organ dysfunction syndrome?
controlling initiating event, promoting adequate organ perfusion, providing nutritional support
What can multiple organ dysfunction syndrome lead to?
DIC (disseminated intravascular coagulation)
What are the cardinal movements of birth?
descent,
What does the mnemonic COLLAPSED stand for for pneumothorax?
Chest pain Overt tachycardia and tachypnea Low BP Low SpO2 Absent lung sounds on affected side Pushing of trachea to unaffected side Subcutaneous emphysema, Sucking sound with open pneumo Expansion of chest rise and fall unequal Dyspnea
What is a coping mechanism?
how stress and anxiety is handled; positive: relaxing negative: drinking, smoking
difference between defense and coping mechanisms?
Defense mechanisms: compensation, denial, displacement, dissociation, projection, rationalization, regression
defense mechanisms protect ourselves and we are not always aware of them
coping mechanisms are for events
what is compensation?
being bad in one area and focusing on your good area
What is denial?
subconsciously do not accept the reality; talking about hope when it is not possible
What is displacement?
redirection of angry or aggressive feelings onto something that is powerless
What is dissociation?
repression; subconsciously suppressing some painful or traumatic memories
What is projection?
unwanted thoughts or impulses projected onto someone else
What is rationalization?
distort the facts to justify something that is unacceptable
What is regression?
returning to an earlier method of behaving
What should a nurse say to a patient who is escalating?
SATA
validate the patient’s feelings (be empathetic), remain calm ourselves, speak in slow, soft voice, get them to verbalize the issue
How does delirium differ from dementia?
Acute onset, has an underlying cause that can be solved
Symptoms of delirium?
Confusion, irritation, sleep wake disturbances, disorganized thoughts, hallucinations/delusions
What is schizophrenia?
disorder that affects a persons overall thoughts, feelings and behavior
What causes schizophrenia?
high levels of dopamine causes positive symptoms; high levels of serotonin cause negative symptoms
What are the positive symptoms of schizophrenia?
delusions, hallucinations, disorganized thoughts, speech, behavior
What are the negative symptoms of schizophrenia?
flat affect, anhedonia, apathy, alogia (lack of speech), avolition (lacks motivation), asociality (ALL START WITH A’s PLUS FLAT AFFECT)
types of hallucinations?
visual, auditory and tactile
what are delusions?
belief in something that is not real; ex. paranoid delusions or delusions of grandiose
difference between hallucinations and delusions?
hallucinations are done by senses
delusions are beliefs
what is alogia?
poverty of speech; a negative symptom of schizophrenia
what drug class is used to treat schizophrenia?
antipsychotics
How do you treat a patient experiencing delusions or hallucinations?
Acknowledge the patient hears them, “that must be very scary to hear those voices, what are they telling you to do?” assess safety
who is at risk for suicide?
adolescents, older white males, mental illness, LGBTQIA, employment
risk factors for suicide?
unemployment, chronic illness, depression, financial troubles, low socioeconomic status, substance abuse, family history and PREVIOUS ATTEMPTS (highest risk)
what is the highest risk factor for suicide?
previous attempts
how to assess a suicidal patient?
ask are you thinking of harming yourself? then if they have a plan in place, which method they would use,
symptoms of a suicidal patient?
high energy level, giving things away, planning finances, saying things like “i don’t want to live anymore, i’m tired of this”, writing notes, searching for weapons, hoarding pills
when does a person begin experiencing alcohol withdrawal?
4-12 hrs after their last drink
symptoms of alcohol withdrawal?
tremors, diaphoresis, agitation, tachycardia, elevated BP, restlessness
how do you know when to initiate benzodiazepines for alcohol withdrawal?
MINDS protocol
treatment for alcohol withdrawal?
seizure precautions, benzos, emotional support, calm low stress environment, dim lights, do not close doors
nursing care for patients who have experienced sexual assault?
provide emotional support, give patient control over situation, ask if there is anyone they want with them and what order they want you to do things, SANE nurse
What is included in a rape kit?
vaginal swab, swab of skin, mouth, anus, nails, pictures of wounds and abrasions, medications, collect clothes, combing pubic hair
What is the order for caring for a sexual assault patient?
prophylactic meds
offer sti testing
physical exam
have pt describe what happened, provide emotional support
what symptoms may a person experience after sexual assault?
rape trauma syndrome (like PTSD)
denial, anger, fear
what is pyelonephritis?
Upper UTI located WITHIN the kidney
important considerations as a nurse for pyelonephritis?
it is caused by bacteria crawling up ureters
signs and symptoms
signs and symptoms of pyelonephritis? SATA
costovertebral flank pain, chills, high fever, UTI symptoms, N/V, pyuria, abd pain
diagnostics of pyelonephritis?
UA, WBC’s (CBC), urine cultures
treatment for pyelonephritis?
antibiotics; URINE CULTURE before abx
education for pyelonephritis prevention?
hydration, do not retain urine, void after sex, wipe front to back, finish abx course, no feminine hygiene sprays or douches
what is AKI?
injury to the kidney that can be reversed if caught on time
symptoms of AKI?
inability to concentrate urine, increased BUN and Creatinine (because these are metabolic waste), low GFR, buildup of nitrogenous waste, azotemia, uremia
What is azotemia?
increased BUN, decreased GFR
what does prerenal AKI mean?
AKI before reaching the kidney due to hypoperfusion
What does intrarenal AKI mean? what causes it?
AKI inside the kidney due to
What does postrenal AKI mean?
AKI after the kidneys stones, BPH
four phases of AKI?
onset, oliguria, diuretic, recovery
What happens during onset phase of AKI?
decreased urine output, asymptomatic
What happens during oliguric phase of AKI?
decreased urine output, edema, fluid retention, electrolyte imbalances, confusion, uremia, high BP, increased BUN/Creat, decreased GFR, high potassium, anemia, dry, itchy skin
What happens during diuretic phase of AKI?
urine output increases, GFR increases, other labs do not change yet
What happens during recovery phase of AKI?
GFR 70-80%, recovery
What acid base imbalance would be created from AKI?
metabolic acidosis
How do you treat AKI?
Fix underlying causes
What is renal calculi?
kidney stones
Symptoms of kidney stones?
renal colic (intermittent pain), flank pain, blood in urine
Diagnostics for kidney stones?
Xray, urinalysis
Treatment for kidney stones?
Increase fluids, pain medications, strain all urine, extracorporeal lithotripsy, laparoscopy
If a patient has hypercalcemia what will you instruct them to do?
stop intake of calcium
what is the primary cause of pneumonia?
inflammation reaction to infection in the lungs
Where will the infection be in the body in pneumonia?
exudate In the alveolar sacs
What is alveoli responsible for?
gas exchange
What happens to air in the affected alveoli in pneumonia?
the body is not getting oxygen to the rest of the body; gas exchange with the end result of hypoxemia takes place
risk factors for pneumonia?
recent surgery, elderly, immobility, immunosuppression, chronic conditions
risk factors for aspiration pneumonia?
stroke patients, feeding tubes, dysphagia, alcoholics, trach’d patients
how should patients be positioned that have feeding tubes?
sitting up during and after eating
what is community acquired pneumonia?
gotten in the community
What is hospital acquired pneumonia?
pneumonia occurs 48 hrs after hospitalization
manifestations of pneumonia?
crackles, pain upon inspiration, pleuritic pain, sharp pain in area of affected lung, referred shoulder pain, splinting (pressure to try and relieve pain), shallow breathing, fever, egophony, signs of consolidation, sputum production–rusty, blood tinged or purulent, cough, chills, cyanosis
diagnostic measures for pneumonia?
sputum culture, chest xray, ABG’s
prevention of pneumonia?
early ambulation, vaccination for high risk, incentive spirometer, coughing, deep breathing
what is RSV?
respiratory synctovial virus
What can RSV cause?
bronchiolitis
Age group most common to obtain RSV?
infants
How do you diagnose RSV?
nasal swabs
s/s of RSV?
nasal flaring, use of accessory muscles, decreased appetite, fever, grunting, crying, wheezing, retractions
treatment of RSV?
oxygen when sats drop below 90% consistently, suctioning, corticosteroids,
do we give antibiotics for RSV?
no because it is a virus
how is RSV spread?
droplet
prevention of RSV?
hand washing, vaccine only if high risk children under 2, position semi-fowler to fowler
what is ARDS?
acute respiratory distress syndrome that is classified by fluid on lungs; the difference between ARDS and pneumonia is ARDS is diffuse, pneumonia is localized.
patho of ARDS?
refractory hypoxemia preventing gas exchange in alveoli/ vq mismatching; intrapulmonary shunting of blood, stiff lung/not inflating, increased capillary permeability b/c of damage from fluid buildup
manifestations of ARDS?
cyanosis, crackles, increased HR, RR
how is ARDS diagnosed?
chest xray, abg’s
nursing management of ARDS?
low stimuli, decrease oxygen consumption, provide tpn/fluids, prone position, suctioning, chest physiotherapy
what does PEEP do?
keeps alveoli from collapsing; stands for positive end expiratory pressure
how do you assess if chest percussion and physiotherapy is needed or effective?
listen to lung sounds
what care should be given to patients who are on a vent?
pain medications or sedatives because paralytics do not decrease pain; frequent mouth care (chlorhexidine), positioning (prone or semi to high fowlers)
what is cholelithiasis?
gallstones caused by cholesterol in the gallbladder
negative consequences of cholelithiasis
obstruction of the bile duct which causes jaundice and increased bilirubin, pain, inability to digest food, steatorrhea (white or clay poop), dark TEA COLORED urine, itchy skin
diagnosis of cholelithiasis?
CT scan, ultrasound, ERCP
What is an ERCP?
dye is injected and visualized through a scope and xray to assess for gallstones and blockage of the bile duct
s/s of cholelithiasis?
epigastric pain after high fat meals, pain radiating to shoulder
what is peritonitis?
buildup of fluid in the peritoneal cavity
s/s of peritonitis?
board like abdomen, shiny belly, pain, no bowel sounds, peristalsis leading to paralytic ileus
what do we worry most about after a liver transplant?
infection
what is pancreatitis?
inflammation of the pancreas
s/s of pancreatitis?
extreme epigastric or periumbilical pain, pain radiates to back, n/v, guarding, tenderness, distention; can cause ARDS
what causes pancreatitis?
digestive enzymes are eating the pancreas
how do patients posture when they have pancreatitis?
knees to chest or sitting up
does n/v relieve pain of pancreatitis?
no.
what occurs in the body with pancreatitis?
decreased BP and increased HR, hyperglycemia, tachypnea
what electrolyte imbalances occur with pancreatitis?
hypocalcemia, hyperglycemia,
what is grey turner’s sign?
flank bruising
what is cullen sign?
belly button bruising
Labs drawn for pancreatitis?
Lipase, amylase (3x the upper normal limit)
what is HHS?
hyperglycemic hyperosmolality syndrome occurring from uncontrolled type II diabetes
risk factor for controlled type II diabetes and HHS?
being ill
s/s of HHS?
dehydration, 600+ BS, fluid excretion with glucose and water
difference between DKA and HHS?
DKA has ketones, HHS has large fluid loss and dehydration
tx for HHS?
fluid & electrolyte replacements, IV regular insulin
What is experienced more by patients with HHS versus DKA?
neuro manifestations because of cerebral dehydration
What disorders are included under ACS?
Unstable Angina
NSTEMI
STEMI
What is the pathophysiology of acute coronary syndrome?
Unstable plaque from atherosclerosis ruptures and causes thrombus which occludes vessel and leads to inflammation and ischemia and necrosis
Why does nitro relieve pain in unstable angina?
The vessel is not totally occluded
Diagnosis criteria for unstable angina?
pain not relieved by nitro, no EKG changes, no biomarkers
Diagnosis criteria for NSTEMI:
pain relieved by nitro, no EKG changes, elevated biomarkers
Diagnosis criteria for STEMI:
elevated biomarkers, ST elevation, symptomatic
What are the labs used to test for ACS?
Troponin I and T, CKMB, myoglobin
What are risk factors for ACS?
smoking, HTN, obesity, high cholesterol, lack of exercise, family hx, diabetes
What are types of reperfusion therapy?
PCI, CABG, thrombolytics (AKA fibrinolytics)
Why do you give a patient post MI a clear liquid diet?
To reduce the metabolic workload of digestion.
What happens in the heart with an anterior wall MI?
T wave inversion, elevated ST segment, abnormal QRS waves
What is BNP and why do we draw it?
A lab used to check for heart failure
Which age group is most at risk for heart failure?
75+
Which age group is most at risk for heart failure?
75+
How many body systems are involved in shock?
All of them
What are the body’s physiologic responses to shock?
Hypoperfusion of tissues, hypermetabolism, activation of inflammatory response
What is the primary source needed for cells to produce ATP?
glucose
What is the end product of anaerobic metabolism?
lactic acid
How is the clotting cascade activated?
By the inflammatory process
What happens when catecholamines release?
The adrenal medulla releases catecholamines (epi and norepi) to restore BP, increase HR and cause vasoconstriction
The kidneys secrete renin to activate the RAAS system to respond to hypoperfusion
The END RESULT converts angiotensin I to angiotensin II (vasoconstrictor) and aldosterone (promotes Na and water retention)
hypernatremia by aldosterone stimulates secretion of ADH which conserves water to increase BP and volume
What is the most significant event in the compensatory stage of shock?
Symptoms of fight or flight are activated
HR >100
RR>20 breaths/min
PaCO2 <32
What is the most significant event in the progressive stage of shock?
Compensation has failed, lactic acid buildup is most significant
What is the most significant event in the irreversible Refractory stage?
BP and MAP remain low despite fluid resuscitation
What is urine output in the progressive stage?
<0.5mL/kg/hr
What are signs compensation has failed in the progressive stage?
HR >150 RR rapid, shallow, crackles PaCO2 >45, PaO2 <80 Metabolic acidosis Skin mottled, petechiae 0.5mL/kg/hr Declining mental status/lethargy
S/S of irreversible refractory stage of shock?
HR erratic Requires intubation and mechanical vent Profound acidosis Skin jaundiced Anuric urine output (need dialysis) Unconscious
What are s/s of neurogenic shock?
vasodilation, bradycardia, skin warm/dry
Which types of shock have vasodilation?
Distributive shock: anaphylactic, septic, neurogenic
Which immunoglobulin is responsible for anaphylactic shock?
IgE
What are s/s of anaphylactic shock?
tachycardia, wheezing, stridor, other shock symptoms
How is anaphylactic shock caused (patho wise)?
IgE promotes mast cells to release potent vasodilators (histamine, bradykinin) which causes widespread vasodilation and capillary permeability
How is septic shock caused (patho wise)?
SIRS causes vasodilation and capillary instability
Coagulation cascade activated by inflammatory mediators
How is neurogenic shock caused (patho wise)?
SNS loses ability to stimulate nerve impulses and control vasculature space
Results in vasodilation and loss of vessel tone
Which type of shock are newborns most susceptible to?
Septic shock
What are the risks of septic shock for newborns?
preterm labor
prolonged rupture of membranes
How are newborns different when it comes to shock?
they do not have an immune system to protect themselves so they will go through shock stages quickly.
What are the risks for neurogenic shock?
spinal cord injury, spinal anesthesia, hypoglycemia
Which nervous system is stimulated in neurogenic shock?
PNS
Which type of shock requires antibiotics?
Septic shock; CULTURE FIRST then abx
What should the nurse monitor for while caring for shock patients?
fluid overload; monitor heart and lungs
What are different forms of fluid replacement for shock patients?
Crystalloids, colloids, blood components
Three types of vasoactive meds to maintain MAP above 65?
inotropics, vasodilators, vasopressors
Which form of nutritional support is most supportive of shock patients?
enteral or TPN to maintain more than 3000 calories/day
Nursing interventions for shock?
Abx, fluid replacement, vasoactive meds, maintain body temperature, nutritional support
What is MODS?
A life threatening complication of shock (irreversible stage) that disrupts hoemostasis and affects the kidneys, heart, liver, brain and lungs
What are risks for MODS?
Trauma, liver dysfunction, prolonged hypotension, infarcted bowel, advanced age, alcohol use disorder
What is nursing management for MODS?
supportive therapy for affected organs
What are symptoms of pre-eclampsia?
proteinuria, n/v, elevated BP, reduction in blood flow to brain, liver, kidneys, placenta and lungs, epigastric pain, elevated liver enzymes, headaches, vision changes, blurred vision, hyperactive DTR
What are characteristics that can predispose a newborn to heat loss?
Thin skin, lack of shivering ability, limited voluntary muscle use, large body surface area, lack of subcutaneous fat
What are the four mechanisms infants can lose heat through?
Conduction, convection, evaporation, radiation
How do neonates behave at birth?
Incomplete vision, close-proximity focus, acute hearing, smell and taste
How does a newborn behave in the first period of reactivity (birth to 30 minutes to 2 hours after birth)
alert, moving, may be hungry
How does a newborn behave within 30 to 120 minutes after birth?
decreased responsiveness; period of sleep or decreased activity
How does a newborn behave in the second period of reactivity (2 to 8 hours after birth)?
awakens and shows interest in stimuli
Which infants are at risk for hypoglycemia?
SGA, LGA, post-term, pre-term, late-preterm infants
What are the s/s of hypoglycemia in an infant?
lethargy, tachycardia, respiratory distress, jitteriness, drowsiness, poor feeding, hypothermia, diaphoresis, weak cry, hypotonia, seizures, BG less than 40 for infants, less than 20 for preterm infants
What is a complete spinal cord injury?
No function below the level of injury
What is anterior cord syndrome?
The front part of the spinal cord is damaged. No feeling below level of injury but sense of position, vibration and sense of light/deep is intact
What is central cord syndrome?
The middle part of the spinal cord is damaged causing LOSS OF MOVEMENT AND SENSATIONS IN THE ARMS.
What is Brown Sequard syndrome?
HALF of the spinal cord is damaged, causing one side of the body to be stronger than the other
s/s of autonomic dysreflexia?
severe hypertension throbbing headache bradycardia facial flushing nasal congestion piloerection, diaphoresis
What spinal cord injury area can cause autonomic dysreflexia?
T6 and above
Causes of autonomic dysreflexia?
Full or distended bladder, constipation, tight clothing
Why does autonomic dysreflexia occur?
Vasodilation occurs above injury site and vasoconstriction occurs below injury site as SNS and PNS dysregulate
Ways to treat autonomic dysreflexia?
Bladder assessment, bowel assessment, remove constrictive clothing, give BP meds after assessment
Potential complications of having a large baby?
over 90th %ile or over 4,000 g; birth trauma, hypoglycemia, polycythemia, hyperbilirubinemia
Risk factors for placental previa?
maternal age over 35, previous c-section, multiparity, HTN, diabetes, smoking, multiple children, previous surgical abortions, cocaine use, short interval pregnancy
What do the cardiac receptor cites control?
Alpha, beta, and dopaminergic
What is the function of Alpha 1?
Causes peripheral vasoconstriction on vascular smooth muscle to increase blood pressure
What is the function of Beta 1?
Increased heart rate and contractility
What is Beta 2?
Dilates bronchial smooth muscle
What is a dopaminergic receptor?
Causes arteries to dilate
What is ventricular depolarization and normal QRS?
contraction; normal .06 to .10
