Gen Med Flashcards

Question 1

Q

Rule of the Bs

Answer

A

If the pH and the Bicarb are both in the same direction, then it is metabolic

Question 2

Q

Precautions

Answer

A

Contact
- Herpes, Enteric (Rotavirus, Shigellosus), Staph, RSV
- Private Room, Gloves, Gown, Handwashing, Disposable supplies
Droplet
- Influenza, meningitis, diphtheria, pertussis, mumps
- Private Room, mask, gloves, handwashing, disposable supplies, pt. wears mask when leaving room
Airborne
- Measles, Mumps, Rubella, TB, Chicken Pox, SARS
- Negative pressure Private room (door closed), mask, gloves, gown, handwashing, N95 (for TB), Pt. wear mask when leaving room, disposable supplies
Donning PPE order
- Gown → Mask → Goggles → Gloves
Doffing PPE
- Gloves → Goggles → Gown → Mask

Question 3

Q

Neutropenic Precautions

Question 4

Q

Bleeding Precautions

Answer

A

Use drawsheet
No toothbrush/flossing
No hard foods
Well-fitting dentures
Blow nose gently
No rectal temp, enema, suppository
No aspirin
No contact sports
No walking in bare feet
No tight clothing or shoes
Use stool softeners (no straining)
Notify MD of blood in urine/stool

Question 5

Q

Diabetes mellitus

Answer

A

Type I
- Insulin-dependent
- Ketosis prone
- Treatment (DIE)
  1. Insulin
  2. Exercise
  3. Diet (count carbs)
Type II
- Non-insulin-dependent
- Non-ketosis prone
- Treatment (DOA)
  1. Diet (6 small meals a day)
  2. Activity
  3. Oral hypoglycemics
Signs/Symptoms (3 Ps)
- Polyuria
- Polydipsia
- Polyphagia (increased swallowing)
Problems when sick
- Hyperglycemia
- Dehydration
Long term complications
- Poor tissue perfusion
- Peripheral neuropathy
Ha1c - goal around 6

Question 6

Q

Diabetes insipidus vs. SIADH

Answer

A

Diabetes insipidus
- Polyuria/polydipsia leading to dehydration
- “like diabetes mellitus with only the fluid part”
- normal blood glucose
SIADH
- Oliguria/not thirsty
- normal blood glucose
- low sodium
- High specific gravity
- Decreased osmolality

Question 7

Q

Complications of Diabetes: Hypoglycemia

Answer

A

Causes
- Not enough food
- Too much insulin (primary)
- Too much exercise
Potential for permanent brain damage
Signs and symptoms
- “Drunk in shock”
  - Drunk = Cerebral impairment, labile emotions, slow reaction time, staggering,
  - Shock = vasomotor collapse, hypotensive, tachycardic, tachypnia, cold/clammy/pale skin
Treatment
- Administer rapidly metabolized carbs (candy, honey, juice, milk)
  - sugar/protein (ideal) or sugar/starch
    - never stack sugars
- If unconscious - glucagon IM or IV dextrose (D10 or D50)

Question 8

Q

Complications of Type I Diabetes: DKA/ Diabetic coma (Hyperglycemia)

Answer

A

Causes
- Acute viral respiratory infection within last 2 weeks (most common cause)
- Too much food
- Not enough insulin
- Not enough exercise
Signs/Symptoms (DKA)
- Dehydration
- Ketones, Kussmaul breathing, high K+
- Acidosis, Acetone breath, anorexia
Treatment
- IV Insulin (R)/ fluids (NS, D5) at fast rate (200ml/hr)

Question 9

Q

Complications of Type II Diabetes: HHNK (Hyperglycemia)

Answer

A

Hyperosmolar, Hyperglycemic, Non-Ketotic Coma
Severe dehydration
Signs/Symptoms
- Hot, dry skin
- Decreased skin turgor
- Tachycardia
Treatment
- Rehydration

Question 10

Q

Diabetes Treatment

Answer

A

Cold and clammy - get some candy
Hot and dry - Sugar’s high

Question 11

Q

Dumping Syndrome vs. Hiatal Hernia

Answer

A

Dumping Syndrome
- post-op gastric surgery complication in which gastric contents dump too quickly into the duodenum
- “right direction at the wrong rate”
- S&S (ADS)
  - Abdominal distress
  - Drunk (cerebral impairment)
  - Shock (vasomotor collapse, rapid thready HR)
- Treatment
  - HOB during and after meals - LOW
  - Amount of fluids - LOW
  - Carbs in meals - LOW
    - Protein opposite
Hiatal hernia
- Regurgitation of acid into the esophagus, because the upper stomach herniates upward through the diaphragm
- “wrong direction at the right rate”
- Symptoms
  - GERD-like symptoms (heartburn/indigestion) when supine after eating
- Treatment
  - HOB during and 1 hr after meals - HIGH
  - Amount of fluids - HIGH
  - Carbs in meals - HIGH
    - protein opposite

Question 12

Q

Hyperthyroidism (Grave’s Disease)

Answer

A

Thyroidism = metabolism
- hyperthyroidism = hypermetabolism
S/S - (Don Knotts)
- Weight loss, diarrhea, Increased HR, heat intolerance, HTN, exophthalmos (bulging eyes)
Treatment
- Radioactive iodine
  - Patient should be alone for 24H after treatment and be careful about handling urine
- PTU (propylthiouracil)
  - “Put Thyroid Under”
  - Lowers WBC → immunosuppression
- Thyroidectomy
  - Total thyroidectomy (T= tetany)
    - Need lifelong hormone replacement
    - At risk for hypocalcemia (difficult to spare parathyroid)
  - Subtotal thyroidectomy (S=Storm)
    - hormone replacement not necessarily needed
    - Thyroid storm (medical emergency)
      - S/S
        
        High fever (105+)
        
        HTN (very high)
        
        Very tachy (180+)
        
        Psychotically delirious
      - Treatment
        Oxygen (10L) and Lower body temperature (ice, cooling blanket)
  - Post-op risks
    - for either (T or S) in first 12 hours
      - Airway/Breathing, bleeding
    - For 12-48 hours
      - Total → tetany r/t to low calcium
      - Subtotal → thyroid storm

Question 13

Q

Hypothyroidism (Myxedema)

Answer

A

Thyroidism = metabolism
- hypothyroidism = hypometabolism
S/S
- Weight gain, hypotension, constipation, lethargy, cold intolerance
Treatment
- Thyroid hormone (Synthroid/ levothyroxine) - never hold before surgery
- Do not sedate

Question 14

Q

Adrenal Cortex Diseases

Answer

A

Begin w/ A or C
Addison’s (“add-a-sone”)
- Undersecretion of the adrenal cortex
- S/S
  - Hyperpigmented
  - Don’t respond to stress well (slip into shock easily)
  - htn, hypoglycemia
- Treatment
  - Steroids (med-alert bracelet)
Cushing’s (cushy = more)
- Oversecretion of the adrenal cortex (glucocorticoids, mineralocorticoids, androgenic hormones)
- Resembles chronic steroid therapy
- S/S (same as s/e steroids)
  - Moon face, hirsutism
  - Water retention, gynecomastia, buffalo hump, truncal obesity w/small skinny limbs
  - Striae, decreased bone density, easy bruising, irritability, immunosuppression
  - Hypernatremia, Hyperglycemia, Hypokalemia
  - HTN
- Treatment
  - Adrenalectomy → replacement therapy → steroids

Question 15

Q

AIDS

Answer

A

Transmission
- Blood, sex, breastfeeding, across placenta
First test for HIV antibodies
- ELISA
  - →confirmed by Western Blot
CD4
- <500
  - onset of aids related symptoms
- <200
  - onset of opportunistic infections
Symptoms
- Anorexia, fatigue, weakness, diarrhea, night sweats, fever
- Typical pneumonia - Pneumocystic carinii
- Oral candida
- Cancer - Kaposi’s sarcoma (cancer of the skin)
- Lymphomas
Treatment
- NRTI (nucleoside reverse transcriptease inhibitors)
  - Truvada, AZT (zidovudine)
- PI (protease inhibitors)
  - end in -navir or -previr
Labs
- Decreased RBCs, WBCs, and platelets

Question 16

Q

Acute Glomerulonephritis

Answer

A

Diet
- Proteins only limited with severe azotemia
- Moderate Na+ restriction
- Fluid restriction if edema is severe
Cause
- most cases occur 2-3 weeks after strep infections (group a hemolytic strep)
Nursing Interventions
- Bedrest - can walk if no hematuria, edema or hypertension
- Vitals Q4H
Symptoms
- Puffiness of face
- Dark urine
- HTN
Labs
- Hematuria
- Proteinuria (+3 - +4)
- Specific gravity increased

Question 17

Q

Amputations

Answer

A

AKA
- patients should lie prone to prevent flexion contracture
- biggest problem is flexion of the hip
BKA
- biggest problem is flexion of the knee
- patient needs to straighten knee while standing
Teaching
- Stump should be elevated for 12 to hours post-op
- Stump should be washed daily
- Bandage should be tightest distally and loosest proximally
Phantom limb sensation
- should subside in a few months
Push stump against wall/hitting with pillows is a good way to toughen the stump

Question 18

Q

Aneurysm

Answer

A

widening/weakening of the wall of an artery
Thoracic aneurysm - aorta
- chest tube common
Cause
- Can be from an infection
- syphillis
Abdominal aneurysm
- pulsating mass above the umbilicus
- can be “silent” - no symptoms
- NG tube common post-op
Interventions
- measure pulse and blood pressure
  - will affect pulse first
- Maintain bedrest
Rupture biggest risk (medical emergency)
- Treatment - mast trousers
- S/S
  - Decreased LOC (restlessness)
  - Tachycardia
  - htn
Treatment
- Antihypertensives

Question 19

Q

Appendicitis

Answer

A

Inflammation of the appendix due to obstruction
Most common in young adults (15-35)
Complications
- Peritonitis (inflammation of the peritoneum)
  - indicated by rebound tenderness
S/S
- pain originates in RUQ and ends in RLQ (finalizes in McBurney’s Point)
- N/V
- Temp up to 102
- WBC elevated (leukocytosis)
Treatment
- Surgery (appendectomy)
Teaching
- Avoid pain meds, enemas, laxatives, food before seeing pcp
- Fowlers position to avoid pain pre and post op
- Never apply heat to the appendix (can cause rupture)

Question 20

Q

Bell’s Palsy

Answer

A

CN 7 (facial nerve)
Teaching
- Patients recover in 4-6 weeks
S/S
- unilateral facial paralysis
- taste is affected
Interventions
- Dark glasses
- Artificial tears
- Cover eye at night

Question 21

Q

BPH

Answer

A

Men over 50
S/S
- Urinary retention
- Increased frequency
- Decreased and forked urinary stream
- Urinary hesitancy
- Nocturia
Screening
- digital rectal exam
Treatment
- Fluids forced
- TURP (transurethral resection of the prostate)
  - CBI (w/ NS) to keep cath free of clots
- Perineal prostatectomy
- Acid Ash diet
  - decrease pH
    - cheese, eggs, meat, fish, oysters, poultry, bread, cereal, whole grains, pastries, cranberries, prunes, plums, tomatoes, peas, corn, legumes

Question 22

Q

Blood Transfusions

Answer

A

Vitals
- Check before starting
- Q15 x 2 after start
- Q1 x 1 after transfusion is finished
Transfused with NS
Use 18g needle
Dextrose causes blood to clump together
For transfusion reactions
- stop blood, let NS run
- get urine and blood samples if reaction suspected
- Hemolytic transfusion reaction (common in first 10-15 minutes)
  - Shivering
  - HA
  - Low back pain
  - Increased pulse and respirations
  - Decreasing BP
  - Oliguria
  - Hematuria
- Febrile Transfusion reaction (common in first 30 minutes)
  - Low back pain
  - Shacking HA
  - Increasing temps
  - Confusion
  - Hemoptysis
- Allergic transfusion reaction
  - Hives - urticaria, wheezing, pruritus, joint pain
Transfusion must be started within 30 minutes of getting to the unit, wait for it to warm first
rH factor
- Coombs test detects rH
Whole blood contains more plasma and volume than packed cells
Call PCP before administering blood if pt. temp is rising
One unit should infuse in 1-3 hours
Stay with patient 15-30 minutes after start of transfusion
Types
- AB universal recipient
- O universal donor

Question 23

Q

Buerger’s disease

Answer

A

Affects lower extremities
- Intermittent claudication
  - pain in calf upon walking
Most common in males and smokers

Question 24

Q

Burns

Answer

A

1st degree
- Red
- No vesicles
2nd degree
- Red, shiny and wet
- Vesicles
3rd degree
- White, dry and hard
- least painful
Rule of nine
- head/neck, arms - 9% each
- posterio/anterior trunk - 18% each
- Legs - 18% each
- Genitalia - 1%
Tetanus toxoid only IM given
Emergent phase
- cover with anything clean and dry
Phases
- Shock (24-48 hours after burn)
  - metabolic acidosis common due to K+ being released from damaged cells
  - Fluid replacement (per day)
    - 3 cc x kg x % burned
    - half infused over 8 hours
    - flow rate dictated by hct
- Diuretic (lasts 2-5 days)
  - begins when urine output increases
  - K+ levels begin to fall
  - decrease IV flow rate to prevent PE
- Recovery
Treatment
- Sulfamyon cream burns
- Silver nitrate cream stains the skin
  - dressings must be kept wet
Curlings ulcer
- stress GI ulcer common with burns
- Treatment
  - Tagamet, Zantac, Pepcid, Protonix, Prilosec

Question 25

Q

Cancer

Answer

A

Yearly screening starting at 40
Drugs
- Chemotherapy s/e
  - Thrombocytopenia (platelets)
    - avoid ASA, hold IM injections
    - s/s - petechiae, epistaxis, ecchymosis
  - Leukopenia (WBC low)
    - ANC below 500 → reverse isolation
  - Anemia
  - Alopecia
    - can be prevented with scalp tourniquets and ice packs in some
  - N/V/D
  - Stomatitis
    - Give lidocaine before meals
    - Wash mouth with H2O2 after meals
    - KY jelly can be used on lips
- Cesium implants
  - symptoms that should be reported to PCP (indicate infection and perforation)
    - Profuse vaginal discharge
    - Elevated temp
    - N/V
  - HOB elevated to 45 max
  - Bed rest required
  - Low residue diet
  - No more than 30 minutes of exposure for nurse per day

Question 26

Q

Casts

Answer

A

Handle a cast with your palm
Support with pillows (no plastic)
24 hours to dry
- White/shiny when dried
Petal edges to prevent irritation
Report s/s to HCP
- Numbness
- Tingling
- Burning
- Pallor
- Unequal or absent pulses
- Unequal coolness
Cast syndrome
- caused by body casts
- S/s
  - N/V due to bowel obstruction
- Treatment
  - NPO
  - NG decompression
    *

Question 27

Q

Traction

Answer

A

Types of skin traction
- Bucks
  - used for hip fractures in adults
  - can turn on unaffected side
- Bryants
  - used for hip fractures in children
  - hip should be off the bed
- Pelvic
  - pt. should be in semi-fowlers w/ knee gatched
- Russell traction
  - prone to thrombophlebitis
Types of skeletal traction
- Cranial tongs
- Thomas splints w/ pearson attachment

Question 28

Q

Cataracts

Answer

A

Causes
- Injury, congenital, exposure to heat, heredity, age
Symptoms
- cloudiness
- Diplopia (double vision)
- Photophobia
Treatment
- Laser removal
- Surgical removal
- Give pre-op
  - Mydriatics
  - Dilators
  - Antibiotics
Post -op
- shield on operative eye for 24 hours, then metal shield (at night only) for 3 weeks
- Antiemetics, analgesics, stool softeners
- if no lens implanted, they will be fit for contacts 3 months post-op
- Do not lie face down or on operative side for 1 month
- S/s of hemorrhage
  - Severe pain
  - restlessness
- Avoid
  - coughing, sneezing, bending at the waist, straining at stool, touching eye, rapid head movements
Increased intraocular pressure
- Pain
- Restlessness
- Increased pulse rate

Question 29

Q

Celiac

Answer

A

Intolerance of gluten (protein)
S/s
- large, greasy, foul-smelling stools
- Inability to observe fat-soluble (ADEK) vitamins
  - Malabsorption of vitamin K leads to bleeding disorders
- Distended abdomen w/ flatus
Treatment
- avoidance of grains besides rice and corn
- Avoid ice cream, puddings, cream soups

Question 30

Q

Colostomy

Answer

A

Indications
- Cancer
  - usually permanent
- Diverticulitis
- Ulcerative colitis
Double barrel colostomy
- colon cut and both ends are brought out into the abdomen
- stool comes out of proximal end
New stoma should be red, large and noisy
- noise will go away in a few days to a week
- patient should take care of the stoma by 3rd or 4th day post-op
Colostomy irrigation
- done QD with warm tap water while sitting

Question 31

Q

Types of ostomies

Answer

A

Ileostomy
- Liquid stool
- mild odor
- Stool damaging to the skin
- Continuous drainage
- High risk for fluid/electrolyte imbalances
- Incontinent
- Never irrigate
Transverse Colostomy
- Stool is soft
- Typical stool odor
- Stool damages the skin
- Empty several times per day
- May or may not be at risk for fluid
- May irrigate
Descending Colostomy
- Stool is formed
- Typical stool odor
- Stool doesn’t irritate unless diarrhea
- Empty 2-3 times per day
- Lowest risk for fluid/electrolyte imbalances
- Continent
- May irrigate

Question 32

Q

Transverse Colostomy

Question 33

Q

Cystic Fibrosis

Answer

A

Affects exocrine glands (increased viscosity leads to obstruction)
Risk Factors
- hereditary
S/S
- Fat, frothy, foul-smelling, floating (steatorrhea) stools
- most problems with lungs and pancreas (observe for steatorrhea)
- Meconium ileus probably recorded at birth
Interventions
- Decreased airway clearance (postural drainage, HOB elevated
- Alteration in nutrition or absorption
- Diet
  - High calorie, high protein, modified fat
- Replace fat soluble vitamins
- Take NaCl tablets
Diagnosis
- Sweat test (Iontophoresis)

Question 34

Q

Retinal Detachment

Answer

A

Causes
- Trauma
- Aging
- Cataract surgery
S/S
- Veil or curtain in the line of sight
- flashes of light
- floaters
Treatment
- Tranquilizers
- Surgery (scleral buckling)
- Laser surgery
- Cryosurgery
- Both eyes bandaged before and after surgery
Interventions
- Bedrest
- return to work 3 weeks
  - active jobs 6-8 weeks after that
- Dimmed lighting
Complications
- hemorrhage

Question 35

Q

STIs

Answer

A

Herpes simplex II
- Incubation 3-7 days (same for gonorrhea)
- Treatment
  - Acyclovir (any -cyclovir)
  - Keep lesions dry
- C-section if vesicles are present
- Heals in 2-4 weeks
Gonorrhea
- most common STI next to chlamydia
- Can infect the eyes
  - particularly in neonates (Ophthalmia Neonatorum)
    - discharge starts 2-3 after birth
    - Given erythromycin or tetracycline
    - can lead to blindness
- Can lead to sterility in women
- S/S
  - dysuria or purulent discharge
  - can be asymptomatic in women
- Incubation - 2-3 weeks
- Treatment
  - IM penicillin
Pelvic Inflammatory Disease
- Treatment
  - IV penicillin
- Positioned semi to high fowlers

Question 36

Q

Glaucoma

Answer

A

Increased intraocular pressure due to imbalance in drainage of aqueous humor
Affects both eyes
Tunnel vision
Types
- Open-angle
  - most common
  - seen in later life
  - Painless
- Closed angle
  - painful
Treatment
- Miotics (pilocarpine, timoptic)
  - constricts the pupil
- Diamox
  - decreases aqueous humor
- Surgery
Post-op
- severe ocular pain sign of hemorrhage

Question 37

Q

GBS vs. Myasthenia Gravis

Answer

A

GBS
- Ascending paralysis due to demyelination of peripheral nerves
- recover in 4-6 months
- Clumsiness first symptom
- Respiratory arrest biggest danger
- In acute stage, assess motor function q2H
- Treatment
  - Plasma phoresis most aggressive

Question 38

Q

Hemophilia

Answer

A

Bleeding disorder
Deficiency of factor 8
Labs
- PTT increased
- Clotting time increased
Hemarthrosis
- bleeding in the joints
- Immobilize and elevate above the heart
- Wait 48 hours before ROM, weight-bearing exercise
Treatment
- Cryoprecipitate
- epinephrine topically to stop bleeding

Question 39

Q

Hepatitis

Answer

A

Overview
- Acute inflammatory disease of the liver
- Viral
S/S
- Early stages look like the flu
- Later stages urine turns dark
- Pre-icteric - stage before jaundice
- Pruritus
- Jaundice
- Aversion to cigarettes
- Light-colored stools
Hep A
- anorexia
- fatigue
Hep B
- more severe symptoms

Question 40

Q

Shingles

Answer

A

Overview
- Vesicular rash over sensory nerve
- Heals in 30 days
- Pain
- Impaired skin integrity
- related to chickenpox
Treatment
- Acyclovir
- Tegretol
- Steroids