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Mark Klimek > Gen Med > Flashcards

Gen Med Flashcards

1
Q

Rule of the Bs

A
  • If the pH and the Bicarb are both in the same direction, then it is metabolic
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2
Q

Precautions

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
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3
Q

Neutropenic Precautions

A
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4
Q

Bleeding Precautions

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
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5
Q

Diabetes mellitus

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
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6
Q

Diabetes insipidus vs. SIADH

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
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7
Q

Complications of Diabetes: Hypoglycemia

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)
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8
Q

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

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)
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9
Q

Complications of Type II Diabetes: HHNK (Hyperglycemia)

A
  • Hyperosmolar, Hyperglycemic, Non-Ketotic Coma
  • Severe dehydration
  • Signs/Symptoms
    • Hot, dry skin
    • Decreased skin turgor
    • Tachycardia
  • Treatment
    • Rehydration
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10
Q

Diabetes Treatment

A
  • Cold and clammy - get some candy
  • Hot and dry - Sugar’s high
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11
Q

Dumping Syndrome vs. Hiatal Hernia

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
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12
Q

Hyperthyroidism (Grave’s Disease)

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
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13
Q

Hypothyroidism (Myxedema)

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
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14
Q

Adrenal Cortex Diseases

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
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15
Q

AIDS

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
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16
Q

Acute Glomerulonephritis

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
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17
Q

Amputations

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
18
Q

Aneurysm

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
19
Q

Appendicitis

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)
20
Q

Bell’s Palsy

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
21
Q

BPH

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
22
Q

Blood Transfusions

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
23
Q

Buerger’s disease

A
  • Affects lower extremities
    • Intermittent claudication
      • pain in calf upon walking
  • Most common in males and smokers
24
Q

Burns

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
25
Q

Cancer

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
26
Q

Casts

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
        *
27
Q

Traction

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
28
Q

Cataracts

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
29
Q

Celiac

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
30
Q

Colostomy

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
31
Q

Types of ostomies

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
32
Q

Transverse Colostomy

A
33
Q

Cystic Fibrosis

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)
34
Q

Retinal Detachment

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
35
Q

STIs

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
36
Q

Glaucoma

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
37
Q

GBS vs. Myasthenia Gravis

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
38
Q

Hemophilia

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
39
Q

Hepatitis

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
40
Q

Shingles

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

Mark Klimek (21 decks)

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