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Clinical Simulation > General Medical/Surgical Conditions > Flashcards

General Medical/Surgical Conditions Flashcards

1
Q
  • A chronic, inflammatory, obstructive, non-contagious airway disease with varying levels of severity, characterized by exacerbations of wheezing and coughing
  • A reversible condition characterized by increased responsiveness of the small airways to stimuli
A

Asthma

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2
Q

-Past medical history: allergies, episodes of cough and wheezing
-Shortness of breath: pursed-lip breathing, chest tightness
-Cough: increased and productive with presence of eosinophils, increased IgE levels
-Appearance of the chest: increased AP diameter during episode
-Respiratory Pattern: accessory muscle usage, tachypnea
-Color: cyanotic
-Diagnostic Chest percussion: hyper resonant/tympanic
-Breath sounds: diffuse wheezing, diminished breath sounds
-Physical appearance:
diaphoresis, anxious, speaks in short phrases
-Vital Signs: tachycardia, pulses paradoxes during severe episodes

A

Primary assessment of Asthma

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3
Q

Secondary assessment of Asthma

A

CXR
ABG
Pulmonary Function

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4
Q

During acute episode:

  • increased A-P diameter
  • translucent (dark) lung fields
  • depressed or flattened diaphragms
A

CXR findings in Asthma

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5
Q

Pulmonary Function findings in Asthma

A
  • Decreased flow rates
  • Normal DLco
  • Pre and post bronchodilator improvement: at least 12% and 200 mL increase in FEV1
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6
Q
  • Oxygen therapy
  • Aerosol therapy with SABA and anticholinergic (consider continuous aerosol therapy)
  • Corticosteroids (oral or IVl)
  • Close monitoring (PEFR)
  • Intubation and mechanical ventilation if respiratory arrest occurs
  • Consider adjunct therapies: Heliox, magnesium sulfate, subcutaneous epinephrine
A

Emergency room treatment for acute episodes of Asthma

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7
Q

Long Term Control of Asthma

A
  • Bronchodilators (SABA, LABA, anticholinergic)
  • Corticosteriods
  • Asthma action plan (based on peak flow)
  • Bronchopulmonary hygiene
  • Environment control
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8
Q
  • Marked cooling of core temperature (below 35 degrees C or 95 degrees F)
  • Generally the result of sudden immersion in cold water or prolonged exposure to cold environments
A

Exposure/Accidental Hypothermia

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9
Q

Primary assessment for Exposure/Accidental Hypothermia

A
  • Past medical history: history of near drowning or cold exposure
  • Physical appearance: shivering, confused, poor coordination, cyanosis, peripheral vasoconstriction
  • Vital signs: Decreased HR, RR, QT, temp
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10
Q

Secondary assessment for Exposure/Accidental Hypothermia

A

ABG: Moderate to severe acidosis with hypoxemia

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11
Q

If patients body temperature is less than 37C or 98.6 then the patients actual values will show

A

pH increased
PCO2 Decreased
PO2 Decreased

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12
Q

ABG - Exposure/Accidental Hypothermia

A

Typically analyzed at 37 degrees Celsius

-For hypothermic patients, ABG should be corrected to match patient’s temp

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13
Q

Treatment and management for MILD cases of Exposure/Accidental Hypothermia

A

Passive rewarming may be sufficient

  • Warm, dry clothes
  • Warm drinks
  • Isometric exercises to increased heart production
  • Check core temperature as soon as possible
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14
Q

Treatment and management for MODERATE cases of Exposure/Accidental Hypothermia, core temp >30C

A

Active rewarming may be required

  • Warm water baths
  • Warm blankets
  • Heating pads
  • Warm oral fluids when patient is alert
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15
Q

Treatment and management for SEVERE cases of Exposure/Accidental Hypothermia core temp of <30C

A

Active rewarming required

  • Warm intravenous solutions
  • Warm gastric lavage or peritoneal lavage
  • Inhalation of warm gases

-Mechanical ventilation for indicated ventilatory failure

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16
Q
  • An infectious inflammatory process that primarily affects the gas exchange area of the lung causing capillary fluid (serum) to pour into the alveoli.
  • This process leads to inflammation of the alveoli, alveolar consolidation, and atelectasis

Extremely common
–Causes include: bacteria, virus, and aspiration

A

Infectious Disease/Pneumonia

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17
Q

Primary assessment of Infectious Disease/Pneumonia

A
  • Past medical history: initially mimics a cold or flu, signs and symptoms may develop quickly, may have chest pain
  • Shortness of breath: may be present
  • Cough: productive, yellow/green sputum
  • Chest findings: decreased expansion, increased tactile and vocal fremitus
  • Respiratory pattern: tachypnea
  • Color: cyanosis
  • Diagnostic chest percussion: flat or dull
  • Breath sounds: crackles, bronchial, whispered pectoriloquy
  • Physical appearance: diaphoretic
  • Vital signs: increased HR, BP, QT, temp
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18
Q

Secondary assessment of Infectious Disease/Pneumonia

A 
CXR
ABG
Pulmonary function 
CBC
Sputum Culture
Special tests
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19
Q
  • Increased density from consolidation and atelectasis
  • Air bronchograms
  • Pleural effusion
A

CXR finding in Infectious Disease/Pneumonia

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20
Q

Pulmonary function findings in Infectious Disease/Pneumonia

A

Decreased volumes and capacities (VT, VC, TLC)

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21
Q

CBC findings in Infectious Disease/Pneumonia

A
  • Increased WBC with bacterial infection

- Decreased WBC with viral infection

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22
Q

Sputum findings in Infectious Disease/Pneumonia

A

Gram positive or gram negative organisms

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23
Q

Special tests for Infectious Disease/Pneumonia

A
  • CT scan
  • Acid fast stain for TB
  • ELISA test for HIV
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24
Q

Treatment and management for Infectious Disease/Pneumonia

A
  • Oxygen therapy
  • Pulmonary hygiene therapy
  • Hyperinflation therapy
  • Mechanical ventilation for ventilatory failure
  • VAP protocol for intubated patients
  • Drug therapy
  • Bedrest
  • Adequate fluid intake
  • Thoracentesis for large pleural effusion
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25
Q

Drug Therapy - Infectious Disease/Pneumonia

A
  • Antibiotics determined by history, sputum culture
  • Antipyretics to control fever
  • Analgesics for pain
  • Cough suppressants if necessary
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26
Q

Situation in which a victim survives a liquid immersion.

A

Near drowning

Wet drowning - glottis relaxes and allows water to flood the lungs

Dry drowning - the glottis spasms and prevents water from entering the lungs

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27
Q

Primary assessment of Near drowning

A
  • Past medical history: swimming pool, ocean, lake
  • Cough: frothy pink stable bubbles
  • Respiratory pattern: ranges from tachypnea to apnea
  • Color: cyanosis
  • Breath sounds: crackles and rhonchi
  • Physical appearance: confused, unconscious, comatose
  • Vital signs: increased HR, BP, QT, hypothermia
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28
Q

Secondary assessment of Near drowning

A

CXR

ABG

29
Q
  • Initially can be normal
  • Fluffy infiltrates
  • Pulmonary edema
A

CXR findings in Near drowning

30
Q

Treatment and management of Near drowning

A
  • O2 therapy at 100%
  • Intubate and MV with PEEP for apnea or patients who can’t maintain a PaO2 of 60 torr on FiO2 of < 50%
  • Inotropic agents
  • Diuretics
31
Q

Warming of the victim in hospital - Near Drowning

A
  • IV administration of heated solutions
  • Heated lavage of the gastric, intrathoracic, pericardial and peritoneal spaces, or the bladder and rectum
  • Heated blankets
  • Warm baths
  • ECMO for severe cases
32
Q

Near Drowning - If neck injury is suspected, intubated patient with

A

Flexible bronchoscope

33
Q

Decreased renal function secondary to diabetes mellitus or renal insufficiency

A

Diabetes/Renal failure

34
Q
  • Past medical history: history of diabetes mellitus, renal disease
  • Respiratory pattern: may exhibit Kussmaul breathing
  • Breath sounds: rales if CHF present
  • Physical appearance: alert, lethargic, confused, comatose, unresponsive, pedal edema
A

Primary assessment of Diabetic/Renal failure

35
Q

Secondary assessment of Diabetic/Renal failure

A
  • ABG: Metabolic acidosis
  • Urine output: Decreased <500 mL/day
  • Blood glucose level: > 160 mg (Diabetic)
36
Q

Treatment and management of Diabetic Patients

A

Closely monitor glucose levels, ABG, watch for signs of respiratory failure

37
Q

Treatment and management of Renal Failure

A

Carefully monitor intake and output, electrolytes, watch for signs of CHF

38
Q

Acquired dysfunction of the immune system

  • Transmission by trans placental, route (newborns) or by semen or body fluids of affected persons.
  • Can also occur from blood transfusions, intravenous drug use or medical use of blood products
A

AIDS

39
Q
  • Past medical history: IV drug abuse, blood transfusions, previous pneumonia
  • Color: pallor
  • Physical appearance: weight loss, nocturnal diaphoresis, frequent herpes simplex infections
  • Vital signs: recurrent fever
  • Sign and Symptoms: diarrhea, lymphadenopathy
A

Primary assessment of AIDS

40
Q

Secondary assessment of AIDS

A
  • Special tests: Positive HTLV III or HIV from an ELISA test

- Bronchoscopy: To obtain tracheal washings or lung biopsy which may be positive for Pneumocystis carinii/Jiroveci

41
Q

Treatment and management of AIDS

A
  • Do not order culture and sensitivity tests. pneumocystis carinii/Jirovecii (carinii) can’t grow outside of the body
  • Utilize standard/universal precautions
  • Infection may be treated with monthly pentamidine (NebuPent) aerosol therapy
  • TB is endemic in this population
42
Q

AIDS - Pneumocystis carinii/Jirovecii (carinii) infection is treated prevented with

A

Pentamidine (NebuPent) aerosol therapy.

-Administer in Semi-fowlers position

43
Q

Treat TB with

A

18-24 month course of INH, rifampin, ethambutol, streptomycin

44
Q

Any surgical procedure performed on structures within the thoracic cavity

  • Lung repairs or resections
  • Tracheal / mediastinal repairs or resections
  • Pneumonectomy or lobectomy
  • Cardiac surgery: valve replacements, bypass grafts
A

Thoracic Surgery

45
Q

Primary Assessment of Thoracic Surgery

A
  • Past medical history: carcinoma, heart disease
  • Shortness of breath: may be present
  • Cough: nonproductive, or may include hemoptysis
  • Appearance of the nail beds: clubbing with chronic hypoxemia
  • Diagnostic chest percussion: may be dull/flat over affected area
  • Breath sounds: may be diminished over affected area
46
Q

Secondary assessment of Thoracic Surgery

A

Routinely performed pre-operative basic laboratory testing

  • CXR
  • Pulmonary function
  • -both may be abnormal with lung pathology
47
Q

Treatment and management of Thoracic Surgery PRE-OPERATIVE

A

Hyperinflation therapy (IS/SMI, IPPB)

48
Q

Treatment and management of Thoracic Surgery POST-OP

A
  • Hyperinflation therapy (IS/SMI, IPPB)
  • Prevention of infection
  • Monitor chest drainage systems
  • Observe for post-op complications

-MV if indicated

49
Q

Any injury or surgical procedure performed on the skull and or brain

  • Traumatic brain injury
  • Tumors
  • Aneurysms
  • Cerebrovascular accidents
  • Seizures
A

Head Trauma/Surgery

50
Q

Primary assessment of Head Trauma/Surgery

A
  • Past medical history: tumors, headaches, cranial bleeds, trauma, slurred speech
  • Respiratory pattern: Irregular rhythm, Cheyne-Stokes breathing
  • Level of consciousness: altered LOC
  • Pupillary response: abnormal
51
Q

Secondary assessment of Head Trauma/Surgery

A
  • Special Tests
  • ICP monitoring
  • -normal 5-10 mmHg
52
Q

Special Tests for Head Trauma/Surgery

A

Glasgow Coma Scale, CT, MRI, PET scans

53
Q

Treatment and management of Head Trauma/Surgery

A
  • Oxygen therapy: maintain PaO2 level near 100 torr

- Mechanical ventilation

54
Q

Mechanical ventilation for Head Trauma/Surgery

A
  • Reduce PaCO2 level to 25-30 torr to treat acute elevations in ICP (iatrogenic hyperventilation)
  • Minimize mean airway pressure by utilizing low PEEP and PIP
  • Set low pressure and exhaled volume alarms appropriately
55
Q

Medications used to treat Head Trauma/Surgery

A
  • Barbiturates for sedation
  • Mannitol to decrease ICP
  • Dilantin (phenytoin) for seizures
56
Q

Any injury or surgical procedure performed on the neck and/or spine

  • Traumatic injury
  • Tumors
  • Spine deformities
A

Neck and Spinal Injury/Surgery

57
Q

Primary assessment of Neck and Spinal Injury/Surgery

A
  • Past medical history: fall, accidents, tumors
  • Appearance of the neck/spine: bruises over affected area
  • Respiratory Pattern: may be apnea with severe damage to spine
  • Level of consciousness: altered
58
Q

Secondary assessment (Special Tests) of Neck and Spinal Injury/Surgery

A
  • CT

- MRI

59
Q

Treatment and management of Neck and Spinal Injury/Surgery

A
  • Oxygen therapy to treat or prevent hypoxemia
  • Stabilize the neck and spine to minimize movement
  • Maintain patent airway
  • -modified jaw thrust technique
  • -Intubate with flexible bronchoscope

-Support ventilation, oxygenation, circulation and perfusion as indicated by bedside assessment and laboratory testing

60
Q

Any surgical procedure performed on structures within the abdominal cavity

  • Gall bladder
  • Stomach
  • Liver
  • Colon
  • Uterus
  • Appendix
A

Abdominal Surgery

61
Q

Primary assessment of Abdominal Surgery

A
  • Past medical history: abdominal pain, bleeding, family and social history
  • Respiratory pattern: may be tachypneic
62
Q

Secondary assessment of Abdominal Surgery

A
  • Routinely perform pre-op basic laboratory testing

- Pre-op pulmonary function testing (basic spirometry testing)

63
Q

Treatment and management of Abdominal Surgery PRE-OP therapy

A

Hyperinflation therapy (IS, IPPB)

64
Q

Treatment and management of Abdominal Surgery POST-OP therapy

A
  • Hyperinflation therapy (IS,IPPB)
  • Prevention of infection
  • Analgesics as needed
  • Observe for post-op complications: increased pressures, decreased static lung compliance, hypovolemic shock
  • Mechanical ventilation if needed
65
Q

Surgical removal of the larynx

Causes:

  • Carcinoma of the upper airway
  • Trauma
A

Laryngectomy

66
Q

Following Laryngectomy

A
  • There is nor longer a connection between the upper and lower airways, and the patient has a permanent stoma
  • The patient can not be orally or nasally intubated.
  • If mechanical ventilation is required. insert an endotracheal tube into the laryngectomy opening
67
Q

Primary assessment of Laryngectomy

A

Past medical history: upper airway carcinoma

68
Q

Secondary assessment of Laryngectomy

A

Routinely perform basic laboratory testing

69
Q

Treatment and management of Laryngectomy

A
  • Use meticulous suctioning technique (watch for bleeding/clots post-op)
  • Cool aerosol will help keep secretions thin in the early post-op period
  • Laryngectomy tube is removed after 3 to 6 weeks, at that time the stoma is considered stable and permanent
  • Monitor basic laboratory tests

Clinical Simulation (7 decks)

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