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Hospital Practicum > HP Final > Flashcards

HP Final Flashcards

1
Q

Admission Orders:

A 
ADC VANDALISM:
A-admit to whom/where
D--dx
C--condition
V--v/s
A--allergies
N--nursing orders
D--diet
A--activity
L--labs
I--IV/fluids
S--special tests
M--meds
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2
Q

Discharge Orders:

A 
ADAD SMIFP
A--admit date
D--discharge date
A--admit dx
D--discharge dx
S--summary
M--med list
I--instructions
F--f/u with:
P--pending
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3
Q

most common hernia

A

indirect (through inguinal canal)

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4
Q

Causes of urinary incontinence:

A 
DIAPERS
D--delirium
I--Infection
A--atropic vaginitis
P--pharm agents
E--endocrine problem
R--restricted mobility
S--stool impaction
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5
Q

bleeding between periods

A

metrorrhagia

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6
Q

Increased bleeding during menses

A

menorrhagia

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7
Q

increased bleeding during and in between menses

A

menometrorrhagia

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8
Q

increased frequency of periods

A

polymenorrhea

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9
Q

what type of epithelium is in the mucosa of the cervical canal?

A

columnar

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10
Q

what type of epithelium is the vaginal portion of the cervix?

A

spuamous

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11
Q

5 P’s of the sexual hx

A

1) Partners
2) Practices
3) Prevention of pregnancy
4) Prevention of STI’s
5) Past h/o STI’s/GYN screening, GP-FPAL

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12
Q

gonorrhea d/c is usually what color?

A

yellow

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13
Q

Chlamydia d/c is usually what color?

A

white

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14
Q

alcohol screening questionnaire:

A 
CAGE:
Cut down
Annoyed
Guilty
Eye opener
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15
Q

What lab test is best to evaluate nutrician?

A

albumin (per the HP quiz…but I think pre-albumin is even better)

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16
Q

Heart sound for CHF

A

S3

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17
Q

5th vital sign? 6th vital sign?

A

5th–pain

6th–functional assessment

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18
Q

blockage of the apocrine ducts which leads to inflammation, bacterial overgrowth, and scarring

A

hidradenitis suppurativa

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19
Q

gynecomastia in males can be caused by what 5 things?

A

1) puberty
2) increased estrogen
3) decreased testorsterone
4) chronic kidney dz
5) Chronic liver dz

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20
Q

What UA findings will be present on patient with DKA?

A

glucose (>180) and ketones

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21
Q

Hyphae on wet prep indicates what?

A

candida

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22
Q

elements of the dip UA (10)

A

1) leuks
2) RBC’s
3) glucose
4) nitrites
5) pH
6) spec gravity
7) ketones
8) bili
9) urobili
10) protein

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23
Q

what do hyline casts indicate?

A

benign, often with strenuous exercise

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24
Q

what do WBC casts indicate?

A

pyelonephritis

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25
Q

what do RBC casts indicate?

A

glomerulonephritis

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26
Q

If you see glucose in urine, what does that mean?

A

BS>180

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27
Q

bilirubin in urine means what?

A

liver problem

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28
Q

urobilirubin in urine means what?

A

it is normal to have some in urine, but excess indicates either liver problem or hemolytic process

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29
Q

ketones in the urine mean what?

A

muscle breakdown–

1) high protein diet
2) starvation
3) DKA

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30
Q

Blood in urine means what?

A

myoglobin, hemoglobin, or RBC’s are included and you need to order micro to determine cause. (Or excess vitC)

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31
Q

leukes in urine means what?

A

likely UTI or other infection

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32
Q

Nitrites in urine means what?

A

UTI

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33
Q

proteins in urine mean what?

A

1) fever
2) exercise
3) kidney problem (leaky)

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34
Q

Are UTI’s more common in acidic or basic urine?

A

basic

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35
Q

If you are dehydrated, your specific gravity will be high? or low?

A

high

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36
Q

Refer patients with kidney stones > ____mm

A

7

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37
Q

acceptable tx for UTI includes what?

A

1) nitrofurantin (macrobid)
2) Bactrim
3) FQ’s

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38
Q

This finding on wet prep indicates BV

A

clue cells–endothelial cells covered in bacteria

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39
Q

This finding on wet prep indicates trich

A

flagellated creatures

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40
Q

Which vaginal infections are best seen with KOH?

A

yeast (budding hyphae)

(KOH used during “whiff test” of BV, but plain NS will show both clue cells and trich….so the only one that HAS to have KOH is yeast)

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41
Q

tx of candida albicans

A

azoles

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42
Q

strawberry cervix indicates what?

A

trich

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43
Q

tx of trich

A

metro

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44
Q

Normal vaginal pH

A

<4.5

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45
Q

tx of BV

A

metro

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46
Q

the presence of urobiliogen, oalone or with other findings, in the urine is concerning for: (all that apply)

1) cirrhosis
2) UTI
3) hemolysis
4) DM

A

A–cirrhosis
C–hemolysis

(liver or hemolysis pathology)

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47
Q

What is the most concerning for hypertensive kidney dz?

a) ketones
b) leuks
c) protein
d) low spec gravity

A

protein

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48
Q

organisms that convert nitrate to nitrite

A

1) e.coli
2) enterobacter
3) proteus

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49
Q

what is the expected primary acid-base disorder in pt with severe vomiting?

A

metabolic alkalosis

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50
Q

Normal range for

1) pH
2) CO2
3) HCO3

A

1) 7.35-7.45
2) 35-45
3) 21-27

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51
Q

calculate anion gap

A

Na+ - (Cl- + HCO3-) = X

X>12 = mudpiles

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52
Q

mudpiles

A 
methanol
uremia
dka/aka
paraldehyde
iron/INH/ingestion
lactic acid
ethylene glycol
salicylates/sz
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53
Q

would diuretics cause and an anion gap that is greater than or less than 12?

A

less than

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54
Q

Administering insulin would treat what type of electrolyte imbalance (not involving glucose)

A

hyperkalemia

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55
Q

When you have hyponatremia, you need to determine what next?

A

fluid volume

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56
Q

Hypoparathyroid and vit D deficiency cause what metabolic imbalance?

A

hypocalcemia

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57
Q

SIADH would cause what electrolyte imbalance? What will the urine osmolality be?

A

hyponatremia and increased osmolality (retains as much fluid as possible, so only urinating small amt of concentrated fluid)

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58
Q

hyperreflexia occurs in what imbalance(s)

A

hypocalcemia
hypomagnesemia
hypernatremia

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59
Q

How do you tx toursades de pointe?

A

IV Mg

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60
Q

What diuretic spares potassium?

A

spironolactone

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61
Q

hyporeflexia is caused by what?

A

decreased sodium

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62
Q

multiple myeloma will likely cause what electrolyte imbalance?

A

hypercalcemia

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63
Q

functions of liver:

A

1) synthesis of proteins, cholesterol
2) coag synthesis
3) ammonia to urate
4) vitamin storage
5) catabolizes hemoglobin
6) excretes bile

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64
Q

These LFT’s look at liver’s synthetic function

A

1) total protein*
2) albumin and pre-albumin*
3) PT-INR

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65
Q

these LFT’s look at liver’s excretory fxn:

A

1) ALP*
2) GGT
3) total and direct bili*
4) 5-nucleotidase

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66
Q

these LFT’s look at liver injury:

A

1) ALT*

2) AST*

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67
Q

this protein binds free Hgb released from RBC’s, and can be used in combination with _________ to test for hemolytic anemia

A

haptoglobin, LDH

68
Q

normal range of albumin

A

4-5

69
Q

what does low albumin indicate? What s/s will be present?

A

chronic liver dz is most common, although this could be caused by malnutrician/malabsorption
S/S: edema, ascites are common

70
Q

When do you see high albumin?

A

dehydration, anabolic steroids (often asymptomatic)

71
Q

best test for protein nutrition?

A

pre-albumin (better than albumin b/c short t1/2 makes it more responsive to changes and less sensitive to dehydration)

72
Q

Normal range of total protein. What proteins are included in this?

A

6-8.3; albumin and globulins

73
Q

Extrinsic clotting factors

A

7

74
Q

Intrinsic clotting factors

A

12, 11, 9, 8

75
Q

Shared clotting factors

A

10, 5, 2

76
Q

Intrinsic coag test

A

PTT

77
Q

Extrinsic coag test

A

PT/INR

78
Q

PT does not become prolonged until > ____% of liver synthetic capacity is lost

A

80

79
Q

Explain metabolism of blood/bilirubin

A

1) RBC’s broken down by macrophages into heme and globin
2) globin broken into amino acids
3) heme broken into biliverdin and unconjugated bilirubin
4) bilirubin taken up by hepatocytes where it is
5) conjugated by glucuronic acid and
6) excreted into bile

80
Q

Normal range for total bili

A

0.3-1.3

81
Q

Indirect bili is conjugated? or unconjugated?

A

unconjugated (0.2-0.9)

82
Q

RR for direct bili:

A

0.1 - 0.4

83
Q

If your patient has jaundice, do they have direct or indirect bili?

A

either, they both cause jaundice

84
Q

if you see high bili, what is the FIRST STEP?

A

is it direct or indirect? (TBR = DBR+IBR)

85
Q

If your elevation is from Unconjugated bili, what might that mean?

A

Unconjugated means there’s

1) too much blood breakdown, liver can’t keep up
2) decreased liver uptake, HF/sepsis
3) impaired conjugation, hereditary/acquired

86
Q

If your elevation of TBR is primarily from DBR, what might the cause be?

A

1) hepatic injury (inflammation/scarring/toxins)

2) obstruction of bile (gallstone, tumor)

87
Q

Liver disease falls into what 2 broad categories?

A

1) hepatocellular (hepatocyte damage)

2) cholestatic (everything else)

88
Q

What LFT’s measure hepatocellular injury?

A

ALT–hepatocyte damate
AST–general inflammation (less specific than ALT)
GGT–bile duct dz

89
Q

ALP and GGT elevation indicate what?

A

cholestatic syndrome

90
Q

ALP elevation with all other levels being normal indicates what?

A

non-hepatic cause (pregnancy)

91
Q

ALT and AST elevation indicate what?

A

hepatocellular dz

92
Q

where does urea come from?

A

amino acids break down into ammonia, which is converted to urea by the liver

93
Q

what does liver disease do to blood urea levels (BUN)

A

decrease (and increase in ammonia)

94
Q

this autoimmune disease occurs most commonly in females in their 20’s who present with jaundice, fatigue, pruritus, and dry mouth. It is caused by destruction of the tiny intrahepatic ducts which leads to scarring.

A

primary biliary cirrhosis

95
Q

what is the functional test for the pancreas?

A

lipase (3-43)

96
Q

causes of macrocytic anemia (6)

A

1) B12/folate deficiency
2) drugs/ETOH
3) cirrhosis
4) hypothyroid
5) release of immature cells
6) multiple myeloma

97
Q

causes of microcytic anemia (4)

A

1) iron deficiency (#1 cause)
2) thalassemia
3) sideroblastic anemia
4) ACD (anemia of chronic dz)

98
Q

causes of normocytic anemia (2)

A

1) acute blood loss

2) renal failure (low epo)

99
Q

abnormal erythroid progenitor cells that make too many RBC’s

A

polycythemia

100
Q

what causes schistocytes?

A

RBC trauma: DIC, prosthetic heart valve

101
Q

what causes anisocytosis, poikilocytosis, spherocytes?

A

Problem with factory (r/o BM cancer)

102
Q

cold agglutinin dz

A

think Rouleaux

103
Q

The absolute neutrophil count includes what?

A

1) neutrophils

2) bands

104
Q

What leukocytes are elevated in allergies, parasites, and cancer?

A

eosinophils

105
Q

what leukocytes are elevated in bacterial infection?

A

neutrophils

106
Q

what leukocytes are elevated in viral infections?

A

lymphocytes

107
Q

what leukocytes are elevated in inflammation

A

monocytes

108
Q

If you have an iron deficiency, will your TIBC be low or high?

A

high (plenty of room for more iron)

109
Q

What is the general RR for the CBC w/ differential?

A 
Neutrophils:  40-60%
Lymphocytes:  20-40%
Monocytes:  2-8%
Eosinophils:  1-4%
Basophils:  0.5-1%
Bands:  0-3%
110
Q

what is left shift?

A

increased bands = high neutrophil turnover = infection

111
Q

most common electrolyte disorder

A

hyponatremia (excess fluid)

112
Q

labs show hyponatremia, what is your next step?

A

osmolality = 2(Na) + Glucose/18 + BUN/2.8

RR for osmolality is 285-295

113
Q

High osmolality means what?

A

high amt of particles in little fluid = dehydrated

114
Q

If you have psychogenic polydipsia, what will your urine osmolality look like?

A

low, very dilute

115
Q

If you have planty of fluid and low sodium, what are the causes (3)?

A

heart/renal/liver failure

116
Q

Normal fluid level and low sodium, what are the causes?

A

1) SIADH (will have high urine osmolality)
2) hypothyroid
3) adrenal insufficiency

117
Q

Low fluid, low sodium, what are the causes?

A

1) vomiting/diarrhea

2) diuretics

118
Q

tx of hyponatremia?

A

1) limit fluid intake
2) diuretics
3) replace sodium (for severe cases only, max 0.5mmol/hr)

119
Q

Replace Na too fast = risk of what?

A

central pontine myelinolysis

120
Q

primary causes of hypernatremia?

A

1) not enough fluid intake

2) dehydration from sweat, burns, diarrhea

121
Q

flat T wave, ST depression, wide QRS =

A

hypokalemia

122
Q

most common cause of hypokalemia

A

diuretics

123
Q

what causes hyperkalemia?

A

1) renal failure (can’t secrete)

2) drugs (potassium sparing, like spironolactone)

124
Q

acute tx of hyperkalemia

A

1) calcium gluconate
2) insulin
3) kayexalate

125
Q

cause of hypercalcemia?

A

HYPERPARATHYROIDISM X 3…and cancer

126
Q

tx of hypercalcemia

A

bisphosphonates, calcitonin, remove parathyroid/tumor

127
Q

causes of hypocalcemia

A

1) hypoparathyroidism

2) vit D deficiency

128
Q

BMP RR’s:

A 
Na:  135-145
K:  3.5-5.1
Cl:  96-106
HCO3:  21-27
BUN:  7-20
Creat:  0.6-1.2
129
Q

what is cholesterol?

A

1) structure of cell walls
2) precursor for steroids
3) precursor for bile

130
Q

what are triglycerides?

A

lipid storage

131
Q

what are phospholipids?

A

lipid with a phosphate group

132
Q

cholesterol + triglycerides + phospholipids all bound together = ?

A

lipoprotein

133
Q

this lipoprotein is the largest and is mostly triglycerides

A

chylomicron

134
Q

this lipoprotein is the major carrier of cholesterol

A

LDL

135
Q

This lipoprotein removes cholesterol from atherosclerotic plaques and takes it to the liver to be turned into bile

A

HDL

136
Q

High cholesterol makes you ____ x more likely to develop heart disease

A

2

137
Q

Total cholesterol should be under _____mg/dL

A

200

138
Q

Drugs that induce hyperlipidemia:

A

1) BB
2) thiazides
3) oral contraceptives
4) steroids

139
Q

Low cholesterol can be bad. It can indicate what?

A

1) hyperthyroid
2) malnutrition
3) ACD
4) cancer
5) liver dz (severe)

140
Q

which cholesterol level must be checked while fasting?

A

LDL–food falsely decreases

Triglycerides–food falsely elevates

141
Q

If your triglycerides are high, your HDL is probably _______

A

low

142
Q

Normal triglyceride levels are under _______

A

150mg/dL

143
Q

when triglycerides “go wild”, you are at risk for what?

A

1) pancreatitis

2) hyperviscosity–>thrombus

144
Q

How often should you screen for cholesterol levels?

A

Q5years after age 20 (more frequently with risk factors or known dz)

145
Q

Which of the following will NOT affect lipid test results:

1) exercise
2) pregnancy
3) vit K deficiency
4) recent wt loss
5) acute coronary syndrome

A

3) vit K deficiency, all others will alter results

146
Q

what are the CHD risk equivalents?

A

1) DM
2) PAD
3) TIA
4) CVA
5) Framingham Risk > 20%

147
Q

Framingham Risk Factors include what?

A

1) age
2) gender
3) total cholesterol
4) HDL cholesterol
5) smoking status
6) systolic BP
7) current BP medications

Other risk: FHx, DM

148
Q

LDL goals for

1) high risk (>20% risk)
2) medium-high risk (10-20% risk)
3) medium risk (2-10%)
4) low risk (minimal)

A

1) target is < 70, start med at 100
2) target is < 100, start med at 130
3) target is <160, start med at 190

149
Q

Well….before starting meds, what must you do first?

A

lifestyle changes x 6 weeks, then re-eval (unless high risk patients or terrible levels)

150
Q

1 treatment option

A

STATINS: lower LDL/TG, elevate HDL

inhibits acetoacetyl CoA, which slows/stops cholesterol synthesis

151
Q

If initiating statin therapy, what do you have to do?

A

1) LFT prior to tx, then re-eval at 6wks, 12wks, 12 months due to risk of liver inflammation (AST, ALT)
2) CPK prior to tx, then re-eval if pt c/o muscle pain/weakness. d/c statin if level is 10 x higher.
3) advise: no grapefruit, minimal EtOH (myopathy)

152
Q

this drug inhibits absorption of cholesterol (in combo with statins)

A

ezetimibe (zetia)

153
Q

these medications bind with cholesterol and are eliminated in the stool

A

bile acid sequestrants (all the chole’s)

154
Q

this medication decreases LDL/TG, increases HDL, and decreases mortality a/w cardiac events….BUT, side effects are not well tolerated, especially flushing

A

niacin (which is a B vitamin)

155
Q

these medications lower TG’s by increasing lipase activity

A

fibric acid derivatives “fibs”

1) gemFIBrozil
2) fenoFIBrate

156
Q

these medications are aimed at increasing HDL, but LDL often increases as well….no rx required

A

Omega 3 fatty acids

157
Q

troponin levels rise ___hours after MI

A

3-12 hours…so if you’re monitoring patient with CP, and no tpn increase at 12 hours, its safe to d/c

158
Q

which troponin level can be checked in the ED with a turnaround time of 9 minutes?

A

troponin T

159
Q

ACS with inconclusive EKG and negative troponin x 2 will be diagnosed as what?

A

unstable angina

160
Q

CK is found where? RR?

A

CKBB: brain, lungs, GI
CKMM: skeletal and cardiac muscle
CKMB: specific to cardiac muscle, but also in skeletal
normal: <5.9ng/mL

161
Q

When does CKMB start to rise in cardiac injury?

A

3-12 hours, same as Tpn

162
Q

how can you tell if CKMB elevation is due to cardiac injury or skeletal muscle injury?

A

(CKMB x 1000)/total CK

1: 3 (or less) = skeletal
1: 5 (or more) = cardiac

163
Q

what kind of heme is prominent in cardiac muscle?

A

myoglobin, so myoglobin levels will rise with cardiac injury (sensitive, but NOT specific)

164
Q

When will you use LDH and AST markers to help form a plan of care for a patient with acute coronary syndrome?

A

NEVER, no longer recommended b/c not specific for MI

165
Q

In order of most to least specificity, name the cardiac markers:

A

1) troponin
2) CKMB
3) myoglobin

Hospital Practicum (3 decks)

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