Med Surg Exam 4 Deck 2 Flashcards
1
Q
ESI
A
-emergency severity index
Level 1: highest priority or life-threatening
Level 4-5: frequently tx in fast track setting w/in emergency department
2
Q
XABCDE (Primary Survey)
A
X: Apparent Life Threats (hemorrhage or if pt needs CPR)
A: Airway and AVPU (level of alertness) w/ c-spine precautions
B: Breathing
C: Circulation (tx pt not monitor, normal HR but pale, diaphoretic, tachy?)
D: Disability
E: Exposure
3
Q
Secondary Survey
A
- complete health history
- head to toe assessment
4
Q
complete or partial airway obstruction
A
- complete: death in under 5 minutes/can’t speak or breath or cough; NO MOVEMENT of air
- partial: hear stridor (**most commonly from meat bolus)
5
Q
RSI responsive pt meds
A
-sedative and paralytic (rocoronium)
**sedative first (etomidate)
6
Q
s/s hemorrhage
A
- decreasing pulse pressure
- tachy
- anxiety
- hypotension
- delayed cap refill
- rapid respirations
7
Q
when transfusing blood products…
A
-prevent hypocalcemia (blood products have citrate which eats up Ca which is needed for clotting cascade) and hypothermia (warm the blood product)
8
Q
labs for hemorrhage
A
- coag panel
- type and screen
- CBC
- chem panel
9
Q
tourniquet
A
leave on for up to hour
10
Q
most common form of shock
A
-hypovolemic
11
Q
trauma delineated as…
A
…penetrating or blunt trauma
12
Q
injury from trauma predisposes pt to:
A
- hypothermia (not warm enough? can’t clot.)
- coagulopathy
- hypocalcemia (even pts. who don’t get blood products)
13
Q
trauma diamond of death
A
-add in acidosis which decreases ability to clot
14
Q
irrigate wound
A
-if not bleeding too profusely
15
Q
staples
A
-dont use for wounds that are visible
**use for head wounds
16
Q
bitten
A
-increased risk for infection
17
Q
solid organs
A
- bleed more than hollow organs
ex. : liver and kidney
18
Q
s/s intra-abdominal trauma
A
- changes in bowel sounds
- rigid
- distended
- tender
- pain/guarding
- Cullen sign/ Grey-Turner’s sign (kidney injury)
19
Q
dx intra-abdominal injury
A
- FAST
- CT
- CBC
- coag labs (WBC always high as part of stress response but not all of them have infection)
- chem panel
- UA
20
Q
FAST exam
A
-sonography for trauma
-) if no free-floating fluid or (+) if free floating fluid (typically internal bleeding
21
Q
peritonitis/peritoneal inflammation
A
-cough pain also marker for peritoneal inflammation (if pain intensifies upon cough, positive for peritoneal involvement)
22
Q
if abdominal viscera protruding
A
-moist sterile gauze applied and prep for surgery
23
Q
s/s crush injury
A
- hypovolemic shock
- erythema and blistering of skin
- rhabdomyolysis
- AKI
- hyperkalemia (K+ typically inside of cells)
- swollen and hard extremity
24
Q
management of crush injury
A
- XABC’s
- fluids
- monitor for AKI
- px management
- splint fractures
- fasciotomy if compartment syndrome
25
crush injury causes...
...muscle ischemia and necrosis from prolonged pressure
26
crush syndrome systemic effects
- third spacing (fluid retention in extremities), causing hypotension
- myoglobinuria, causing renal failure
- metabolic/electrolyte abnormalities, causing cardiac arrhythmias
- secondary complications, i.e. compartment syndrome
27
blood present at urinary meatus
- do NOT place catheter
| - consult urology
28
male and prostate
-high riding prostate during rectal exam can indicate urethral injury
29
anaphylaxis management
- IM epi admin
- airway
- antihistamines
- steroids
- albuterol
30
if shock occurs in anaphylaxis...
- IV fluids
| - vasopressors
31
epi
- alpha and beta adrenergic effects
| * causes vasoconstriction and bronchial smooth-muscle relaxation
32
management of ingested poisons
- induced vomiting
- activated charcoal (corrosive agent)
- gastric lavage (corrosive agent)
- dialysis (can't be absorbed thru kidneys
- antidote admin
33
monitor w/ ingested poisons
- hypotension
- airway edema
- electrolyte imbalances
- seizures (alkolitic and acidic substance can affect nerves)
34
carbon monoxide poisoning s/s
- dizzy
- HA
- confusion
- coma
35
management carbon monoxide poisoning
- remove pt from source
- admin 100% O2
- hyperbaric chamber may be utilized
36
labs for carbon monoxide
-carboxyhemoglobin
37
intermediate triage
**RED
-injuries life-threatening but survivable w/ minimal intervention (can progress rapidly to expectant category if tx is delayed)
38
Red examples
- shock
- hemothorax
- airway obstruction secondary to mechanical obstruction
- unstable chest/abd wounds
- incomplete amputations
- open fx long bones
39
delayed triage
**YELLOW
-injuries significant and require medical care but can wait hours w/out threat to life or limb (can't delay tx and won't die)
40
Yellow examples
-closed fx
-stable abd wounds w/out hemorrhage signs
-soft tissue injury
-maxofacial wounds w/out airway compromise
-vascular injuries w/ adequate circulation
most eye and CNS injuries
41
minimal triage
**GREEN (often walking)
-minor injuries and tx can be delayed hrs to days
42
Green examples
- upper extremity fx
- minor burns
- sprains
- behavioral dx/psych
43
expectant triage
**BLACK
- injuries extensive, low survival chances even w/ care(do not abandon still)
- comfort measures if possible
44
Black examples
- unresponsive pts w/ penetrating head wounds
- high spinal cord injuries
- wounds involving multiple organs/anatomical sites
- second/third degree burns in excess of 60% BSA
- seizures/vomiting w/ in 24 hrs after radiation exposure
- profound shock w/ mult injuries
- agonal respirations
- fixed and dilated pupils
45
Critical Incident Stress Management
-aims to assist health care providers w/ emotional trauma by defusing and debriefing after incident
46
report weapons of mass destruction
- CDC
- health department
- infection control
47
PPE
-used to shield health care workers from chemical, physical, biologic, and radiologic hazards
48
2 steps of decontamination
- remove all clothes and rinse with water
| - soap and water rinse wash
49
bio agents
- anthrax
- smallpox
- sever acute respiratory syndrome (SARS)
50
anthrax can be contracted thru
-exposure to infected, raw meat products
51
anthrax
- resembles common cold
- after several days, progresses to severe respiratory distress and shock
**frequently fatal even w/ aggressive ABx therapy and supportive tx
52
smallpox has...
...long incubation period and is highly contagious (no symptoms during incubation)
53
later symptoms of smallpox
- fever
- malaise
- fatigue
- flat lesioned rash
- after several days, lesions fill with pus
54
management of smallpox
-no specific tx except supportive care, proper isolation, and vaccination
55
SARS
- causes atypical pneumonia
| - s/s: dry cough, SOB, progresses to ARDS
56
chemical agents
- nerve agents
| - blood agents
57
examples of chem agents
- sarin (chemical warfare)
- tabun
- organophosphates
*inhaled or absorbed percutaneously
58
s/s nerve agents
- cholinergic crisis
- pupil constriction
- vision disturbances
- bradycardia
- twitching
- laryngeal spasm
- increased GI motility
- weakness
59
cholinergic crisis
```
-SLUDGE
S: salivation
L: lacrimation
U: urination
D: defecation
G: gi cramping
E: emesis
```
*constricted pupils
60
lethal dose of nerve agents
- LOC
- seizures
- increased secretions
- apnea
61
management of nerve agent exposure
- copious decontamination
- airway maintenance
- suctioning
- atropine admin
- benzodiazepines for seizures
62
blood agents examples
- hydrogen cyanide (fires a lot)
| - cyanogen chloride
63
blood agents act on...
....cellular metabolism resulting in asphyxiation thru alterations in hemoglobin
-inhibits aerobic metabolism
64
cyanide
- released from burning of plastics and causes cyanide poisoning
* can be ingested, inhaled, or absorbed thru skin
65
s/s blood agents/cyanide exposure
- flushing
- tachycardia
- tachypnea
- respiratory muscle failure
- stupor/coma/seizures/respiratory arrest/death
66
management of blood agents exposure
- intubation
- admin of cyanide antidote
- admin hydroxocobalamin (vitamin b12)
67
Trajectory Model
*phases of chronic illness
- Pre-Trajectory (past life hx, genetics, lifestyle)
- Trajectory Onset (onset of noticeable symptoms; announce dx)
- Living w/ Progressive dz
- Downward Phase
- Dying Phase
68
critical times for terminally ill pts.
- before death
- death event
- bereavement
69
anticholinergic
-atropine (for the death rattle from secretions)
70
cachexia
common phenomenon in elderly pts
71
dyspnea
-common and is often distressing for fam members (AIR HUNGER)
72
grief
personal feelings accompanying anticipated of actual loss
73
mourning
-individual, fam, group, and cultural expressions of grief and associated behaviors
74
bereavement
-period of time during which mourning takes place
75
stages of grief (Kubler-Ross)
- shock/denial
- anger
- bargaining
- depression
- acceptance
76
neoplasm
can be benign or malignant
77
second leading cause of death in US
cancer
78
carcinogens may be:
- chemical
- radiation
- viral
79
EBV and cancer
Burkitt's lymphoma
80
HIV and cancer
Kaposi sarcoma
81
Hep B virus and cancer
-hepatocellular carcinoma
82
human papillomavirus
squamous cell carcinoma
83
lymphomas
-cancers occurring in infection-fighting organs (ex lymphatic tissue)
84
leukemias
-cancers occurring in blood-forming organ (ex spleen and in bone marrow)
85
sarcomas
-cancers occurring in connective tissue (ex. bone)
86
carcinomas
-cancers occurring in epithelial tissue (ex. skin)
87
metastasis
rapid multiplication of malignant neoplasms which spread to distant body parts thru bloodstream or lymph system
88
breast cancer health promotion
-women at age 40 should have a yearly mammogram and breast exam by health care provider
89
detection of colon/rectal cancer health promotion
- all aged 50 and up should have yearly fecal occult blood test
- digital rectal exam and flexible sigmoidoscopy every 5 years
- colonoscopy every 10 years
90
for detection of uterine cancer health promotion
- yearly pap for sexually active or over age of 18
| - at menopause, high risk women should have endometrial tissue sample
91
for detection of prostate cancer health promotion
-beginning age 50, yearly digital rectal exam and prostate-specific antigen (PSA) test
92
staging and grading
- staging: determines extent of spread of cancer
| - grading: evaluates tumor cells in comparison to normal cells
93
radiologic studies cancer dx
- x-ray
- CT scan
- MRI
- PET scan
94
most accurate dx test for cancer
biopsy
95
TNM staging
T-- size and extent of main tumor (main tumor=primary tumor)
N--number of nearby lymph nodes that have cancer
M--whether cancer has metastasized (cancer spread from primary tumor to other parts of body)
96
goals of cancer
- cure
- control
- palliative
97
chemotherapy
-systemic therapy for cancer for most solid organs and hematologic cancers
98
technique for admin of chemo
- PO
- IM
- IV
- intracavitary
- intrathecal (given into fluid around spinal cord)
- intrarterial
99
nursing care radiation tx
- patient skin (burns their skin; no lotions or ointments; avoid direct exposure of skin to sun)
- oral mucosa (xerostomia--dry mouth)
- nutritional status
- general feeling of well being
- bone exposed to radiation more vulnerable to fracture
100
skin rxns radiation
- develops 1-24 hrs after tx
| - progressive as tx dose accumulates
101
HSCT
-hematopoietic stem cell transplantation
**healthy stem cells are transplanted into your bone marrow or your blood
102
goal of HSCT
-restores body's ability to create RBC, WBC, and platelets
103
ADRs
- infection
- transplant rejection
- infertility
- N/V
104
nursing management HSCT
- vital signs
| - monitor for ADR signs
105
signs of ADR HSCT
- fever
- chills
- SOB
- CP
- cutaneous rxns (hives)
- n/v
- hypo or hypertension
- tachycardia
- anxiety
- taste changes
106
nursing care cancer pts.
- manage stomatitis
- monitor bleeding/prevent bleeding
- monitor infection/prevent (neutropenia)
- manage fatigue
- maintain skin integrity
107
mod to severe px in cancer patients
-occurs in 50% of pts. who are receiving active tx and in 80-90% of pts w/ advanced cancer
108
px in cancer
-sometimes does not occur until advanced stages of dz
109
most common causes of pain in cancer
- metastatic bone dz
- venous or lymphatic obstruction
- nerve compression
110
common fears in cancer
* disfigurement/emaciation
* dependency
* disruption of relationships
* social displacement
* px
* financial depletion
* abandonment
* death
GOAL: quality of life not quantity of life
111
hypersensitivity cells
- B cells become hyperactive
- IgE production increases
**this is an allergic response
112
2 types of hypersensitivity
- atopic: genetic and hereditary factors and produced IgE (ex. allergic rhinitis, asthma, atopic dermatitis/eczema)
- nonatopic: lack genetic component and organ specificity (ex. tetanus, insect venom, airborne allergens) and low IgE
113
anaphylaxis hypersensitivity type
Type I
* clinical response to immunologic rxn
* body's immune system produces IgE antibodies toward a substance that is normally nontoxic
114
reingestion of offending substance after IgE antibodies produced
results in excess amounts of histamine
115
most common causes of anaphylaxis
- foods
- meds
- insect stings
- latex
116
progressive development of symptoms in anaphylactic
- bronchospasm
- laryngeal edema
- severe dyspnea
- cyanosis
- hypotension
117
anaphylactic foods
- milk
- eggs
- soy
- wheat
- nuts
118
anaphylactic meds
- ABX (penicillin and sulfa)
- allopurinol
- radiocontrast agents
- anesthetics (lidocaine, procaine)
- hormones (insulin, vasopressin, ACTH)
- NSAIDs
- aspirin
119
anaphylactic bio agents
- animal serums (tetanus, antitoxin, snake venom antitoxin, rabies antitoxin)
- antigens used in skin testing
120
mild symptoms anaphylaxis
- peripheral tingling
- sensation of warmth
- sensation of fullness in mouth/throat
- nasal congestion
- periorbital swelling
- pruritus
- sneezing
- tearing of eyes
121
moderate symptoms anaphylaxis
- flushing
- warmth
- anxiety
- any of mild symptoms
122
severe symptoms anaphylaxis
- rapid, laryngeal edema
- severe dyspnea
- cyanosis
- bronchospasm
- hypotension
- dysphagia (difficulty swallowing)
- abs cramps/v/d
- seizures
- cardiac arrest and coma
***NEED SEVERAL doses of epi and corticosteroids
123
activation of IgE and subsequent release of chemical mediators s/s
-feeling of impending doom/fright
124
increased vascular permeability and subsequent decrease in peripheral resistance s/s
- hypotension/shock
| - possible cardiac arrhythmias
125
increased capillary permeability and mast cell degranulation s/s
- edema of upper resp tract
| * *results in hypopharyngeal and laryngeal obstruction
126
bronchiole smooth muscle contraction and increased mucus production s/s
- hoarseness
- wheezing
- use of accessory muscles
127
smooth muscle contraction of intestines/bladder s/s
- cramps
- n/d
- urinary urgency and incontinence
128
epi doses
0.3mg for adults and 0.15mg for peds
129
if you have laryngeal edema...
...admin O2
130
most common chronic respiratory allergic dz mediated by immediate rxn
-allergic rhinitis
131
pharm tx for allergic rhinitis
- antihistamines
- adrenergic agents
- mast cell stabilizers
- corticosteroids
132
success of immunotherapy
-successful in up to 90% of pts w/ seasonal allergic rhinitis and 70-80% with perennial allergic rhinitis
133
indications for immunotherapy
- allergic rhinitis, conjunctivitis, allergic asthma
- hx rxn to hymenoptera (wasps/bees)
- want to avoid long-term use or potential ADRs or cost
- lack of control of symptoms by avoidance measures or med use
134
contraindications for immunotherapy
- beta blocker or angiotensin-converting inhibitor therapy can mask early signs of anaphylaxis
- pulmonary or cardiac dz or organ failure
- pt unable to report signs/s
- nonadherence of pt to other med regiments and low probability of compliance
- inability to monitor pt. for at least 30 minutes after
135
contact dermatitis is a....
....delayed hypersensitivity rxn
136
4 types of contact dermatitis
1-allergic
2-irritant
3-phototoxic
4-photoallergic
137
s/s contact dermatitis
- itch/burn/erythema
- skin lesions (vesicles)
- edema
- weeping
- crust/drying and peeling of skin
- hemorrhagic bullae can occur
138
allergic contact dermatitis
- contact of skin and allergenic substance
| - vasodilation and intracellular edema on dorsal aspects of hand
139
irritant contact dermatitis
- chemically or physically damages skin on nonimmunologic basis (occurs after first exposure to irritant)
- dryness/fissures/cracks
140
phototoxic contact dermatitis
-resembles irritant type but requires sun and chemical in combo to damage epidermis
(similar s/s to irritant dermatitis)
141
photoallergic contact dermatitis
-resembles allergic dermatitis but requires light exposure in addition to allergen contact to produce immunologic activity
142
atopic dermatitis =
eczema
143
definition atopic dermatitis
-hypersensitivity dx causing inflammation and hyperreactivity of skin (often causes pruritus)
144
most consistent features of atopic dermatitis
(1) pruritus
| (2) hyperirritability
145
tx of atopic dermatitis
- avoidance therapy
- corticosteroids
- skin care
- antihistamines
146
contraindication to atopic dermatitis
-do not take long showers...rids our skin of oils
147
dermatitis medicamentosa
***Drug Reactions
- causes skin rashs associated w/ certain meds
- avoidance and d/c of med
148
urticaria
- hypersensitive allergic rxn
| * sudden appearance of pinkish, edematous elevations
149
urticaria in adults vs children
- adults: usually rxn to something
| - kids: can be a virus/infection
150
angioneurotic edema
-involves deeper layers of skin, resulting in more diffuse swelling
151
food allergy tx
- use of epi 1st
- H1 blockers
- antihistamines
- adrenergic agents
- corticosteroids
152
ppl at risk for latex allergy
- health care workers
- pts w/ atopic allergies
- multiple surgeries
- people working in factories w/ latex products
- females
- pts. w/ spina bifida
153
who is more likely to be affected by rheumatic dx
-women
154
rheumatic disorders can include
- autoimmune conditions
- degenerative conditions
- inflammatory conditions
- systemic conditions
**affect joint, skeletal muscles, and soft tissues (connective tissues) of body
155
s/s rheumatic dx
* major one: pain
- joint swelling
- limited movement
- stiff
- weak
- fatigue
156
lab tests for rheumatic dx
- ESR (erythrocyte sedimentation rate)
- uric acid
- antinuclear antibody (ANA)
- anticentromere antibody test
- anticyclic citrullinated peptide (Anti-CCP)
- anti-double stranded DNA (Anti-dsDNA)
- complement level--C3, C4
- C-reactive protein test (CRP)
- Rheumatoid factor (RF)
157
NSAIDs
*salicylates, non-salicylates, second gen: COX-2 inhibitors
158
disease-modifying antirheumatic drugs
**DMARDs
- nonbiologic DMARDs (traditional)
- nonbiologic DMARDs (minor)
- biologic DMARDs (immunomodulators)
159
3 med classes for tx
- NSAIDs
- DMARDs
- glucocorticoids
160
osteoarthritis definition
-chronic NONINFLAMMATORY progressive dx that causes cartilage deterioration in synovial joints and vertebrae
161
risk factors OA
- obesity
- aging
- trauma/malalignment of joints
- women after menopause
162
manifestations OA
- px
- stiff
- loss of movement/fxn
163
Heberden and Bouchard Nodes
- Heberden: distal interphalangeal
- Bouchard: proximal interphalangeal
**osteoarthritis
164
gout definition
-deposition of monosodium urate crystals within joints and other tissues (defect in purine metabolism)
**METABOLIC dx
165
gout results from..
....hyperuricemia
166
primary concern in gout
px management
167
nursing care gout
- joint rested and elevated
- ice for relief (NO HEAT)
- low purine
- avoid sugary drinks/food high in fructose (as fructose breaks down in the body, purines are released)
- Vit C supplements may reduce risk of gout
168
low-purine diet gout (eat less of this)
- shellfish
- organ meats (liver)
- alcoholic beverages
- soft drinks
169
low-purine diet gout (eat more of this)
- fruits/veggies
- whole grains
- low fat dairy
- legumes/nuts
170
meds for gout
- colchicine
- probenecid (Benemid), sulfinpyrazone (Anturane)
- allopurinol (Zyloprim), febuxostat (Uloric)
- pegloticase (Krystexxa)
171
fibromyalgia
-chronic px syndrome characterized by diffuse musculoskeletal achiness, stiffness, fatigue, and exaggerated tenderness at 18 specific tender points (usually at least 11 tender spots or more)
172
tx of fibromyalgia
-tramadol
173
most common inflammatory arthritic disorder
-rheumatoid arthritis
174
rheumatoid arthritis results from:
-autoimmune rxn involving macrophages, T cells, B cells, fibroblasts, chondrocytes, and dendritic cells
175
s/s rheumatoid arthritis
- joint px, swelling
- warmth, erythema
- lack of fxn
- extra-articular symptoms
176
tx of RA
- NSAIDs
| - DMARDs
177
other issues in RA outside of joints
- skin
- eyes
- lungs
- heart
- blood vessels
**unlike wear-and-tear damage of osteoarthritis, RA affects lining of joints, causing painful swelling that can eventually results in bone erosion and joint deformity
178
lupus is
(SLE)
- chronic inflammatory autoimmune dz
* characterized by remissions and exacerbations
179
SLE patho
-disturbed immune regulation that causes exaggerated production of autoantibodies and antigens
180
COX-2
cardiovascular dz
181
common manifestations of lupus
- fatigue
- myalgias (muscle px) and arthralgias (joint stiffness)
- fever
- weight loss
- difficulty expressing thoughts (CNS)
- can lead to anemia or pleursy (respiratory issues)
- increase risk for heart dz
- increase risk for miscarriage
182
tx of SLE
- DMARDs (includes antimalarials)
- NSAIDs
- glucocorticosteroids
- immunosuppressive meds
183
scleroderma
*begins w/ skin changes but pathogenesis integrates 3 cardinal features
1-vascular injury and damage
2- activation of innate and adaptive arms of immune system autoimmunity
3- generalized interstitial and vascular fibrosis
184
cutaneous symptoms of scleroderma
*CREST*
C-calcinosis (calcium deposits in tissues)
R-raynaud phenomenon (spasm of BV in response to cold/stress)
E-esophageal dysfxn (acid reflux and decrease in mobility of esophagus)
S-sclerodactyly (thickening and tightening of skin on fingers and hands)
T-telangiecstasia (capillary dilation that forms vascular red marks on surface of skin)
185
goals/interventions rheumatic dx
- maintenance of self-care
- adherence to therapeutic regimen
- improved body image
- effective coping
- absence of complications
- promotion of home care
186
isometric exercise
- improve muscle tone, endurance, and strength (weight-bearing exercises)
* can increase BP and decrease blood flow to muscles
* do not affect length of muscle
187
dynamic exercise
- increase dynamic strength/endurance
| * lengthen muscles
188
aerobic exercise
cardiovascular fitness
189
aquatic exercise
- supports or resists movement
- warm water=muscle relaxation
**provides bouyant medium
